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At least 1,657 records · Page 92Linked to original sources
PubMed2000

Microvascular anastomoses using an Nd-YAG laser.

The authors performed anastomoses of small vessels with the Nd-YAG laser, comparing these with conventional suture anastomoses. Some arteries were sutured with 10-0 nylon with about eight suture sites, and others were held by stay sutures at three points with laser irradiation performed between them. Two surgeons performed the anastomoses in the same way. The first was well-trained and experienced, and the second was technically inexperienced. The authors evaluated clamping time, patency rate, and endoscopic and histologic findings. The patency rate of the first surgeon was 100 percent (30/30) in the suture anastomoses and was 97 percent (29/30) in the laser anastomoses. For the second surgeon, the rates were 60 percent (18/30) in the suture group and 80 percent (24/30) in the laser group. On histologic examination, the suture group showed inflammatory cells around the suture site at the fourth week after the operation. In the laser group, an inflammatory reaction around the suture material was observed, but the other areas recovered. For the experienced surgeon, the patency rate and clamping time of the laser anastomosis provided no statistically significant difference to those of the suture anastomosis. On the other hand, for the inexperienced surgeon, the patency rate of the laser anastomosis was superior to that of the suture anastomosis, and the clamping time of the laser anastomosis was shorter than that of the suture anastomosis. Therefore, the authors concluded that the Nd-YAG laser anastomosis is useful for small vessels.

Anastomosis, Surgical↗
PubMed2007

Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills.

BACKGROUND: Teaching of technical surgical skills to undergraduate medical students in a laboratory setting away from the patient is not common practice. Because of the large volume of students and shortage of available teaching faculty new methods of teaching must be developed for this group of trainees. In this study we examined the effectiveness of computer-based video training, different types of computer-based motion efficiency feedback (with and without expert criteria), and expert feedback on learning of a basic technical skill in medical students. METHODS: Forty-five junior medical students were randomized into 3 groups and learned suturing and knot-tying skills. Group A received computer-generated feedback about the economy of their movements. Group B received the same motion economy feedback, as well as expert reference values. Group C received verbal feedback from an expert. All groups were pre-tested, allowed 18 practice trials, and post-tested, and their skill retention was retested after 1 month. Performance was assessed by expert analysis using an objective structured analysis of technical skill and by computer analysis (Imperial College Surgical Assessment Device [ICSAD]). RESULTS: All groups showed improvement from pre-test to post-test. However, only group C showed retention of skill on delayed performance testing. CONCLUSIONS: Verbal feedback from an expert instructor led to lasting improvements in technical skills performance. Providing information about motion efficiency did not lead to similar improvements.

Biofeedback, Psychology↗
PubMed2004

Systematic traction techniques in minimal-access pediatric cardiac surgery.

Minimal-access pediatric cardiac surgery is now common in the treatment of simple congenital heart defects. However, methods of securing a good, unobstructed view for surgery and the difficulties of working in a deep, narrow field jeopardize safety in surgical procedures, especially for less experienced surgeons have been described. Our systematic, step-by-step traction techniques on the skin, the pericardium, the right atrial appendage, the aortic root, both venae cavae, and the free wall of the right ventricular outflow, using a mechanical retractor and traction sutures, facilitate surgical field exposure and the achievement of safety. As described below, our procedures are simple, allow direct inspection, and assist those working toward technical mastery.

Adolescent↗
PubMed2001

Laparoscopic Anderson-Hynes dismembered pyeloplasty in children using needlescopic instrumentation.

The technique of needlescopic Anderson-Hynes dismembered pyeloplasty is discussed. The recent development of robust 3-mm needlescopic instruments designed to perform dismembered pyeloplasties has added a new dimension to laparoscopic suturing and will significantly enhance the ability to perform microanastomosis--the limiting factor preventing many surgeons from performing this technically demanding operation. The use of such fine instrumentation also reduces the size of instrument cannulae necessary, further reducing the postoperative pain and results in spectacular postoperative cosmetic appearance.

Child↗
PubMed2002

Intussusception of the reconstructed bladder neck leads to earlier continence after radical prostatectomy.

INTRODUCTION: Although there is no evidence that the reconstructed bladder neck actively contributes to post-radical prostatectomy continence, we set out to determine whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, would result in the earlier return of urinary control. TECHNICAL CONSIDERATIONS: Forty-five men (mean age 57 years, range 37 to 67) with clinical localized prostate cancer underwent anatomic radical retropubic prostatectomy with standard tennis racket bladder neck reconstruction. The bladder neck was then intussuscepted using two 2-0 Maxon Lembert sutures placed lateral and posterior to the reconstructed bladder neck. Filling of the bladder with saline at this point revealed little leakage. Patient-reported continence at 3 months was compared with the published outcome of 64 men using the same quality-of-life instrument (the UCLA Prostate Cancer Index). At 3 months, 82% of men who underwent intussusception of the bladder neck were continent (no pad/dry pad) compared with 54% in our prior report (P = 0.0035). The occurrence of bladder neck contracture was similar: 7% versus 5%. CONCLUSIONS: Intussusception of the bladder neck led to a significant improvement in urinary control at 3 months postoperatively. Longer follow-up will be necessary to determine whether this approach may eliminate the 2% probability of long-term significant problems with urinary control.

Adult↗
PubMed1977

Comparison of fascicular, interfascicular and epineural suture techniques in the repair of simple nerve lacerations.

Simple lacerations of dog anterior tibial nerves were repaired utilizing fascicular interfascicular, and epineural suture techniques. Two months following repair, the involved regions of the nerve were removed and stained with hematoxylin and eosin, Weil, Bielschowsky, and Masson trichrome stains. An independent, unbiased observer rated proximal and distal myelin, connective tissue responses, and proximal to distal axon counts. The proportion of proximal to distal axons revealed no significant difference between fascicular (77%) and epineural (67%) neurorrhaphy, but showed a significant beneficial effect of fascicular suture to the interfascicular (52%) repair (significance at less than 0.02). Masson stain revealed dense connective tissue responses, but the axon counts were adversely affected only when the separate fascicles showed internal disruption by connective tissue. In general, distal myelinization was mildly superior with the fascicular neurorrhaphy technique. It appears that in simple lacerations in nerves which are repaired via direct end-to-end suture, there is no significant advantages to fascicular over epineural repair; however, there is a definite deleterious effect of interfascicular neurorrhaphy. The theoretical and technical implications of these findings are discussed.

Animals↗
PubMed1994

Upper eyelid blepharoplasty. A technical comparative analysis.

The purpose of this study was to compare the results of subcuticular closure with a 5-0 polypropylene suture (Prolene) with those of closure with a running 6-0 fast-absorbing catgut approximation in upper eyelid blepharoplasty. A prospective, double-blind study was designed to compare the results of these closures in patients who presented to the Otolaryngology-Head and Neck Surgery Facial Plastic Surgery Clinic, University Hospitals of Cleveland (Ohio). Thirty consecutive patients voluntarily agreed to participate in the study, and all of them had both types of closure performed on their upper eyelids. Twenty of the 30 patients who were originally enrolled in the study complied with our follow-up recommendations, completed the study, and were the basis for this report. At the time of the procedure, a random selection of closure type was made and a variety of outcome measures were recorded, including operative time, minor complications, senior author and patient aesthetic preferences, and postoperative discomfort levels. Based on the aesthetic preferences, we are of the opinion that a running 6-0 fast-absorbing catgut suture may offer some surgeons slightly better results than a subcuticular permanent suture for closure of the upper eyelid blepharoplasty incision. Comparable morbidity was seen with both techniques. No significant differences in postoperative discomfort levels were identified.

Absorption↗
PubMed1983

End-to-side anastomosis of the vein: a technical innovation.

A new technique for easier end-to-side anastomosis of veins is presented. By applying a few traction sutures to the edge of the venotomy and tenting the venous wall, thereby keeping the venotomy open, end-to-side anastomosis of the vein can be easily performed.

Animals↗
PubMed1985

A survey of technical considerations in the construction of intestinal stomas.

Reported complications rates for the construction of intestinal stomas are high. Many of these complications result from improper construction, improper location, or other technical errors. In order to sample the techniques of stoma construction currently in use, a survey was conducted at the 69th Annual Clinical Congress of the American College of Surgeons in Atlanta in conjunction with our scientific exhibit "Complications of Intestinal Stomas." A total of 245 surgeons completed the questionnaire with a mean age of 47.8 years. The routine use of fascial-seromuscular tacking sutures and primary maturation of a loop colostomy in the presence of distal obstruction were among the most controversial technical points considered. Many other subtle but important principles of stoma construction were also discussed. In addition, the authors contend that many of the techniques currently in use result from an underemphasis on the importance of proper stoma construction in many surgical training programs.

Adult↗
PubMed2005

Laparoscopic management of pediatric choledochal cysts in developing countries: review of ten cases.

We report laparoscopic management of choledochal cysts (CDC) in 10 children. We dissect the CDC using conventional mono- and bi-polar diathermy up to the lower end, ligate or clip it at the lowest possible level and divide it. The proximal end is divided after leaving a sufficient cuff for anastomosis. In the first three cases, we formally opened to complete the biliary-enteric anastomosis. However, in the subsequent seven cases, we made a small midline incision to develop a Roux-en Y loop, and the anastomosis was then completed by intra-corporeal suturing after re-creating the pneumo-peritoneum. Apart from biliary leak in one case, we did not encounter any major complications. The mean operative time was 4.2 h. We have discussed the technical points in the study. We conclude that CDC is eminently suitable for laparoscopic correction; it requires advanced skills and expertise for precise dissection and meticulous suturing in restricted spaces. If the case selection is good and if the team is experienced, CDC can be effectively managed using laparoscopy even without a sophisticated equipment. The wound- and scar-related morbidity is minimized.

Anastomosis, Roux-en-Y↗