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PubMed1994

Skin simulation for minor surgical procedures.

A simulated skin preparation is described which is made by bonding siliconized rubber to a latex foam base. This composite material, which simulates both the dermis/epidermis and subcutaneous fat, provides a realistic model which can be used to teach excision of skin lesions and a variety of suturing methods. We believe that this simulator is of value not only for surgeons in-training but also will allow general practitioners to improve their technical skills in performing minor surgical procedures.

Dermatologic Surgical Procedures↗
PubMed1979

Experience with the Russian model 249 suture gun for anastomosis of the rectum.

The Russian Model 249 circular suturing device used for rectal anastomoses in 62 patients undergoing high or low anterior resection or colectomy and ileorectal anastomosis was technically easy to use. The 38 high anastomoses were all shown to be intact by a Gastrografin, meglucomine diatrigoate, enema study 14 days after the operation. Of the 24 low anastomoses, six demonstrated small, 5 to 10 millimeters, dehiscences, two of the latter being evident also upon clinical examination. At least six of the low anastomoses were made at levels too low for hand suture from the abdomen. In three patients, moderate hemorrhage from the anastomotic site during the first two or three days complicated the situation; in all, it ceased spontaneously. In two patients, strictures developed, one of which rectified itself once the fecal stream was restored to the rectum on closing the transverse colostomy, the other was submitted to instrumental dilation, perhaps unnecessarily. The Model 249 circular suturing device provides colorectal anastomoses that are at least as secure as those done by hand suture and, sometimes, enables an anastomosis to be made at a lower level than would be possible by the conventional suture technique through the abdomen. Bleeding from the anastomotic site and subsequent stricture formation are rare complications of this technique.

Colectomy↗
PubMed2002

[Surgical procedures for labial reanimation in facial paralysis].

With an extensive review of the literature, the authors described the surgical approach of the labial reanimation in facial palsy. First they remind some important points about neural suture, with or without graft. After, the palliatives procedures are detailed (upper and lower lip, unilateral or bilateral). The main surgical treatments are exposed in technical notes, particularly lengthening temporalis myoplasty and free muscle transplantation.

Facial Paralysis↗
PubMed2006

Hemostatic techniques during laparoscopic partial nephrectomy.

PURPOSE OF REVIEW: To review the current techniques and technologies being used for hemostatic control during laparoscopic partial nephrectomy. RECENT FINDINGS: Laparoscopic nephron-sparing surgery has become more common for the treatment of renal masses. With increasing experience, the indications for nephron sparing are increasing. Despite the increased use of these techniques in high-volume centers, however, more widespread application has been limited because of the need for advanced laparoscopic skills including the laparoscopic control of intraoperative renal bleeding. As a result, many techniques have been developed to achieve hemostasis, including conventional suture repair, tissue sealants, radiofrequency ablation, lasers, water dissection, and microwave tissue coagulation. SUMMARY: Laparoscopic partial nephrectomy is a technically challenging procedure. Many promising techniques are being developed currently, most geared toward improved hemostasis and collecting system repair. These techniques and products have made, and will continue to make, the procedure less demanding and more universally accepted.

Adhesives↗
PubMed2000

Complications following esophageal surgery.

Chronologically, complications can be classified as intraoperative, early, and late. The authors analyze complications according to this classification on the basis of more than 400 esophageal operations and related literary data. As regards intraoperative complications, they deal only with those occurring at transhiatal esophagectomy (e.g., tracheal tear, bleeding, pneumothorax, laryngeal nerve injury). Among the early complications, they survey the incidence of transplant necrosis and related mortality, further sequelae ensuing from subacute ischemia of the replaced organ and analyze in detail the questions which arise regarding anastomotic leakage. Firstly, they deal with those causative factors that influence the frequency of anastomotic insufficiency, such as the technical "know-how" of anastomosis making (e.g., one layer vs two layers; stapling or manual suture; interrupted or running suture), the way of replacement using whole stomach or tube-stomach and the consequences originating from the route of replacement (e.g., anterior or posterior mediastinal route). Incidence and management of chylothorax are also dealt with. While dealing with late complications, the authors give a detailed comment on anastomotic strictures and also other factors facilitating the development of late dysphagia, such as peptic stricture and tumor of the organ remnant. Finally, some cases successfully treated by surgery are presented (skin-tube formation in cases following transplant necrosis; abolition of a pharyngogastric anastomosis stricture using a free jejunal transplant and surgical solution of an anastomotic stricture from median sternotomy approach).

Deglutition Disorders↗
PubMed2004

[Arthroscopically assisted refixation for avulsion fracture of the intercondylar eminence with Fiber-Wire cerclage].

Avulsion fracture of the intercondylar eminence is a rare knee injury. It is found either isolated or connected to other bone or intra-articular injuries. Arthroscopically assisted treatment is nowadays the most common procedure. The refixation of the fragment is technically sophisticated and usually requires a longer period of immobilization. In two patients we used a suture cerclage with extreme tensile strength (Fiber-Wire, Arthrex Inc.) placed through a tibial guide. Using this procedure we combined the advantages of easy implantation, sufficient retention, and thereby the possibility of forced follow-up treatment. The present results are promising.

Adolescent↗
PubMed2004

New technique for chronic posterolateral instability of the knee: posterolateral reconstruction using the tibialis posterior tendon allograft.

Posterolateral instability of the knee is known as one of the most challenging injuries. Although several procedures have been designed for the posterolateral instability, there is no gold standard management as yet. We present a technique for posterolateral instability of the knee using a tibialis posterior tendon allograft, which reconstructs the lateral collateral ligament and popliteal tendon with its attachment to the tibia. This can correct not only varus, but also external rotary instability.

Absorbable Implants↗
PubMed2005

Salvage rotator cuff repair using a biotenodesis screw.

Rotator cuff tear fixation can be difficult when humeral head bone stock is poor as a result of osteopenia or osteoporosis. This technical note describes biotenodesis screw use to achieve effective fixation after 2 previous attempts at implanting suture anchors failed.

Bone Screws↗
PubMed2006

The prevention and management of perioperative complications.

The most important issues in perioperative complications of oesophagectomy are prevention, early detection and appropriate management. Anastomotic leakage is the most frequent technical surgical complication. Prevention comprises avoidance of tension or impaired vascularization of the conduit and meticulous suture technique. Management includes early diagnosis, conservative treatment or endoscopic stenting of contained leakage, and re-operation of non-contained insufficiency. All other surgical complications - such as bleeding, tracheobronchial lesions or chylothorax - are rare and warrant special therapeutic modalities. The main general non-surgical complication is postoperative pneumonia, which should be prevented by effective pain control (especially peridural catheter) and appropriate techniques of artificial respiration. Special attention should be offered to postoperative tachyarrhythmias and alcohol withdrawal syndrome. Prevention of complications also includes exclusion of patients with high operative risk based on scores and specific preoperative treatment of risk factors.

Adenocarcinoma↗
PubMed2001

Use of bowel in laparoscopic urology.

Minimally invasive urology is a rapidly expanding field. What once was thought technically impossible is now becoming a reality, especially with the advent of intracorporeal stapling and automated suturing devices. Laparoscopic assistance and pure laparoscopy improve convalescence and cosmesis in comparison with open surgical procedures. Minimally invasive continent urinary stomas, ACE procedures, bladder augmentation, urinary diversion, and urinary undiversion have all been described in clinical practice. Continent urinary diversions and ileal bladder augmentations are being developed. Eventually, even the most challenging urologic procedures will be performed in a minimally invasive manner.

Animals↗
PubMedDate not supplied

Percutaneous deployment of a valved bovine jugular vein in the swine venous system: a potential treatment for venous insufficiency.

PURPOSE: To develop a system for potential use in the treatment of chronic venous insufficiency by using percutaneous techniques. MATERIALS AND METHODS: A segment of a glutaraldehyde-fixed bovine external jugular vein with valves was trimmed and sutured to a nitinol stent. Animals were premedicated and anesthetized (n = 11). Venography of the right external jugular vein, inferior vena cava (IVC), and common iliac vein was performed. Deployment was accomplished via a sheath (12-24 F) with use of fluoroscopic guidance. Eleven bioprostheses were deployed in 11 animals. Bioprostheses were deployed in the IVC (n = 3) or right external iliac vein (n = 6). Animals were killed immediately after deployment (n = 7) at 1 week (n = 1) or at 2 weeks (n = 2). One animal was found dead in the cage. At necropsy, each bioprosthesis (n = 4) was explanted and histopathologic analysis was performed. RESULTS: Deployments of the bioprostheses were successful in nine of 11 swine. Two deployments were unsuccessful (one accidental deployment in the right renal vein, one deployment in the IVC caused rupture of the vein). Postdeployment venography (n = 9) confirmed no reflux (in the recumbent position of the swine) of the valve leaflets and patency of the vein inferior to the level of the bioprostheses. in the first group of animals (n = 5), valve leaflets were normal and competent. In the survival animal group (n = 4), the bioprostheses remained patent without evidence of thrombus formation by ascending and descending venography. Gross inspection of the explanted bioprostheses (n = 4) demonstrated grossly normal valves that fully occluded the lumen. Complications included hemarthrosis (n = 1), death (n = 1), and bioprosthesis thrombosis immediately after deployment (n = 1). Histopathologic analysis showed endothelial cells covering the luminal surfaces. The wall of the bioprostheses had granulomatous response and foreign body reaction. Bacterial contamination was noted in one bioprosthesis. CONCLUSIONS: Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the swine iliac vein or IVC is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence.

Alloys↗
PubMed1979

Purse string placement for staple anastomosis using the end-to-end anastomosis stapling instrument.

There may be technical difficulties in the use of recommended clamp for the insertion of the purse-string suture during the construction of an end-to-end staple anastomosis. Hand sewing the purse string eliminates some of the problems, but unless the suture is positioned within a few millimetres of the cut edge of the bowel, ischaemic tissue may be included in the staple line. In dogs, this leads to anastomotic dehiscence. The anastomosis may, however, be protected by excising the ischaemic tissue and reinforcing the staple line with sutures. An "over and over" purse-string technique is now preferred to minimize the risk of this occurring.

Animals↗
PubMed1986

Extended use of the internal mammary-coronary artery bypass.

Extended use of the IMA for routine coronary bypass grafting should do much to reduce the eight- to ten-year failure rate seen so frequently with the saphenous vein graft. However, considerable judgment is necessary for its proper use in a large number of situations and the performance of multiple sequential IMA anastomoses is technically more difficult than with saphenous veins. Special instruments have been devised to improve handling and suturing of the IMA and, as with the saphenous vein graft operation, performance of these anastomoses will be improved with increased experience. Extended use of the IMA is the operation of choice for younger patients with good left ventricular function and offers significant advantages to a group of patients that stands to benefit most by preventing both early and late conduit failure.

Anastomosis, Surgical↗