The efficacy of bidirectional barbed sutures for incision closure in total knee replacement: A protocol of randomized controlled trial.

BACKGROUND: Barbed suture is a novel type of suture introduced in different surgical specialties. Nevertheless, its effect in total knee replacement is still unclear in terms of wound complications and cost effectiveness. The purpose of the present work is to evaluate the safety and efficacy of bidirectional barbed suture in reducing postoperative wound complications in the patients undergoing total knee replacement. METHODS: This prospective, randomized, and controlled study was performed from January 2017 to December 2018. It was authorized via institutional review committee of Yuebei People's Hospital (GDYB1002189). Hundred participants were divided randomly into 2 groups, namely, control group (n = 50) and the study group (n = 50), respectively. All operations were performed using the Miller-Galante prosthesis (Zimmer; Warsaw, IN). For study groups, the joint capsule (Stratafix1-0) and subcutaneous (Stratafix2-0) and intracutaneous (Stratafix3-0) tissues were sutured by a bidirectional barbed suture. At the end, extra 4 to 5 stitches were made to avoid detachment and incision rupture. For control group: the joint capsule was sutured by a traditional absorbable suture (Ethicon VICRYL* Plus 1-0), and the subcutaneous tissue was sutured by an absorbable suture (Ethicon VICRYL* Plus 2-0). The skin was sutured by staples. Incision length, suture time, operation time, postoperative length of hospital stay, and incision complications (such as effusion, infection, hematoma, and skin necrosis) were recorded. All data analyses are implemented through utilizing SPSS for Windows Version 20.0. RESULTS: The results will be shown in Table 1. CONCLUSION: This study can reach a reliable evidence for utilizing bidirectional barbed suture in wound closure in total knee replacement. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5823).

Clinical outcome of different skin closure in total-knee arthroplasty: running subcuticular closure vs intermittent closure: A retrospective study.

An intermittent closure with silk suture is routinely used for closing different surgical wounds. However, subcuticular closure with absorbable sutures has gained considerable attention due to convenience and better cosmetic appearance.To compare the clinical outcomes and risk of surgical-site infection of subcuticular and intermittent closure after total-knee arthroplasty (TKA), 106 patients that underwent TKA between January 2017 to June 2019 at the Department of Orthopedics in Xiangya Hospital of Centre South University were retrospectively assessed. Forty-three had received running subcuticular closure (group A) and 58 underwent intermittent closure (group B). The Knee Society score was measured before and 6 months after operation. Inflammation markers including the serum levels of procalcitonin, interleukin-6, and C-reactive protein, and the erythrocyte sedimentation rate were evaluated before operation, 1 day after and 1 month after operation. Patient satisfaction with the closure was evaluated using the Likert scale at the last follow-up.No significant difference was seen in the 6-month postoperative Knee Society score, or in the 1-day and 6-month postoperative inflammation marker levels between both groups (P > .05). Likert scores were higher in group A compared to group B (4.0 ±â€Š1.0 vs 3.6 ±â€Š1.2, P < .05).Running subcuticular closure after TKA results in a better appearance compared to intermittent closure, although neither method has an advantage in terms of efficacy and risk of infection.

Desarrollo y validación de una herramienta para la evaluación de la anastomosis intestinal laparoscópica en simulación / Development and Validation of a Tool for the Evaluation of Laparoscopic Intestinal Anastomosis in Simulation

INTRODUCCIÓN: La anastomosis intestinal laterolateral laparoscópica es una práctica habitual en la clínica y entrenada en simulación. El objetivo del estudio es el diseño y posterior validación de una herramienta fiable y reproducible para su evaluación. MÉTODOS: Se utilizó un método Delphi modificado para desarrollar los elementos de evaluación al que finalmente incluyeron 5 apartados (separación entre puntos, eversión, tensión, estanqueidad y iatrogenia). Se incluyeron 21 participantes, 10 residentes quirúrgicos de primer año y 11 expertos. Realizaron anastomosis enteroentéricas laterolateral laparoscópica en víscera ex-vivo porcina de 5 cm. Las evaluaciones fueron ciegas y realizadas por 2 evaluadores de forma independiente. RESULTADOS: Las medias obtenidas por noveles y expertos fueron respectivamente: separación entre puntos 3,2 vs.5,7 (p < 0,001), eversión 3,3 vs.5,9 (p = 0,004), tensión 2,9 vs.5,9 (p = 0,001), estanqueidad 3,2 vs.5,7 (p = 0,005), iatrogenia 6,9 vs.7 (p = 0,47). El parámetro iatrogenia no es discriminatorio, por lo que fue eliminado de la herramienta. Los resultados totales fueron 12,5 los noveles y 23,2 los expertos (p = 0,001). La correlación entre observadores presenta un coeficiente de correlación intraclase de 0,99 para la separación entre puntos, 0,94 la eversión, 0,98 la tensión y 0,99 la estanqueidad. La relación entre la puntuación y la fuga anastomótica sin presión: presenta una R de Rosenthal de -0,71 (p < 0,001); con presión se obtiene una R = 0,55 (p = 0,01). CONCLUSIONES: La herramienta diseñada es válida para discriminar entre participantes noveles y expertos, presenta muy alta concordancia entre observadores y se correlaciona con el riesgo de fuga

INTRODUCTION: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5 cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs.5.7 (P < .001), eversion 3.3 vs.5.9 (P = .004), tension 2.9 vs.5.9 (P = .001), leak tightness 3.2 vs.5.7 (P = .005), iatrogenesis 6.9 vs.7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak

Development and Validation of a Tool for the Evaluation of Laparoscopic Intestinal Anastomosis in Simulation. / Desarrollo y validación de una herramienta para la evaluación de la anastomosis intestinal laparoscópica en simulación.

INTRODUCTION: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs. 5.7 (P < .001), eversion 3.3 vs. 5.9 (P = .004), tension 2.9 vs. 5.9 (P = .001), leak tightness 3.2 vs. 5.7 (P = .005), iatrogenesis 6.9 vs. 7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak.

Use of Laparoscopic Slip Knot with Purse-String Suture in Surgical Management of Unruptured Heterotopic Interstitial Pregnancies.

BACKGROUND The aim of this study was to investigate the advantages and disadvantages of using laparoscopic slip knot with purse-string suture technique in the surgical management of unruptured heterotopic interstitial pregnancies compared with other surgical strategies. MATERIAL AND METHODS We retrospectively analyzed data on 13 patients with unruptured heterotopic interstitial pregnancies who underwent laparoscopy in our hospital between May 2012 and August 2018. The control group consisted of 10 patients who underwent cornual resection or cornuostomy with conventional sutures and knots. The study group consisted of 3 patients whose surgical plans involved use of the slip knot with purse-string suture technique followed by cornuostomy. We evaluated the surgical records and video to comparatively analyze their operation duration, intraoperative blood loss, and pregnancy outcomes. RESULTS The average volume of intraoperative blood loss was 76.67±25 ml in the study group and 215.00±110 ml in the control group. On average, the intraoperative blood loss volume in the study group was 138 ml less than in the control group and the difference was statistically significant (P<0.05). There was no statistically significant difference in the live birth rate and operation time between the 2 groups (P>0.05). The duration of hemostasis in the study group was 11 min shorter than in the control group, while the duration of cornual electrocoagulation in the study group was 18.5 s shorter. Both groups achieved thorough hemostasis without the help of vasopressin and avoided use of embryo-killing drugs such as methotrexate. Neither group required second surgery or developed postoperative complications such as uterus rupture or persistent ectopic pregnancy. CONCLUSIONS This strategy is safe and reliable for gestational sac clearance while simultaneously preventing any potential harm to the intrauterine embryo. It is particularly suitable for unruptured HIP patients who have a strong desire to preserve their intrauterine embryos.

Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study.

PURPOSE: Proper fixation of central venous catheters (CVCs) is an integral part of safety to avoid dislodgement and malfunction. However, the effectiveness of different CVC securement sutures is unknown. METHODS: Analysis of maximum dislodgement forces for CVCs from three different manufacturers using four different suture techniques in an in vitro tensile loading experiment: 1. "clamp only", 2. "clamp and compression suture", 3. "finger trap" and 4. "complete", i.e., "clamp + compression suture + finger trap". Twenty-five tests were performed for each of the three CVC models and four securement suture techniques (n = 300 test runs). RESULTS: The primary cause of catheter dislodgement was sliding through the clamp in techniques 1 and 2. In contrast, rupture of the suture was the predominant cause for dislodgement in techniques 2 and 3. Median (IQR 25-75%) dislodgement forces were 26.0 (16.6) N in technique 1, 26.5 (18.8) N in technique 2, 76.7 (18.7) N in technique 3, and 84.8 (11.8) N in technique 4. Post-hoc analysis demonstrated significant differences (P < .001) between all pairwise combinations of techniques except technique 1 vs. 2 (P = .98). CONCLUSIONS: "Finger trap" fixation at the segmentation site considerably increases forces required for dislodgement compared to clamp-based approaches.

A Systematic Review of Suture Technologies in Total Knee Arthroplasty.

Over time, various materials and techniques have been developed for superficial and deep wound closure. However, potential complications, such as infections and dehiscences, can still occur, driving the development of new closure modalities. As wound closure technology continues to advance and change, the need to continuously evaluate the current techniques and materials persists. Therefore, the purpose of this systematic review was to evaluate the current literature on the various closure materials and techniques utilized for total knee arthroplasty. Specifically, we evaluated: 1) closure times; 2) infections and complication rates; as well as 3) costs related to superficial and deep wound closures. Based on the findings from the current literature, barbed suture was associated with significantly shorter closing times in all five studies when compared to interrupted sutures (p<0.05). Additionally, the use of barbed sutures may result in similar postoperative complication rates. Although the cost of an individual barbed suture is potentially higher than the cost of an individual conventional suture, a knotless technique can require a shorter suture length, which might also help decrease costs.

New Developments Are Improving Flexor Tendon Repair.

New developments in primary tendon repair in recent decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening and gap formation between tendon ends. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, although marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers (i.e., the A2 pulley) can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx (i.e., the A4 pulley) can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients with a short splint and flexible wrist positioning, and are now moving toward out-of-splint freer early active motion. Improved outcomes have been reported over the past decade with minimal or no rupture during postoperative active motion, along with lower rates of tenolysis.

Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.

BACKGROUND: Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. OBJECTIVE: To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. DESIGN, SETTING, AND PARTICIPANTS: Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. RESULTS AND LIMITATIONS: The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. CONCLUSIONS: The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. PATIENT SUMMARY: The study was conducted in a pelvi trainer and no patients were recruited.

To show the efficacy of compressive sutures alone in the management of acute hydrops in a keratoconus patient.

A 17-year-old boy presented with sudden loss of vision in the left eye (OS) for 3 days. He was diagnosed with acute hydrops following keratoconic progression in OS. The patient was initially started on topical medical therapy, including steroids and hypertonic eye drops; showing no signs of resolution. Hence, the patient was planned for full-thickness compressive corneal sutures. Four sutures were placed along the central oedematous area covering the area of ruptured Descemet's membrane. Signs of resolution were noticed by 1st week and there was complete resolution of oedema by 3rd post-op week. Sutures were removed by 7th postoperative week/45th day. The patient was doing fine with visual acuity of 6/60 in the last visit with no symptoms of discomfort and no signs of corneal vascularisation. Full-thickness corneal compressive sutures is an effective alternative in cases of acute hydrops if perfluoropropane gas is not available.

An immobile postsurgical nasojejunal tube: a case for King Arthur

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Load response and gap formation in a single-row cruciate suture rotator cuff repair.

BACKGROUND: Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. METHODS: Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. RESULTS: Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). CONCLUSION: The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair.

Two-month longitudinal study of mechanical properties of absorbable sutures used in orthopedic surgery.

BACKGROUND: This is the first study assessing the properties of large-diameter degradable sutures relevant for orthopedic applications over the course of in vitro incubation for 2 months. The data we present here provide guidance to the orthopedic surgeon in predicting the long-term performance of suture materials used everyday in surgical practice. METHODS: Five different absorbable (Vicryl, Maxon, Monocryl, PDS II, Vicryl rapide) and one non-absorbable (Ethibond) suture materials were tested. Measurements were made at five time points during the 56 days of incubation under physiological conditions (37.0 ± 0.02 °C; pH 7.4 ± 0.2). The following variables were recorded: load to failure, strain at maximal load as elongation normalized to original length, stiffness as the ratio of load to displacement on the linear proportion of the stress strain curve, and hysteresis as area under the curve of the stress strain curve. RESULTS: Vicryl was the strongest fiber on day 0 (195 N); however, by day 42, the tensile strength of the suture reduced to 14 N. Between days 14 and 28, PDS II (171 N) and Maxon (182 N) sustained the highest loads. Monocryl (p = 0.003) and Maxon (p < 0.001) showed an increasing strain with time, whereas Vicryl (p = 0.002) and Vicryl rapide (p = 0.007) revealed an increasing material stiffness. Furthermore, both Vicryl (p = 0.053) and Monocryl (p < 0.001) had an increasing hysteresis with ongoing degradation. Maxon, PDS II, and Ethibond showed stable material properties during the 2 months. CONCLUSIONS: The three absorbable sutures Vicryl, PDS II, and Maxon could sustain higher loads during the first 2 weeks than the non-absorbable Ethibond. Unexpectedly, Maxon and PDS II maintained their elastic properties in spite of their proceeding degradation and loss of tensile strength.

Modified Quilting Sutures: ANew Technique for Hematoma and Abscess of Nasal Septum.

This study aimed to analyze the results of a modified continuous quilting sutures technique in a series of patients presenting with hematoma and/or abscess of nasal septum (HANS). Only patients with a confirmed diagnosis of HANS without co-morbid conditions (which could predispose to a bleeding tendency), were selected. Following incision and drainage, nasal septal flaps were coapted by applying continuous quilting sutures only. The success rate of this technique in terms of recurrence requiring re-exploration and drainage was 100%. Quilting sutures were generally well tolerated with few complaints. Saddle deformity was the most obvious complication of HANS, seen with septal abscess. Quilting sutures can be considered as an alternative treatment option for HANS. The modified technique employed in this study demonstrated impressive results and avoided the morbidity of nasal packing with fewer complications.

Experiencia en el tratamiento de los mucoceles en atención primaria / Experience in treating mucoceles in primary care

En los últimos años en la consulta de atención primaria hemos tratado múltiples casos de mucocele, lesión benigna, relativamente frecuente (2,5/1.000), que se origina por una retención mucosa a nivel de las glándulas salivales menores en la cavidad oral, principalmente a nivel del labio inferior. En este artículo exponemos nuestra experiencia en su tratamiento y realizamos una revisión de la bibliografía para ver si nuestro tratamiento era el correcto (AU)

Several cases of mucocele have been treated in our Primary Health Care centre. These are benign lesions, relatively frequent (2.5/1000), which is caused by a retention of mucous from the minor salivary glands into the oral cavity, mainly at the level of the lower lip. The experience in their treatment in this centre is presented, along with a review of the literature to see if our treatment was correct (AU)

Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills.

BACKGROUND: Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy(®), has been developed. The aim of this study was to evaluate its effects on ergonomics and skills. METHODS: Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy(®) and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument. RESULTS: The RULA score showed a statistically improved posture with Jaimy(®) (p < 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris (p < 0.001) and the triceps (p = 0.027). The number of movements was not different (p = 0.39) although the path length was shorter with Jaimy(®) (p = 0.012). The score for task 1 was in favor of the NH (p = 0.006) with a higher quantity score. Task 2 score was not different (p = 0.086): The quality part of the score was in favor of Jaimy(®) (p = 0.009) and the quantity part was higher with the NH (p = 0.04). The score for task 3 was higher with Jaimy(®) (p = 0.001). CONCLUSION: This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.

Sutura continua por planos / Continuous Suture by Tissue Planes

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Instrumento de grapado quirúrgico vascular para realizar una sutura mecánica entre un vaso sanguíneo y una prótesis sintética / Vascular surgery stapling tool for making a mechanical suture between a blood vessel and a synthetic implant

OBJETIVO: Realización y desarrollo de un modelo de sutura vascular mecánica entre un vaso y una prótesis sintética. MATERIAL Y MÉTODOS: Para la realización del prototipo actual se diseñó un modelo experimental matemático que fue aplicado en un programa de diseño informático. Se utilizó como base un modelo similar descrito previamente por el autor y recogido en un documento de literatura científica protegido con el n.° 03/2008/258 en el registro de la propiedad intelectual con el título de «Sistema o dispositivo de soporte y sutura vascular mecánica», lo que permitió la descripción detallada de las diferentes partes y sus medidas específicas con el objetivo de obtener un sistema de sutura vascular mecánica cuyo mecanismo de funcionamiento fuese más efectivo. RESULTADOS: El sistema de sutura mecánica vascular que se describe es efectivo y seguro: demuestra la posibilidad de fabricación de un dispositivo de sutura circular con un diámetro superior a 16 mm. La máquina grapadora presenta una zona proximal de donde salen 3 filas de grapas a través de unas minirranuras. La suelta de las grapas se hace con un sistema de émbolo semejante a los aparatos de sutura mecánica intestinal. La prótesis se aloja en el interior del vástago, que es semihueco, que permite después de la sutura la retirada de la grapadora. CONCLUSIONES: Este prototipo permite realizar la sutura mecánica entre un vaso y una prótesis de forma mecánica ya sea por vía abierta o laparoscópica, facilitando y acortando este tiempo quirúrgico, que hasta la actualidad era uno de los inconvenientes mayores para el avance de la cirugía vascular laparoscópica

PURPOSE: Implementation and development of an experimental model of mechanical vascular suture between a vessel and a synthetic implant. MATERIAL AND METHOD: To use this experimental device, a mathematical model was designed and applied on design computer software. A similar model previously described by the author and included in a scientific document (No. 03/2008/258 copyright) was used as the basis. This method presented the detailed description of the different parts, and specific measurements of this mechanical tool in order to obtain an accurate mechanical system. RESULTS: The vascular stapling system described is effective and safe, demonstrating the possibility of performing a circular suture with a diameter greater than 16 mm. The stapling device has a proximal area from where 3 rows of staples that pass through mini-slots. The staples are released using a system similar to the mechanical intestinal suture. The prosthesis is fixed within a stem that is semi-hollow allowing the suture after removal of the stapler. CONCLUSIONS: The device describe here allows a mechanical suture between a vessel and a synthetic prosthesis, assisting and shortening the surgical time, which until now was one of the biggest drawbacks to the advancement of laparoscopic vascular surgery

Endoscopic management of common patologies with a new suturing system / Tratamiento endoscópico de enfermedades comunes con un nuevo sistema de sutura

Background: Overstitch endoscopic suturing system (Apollo Endosurgery. Austin, Texas) was created for NOTES procedures. As it demonstrated to be feasible, secure and effective in this field, further studies have evaluated its use in common gastrointestinal disorders in which current therapeutic tools, endoscopic or not, are not efficient or safe enough. Published results are promising. We present our initial experience with this system in the management of pathologies we usually face in our clinical practice. Method: Suturing system was evaluated for: 1. Endoscopic fixation of metallic stent to prevent migration in patients with gastrointestinal non-neoformative pathology. 2. Outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Results: During a period of 6 months Overstitch endoscopic suturing system was used in 5 patients: For stent fixation in 3 and for outlet reduction in 2. Technical success: Suture was performed in all the patients. Only 1 stitch was lost. Effectiveness: Stent fixation and outlet reduction were achieved in all the patients. However, in 1 patient the final anastomotic size was not close enough. Clinical success: Clinical recovery was achieved in all the patients in whom endoscopic stent fixation was performed. The patient which appropriated outlet closure developed a significant weight loss. The patient in which final size was not close enough did not lose weight. Conclusions: We found Overstitch endoscopic suturing system feasible, safe and effective, as it has been previously described. We encourage the publication of further studies evaluating the real utility of this tool, mostly taking into account that it allows a successful management of usual disorders for which there are not current effective therapies (AU)

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