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1.
Medicine (Baltimore) ; 100(4): e24494, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530270

RESUMO

RATIONALE: An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited. PATIENT CONCERNS: A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close. DIAGNOSES: Intractable esophago-bronchial fistula associated with esophageal surgery. INTERVENTIONS AND OUTCOMES: On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case. LESSONS: We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.


Assuntos
Coagulação com Plasma de Argônio/métodos , Fístula Brônquica/cirurgia , Fístula Esofágica/cirurgia , Técnicas de Sutura/instrumentação , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 35-42, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461250

RESUMO

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/tendências , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Previsões , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Excisão de Linfonodo , Metástase Linfática , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas de Sutura/instrumentação , Técnicas de Sutura/tendências
3.
J Surg Res ; 257: 317-325, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32889330

RESUMO

BACKGROUND: Onlay mesh repair (OMR) has proven to be a widely used, simple, and effective technique for treatment and prevention of hernia occurrence. Despite established benefits, there is still a lack of widespread adoption. In this study, we present the Dual Tacker Device (DTD), an enabling technology that directly addresses the limitations to the adoption of OMR, saving surgical time and effort and making OMR more reproducible across a wide range of patients. METHODS: The DTD mesh fixation system is a semiautomated, hand-held, disposable, multipoint onlay mechanical mesh fixation system that is able to rapidly and uniformly tension and fixate mesh for both hernia treatment and prevention. A cadaveric porcine model was used as a pilot test conducted during a 2 day session to assess the usability of the device and to show that the DTD provided equivalent or superior biomechanical support compared with the standard of care (hand-sewn, OptiFix). RESULTS: Our study included 37 cadaveric porcine incisional closure abdominal wall models. These were divided into four groups: DTD-mediated OMR (n = 14), hand-sewn OMR (n = 7), OptiFix OMR (n = 9), and suture-only repair (no mesh) (n = 7). Eight surgical residents performed device-mediated and hand-sewn OMR. Average time to completion was fastest in the DTD cohort (45.6s) with a statistically significant difference compared with the hand-sewn cohort (343.1s, P < 0.01). No difference in tensile strength was noted between DTD (195.32N), hand-sewn (200.48N), and OptiFix (163.23N). Discreet hand movements were smallest in the DTD (29N) and significant (P < 0.01) when compared with hand-sewn (202N) and OptiFix (35N). CONCLUSIONS: The use of the DTD is not only feasible, but demonstrated improvement in time to completion and economy of movement over current standard of care. While more testing is needed and planned, compared with conventional approaches, the DTD represents a robust proof of principle with promising implications for clinical feasibility and adoptability.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Animais , Fenômenos Biomecânicos , Cadáver , Ergonomia , Estudos de Viabilidade , Hérnia Ventral/etiologia , Hérnia Ventral/prevenção & controle , Herniorrafia/métodos , Humanos , Modelos Animais , Duração da Cirurgia , Projetos Piloto , Cirurgiões/psicologia , Suínos , Resistência à Tração
4.
Obstet Gynecol ; 136(2): 355-364, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649494

RESUMO

OBJECTIVE: To compare mesh and permanent suture exposure rates in the first year after minimally invasive total hysterectomy and sacrocolpopexy with a light-weight polypropylene mesh using permanent or delayed absorbable sutures. METHODS: Across five centers in the United States, women were randomized to permanent or delayed absorbable suture for vaginal attachment of a Y-mesh during hysterectomy and sacrocolpopexy for stage II prolapse and worse. The primary outcome was mesh or permanent suture exposure in the first year after surgery. The secondary outcome was to compare a composite measure for success defined as leading edge of prolapse not beyond the hymen and apex not descended more than one third vaginal length, and no subjective bulge and no prolapse retreatment. Patients completed a pelvic examination including the pelvic organ prolapse quantification system and questionnaires at baseline, 6 weeks and 1 year postsurgery. A sample size of 80 per group was planned to compare the rate of mesh or permanent suture exposure in the permanent compared with delayed absorbable groups. RESULTS: From April 2015 to May 2019, 204 patients (n=102 permanent; n=102 delayed absorbable) were randomized. One hundred ninety-eight women had follow-up data, with 182 (93%) completing 1-year follow-up: 95 of 99 (96%) permanent, 87 of 101 (86%) delayed absorbable. The total rate of mesh or permanent suture exposure was 12 of 198 (6.1%): 5.1% for permanent compared with 7.0% for delayed absorbable (risk ratio 0.73, 95% CI 0.24-2.22). The majority (9/12) were asymptomatic. Composite success was 93% for permanent compared with 95% for delayed absorbable suture, P=.43). Six (3.0%) women had a serious adverse event. CONCLUSION: Suture type used for vaginal graft attachment did not influence mesh or permanent suture exposure rates. FUNDING SOURCE: Boston Scientific Corporation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02277925.


Assuntos
Histerectomia/métodos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Técnicas de Sutura/instrumentação , Idoso , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Polidioxanona/uso terapêutico , Politetrafluoretileno/uso terapêutico , Procedimentos Cirúrgicos Robóticos/métodos , Suturas , Resultado do Tratamento , Vagina/cirurgia
6.
J Vis Exp ; (160)2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32568228

RESUMO

Peripheral epitendinous sutures are believed to enhance core suture strength in tendon repair and decrease the risk of gapping between tendon ends. Here Q suture, an alternative to peripheral sutures, is presented for the use in tendon repair. Its effects on gap formation and tensile strength of the repaired tendons were compared with conventional running peripheral sutures. Three 2-strand sutures and three 4-strand sutures were used in repairing porcine tendons. The time required for performing 2Q and running sutures were recorded. The repaired tendons were subjected to a cyclic loading test, and the cycle number, during which a 2-mm gap was formed, was determined. After the cyclic loading, the gap size at the tendon ends and the ultimate strength of the repaired tendons were measured. Augmentation with the Q sutures reduced the number of tendons showing 2-mm gaps at tendon ends during cyclic loading. With addition of Q sutures 2-strand sutures significantly increased the ultimate strength of the repaired tendons and 4-strand sutures decreased the gap distance at the repair site of tendons. The time required for performing 2Q sutures was significantly less than that for running sutures. Therefore, we conclude that the Q suture is efficient in enhancing the tensile resistance and tendon repair strength and can be an alternative to conventional peripheral sutures.


Assuntos
Técnicas de Sutura/instrumentação , Suturas/estatística & dados numéricos , Tendões/fisiopatologia , Resistência à Tração/fisiologia , Animais , Suínos
7.
Knee ; 27(3): 701-708, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32563426

RESUMO

BACKGROUND: Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. METHODS: The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. RESULTS: Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. CONCLUSIONS: The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.


Assuntos
Artroscopia/métodos , Meniscos Tibiais/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Ruptura , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico
8.
PLoS One ; 15(6): e0234982, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589672

RESUMO

BACKGROUND: Rotator cuff tendon repair in humans is a commonly performed procedure aimed at restoring the tendon-bone interface. Despite significant innovation of surgical techniques and suture anchor implants, only 60% of repairs heal successfully. One strategy to enhance repair is the use of bioactive sutures that provide the native tendon with biophysical cues for healing. We investigated the tissue response to a multifilament electrospun polydioxanone (PDO) suture in a sheep tendon injury model characterised by a natural history of failure of healing. METHODOLOGY AND RESULTS: Eight skeletally mature English Mule sheep underwent repair with electrospun sutures. Monofilament sutures were used as a control. Three months after surgery, all tendon repairs healed, without systemic features of inflammation, signs of tumour or infection at necropsy. A mild local inflammatory reaction was seen. On histology the electrospun sutures were densely infiltrated with predominantly tendon fibroblast-like cells. In comparison, no cellular infiltration was observed in the control suture. Neovascularisation was observed within the electrospun suture, whilst none was seen in the control. Foreign body giant cells were rarely seen with either sutures. CONCLUSION: This study demonstrates that a tissue response can be induced in tendon with a multifilament electrospun suture with no safety concerns.


Assuntos
Polidioxanona/efeitos adversos , Complicações Pós-Operatórias/patologia , Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura/instrumentação , Suturas/efeitos adversos , Animais , Modelos Animais de Doenças , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/patologia , Ovinos , Técnicas de Sutura/efeitos adversos , Resistência à Tração
9.
Arch Gynecol Obstet ; 302(2): 365-376, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32500216

RESUMO

PURPOSE: This study is performed to evaluate and compare the efficacy of cervical-lifting suture and lower B-Lynch suture in different severity of placenta previa associated with lower uterine segment bleeding. METHODS: We evaluated the effectiveness of cervical-lifting suture (n = 51) and lower B-Lynch suture (n = 137) in stopping the bleeding from lower uterine segment. Additionally, we used different statistical methods, including overall analysis, subgroup analysis and approximate randomization analysis, to evaluate the efficacy of the two assessments. RESULTS: The medical records of these 188 participants were extracted and all of the patients were followed up for six weeks. The majority of patients were multipara and complicated with previous cesarean delivery and abnormal adherent placenta. The median intraoperative blood loss and the median amount of red blood cell transfusion were lower in the cervical-lifting suture group in comparison to the lower B-Lynch suture group. CONCLUSION: Our study provides evidence that cervical-lifting suture has less intraoperative blood loss and red blood cell transfusion for controlling lower uterine segment bleeding in placenta previa.


Assuntos
Colo do Útero/cirurgia , Placenta Prévia/cirurgia , Técnicas de Sutura/instrumentação , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
10.
Medicine (Baltimore) ; 99(21): e20312, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481315

RESUMO

The treatment of type 3 acromioclavicular joint injuries has still controversial issues. In this retrospective study, we aimed to compare the radiological and functional outcomes of the suture anchor and double-button fixation methods for the treatment of type 3 acromioclavicular joint injuries.This study included 20 patients who underwent suture anchor (9 patients) and double-button fixations (11 patients) for isolated type 3 acromioclavicular dislocation. Injuries were classified according to the Rockwood Classification System. Coracoclavicular(CC) distances and anterior translation have been measured pre-operatively and at the 12th month follow-up. Functional evaluation was performed using the DASH, and Constant-Murley scores of the patients were recorded at the12th-month follow-up.The mean age of the patients was 37 (22-50) years in Group 1(double-button group) and 39 (24-56) years in Group 2(suture anchor group). All of the patients were male. There was no statistically significant difference between the DASH and Constant-Murley scores of the 2 groups (P > .05). The mean DASH score of the patients evaluated at the postoperative 12th month was 6.65 (0-38.3) in Group 1 and 2.48 (0-4.2) in Group 2. The mean Constant-Murley score of the patients evaluated at the postoperative 12th month was 89,6 (50-98) in Group 1 and 93,6 (90-98) in Group 2. Comparison of the pre- and post-operative CC distances and pre- and post-operative anterior translation distances of both groups revealed that there was no statistically significant difference between groups regarding postoperative CC distances and anterior translation distances (P > .05).Suture anchor and double-button techniques are reliable treatment methods that are not superior to one another and can yield excellent functional outcomes.


Assuntos
Articulação Acromioclavicular/lesões , Procedimentos Ortopédicos/métodos , Lesões do Ombro/cirurgia , Âncoras de Sutura , Técnicas de Sutura/instrumentação , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Lesões do Ombro/diagnóstico , Resultado do Tratamento , Adulto Jovem
11.
Cir. plást. ibero-latinoam ; 46(2): 177-186, abr.-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-194720

RESUMO

INTRODUCCIÓN Y OBJETIVO: La cicatriz queloide es uno de los problemas clínicos más frustrantes en la curación de heridas y un gran desafío para los médicos. Los diversos tratamientos (escisión parcial o total), inyección de drogas intralesionales, radioterapia, láser, silicona, prendas de lycra, entre otros, tienen un alto riesgo de recurrencia (10-45%). Los desafíos que enfrenta la comunidad dedicada a la rehabilitación incluyen la investigación del proceso de curación, los efectos de los diferentes factores involucrados en la cicatrización de heridas y el desarrollo de cicatrices, y la mejor combinación de intervenciones quirúrgicas, farmacológicas y terapéuticas para maximizar el resultado. La cirugía se puede realizar para tratar los queloides de dos maneras: primero, resección radical de los queloides y, en segundo lugar, reducción de la masa queloide. El objetivo que proponemos es mejorar las cicatrices hipertróficas y queloides mediante múltiples zetaplastias o con resección parcial más múltiples zetaplastias. MATERIAL Y MÉTODO: Realizamos un estudio prospectivo sobre un total de 335 cicatrices clasificadas según la escala de Vancouver entre febrero de 2013 y julio de 2018. Se intervinieron cicatrices lineales con zetaplastia múltiple teniendo en cuenta las líneas de menor tensión, tanto en cicatrices hipertróficas como en queloides extensos; si el tejido vecino lo permitía, la cicatriz se resecó parcialmente y se hizo zetaplastia múltiple; si el tejido vecino no permitía la resección, se seleccionaron algunas áreas para realizar la primera sesión de zetaplastia y en intervenciones posteriores se realizaron otras para poder intervenir en toda el área en función de las fuerzas de tensión. RESULTADOS: Revisamos un total de 335 cicatrices, 188 (56.1%) hipertróficas y 147 (43.9%) queloides, en pacientes entre 1 y 56 años, durante un promedio de 13 años. Cara y cuello 123 (37%), extremidades superiores 85 (25,3%), extremidades inferiores 63 (18,8%), tórax 53 (15,8%) y oreja 11 (3,3%) fueron las principales áreas tratadas. De las 123 fotografías intraopoeratorias revisadas, 4 (3%) tenían solo 1 zetaplastia, 3 (2.4%) tenían 2, 27 (21.9%) tenían 3 y 89 (72.3%) más de 4 zetaplastias múltiples (promedio de 6). Con los buenos resultados obtenidos, la cirugía también se realizó en cicatrices durante el proceso de maduración, 3 o 4 meses después de la qemadura. Setenta y ocho pacientes (23.2%) con seguimiento de 5 años no presentan recurrencia, ni 35 (10.4%) a los 4 años. CONCLUSIONES: La zetaplastia múltiple, con o sin resección parcial de cicatriz hipertófica o queloidea, puede realizarse en cicatrices activas inmaduras, rompiendo el paradigma de esperar hasta que la cicatriz esté madura o incluso cuando los tratamientos terapéuticos hayan fallado. La sutura continua con monofilamento es una contribución técnica que permite reducir el tiempo quirúrgico y facilita la extracción


BACKGROUND AND OBJECTIVE: The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%). The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass. Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties. METHODS: A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces. RESULTS: A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years. CONCLUSIONS: Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cicatriz Hipertrófica/cirurgia , Queloide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Técnicas de Sutura/instrumentação , Estudos Prospectivos , Queimaduras/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Cirurgia Plástica/métodos
12.
Ann Thorac Surg ; 110(4): e335-e337, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32439393

RESUMO

We described an alternative technique for ascending aorta replacement with sinotubular junction reduction and stabilization. This technique is performed by suspending the 3 commissures, invaginating the aortic polyester fiber graft, and advancing the graft into the ventricles. The proximal anastomosis is performed with 2 suture lines. This procedure is easy, fast, and hemostatic. It can be adopted in some cases of ascending aorta dilatation with aortic regurgitation due to loss of the sinotubular junction.


Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Procedimentos Cirúrgicos Vasculares/métodos , Humanos
14.
Khirurgiia (Mosk) ; (3): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271731

RESUMO

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.


Assuntos
Hepatectomia/efeitos adversos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Algoritmos , Doenças Biliares/etiologia , Doenças Biliares/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Protocolos Clínicos , Dissecação/efeitos adversos , Dissecação/métodos , Hepatectomia/instrumentação , Hepatectomia/mortalidade , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Tamanho do Órgão , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Técnicas de Sutura/instrumentação
15.
PLoS One ; 15(3): e0230113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142547

RESUMO

BACKGROUND: The drawback of the delta-shaped gastroduodenostomy (DSG) in totally laparoscopic distal gastrectomy (TLDG) is the presence of intraoperative duodenal injury and postoperative anastomotic stenosis, which can occur due to a relatively short duodenal bulb diameter. MATERIALS AND METHODS: From June 2013 to June 2019, 35 patients with gastric cancer underwent TLDG with a modified DSG consisting of linear stapling and single-layer hand suturing in our institution. All anastomotic procedures were performed by the right hand of the operator positioned between the patient's legs. Linear stapling of the posterior walls of the remnant stomach and duodenum without creating a gap was performed using a 45-mm linear stapler, considering the prevention of intraoperative duodenal injury. The stapler entry hole was closed using a single-layer full-thickness hand suturing technique with knotted sutures and a knotless barbed suture. We described the clinical data and outcomes in the present retrospective patient series. RESULTS: No intraoperative duodenal injury occurred in any of the 35 patients. The median staple length at linear stapling of the posterior walls of the remnant stomach and duodenum was 41.7 ± 4.2 (30-45) mm, and 2 patients (5.7%) had a staple length of 30 mm. There were no incidences of postoperative anastomotic stenosis. CONCLUSIONS: We suggest that a modified DSG consisting of linear stapling and single-layer hand suturing performed by an operator positioned between the patient's legs can be one option for B-Ⅰ reconstruction following TLDG because it can aid in preventing both intraoperative duodenal injury and postoperative anastomotic stenosis.


Assuntos
Constrição Patológica/prevenção & controle , Duodeno/lesões , Gastrectomia/métodos , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Duodeno/patologia , Feminino , Coto Gástrico/patologia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Grampeadores Cirúrgicos , Técnicas de Sutura/instrumentação
17.
J Surg Res ; 251: 85-93, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32114213

RESUMO

BACKGROUND: Laparoscopy is the gold standard approach in numerous surgical procedures. A new generation of robotized instruments has been developed to compensate for the ergonomic constraints of conventional instruments. The main objective was to compare the learning curves of novices for intracorporeal suturing on a laparoscopy pelvitrainer, using either a robotized needle holder or conventional needle holders. The post-training performances under ergonomically difficult conditions were also analyzed. MATERIALS AND METHODS: Fifth-year medical students were randomized in group A using a robotized needle holder (JAIMY; Endocontrol, Grenoble, France) and group B using straight conventional needle holders. They undertook four training sessions (intracorporeal knot-tying task) followed by an evaluation session (intracorporeal knots-tying task, frontal suture, and hexagonal suture). RESULTS: Twenty participants were included. The performances of the two groups (n = 10) were not significantly different at baseline. During the training sessions, there was a learning curve with a plateau at the third session for both the groups. At the final evaluation session, there was no significant difference between group A and group B for the intracorporeal knot-tying task (median fundamentals of laparoscopic surgery score: 468 versus 474.5 respectively; P = 0.762). There was a significant difference between group A and group B for the frontal suture (median global score: 15.75 versus 3.75 respectively; P = 0.005) but not for the hexagonal suture (median global score: 18 versus 15 respectively; P = 0.284). CONCLUSIONS: Learning curves were equally fast using the robotized needle holder versus conventional instruments and led to equivalent performances. Under ergonomically difficult conditions, the robotized needle holder provided an advantage relative to conventional instruments.


Assuntos
Laparoscopia/educação , Curva de Aprendizado , Modelos Anatômicos , Procedimentos Cirúrgicos Robóticos/educação , Técnicas de Sutura/educação , Técnicas de Sutura/instrumentação , Competência Clínica , Ergonomia , Feminino , Humanos , Laparoscopia/instrumentação , Masculino , Agulhas , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Estudantes de Medicina , Adulto Jovem
18.
Cardiovasc Intervent Radiol ; 43(5): 781-786, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32166353

RESUMO

PURPOSE: After any procedure through the percutaneous gastrostomy (PG), a PG tube should be kept in place until a mature tract develops. For this period of maturation which takes about 2 to 4 weeks, tube dislodgement, leakage, or peritonitis can occur. Complications from PG tube maintenance can be prevented by closing the PG immediately after the procedure. The purpose of this study was to evaluate the feasibility and safety of immediate PG closure using Perclose ProGlide. MATERIALS AND METHODS: A 2-week survival study was performed in a swine model. We applied one Perclose ProGlide device for closing a 13-Fr PG (n = 3) and two devices for closing a 20-Fr PG (n = 3). Body weight, temperature and laboratory findings were observed. Autopsy and microscopic examination were performed after 2 weeks. RESULTS: All the swine subjects did not demonstrate any sign of systemic inflammatory responses in terms of fever and laboratory findings. From autopsy results, five pigs showed complete healing of the PG. One pig that underwent 20-Fr gastrostomy site closure with double Perclose ProGlide had scanty semitransparent fluid in the peritoneal cavity but that was not indicative of inflammation. En bloc tissue samples from all the pigs demonstrated complete wound healing of the PG sites. CONCLUSION: Percutaneous application of single or double Perclose ProGlide devices is feasible and safe for the PG closure in a swine model. LEVEL OF EVIDENCE: No level of evidence, Animal study.


Assuntos
Gastrostomia/instrumentação , Gastrostomia/métodos , Técnicas de Sutura/instrumentação , Dispositivos de Oclusão Vascular , Animais , Feminino , Modelos Animais , Suturas , Suínos , Fatores de Tempo , Resultado do Tratamento
19.
Ann Vasc Surg ; 67: 553-556, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32205251

RESUMO

We developed a new reinforcement technique, the Gorget-like Cuddling (GOCU) suture, to prevent suture line bleeding during aortic surgery. After continuous aortic anastomosis with thick outer felt, an additional 2-0 Ticron (Medtronic, Minneapolis, MN) suture is placed distal from the first suture line. This GOCU suture directly holds the needle holes. Wall tension on the anastomosis can also be reduced to prevent longitudinal dilatation of the aorta. This technique can contribute to hemostasis for a fragile aortic wall in cases like acute aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Técnicas de Sutura/instrumentação , Suturas , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento
20.
Cir. Esp. (Ed. impr.) ; 98(3): 136-142, mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195833

RESUMO

INTRODUCCIÓN: Posiblemente la parte técnica que más destreza precisa en laparoscopia es la realización de anastomosis y suturas intracorpóreas. La aparición de las nuevas suturas barbadas durante los últimos años parece facilitar dichos gestos quirúrgicos. El objetivo de nuestro estudio es evaluar los resultados a corto plazo en pacientes con neoplasias de colon derecho, tras hemicolectomía derecha laparoscópica con anastomosis intracorpórea mediante la utilización de sutura barbada en el cierre de la enterocolotomía. MÉTODOS: Se trata de un estudio descriptivo prospectivo multicéntrico en el que se incluyen pacientes que han sido intervenidos mediante hemicolectomía derecha laparoscópica por patología neoplásica colónica entre junio del 2015 y diciembre del 2018. En todos ellos se realizó la anastomosis intracorpórea mediante el uso de endocortadora y el cierre de la enterocolotomía mediante una doble capa de sutura barbada. RESULTADOS: Se ha intervenido a un total de 80 pacientes (47,5% mujeres), con una edad media de 70,6 ± 9 (49-92) años. El tiempo operatorio medio fue 99,5 ± 38 min. Un 2,5% de la muestra presentó dehiscencia de anastomosis y se tuvo que reintervenir a 5 pacientes (6,2%) como consecuencia de 2 dehiscencias, 2 cuadros obstructivos y un sangrado peritoneal. La mediana de estancia hospitalaria fue de 7 (3-173) días. CONCLUSIONES: El uso de la sutura barbada en la hemicolectomía derecha laparoscópica con anastomosis intracorpórea parece presentar una morbilidad similar a las series descritas en la literatura. En cualquier caso, serían necesarios estudios con mayor número de pacientes, prospectivos, controlados y aleatorizados para confirmar estos hallazgos


INTRODUCTION: Performing intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. METHODS: This is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. RESULTS: A total of 80 patients were treated (47.5% women), with an average age of 70.6 ± 9 (49-92) years. The average operative time was 99.5 ± 38 minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2 leaks, 2 obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days. CONCLUSIONS: The use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Colectomia/métodos , Laparoscopia/métodos , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/instrumentação , Técnicas de Sutura/estatística & dados numéricos , Suturas , Neoplasias do Colo/cirurgia , Desenho de Equipamento , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
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