The role of Cor-Knot in the future of cardiac surgery: A systematic review.

OBJECTIVE: The Cor-Knot automated fastener has been used to eliminate the need for manual knot-tying in cardiac valve surgery for over a decade. We review the current literature pertaining to Cor-Knot and discuss its benefits and shortcomings with respect to cardiac valve surgery. METHODS: A comprehensive literature search was conducted to identify articles discussing the use of automated fasteners and manually tied knots in the setting of cardiac valve surgery. The search terms used were "heart", "valve surgery", "cardiac", "Cor-Knot", "fastener", "automated fastener", "aortic valve", "mitral valve", "minimally invasive", and "titanium". These terms were used as keywords and, in combination, as MeSH terms to maximize the output of literature searches. Twenty-four relevant articles were identified and reviewed. RESULTS: Current literature provides evidence to support the role of Cor-Knot in facilitating enhanced intraoperative efficacy by reducing total operation times as compared with manual knot-tying. However, studies to date fail to provide evidence for the translation of these intraoperative advantages into improved patient outcomes. Moreover, Cor-Knot is associated with a significant financial burden. CONCLUSION: A plethora of evidence exists to support the intraoperative advantages provided by Cor-Knot. However, the literature is yet to support its role in facilitating superior clinical outcomes as compared with manual knot tying. Larger high-quality trials and studies are required to provide evidence supporting the ongoing use of Cor-Knot in valve surgery.

Preoperative endoscopic titanium clip placement facilitates intraoperative localization of early-stage esophageal cancer or severe dysplasia.

BACKGROUND: Accurate intraoperative localization of esophageal lesions is essential for successful surgical resection. We tested whether preoperative endoscopic placement of titanium clips could facilitate intraoperative localization of early-stage esophageal cancer or severe dysplasia. METHODS: A prospective randomized clinical trial was performed between May 2012 and July 2014. All enrolled patients received preoperative endoscopy and esophageal endoscopic ultrasound, as well as pathological study on the biopsy specimen, to confirm early stage esophageal cancer or severe dysplasia. One day before the surgical operation, patients in the experimental group received the preoperative endoscopic titanium labeling of esophageal lesions. Then, during the surgical operation, palpitation of titanium clips was used to localize the lesions in these patients. In patients in the control group, palpitation of nodules or esophageal wall mucosal thickening, together with the consideration of the results from preoperative endoscopic and ultrasound studies, was applied to estimate the location of the esophageal lesions. Study outcomes included the proportions of patients having successful intraoperative pre-resection lesion localization, post-esophagectomy lesion visualization, negative upper surgical margin, change of surgical approaches, and positive postoperative pathological diagnosis. RESULTS: A total of 27 patients were enrolled into the study, with 14 in the experimental group and 13 in the control group. Compared to the patients in the control group, a higher proportion of patients in the experimental group had statistically significant successful intraoperative esophageal lesion localization (100 versus 15.3% in the experimental versus control group). CONCLUSIONS: Preoperative endoscopic titanium clip placement could facilitate intraoperative localization of early-stage esophageal cancer or severe dysplasia. TRIAL REGISTRATION: Current study was registered in Chinese Clinical Trial Registry and World Health Organization International Clinical Trials Registry Platform, ChiCTR-INR-17010949 . Registered 22 March 2017, retrospectively registered.

Ceramic Aneurysm Clip with Titanium Spring.

OBJECTIVE: To design and evaluate ceramic aneurysm clips with integrated titanium springs, focusing on ergonomic application and precision in neurosurgical procedures. METHODS: The clip design was executed with precision using Creo Parametric 3D CAD software. It comprises a zirconia body and a titanium spring for durability and consistent tension and features a four-coil hairpin titanium spring for enhanced closing force and a ball-type head for versatile maneuverability during surgery. To assess durability, closing forces were rigorously measured using a force gauge system, comparing the ceramic clip with the standard Mizuho permanent clip over 30 open-close cycles. For the assessment of magnetic resonance (MR) artifacts, both the ceramic and Yasargil clips were evaluated using a 3 Tesla (T) MRI scanner, employing specific imaging sequences. RESULTS: The straight type ceramic clip's initial closing force was 1.70 N, dropping to 1.22 N after 30 cycles, indicating a retention of 72% of its initial force. In MRI, the ceramic clip displayed significantly lower measurement discrepancies compared to the titanium alloy Yasargil clip, particularly in high-resolution T1-weighted images. The lowest variance was at measurement point L2, where the ceramic clip showed a 3% discrepancy. Furthermore, the ceramic clip yielded clearer images than the titanium alloy clip, particularly at the clip's end. CONCLUSIONS: Ceramic clips with titanium springs demonstrated satisfactory closing force and superior MRI compatibility, promising enhancements in surgical application and postoperative assessment.

The Use of Cranial Aneurysm Clips for Repair of Incidental Lumbar Durotomy: Operative Technique and Case Series.

BACKGROUND: Incidental durotomy is a common complication of posterior lumbar spine surgery; however, effective and durable methods for primary repair remain elusive. Multiple existing techniques have previously been reported and extensively described, including sutured repair and the use of nonpenetrating titanium clips. The use of cranial aneurysm clips for primary repair of lumbar durotomy serves as a safe and effective alternative to obtain watertight closure of a dural tear. METHODS: We performed a retrospective review of patients at a single institution who underwent primary repair of an incidental lumbar durotomy with the use of an aneurysm clip during open posterior lumbar surgery between 2012 and 2023. Patient demographics, operative details, and postoperative metrics were collected and examined to evaluate the safety and efficacy of the novel technique. RESULTS: A total of 51 patients were included for analysis. Four patients underwent durotomy repair with an aneurysm clip alone, 27 patients were repaired with an aneurysm clip and fibrin glue, and 20 patients underwent repair with an aneurysm clip, fibrin glue, and a collagen dural substitute. Three patients (5.9%) reported headaches: 2 (3.9%) with pseudomeningocele and 1 (2%) with wound leakage. Two patients (3.9%) had treatment failure with a return to the operating room for repair of a cerebrospinal fluid leak. CONCLUSIONS: To the best of our knowledge, we report the largest series of patients undergoing primary repair of incidental durotomy with the use of an aneurysm clip. Use of an aneurysm clip is noted to be a safe, quick, and effective method of primary repair compared with existing repair techniques such as sutured repair or nonpenetrating titanium clips.

Preoperative ultrasound-guided dual localization with titanium clips and carbon nanoparticles for predicting the surgical approach and guiding the resection of Siewert type II esophagogastric junction adenocarcinoma.

OBJECTIVE: To investigate the superiority of preoperative ultrasound-guided titanium clip and nanocarbon dual localization over traditional methods for determining the surgical approach and guiding resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). METHOD: This study included 66 patients with Siewert type II AEG who were treated at the PLA Joint Logistics Support Force 900th Hospital between September 1, 2021, and September 1, 2023. They were randomly divided into an experimental group (n = 33), in which resection was guided by the dual localization technique, and the routine group (n = 33), in which the localization technique was not used. Surgical approach predictions, proximal esophageal resection lengths, pathological features, and the occurrence of complications were compared between the groups. RESULT: The use of the dual localization technique resulted in higher accuracy in predicting the surgical approach (96.8% vs. 75.9%, P = 0.02) and shorter proximal esophageal resection lengths (2.39 ± 0.28 cm vs. 2.86 ± 0.39 cm, P < 0.001) in the experimental group as compared to the routine group, while there was no significant difference in the incidence of postoperative complications (22.59% vs. 24.14%, P = 0.88). CONCLUSION: Preoperative dual localization with titanium clips and carbon nanoparticles is significantly superior to traditional methods and can reliably delineate the actual infiltration boundaries of Siewert type II AEG, guide the surgical approach, and avoid excessive esophageal resection.

The value of endoscopic duodenal papilloplasty with titanium clip in improving post-operative complications of choledocholithiasis.

OBJECTIVE: To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications. MATERIALS AND METHODS: One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage. RESULTS: In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates. CONCLUSIONS: The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.

OBJETIVO: Investigar el valor de la esfinterotomía papilar duodenal endoscópica combinada con dilatación con balón en el tratamiento de la papiloplastia duodenal con clip de titanio después de coledocolitiasis en complicaciones postoperatorias. MATERIALES Y MÉTODOS: Se incluyeron un total de 125 pacientes (69 hombres y 56 mujeres) con una mediana de edad de 65 (32-81) años. Los pacientes del Grupo A se trataron con esfinterotomía endoscópica (EST) combinada con dilatación papilar endoscópica con balón grande (EPLBD), seguida de clip de titanio para papiloplastia duodenal y luego drenaje nasobiliar permanente, mientras que los del Grupo B se trataron con EPLBD combinado con EST para eliminar cálculos y luego drenaje nasobiliar permanente. RESULTADOS: En pacientes con coledocolitiasis o con cambios anatómicos que dificultan la extracción de cálculos, este estudio prospectivo intentó realizar papiloplastia duodenal con clips de titanio después de litotricia EST y EPLBD para comparar y observar la cicatrización papilar postoperatoria, el reflujo biliar y las tasas de complicaciones. CONCLUSIÓN: El uso de papiloplastia duodenal endoscópica con clips de titanio puede mejorar el reflujo biliar después de la litotricia y reducir la incidencia de complicaciones de colangitis postoperatorias.

The effect of the shape of a clip on the magnetic field during magnetic resonance imaging examinations.

Aim Plastic clips are a diamagnetic material and produce fewer artefacts in the MR field than titanium clips, which are standard in neurosurgery. However, alongside their physical properties, the shape of the clips, and their very geometry subtlety affects their behaviour in the magnetic field. Therefore, we performed a simulation in order to establish which clips cause less disturbance in the magnetic field from the point of view of the geometry of the body. Methods The simulation tool used for the research was the software package COMSOL Mph version 4.3. Since it was a question of magnetics, the models were prepared in the AC/DC module within the option Magnetic Fields, No Currents (mfnc). Within this module we were able to analyse electro-magnetic fields for a specific geometrical structure, using the Finite Element Method in order to resolve the two-dimensional electromagnetic problems. Results The value of the magnetic field with titanium clips with their specific geometric reference lines reached the value of c. (A/m). The simpler geometry of the plastic clips resulted in a less intensive magnetic field, amounting to c. (A/m), which is an entire order of magnitude less than the field with the titanium clips. Conclusion The simpler geometry of the plastic clips and the type of material from which they are made causes less disturbance to the magnetic field, which was precisely confirmed with the simulation model. The use of plastic clips in neurosurgery and neuroradiology will facilitate the interpretation of MR images.

Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note.

BACKGROUND: Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow surgical corridor. No data exist on the efficacy of these clips for pediatric spinal dural closure. METHODS: A single surgeon case series of 152 pediatric patients underwent procedures involving lumbar durotomy with subsequent dural closure using the AnastoClip® nonpenetrating titanium clip closure system. Rates of infection and cerebrospinal fluid leak were measured during the follow-up period. RESULTS: A total of 152 pediatric patients (mean age: 6.25 ± 5.85 years, 50.7 % female) underwent intradural surgery with clip closure. The mean follow-up time was 57.0 ± 28.5 months. All patients were initially indicated for procedures involving spinal durotomy, with a majority being isolated tethered cord release (84.2 %). Others required tethered cord release and excision of a lipomyelomeningocele, spinal meningioma or arachnoid cyst (15.8 %). Post operative CSF leak occurred in two (1.32 %) patients at 11 and 18 days. Only one (0.66 %) patient was diagnosed with an infection, which was in a separate patient from those that had CSF leaks. CONCLUSION: The remarkably low incidence of post-operative CSF leak and infection with nonpenetrating titanium clips suggests a strong safety and efficacy profile for this form of dural closure in a pediatric cohort. Further research evaluating this technique is required to fully demonstrate its acceptability as a cost-effective alternative to traditional suture-based closure.

Role of clip markers placed by endoscopic ultrasonography in contouring gross tumor volume for thoracic esophageal squamous cell carcinoma: one prospective study.

BACKGROUND: We aimed to analyze the value of metal clip markers guided and placed by endoscopic ultrasonography (EUS) in the delineation of gross tumor volume (GTV) for thoracic esophageal squamous cell carcinoma. METHODS: From September 2016 to September 2018, patients with thoracic esophageal squamous cell carcinoma in Tianjin Medical University Cancer Institute and Hospital were recruited in the prospective trial, NCT02959385. They underwent titanium clips placement on tumor superior and inferior boundaries under EUS by a single expert endosonographer before radiotherapy computed tomography (CT) simulation. According to the clip markers, the reference GTVs were contoured by one experienced radiation oncologist. With the help of the Eclipse treatment planning system, clip markers on CT were concealed. Afterward, two other radiation oncologists with expertise in esophageal cancer delineated GTVs, defined as conventional GTVs, based on endoscopy and barium radiography findings. The two GTVs were compared and analyzed. Subgroup analysis was conducted in different T stage [early (T1 + T2) vs. advanced (T3 + T4)], focus location (upper vs. middle vs. lower segment), and tumor length (<5 vs. >5 cm) groups. RESULTS: The trial recruited 55 patients with 60 thoracic esophageal cancer foci. A total of 111 titanium clips were guided and implanted by EUS. Before CT simulation, two titanium clips at two foci fell off. After the procedure, no case of intolerable esophageal pain, hemorrhage, or perforation occurred. Compared to reference GTVs', discrepancies of conventional GTVs' superior borders were 0.91±0.82 cm (P<0.001), while differences of inferior borders were 0.74±0.63 cm (P<0.001). On the contrary, conventional GTVs' lengths were not significantly different from reference GTVs' with discrepancies 0.08±1.30 cm (P=0.64). Regardless of T stage, tumor location, and tumor length, conventional GTVs' superior and inferior borders were significantly different from reference GTVs', while GTVs' lengths differed insignificantly. CONCLUSIONS: This study confirmed that EUS-placed titanium clips could correct contouring of GTVs in thoracic esophageal cancer in different T stages, tumor locations, and lengths.

Dural Tears in Percutaneous Biportal Endoscopic Spine Surgery: Anatomical Location and Management.

OBJECTIVE: To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal endoscopic surgery (PBES) technique. We investigated the relationship between dural tears and the type of procedure and type of instrument used. METHODS: We retrospectively analyzed 643 PBES cases by reviewing the medical records, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of the dural tears, the surgical instrument that caused the tear, and the technique used to seal the tear. RESULTS: The dural tear incidence was 4.5% (29 of 643 cases). Tears in the exiting nerve area (2 cases; 6.9%) had mainly been caused by curettage, tears in the thecal sac area (18 cases; 62.1%) were associated with electric drill and forceps use; and tears in the traversing nerve area were associated with the use of a Kerrison punch (9 cases; 31%). Of the 29 cases of dural tear, 12 were treated with in-hospital monitoring and bed rest, 14 were treated with a fibrin sealant, 2 were treated with a nonpenetrating titanium clip, and 1 was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear. CONCLUSIONS: Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no greater than that associated with microscopic surgery. Our management strategy for incidental dural tears during PBES has been shown to be safe and effective.

Skull Base Dural Closure Using a Modified Nonpenetrating Clip Device via an Endoscopic Endonasal Approach: Technical Note.

Skull base reconstruction after an endoscopic endonasal approach into the cerebrospinal fluid (CSF) space is always challenging. Various reconstructive methods are available, but no standard technique is established. This report describes the endoscopic skull base dural closure using a modified nonpenetrating clip device with shaft length of 15 cm. Six patients with an intra-suprasellar or suprasellar tumor who underwent extended endoscopic endonasal transsphenoidal surgery were targeted. For closure of the skull base dural defect after tumor removal, fascia lata was first placed as an inlay graft and was subsequently fixed with the dura using a modified nonpenetrating clip device. No CSF leakage from the closed dura with an inlay fascia lata fixed with clips was confirmed by the Valsalva maneuver. To complete skull base reconstruction, fascia lata was then positioned as an overlay graft and covered with vascularized pedicled nasoseptal flaps. Five of six patients experienced no CSF rhinorrhea postoperatively. The modified nonpenetrating clip device may achieve effective dural closure in the deep and narrow nasal cavity. We introduce this clip device technique as one of the endoscopic skull base dural closure methods.

Radiologic advantages of potential use of polymer plastic clips in neurosurgery.

BACKGROUND: Plastic clips are made of diamagnetic material and may result in fewer computed tomography (CT) and magnetic resonance artifacts than titanium clips. Considering that polymer plastic clips are increasingly being used in endoscopic surgery, our study examined the CT and magnetic resonance imaging (MRI) characteristics of plastic clips after application in the neurocranium and compared them with titanium clips. METHODS: Craniotomy was performed on the heads of domestic pigs (Sus scrofa domestica), and, at an angle of 90°, a permanent Yasargil FT 746 T clip was placed in a frontobasal, interhemispheric position. A plastic polymer medium-large Hem-o-lok clip was placed in the same position into another animal. After this procedure, CT of the brain was performed using Siemens 16 slice, followed by an MRI scan, on Philips MRI, 1.5 Tesla. The CT and magnetic resonance scans were analyzed. RESULTS: On axial CT sections through the site of placement of titanium clips, dotted hyperdensity with a high value of Hounsfield units (HUI) of about 2800-3000 could be clearly seen. At the site where the plastic polymer clips were placed, discrete hyperdensity was observed, measuring 130-140 HUI. MRI of the brain in which titanium clips were used revealed a hypointensive T1W signal in the interhemispheric fissure, with a hypointensive T2W signal. On the other hand, upon examination of the MRI of the brain in which plastic clips were used, the T1W signal described above did not occur, and there was also no T2W signal, and no artifacts observed. CONCLUSIONS: The plastic clips are made of a diamagnetic, nonconductive material that results in fewer CT and MRI artifacts than titanium clips.

Application of endoscopy-guided titanium clip placement in precision radiotherapy for early esophageal cancer / 中华放射肿瘤学杂志

Objective To evaluate the application of the placement of titanium clips in the upper and lower tumor margins in precision radiotherapy for early esophageal cancer. Methods:Seventeen patients with early esophageal cancer underwent endoscopy-guided implantation of titanium clips to mark the upper and lower tumor margins. CT-based simulation was performed to delineate the gross tumor volume ( GTV) . The application value of this technology in precision radiotherapy was evaluated. Results:For all patients (including 13 cases with initial treatment and 4 patients requiring radiotherapy after endoscopic resection), the esophageal tumors were not explicitly displayed on CT and barium meal images and the GTV range could not be accurately determined. The esophageal tumors were marked by successful placement of at least one titanium clip in the upper and lower tumor margins. Subsequently, the esophageal tumors were successfully displayed on CT simulation and the target area was accurately delineated. No grade 3-4 adverse events, such as bleeding and perforation occurred. Conclusion Endoscopy-guided titanium clip placement is convenient and feasible for early esophageal cancer, which is of clinical significance for determining the target area of radiotherapy.

Effects of sleeve gastrectomy in mice by using titanium clip / 国际外科学杂志

Objective To introduce details of a new procedure of sleeve gastrectomy in mice by using titanium clip,and to observe whether this model has the same post-surgical metabolic effects as traditional procedure of sleeve gastrectomy in mice by using running stitch.Methods Thirt-one male FVB-Tg (NPY-hrGFP) mice,6 weeks (29-31 g) were randomly divided into SG (running stitch) group (n =8),SG (titanium clip) group (n =15) and Sham Operation (SO) group (n =8) by using random number table.Titanium clip was applied to close the side incision of stomachin SG (titanium clip) group,while running stitch was used in SG (running stitch) group which was detailed described in current references.Ligaments around stomach were detached without any stomach incision in SO group.Operation duration,mortality,and changes of post-surgical body weight and food intake were observed.Measured data were expressed as mean ± standard deviation ((x) ± s).Independent sample t test was used for comparison between the two groups.The variance of the data between the three groups was equal and analysis of variance (least significant LSD method) was used to compare each group.Preoperative and postoperative data were compared using a paired t test.Results Operation duration of SG (running stitch) group and SG (titanium clip) group were (44.60 ± 3.13) min and (28.25 ± 2.77) min,respectively.Compared with SG (running stitch) group,operation duration was significantly reduced in SG (titanium clip) group (P ≤ 0.01).Mortality of SG (running stitch) group and SG (titanium clip) group were 37.5％ and 20％,respectively,which has no significant difference (P =0.621).Compared with SO group,postoperative food intake was significantly reduced in both two SG groups (P ≤ 0.01),but there's no difference between two SG groups (P =0.149).At the end of the 6-week-postoperative,body weights of SG (running stitch) group and SG (titanium clip) group were reduced (17.67 ± 5.06) ％ and (18.76 ± 7.87) ％,respectively,while body weight of SO group increased (7.17 ± 2.31)％.Compared with SO group,postoperative change of body weight was significantly reduced in both two SG groups (P≤ 0.0 1),but there's no difference between two SG groups (P =0.746).Conclusions SG by using titanium clip in mice can reduce food intake and body weight as traditional SG by using running stitch does.But with shorter operation duration,this new model of SG in mice can provide a better and stable surgical model in research of mechanism of SG.

Endoscopic clipping with histoacryl in management of type 2 gastroesophageal varices (30 cases) / 中国内镜杂志

Objective To summarize clinical experience and explore application value of endoscopic clipping with histoacryl using in management of type 2 gastroesophageal varices. Methods Clinical data of 30 patients with type 2 gastroesophageal varices patients (including acute hemorrhage and primary prevention) from May 2015 to December 2016 were collected. Then evaluate therapeutic effect and safety of endoscopic clipping adjuvant therapy. Results Average glue dosage was (1.46 ± 0.70) ml, average using of clips were (5 ~ 6), and intraoperative needle pulling hemorrhage occurred in 2 cases. 14 patients (46.7%) underwent endoscopic re-examination, 3 patients (10.0%) achieved varicose vein elimination, 11 cases (36.7%) remained residual. Rebleeding occurred in 4 cases (13.3%), and 2 cases died (6.7%), one because of postoperative hematemesis and hemorrhagic shock, the other one died of spontaneous peritonitis and septic shock. For general curative effect, 2 cases (6.7%) were healed, 22 cases (73.3%) were improved, and 6 cases were unhealed (20.0%, 4 cases occurred rebleeding, 2 cases died); 17 cases underwent CT portal venograpy, abnormal embolization was not found in any patients, glue extrusion bleeding occurred in 1 case (3.3%), no patients had severe postoperative complications. Conclusion Endoscopic clipping with histoacryl can be used in the prevention and treatment of type 2 gastroesophageal varices to improve the treatment effect and reduce postoperative bleeding risk, may have good clinical practice value.

Primary closure of a cerebrospinal fluid fistula by nonpenetrating titanium clips in endoscopic endonasal transsphenoidal surgery: technical note.

Postoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF rhinorrhea or complications related to the use of the VCS. Metal artifact by the clips on postoperative images was tolerable. Primary closure of the fistula using the VCS was an effective strategy to prevent postoperative CSF leakage in transsphenoidal surgery. Future application can be expanded to reconstruction of the skull base dura via endonasal skull base approaches.

Comparison and clinical application of two kinds of endoscopic titanium clip for closing duodenal perforation / 中国内镜杂志

Objective To investigate the effect and clinical application of two kinds of endoscopic titanium clip in treatment of iatrogenic or iatrogenic perforation of duodenal descending part. Methods For 15 cases of perforation of duodenal descending part, according to the specific location of the perforation, select different endoscopic, compare the closing efficiency and success rate. Results 8 cases closed under gastroscopy in 15 cases of descending part of duodenum perforation, successfully closed in 7 cases, success rate was 87.5 %; 7 cases closed under duodenoscopy, successfully closed in 7 cases, the success rate 100.0%. 14 cases successfully closed by endoscopic titanium clip in 15 cases, 1 case failed, the success rate was 93.3 %. The effective titanium clip quantity, invalid (loss) titanium clip quantity and the closing time between the two groups has no statistically significance (P > 0.05). Conclusion It is safe and effective to use two kinds of endoscopic titanium clips in treatment of iatrogenic or iatrogenic duodenal per-foration.

Clinical application of titanium clip in endoscopic mucosal resection / 重庆医学

Objective To investigate the clinical efficacy of the titanium clip in endoscopic treatment of the transverse colon pol‐yps and discuss the incidence of postoperative complications .Methods A retrospective analysis of 47 patients with the diameter of the transverse colon polyps with the diameter of 1 .0 cm above for EMR treatment .47 patients divided into titanium clip group (EMR preoperative using the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution ,n=21) and no titanium clip group (EMR preoperative no using the titanium clip ,n=26) .Analysis one‐time complete resection ,intraoperative blood loss and the hemorrhage after 7 days of two groups .Results There were one‐time removal of the tumor in the titanium clip group ,and no one‐time removal of the tumor in the no titanium clip group due to the large blood loss with poor visibility ,three cases can not be a one‐time complete resection ,the two groups were significantly different (P< 0 .05);the average amount of bleeding (20 .0 ± 5 .6)mL in titanium clip group ,that was (80 .0 ± 8 .2)mL in the on titanium clip group ;compared with the two groups , there was statistically significant (P<0 .01) .There was not complication of hemorrhage after 7 days ,but three cases were that in no titanium clip group ,the difference was significant (P<0 .05) .Conclusion EMR preoperative use the titanium clip in the tumor periphery 1 .0 cm extension and vascular anatomy distribution in trement of benign tumor of the transverse colon ,which can signifi‐cantly improve the clinical efficacy of EM R technique ,and significantly reduced the intraoperative and postoperative bleeding occur‐rence ,thus it's worthy of promotion .

Surgical mini-incision treatment of patent ductus arteriosus of premature infants with titanium clip in 110 cases / 中国综合临床

Objective To investigate the clinical effects of surgical small incision treatment of patent ductus arteriosus (PDA) in premature infants with titanium clip.Methods One hundred children received and cured by our hospital from January 2010 to January 2013 were divided into two groups.Group A:body weight ＞ 1.5 kg of patent ductus arteriosus (PDA),71 cases of premature children; group B:body weight ＜ 1.5 kg of low body weight preterm the children PDA,29 cases.The operations were performed in the newborn intensive care unit (NICU).The patient was placed in a lateral position with the left arm abduction under general anesthesia.A 1.5-2.5 cm long posterolateral mini-thoracotomy was made and the pleural cavity was entered via the 2-3rd intercostal space.The PDA was closed with two titanium clips.Results Ninety-nine cases were cured,1 died.2 residual shunt postoperatively.One patient on postoperative 5 day was found wound infected,wound healing after the use of antibiotics by intravenous.There was no significant difference in incidence of postoperative complications and mortality rate between group A and group B (P ＞ 0.05).Majority of children successfully weaned from the ventilator due to the rapid improvement of hemodynamics and lung conditions.In group B,mechanical ventilation time (12.6 ± 7.5) d and postoperative hospital stay (21.0 ± 15.4) d was significantly longer than group A ((9.6 ± 4.2) d and (12.0 ± 10.8) d),the difference between the two groups was significant (t =7.35,9.12,P ＜ 0.05).Conclusion (1) It is a viable treatment that bedside minimally invasive titanium clip closed ductus arteriosus in preterm children PDA.(2) As the treatment of low body weight premature children is poor,the tolerance of the surgical trauma of the surgery as a minimally invasive,simple method is particularly suitable for low body weight premature children PDA.

Thoracoscopic sympathetic trunk clipping for craniofacial hyperhidrosis: Analysis of 10 cases / 中国微创外科杂志

Objective To investigate the feasibility of video-assisted thoracoscopic sympathetic trunk clipping in the treatment of craniofacial hyperhidrosis. Methods A total of 10 patients were operated on under general anesthesia with double-lumen endotracheal intubation. The patients were placed in lateral recumbent position with one-lung ventilation. A 7 mm trocar and a 4.5 mm trocar were inserted at the 2~3 intercostal space on the midaxillary line and at the 4~5 intercostal space on the posterior axillary line, respectively, to introduce surgical instruments and thoracoscopic camera. Alongside the sympathetic chain, the sympathetic nerve trunk immediately below the second costal margin was blocked with small-sized titanium clips. Then the lung was inflated and the incision sutured. Afterwards, the procedure in the contralateral hemithorax was performed using the same method. Results The operating time was 55~130 min (mean, 110 min). Symptoms of craniofacial hyperhidrosis disappeared in the 10 patients, all of who were satisfied with curative results. The postoperative hospital stay was 2~3 days. Neither Horner’s syndrome nor other serious complications were observed. Seven of the patients developed slight compensation hyperhidrosis in their chest, abdomen, back or legs. All the patients had normally returned to work and physical exercises in 7~10 days. Postoperative follow-up for 1~9 months (mean,6.3 months) in all the patients found no recurrence. Conclusions Video-assisted thoracoscopic block of sympathetic trunk below the second costal margin for craniofacial hyperhidrosis is safe and effective.