Absorbable Barbed Suture Research Articles

Primary robot-assisted laparoscopic partial nephrectomy for hemorrhage secondary to angiomyolipoma: a retrospective study from a large tertiary hospital in China

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14–56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization.

812. INTRAOPERATIVE USE OF IMPEDANCE PLANIMETRY FOR RECURRENT ACHALASIA AFTER HELLER-NISSEN

Abstract Background Re-operations after Heller myotomy for esophageal achalasia is a challenging operation due to the fibrotic tissue surrounding the esophago-gastric junction (EGJ). The risk of both undertreatment or, on the other hand, esophageal perforation is significant. The impedance planimetry could guide the operation and assess whether the patients needs further dissection of adhesions, an extension of the previous myotomy and anti-reflux treatment. Methods A 70-year-old woman treated with Heller-Nissen in 1983 for type II achalasia was referred to our tertiary care center with absolute dysphagia for three days. In the past 41 years she reported occasional and self-limited episodes of dysphagia, regurgitation and chest pain. Aside from that, her medical history was unremarkable. An esophagogastroduodenoscopy (EGD) with airway protection was performed, showing retained solid food. A water-soluble swallow study showed a tortuous megaesophagus and a misaligned esophageal gastric junction (EGJ), which did not allow endoscopic dilation. Esophageal wall thickening and focal lesions were ruled out by a CT scan. Results A laparoscopy with impedance planimetry technology support was scheduled. The first EGJ distensibility index (EGJ-DI) measurement was 2.1 mm2/mmHg. Esophagus was freed, encircled and released from the hiatus. An EGD confirmed the reposition of the cardia in the abdomen and the previous anterior esophageal myotomy. The Nissen fundoplication was not detectable. At this stage, an EGJ-DI of 4,2 mm2/mmHg was found. To obtain a regular esophageal outflow an anterior myotomy of the EGJ and proximal stomach was carried out and the edge was everted with absorbable barbed suture. A posterior cruroplasty was then performed. The final EGJ-DI was 8,8 mm2/mmHg. Conclusion The postoperative course was uneventful and she was discharged on post-operative day 4 eating a soft diet. In conclusion, the intraoperative use of the impedance planimetry technology has been crucial for a correct decision-making process during complex redo operations for esophageal achalasia as it has helped to tailor the surgical treatment. https://www.dropbox.com/scl/fi/pednopcqnalooidynge3q/ISDE-Definitivo.mov?rlkey=8exx0oe6ompxoex8wqmlsgi0i&st=xgnfnjyt&dl=0

Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication.

Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis. The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated. Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.

Barbed suture related small bowel obstruction in bariatric surgery: a case series

Bariatric surgeries are amongst the most commonly performed yet technically demanding laparoscopic procedures in Australia. The use of barbed suture has been widely adopted for use in gastric bypass surgeries to avoid the need for intracorporeal knot tying while maintaining tension and improving surgical efficiency. Whilst barbed suture has been reported as safe with similar outcomes to traditional suture use in bariatric surgery there is a risk that the barbs on the tail of the suture can grasp other tissues and form band adhesions resulting in small bowel obstruction (SBO). We present a series of four cases of barbed suture related SBO post Roux-en-Y gastric bypass (RYGB) surgery. In all four patients the SBO was caused by a band adhesion related to the tail of the non-absorbable (permanent) barbed suture used to close the mesenteric defect adjacent to the jejunojejunostomy. The time to presentation with SBO ranged from 1 day to 20 months post RYGB and all patients underwent diagnostic laparoscopy where the adhesion was divided and the tail of the suture trimmed. To avoid this uncommon complication, we recommend the use of absorbable barbed suture with two extra passes beyond the completion of the suture line and the tail cut almost flush with the tissue. Further data is needed to determine if the recommended modified technique still poses a risk of SBO or if use of absorbable suture to close the mesenteric defect increases the risk of internal hernia.

Management of Grade IV Renal Graft Trauma Secondary to Oncological Surgery: A Case Report

Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.

Barbed Suspension Bridge Pharyngoplasty: Introducing a Novel Technique for Barbed Pharyngoplasty.

Surgical management of Obstructive Sleep Apnea (OSA) and Snoring has undergone many major and minor changes over a period of last decade. The most common surgical approach for OSA is uvulopalatopharyngoplasty (Stuck et al. in Sleep Med 50:152-165, 2018). The main goals of treatment of OSA are to decrease the risk of deleterious health effects and improve quality of sleep (Evans et al. in Otolaryngol Clin North Am 53: 319-328, 2020). Since bimanual surgical techniques in the depth of oral cavity have been tricky, search for a less demanding & easy to learn technique is always on. The surgical technique should also provide long term results with manageable complications. Barbed suture has been in sporadic use for the last decade amongst sleep apnea surgeons for its advantage of knotless application and distributed suture tension. However, the barbed suture which has been used is absorbable and is used only to close the surgical wound on the soft palate. In this paper we are describing our technique of using the 3-0 Polybutester non absorbable barbed suture to perform a novel technique of palatal surgery, in which we suspend the lower part of the soft palate permanently as a suspension bridge between the right and left Pterygomandibular raphae, so that the lower part of the soft palate cannot move posteriorly to touch the posterior pharyngeal wall preventing airway obstruction whereas it can still move superiorly freely while swallowing or during phonation. This technique can prove to be a technically less demanding one which provides excellent long-term results in snoring and OSA with manageable complications.

Endoscopically Assisted Correction of Malpositioned Breast Implants Using Absorbable Barbed Sutures.

Breast implant malpositioning is the second most common reason for revisional breast surgery. Multiple correction methods are suggested, depending on the malposition, but most of the methods, such as the inframammary fold incision, result in additional scars. We performed transaxillary endoscopic breast implant bottoming out corrections and used V-Loc thread for capsulorrhaphy. Fourteen patients who underwent correction for breast implant bottoming out after transaxillary breast augmentation were included in this study. Transaxillary endoscopic correction was performed using a V-Loc thread. All the 14 patients were satisfied with the result immediately after surgery. One case of overcorrection and one with implant bottoming out occurred, but did not require additional surgery. Transaxillary endoscopic bottoming out correction is a useful technique for those individuals who underwent primary transaxillary incisional breast augmentation. V-Loc thread is useful for endoscopic capsulorrhaphy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

P-077 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR (TAPP): OUR EXPERIENCE IN 200 PATIENTS

Abstract Aim To review and report our experience in the laparoscopic hernia treatment. Material & Methods It's a retrospective observational study including all patients who underwent a laparoscopic transabdominal preperitoneal hernia repair (TAPP) in our hospital between January 2016 to April 2022. Results From a total of 190 patients, 92% were male with a median age of 55,7 years old. Most of the cases were a primary hernia repair (81%) and 51,6% had bilateral presentation. Regarding the type of mesh employed, 89,1% were Adhesix®, 7,5% were Progrip® and 3,2% were flat polypropylen meshes. Tackers were used to fix the mesh only in a 11,2% of the patients. To close the peritoneum flap an absorbable barbed suture was used in a 94% of the cases, while tackers in a 5,9%. No intra-operative complications were described and 91,5% of surgeries were performed on an outpatioent basis. Concerning complications on the first fllow-up month: 7 patients suffered pain (3,4%) and 7 hematoma/seroma. Long-term complications were: chronic pain in 4 patients (2 with Adhesix®, 1 Progrip®, the forth one unknown; in none of them tackers were used); recurrence happened in 14 patients (7,6%) (11 Adhesix®, 2 Progrip®, 1 flat polypropylen mesh; tackers were used in three of these patients to fix the mesh). Conclusions Adhesix® mesh was the most employed (89,1%) and the one with the lowest recurrence rate (6,6%). According to our experience, tackers aren't necessary when an auto-adhesive mesh is used. Although they weren't related with postoperative pain, they didn't seem to prevent recurrence eiher.

The effect on incisional hernia of absorbable barbed suture for midline fascial closure in minimally invasive surgery for colorectal and gastric cancers: study protocol for a randomized controlled trial

BackgroundIncisional hernia following abdominal surgery is a frequent complication of midline laparotomy. This complication is strongly associated with the technique and material used for suture. While a monofilament absorbable suture is recommended to prevent incisional hernia, it can lead to suture loosening or surgical-knot breakage. Although barbed sutures can be an alternative suture material in abdominal fascial closure, evidence for its safety and effectiveness is lacking. Therefore, we designed a prospective randomized trial to evaluate the safety and efficacy of absorbable barbed sutures for midline fascia closure in minimally invasive surgery for colorectal and gastric cancers in comparison with conventional absorbable monofilament sutures.MethodsA total of 312 patients who underwent minimally invasive surgery for colorectal and gastric cancers will be randomly allocated to either the absorbable barbed or monofilament suture group for abdominal fascia closure in a 1:1 ratio. The primary outcome is incisional hernia rate within 3 years after surgery, as verified by physical examination and computed tomography. Postoperative complications, including surgical site infection, postoperative pain, and quality of life, will be compared between two groups as secondary outcomes. The investigator will examine the patients until discharge and at 6, 12, 18, 24, and 36 months postoperatively.DiscussionThis is the first randomized controlled trial to compare absorbable barbed sutures with monofilament sutures for midline fascia closure in minimally invasive surgery. If absorbable barbed sutures demonstrate superior results to those of monofilament sutures, this type of suture material may be recommended as an alternative option for abdominal fascia closure.Trial registrationKCT0007069. Registered on January 30, 2023

Close orthopedic surgery skin incision with combination of barbed sutures and running subcuticular suturing technique for less dermal tension concentration: a finite element analysis

BackgroundMechanical forces have an important role in the initiation and progression of orthopedic surgical incisions complications. To avoid incision complications with the reduction of dermal tension, surgeons may choose a buried continuous suture technique other than the traditional interrupted vertical mattress suture. Absorbable barbed sutures are widely used in orthopedics due to their convenience and reducing wound tension. The aim of this research is to compare and explain the advantages of running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure.MethodsFinite element models of layered skin and two different suture techniques, running subcuticular suture and intradermal buried vertical mattress suture, ware constructed. The mechanical property difference between standard sutures and barbed sutures was modelled using different contact friction coefficient. Pulling the skin wound was simulated, and the sutures’ pressure on the skin tissue was determined.ResultsCompared with traditional smooth sutures, the barbed sutures effectively increased the contact force for subepidermal layers, which led the less force variation between different layers. The results also suggested that subcuticular suture caused less stress concentration compared with intradermal buried vertical mattress suture.ConclusionsIn conclusion, our study indicated that running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure results in more uniform stress distribution in the dermis. We recommend this combination as the preferred method of skin closure in orthopedic surgery unless contraindicated.

V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE

You have accessJournal of UrologyCME1 Apr 2023V07-07 WIRE-GUIDED EXTRAVESICAL ROBOT-ASSISTED BLADDER DIVERTICULECTOMY AND Y-V PLASTY FOR RECURRENT BLADDER NECK STRICTURE Francesco Ditonno, Alessandro Veccia, Giovanni Novella, Lorenzo De Bon, Paola Irene Ornaghi, and Alessandro Antonelli Francesco DitonnoFrancesco Ditonno More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Giovanni NovellaGiovanni Novella More articles by this author , Lorenzo De BonLorenzo De Bon More articles by this author , Paola Irene OrnaghiPaola Irene Ornaghi More articles by this author , and Alessandro AntonelliAlessandro Antonelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To present the surgical technique for robot-assisted wire-guided extravesical bladder diverticulectomy and simultaneous Y-V plasty for recurrent bladder neck stricture. METHODS: A 58-year-old man referred to our center for recurrent LUTS after TURP. Thereafter, the patient underwent TUIP and 2 endoscopic bladder neck incisions, unsuccesfully. A CT scan showed two bladder diverticula of 4 and 8 cm located on the right and left postero-lateral wall, respectively. The patient was scheduled for robot-assisted bladder diverticulectomy and Y-V plasty for recurrent bladder neck stricture. As first step, a double J stent was placed bilaterally and a guidewire was inserted in the lumen of each diverticulum to facilitate their identification and handling. The robotic stage was performed with Da Vinci Xi platform, with the patient in supine position, with a 25 degrees Trendelemburg. Six ports were placed across the lower abdomen, transperitoneally: four 8 mm robotic trocars and 2 assistant trocars (12 and 5 mm). The peritoneum was incised to expose posterolateral bladder wall. Perivesical fat was dissected and protruding mucosa of the diverticula isolated. A blunt dissection was mostly used, detaching the mucosa from the bladder wall. Once completely isolated, bladder mucosa was entirely excised and the neck of the diverticulum closed with a triple-layer continuous 3-0 monofilament absorbable suture. Retzius space was then opened and prostatic defatting was performed. The bladder neck was incised obtaining a Y-shaped flap. Two stay 3-0 monofilament sutures were placed at the end of the two branches of the Y. The flap was advanced and the margins closed with a double-layer emicontinuous 3-0 barbed absorbable suture. RESULTS: Operative time was 318 min. Estimated blood loss was 200 mL. There were no perioperative or postoperative complications. A voiding cystourethrogram before catheter removal, after 12 days, showing almost complete resolution of diverticular protrusion. Ureteral stents were removed 30 days post-operatively. CONCLUSIONS: Robot-assisted extravesical diverticulectomy and simultaneous Y-V plasty of the bladder neck is a safe and feasible procedure. Endoscopic guide-wire insertion into the diverticulum allowed for easier traction and dissection of the tissues. Advantages of the procedure consist of avoidance of cystotomy, easy individuation and excision of diverticular mucosa and concomitant resolution of relapsing cervico-urethral obstruction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Ditonno More articles by this author Alessandro Veccia More articles by this author Giovanni Novella More articles by this author Lorenzo De Bon More articles by this author Paola Irene Ornaghi More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement PDF downloadLoading ...

8407 Interstitial Ectopic Pregnancy: A Case Series with Practical Tips for Surgical Management

<h3>Study Objective</h3> To review current treatment options for interstitial ectopic pregnancy (IP), with a focus on surgical treatments. To review outcomes of three surgically managed cases of IP. To demonstrate practical tips for success in laparoscopic management of IP. <h3>Design</h3> A case series presenting three cases of surgically managed IP with guided explanation of surgical intervention using video. <h3>Setting</h3> Academic affiliated community hospital. <h3>Patients or Participants</h3> The 3 cases of IP evaluated and treated over the past year were included in the study. <h3>Interventions</h3> Two patients underwent laparoscopic cornual resection of IP and one patient underwent emergent abdominal repair of ruptured IP. <h3>Measurements and Main Results</h3> Estimated blood loss (EBL) for laparoscopic management of 6-week IP with preoperative uterine artery embolization (UAE) was 20ml; length of post operative length of stay (LOS) was 1 day. EBL for 13-week IP without embolization was 50 ml, post op LOS was 0 days. EBL for ruptured IP repaired via open approach was 1000ml including hemoperitoneum, post operative LOS was 2 days. Beta hCG was trended once per week post operatively for all patients. Both patients undergoing laparoscopic resection had negative HCG by week 4. The patient with ruptured IP had negative hCG by week 8; however, she did not complete testing between week 5-7; at 4 weeks her hCG was 17. <h3>Conclusion</h3> IP is sometimes a difficult diagnosis to make; a high index of suspicion is necessary. Laparoscopic surgery for IP is achievable using similar techniques as laparoscopic myomectomy for limiting perioperative blood loss and repair of the myometrial defect; Ultrasonic scalpel, vasopressin, delayed absorbable barbed suture. IP can often be treated laparoscopically, however laparotomy may be necessary in unstable patients with advanced gestation. Further investigation is necessary to determine the best practice for surgical management of IP.

V-016 PARAHIATAL HERNIA: A RARE CASE OF DIAPHRAGMATIC HERNIA ROBOTICALLY REPAIRED

Abstract Aim Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair. We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures. Material and Methods A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use. Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement. Results The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged. At six months no recurrences were detected. Conclusions Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.

V-010 LAPAROSCOPIC TAPP APPROACH OF A GRYNFELLT HERNIA

Abstract Aim To describe our laparoscopic transabdominal preperitoneal approach of a Grynfellt hernia. Material &amp; Methods A female patient 69 years of age with no previous medical history came to our consultation with a chronic right lumbar bulge that produced local pain and discomfort. Preoperative CT scan showed a primary lumbar hernia with a defect estimated at 11cm. Laparoscopic approach seemed feasible and was accepted. Results The patient was placed on a left decubitus with the OR bed at a 45° angle. 3 trocars were used, one slightly lateral of the umbilicus for the camera, and for triangulation a subcostal 5mm and an 11mm trocar in the left flank. We started opening the peritoneum and performing preperitoneal space dissection. The hernia sac was identified and its contents were reduced. We closed the defect using a monofilament absorbable barbed suture with a running stitch. Once the defect was closed, we placed a medium-weight polypropylene mesh in a 3D “taco” configuration covering the defect with sufficient overlap. Both the mesh and the peritoneum closure were done using cyanoacrylate glue. No complications occurred and discharge was the next day. Conclusions Primary lumbar hernias are rare. Symptomatic hernias should be treated as they can lead to pain, discomfort, and a decrease in quality of life. Laparoscopic TAPP is a safe and simple way to access and repair these hernias, allowing an adequate space of dissection that permits the placement of a mesh tension-free with sufficient overlap, with a quick recovery time and minimal morbidity.

Extraperitoneal Laparoscopic Modified Y-V Plasty for the Treatment of Refractory Bladder Neck Contracture.

Bladder neck contracture (BNC) is a rare, late complication of transurethral resection of the prostate (TURP). Although the endoscopic procedure is the primary treatment for BNC, the recurrence rate remains high. Y-V plasty offers excellent surgical results for those individuals with refractory and recurrent BNC. Traditional open operations usually fail to provide satisfactory exposure to the operating field and lead to greater invasiveness. Interrupted sutures lead to prolonged operative time and increased anastomotic leakage. Laparoscopic modified Y-V plasty is performed through extraperitoneal access to the pelvis, which provides adequate exposure to the surgical view and avoids intra-abdominal injury. After incising the anterior bladder wall neck in a Y-shaped fashion, anastomosis is performed using two absorbable barbed sutures. The mucosa and submucosa layer of the bladder is closed to both sides with consecutive sutures in a V-shape before suturing serosa, and tunica muscularis are sutured to reinforce. The aforementioned procedures reduce leakage from the anastomosis and decrease operative time and patient trauma. Extraperitoneal laparoscopic modified Y-V plasty offers significant advantages over the open approach in terms of post-surgical recovery and invasiveness, making it a feasible and safe surgical option for patients with refractory BNC.

Modification of book-binding technique during totally laparoscopic distal gastrectomy with Billroth I reconstruction.

The book-binding technique (BBT) has been developed to minimise extra detachment and mobilisation of the duodenum for totally laparoscopic distal gastrectomy (TLDG) with Billroth I reconstruction. Because of the cost-effectiveness and maximisation of the anastomotic lumen, we have modified the BBT in collaboration with the laparoscopic hand-sewing technique. Herein, we introduce a modified BBT (MBBT) and discuss its outcomes. The MBBT was performed using laparoscopic hand-sewing techniques with an absorbable barbed suture instead of using linear staples to close the defect of the anterior wall of the anastomosis site. The data of 163 patients with gastric cancer who underwent TLDG with Billroth I reconstruction performed with MBBT were retrospectively collected between April 2014 and December 2019. The mean anastomosis time was 25 min (interquartile range, 21 - 30). Postoperative complications of Clavien-Dindo grade II or greater occurred in 20 of the 163 patients (12.3%). Anastomotic leakage occurred in three patients (1.8%), whereas anastomotic stenosis occurred in one patient (0.6%). The cumulative incidence rate of anastomotic stenosis that required endoscopic dilation at 1 year was 1.2%. The MBBT method may be safe, practical, cost-effective and results in reduced staple use and anastomotic time.

Alimentary tract obstruction attributed to use of barbed suture for double tract reconstruction after robot-assisted proximal gastrectomy: a case report

BackgroundAnastomotic stenosis following esophagojejunostomy reconstruction by the overlap method with absorbable barbed sutures occurs only rarely in patients who have undergone laparoscopic surgery. We report anastomotic stenosis by the overlap method that we attributed to the lack of tactile sensation during robot-assisted surgery.Case presentationAn 83-year-old man underwent robot-assisted laparoscopic proximal gastrectomy and lymph node dissection at our hospital for treatment of gastric cancer. Double tract reconstruction followed with side-to-side esophagojejunostomy (overlap method) performed with an endoscopic linear stapler. On completion of the anastomosis, the enterotomy was closed under robotic assistance with absorbable barbed suture. Once solid foods were introduced, the patient had difficulty swallowing and felt as though his digestive tract was stopped up. When upper gastrointestinal endoscopy was performed, we found the anastomotic lumen to be coated with food residue. After rinsing off the residue with water, we could see barbed suture protruding into the anastomotic lumen that had become entangled upon itself, which explained how the food residue had accumulated. We cut the entangled suture under endoscopic visualization using a loop cutter.ConclusionThis case highlights a stricture caused by insufficiently tensioning barbed suture, which subsequently protruded into the anastomotic lumen and became entangled upon itself. We believe this occurrence was associated with the lack of tactile sensation in robot-assisted surgery.

Comparison of absorbable barbed suture devices versus polyglactin 910 sutures in double-layer gastrotomy closure in A canine model

Objectives: To evaluate the safety and efficacy of a commercially available absorbable barbed suture device in double-layer gastrotomy closure in a dog model. Methods: In this experimental comparative study a gastrostomy was performed in 12 adult healthy mongrel dogs (divided into two groups A and B). The stomach was closed using polyglactin 910 (Vicryle, Ethicon) suture in group A and using absorbable barbed suture (Stratafex, Ethicon) in group B. Results: Polyglactin 910 suture produced a more inflammatory reaction around the wound which caused a delay in gastric wound healing and gastric motility as well as gastric emptying time. The ultrasonographic examination revealed a significant increase in gastric wall thickness in group A compared to group B and a highly significant decrease of gastric contraction in group A in comparison to group B. Gastric closure time was significantly shorter in group B than in group A. No postoperative complications or deaths were observed in both groups. Conclusion: Absorbable barbed suture was recommended in gastric surgery as it is minimizing the time of gastric closure and optimizing the healing of the wound with faster returning of the stomach to its normal function.

Two-Port Robotic Laparoscopic Hysterectomy

<h3>Study Objective</h3> To demonstrate a surgical video wherein a technique for port-reducing robot-assisted laparoscopic hysterectomy was performed with the use of a gel-capped multi-trocar port that accommodates necessary instruments to safely complete the procedure. <h3>Design</h3> Case report, step-by-step video describing a port-reducing robot-assisted laparoscopic hysterectomy with the gel-capped multi-trocar port. Institutional Review Board (IRB) approval was not required. <h3>Setting</h3> Tertiary referral medical center in New Haven, Connecticut. A 40-year-old female with symptomatic uterine leiomyoma who underwent failed medical management. She has completed her childbearing. Her body mass index was 41 kg/m². A pelvic sonogram showed a 10-centimeter uterus with a 10-centimeter fibroid. On examination, her uterus was mobile. <h3>Patients or Participants</h3> Singular patient who consented for this demonstration video. <h3>Interventions</h3> The patient underwent an uncomplicated robotically assisted total laparoscopic hysterectomy and bilateral salpingectomy. This was accomplished using a two-port technique. A multi-channel port system and a second robotic trocar were used. <h3>Measurements and Main Results</h3> Effective dissection of the adnexal structures and ligaments of the uterus was accomplished. Isolation, coagulation, and transection of blood vessels was optimally done with the vessel sealer. Despite the size of the uterus and leiomyoma, the specimen was completely removed transvaginally, without morcellation. Vaginal cuff closure was done with delayed absorbable barbed suture with ease. The three-centimeter fascial incision was re-approximated. There were no intra-operative complications. Estimated blood loss was 150 ml. She was discharged home on the same day. Her final histopathology was benign. <h3>Conclusion</h3> The two-port robotic hysterectomy with the gel-capped multi-channel laparoscopic port afforded the use of additional necessary laparoscopic instruments to safely complete the procedure while avoiding the usual three to five port incisions most gynecological surgeons use. This approach utilized the advantages of robotic laparoscopy: superior operative visualization, improved instrument mechanics and stabilization, and upgraded ergonomics for the surgeon. Our robotic hysterectomy technique is a feasible alternative for the appropriately selected patients.

Malar reshaping technique using bidirectional barb thread suspension procedure for 3-dimensional aging in Asian faces.

Background: Aging is a natural process that causes skin texture changes, facial volume loss, and altered 3-dimensional topography of the underlying tissues.Objective: The aim of this study is to assess the malar reshaping strategy in Asian patients using bidirectional suspension-barbed threads.Methods: A prospective interventional study was conducted on Asian patients presenting with mild-to-moderate facial aging who were treated with the Definisse double-needle thread in the Hong Kong Special Administrative Region. The primary endpoint was assessed using the Global Aesthetic Improvement Scale and scoring the benefit of anterior projection using a questionnaire. Patient safety was the secondary endpoint measured.Results: Twenty Asian patients (4 men [20%] and 16 women [80%]; age <45 to ≥45 years) were included in the study. The patients experienced marked improvement (score 2) in their appearance, except for the follow-up after 1 month. One month after the procedure, patients scored 1 for optimal cosmetic improvement in their looks. The nasolabial fold disappeared in all patients (n = 20 [100%]) and the face looked slimmer. Nine patients (45%) reported that the focus seemed centralized. Four patients (20%) reported prominence of the nose and chin. Redness, swelling, and bruising were the most common adverse events experienced by 75% of patients (n = 15), followed by pain (n = 6; 30%). All adverse events resolved within 4 weeks after their incidence. Because 80% of our patients were women, these positive cosmetic outcomes may be of interest across the aging female population.Conclusion: Overall, 3-dimensional facial rejuvenation with the Definisse thread seems to be an effective, safe, and minimally invasive office-based procedure to achieve immediate and long-term effects. These absorbable barbed sutures used in the malar reshaping technique can result in satisfactory esthetic enhancement of 3-dimensional aging, including sagginess, jowling, central facial heaviness, and tissue descent in female and male Asian patients.