Clip Application Research Articles

Transurethral Hem-o-lok Clip Ligation of the Distal Ureter in Retroperitoneal Laparoscopic Radical Nephroureterectomy

Background and Objective: Distal ureter management is an essential part of radical nephroureterectomy (RNU). However, there is no agreement on the optimal surgical treatment for ureter and bladder cuff excision. The classical “pluck” technique following transurethral resection of the intramural ureter increases the risk of extravesical and intravesical tumor cell spillage. We aimed to provide a simple transurethral technique with the Hem-o-lok clip ligation for the management of the distal ureter during retroperitoneal laparoscopic RNU. Methods: Transurethral resection of the bladder cuff was performed using a bipolar β electrode mounted on resectoscope. Subsequently, a Super Scope (S-scope) with a 5.6-mm diameter working channel was used with a clip applier to deliver the 5-mm Hem-o-lok clips, which consequently ligated the ureteral stump and avoided urine spillage from the upper tract. Traditional retroperitoneal laparoscopic surgery was used to treat the renal and upper ureter. The resected distal ureter and the Hem-o-lok clip were gently pulled out of the bladder by the “pluck” technique. Results: A total of 14 upper tract urothelial carcinoma patients were analyzed, including 10 men and 4 women. The Hem-o-lok clip ligation took less than 20 s. In each patient, the clip was clearly visible and attached tightly to the ureter, and a clear distal ureter was observed in all patients. Histopathology results showed pT2 in 8 and pT3 in 6 patients. A median follow-up of 15 months revealed no extravesicular or intravesicular recurrences. Conclusions: Transurethral Hem-o-lok clip ligation technique provides a simple and safe option for distal ureter management in retroperitoneal laparoscopic RNU. This novel approach enables construction of a watertight system of the upper urinary tract, preventing the spread of tumor cells effectively and minimizing local tumor implantation risk.

The Application of Clip in Short Videos - Take 5 Short Videos as an Example

The article describes five different short films and their editing techniques. Film 1 focuses on appearance anxiety of young women caused by external influences. The authors use black and white filming and sound montage to add a humorous effect. Film 2 shows the shadow of desire through a transfer student who turns to the dark side and uses flashbacks and j-cuts to add depth and intrigue to the story. Film 3 tells the story of a college student who receives an F on her transcript and uses flashbacks and internal monologues to reveal the cause and effect of the story. Film 4 is about a little girls day in high school and uses long shots, jump cuts, montage, and empty scenes to tell a story of loneliness and the importance of facing life. Film 5 is a story about family affection and uses continuous editing and montage to create an immersive cinematic narrative.

Evaluation of the mechanical properties and clinical application of nickel-titanium shape memory alloy anal fistula clip.

The study investigates the mechanical properties of a nickel-titanium shape memory alloy anal fistula clip (NiTi-AFC), studies the surgical method of treating anal fistula, and evaluates its clinical efficacy. The anal fistula clip was formed in nickel-titanium alloy with a titanium content of 50.0%-51.8%. The mechanical properties and chemical properties were tested. A total of 31 patients with anal fistula were enrolled between 1 January 2020 and 1 January 2023. All patients underwent internal orifice closure surgery using NiTi-AFC, and anorectal magnetic resonance or ultrasound was performed before surgery and 6 months after surgery for diagnosis and evaluation. Fistula cure rates, length of stay, perianal pain, and Wexner incontinence scores were retrospectively compared between patients treated with NiTi-AFC and patients treated with other surgical methods. NiTi-AFC has a density of 6.44-6.50 g·cm-3, with a shape-restoring force of 63.8 N. The corrosion rate of NiTi-AFC in 0.05% hydrochloric acid solution at atmospheric pressure and 20°C is approximately 6.8 × 10-5 g·(m·h)-1. A total of 31 patients (male/female: 19/12, age: 43.7 ± 17.8 years) were included. Among them, 22.6% (7) had multiple anal fistula, 16.1% (5) had high anal fistula, and 48.3% (15) had perianal fistula Crohn's disease. In total, 12.9% (4/31) did not achieve primary healing, underwent fistula resection, and eventually recovered. A retrospective analysis showed that the fistula healing rate, length of stay, and anal pain of NiTi-AFC treatment were similar to those of other traditional surgeries, but the Wexner incontinence score was significantly lower. NiTi-AFC has shape memory properties, corrosion resistance, superelastic effect, and surface cell adhesion. It is applied to internal orifice closure surgery of anal fistula, with good therapeutic effect, and can protect the anal function.

Expert laparoscopist performance on virtual reality simulation tasks with and without haptic features.

Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback's effect on skill development. Our objective is to compare expert laparoscopists' skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces. Five expert laparoscopists performed seven skills tasks on two laparoscopic simulators, one with and one without haptic features. Tasks consisted of 2-handed instrument navigation, retraction and exposure, cutting, electrosurgery, and complicated object positioning. Laparoscopists alternated platforms at default difficulty settings. Metrics included time, economy of movement, completed task elements, and errors. Progressive change in performance for the final three iterations were determined by repeated measures ANOVA. Iteration quartile means were determined and compared using paired t-tests. No change in performance was noted in the last three iterations for any metric. There were no significant differences between platforms on the final two quartiles for most metrics except avoidance of over-stretch error for retraction; and cutting task was significantly better with haptics on all iteration quartiles (p < 0.03). Economy of movement was significantly better with haptics for both hands for clip application (p < 0.01) and better for right hand on complex object positioning (p < 0.05). Accuracy was better with haptics for retraction and cutting (p < 0.05) and clip application (p < 0.05). Results showed higher performance in accuracy, efficient instrument motion, and avoidance of excessive traction force on selected tasks performed on VR simulator with haptic feedback compared to those performed without haptics feedback. Laparoscopic surgeons interpreted machine-generated haptic cues appropriately and resulted in better performance with VR task requirements. However, our results do not demonstrate an advantage in skills acquisition, which requires additional study.

Safety and Feasibility of Cholecystectomy with the HugoTM RAS: Proof of Setup Guides and First-In-Human German Experience

Introduction: The Hugo RAS robotic platform by Medtronic was recently certified for human use in Europe. Several centers have gained initial experience with this system in urology and gynecology. However, few data about its feasibility and safety in general surgery have been published. Methods: The first-in-human surgical procedures with the Hugo RAS in Germany were performed at our hospital in February 2023. We report our early experience with robotic cholecystectomy using this new platform. The primary aim was to test the setup guides of the manufacturer and to evaluate the safety and feasibility of Hugo RAS for this procedure. Results: A modified setup with two 11-mm ports and two 8-mm ports without an assistant port was used in 14 consecutive cases. A 30° or a 0° camera, a bipolar grasper or a Maryland on the left arm, a monopolar scissors on the right arm, and a double-fenestrated grasper on the additional arm were mounted. Clip application and gallbladder extraction were performed by the bedside assistant through the right arm 11-mm port. There were no complications, no adverse events, and no conversions. Arm collisions were reduced through slight corrections in trocar positions. Conclusion: Robotic-assisted cholecystectomy with the Hugo RAS was safe and feasible. The modularity of robotic arms allows individual setup modifications which may be of advantage for patients and surgeons.

Optimising Two-Stage Vacuum Heat Treatment for a High-Strength Micro-Alloyed Steel in Railway Spring Clip Application: Impact on Microstructure and Mechanical Performance.

The heat treatment process is a vital step for manufacturing high-speed railway spring fasteners. In this study, orthogonal experiments were carried out to obtain reliable optimised heat treatment parameters through a streamlined number of experiments. Results revealed that a better comprehensive mechanical performance could be obtained under the following combination of heat treatment parameters: quenching temperature of 850 °C, holding time of 35 min, medium of 12% polyalkylene glycol (PAG) aqueous solution, tempering temperature of 460 °C, and holding time of 60 min. As one of the most important testing criteria, fatigue performance would be improved with increasing strength. Additionally, a high ratio of martensite to ferrite is proven to improve the fatigue limit more significantly. After this heat treatment process, the metallographic microstructure and mechanical properties satisfy the technical requirements for the high-speed railway practical operation. These findings provide a valuable reference for the practical forming process of spring fasteners.

Bipolar Cautery in Aneurysms: Effective but Underutilised Technique

ABSTRACT Background: Bipolar cautery for aneurysms is an effective technique, described in the literature about 50 years back by Yasargil, however, there is an inadequacy of articles highlighting the technique. Materials and Methods: Operative videos of aneurysm surgeries were analysed to select the videos/photographs which can help readers to understand the technical nuances of using bipolar cautery during aneurysm surgeries. Cautery was used after the completion of sharp dissection around the neck and demarcation of proximal and distal vessels in non-giant aneurysms. Cautery setting was kept around 10%–20% of the maximum. Blunt tip forceps were used with continuous irrigation. A shaft instead of the tip of the cautery was used. Results: Bipolar cautery resulted in the shrinkage of the wall of the aneurysm. It had a similar effect on the neck, fundus or transition zone between the neck and fundus. It helped in controlling the bleeding from the fundus even during intraoperative rupture of the aneurysms. Even the flimsy wall of the fundus shrunk, which prevented their rupture during dissection. It was very useful to make giant aneurysm fundus shrink to a smaller size providing space for dissection. The wide neck could be modified to a desirable shape for easier clip applications. Conclusion: Fear of intraoperative rupture by cautery appears misconceived. It causes shrinkage of the wall of the aneurysm, can stop bleeding from the fundus and can change the shape of the neck fundus, which helps clipping the aneurysms easily.

Management of brain aneurysm neck-avulsion during clipping surgery

Background. Intra-operative rupture (IOR) of intracranial aneurysms is a critical event affecting the operation course and the patient’s outcome. However, A rupture induced by an avulsion in the aneurysmal neck is exceedingly challenging, as sealing the neck tear by clip application might result in ischemic injury due to parent vessel occlusion. Here we reviewed the literature regarding the intraoperative avulsion of the aneurysmal neck with an illustrative case to provide explanations of its surgical management intricacies. Methods. A Midline PubMed literature review was performed using the following keywords; (Aneurysm) AND (neck) AND (surgery or clipping) AND (tear OR avulsion). Fifty-three results were found initially. After excluding non-human subject studies, and non-English studies, two independent researchers examined the title and the abstract for the cases of neck tear or avulsion with its management. Results. Fourteen articles were found to be included in this study. The average age of the cases is around 57 years. The percentages of females in the review were 62% (8/13), and among the males, 38% (5/13). Regarding the locations, PcomA and AcomA were both 23% (3/13) of the cases; other locations include ACA, 15%, and MCA, 15%. The surgical techniques that opted from the literature include the cotton clip method, clip wrapping, parallel clipping and micro-suturing Conclusion. IOR due to aneurysmal neck avulsion is a devastating surgical complication, and its management may differ according to the extent of the rupture. Choosing the most convenient technique depends on the surgeon’s knowledge and experience.

A synthetic model simulator for intracranial aneurysm clipping: validation of the UpSurgeOn AneurysmBox.

In recent decades, the rise of endovascular management of aneurysms has led to a significant decline in operative training for surgical aneurysm clipping. Simulation has the potential to bridge this gap and benchtop synthetic simulators aim to combine the best of both anatomical realism and haptic feedback. The aim of this study was to validate a synthetic benchtop simulator for aneurysm clipping (AneurysmBox, UpSurgeOn). Expert and novice surgeons from multiple neurosurgical centres were asked to clip a terminal internal carotid artery aneurysm using the AneurysmBox. Face and content validity were evaluated using Likert scales by asking experts to complete a post-task questionnaire. Construct validity was evaluated by comparing expert and novice performance using the modified Objective Structured Assessment of Technical Skills (mOSATS), developing a curriculum-derived assessment of Specific Technical Skills (STS), and measuring the forces exerted using a force-sensitive glove. Ten experts and eighteen novices completed the task. Most experts agreed that the brain looked realistic (8/10), but far fewer agreed that the brain felt realistic (2/10). Half the expert participants (5/10) agreed that the aneurysm clip application task was realistic. When compared to novices, experts had a significantly higher median mOSATS (27 vs. 14.5; p < 0.01) and STS score (18 vs. 9; p < 0.01); the STS score was strongly correlated with the previously validated mOSATS score (p < 0.01). Overall, there was a trend towards experts exerting a lower median force than novices, however, these differences were not statistically significant (3.8 N vs. 4.0 N; p = 0.77). Suggested improvements for the model included reduced stiffness and the addition of cerebrospinal fluid (CSF) and arachnoid mater. At present, the AneurysmBox has equivocal face and content validity, and future versions may benefit from materials that allow for improved haptic feedback. Nonetheless, it has good construct validity, suggesting it is a promising adjunct to training.

Effectiveness of fluorescence-guided methods using near-infrared fluorescent clips of robotic colorectal surgery: a case report

BackgroundThis is the first report on the application of the Da Vinci-compatible near-infrared fluorescent clips (NIRFCs) as tumor markers to localize colorectal cancer lesions during robotic surgery. In laparoscopic and robotic colorectal surgeries, the accuracy of tumor marking is a critical issue that remains unresolved. This study aimed to determine the accuracy of NIRFCs in localizing tumors for intestinal resection. Indocyanine green (ICG) was also used to verify the feasibility of safely performing an anastomosis.Case presentationA patient diagnosed with rectal cancer was scheduled to undergo a robot-assisted high anterior resection. During colonoscopy 1 day prior to the surgery, four Da Vinci-compatible NIRFCs were placed intraluminally 90° around the lesion. The locations of the Da Vinci-compatible NIRFCs were confirmed using firefly technology, and ICG staining was performed before cutting the oral side of the tumor. The locations of the Da Vinci-compatible NIRFCs and the intestinal resection line were confirmed. Moreover, sufficient margins were obtained.ConclusionsIn robotic colorectal surgery, fluorescence guidance with firefly technology offers two advantages. First, it has an oncological advantage, because marking with the Da Vinci-compatible NIRFCs allows for real-time monitoring of the lesion location. This enables sufficient intestinal resection by grasping the lesion precisely. Second, it reduces the risk of postoperative complications, because ICG evaluation with firefly technology prevents postoperative anastomotic leakage. Fluorescence guidance in robot-assisted surgery is useful. In the future, the application of this technique should be evaluated for lower rectal cancer.

Endoscope-assisted microsurgical clipping and reduction of post-clipping cerebral infarction: historical comparison using diffusion-weighted images

Endoscopic assistance for aneurysm clipping and its possible benefits have been suggested in previous studies, but its clinical significance has not been fully elucidated. This study aimed to present the efficacy of endoscopy-assisted clipping in reducing post-clipping cerebral infarction (PCI) and clinical outcomes via a historical comparison of patients in our institution from January 2020 to March 2022. A total of 348 patients were included, 189 of whom underwent endoscope-assisted clipping. The overall incidence of PCI was 10.9% (n = 38); it was 15.7% (n = 25) before applying endoscopic assistance and decreased to 6.9% (n = 13) after endoscope application (p = 0.010). The application of a temporary clip (odds ratio [OR]: 2.673, 95% confidence interval [CI]: 1.291-5.536), history of hypertension (OR: 2.176, 95% CI: 0.897-5.279), history of diabetes mellitus (OR: 2.530, 95% CI: 1.079-5.932), and current smoker (OR: 3.553, 95% CI: 1.288-9.802) were independent risk factors of PCI, whereas endoscopic assistance was an independent inverse risk factor (OR: 0.387, 95% CI: 0.182-0.823). Compared to the location of the unruptured intracranial aneurysms, internal carotid artery aneurysms showed a significant decrease in the incidence of PCI (5.8% vs. 22.9%, p = 0.019). In terms of clinical outcomes, PCI was a significant risk factor for longer admission duration, intensive care unit stay, and poor clinical outcomes. However, endoscopic assistance itself was not a significant risk factor for clinical outcomes on the 45-day modified Rankin Scale. In this study, we noted the clinical significance of endoscope-assisted clipping in preventing PCI. These findings could reduce the incidence of PCI and improve the understanding of its mechanisms of action. However, a larger and longer-term study is required to evaluate the benefits of endoscopy on clinical outcomes.

Complementary role of Indocyanine green video angiography, dual-image video angiography and flow-800

Background Visualization of cerebral vessels, their branches and the surrounding structures are essential during cerebrovascular surgery. Indocyanine green dye-based video angiography is a commonly used technique in cerebrovascular surgery. This paper aims to analyze the real-time imaging of ICG-AG, DIVA, and the use of ICG-VA with Flow 800 to compare their usefulness in surgery. Methods Intraoperative real-time identification of vascular and surrounding structures in twenty nine anterior circulation aneurysms and three posterior circulation aneurysm clipping, one STA-MCA bypass, and two carotid endarterectomies were performed in patients using ICG-VA alone, DIVA, ICG-VA with Flow 800 to analyze and compare each of these methods in details. Results ICG-VA and DIVA couldn’t visualize perforators in twenty-three cases of cerebral aneurysms clipping when used alone. Compared to that by adding Flow 800 perforators were easily visualized. In three cases, occlusion of perforators after clip application was visualized by DIVA and solved by repositioning surgical clips. In one STA-MCA bypass surgery, adequate blood flow to cortical branches of MCA (M4) from STA branches was assessed with ICG-VA, DIVA, and the use of ICG-VA with Flow 800 color mapping. ICG-VA, DIVA, and Flow 800 observed the lack of blood flow and fluttering atherosclerotic plaques in carotid endarterectomy. In one case of basilar tip aneurysm, we used ICG-VA with Flow 800; the intensity diagram drawn after determining regions of interest showed that there was no flow within the aneurysm sac after clipping. Conclusion In real-time surgery, a multimodal approach using ICG-VA, DIVA, and ICG-VA with Flow 800 colour mapping can serve as useful tools for better visualization of vascular and surrounding structures. The benefits of flow 800 color mapping, such as determining regions of interest, intensity diagrams, and color-coded images, outweigh the advantages over the ICG-VA and DIVA in the visualization of critical vascular anatomy in humans during surgical procedures.

Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids.

Ear keloids are disfiguring disorders resistant to various treatments. The authors aimed to assess the efficacy of surgical treatment of ear keloids in a Chinese population using a tongue flap with electron beam radiotherapy. The authors conducted a retrospective analysis of 41 patients treated at the Affiliated Hospital of Nantong University between January 2018 and May 2021. Core excision with a tongue flap was performed, followed by 3 days of electron beam radiotherapy and 3 to 6 months of pressure clip application. The Vancouver Scar Scale (VSS) and the Visual Analog Scale (VAS) were used to assess the results. The mean age of the patients was 28.10 years (9-61 years). Postoperative follow-up ranged from 5 to 32 months (mean:12.07). The patients underwent 3 days of postoperative radiotherapy followed by pressure clips for 2 to 6 months. Thirty-seven patients had no recurrence, whereas 4 had a mild recurrence (<3 mm in height) with redness and itchiness. The VSS and VASscores significantly decreased. (p < .05). Excision with a tongue flap and radiotherapy can be used as the primary treatment for ear keloids considering the good outcome and long-term management.

How I do it: neuromonitoring-guided clipping of high-riding basilar tip aneurysm.

Clipping of basilar tip aneurysms presents unique challenges due to the risk of perforator compromise and subsequent disabling stroke. Herein, we describe the correct trajectory of the clip applier to clip basilar tip aneurysms through an orbitozygomatic approach to prevent perforator injury and discuss management of intraoperative neuromonitoring changes. We anticipate that this video and illustration will aid surgeons as they treat complex wide-necked basilar tip aneurysms with microsurgical clipping.

A Comparative Study between Metal Clip Application and Suture Ligation of Cystic Duct in Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy has been performed for decades and is a fairly standardized procedure throughout the world. Occlusion of the cystic duct is popularly done with the help of metal clips. There are many other techniques described in the literature to deal with occlusion of the Cystic Duct. Suture ligation of the duct is one such way.To evaluate the effectiveness in term of cost, safety, and complication in occlusion of cystic duct with suture ligation compared to clip application. Materials and Methods: A prospective cross sectional comparative study was carried out From June 2020 to November 2020. Data were collected from 80 patients undergone laparoscopic cholecystectomy for Gall stone diseases. 40 patients were enrolled in each group by consecutive purposive sampling. Complete history was taken. Thorough clinical examination was done. Relevant investigations report was collected. Results: Female patients were predominant in both groups and most of the patients were underweight. Mean time for ligation was more in occlusion of cystic duct with clip application. Bile leakage was found and duration of drain in situ was more in occlusion with clip application. Cost was high in occlusion with clip application. Conclusion: : Time for ligation, Bile leakage, mean duration of drain in situ (days), and cost of Cystic Duct occlusion and port closure were significantly higher in Laparoscopic Cholecystectomy with conventional Clip application of Cystic Duct group in comparison to Laparoscopic Cholecystectomy with ligation of the Cystic duct with no-1vicryl by extra corporeal knotting group. Medicine Today 2023 Vol.35(1): 27-30

The carbon footprint of products used in five common surgical operations: identifying contributing products and processes.

Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots). A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England. The carbon footprint inventory was based on direct observation of 6-10 operations/type, conducted across three sites within one NHS Foundation Trust in England. Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 - January 2020). We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes. The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%. Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%-42%.

Gastric Staple Line Reinforcement With Ligation Clips for Hemostasis in Laparoscopic Sleeve Gastrectomy.

In Pakistan and worldwide, there is a lack of literature on the role of ligation clips in controlling hemostasis in laparoscopic sleeve gastrectomy. ligation clips are being used to secure hemostasis and act as staple line reinforcement to prevent intra-operative and postoperative bleeding. Data can be utilized to reflect the role of staple line reinforcement with ligation clips so as to guide surgeons about its safety and efficacy. This retrospective observational study was conducted at the Shalamar Hospital, Lahore, Pakistan, and included 120 patients. The patients' demographic parameters, BMI, intra-operative and postoperative bleeding in terms of hematemesis, melena, and fall in hemoglobin (Hb) postoperatively were compared to preoperative Hb and recorded. One hundred and twenty cases of laparoscopic sleeve gastrectomy (LSG) were included with a mean age of 44.77±12.05 years. The mean BMI was 52.06±13.85 preoperatively. The mean drop in hemoglobin was 0.04±0.26 with a p-value of 0.07, which is statistically insignificant. Among 120 cases, two (1.7%) patients reported episodes of melena, and four (3.3%) patients reported hematemesis. Postoperative hypotension was recorded in six (5%) patients and eight (6.7%) patients had postoperative tachycardia. This study shows ligation clip application along the staple line is an effective means of hemostasis similar to suture application.

Animal model of contusion compression spinal cord injury by Yasargil aneurysm clip

Background: Animal spinal cord injury (SCI) models have shown to be invaluable in better understanding the mechanisms related to traumatic SCI and evaluating the effectiveness of experimental therapeutic interventions. The use of clip compression can produce contusion–compression SCI models in rats with clinical features in the form of total paralysis, retention of micturition, and retention of defecation. This study aimed to validate the effects of the duration of Yasargil aneurysm clip application on the formation of SCI models with analyzed neuropathic pain, locomotor function, histology, and tumor necrosis factor (TNF-α). Methods: We did true experimental study investigated 20 Sprague Dawley divided into normal, 30-second, 60-second, and 90-second groups. Contusion–compression model of SCI post-laminectomy was done in 0, 30, 60, and 90 seconds using a Yasargil aneurysm clip, with a force of 65g (150kDyne). Data were analyzed using SPSS version 25 for Windows. Result: We found that the locomotor expression did not indicate total paralysis after compression durations of 0 and 30 seconds, while compression durations of 60 and 90 seconds could result in total paralysis. There was no significant difference in the mean BBB scores between the compression durations of 60 and 90 seconds (p=1.000). In addition, there was no significant difference in the mean RGS value between the 60-second model group and the 90-second model group on days 21 and 28 (p=1.000; p=0.900). The histological pictures at compression durations of 60 and 90 seconds show severe damage to spinal cord continuity. There was no significant difference in the mean value of TNF-α between the duration compressions of 60 and 90 seconds (p=0.937). Conclusion: The use of Yasargil aneurysm clips for 60 and 90 seconds could produce a contusion–compression SCI model with expressions of neuropathic pain, locomotor function, histology, and pro-inflammatory cytokine.

A PROSPECTIVE STUDY COMPARING THE OUTCOMES OF NASAL SEPTAL CLIP VERSUS MEROCEL APPLICATION AFTER NASAL SEPTAL CORRECTIVE SURGERY

Nasal splint application is an important step of septal corrective surgeries to keep the septum in midline after the surgery. Septal clip is most commonly used. In our study we have compared the use of nasal septal clip and Merocel application post surgery and the morbidities associated with it

Invited commentary: Mortality associated with the use of stapler devices and clip appliers: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience database

Invited commentary: Mortality associated with the use of stapler devices and clip appliers: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience database