Complete Sutures Research Articles

Impact of laparoscopic training course for surgical trainees based on an evidence-based pedagogical framework: randomized trial.

The 'Learn, See, Practice, Prove, Do, Maintain' (LSPPDM) pedagogical framework is an evidence-based framework developed through a careful review and synthesis of the literature. The purpose of the study was to explore the effectiveness and applicability of the LSPPDM pedagogical framework in the laparoscopic training course for surgical residents. Prospective study of surgical residents who underwent standardized surgical residency training in a single institution from December 2020 to December 2022. Trainees were randomized to either the pedagogical group (6-step LSPPDM pedagogical framework) or traditional group (2-step traditional approach with twice-weekly lectures and a weekly laparoscopic operating skills session). The Global Operative Assessment of Laparoscopic Skills scale was used for technical skills, and the Non-Technical Skills for Surgeons assessment form was used for non-technical skills. Sixty trainees were randomized. The pedagogical group scored higher on subjective perception (P < 0.050) and the theoretical assessment (mean(s.d.) 41.83(6.66)) than those in the traditional group (37.83(5.77)) (P = 0.016). Trainees in the pedagogical group took less time to complete the assessment of models, had fewer failures and higher scores, took less time to complete laparoscopic sutures and knots, showed better proficiency with laparoscopic instruments, and completed at higher quality (P < 0.050). Trainees performing laparoscopic cholecystectomy in animal models demonstrated higher technical and non-technical skill scores in the pedagogical group (P < 0.050). 'Tissue handling' and 'Decision making' were common areas for improvement for both groups of trainees. The LSPPDM pedagogical framework is feasible and demonstrated improvements in technical and non-technical skills in surgical trainees compared to a traditional training programme.

Utilizing Grasp Monitoring to Predict Microsurgical Expertise

IntroductionMost microsurgical procedures require the surgeon to use tools to grasp and hold fragile objects in the surgical site. Prior research on grasping in surgery has mostly either been in other surgical techniques or used grasping as an auxiliary metric. We focus on microsurgery and investigate what grasping can tell about microsurgical skill and suturing performance. This study lays groundwork for using automatic detection of grasps to evaluate surgical skill. MethodsFive expert surgeons and six novices completed sutures on a microsurgical training board. Video recordings of the performance were annotated for the number of grasps, while an eye tracker recorded the participants’ pupil dilations for cognitive workload assessment. Performance was measured with suturing duration and the University of Western Ontario Microsurgical Skills Assessment instrument (UWOMSA). Differences in skill, suturing performance and cognitive workload were compared with grasping behavior. ResultsNovices needed significantly more grasps to complete sutures and failed to grasp more often than the experts. The number of grasps affected the suturing duration more in novices. Decreasing suturing efficiency as measured by UWOMSA instrument was associated with increase in grasps, even when we controlled for overall skill differences. Novices displayed larger pupil dilations when averaged over a sufficiently large sample, and the difference increased after the grasp. ConclusionsGrasping action during microsurgical procedures can be used as a conceptually simple yet objective proxy in microsurgical performance assessment. If the grasps could be detected automatically, they could be used to aid in computational evaluation of surgical trainees’ performance.

A new species and a new record of the genus Otostigmus Porat, 1876 (Chilopoda: Scolopendromorpha: Scolopendridae) in Vietnam.

Otostigmus consonensis sp. nov. was described from Vietnam, and O. sulcipes Verhoeff, 1937 was recorded for the first time in this country. The new species can be recognized by having 18 antennomeres including 2.32.5 glabrous basal ones, three coxosternal teeth, tergites 520 with complete paramedia sutures, sternites with incomplete paramedian sutures, and the ultimate leg with 1115 prefemoral spines. The fragment of the COI gene was extracted for each species; thus, a new species and a record of O. sulcipes were supported by the COI genetic distances and the corresponding phylogenetic analysis.

New Genus and Two New Species of Semiterrestrial Crabs (Decapoda: Brachyura: Gecarcinucidae) from the Southern Western Ghats, India.

One new genus and two new species of semiterrestrial freshwater crabs are described from the Southern Western Ghats mountain range in India: Pavizham gavi gen., sp. nov. and Rajathelphusa brunnea sp. nov. The carapace of Pavizham n. gen. is superficially similar to Baratha and Snaha described from the same region, but it can be distinguished from Baratha in having no visible postorbital cristae, complete sutures between male thoracic sternites 2 and 3, the possession of a triangular male pleon and the elongate terminal segment of the male first gonopod; and from Snaha by the presence of a long flagellum on the exopod of the third maxilliped, a complete suture separating male thoracic sternites 2 and 3, and its triangular male pleon. Rajathelphusa brunnea sp. nov. can easily be distinguished from congeners in possessing a distinctly more slender and elongate male first gonopod.

Scolopocryptops longipes sp. nov., a troglobitic scolopocryptopine centipede (Chilopoda: Scolopendromorpha: Scolopocryptopidae) from China.

We describe Scolopocryptops longipes sp. nov., a new troglobitic scolopocryptopine centipede species from a karstic area in southern China. The species was found in Shuiba Cave of Libo County, Guizhou Province. The cephalic plate wider than long, with complete margination along the lateral margin of cephalic plate; TT619 with complete paramedian sutures; tibia, tarsus 1 and tarsus 2 of leg 22 each with one spur; prefemur and femur of ultimate legs glabrous, tibia and tarsi with dense bristles. S. longipes is the second troglobitic scolopocryptopine in China and the fourth in the world described thus far.

Otostigmus (Otostigmus) xizangensis n. sp., from China and a case of sexual dimorphism in the subgenus Otostigmus (Otostigmus) Porat, 1876 (Chilopoda, Scolopendromorpha, Scolopendridae).

Otostigmus (Otostigmus) xizangensis n. sp., a new species of subgenus Otostigmus Porat, 1876 from Xizang, China, is described and illustrated. The new species is diagnosed as follows: antennae 1719 articles (mainly 19), basal antennal articles cylindrical; forcipular tooth-plate with 4 teeth; tergites (5) 620 with complete paramedian sutures; well-developed lateral margination on tergites (6) 921; ultimate leg prefemora with four rows of spines, leg 20 with one tarsal spur. The coxopleural process of O. (O.) xizangensis n. sp. exhibits remarkable sexual dimorphism, being long and curved in females, short and straight in males.

Incidence of persistent metopic suture in Australia: findings from 1034 three-dimensional computed tomography scans.

To investigate the incidence of persistent, open metopic sutures in contemporary Australians aged 24months and older. Metopic suture evaluation was conducted on retrospective cranial/cervical computed tomography scans of patients aged 24 to 252months who presented to the Women's and Children's Hospital in Adelaide, Australia, between 2010 and 2020. Suture ossification was graded according to Lottering scoring system based on 4 stages, on three-dimensional volume-rendered reconstructions (stage 1: fibrous tissue interface, stage 2: commenced fusion, stage 3: complete fusion and stage 4: obliterated suture). The complete persistent sutures were classified as stage 1. Partially closed sutures were classified into stages 2 and 3, while completely closed sutures were defined as stage 4. One thousand thirty-four patients (61.2% male and 38.8% female) were included, with a mean age at scan of 66months. More than half of patients were subject to scanning due to closed-head injuries. The incidence of persistent (completely open) metopic suture was 4.8% (2.3% in males and 2.5% in females). In comparison, a partially closed metopic suture was found in 6.3% of the study cohort, with the remaining sutures located along the metopic suture line, at the glabella, mid-part of the suture, bregma and glabella-bregma areas. The prevalence of persistent metopic sutures in our study of the Australian population is 4.8%, and it is equally distributed between the genders. The pattern of suture closure can commence from any location along the suture line, which is in contrast to the existing literature.

English

BACKGROUND Metopic suture is located anterior to the coronal suture. There are two types: complete and incomplete metopic sutures. Knowledge regarding the metopic sutures in adults is necessary to avoid misinterpretation of radiographs as frontal bone fracture. Knowledge with regard to metopic suture is helpful for anatomists and medico legal experts. This study has been done to find out the incidence of metopic suture, classify the metopic sutures into complete and incomplete type and further classify the incomplete variety based on shape. METHODS This study was conducted on 50 skulls from the Department of Anatomy, Autonomous Government Medical College and Hospital, Ratlam (MP). Skulls with signs of disease and damaged skulls were excluded from the study. RESULTS In the present study, out of 50 dry adult cadaveric skulls, 2 skulls (4 %) showed complete metopism. Incomplete metopic sutures were present in 28 / 50 (56 %) and absent in 20 / 50 (40 %). Out of 28 incomplete metopic sutures, single linear metopic sutures were present in 12 / 28 (42.85 %). Double linear metopic sutures were present in 7 / 28 (25 %). V-shaped metopic sutures were present in 5 / 28 (17.85 %) and U shaped metopic sutures were present in 4 / 28 (14.28 %). CONCLUSIONS Detailed knowledge of the metopic suture is important for neurosurgeons and radiologists in routine practice. Vertical frontal bone fractures may be easily misdiagnosed with persistent metopic sutures. This anatomical knowledge of metopic sutures is very useful for doctors while treating traumatised patients and during surgical intervention including frontal craniotomy. KEYWORDS Suture, Metopism, Frontal Bone, Nasion, Bregma

Displacement and stress distribution of the maxilla under different surgical conditions in three typical models with bone-borne distraction: athree-dimensional finite element analysis.

The present study compared the skeletal effects of surgically assisted rapid maxillary expansion (SARME) with different surgeries in three representative finite element (FE) models. According to the ossification level of midpalatal suture, three FE models, with different elasticity moduli of sutures (E = 1 MPa, 500 MPa, and 13,700 MPa) were constructed, to represent three age groups of patients. Within each model, four groups were set up according to different surgeries: groupI (control group without surgery), II (paramedian osteotomy), III (pterygomaxillary separation), and IV (paramedian osteotomy and pterygomaxillary separation). An expansion force of 100 N and 1mm displacement were applied via abone-borne distraction to simulate the expansion process. By analyzing these models, the maximum displacement of maxilla was observed in groupIV, with E = 1 MPa model exhibiting the most displacement (28.5 × 10-6 mm), followed by groupII (21.4 × 10-6 mm). GroupIV showed aunique backward-downward rotation with minimum stress distributions in three models (9 MPa, 131 MPa, and 140 MPa, respectively), and groupII exhibited comparable low stress distributions (12 MPa, 151 MPa, and 230 MPa, respectively). Lowest stress was found in E = 1 MPa model, compared with the other two models. There is no need to perform surgeries when the midpalatal suture is open, and surgery guidelines are the same for partial and complete fusion sutures. Furthermore, exclusive use of partial paramedian osteotomy is sufficient enough to reduce stress and expand the posterior part of maxilla, and it is less invasive.

Cuantificación de la variabilidad entre progenies de tacaco (Sechium tacaco)

The variation in the morphological characteristics of fruits from two tacaco [Sechium tacaco (Pittier) C. Jeffrey] progenies was measured with referent to fruits of the original plant. The study was developed in Costa Rica. Ten quantitative variables were evaluated. There were statistically significant differences between fruits of the original plant and those of at least one of its two progenies for the following fruit variables: weight, length, width, number of incomplete longitudinal sutures, number of spines, length/width ratio, and width/thickness ratio. Conversely, there were no significant differences for fruit thickness, number of complete longitudinal fruit sutures, and fruit length/thickness ratio. This investigation provides the first known report in the literature regarding morphological variability in fruits of progenies of tacaco. These results yield evidence of the gene flowmagnitude in this species.

Hemangiossarcoma primário intrauterino em um macaco aranha de cara vermelha (Ateles paniscus)

Hemangiosarcoma is a common neoplasm in dogs and less frequently seen in cats. In nonhuman primates, this tumor is rarely reported. A 17 year-old female spider monkey ( Ateles paniscus) was submitted an ultrasound exam due to gestation suspicion, which was seen a circular mass intra-uterine measuring 1.3 cm. New exams shown increase of the mass to 4.4 x 3.0 cm associated with a viable fetus. Was realized cesarean with ovariohysterectomy and excision of the mass; however the animal died in less than 24 hours after the surgery. In the necropsy, severe hemoabdomen was evidenced, although the surgical stumps were properly ligated and the complete sutures. Macroscopically, the uterine mass was soft, dark heterogeneous and measuring 5.0 cm in diameter. Histologically was visualized proliferation of spindle cells that form vascular channels replete of erythrocytes a nd some with thrombus, marked pleomorphism, nucleolus evident, binucleated cells and mitotic figures were rare. The immunohistochemistry (IHC) was performed, using streptavidin-biotin peroxidase technique (Dako Cytomation, USA) with the use of antibodies CD31 (clone JC/70A), CD34 (clone QB-END/10). The IHC showed a specific antigen-antibody reaction for CD31. According to localization, morphology and IHC, the present study reports a primary uterine hemangiosarcoma in a spider monkey that caused hemostatic abnormalities and consequent death of the animal.

Caracterización de frutos de cinco genotipos de tacaco [Sechium tacaco (Pittier) C. Jeffrey] en Costa Rica

&lt;p&gt;Se caracterizaron los frutos de cinco genotipos de tacaco de alta calidad en Costa Rica, tanto a nivel cualitativo (tres variables) como cuantitativo (10 variables). Se presentaron diferencias estadísticamente significativas entre genotipos en el caso de las variables cuantitativas. Los datos muestran una amplia variabilidad en cuanto al peso del fruto (31,55 – 40,30 g), longitud del fruto (57,36 – 63,61 mm), ancho del fruto (39,72 – 41,57 mm), grosor del fruto (28,01 – 30,40 mm), número de suturas longitudinales completas del fruto (5,11 – 5,61), número de suturas longitudinales incompletas del fruto (0,22 – 1,61), número de espinas del fruto (0 – 22,36), relación largo/ancho del fruto (1,42 – 1,53), relación largo/grosor del fruto (1,92 – 2,21), y relación ancho/grosor del fruto (1,36 – 1,45). Estos genotipos pueden ser buenas opciones para los productores y los consumidores que demandan frutos de tacaco de alta calidad. En la presente investigación se informa por primera vez sobre la existencia de frutos de tacaco con seis y siete suturas longitudinales completas, y con entre dos y cinco suturas longitudinales incompletas, lo que representa un hallazgo que puede ilustrar los cambios evolutivos recientes de esta especie.&lt;/p&gt;

Phylogeny of the Homalotina (Coleoptera: Staphylinidae: Aleocharinae) based on morphology

AbstractThe aleocharine subtribe Homalotina Heer represents one of the most diverse lineages of Staphylinidae. Despite its wide distribution and diversity, the phylogenetic relationships of the subtribe remain poorly understood. Here, we present the first cladistic analysis of the Homalotina based on morphological data. The subtribe is hypothesized to be a monophyletic group consisting of seven genera (Anomognathus Solier, Cephaloxynum Bernhauer, Holisomimus Cameron, Homalota Mannerheim, Neomalota Cameron, Stenomastax Cameron, and Thecturota Casey). The dataset for phylogenetic analysis comprised 83 characters representing 245 character states derived from adult morphology. These data were analysed using equal weighting and implied weighting schemes (k = 1–6) and results support the monophyly of the subtribe based on two synapomorphic characters (complete postoccipital sutures on head, posterolateral margin of metacoxae with macrosetae) and three homoplastic characters (medial setae on prementum not extended to apex of ligula, medial setae on labium contiguous, posterolateral angle of elytron slightly sinuate). Generic relationships differ in each analysis within the Homalotina (EW, IW with k = 1, 2–4, 5–6) although there are some identical topologies among the IW trees. Clades A, B, C, D, H, J and G were resolved as monophyletic in all weighting regimes. The monophyly of the genera is relatively well supported except for the genera Homalota and Stenomastax. Homalota species were recovered in four independent clades (clade C, D, I, K) and the Stenomastax species were recovered in two independent lineages. Candidates for the possible new genera are discussed. We herein transfer Homalota flavomaculata Bernhauer to the genus Stenomastax, resulting in the new combination [Stenomastax flavomaculata (Bernhauer)]. Our preliminary character correlation tests using phylogenetic pairwise comparisons did not support the hypothesis of association between flattened body form, and subcortical habitat and anterior shift of antennal insertion in Homalotini.

Effectiveness of cyanoacrylate adhesive in rabbit aortorrhaphy

BACKGROUND: Even when properly performed, arterial sutures are not always absolutely hemostatic. Tissue sealants and adhesives have become available that can be used to complete sutures, preventing hemorrhage problems.OBJECTIVES: To evaluate the effectiveness of cyanoacrylate adhesive for sealing aortotomies in rabbits in a coagulopathic state, by analyzing survival of the animals and the time taken to achieve hemostasis.METHODS: Ten-mm long aortotomies were performed on the infrarenal aortas of 12 animals. In four animals, aortorrhaphy was conducted using four interrupted polypropylene sutures and in the remaining animals aortorrhaphy was performed using four or fewer polypropylene stitches, followed by application of a cyanoacrylate adhesive.RESULTS: The four animals sutured without adhesive died within the postoperative period due to severe hemorrhage (3 animals) or intestinal ischemia. The eight animals to which the adhesive was applied exhibited no transoperative bleeding, but one animal died during the postoperative period. Using cyanoacrylate permitted more rapid procedures (p&lt;0.004) and no local reactions were observed in macroscopic examination of tissues.CONCLUSIONS: The cyanoacrylate adhesive demonstrated effectiveness for sealing aortotomies, considering the survival outcomes, duration of procedures and absence of local reactions on macroscopic examination.

An Endoscopic Surgical Skill Validation System for Pediatric Surgeons Using a Model of Congenital Diaphragmatic Hernia Repair.

We developed a system to objectively verify the endoscopic surgical skills of pediatric surgeons. We developed a thoracoscopic model of congenital diaphragmatic hernia mimicking a newborn's size. The examinees were divided into Experts (n = 10) and Trainees (n = 19), and each group performed two tasks (Task 1, reduction of a herniated intestine from the thoracic space to the abdomen; Task 2, perform three suture ligatures of a diaphragm defect using intracorporeal knot-tying). The end points were the time required to complete Task 1, time score calculated using the residual time from the time limit for Task 2, number of complete full-thickness sutures, maximum air-pressure tolerance, degree of diaphragm deformation, and the residual defect areas after suturing. We also evaluated the total path length and velocity of the forceps tips using a three-dimensional position measurement instrument. The Experts had significantly superior results for the time for Task 1, time score, number of complete full-thickness sutures, maximum air-pressure tolerance, and degree of diaphragm deformation in Task 2 (all P < .05). We found that the total path length and average velocities for the left forceps were inferior to those of the right forceps in both tasks in the Trainees (both P < .05, respectively), whereas the Expert group showed no significant laterality in these tasks. Our model could validate the quality of endoscopic surgical skills and could differentiate between Expert and Trainee pediatric surgeons. The Experts could use their forceps equally well to perform tasks even in a small working space.

Anatomic Features of Metopic Suture in Adult Dry Skulls

The metopic suture (MS) lies on the midline of the forehead and extends from the frontal bone to the root of the nose. The aim of the current study was to evaluate morphologic features of the complete and incomplete MSs of skulls in the West Anatolian population and rates of the suture types. One hundred sixty crania of West Anatolian people with unknown ages and sex belonging to the anatomy department laboratory of Dokuz Eylül University Medical School were examined. When the MSs that extend from the nasion to the bregma are complete, this condition was named as metopism. The length of the complete sutures was measured using a flexible millimeter calibrated ruler. If the suture was not present throughout between these 2 landmarks (nasion and bregma), these were considered as the incomplete MSs. The incomplete MSs were classified as linear, V-shaped, and double types. The incidence of the complete and incomplete sutures was 75%. The complete (metopism) and incomplete MSs were found in 7.50% and 67.50% of the skulls, respectively. The most common type was linear (39.40%), followed by double shaped (23.10%) and V shaped (5%). The mean length of the complete MS was 12.30 cm. Because the localization and types of MSs are important during clinical approaches, while evaluating patients with head trauma in the emergency department, these should be considered.

Study on metopic sutures in south Indian skulls

The midline suture between two halves of the developing frontal bone usually fuses by infancy or early childhood. In some cases it may persist in complete or incomplete metopic sutures with variable morphology. The incidence and morphological pattern of these sutures were being studied using 120 skulls from the Department of Anatomy, Yenepoya Medical College among which 4 skulls (3.33%) showed complete metopism, 98 skulls (81.66%) showed presence of incomplete metopic suture whereas 18 skulls (15%) showed total absence of metopic suture. Of the skulls that showed incomplete metopic sutures, 96 (97.95%) were on the anterior 1/3 starting from nasion extending over glabella, 2 (2.04%) were on the middle 1/3. No suture could be found on the posterior 1/3.The morphological pattern was studied on the sutures present on anterior 1/3 of the skull. Among these, 26 (26.53%) were linear, 13 (13.26%) were double linear, 13 (13.26%) were V shaped, 12 (12.24%) were U shaped, 7 (7.14%) were H shaped, 5 (5.1%) were Y shaped. 2 (2.04%) showed inverted-U pattern whereas 18 (18.36%) showed side to side excursion patterns. The data obtained in this study will be useful in the field of Anatomy, Forensic medicine, radio diagnosis and neurosurgery.

Preliminary results of direct closure of an atrioventricular septal defect: revisiting the original technique

Background: This study aims to assess the preliminary results of direct closure of atrioventricular septal defect (AVSD). Methods: Thirteen patients (complete type n=7, partial type n=6) who underwent AVSDs correction with direct closure technique in our department between September 2009 and June 2011 were included. Two patients with concomitant pulmonary stenosis were managed in a single session. For direct suture closure of ventricular septal defect (VSD), multiple interrupted Teflon pledgets sutures were placed on the right side of the interventricular septal crest and then they were passed through the bridging leaflets of the common valve. For direct closure of primum atrial septal defect (ASD) in patients with complete type VSD closure sutures were used by passing through the remnant of interatrial septum and tied off. Results: The median age of the patients was 13 months. The median age (7.5 months) and weight (4.3 kg) of the patients with complete type was lower. The mean VSD size was 30.4±10 mm/m2. The mean cardiopulmonary bypass and ischemic cross clamp times were 51.3±11.2 min and 34.7±10.9 min, respectively. There was no in-hospital mortality. All patients were discharged with sinus rhythm and less than (2+) atrioventricular valve regurgitation. All the patients were followed. The mean follow-up was 12.1±4.1 months. Repeated echocardiograms did not revealed any progressive atrioventricular valve dysfunction or left ventricular outflow tract gradient. Conclusion: Direct closure technique for repair of atrioventricular septal defect is rapid and simple surgery for the management of this complex pathology. This easily reproducible technique could also encourage and facilliate earlier repair of this pathology, preventing potential technical challenges.

The biomechanical assessment of gap formation after flexor tendon repair using partial interlocking cross-stitch peripheral sutures

The gap formation of five core plus peripheral suture techniques for flexor tendon repair was evaluated by cyclic load testing. Fifty pairs of dental roll tendon models were sutured using six-strand Pennington modified Kessler core suture with 4-0 Polypropylene. One-half or three-fourths circumferential interlocking cross-stitch, or three complete circumferential peripheral suture techniques were performed using 6-0 Polypropylene. An initial cyclic load of 10 N for 500 cycles was applied and increased by 5 N for an additional 500 cycles at each new load until rupture. The complete circumferential interlocking cross-stitch had the greatest fatigue strength. The partial circumferential cross-stitches resulted in significantly larger gap formations at both the repaired and unrepaired sides than the complete circumferential sutures, and were also associated with early rupture. The full circumference of the cut tendon must be sutured using an interlocking cross-stitch peripheral suture to improve strength and avoid gap formation.

Design of a Compliant Endoscopic Suturing Instrument

This paper describes the initial design and optimization of a compliant endoscopic suturing instrument. The emerging field of Natural Orifice Transluminal Endoscopic Surgery (NOTES) requires innovative instruments to meet the size limitations inherent in this type of minimally invasive surgery; using compliant mechanisms is proposed as one method of meeting this requirement. The compliant design was modeled and optimized to maximize the distal opening and provide a puncture force of at least 4.6N, while being small enough to fit within a 3.3mm working channel. The design utilizes contact for stress relief and intertwining parts for added deflection. ANSYS® was used for finite element analysis including contact and nonlinear deformations. A prototype was fabricated from the optimized geometry and experimentally tested. The best geometry is predicted to have a distal opening of 14.6mm at the tips and supply a puncturing force of 4.83N. The force supplied at the tip was measured and was found to exceed the required 4.6N. The prototype successfully passed two complete sutures and qualitative results are provided. The results of the study will lead to further refinements and improvements in future designs.