Conventional Dissection Technique Research Articles

Editorial Comment from Dr Senel to Circumcision with a novel disposable device in Chinese children: A randomized controlled trial

Since the introduction of the Shenghuan device in 2008, there has been limited data regarding its use in children's circumcision.1 This initially-described technique is known as the Peng method, where the inner ring of the device is placed on the outer layer of foreskin. The technique was modified by Yan in 2010, where the inner ring was placed between the foreskin and glans.2 Yan's method is a similar technique to PrePex, the main difference being the outer elastic ring of PrePex instead of the outer plastic ring of the Shenghuan device.3 However, there are not any data regarding the use of PrePex device in children's circumcision. Although the initial report of Yan with the Shenghuan device in child circumcision reported the ease of application within a short duration with low complications and satisfactory cosmetic results, it was not a comparative study.2 In the current study,4 two methods of the Shenghuan circumcision technique carried out in children were compared for the first time. According to the results, Yan's method seems better for child circumcision compared with the Peng method, as the device might fall off on its own, thus avoiding extra pain during removal. Additionally, the overall failure rate of 13.5% as a result of phymosis in Peng's method is a limiting aspect of the method for children's circumcision. The outcomes and complications of different Shenghuan methods were also compared with the conventional dissection technique in the current study. Although a previous study of Li et al. compared the results of Shenghuan circumcision with those of conventional surgical procedures, the data were limited to adult circumcisions.5 In both studies, the Shenghuan methods were found superior to conventional surgical procedure because of shorter operation time and better cosmetic appearance. Li also reported a lower degree of pain after circumcisions carried out with the Shenghuan device. A difference of the current study was the higher degree of early post-circumcision pain observed among the children circumcised with the Shenghuan device. This could be related to different age groups enrolled in these two studies. Nevertheless, there is a need for a randomized study with a higher number of children to compare post-circumcision pain. In addition, the pain after circumcision and during the removal of the Shenghuan device can be compared with a similar disposable device utilized in children's circumcision, such as Ali's clamp, where the device is removed 3–5 days after circumcision within a mean of 15 s.6 It was interesting that the authors were not able to find any significant difference between the complication rates of the Shenghuan device and the conventional technique. The previous studies reported significant differences between these two techniques regarding bleeding and infection rates; therefore, disposable devices were suggested as the choice of circumcision.5, 7 The similar complication rates between the different techniques in the current study might be related to the limited sample size. The authors will probably observe significant differences among the complication rates as their experience with the Shenghuan techniques increases. As a summary, the Shenghuan technique seems to be a safer and quicker method for children's circumcision with better cosmetic results compared with conventional techniques despite the disadvantages, such as longer duration of pain, difficulty of removal or long fall-off period of the device. None declared.

LigaSure Impact™ versus conventional dissection technique in pylorus-preserving pancreatoduodenectomy in clinical suspicion of cancerous tumours on the head of the pancreas: study protocol for a randomised controlled trial

BackgroundThe pp-Whipple procedure requires extensive preparation. The conventional preparation technique is done with scissors for dissection and ligatures, and with clips and sutures for hemostasis. This procedure is very time-consuming and requires numerous changes of instruments. The LigaSure™ device allows dissection and hemostasis for preparation with one instrument. Up to now there has been no comparison of the two techniques with regard to operating time and the patients' outcome. It is still unclear which technique has the optimal benefit/risk ratio for the patient.Methods/DesignA single-center, randomized, single-blinded, controlled superiority trial to compare two different techniques for dissection in a pp-Whipple procedure. 102 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective pp-Whipple procedure who signed the informed consent will be included. The primary endpoint is the operating time of the randomized technique. Control Intervention: Conventional dissection technique; experimental intervention: LigaSureTM dissection technique. Duration of study: Approximately 15 months; follow up time: 3 years. The trial is registered at German ClinicalTrials Register (DRKS00000166).

LigaSure versus conventional dissection technique in pancreatoduodenectomy: a pilot study

Background Pancreatic surgery requires extensive preparation and tissue dissection. Therefore, LigaSure (Valleylab, Boulder, CO) provides an alternative to conventional dissection techniques. The aim of the present study was to describe the feasibility, safety, and cost efficiency of LigaSure in pancreatoduodenectomy. Methods Seven patients underwent surgery with the Ligasure and 7 patients underwent surgery with conventional dissection techniques. The patients were investigated for surgical time, intraoperative blood loss, complications, mortality, duration of hospital stay, and surgery-related costs. Results Surgical time was 207 minutes in the LigaSure group and 255 minutes in the conventional group ( P = .020). Intraoperative blood loss was 271 and 771 mL, respectively ( P = .010). Other perioperative outcomes were comparable. The respective surgery-related costs averaged €4,125 and €4,931 ( P = .023). Conclusions The use of LigaSure in pancreatoduodenectomy seems to be feasible and safe. In addition, it might lead to a reduction in the surgery-related costs.

A simple enzymatic method for parietal yolk sac removal in early postimplantation mouse embryos

Crucial aspects of axial development in mice occur at early postimplantation stages from the time of implantation to the appearance of the primitive streak. However, this period of development is notoriously refractory to experimental approaches due to the small size of the conceptus and to the presence of the parietal yolk sac, a protective tripartite membrane that surrounds the developing egg cylinder. Here, we describe a method that combines enzymatic digestion and mechanical manipulation to remove the parietal yolk sac of conceptuses at stages between 5.5 and 6.5 days post coitum. This method, which is compatible with whole-mount in situ hybridization and immunostaining techniques, offers a significant improvement over conventional dissection techniques, and it will greatly facilitate research in early mammalian development.

A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique

A randomized trial of routine circumcision in children using the Plastibell device is described and compared to a dissection suturing technique. One hundred children were studied with a mean age of 4.7 years. The device was applicable to all boys up to the age of 8, and a few older. General discomfort was carefully assessed and slightly less common after plastibell circumcision, but dysuria more so. No serious complication was encountered with either method; infection was slightly more common after the conventional procedure. Cosmetic results were similar for both methods. It is concluded that the Plastibell device is a satisfactory method for circumcising children of this age.

Retained Common Bile Duct Stone as a Consequence of a Fundus-First Laparoscopic Cholecystectomy

The fundus-first technique for laparoscopic cholecystectomy provides an alternative to the conventional dissection technique in patients at high risk for conversion to open cholecystectomy or at risk for bile duct injury. We report the complication of a retained common bile duct (CBD) stone after utilizing this technique. Intraoperative cholangiography (IOC) was not performed due to the concern for causing CBD injury in a patient with significant periductal inflammation and no risk factors for CBD stones. Following discharge, the patient developed scleral icterus 3 days later and returned for evaluation. He required endoscopic retrograde cholangiopancreatography for removal of a CBD stone. None of the four series reporting on this technique have described this complication. It should now be recognized that there is a risk of displacing a gallstone into the CBD in utilizing this technique. This report highlights the importance of intraoperative imaging of the CBD when using this technique, even in patients considered to be at low risk for having CBD stones. If IOC is considered hazardous, then intraoperative ultrasound should be the modality of choice.

A simple and rapid DNA extraction method for the detection of Wuchereria bancrofti infection in the vector mosquito, Culex quinquefasciatus by Ssp I PCR assay

A simple, rapid and inexpensive method for the extraction of DNA from filarial vector, Culex quinquefasciatus, useful in Ssp I PCR assay for xenomonitoring of infection with Wuchereria bancrofti is presented. The DNA extracted by this method was found suitable for PCR detection of W. bancrofti infection in pools of 10–30 mosquitoes. The PCR assay employing the simplified DNA extraction method was evaluated for its sensitivity on field caught Cx. quinquefasciatus, in comparison with the conventional dissection and microscopy technique. When assayed on dissection washings of vector mosquitoes the PCR assay detected 45 pools out of 49 dissection positive pools as positive for infection and hence found to be less sensitive than the conventional technique. The reason for detecting four dissection positive pools as negatives by the PCR assay may be due to the loss of a few numbers of parasites (1–3) present in these pools during the transfer of washings of dissected mosquitoes. The PCR assay detected ten out of 72 dissection negative pools as positives, while it did not detect any of the 62 known negative (laboratory reared, uninfected) mosquito pools as positives. When 38 pools (10 mosquitoes/pool) of intact mosquitoes were assessed for infection by each method, the infection rates obtained by the two methods were almost similar (3.35 and 3.01%, respectively, for conventional method and PCR assay). The results thus show that the DNA extraction method, which is simple, rapid, safe and inexpensive, is efficient to generate DNA from vector mosquitoes useful in PCR assay and hence has potential application in xenomonitoring.

Religious circumcision under local anaesthesia with a new disposable clamp

To compare the results using a new disposable clamp (the Taraklamp Circumcision Device, TCD, Taramedic Europe BV, Bilthoven, The Netherlands), used since 1998 in one clinic, and the conventional dissection technique (CDT) in another clinic, for religious circumcision in infants. The TCD and CDT were compared prospectively; the duration of the procedure, complications and postoperative pain were recorded. The cosmetic result and the degree to which the parents were satisfied were evaluated after 6 weeks. After obtaining informed consent, 275 boys were included in the study (median age 3 years). The median operative duration was 8 min less for the TCD (15 vs 7 min; P < 0.001). There was no difference in complication rate (bleeding in one vs two; infection in two vs three) and postoperative pain was comparable in both groups. The cosmetic results were better for the TCD group (P < 0.001). The parents' satisfaction score for the procedure was equal in the groups, at 8, on a scale of 1 (very bad) to 10 (extremely good). A religious circumcision outside the hospital with the TCD is quicker and leads to a better cosmetic result than with the CDT, without increasing morbidity.

Detection of Brugia malayi in laboratory and wild-caught Mansonioides mosquitoes (Diptera: Culicidae) using Hha I PCR assay.

An Hha 1 based polymerase chain reaction (PCR) assay developed for the detection of Brugia malayi, the causative agent of Brugian lymphatic filariasis, was evaluated for its sensitivity in the laboratory and for its usefulness in measuring changes in transmission of the disease in the field. Laboratory studies showed that the new assay was highly sensitive in comparison with the standard dissection and microscopy technique. The assay can detect as little as 4 pg of parasite DNA or a single microfilaria in pools of up to 100 mosquitoes. The optimum pool size for convenience was found to be 50 mosquitoes per pool. The efficacy of PCR assay was evaluated in filariasis control programmes in operation in endemic areas of Kerala State, South India. The infection rates obtained by the Hha I PCR assay and the conventional dissection and microscopy technique were 1.2% and 1.7% respectively in operational areas and 8.3% and 4.4% respectively, in check areas, which were not significantly different (P < 0.05). Thus, the Hha I PCR assay was found to be as sensitive as the conventional technique and hence it can be used as a new epidemiological tool for assessing parasite infection in field-collected mosquitoes.

KTP‐532 laser tonsillectomy: A comparison with standard technique

It has been stated that laser excision of oral and oropharyngeal lesions result in less intraoperative blood loss, reduced postoperative pain, and quicker wound healing, but few controlled studies have been done to substantiate these claims. A study was undertaken to examine the benefits of the KTP-532 laser in a group of 31 patients who underwent tonsillectomy. One tonsil was removed with the KTP-532 laser and the other was excised with conventional dissection and snare technique. Patients were not told which tonsil was removed with the laser. Pain, healing, and intraoperative blood loss comparing one side to the other was assessed. On the evening of surgery, 83% of patients selected the side that underwent standard dissection and snare tonsillectomy as the most painful. By midweek, however, approximately equal numbers of patients selected the laser side as the most painful. At the end of 1 week, 63% of patients felt more pain on the laser dissection side. Possible reasons for these results are discussed. Intraoperative blood loss was significantly reduced with the use of the KTP-532 laser, but healing was not accelerated.

Aortoiliac operations and sexual dysfunction.

Male sexual dysfunction after aortoiliac operations can be a distressing complication. Since previous studies dealing with this problem have not excluded other causes of sexual dysfunction, the true incidence of this complication has been difficult to ascertain. We assessed preoperative and postoperative sexual function in a group of patients with no identifiable organic or functional etiology of sexual dysfunction other than aortoiliac operations or arterial occlusive disease. Seventy-six male patients had no evidence of sexual dysfunction of ambiguous etiology before or after operation. Preoperatively, 33% of patients with abdominal aortic aneurysm and 22% of those with aortoiliac occlusive disease were functionally impotent. Conventional dissection techniques rendered an additional 30% of each group functionally impotent. Postoperative impotence was twice as common in those with minor dysfunction preoperatively.

A randomized trial to assess childhood circumcision with the plastibell device compared to a conventional dissection technique: I. A. Fraser, M. J. Allen, P. F. Bagshaw, and M. Johnstone. Br J Surg 68:593–595, 1981

A randomized trial to assess childhood circumcision with the plastibell device compared to a conventional dissection technique: I. A. Fraser, M. J. Allen, P. F. Bagshaw, and M. Johnstone. Br J Surg 68:593–595, 1981