Conventional Manual Suturing Research Articles

Linear stapler closure of the pharynx in laryngectomy: our experience (endoscopic closed technique)

Background: Total laryngectomy is the surgical treatment for advanced laryngeal carcinoma. Recently it’s used the linear stapler to treat laryngeal carcinoma. The pharyngeal repair is performed with layered sutures, or using a linear stapler device, using technique of closed pharyngoplasty with linear stapler, by laryngoscope’s guide to see and to hook epiglottis through the trachea. Methods: We compared the results between total laryngectomy technique with conventional manual suture with needle and gut and closed technique adopted by our otolaryngology’s service with mechanical stapler (GIA) in advanced laryngeal carcinoma. We used a linear stapler Ethicon endo-surgery 90 mm (Proximate) with 76 titanium staples and an integrated scalpel (dimension open suture: 3.0 mm × 3.85 mm) and an endoscope (2.7 mm 0°). Results: We had an important reduction of surgical times, less immediate complications, reduction of length of stay in hospital with the gastric nose tube and reduction of general length of hospital stay. Conclusions: Comparing to the traditional technique, the use of mechanical sutures improve significantly: the surgical time, reducing the length of hospital stay, restoring the physiological oral nutrition and the time of removal of the gastric nose tube. Finally, we demonstrated the reduction in the incidence of complications such as fistula and postoperative fever.

Novel Suture-Less Vascular Anastomotic Device (BYFix) in Femoro-Popliteal Surgery, Early Clinical Experience

Objectives: To evaluate the early experience of using the BYFix-innovative anastomotic device for creating suture-less vascular anastomosis in major and peripheral arteries surgery. Design: Uncontrolled prospective study. Materials: The BYFix anastomotic device for suture-less vascular anastomosis with surgical tools and standard vascular grafts. Methods: 7 patients, age 63.6 ± 9.2 years, with peripheral vascular occlusion above the knee scheduled for surgical repair were operared. They underwent the surgical procedure using the BYFix anastomotic device for creating proximal anastomosis and the conventional manual suturing for creating the distal anastomosis of the implantable vascular graft. Results: The anastomoses by using BYFix anastomotic device were successfully created in all patients. The duration of anastomosis creation was significantly shorter by using BYFix device, compared to conventional manual suturing, 5:10 ± 1:50 minutes compared to 33 ± 17:40 minutes respectively. No adverse events related to BYFix anastomotic device were observed, during the surgical procedure or recovery period. One year follow up revealed no complications related to BYFix anastomotic device. Conclusions: The BYFix anastomotic device enables the creation of efficient vascular anastomosis in peripheral vascular occlusions. It shortens the time needed for creating vascular anastomosis and thus reducing the operation time and might reduce distal complications related to the vascular procedure. Further clinical trials are needed to establish the results.

Esofagojejunostomia após gastrectomia total: anastomose mecânica ou manual?

OBJETIVO: Os autores apresentam um estudo observacional, transversal, comparando a anastomose manual com a anastomose mecânica para reconstrução do trânsito digestivo em Y de Roux em pacientes submetidos à gastrectomia total para câncer gástrico. MÉTODOS: O estudo foi realizado no Hospital Governador Israel Pinheiro, no período de janeiro de 1997 a março de 2002. Um total de 40 pacientes neste período foram submetidos à gastrectomia total com reconstrução em Y de Roux. O Grupo I formado por 16 pacientes foi submetido à anastomose mecânica e o grupo II por 24 pacientes foi submetido à anastomose manual. Os dois grupos foram comparados quanto à incidência de complicações pós-operatórias, necessidade de re-operação, alta hospitalar e mortalidade per e pós-operatória. RESULTADOS: Quanto às complicações relacionadas à anastomose, fístula e abscesso intra-abdominal, elas ocorreram em nove pacientes do grupo com anastomose manual e em nenhum paciente no grupo com anastomose mecânica. (p= 0,006). A morbidade e a permanência hospitalar pós-operatória foram maiores no grupo submetido à sutura manual. Houve um óbito em cada grupo e 37% dos pacientes em cada grupo não apresentaram quaisquer tipos de complicações. CONCLUSÃO: Considerando a fístula e o abscesso intra-abdominal juntamente como complicações da anastomose esôfago-jejunal, os resultados deste estudo sugerem uma maior viabilidade da sutura mecânica.

Estudio comparativo entre el empleo de la sutura manual y la sutura mecánica en el cierre del defecto mucoso en la laringectomía total

With the present study we try to achieve an objective confirmation of the efficacy given by the mechanical suture in the closing of the pharyngeal defect following a total laryngectomy against the conventional manual suture with absorbable material. Therefore we have studied three random groups of patients: in the first one we include those who had a manual suture (n=50), in the second one those who had performed a mechanical suture with closed technique (n=38) and in the third one those who had a mechanical suture with an open technique (n=12). We have checked that mechanical suture with a closed technique improves significantly the surgical length (212 minutes), the beginning of the oral feeding (10.73 days) and the time of in-hospital stay (13.5 days). Mechanical sutures with a closed technique also reduce the rate of complications such as fistulae (5.26%), infection (0%) and haemorrhage (0%).

Morphological analysis of microarterial media repair after 830 nm diode laser assisted end-to-end anastomosis: Comparison with conventional manual suture.

A series of 240 diode laser assisted end-to-end microvascular anastomoses (LAMA) and conventional manual anastomoses (CMA) were performed in the left and right common carotid of Wistar rats, respectively. In comparison with the two anastomotic methods, optic and scanning electron microscopic examinations were achieved from Day 0 to Day 210, in order to clarify the mechanism of media repair after diode laser welding, especially the long-term results. In the LAMA group, the cut vessel edges were welded without obvious thermal necrosis after laser treatment. On Day 10, media repair was underlined by circular bulges corresponding to the folds of cut vessel endings brought together. Inflammatory cells were regularly scattered in the adventitia in the vicinity of the anastomotic site, and were gaining ground intensively in the media by Day 20. At this time, the parallel organization of elastic laminae disappeared while the collagen network developed. On Day 120, irregular elastic fibres aggregated in the anastomotic site. On Day 210, reconstituted elastic lamina was present. In the CMA group, on Day 20, fibrotic repair appeared between cut vessel edges, and the injury incorporated by sutures was important. The elastic laminae were not reconstituted by Day 210 in any case. This microscopic study proves that the long-term repair of diode LAMA facilitates media repair and prevents fibrotic scarring of the media.

Scanning Electron Microscopy of Microarterial Anastomoses with a Diode Laser: Comparison With Conventional Manual Suture

A diode-laser (830 nm)-assisted carotid artery end-to-end microanastomosis (LAMA) and a contralateral manual suture anastomosis (CMA) were performed in 70 Wistar rats. The vessel sealing was performed on the left carotid by laser pulses (average 3) of 500 mW power and 4.5 sec exposure time, the beam being focused on a spot of 300 microns diameter (700 W/cm2). The CMA was achieved on the right carotid by six 10-0 stitches. From day 0 to day 210, 40 specimens underwent scanning electron microscopy. The laser impact produced a wall injury of 100 microns in width, with an immediate sealing effect due to protein denaturation and collagen fusion of media and adventitia. The anastomosis became re-endothelialized by day 3, while the longitudinal arrangement of the endothelial cells was restored from day 10 on. In the long term, a thick collagenous meshwork of collagen and elastic fibers maintained the strength of the media, while normal endothelium covered the anastomosis. Inversely, after CMA vessel repair was delayed, and the anastomotic line was more irregular and underlined by medial fibrotic scar. In both anastomoses, the patency rate was 93 percent, with nonlethal complications. The advantages of LAMA vs. CMA were: shorter operating time (13 min/22 min), reduced intraoperative trauma, better healing of endothelium, and a miniaturization of the laser source well adapted to microsurgery.

Kumacone II: an adapter to aid in the placement of a purse-string suture in very low anterior rectal resection.

We have designed an adapter called the "Kumacone II", being a bottle-shaped rubber device which greatly aids in placing a purse-string suture, even at the lowest level near the anorectal junction of the rectum. When this adapter is used, performing the anastomosis is much less time-consuming and not as much training is needed as for low anterior resection using conventional manual suturing. In a clinical study, the incidence of leakage and incontinence was nil in five out of five patients.

Stapled or manual suturing in esophagojejunostomy after total gastrectomy: A comparison of outcome in 379 patients

From January 1983 to December 1989, we performed esophagojejunostomy on 379 patients who underwent total gastrectomy for gastric cancer. A mechanical EEA stapler or conventional manual suturing was used. The clinical outcomes of 199 patients in whom stapling was used (stapler group) and 180 patients in whom manual suturing was done (manual group) were compared. Two of the 199 patients in the stapler group and 3 of the 180 patients in the manual group died of causes directly related to the anastomosis. In the stapler group, 16 stapled anastomoses were formed supradiaphragmatically, and manual suturing was done for 6 patients. The highly placed anastomosis was formed without left thoracotomy or with median sternotomy in 8 of the 16 patients in whom the stapling device was used and in 1 of the 6 patients in whom manual suturing was used. The incidence of anastomotic leakage and stenosis did not differ between the groups. Thus, the mechanical stapler facilitated the construction of a rapid, reliable esophagojejunostomic anastomosis.

Mechanical and Conventional Manual Sutures of the Bronchial Stump.A Comparative Study of 298 Surgical Patients

A U.S.-made TA-30 model stapling device was utilized to close the bronchial stump in 146 patients, while conventional manual suturing with chromic catgut was performed for the same purpose in 152 patients. The two groups were comparable in respect of pre-operative status and operative diagnosis. Patients, in whom the stapler was utilized, showed a decreased incidence of bronchial fistula (1% vs. 3%) and empyema without fistula (1% vs. 3%). The stapler, compared with conventional manual sutures, allows a simpler and swifter suture of the bronchial stump, reduces the contamination of the operative field, achieves uniform and tighter closure of the bronchus, leaves a better preserved terminal blood perfusion of the stump and utilizes a more tolerated sewing material with less resultant tissue inflammation.