Dissection Method Research Articles

Isolation of Umbilical Cord-Derived Mesenchymal Stem Cells with High Yields and Low Damage.

Mesenchymal stem cells (MSCs) are a population of multipotent cells with remarkable regenerative and immunomodulatory properties. Wharton's jelly (WJ) from the umbilical cord (UC) has gained increasing interest in the biomedical field as an outstanding source of MSCs. However, challenges such as limited supply and lack of standardization in existing methods have arisen. This article presents a novel method for enhancing MSC yield by dissecting intact WJ from the umbilical cord. The method employs blunt dissection to remove the epithelial layer, maintaining the integrity of the entire WJ and resulting in an increased quantity and viability of harvested MSCs. This approach significantly reduces WJ waste compared to conventional sharp dissection methods. To ensure the purity of WJ-MSCs and minimize external cellular influence, a procedure utilizing internal tension to peel off the endothelium after flipping the UC was conducted. Additionally, the Petri dish was inverted for a short time during explant culture to improve attachment and cell outgrowth. Comparative analysis demonstrated the superiority of the proposed method, showing a higher yield of WJ and WJ-MSCs with better viability than traditional methods. The similar morphology and expression pattern of cell surface markers in both methods confirm their characterization and purity for various applications. This method provides a high-yield and high-viability approach for WJ-MSC isolation, demonstrating great potential for the clinical application of MSCs.

Fixed parotid sialoliths: surgical treatment via transfacial approach using sialendoscopy and ultrasound guidance—retrospective cohort study

The most common cause of symptomatic parotitis is the obstruction of its duct, most commonly by a stone. Despite the development of minimally invasive endoscopic techniques, some of these obstructions cannot be treated entirely endoscopically, requiring combined approaches. This study reviewed the outcomes and surgical technique of ultrasound-guided transfacial parotid sialolithotomy following a failed endoscopic approach. Conducted as a case series with retrospective chart review at an academic tertiary care center, the study evaluated patients who underwent this combined transfacial-endoscopic operation for symptomatic parotid sialolithiasis from April 2022 through January 2023. Key outcomes included operative technique, stone size, stone location, complications, and symptom relief. A total of four male patients with a mean age of 66 years underwent the ultrasound-guided transfacial operation for symptomatic parotid sialolithiasis. Needle localization facilitated transfacial stone retrieval in all cases. The follow-up period ranged from 6 to 15 months. Stone locations included the proximal one-third of the ductal lumen (1 patient), the parotid hilum (1 patient), and within the gland parenchyma (2 patients). The average sialolith length was 8 ± 1.4 mm, and the width was 3 ± 0.8 mm. The average surgical time was 113 ± 16.5 minutes. All cases (100%) achieved successful stone retrieval and symptomatic improvement, with complete resolution of symptoms in 3 cases (75%). No major complications were reported. Ultrasound-guided transfacial parotid sialolithotomy is a safe and effective alternative to parotidectomy for patients who have failed a purely endoscopic approach. A novel transfacial surgical dissection method, based on the middle premasseter space, is proposed for accessing the main parotid duct when obstructions are located in the middle portion of the duct.

Live Imaging of the Shoot Apical Meristem of Intact, Soil-Grown, Flowering Arabidopsis Plants.

All aerial organs in plants originate from the shoot apical meristem, a specialized tissue at the tip of a plant, enclosing a few stem cells. Understanding developmental dynamics within this tissue in relation to internal and external stimuli is of crucial importance. Imaging the meristem at the cellular level beyond very early stages requires the apex to be detached from the plant body, a procedure that does not allow studies in living, intact plants over longer periods. This protocol describes a new confocal microscopy method with the potential to image the shoot apical meristem of an intact, soil-grown, flowering Arabidopsis plant over several days. The setup opens new avenues to study apical stem cells, their interconnection with the whole plant, and their responses to environmental stimuli. Key features • Novel dissection and imaging method of the shoot apical meristem of Arabidopsis. • Procedure performed with intact, soil-grown, flowering plants. • Possibility of long-term live imaging of the shoot apical meristem. • Protocol can be adapted to different plant species.

Assessment of Anatomical Morphology of the Ileocecal Junction and Ileocecal Valve by Dissection and Endoscopy.

The ileocecal valve (ICV) guards the opening of the ileocecal junction (ICJ) and acts as a mechanical barrier to prevent the reflux of material from the colon into the ileum. The morphology of the ICV noted in living is different from that of cadavers. The ICV is better studied in the living by endoscopy. A study of variation in the gross anatomy of the ICV can help determine the factors responsible for its competency. A descriptive study was conducted on a total of 85 (N) patients each in two groups over a period of two years. Group I: 85 specimens of the ileocecal region obtained during dissection; Group 2: 85 patients undergoing colonoscopic study undertaken in the Department of Medical Gastroenterology. In the dissection method, the apparently normal ICJ was inspected, photographed, and measured using Vernier calipers. In the colonoscopy method, the procedure was observed and while observing ICV, photos were taken. These photographs were later compared with other photographs in the literature to identify the morphology of ICV. The age, gender, location, and morphology of ICV were represented in percentile, and qualitative variables were analyzed by Pearson correlation coefficient. Out of 85 participants in Group A, 80% (68) were males and 20% (17) were females; in Group B, 58% (49) were males, and the remaining 42% (36) were females. In the dissection method out of 85 (N) patients, 98% had reverse S type terminal ileum, correlation of diameter of ICV with age p=0.003and correlation of morphology of ICV with age p=0.006, and was statistically significant. In the colonoscopy method, 58% were males and 22% of them were 31-40 years. In 49% of patients, ICV was viewed from the left lateral position. The correlation of success of ileoscopy with age (p=0.608), gender (p=0.896), the position of the patient (p=0.236), and morphology of ICV (p=0.631)was not statistically significant. There were no age-related changes observed regarding the morphology of the ICJ. It was found that as age increases diameter of ICV increases. The success of ileoscopy was highest in 31-40 years of age.

Identifying suitable methods for evaluating the sterilizing effects of pyriproxyfen on adult malaria vectors: a comparison of the oviposition and ovary dissection methods

BackgroundNets containing pyriproxyfen, an insect growth regulator that sterilizes adult mosquitoes, have become available for malaria control. Suitable methods for investigating vector susceptibility to pyriproxyfen and evaluating its efficacy on nets need to be identified. The sterilizing effects of pyriproxyfen on adult malaria vectors can be assessed by measuring oviposition or by dissecting mosquito ovaries to determine damage by pyriproxyfen (ovary dissection).MethodLaboratory bioassays were performed to compare the oviposition and ovary dissection methods for monitoring susceptibility to pyriproxyfen in wild malaria vectors using WHO bottle bioassays and for evaluating its efficacy on nets in cone bioassays. Blood-fed mosquitoes of susceptible and pyrethroid-resistant strains of Anopheles gambiae sensu lato were exposed to pyriproxyfen-treated bottles (100 μg and 200 μg) and to unwashed and washed pieces of a pyriproxyfen long-lasting net in cone bioassays. Survivors were assessed for the sterilizing effects of pyriproxyfen using both methods. The methods were compared in terms of their reliability, sensitivity, specificity, resources (cost and time) required and perceived difficulties by trained laboratory technicians.ResultsThe total number of An. gambiae s.l. mosquitoes assessed for the sterilizing effects of pyriproxyfen were 1745 for the oviposition method and 1698 for the ovary dissection method. Fertility rates of control unexposed mosquitoes were significantly higher with ovary dissection compared to oviposition in both bottle bioassays (99–100% vs. 34–59%, P < 0.05) and cone bioassays (99–100% vs. 18–33%, P < 0.001). Oviposition rates of control unexposed mosquitoes were lower with wild pyrethroid-resistant An. gambiae s.l. Cové, compared to the laboratory-maintained reference susceptible An gambiae sensu stricto Kisumu (18–34% vs. 58–76%, P < 0.05). Sterilization rates of the Kisumu strain in bottle bioassays with the pyriproxyfen diagnostic dose (100 μg) were suboptimal with the oviposition method (90%) but showed full susceptibility with ovary dissection (99%). Wild pyrethroid-resistant Cové mosquitoes were fully susceptible to pyriproxyfen in bottle bioassays using ovary dissection (> 99%), but not with the oviposition method (69%). Both methods showed similar levels of sensitivity (89–98% vs. 89–100%). Specificity was substantially higher with ovary dissection compared to the oviposition method in both bottle bioassays (99–100% vs. 34–48%) and cone tests (100% vs.18–76%). Ovary dissection was also more sensitive for detecting the residual activity of pyriproxyfen in a washed net compared to oviposition. The oviposition method though cheaper, was less reliable and more time-consuming. Laboratory technicians preferred ovary dissection mostly due to its reliability.ConclusionThe ovary dissection method was more accurate, more reliable and more efficient compared to the oviposition method for evaluating the sterilizing effects of pyriproxyfen on adult malaria vectors in susceptibility bioassays and for evaluating the efficacy of pyriproxyfen-treated nets.

Exploring heart dissection techniques for enhancing anatomical education: a pilot study to replicate transthoracic echocardiography.

For novice learners, converting two-dimensional (2D) images of echocardiography to three-dimensional (3D) cardiac structures is deemed challenging. This study aimed to develop an accurate dissection method of the heart to reproduce the transthoracic echocardiographic views on cadavers and elucidate new educational methods in human anatomy dissection courses. A total of 18 hearts were used in this study. After reflecting the anterior thoracic wall inferiorly, the hearts were excised from embalmed cadavers. Thereafter, three landmarks were set on the heart for each plane of the incision, and the hearts were incised to observe the three different echocardiographic views, which include the apical four-chamber view (A4C), parasternal long axis (PLAX) view, and parasternal short axis (PSAX) view at the papillary muscle level. If all structures for observation during routine echocardiography are clearly observed in each view, a successful incision is considered. All procedures and incisions were performed by the medical students. After a successful incision, hearts were returned to the original position in the pericardial sac for further observation. The success rates of incision for each view were 83.3% (5/6 success cases), 83.3% (5/6 success cases), and 66.7% (4/6 success cases) in the A4C view, PLAX view, and PSAX view at the papillary muscle level, respectively. This dissection method could probably be employed to reproduce transthoracic echocardiographic views on cadaveric hearts, which is beneficial for novice learners for a deeper understanding of the anatomy.

Comparison of Surgical Complications between Cold Steel Dissection Method and Bipolar Electro Dissection Method in Tonsillectomy

Objectives: To assess whether bipolar electro dissection tonsillectomy has better surgical outcome compared to traditional cold steel dissection followed by silk ligature. Methodology: A Randomized Control Trial (RCT) was conducted at Department of ENT and Head-Neck surgery, Dhaka Medical College Hospital, from 1st January, 2020 to 30th July, 2021 Total 100 patients were enrolled through non- probability consecutive sampling and according to the selection criteria, who were admitted for elective tonsillectomy. They were randomly allocated into two groups of 50 persons each Bipolar electro dissection' (BED) and 'Cold Steel Dissection (CSD) group according to surgical method applied on them. The parameters of comparison were-duration of surgical technique, intraoperative blood loss, post-operative hemorrhage, pain, time taken returning to solid diet and healing rate of tonsillar fossac. Results: The mean operative time was 23.7±4.4 minutes in BED whereas 47.2±48.1 minutes in CSD method (p&lt;0.0001). Mean intra operative blood loss was less in BED (16.4±6.6ml) than in CSD (37.8±6.6ml) technique (p&lt;0.001). Overall reactionary hemorrhage rate was 12% and overall secondary hemorrhage rate was 18%. There was no statistically significant difference in post-operative hemorrhage incidence between two methods (p=0.373). Moderate to severe post- operative pain is more common bipolar method (68% &amp; 12%) than dissection method (46% &amp; 6%) which was significant (p=0.012). Mean time taken to return to solid diet for BED group was 8.12 days (range 3-16 days) and for the CSD group was 4.23 days (range 3-15 days) (p&gt;0.05). Regarding aspect of the tonsillar fossa in the CSD group healing was faster than BED group (p&gt;0.05). Conclusion: Operative time and intraoperative blood loss was significantly less in the bipolar electro dissection tonsillectomy (BED) group. Postoperative pain was significantly less in cold steel dissection tonsillectomy (CSD) group. Time taken to return to solid ......

A Prospective Study of the Efficacy of Endofascial Axillary Dissection to Reduce Axillary Seroma Formation.

Introduction Seroma formation is a common complication following axillary dissection. The pathogenesis of seroma is poorly understood. Various chemical and mechanical methods have been tried to reduce seroma with varying results. In this study, we look at a novel method of axillary dissection to reduce seroma and its attendant morbidity. The objective of the study is to compare endofascial axillary lymphadenectomy with routine axillary lymphadenectomy regarding axillary drain output following breast conservation surgery. Methods We did a prospective interventional study of endofascial axillary dissection in patients undergoing breast conservation surgery. Comparison was done with historical controls who underwent breast conservation surgery with routine axillary lymphadenectomy before the study period. All patients were operated by the same surgeon. Results Breast conservation surgery with endofascial axillary dissection was performed in 36 patients and compared with 36 patients who underwent routine axillary dissection before the study period. The mean total axillary drain output in the endofascial and routine groups were 796.8 and 1,259.3 mL, respectively ( p = 0.001). The average day of drain removal in the endofascial and routine groups were 10.8 and 14.9 days, respectively ( p = 0.001). The nodal yield of the endofascial and routine groups were 15.3 and 16.4 nodes, respectively ( p = 0.449). The duration of surgery of the endofascial and routine groups were 89.3 and 85.1 minutes, respectively ( p = 0.366). Conclusion Endofascial axillary dissection significantly reduced the mean total axillary drain output and resulted in early drain removal compared with routine axillary dissection. There were no significant differences in the nodal yield, operative time, seroma aspirations, and wound complications between the endofascial and routine axillary dissection groups.

Telescopic dissection versus balloon dissection during laparoscopic totally extraperitoneal inguinal hernia repair: A prospective randomised control trial.

Totally extraperitoneal (TEP) repair involves creating a preperitoneal space. The preperitoneal space can be created by balloon or telescopic dissection (TD). Nevertheless, these techniques may have some complications. However, there are very few studies that compare these two techniques. This study aims to assess the impact and comprehensively compare the TD and balloon dissection (BD) methods in patients undergoing laparoscopic TEP inguinal hernia repair. This was a single-centre, double-blinded, prospective, randomised, controlled trial comparing BD and TD for the creation of the preperitoneal space. The primary end point was to compare the post-operative pain score, intraoperative complications and surgical site occurrence between the two groups. The secondary end point was to assess the impact of the dissection technique on operative time for the creation of extraperitoneal space during laparoscopic TEP inguinal hernia repair. A total of 46 patients were included in the study (23 in each group). Baseline parameters were comparable between the groups. The total operative time between the groups (120 min vs. 160 min; P < 0.005) was statistically significant. The incidence of the peritoneal breach was statistically less in the BD group (43% vs. 13%; P < 0.005). Other short-term and long-term complications were less in the BD group but not statistically significant. BD in TEP inguinal hernia repair reduces the operative time and peritoneal breach. When compared to TD in terms of operative time, routine use of BD can be proposed. It will be beneficial in the early part of the learning curve.

New Technique of Glenohumeral Joint Dissection

Objectives: Glenohumeral is a ball and socket type of synovial joint which permits a wide range of movement. During the typical shoulder joint dissection, we are unable to see the intracapsular view of shoulder joint. Methods: A dissection technique that was performed in Sharir Rachana Dept. of NIA, Jaipur, which exposes the glenohumeral joint's internal capsule, the glenoid labrum, the proximal insertion of the long head of the biceps tendon, and the surfaces of the joint while protecting the posterior aspect of the capsule and the surrounding muscles and tendons that support the joint. Results: This new dissection method allowed the preservation of glenohumeral joint structures and provides a better understanding of its intracapsular view and related structures. Conclusion: The glenohumeral joint can be dissected using this new technique, by which we can prevent the damage to the structures that surround it and enabling visualization of its intracapsular view.

A New Multiplane Dissection Method for Frontotemporal Lift and Fixation.

Lifting procedures of the upper face have gained significant popularity, and various methods and dissection planes have been described. The deep temporalis fascia (DTF) is a crucial structure for securing lifting sutures and allowing horizontal tissue vectorization. However, achieving vertical eyebrow lifting often requires bone maneuvers and introduces potential complications. This letter proposes a novel multiplanar dissection method for the temporal and forehead regions, obviating the need for bone maneuvers in lifting suture fixations. The presence of the subgaleal fascia in the temporal region has been identified, in addition to the DTF and superficial temporal fascia. Furthermore the superficial temporal fascia is divided into 3 layers, with attention paid to their medial connection with the structures of the forehead. Surgical techniques involve meticulous dissection down to the DTF and identification of the subgaleal fascia for lateral temporal dissection or transition to the subplane of the epicranial aponeurosis for forehead lifting. By leaving a thick layer, the subplane of the epicranial aponeurosis during forehead lifting eliminates the need for drilling and reduces the risk of relapse. The described multiplanar dissection method enhances the safety and effectiveness of forehead lift procedures, offers a viable alternative to bone drilling, minimizes flap-related complications, and provides valuable insights for facial rejuvenation surgery.

Enhancing Learning Opportunities in Laboratory Science Using Virtual Reality Lessons: A Use Case

Animal dissections are a common approach to teaching anatomy and physiology, but they are costly, pose safety risks, and raise ethical concerns. Alternatives like computer simulations and synthetic specimens have been explored, but they lack the realism of live dissections. Virtual reality (VR) technology provides a promising solution by immersing learners in a virtual environment that closely mimics real-life dissections and allows for skill development and feedback. VR also removes ethical and emotional concerns associated with dissections and enhances learning opportunities. To explore the effectiveness of VR in anatomy and physiology education, we conducted a detailed survey of 48 students in an undergraduate physiology laboratory course. The survey, administered before and after students performed both a VR frog dissection and an in-person frog dissection, was designed to gauge their perceptions, preferences, and learning experiences with both methods. Results indicate that while no participants considered VR a perfect substitute, a majority (80%) still viewed animal dissections as an essential part of science laboratory courses. Interestingly, 43% of participants expressed a stronger preference for live dissections post-experiment, citing greater excitement and perceived informativeness. In contrast, 25% favored VR or alternative methods, highlighting increased comfort and reduced discomfort. A recurring theme was VR's role as a preparatory or alternative tool for those hesitant towards live dissection. This study underscores VR's potential in addressing traditional dissection methods' limitations and emphasizes the need for further research into VR's effectiveness in anatomy and physiology education. We aim to foster dialogue on the use of alternative technologies in enhancing learning opportunities within laboratory and clinical sciences. This project was funded by the Department of Physiology at Michigan State University. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Para Incisional Quadrant Saving Dissection in Refractive Lenticule Extraction for Myopia by Reverse Pull using Shearing Applied Force Extraction (SAFE)

There is no standard technique of lenticule separation in Refractive Lenticule Extraction (ReLEx) or Small Incision Lenticule Extraction (SMILE) procedure used for spectacle number treatment by Laser. We present a unique method of lenticule dissection using reverse pull by shearing applied force extraction (SAFE) to ensure complete removal of the lenticule with minimal postoperative inflammation. This technique keeps the lenticule under control of the operating surgeon throughout the dissection. Random separation of lenticule may leave a part of the lenticule attached to the periphery. Separated lenticule overrides the attached part of lenticule. This reduced visibility of the attached part makes further separation difficult and causes excessive manipulation, consumes more time, leads to inflammation and may cause incomplete lenticule removal. This new technique ensures safe and full removal of the lenticule irrespective of its thickness (thin lenticule is difficult to identify and separate while thick lenticule tends to get accumulated on one side) and improves postoperative outcome.

Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach

BackgroundAn alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level. MethodIn GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in <20 % of the cases (N = 150,119), in 20–79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time. ResultsNo difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14–0.86]) and gallbladder perforation (OR 0.61 [0.45–0.82]) were significantly lower in the “fundus first > 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]). ConclusionIn this study including >160,000 cholecystectomies, both methods was found to be equally safe. Key messageDuring laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.

Three-dimensional imaging to estimate in vivo body and carcass chemical composition of growing beef-on-dairy crossbred bulls

The dynamics of cattle body chemical composition during growth and fattening periods determine animal performance and beef carcass quality. The aim of this study was to estimate the empty body (EB) and carcass chemical composition of growing beef-on-dairy crossbred bulls (Brown Swiss breed as dam with Angus, Limousin or Simmental as sire) using three-dimensional (3D) imaging. The 3D images of the cattle’s external body shape were recorded in vivo on 48 bulls along growth trajectory (75–520 kg BW and 34–306 kg hot carcass weight [HCW]; set 1) and on 70 bulls at target market slaughter weight, including 18 animals from set 1 (average 517 ± 10 kg BW and 289 ± 10 kg HCW; set 2). The linear, circumference, curve, surface and volume measurements on the 3D body shape were determined. Those predictive variables were used in partial least square regressions, together with the effect of the sire breed whenever significant (P < 0.05), with leave-one-out cross-validation to estimate water, lipid, protein, mineral and energy mass or proportions in the EB and carcass. Mass and proportions were determined directly from postmortem grinding and chemical analyses (set 1) or indirectly using the 11th rib dissection method (set 2). In set 1, bulls’ BW and HCW were estimated via 3D imaging, with root mean square error of prediction (RMSEP) of 12 kg and 6 kg, respectively. The EB and carcass chemical component proportions were estimated with RMSEP from 0.2% for EB minerals (observed mean 3.7 ± 0.2%) to 1.8% for EB lipid (11.6 ± 4.2%), close to the RMSEP found for the carcass. In set 2, the RMSEP for estimation via 3D imaging was 9 kg for BW and 6 kg for HCW. The EB energy and protein proportions were estimated, with RMSEP of 0.5 MJ/kg fresh matter (10.1 ± 0.8 MJ/DM) and 0.2% (18.7 ± 0.7%), respectively. Overall, the estimations of chemical component proportions from 3D imaging were slightly less precise for both sets than the mass estimations. The morphological traits from the 3D images appeared to be precise estimators of BW, HCW as well as EB and carcass chemical component masses and proportions.

Clinical Anatomy of the Ligaments of the Face and Their Fundamental Distinguishing Features.

Our study aimed to clarify the anatomical features of the zygomatic, upper masseteric, lower masseteric and mandibular ligaments and their possible contribution to age-related gravitational ptosis. The study was carried out by the method of layered dissection of fresh cadavers. In several observations, the zygomatic ligament is represented by the fibers originating from the zygomaticus major muscle fibers. It is a true ligament with the fibers inserted directly into the skin. The upper and lower masseteric ligaments originate from the parotideomasseteric fascia and weave into the thickness of the SMAS. The mandibular ligament consists of two connective tissue laminae originating from the parotideomasseteric fascia at the lower edge of the mandible and from the inner surface of this fascia, along the anterior edge of the masseter muscle, skirting the facial vein sheath and the facial artery, traveling toward the platysma and the depressor anguli oris muscle, and merging with their fibers. The zygomatic ligament should be considered an osteo-musculocutaneous ligament, emphasizing the role of the associated zygomaticus major muscle in the mechanism of aging. The upper and lower masseteric and mandibular ligaments are false fascio-SMAS ligaments rather than osteo-cutaneous ones, playing the barrier role and fixing the superficial fascia and the platysma muscle.

Post-Tonsillectomy Pain:Is Cold Steel Dissection Method or Bipolar Diathermy Dissection Method is less Painful?

Background: Pain is one of the sequel of tonsillectomy, as reported in various studies. Tonsillectomy can be done by various methods, so aim of the present study is to evaluate pain of tonsillectomy comparing cold steel dissection method with bipolar diathermy method.Objective: To evaluate post-tonsillectomy pain comparing cold steel dissection method with bipolar diathermy method.Material and Methods: This prospective, randomized, controlled trial was conducted in ENT Department, from 18th January 2021 to January 30th 2022. Post tonsillectomy pain was measured by using visual analogue scale which consists of a 10 cm line with score of 10 means worse pain and score of zero means no pain. In this study a total sample size was 186 patients (i.e. 93 in each group), who were observed by taking the following parameters. Mean ± SD of group A (bipolar diathermy group) = 2.27 ± 1.25. Mean ± SD of group B (cold steel dissection group) = 1.59 ± 1.59. Confidence interval (2-sided) =95%. Power=90%. More over consecutive (nonprobability) sampling technique was used for sample collection.Results: In bipolar dissection group (38%) patients were male and (62%) patients were female. Where as in cold dissection group (40%) patients were male and (60%) patients were female. The mean pain score at 24 hours, 2ndpost operative day, 7th post operative day among two groups was analyzed. In bipolar dissection group, mean pain score at 24 hours was 3.5 ± 0.66, mean pain score at 2nd post operative day was 2.93 ± 0.73 and mean pain score at 7th post operative was 1.59 ± 1.02. Where as in cold dissection group, mean pain score at 24 hours was 3.33 ± 0.53 with a p value of 0.0543, mean pain score at 2ndpost operative day was 2.34 ± 0.60 with a p value of 0.0001and mean pain score at 7th post operative was 1.46 ± 0.82 with a p value of 0.3394.Conclusion: Our study concludes that mean pain score is less in cold steel dissection tonsillectomy as compared to bipolar diathermy tonsillectomy.Keywords: Analogue pain scale, Surgical Diathermy, Tonsillectomy.

Cavitron ultrasonic surgical aspirator (CUSA) compared with conventional pancreatic transection in distal pancreatectomy: study protocol for the randomised controlled CUSA-1 pilot trial

BackgroundPostoperative pancreatic fistula (POPF) remains the most common and serious complication after distal pancreatectomy. Many attempts at lowering fistula rates have led to unrewarding insignificant results as still up to...

CVS: An Effective Strategy to Prevent Bile Duct Injury

Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting. Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.

A prospective randomized trial comparing the pocket-creation method and conventional method of endoscopic submucosal dissection in early gastric cancers and precancerous lesions

BackgroundEndoscopic submucosal dissection (ESD) is widely used as a standard treatment regimen for early gastric cancers (EGCs). However, such an approach is time consuming and has a high risk of perforation and bleeding in some corner-site lesions because of the obscured view and difficulty in submucosal lifting. The newly developed pocket-creation method (PCM) provides a clearer view and better traction of the submucosal layer than conventional ESD (c-ESD). Nevertheless, no prospective randomized study has evaluated the efficacy of the PCM in EGCs and precancerous lesions. MethodsThis was a prospective randomized controlled trial. Patients with superficial gastric neoplastic lesions ≥ 20 mm were randomly assigned to the PCM-ESD group or c-ESD group. The primary outcome was dissection speed. ResultsThere were 28 patients in the PCM-ESD group and 27 in the c-ESD group. The median dissection speed was significantly higher in the PCM-ESD group than in the c-ESD group (21.5 mm2/min vs 14.3 mm2/min, P < .001). Meanwhile, the operation time in the PCM-ESD group was significantly shorter than that in the c-ESD group (30 vs 40 min, P = .047). In multiple linear regression analysis, the treatment method was independently associated with the resection speed of ESD. ConclusionPCM-ESD was an effective and safe treatment for EGCs and precancerous lesions.