Encircling Suture Research Articles

Potential Surgical Exposure of the Parapharyngeal Internal Carotid Artery by Endonasal, Transoral, and Transcervical Approaches.

Objectives Endoscopic and endoscopic-assisted approaches to the parapharyngeal space have been reported; however, their potential for vascular exposure has not been previously assessed. This study aims to compare the potential exposure and control of the parapharyngeal internal carotid artery (ppICA) via various approaches. Design and Main Outcome Measures Ten cadaveric specimens were dissected bilaterally, exposing the ppICA via endonasal, transoral, and transcervical approaches. Length of the exposed vessel and potential control were assessed (feasibility and time required to place an encircling suture). Results Endoscopic transoral and transcervical-transmandibular approaches expose a significantly longer segment of the ppICA (6.89 and 7.09 cm) than the transoral and endonasal approaches. Vascular control was achieved via endoscopic-endonasal, endoscopic-transoral, and open techniques in 121.6, 64.8, and 5.2 seconds, respectively. Conclusion Histopathology, goals of surgery, and familiarity of the surgeon with each technique may ultimately determine the choice of approach; however, this study suggests that exposure of the ppICA by endoscopic-assisted transoral approach is comparable to that of a transcervical-transmandibular approach. Vascular control was feasible under elective circumstances. However, the difficulty varied widely, potentially reflecting the challenges of controlling an injured ppICA. However, one must note that active bleeding obscures the surgical field in ways that may impair ppICA control. Furthermore, the results may not reflect clinical scenarios where tumor distorts the surgical field. Nonetheless, the study suggests that, in properly selected patients, the endoscopic-assisted transoral approach avoids problems associated with unsightly scars, mandibular osteotomy, and facial nerve manipulation, whereas, the transcervical-transmandibular approach offers the swiftest vascular control.

Submucosal endoscopy as an aid to full-thickness resection: pilot study in the porcine stomach

Endoscopic full-thickness resection (EFTR) is commonly performed with laparoscopic assistance. Submucosal endoscopy with full-thickness resection (SEFTR) is a new technique that combines submucosal endoscopy with the mucosal safety valve flap method to enable EFTR. Pilot evaluation of the feasibility and safety of SEFTR in an animal model. Invivo animal study. Developmental endoscopy unit/animal research unit. Five domestic pigs, under general anesthesia, were used. A 2-cm gastric target area was marked. Acircumferential mucosal incision was made. Two parallel submucosal tunnels on opposite sides of the incision were made. The mucosa at the proximal and distal tunnel ends was cut. A suture was passed through the tunnels encircling the target. T bars with sutures were placed full thickness outside the target and brought out of the mouth. Pulling the oral sutures raised the target while the targeted area was cinched serosa to serosa with the encircling suture. Full-thickness excision was then performed without closure. Rate of adverse events, procedure times, adverse events, and difficulty scales were recorded prospectively. Circumferential mucosal incisions, submucosal tunnels, and connections were completed in all. In the first case, looping of the target lesion failed. In the remaining 4 cases, looping, cinching, and lifting were completed. Full-thickness resections were completed in 3 of 4 pigs. There were no procedural adverse events and no damage to adjacent organs. Acute animal study. Procedures were performed by an endoscopist skilled in the submucosal endoscopy with the mucosal safety valve flap method. This pilot experience suggests that SEFTR is feasible and could be safe.

A variant technique for the surgical treatment of left ventricular aneurysms.

ObjectiveTo present a surgical variant technique to repair left ventricular aneurysms.MethodsAfter anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations.ResultsRegarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema.ConclusionThe technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms.

Effectiveness of a bipolar vessel sealant device for sealing uterine horns and bodies from dogs

To compare the bursting strength of a vessel sealant device (VSD) with that of an encircling suture on uterine horns and bodies from dogs. Uteri from 24 shelter dogs with unknown reproductive histories. PROCEDURES-Uterine horns and bodies were allocated to groups to be sealed with suture or a VSD. Uteri were then infused with saline (0.9% NaCl) solution until the seals burst or the uteri reached a maximal pressure of 300 mm Hg. Variables recorded included dog age, uterine body and horn diameter, and maximal pressure. RESULTS-The median (range) bursting pressure reached in sealed uterine horns was 300 (0 to 300) mm Hg for the VSD group and 300 (200 to 300) mm Hg for the suture group. Within the VSD group, seals of 2 of 3 uterine horns with a diameter ≥ 9 mm burst before intraluminal pressure reached 100 mm Hg, compared with 1 of 21 uterine horns with a diameter < 9 mm. The median bursting pressure for uterine bodies was 237 (0 to 300) mm Hg for the VSD group versus 300 (175 to 300) mm Hg for the suture group. Within the VSD group, seals in uterine bodies with a diameter ≥ 9 mm failed at a significantly lower pressure (125 [0 to 125]) mm Hg than those with a diameter < 9 mm (275 [125 to 300]) mm Hg. CONCLUSIONS AND CLINICAL RELEVANCE-The failure pressure for both sealing techniques was high, which indicated that the VSD may be a safe instrument for sealing the uterine horn in dogs. Given the low mean bursting pressure for seals in uterine bodies with large diameters, the VSD cannot be recommended for sealing uterine bodies ≥ 9 mm in diameter.

Intraocular Erosion and Intrusion of an Arruga Encircling Suture

Intraocular Erosion and Intrusion of an Arruga Encircling Suture

Balloon sizing in surgical ventricular restoration: What volume are we targeting?

Surgical ventricular restoration (SVR) by endoventricular circular patch plasty was described by Dor and colleagues as a new approach to treat patients with left ventricular (LV) aneurysm. Over time, this technique was optimized, and most centers currently use an intraventricular balloon to standardize volume and shape of the residual cavity. During SVR, the left ventricle is opened through the infarct, and an endocardial encircling suture (Fontan stitch) is placed at the transitional zone between scarred and normal tissue. Next, the balloon is introduced into the left ventricle and filled with 50 to 60 mL saline per square meter of body-surface area. The Fontan stitch is tightened to approximate the ventricular wall to the balloon, and the residual orifice is closed with a patch. Subsequently, the excluded scar tissue is closed over the patch to ensure hemostasis. The guiding principle behind this operation is the concept that SVR reduces wall stress (according to Laplace’s law) leading to reduced oxygen demand and improved function of the healthy remote myocardium. The balloon technique is generally considered to produce more consistent and more predictable results with improved clinical outcome. One of the first papers to describe balloon sizing mentioned that the balloon was inflated to check that the new LV diastolic volume was between 50 and 70 mL/m. Recently, Dor and associates reported a tighter range of 50 to 60 mL/m and explained that the balloon should help to avoid excessive volume reduction, which might cause impaired diastolic function and restrictive cardiomyopathy. The technique is referred to as ‘‘diastolic volume balloon sizing,’’ but the basis for selecting this specific target volume range was not explicitly mentioned. To put the values in perspective, recent magnetic resonance imaging studies indicate a normal end-diastolic volume index (EDVI) of 74 15 mL/m in men and 65 11 mL/m in women with, respectively, 25 9 mL/m and 18 5 mL/m for indexed end-systolic volume (ESVI). Furthermore, a 20% increase in EDVI after myocardial infarction is considered to indicate remodeling, and an ESVI>60 mL/m is associated with advanced

Uso do adesivo de fibrina na anastomose esôfago-esofágica cervical, em cães

OBJETIVO: Estudar os efeitos da associação do adesivo cirúrgico de fibrina à técnica operatória da invaginação submucosa, em anastomoses esofagianas. MÉTODO: Trinta e dois cães submetidos à anastomose esôfago-esofágica foram alocados em dois grupos: I com sutura em doze pontos e II com sutura em quatro pontos e vedação com adesivo de fibrina. Os animais foram avaliados no sétimo e décimo-quarto dias de pós-operatório. Foram analisados: a evolução ponderal, o índice de estenose, a incidência de deiscências e fístulas, a presença de secreções na tela subcutânea, a presença de líquido intersticial, matriz protêica, celularidade, fibroblastos, fibras de colágeno e concentração de hidroxiprolina. RESULTADOS: O índice de estenose foi menor para os animais do grupo I no sétimo dia de observação. Nos animais do grupo II a incidência de deiscências, secreção serosa e purulenta foram signitivamente maiores aos sete e quatorze dias, enquanto a presença de fístulas foi maior no sétimo dia. Quanto à concentração tecidual de hidroxiprolina não houve diferença estatística entre os grupos. Os fibroblastos e fibras de colágeno tiveram presença mais acentuada no grupo II no décimo-quarto dia. Ocorreram quatro óbitos em animais do grupo II. CONCLUSÕES: A anastomose por invaginação submucosa-mucosa com vedação com adesivo de fibrina apresentou piores resultados que a anastomose convencional de doze pontos circunferenciais.

Operatives Management der cornualen Gravidität - Fallbericht und Übersicht

Die cornuale Gravidität ist eine seltene und potenziell lebensbedrohliche Form der extrauterinen Schwangerschaft, die den interstitiellen Anteil der Tuba uterina betrifft. Das Hauptrisiko besteht in schweren intraabdominalen Blutungen. Allgemein gültige Therapieempfehlungen zum Management dieser Sonderform existieren nicht. Im beschriebenen Fall wurde durch eine spezielle laparoskopische Nahttechnik ein exzellenter Tourniquet-Effekt durch lokale Ischämie ausgenutzt und eine suffiziente Hämostase gesichert. Das therapeutisch-operative Vorgehen sowie weitere mögliche Therapiemodalitäten, beispielsweise die primäre Methotrexatapplikation, werden erörtert.

New simple endoscopic operations for interstitial pregnancies

Objectives: Our aim was to report a new approach of endoscopic management (endoloop and encircling suture methods) for interstitial or cornual pregnancy and to determine the safety and effectiveness of these procedures and their effects on subsequent pregnancies. Study Design: This is an uncontrolled retrospective review of 24 patients treated for interstitial pregnancies through endoscopic operations with 14 to 72 months of follow-up at a large urban medical center. Blood loss, operation time, changes of serum human chorionic gonadotropin levels, the resumption of menstruation, and subsequent pregnancy after operation were analyzed. Results: Among 24 interstitial pregnancies, 3 had ruptured at the time of operation and 21 had not ruptured. Treatment consisted of either the vasopressin and electric cauterization method, the endoloop before evacuation of the conceptus method, or the encircling suture before evacuation of the conceptus method. The blood loss and operation time (mean ± SD) for unruptured cases were 133 ± 134 mL and 51.6 ± 7.6 minutes in the vasopressin and electric cauterization group (n = 3), 32 ± 22 mL and 28.5 ± 6.4 minutes in the endoloop group (n = 15), and 40 ± 17 mL and 35.0 ± 5.0 minutes in the encircling suture group (n = 3). In 3 patients with ruptured pregnancy treated with the endoloop method, the blood loss and operation time (mean ± SD) were 1100 ± 854 mL and 82.5 ± 51.6 minutes. Any of these operative methods resulted in rapid decline of serum human chorionic gonadotropin levels within 1 week with the exception of 1 case, in which the endoloop method was used; this patient needed additional treatment with methotrexate. Seventeen patients desired pregnancy in the future, and 15 eventually became pregnant. One of these 15 pregnancies ended in an ectopic pregnancy on the opposite side 6 months after the interstitial pregnancy. Three ended in a spontaneous abortion, and 11 were delivered by elective cesarean section at term before labor started. Operative records of cesarean section in 8 patients delivered at our institution showed little or no adhesions or defect in the cornual area of the previous operation. Conclusion: The endoloop method and the encircling suture method are simple, safe, effective, and nearly bloodless. There were no uterine ruptures in the pregnancies subsequent to these methods of endoscopic management. (Am J Obstet Gynecol 2000;182:114-21.)

Ornipressin in cold knife cone biopsy of the cervix

SummaryCold knife cone biopsy using ornipressin and a cervical encircling suture is described. Case notes from 81 patients using this technique were studied retrospectively. The 3-7 per cent incidence of haemorrhage requiring hospital re-admission compared very favourably with other surgical techniques used.

Iatrogenic Right Ventricular Failure in Tetralogy of Fallot Repairs: Reappraisal of a Distressing Problem

A patient with tetralogy of Fallot experienced isolated right ventricular failure when the right coronary artery was occluded by an encircling suture at the time of closure of the ventricular septal defect. Recognition and correction of the problem allowed weaning from cardiopulmonary bypass and an uneventful recovery. Because ventricular septal defects in tetralogy of Fallot are usually anterior and subaortic, injury to the right coronary artery, in close proximity to the superior aspect of the defect, is a potential danger. When isolated right ventricular failure occurs immediately after repair, suture occlusion of the right coronary artery should be considered as a possible cause.