Incision Procedure Research Articles

Prevalence and Economic Significance of Cystic Hydatidosis: Bovine at Kombolcha Elfora IndustrialAbattoir, North Wollo, Ethiopia

A cross-sectional study design was conducted out from July 2014 to September 2015 Kombolcha ELFORA industrial abattoir to assess the prevalence of hydatid cyst in slaughtered cattle through post mortem inspection procedure of visualization, palpation and incision of vital organs. During study period there were 384 cattle examined by random sampling data collection method. Among 384 examined slaughtered in the abattoir 53 (13.8%) were found harboring hydatid cyst. There were variation in prevalence rate among different geographical location could be do to strain difference of echinoccus granulosus that exist in different geographical location, culture of people, social activities and probably physiological activities of cattle, health condition and duration of exposure time were contributed for infestation. Hydatid cyst were predominantly in lung and liver representing 10% and 6% respectively, because the lung and liver posses greater capillary field which allows these organs efficiently filter the ingestion oncospher from blood liver and lung undergo sequential which is followed by pulmonary filtration action before other are invaded. Higher percentage of hydatid cyst in the lung compared to liver because lung tissue has soft consistency relatively lower reticulo endothelial cell and less abundant connected tissue.

A Case of Intratarsal Keratinous Cyst of the Meibomian Gland

Purpose: To report a patient presenting with an intratarsal keratinous cyst of the Meibomian gland in the upper eyelid and a review of the relevant literature. Case summary: A 65-year-old male presented with a right upper eyelid mass which started 5 months prior. The patient reported that the mass recurred several weeks prior even after incision and curettage procedure. The mass was 9 x 5 mm in size and located in the center of the right upper eyelid at the level of lid crease, fixed to the tarsus and a whitish elevated focus was observed at the palpebral conjunctival surface. The mass was excised under local anesthesia and originated from the tarsus. The histopathological examinations revealed an intratarsal keratinous cyst composed of stratified squamous epithelium without keratohyalin granules and filled with keratin. The immunohistochemical studies showed positive staining results for cytokeratin 5/6, epithelial membrane antigen, and carcinoembryonic antigen. Conclusions: Intratarsal keratinous cyst of the Meibomian gland should be considered as a differential diagnosis of a recurrent tarsal mass. J Korean Ophthalmol Soc 2015;56(1):109-113

Dešiniosios hemikolektomijos vieno pjūvio laparoskopinė operacija: dviejų atvejų aprašymas

Vieno pjūvio chirurginės procedūros vystosi kaip minimaliai invazinės chirurgijos dalis. Dešinioji hemikolektomija, atlikta SILS būdu, pirmą kartą aprašyta 2008 metais. Mes aprašome pirmąsias dvi laparoskopines transumbilikalines vieno pjūvio dešiniąsias hemikolektomijas, atliktas Vilniaus universiteto ligoninėje Santariškių klinikos.

Severe Neutropenia Presenting With Candida Albicans Eyelid Abscess in a 1-Year-Old Child

A previously healthy 1-year-old boy presented with a right lower eyelid abscess. Oral and topical antibiotics were initiated, and the lesion was drained and explored. Despite medical and surgical treatment, the abscess failed to resolve completely and formed again 1 month later. A second incision and drainage procedure was performed, and Candida albicans grew in cultures. Additional workup revealed severe neutropenia with an absolute neutrophil count of 0.18 k/μl (1.19-7.21 k/μl). The abscess resolved after 2 weeks of oral fluconazole. C. albicans eyelid abscess may be the presenting sign of systemic immunodeficiency.

Corneal coupling of astigmatism applied to incisional and ablative surgery

To redefine measures of corneal coupling for use with incisional and ablation procedures for astigmatism. Private clinics, Melbourne, Victoria, Australia. Retrospective nonrandomized study. The measures known as the coupling ratio (CR) and coupling constant (CC) were redefined to ensure validity in most cases of incisional procedures and laser vision correction procedures. In addition, a new measure--the coupling adjustment (CAdj)--was developed to quantify the amount of spherical adjustment that must be applied to compensate for coupling that occurs as a result of astigmatism treatment. These quantitative measures of coupling were applied to retrospective data to show their applicability. Pure myopic, compound myopic, and compound hyperopic astigmatism excimer laser treatments showed a CR close to zero, a CC close to 0.5, and a CAdj close to zero. Incision LRIs showed a CR close to 1.0 and a CC close to zero. In all cases, the coupling measures were consistent for treatments with a larger astigmatic component (>1.0 diopter) but variable when the astigmatic component of the treatment was smaller. The revised definitions of CR and CC can be used with incisional and ablative surgery. Incorporating the CAdj into the planning of spherocylindrical treatments allows one to factor in the effect of the astigmatic treatment on the spherical component and thus to more accurately target the desired spherical equivalent. Dr. Alpins and Mr. Stamatelatos have a financial interest in the Assort software program. Dr. Ong is an employee of Assort.

Abstract 1665: Biopsy induced metastasis: Role of SOX4/TGF-β driven EMT and immunosuppressive microenvironment

Abstract As a consequence of advances in digital diagnostic imaging, breast cancers are being diagnosed earlier in their development. These smaller tumors are less likely to be metastatic at time of discovery. The majority of newly diagnosed breast cancers in North America are confirmed using an incisional core needle biopsy (CNB). However an increasing number of studies highlight the pro-metastatic inflammatory and microenvironment changes occurring after incisional procedures on breast cancer tumors. This may account for reported higher incidences of lymph node metastases with increased risk of local recurrence and distant metastasis among patients undergoing incisional procedures. Evidence from our studies using a metastatic mouse model shows that incisional core needle biopsies lead to increased pulmonary metastasis. To study the mechanism(s) involved we monitored changes in circulating tumor cells (CTC), cytokine levels, variations in gene expression, microenvironment alteration and pulmonary metastatic burden, following CNB. Gene expression analysis by real-time qPCR showed increased TGF-β expression accompanied by SOX4 upregulation at 3 hours post biopsy (SOX4 is a Master regulator of EMT). This was followed, at 24 hours post biopsy, by significantly increased levels of the SOX4-associated Ezh2 gene and other EMT genes (ZEB2, SNAI2, SNAI3, and CDH2). Monitoring of CTCs over the same time frame showed them to be significantly increased in biopsied mice from 6 to 24 hours post biopsy, indicating continual CTC egress from biopsied tumors. Flow cytometry analysis of tumor microenvironment showed an immunosuppressive microenvironment with increased MDSC levels, reduced CD4+ and CD8+ T cells, macrophage and NKT cell. Interestingly, similar analysis of the Lung microenvironment 4 days later (day 7 post biopsy) revealed an inversion of the tumor situation, in the form of a significant uptick in Th1 type changes described by increased CD4+ and CD8+ type T cells, macrophages and NK cells, as well as increased TNF-β gene expression indicators corresponding to an early response to growth of metastases. We also compared H&E stained histological sections of lungs from biopsied and un-biopsied mice and recorded significant increase in pulmonary metastasis for the biopsied group. The findings of our study indicate that performance of CNB results in increased metastasis with immunomodulation of the tumor microenvironment and unregulated SOX4/TGF- β. Additional studies are needed to further elucidate the mechanism, and explore mitigating strategies to counter CNB related metastasis. Citation Format: Edward G. Mathenge, Cheryl Dean, Derek Clements, Ahmad Vagharkashani, Steffany Photopoulos, Krysta Coyle, Benjamin A. Malueth, Mike Giacomantonio, Anna Nunokawa, Julie Jordan, Shashi Gujar, Paola Marcato, Partick Lee, Carman A. Giacomantonio. Biopsy induced metastasis: Role of SOX4/TGF-β driven EMT and immunosuppressive microenvironment. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1665. doi:10.1158/1538-7445.AM2014-1665

Preliminary experiences of endoscopic CO₂ laser cauterization for treatment of congenital pyriform sinus fistula

To evaluate the effectiveness of endoscopic CO₂ laser cauterization (ECLC) as a definitive treatment of congenital pyriform sinus fistula (CPSF). Eleven patients with CPSF underwent ECLC between January 2011 to March 2013 at Guangdong General Hospital. Of the 11 patients aging from 20 to 672 months (median: 60 months), there were 4 males and 7 females; 10 lesions located in the left necks and 1 located in the right; 6 untreated previously and 5 recurrent; 10 sinus (with internal opening) and 1 fistula. The presentations included reduplicative neck swelling, pain, or a fistulous opening with purulent discharge at the anterior neck region. Preoperative examinations included barium esophagogram, CT, MRI and so on. Six patients had at least received one time incision and drainage procedure previously. All patients had been treated with antibiotics in acute infection period. After inflammation subsided, the openings of pyriform sinus fistula were confirmed by esophagoscopy and then ECLC on internal opening was routinely performed.Esophagoscopy was carried out again by 3 months later in every patient, the same technique would be performed immediately if the internal opening was not completely closed. The existence of an orifice in the pyriform fossa was identified by esophagoscopy in 11 patients. In 9 patients, the treatment was successful and the internal opening completely closed after the first ECLC. However, the other 2 patients received the second cauterization 3 months later because of the incomplete close of the internal opening. The average number of treatments was 1.2 times. No complications such as dysphagia, hoarseness occurred with the endoscopic procedure. Both the patients and their families were satisfied with the cervical appearance. All the patients had an uneventful recovery and remained no symptom from 11 to 35 months (median: 24 months). The endoscopic CO₂ laser cauterization is safe, effective, repeatable and minimally invasive, which can be suggested as first-line treatment for congenital pyriform sinus fistula.

Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique

Objectives:Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear.Methods:A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials database to identify articles reporting distal biceps ruptures through August 2013. We included English language publications based on adult patients with a minimum of three cases. Both single and dual incision technique studies were incorporated. The demographic and outcome data of all studies was retrieved and pooled. A Meta-analysis on the pooled data was then conducted to determine the role of surgical technique on different complications. This was adjusted for age, gender and other independent variables.Results:Fifty-five articles met the inclusion criteria. The complication rate in the single incision group was 28.3% (222/785) versus 20.9% (104/498) in the double incision group. Neuropraxia was the most common complication in the single incision group at 9.8% (77/785), while heterotopic ossification was the most common in double incision cases at 7% (35/498). Re-rupture and failed reattachment occurred in 2.5% of single incision cases, versus 0.6% of double-incision cases (p < 0.034). Posterior interosseous nerve (PIN) palsy occurred in 2.7 % (13/785) of single incision procedures versus 0.2% (1/498) in the double incision group (p< 0.001). When combining heterotopic ossification and synostosis rates, the double incision group demonstrated complications in 9.8% of cases versus 3.2% for single incision cases.Conclusion:Surgical intervention for distal biceps ruptures may help restore function to an active individual; however, this procedure is not without risk of complications. The single incision technique has a higher rate of failed re-attachment and re-rupture compared to the double incision technique. The single incision technique also has a higher rate of overall nerve palsy (PIN, LABC, and Radial Nerve) compared to the double incision technique. The double incision technique does have higher rates of HO compared to the single incision. These complications are important for surgeons to consider and disclose to patients deciding on operative repair.

MP9-13 NEW INSIGHT INTO POST-ROBOTIC PROSTATECTOMY BLADDER NECK CONTRACTURE: THE ROLE OF EXTRUDED HEMOLOCK CLIPS

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2014MP9-13 NEW INSIGHT INTO POST-ROBOTIC PROSTATECTOMY BLADDER NECK CONTRACTURE: THE ROLE OF EXTRUDED HEMOLOCK CLIPS Alla Hamada and Sanjay Razdan Alla HamadaAlla Hamada More articles by this author and Sanjay RazdanSanjay Razdan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post radical prostatectomy bladder neck contracture (BNC) is moderate to severe scarring process involving urethrovesical (U-V) anastomosis resulting in bladder outlet obstruction. Its incidence has been notably reduced with use of robotic assisted laparoscopic prostatectomy (RALP). Weck clips have been used to ligate lateral vascular pedicles and aid in dissection of neurovascular bundles. OBJECTIVE To examine BNC developed after RALP in terms of prevalence, clinical presentation pattern, cystoscopic findings, possible associated risk factors and response to treatment. METHODS After obtaining IRB approval, the retrospective data of 1718 men with prostate cancer who underwent RALP by a high volume surgeon in the period between May, 2004 and June, 2012 were prospectively analyzed to investigate prevalence and risk factors of BNC. The recorded data included clinical, laboratory perioperative, cystoscopic findings (presence of stricture, extruded Weck Hemolock clips and associated bladder stone), number of contemplated laser bladder neck incision (BNI) procedures and rate of recurrence. In all patients, urethrovesical (U-V) anastomosis was performed using Van-Velthoven technique, utilizing running double-armed 3-0 Monocryl suture. RESULTS Prevalence of post-RALP BNC after a median follow-up period of 24 months, was 43/1718 (2.5%). BNC developed after a mean and median period of 9.9 and 6 months, respectively. Within patients with BNC, two categories were identified based on cystoscopic findings: a) 23 patients (53%) had pure U-V anastomotic stricture related BNC (SRBNC) and b) 20 patients (46.5%) had stricture-Weck clip related BNC (SCRBNC), in which single or multiple Hemolock Weck clips were extruded into the U-V anastomotic region resulting into anastomotic stricture. By comparing both groups, no differences were seen in the analyzed parameters. After undergoing laser BNI and removal of extruded clips, recurrence rates of BNC was higher in the SCRBNC (60%) than in SRBNC group (26%) (p=0.025). Patients with SCRBNC required at least 2.2 procedure per patient vs. 1.3 laser BNI procedure in the SRBNC group (P=0.015). CONCLUSIONS Extruded Hemolock Weck clips into vesico-urethral anastomosis in patients who underwent RALP, constitute significant predisposing factor for nearly half of cases of bladder neck contracture and is responsible for its recurrence. Use of biodegradable clips are encouraged to minimize BNC. Table 1. Shows the preoperative, operative and postoperative parameters of the two categories of BNC. Parameter Pure Stricture Clip Related Stricture P value Patients 23 (53.5%) 20 (46.5%) - Age / years 63.3 61.4 0.46 PSA ng/ml 7.5 8.1 0.7 Gleason score G 3+3=6: 15 (65.2%) 10 (50%) G 3+4=7 or 4+3=7: 8(34.8%) 7 (35%) 0.3 G 4+4=8:0 (0%) 2(10%) G ≥ 4+5=9: 0(0%) 1(5%) Prostate volume /g 42.4 47.9 0.3 Operative time/minute 79.8 77.5 0.2 Prolonged urine leak (>150cc/24hour) 3 1 0.6 EBL/ml 102 115 0.8 Time of presentation/months 8 11.4 0.25 Clinical presentation Retention 5 (21.7%) 2 (10%) LUTS 17 (73.9%) 15(75%) Infection 0 (0) 1(5%) 0.5 Hematuria 0 (0) 1(5%) Recto-urethral Fistual 1(4.3%) 1(5%) Rate of continence after BNI 22/23 (95.6%) 19/20 (95%) 0.9 Associated stone 5 (21.7%) 3 (15%) 0.6 Average and range of number of therapeutic BNI 1.3 (1-3) 2.2 (1-6) 0.015 Proportion of men with recurrence after BNI 6 (26%) 12 (60%) 0.025 Average Follow up/ months 30.4 27.5 0.7 Post-op BCR 0 (0) 2 (10) 0.2 Loco-regional disease 2(8.7%) 4(20%) 0.4 BNI: Bladder neck incision, BCR: Biochemical recurrence, G: Gleason, LUTS: Lower urinary tract symptoms, EBL: Estimated blood loss © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e126-e127 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alla Hamada More articles by this author Sanjay Razdan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

Background: The aim of this study is to compare radial artery with saphenous vein grafts which are widely used for coronary bypass, from views of patients’ satisfaction and postoperative findings. Methods: 42 isolated coronary bypass (CABG) patients performed during November 2012-April 2013 are included in the study. 30 days after the operation, in patients who had both RA and SV removal made responses to a questionnaire form which included 6 questions about symptoms of extremity. Results: After analyzing the responses and physical examination, there was no difference in terms of quality of life and usefulness of the extremity for daily use between two grafts. 2 patients (2%) have wound infection on the saphenous vein incision and additional surgical procedure was performed and a scar tissue has occurred. There was no statistically significance between uncomfortable symptoms and demographic data. Conclusion: Our study suggested that RA graft using showed a bit more comfortable and suitable effect against SV in our patients. We think that radial arterial grafts should be used more widely in coronary surgery with selected patients.

Mechanical properties of PVA material for tissue engineering applications

The paper presents the first scientific study of the quasi-linear viscoelastic (QLV) model of poly(vinyl alcohol) (PVA) sponges. The PVA sponges have been considered as a potential implant material for replacement and repair of the soft tissues, including cartilage, liver and kidney. It is also used in ophthalmic surgical treatment, such as Lasik, cataract and refractive surgeries, to manipulate tissue during incision procedures in the eye to absorb fluid. However, a critical barrier to the use of the PVA sponge as a tissue replacement material is the lack of sufficient mechanical properties. In this study, the non-linear mechanical behaviour of a PVA sponge is investigated experimentally and computationally. A series of tension tests are designed and conducted for the PVA sponge. Hyperelastic strain energy density functions, including Yeoh, Ogden, Mooney–Rivlin and Neo–Hookean, are calibrated using the experimental data. A hyperelastic constitutive model is selected to best fit the axial behaviour of the sponge. Its general prediction ability is verified using finite element simulations of PVA tensile experiments. The results in terms of the maximum stress before the holding for the P sponge demonstrate that it can bear 11·94% and 20·17% more stress compared to the EYETEC and CENEFOM sponges respectively. The swelling ratio of the P sponge was 26·78 and 1·78% more than that of the CENEFOM and EYETEC sponges respectively. Moreover, the Yeoh model was selected to represent the non-linear behaviour of the PVA material, which can be used in future biomechanical simulations of the soft tissues. These results can be utilised to understand the QLV and swelling mechanism of PVA sponges and have implications for ophthalmic and plastic surgeries, as well as wound healing and tissue engineering purposes.

A qualitative risk assessment for visual-only post-mortem meat inspection of cattle, sheep, goats and farmed/wild deer

The UK Food Standards Agency is currently funding research to build the evidence base for the modernisation of meat inspection. This includes an assessment of the risks to public health and animal health/welfare of moving to a visual-only post-mortem meat inspection (PMMI), where routine mandatory palpation and incision procedures are omitted. In this paper we present the results of a risk assessment for a change from current to visual-only PMMI for cattle, sheep/goats and farmed/wild deer.A large list of hazard/species pairings were assessed and prioritised by a process of hazard identification. Twelve hazard/species pairings were selected for full consideration within the final risk assessment. The results of the public health risk assessment indicated that all hazard/species pairings were Negligible with the exception of Cysticercus bovis in cattle, which was judged to be of low-medium increased risk for systems not conforming to criteria as laid down by EC Regulation 1244/2007, compared to systems that do conform to Regulations for visual-only PMMI.Most hazard/species pairings were concluded to pose a potential increased risk to animal health/welfare, including Mycobacterium bovis (very low – low increase in risk, but with considerable uncertainty), Fasciola hepatica (negligible – very low) and Cysticercus bovis (very low – low). Due to low feedback rates to farmers, the real risk to animal health/welfare for F. hepatica and C. bovis, including animals in non-conforming systems under visual-only PMMI, is probably negligible. That then leaves M. bovis as the only confirmed non-negligible animal health and welfare risk.

Circumspinal decompression and fusion through a posterior midline incision to treat central calcified thoracolumbar disc herniation: a minimal 2-year follow-up study with reconstruction CT

PurposeThere have been several surgical approaches used in the treatment of thoracolumbar disc herniation (TLDH) from T10/11 to L1/2. However, central calcified TLDH cases are still challenging to spine surgeons. The anterior transthoracic approaches and lateral/posterolateral approaches are all essentially performed from one side; thus, the compressive lesion and the dura matter on the other side of the spinal canal are not clearly visualized, predisposing the procedure to incomplete decompression or inadvertent cord manipulation. Moreover, a number of these approaches are technically demanding and require entry into the chest. The purpose of this study was to introduce a new surgical procedure—circumspinal decompression and fusion through a posterior midline incision—for the treatment of central calcified TLDH and to evaluate its surgical outcome.MethodsIn this study, 22 patients (15 males and 7 females; mean age 49 years) with central calcified TLDH underwent this procedure between April 2008 and April 2011. Altogether, 26 discs were excised, with two discs at T10/11, eight discs at T11/12, nine discs at T12/L1 and seven discs at L1/2. Of these patients, 16 returned for final follow-up, with a mean follow-up period of 41 months (range 24–57 months). Clinical outcomes, including operative time, blood loss, perioperative complications, post-operative time of hospitalization, neurological status improvement, extent of decompression, back pain, local spinal curvature and fusion, were investigated. The patients’ neurological status was evaluated by a modified Japanese Orthopedic Association scoring system of 11 points. Fusion and the extent of decompression were evaluated by reconstruction CT at final follow-up.ResultsThe mean operative time was 185 min, the mean blood loss was 896 ml and the mean post-operative hospitalization time was 8 days. Four patients suffered perioperative complications, but only two were related to dura violation and none involved the respiratory system. All of the 16 patients who returned for the final follow-up showed improvement, and evidence of improvement was found in five of the other six patients who did not return for final follow-up through telephone interview or earlier follow-up evaluations. Complete decompression was achieved in 12 of the 16 patients who returned for final follow-up. In the 16 patients who returned for final follow-up, back pain was significantly reduced and local spinal curvature remained unaltered. In addition, based on reconstruction CT images, solid fusion was observed in 15 of the 16 patients who returned for final follow-up.ConclusionsThe circumspinal decompression and fusion through a posterior midline incision procedure can be used to treat central calcified TLDH patients with neurological deficits. This method’s greatest advantage is that it is a highly effective and safe procedure for decompression. Although it is a major and destructive procedure, spinal stability was well maintained in most of the cases. In this era when minimally invasive spine surgeries like thoracoscopy have been in an upward trajectory, spine surgeons still should be made aware of this procedure.

Is there any place for relaxing incisions in cataract surgery?

AbstractThe advent of toric IOls has certainly reduced the place of relaxing incisions. On the other hand, the use of femtosecond has significantly improved the easiness, the predictability and safety of the incisional procedure. Moreover the recent innovation of the "femtocataract" offers on some platforms the opportunity to combined relaxing incisions at the time of the crystalline lens removal. We will remind the different modalities for performing these incisions and will focus on disparities concerning the popularity of this surgery from one country to the other. The review of literature will provide the demonstration of the efficacy of incisions for correction of astigmatism especially in case of large cylindrical component such secondary astigmatism after triple procedure graft and cataract removal. We will also underline the interest of femtosecond laser in the refinement of the final outcome and will compare transepithelial versus intrastromal incisions. Of course the debate will be opened with toric IOls and photablation, that in some cases can be more complementary rather than competitive.

Is the right vertical axillary incision an alternative technique to the submammarian incision for the repair of simple congenital heart defects in female patients?

We read with interest the surgical approach of Yan et al. [1] to simple congenital heart defects. The right vertical axillary incision (RVAI) procedure decreased neither cardiopulmonary bypass time nor aortic cross-clamp and hospital stay. The authors claim that they had excellent results, achieving cosmetically satisfactory outcomes in young female patients. Although an objective multiple-choice questionnaire that focused attention on the autoevaluation of the aesthetic result and its psychological influences has been reported previously [2], we could not understand how Yan et al. evaluated patient satisfaction. Meanwhile, it is not stated whether the subgroup analysis was made in terms of age and gender. This approach is recommended for its cosmetic advantages in young female patients, but adult patients in particular, might be dissatisfied regarding the incision of lateral breast tissue. Minithoracotomy with a submammarian incision can be specifically considered a more favourable approach. Contrary to the authors’ comment, breast deformity or asymmetry or any cage deformity will not develop when a careful tissue approximation is performed by the elevation of the breast tissue in young or adult female patients [3, 4]. As stated by the authors, due to poor exposure of the operating field with the RVAI approach, the learning period of this technique will take longer than the other minimally invasive techniques. The conversion of the process into another approach such as an additional surgical incision, can be very difficult, may cause the sacrifice of the internal mammarian artery and may pulmonary complications and increase the magnitude of pain in the postoperative period as well. We fully agree with the authors’ concern about femoral artery stenosis in the future, however, vascular complications such as dissection or stenosis after femoral cannulation is still a debateable topic. Femoral access [5] has been shown to be a safe and preferable option in selected patients and allows limited surgical chest incisions thereby reducing the patient’s surgical trauma. In the preoperative period, Doppler examination of the femoral artery (diameter and quality) can minimize the possible vascular problems and assist in determining the surgical strategy in the young or adult patient. In conclusion, this is a valuable study, and we are grateful to the authors for sharing their experiences. This surgical technique, specialized according to gender, might be performed in male adolescent patients in particular. It might be an alternative to the submammarian incision in female and adult patients.

Construction of a Double Eyelid: An Uncut Strip of Orbicularis Removed Through Three Mini-incisions

In recent years, many mini-incisional techniques for double-eyelid plasty have been developed. However, the removal of pretarsal tissue has not been satisfactory because only small pockets of soft tissue just inferior to the skin have been removed to place the suture. The formed double eyelid may therefore not be durable. This report introduces a modified mini-incisional method that involves removing a long uncut strip of orbicularis through three mini-incisions. A strip of orbicularis uncut from the inner canthus to the outer canthus was removed through three mini-incisions made on the upper eyelid, quite similar to that of a full incisional procedure. The left orbicularis then was pruned in three directions: left, right, and down (toward the palpebral margin). Finally, the incisions were sutured, and a vivid fold was created. From 2008 to 2012, the authors applied this technique to 90 patients (174eyes). Although the trauma may have been more severe due to a large amount of orbicularis removed, including an uncut strip of orbicularis, bleeding during the operation was easy to control and usually very limited. The edema period for most patients ended within 3 weeks, mainly because of the skin bridge between each incision. The scars became unnoticeable after 3-6 months. Disappearance of the fold was not found in any case at either the 3- or 12-month (average, 9-month) follow-up evaluation or during the 4-year follow-up period. The described technique combines the advantages of both full incisional and the usual mini-incisional techniques in developing a long-lasting suprapalpebral fold with inconspicuous scars and a short recovery period. Opinions of respected authorities, based on clinical experience,descriptive studies, or reports of expert committees.

Small-Wave Plasty for Correction of Lip Length Deficiency: A Case Report

Lip reconstruction may lead to disappointing results due to secondary deformity and visible scars. The Z-plasty in the Tennison technique is an effective method for repairing the upper lip subunits. The main issue is the visible and ungracious scar. A 38-year-old woman was treated for an upper lip deformity secondary to a dog bite injury. At 1month after a direct suture, a scar contracture with a defect of Cupid's bow and a vermilion height deficiency occurred. A Tennison procedure was chosen to repair the deformity. A small-wave incision procedure also was considered to minimize visibility of the scar. These two techniques were coupled in a small-wave plasty. The small-wave plasty design was performed with a superior flap base (L1) of 7mm and a circle arc of 10mm. The superior height (H1) was 3mm. The middle flap base (L2) was 4mm, and the circle arc was 6mm. The middle height (H2) was 2mm. The surgery time was 55min with the patient under general anesthesia. The skin healing was completed in 10days without scar contracture. The upper lip subunits were reconstructed with a regular Cupid's bow and a symmetric vermilion height. The scars were slightly visible at 1month postoperatively. The results were stable after a follow-up period of 12months. No revision was needed. The small-wave plasty, which couples a Tennison technique with a small-wave incision procedure, is efficient in reconstructing the subunits of the upper lip after a scar contracture deformity. This method should be used for upper lip reconstruction for minimal scar visibility. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of the Single Access Technique in Laparoscopic Surgery

Laparoscopic single access technique is a next step in development of minimally invasive surgery. The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique. 102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study. In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4). Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.

Midurethral sling incision: indications and outcomes

Introduction and hypothesisControversy continues over the effectiveness of sling incision, which is the most common operative approach to treating complications following suburethral sling insertion. This retrospective analysis assessed the indications for sling incision and patient outcomes regarding resolution of complications and stress urinary incontinence.MethodsA review was conducted of the medical records of women who underwent sling incision between 2003 and 2010. Data such as surgical indications, ultrasound findings and medical outcomes were extracted from 198 records, and descriptive and inferential statistical methods of analysis were used.ResultsIn the 198 patients eligible for study inclusion, the primary reasons for sling incision were overactive bladder (68 %), voiding dysfunction (61 %), and recurrent urinary tract infections (53 %). Additional complications included dyspareunia (18 %), chronic pelvic pain (17 %), and sling exposure (15 %). Sling incision led to immediate postoperative cure of voiding dysfunction in 97 % of patients. Cure rates for overactive bladder and dyspareunia were 60 % and 94 % respectively. Chronic pelvic pain was resolved in 82 % of cases and all cases of sling exposure were cured. Eighty-five (61 %) of the 140 patients who were continent before sling incision developed recurrent stress urinary incontinence (SUI) postoperatively.ConclusionsThese findings indicate that sling incision can be highly successful in improving voiding dysfunction and dyspareunia, and moderately successful in curing overactive bladder and chronic pain. However, SUI may recur in more than 60 % of the patients undergoing sling incision. Consequently, patients being considered for a sling incision procedure should be informed about this possible complication.

Corneal changes after a 3 incision cataract surgery by 2.2mm

AbstractPurpose a prospective study to analyze the effects of the miniincision coaxial phacoemulsification (2.2 mm) combined with bimanual irrigation/aspiration (I/A) on the corneal optical quality characterized in terms of corneal aberrations.Methods One hundred and eith eyes underwent mini‐incision phacoemulsification, by the same surgeon. Cataract surgery was performed through a clear corneal incision of 2.2mm, placed at 130°. Two paracentesis of 1mm were performed 90° apart for bimanual irrigation/aspiration. An aberrometry (OPD scannII, Nidek®, Japan) was performed preoperatively (Day 0), 15 days after surgery (Day 15) then 1 month after (M1).Results The corneal surgical induced astigmatism (SIA) was quite neutral : 0.091 D +/‐0.428 at Day 15, and 0.065 D +/‐0.86 at Day 30. Between Day 15 and D30, its variation was not significant ‐ 0.026 D +/‐0.871 (p=0.74). At 1 month: we observed a mean reduction of ‐ 0,25D +/‐ 0.96 in the direct astigmatism group (n=46), and a mean induced astigmatism of + 0.23D +/‐ 0.94 in the inverse astigmatism group (n=37), of + 0.21D +/‐ 0.6 in the oblique stigmatism group (n=25).Corneal topographic astigmatism is modified in the axis : mean rotation was 29.95° +/‐ 27.6 between Day 0 and 30. Congenital astigmatism superior to 1,5D appears to be more stable. Corneal asphericity didn’t change statistically between Day 0 and 30 (1.14 D +/‐ 0.5 versus 1.11 D +/‐ 0.49 p=0,13).Conclusion This 3 incision procedure permits a real neutral power SIA through a 2.2 mm main incision, compared to classical coaxial procedure.The stability of refractive data between Day 15 and M1 allows early spectacles prescription and a quick return to normal life. SIA rotation could explain some undercorrections after toric IOL.