Cuff Length Research Articles

Surgical outcomes of robotic radical hysterectomy after neoadjuvant chemotherapy for locally advanced cervical cancer: Comparison with early stage disease

AimsTo evaluate the feasibility and safety of robotic radical hysterectomy (RRH) with pelvic lymphadenectomy for locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy (NACT). MethodsStarting from 04/2009, consecutive patients with LACC were submitted to robotic surgical staging after NACT. Surgical outcomes were compared to those achieved by women undergoing robotic surgery for an early stage disease during the same temporal interval. ResultsOverall 25 (Group 1) and 21 (Group 2) patients had an early stage and a LACC, respectively. Among women with LACC, 18 achieved best tumor responses to NACT and therefore they were addressed to RRH. Outcomes resulted comparable between Groups in terms of operative time, blood loss, hospitalization and complications. No differences were found in terms of nodal yield, parametrial and vaginal cuff length. ConclusionsRRH is feasible and safe also in patients previously submitted to NACT for LACC. Larger series with longer follow-up are mandatory to establish survival outcomes.

Current Status of Pylorus‐Preserving Gastrectomy for the Treatment of Gastric Cancer: A Questionnaire Survey and Review of Literatures

This study was designed to investigate the current status of pylorus-preserving gastrectomy (PPG) for the treatment of gastric cancer by sending a questionnaire to institutions in Japan. The questionnaire was prepared and sent to 930 institutions approved by the Japanese Society of Gastroenterological Surgery. Questions were the indications for PPG, preservation of the vagus nerves and the infra-pyloric artery, whether suprapyloric lymph nodes are dissected, distance between the pylorus and the gastrogastrostomy, and the advantages and disadvantages of PPG. Responses were obtained from 345 institutions (37.1%). In 148 institutions, PPG was included in the choices of operations for gastric cancer and indicated for patients with tumors no deeper than the submucosal layer for differentiated-type carcinoma, or for tumors limited to the mucosa even in poorly differentiated types in 105 institutions. The vagus was preserved in 73.5%, the infrapyloric artery was preserved in 49.4%, and the dissection of suprapyloric lymph nodes were partly performed in 56.2%. The distance between gastrogastrostomy and the pyloric ring was 3-3.9cm in 43.4% and 2-2.9cm in 39%. Layer-to-layer anastomosis was the most representative technique for gastrogastrostomy. The advantages of PPG with decreased incidence of dumping syndrome and remnant gastritis were quoted in 130 and 82 institutions, respectively. Delayed gastric emptying was considered as the most frequent disadvantage of PPG, as quoted by 111 institutions. These results indicate that standard technique in PPG includes the preservation of the vagus and infrapyloric artery, in part dissection of suprapyloric lymph nodes, and layer-to-layer anastomosis for reconstruction. The optimal length of the antral cuff is still controversial.

Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy in Obese Women With Early-Stage Cervical Cancer

To evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m) and nonobese (BMI <30 kg/m) women. Data were collected prospectively on intraoperative and postoperative parameters and complications for all women undergoing a TLRH for cervical cancer. Patients were classified as obese, BMI >30 kg/m, or nonobese, BMI <30 kg/m. Assessment of surgical radicality was made by comparing the excision specimens in the 2 groups with a cohort of open radical hysterectomy cases performed before the introduction of the TLRH. A total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2-13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3-42 months). She belonged to the nonobese group. The TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies

Aims The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. Materials and methods The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. Results The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%–2% and the 3-year pelvic recurrence rate was 7%–8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Conclusion Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates.

Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

Recent years have seen the preserved pyloric cuff being lengthened in pylorus-preserving gastrectomy for early gastric cancer. We performed clinical assessment of the symptoms after pylorus-preserving gastrectomy in patients treated at the National Cancer Center Hospital in Japan during the past 9 years. Four hundred and fifty-six patients who had undergone pylorus-preserving gastrectomy and been followed up for at least 3 years were studied. We classified the patients into two groups according to the length of the pyloric cuff (group A, within 3.0 cm; group B, more than 3.0 cm). Medical records were reviewed for further histological and follow-up data. A questionnaire regarding dumping syndrome and gastric stasis was also completed by the patients. Our results showed no statistically significant differences in symptoms, such as dumping syndrome or emptying disturbances, between the two groups. Our study revealed that the differences in several functions and symptom scales were not pronounced between the two groups. Regardless of the length of the pyloric cuff, pylorus-preserving gastrectomy can be utilized for the treatment of early gastric cancer even if the tumor is located proximal to the middle body.

Werteim-Meigs Oncology Analyse Security: Laparocopy Versus Laparotomy

Study Objective: To evaluate the oncological security of Laparoscopic Radical Hysterectomy (LRH) through analyzes of the surgical specimen, comparing the material removed from the laparotomic approach with the one extracted from the laparoscopy, using the same surgery technique in both.Design: Prospective and randomized study.Setting: All of them had cervical cancer eith FIGO satge IA1 and IIA. Withdrawal in the two groups was made the comparison of the surgery specimens and stil changeable clinics, epidemiologists, of per and posoperative and pathological datas.Patients: Between March/2006 and May/2008, 21 submitted patients were compared Abdominal Radical Hysterectomy (ARH) with others 21 submitted LRH.Intervention: N/AMeasurements and Main Results: The pathological datas had only shown significance in the size of the tumor that was bigger in LRH group: weight of the uterus (NS), size of the tumor (S); histological type (NS); degre of diferrentiation (NS); angiolinfatica invasion (NS); invasion of parametrial (NS); invasion of the vagina (NS); number of pelvic ganglia (NS); invasion of linfods to the right (NS) and the left (NS) and type of linfonod invaded (NS). The measure of the lateral parametrical and the vaginal cuff was not significant (NS) but not to be in posterior vaginal cuff: parametrial length rigth before the tissue processing (NS) and fixed (NS), length of the parametrial lefth before the tissue processing (NS) an fixed (NS), length of anterior vaginal cuff previous the tissue processing (NS) and fixed (NS), length of posterior vaginal cuff previsu the tissue processing (S) and fixed (S).Conclusion: The surgical specimen in LRH, of the pathologic criteria, is similar to the one that of outcome in the ARH approach, suggesting that the oncological security is the same in both ways. However the LRH presents more difficulties to remove the posterior vaginal cuff. Study Objective: To evaluate the oncological security of Laparoscopic Radical Hysterectomy (LRH) through analyzes of the surgical specimen, comparing the material removed from the laparotomic approach with the one extracted from the laparoscopy, using the same surgery technique in both. Design: Prospective and randomized study. Setting: All of them had cervical cancer eith FIGO satge IA1 and IIA. Withdrawal in the two groups was made the comparison of the surgery specimens and stil changeable clinics, epidemiologists, of per and posoperative and pathological datas. Patients: Between March/2006 and May/2008, 21 submitted patients were compared Abdominal Radical Hysterectomy (ARH) with others 21 submitted LRH. Intervention: N/A Measurements and Main Results: The pathological datas had only shown significance in the size of the tumor that was bigger in LRH group: weight of the uterus (NS), size of the tumor (S); histological type (NS); degre of diferrentiation (NS); angiolinfatica invasion (NS); invasion of parametrial (NS); invasion of the vagina (NS); number of pelvic ganglia (NS); invasion of linfods to the right (NS) and the left (NS) and type of linfonod invaded (NS). The measure of the lateral parametrical and the vaginal cuff was not significant (NS) but not to be in posterior vaginal cuff: parametrial length rigth before the tissue processing (NS) and fixed (NS), length of the parametrial lefth before the tissue processing (NS) an fixed (NS), length of anterior vaginal cuff previous the tissue processing (NS) and fixed (NS), length of posterior vaginal cuff previsu the tissue processing (S) and fixed (S). Conclusion: The surgical specimen in LRH, of the pathologic criteria, is similar to the one that of outcome in the ARH approach, suggesting that the oncological security is the same in both ways. However the LRH presents more difficulties to remove the posterior vaginal cuff.

Blood pressure measurement: arm circumference and cuff size availability

To avoid inaccurate blood pressure (BP) readings, the American Heart Association (AHA) recommends cuff width (CW) encircling 40% of the arm circumference (AC) and cuff length at least 80-100%. This study aimed to identify inpatients AC, the corresponding cuff size and the cuff size availability. In total, 81 AC were measured in the right arm. The cuff sizes to fit them were calculated according to AHA AC/CW width 0.40 ratio. The AC varied from 17.5 to 40.5 cm and the corresponding cuff width from 6 to 16 cm. The standard cuff 12 by 23 cm, the only size available in the clinics, was appropriate for only 17.3% of the subjects, whose AC varied between 32.5 and 34.3 cm. The lack of availability of different cuff sizes continues being a challenging problem to be faced. The standard cuff available, 12 cm large, did not fit 82.7% of the identified AC, resulting in over or underestimated BP registers.

Sarcomere length of torn rotator cuff muscle

Sarcomere length is one of the factors related to the contractile ability of muscle. There is no report about sarcomere length of torn rotator cuff muscles. The purpose of this study was to clarify sarcomere length of torn rotator cuff muscles. Twenty-eight embalmed cadaver shoulders (14 shoulders with intact rotator cuff and 14 shoulders with full-thickness rotator cuff tears: an isolated tear of the supraspinatus in 3, a combined tear of the supraspinatus and infraspinatus in 4, and a combined tear of the supraspinatus, infraspinatus and subscapularis in 7) were used in this study. Muscle fiber length was measured using a digital caliper. Sarcomere length was measured by laser diffraction method. Muscle fiber lengths of the supraspinatus and infraspinatus (33.0 +/- 6.5 mm and 61.5 +/- 14.0 mm, respectively) in the cuff tear group were significantly shorter than those in the intact cuff group (56.9 +/- 10.1 mm and 74.2 +/- 10.0 mm: P < .001 and P = .010). The sarcomere lengths of these muscles were 3.00 +/- 0.44 microm and 3.12 +/- 0.45 microm in the intact cuff group and 2.90 +/- 0.34 microm and 3.01 +/- 0.34 microm in the cuff tear group. The sarcomere lengths showed no significant difference (P = 0.46 and P = .37). The sarcomere lengths of the supraspinatus and infraspinatus with torn tendons were not significantly different from those with intact tendons, although the muscle fiber lengths were significantly shorter with torn tendons.

Contemporary practice patterns in the surgical management of Hirschsprung's disease

Background Many options exist in the surgical management of Hirschsprung's disease (HD). To gain insight into contemporary management, we queried pediatric surgeons listed in the American Pediatric Surgical Association Directory on their management for the typical baby with HD. Methods Surveys were sent electronically to the surgeons concerning a typical newborn diagnosed with HD. Questions included the preferred approach, number of stages, anastomotic technique, length of muscular rectal cuff, point of initiation of the anorectal dissection, and length of colonic resection. Surgeons performing laparoscopy were asked about how the colonic biopsy was performed. Other questions included the type of leveling colostomy, level of residents, and criteria for performing a primary transanal pull-through. The maximum margin of error was calculated using a 95% confidence interval based on the response percentages for discrete variables. Results Surveys were sent to 719 surgeons with 270 responses. A minimally invasive approach is currently used by 80%, of which 42.3% favor laparoscopy and 37.7% prefer transanal dissection only. Only 5.4% of respondents prefer the Duhamel technique. A 1-stage approach is used by 85.6%. An average muscular cuff length of 2.4 cm (range, 0.5-6 cm) is reported. A divided muscular cuff is reported by 55%. On average, the anal anastomosis is 0.73 cm (range, 0-4.5 cm) above the top of the anal columns and 3.0 cm (0-12.5 cm) above the biopsy site on the ganglionic colon. Of the respondents using laparoscopy, 80.2% report using an intracorporeal colonic biopsy technique. Participation in a training program, either fellows and/or residents, is reported by 84.8% of respondents. The most common reason given for not performing a primary transanal pull-through is long segment disease (45.6%). Margin of error was no greater than 6% for any of the responses. Conclusions A minimally invasive approach with a 1-stage operation has become the most common strategy for the surgical management of the typical baby with HD. Opinions vary about the amount of colonic resection, length of the rectal cuff, and site of initiation of the anorectal dissection, and these represent potential points for future studies.

Measuring Blood Pressure in Mice using Volume Pressure Recording, a Tail-cuff Method

The CODA 8-Channel High Throughput Non-Invasive Blood Pressure system measures the blood pressure in up to 8 mice or rats simultaneously. The CODA tail-cuff system uses Volume Pressure Recording (VPR) to measure the blood pressure by determining the tail blood volume. A specially designed differential pressure transducer and an occlusion tail-cuff measure the total blood volume in the tail without the need to obtain the individual pulse signal. Special attention is afforded to the length of the occlusion cuff in order to derive the most accurate blood pressure readings. VPR can easily obtain readings on dark-skinned rodents, such as C57BL6 mice and is MRI compatible. The CODA system provides you with measurements of six (6) different blood pressure parameters; systolic and diastolic blood pressure, heart rate, mean blood pressure, tail blood flow, and tail blood volume. Measurements can be made on either awake or anesthetized mice or rats. The CODA system includes a controller, laptop computer, software, cuffs, animal holders, infrared warming pads, and an infrared thermometer. There are seven different holder sizes for mice as small as 8 grams to rats as large as 900 grams.

Measuring Blood Pressure in Mice using Volume Pressure Recording, a Tail-cuff Method

The CODA 8-Channel High Throughput Non-Invasive Blood Pressure system measures the blood pressure in up to 8 mice or rats simultaneously. The CODA tail-cuff system uses Volume Pressure Recording (VPR) to measure the blood pressure by determining the tail blood volume. A specially designed differential pressure transducer and an occlusion tail-cuff measure the total blood volume in the tail without the need to obtain the individual pulse signal. Special attention is afforded to the length of the occlusion cuff in order to derive the most accurate blood pressure readings. VPR can easily obtain readings on dark-skinned rodents, such as C57BL6 mice and is MRI compatible. The CODA system provides you with measurements of six (6) different blood pressure parameters; systolic and diastolic blood pressure, heart rate, mean blood pressure, tail blood flow, and tail blood volume. Measurements can be made on either awake or anesthetized mice or rats. The CODA system includes a controller, laptop computer, software, cuffs, animal holders, infrared warming pads, and an infrared thermometer. There are seven different holder sizes for mice as small as 8 grams to rats as large as 900 grams.

Medida da pressão arterial no braço e antebraço em função do manguito

OBJETIVO: Identificar e comparar os níveis de pressão arterial no braço e antebraço usando manguitos de dimensões apropriadas e o manguito padrão. MÉTODOS: Estudo transversal com 103 indivíduos, aplicando a razão circunferência braquial (CB) /largura de manguito de 0,40 nos dois segmentos, e registros com o manguito padrão após um minuto. razão CB /comprimento do manguito de 0,80, correto ou padrão, circunferências medidas no ponto médio de cada segmento. RESULTADOS: Diferenças significativas indicaram hiperestimação da pressão diastólica no antebraço, menor daquela observada em outros estudos. A manobra de Forsberg melhorou a audibilidade dos sons de Korotkoff. CONCLUSÃO: Os achados indicam que o manguito correto diminui a hiperestimação dos registros diastólicos observada por outros autores. O avanço no conhecimento da medida no antebraço requer outros estudos.

Feasibility of endoscopic radical and modified radical hysterectomy combined with pelvic lymphadenectomy

Objectives: The purpose of this study was to determine the feasibility and radicality of endoscopic radical hysterectomy (ERH) and endoscopic modified radical hysterectomy (EmRH) combined with pelvic lymphadenectomy (ELND) in invasive cervical cancer patients.Methods: Five patients with invasive cervical cancer underwent ERH or EmRH between May 2003 and March 2007 at Hokkaido University Hospital. Two patients with stage I a adenocarcinoma underwent an EmRH, and two patients with stage I b1 and one patient with stage II a underwent an ERH. All patients gave their informed consent to this experimental procedure before surgery.Results: The median age of patients was 39 years (range, 33-45 years), and the median body mass index was 20.2 kg/m2 (range, 18.5-23.7 kg/m2). The maximum tumor diameter was 20mm in 1 patient, and ≤10mm in 4 patients. The pathologic subtype was squamous cell carcinoma in 2 patients, and adenocarcinoma in 3 patients. The median operative time was 734 min (range, 583-974 min), the median blood loss was 890 ml(range, 280-2650 ml), the median number of lymph nodes removed was 77 (range, 47-103), and the median length of vaginal cuff removed was 20mm(range, 10-25mm). The median duration of hospitalization post-operatively was 16 days (range, 13-23 days). A post-surgical infection occurred in one patient, but no severe complications were noted. There were no relapses after a mean follow-up period of 31.8 months (range, 15-71 months).Conclusions: An ERH or EmRH with ELND is feasible and might be beneficial for early invasive cervical cancer.

Anatomical bases of the surgical dissection of the interatrial septum: a morphological and histological study

The interatrial septum (IAS) can be dissected to resect pulmonary tumors invading the left atrium. The aim of this study was to describe the dissected structures, and to expose the benefits, the limits, and the embryologic reasons of such dissection. We dissected the IAS of 11 fresh, non-embalmed human hearts. The dissected structures were described and the length and depth of the dissection were measured. A histological study was performed in four other fresh hearts to identify and differentiate between dissectible and non-dissectible structures. The dissection was performed through a fatty tissue located between two muscular walls. The depth limit of the IAS dissection was identified as the limbus of the fossa ovalis and the muscular roof of the atria. The section of the latter doubles the depth of the dissection at the level of the upper pulmonary veins. Mean length of the dissected IAS was 77 mm (55-90). Mean depths of the IAS were 41 mm (35-50) at the level of the left upper pulmonary vein, 27 mm (12-35) between the upper and lower pulmonary veins, and 14 mm (8-20) at the level of the left inferior pulmonary vein The surgical dissection of the IAS is performed through the septum secundum that appears as an infold of the atrial wall. The length of the resectable left atrial cuff reaches a mean of 40 mm at the level of the upper pulmonary vein.

Role of Postcircumcision Mucosal Cuff Length in Lifelong Premature Ejaculation: A Pilot Study

Premature ejaculation (PE) is the most prevalent sexual dysfunction among men. Several theories about its etiology have been made. One of the conflicting factors is the effect of circumcision on ejaculation, and there are some concerns about leaving so much mucosa during circumcision. In our study the relationship between mucosal cuff length and PE was investigated. Eighty-four circumcised men were studied, including 42 men with PE and 42 men without. The following data and measurements were investigated: age, education, smoking, intravaginal ejaculation latency time (IELT), circumcision timing, stretched penile, penile skin, and mucosal cuff lengths. Penile, mucosal cuff, and penile skin lengths, the IELT. The mean penile, mucosal cuff, and penile skin lengths were 121.1 +/- 12.8, 15.4 +/- 4.8, and 80.8 +/- 21.0 mm in PE men, respectively, and were 130.1 +/- 10.4, 14.7 +/- 3.4, and 88.7 +/- 12.2 mm in the control group, respectively. No statistically significant differences were seen regarding the length of the penis (P = 0.80), mucosal cuff (P = 0.84), and penile skin (P = 0.99). The two groups were not different regarding education (P = 0.90), smoking (P = 0.70), and circumcision timing (P = 0.65). Postcircumcision mucosal cuff length is not a risk factor for PE.

The Margin of Safety of a Left Double-Lumen Tracheobronchial Tube Depends on the Length of the Bronchial Cuff and Tip

The left tracheobronchial double-lumen tube is the commonest device to separate the left and right lungs for differential ventilation. With the appropriate tube, the left bronchial cuff is positioned in the bronchus so that the cuff is beyond the carina but the tip of the tube does not occlude the aperture of the left upper lobe bronchus. The difference between the length of the left main bronchus and the length of the cuff and tip of the bronchial segment of the tube has been termed "the margin of safety" by Benumof. If the length of the cuff plus the tip exceeds that of the left main bronchus, there will be occlusion of the left upper lobe bronchus. The bronchial cuff and bronchial tip lengths were measured on two hundred and twenty left tracheobronchial (double-lumen) tubes from four manufacturers. The largest cuff-tip length was 40 mm with a Portex 41Fr tube but some 41Fr tubes from all manufacturers had cuff-tip lengths of 33 mm or greater which exceed the length of the shortest left main bronchus measured by Benumof. There was also a marked variation in cuff-tip lengths of the same size tube from the same manufacturer. The largest variation was 18 mm for the Portex 41 but substantial variation of 8 mm or more was found in at least one French size of all manufacturers. Users must be aware that significant cuff-tip length variation occurs and match the selected tube to the patient to ensure an adequate margin of safety.

Miscuffing: A Problem With New Guidelines

To the Editor: Cuff dimensions have been a source of controversy for many years. Early guidelines of the American Heart Association recommended a cuff width 20% wider than the diameter of the arm or thigh and a cuff length “sufficient to half-encircle a limb … provided care is taken by the operator to place it on the side of the compressible artery.”1 For adults, a cuff width of 12 cm was recommended. In the next recommendation, the cuff width for adults was 12 to 14 cm, …

Bursting Strength with Various Methods of Renal Artery Ligation and Potential Mechanisms of Failure

Vascular control is crucial during laparoscopic ligation of the renal vessels. Intracorporeal suture ligation has been replaced by easier methods, such as specialized clip appliers and automatic stapling devices; nevertheless, the optimal application and margin of safety of such devices have yet to be determined. We sought to address this question by measuring the bursting strength of arteries ligated with several standard devices. One end of an adult porcine artery (3-7-mm diameter) was occluded with a titanium clip, self-locking polymer clip, or laparoscopic linear cutting stapler. Comparisons were made with one or two clips and with different distal cuff lengths (i.e., flush or 2 mm). The open end was secured to a pulsatile infusion pump. Leak/failure pressures were measured using a digital barometer. The mean bursting pressures for the clips were above physiologic arterial pressures (1220-1500 mm Hg). However, the vessels closed with the stapler leaked at a lower mean pressure (262 mm Hg). Failure of titanium or self-locking polymer clips was the result of vessel retraction into and behind the clip, while staple- line leakage occurred between individual staples. Bursting pressures with the titanium and self-locking polymer clips was unaffected by the number of clips or length of vascular cuff. All tested methods of vascular control performed well at physiologic pressures, suggesting that safety is not increased with traditional maneuvers such as additional clips or longer cuff length.

Multiple-electrode nerve cuffs for low-velocity and velocity-selective neural recording

In the paper, a method using multiple-electrode nerve cuffs is presented that enables electroneurographic signals (ENG) to be recorded selectively by action potential velocity. The theory uses a one-dimensional model of the electrodes in the cuff. Using this model, the transfer function for a single tripole is derived, and it is shown that more than one tripole signal can be recorded from within a cuff. When many tripole signals are available and are temporally aligned by artificial delays and summed, there is a significant increase in the amplitude of the recorded action potential, depending on the cuff length and the action potential velocity, with the greatest gain occurring for low velocities. For example, a cuff was considered that was constrained by surgical considerations to 30 mm between the end electrodes. For action potentials with a velocity of 120 m s(-1), it was shown that, as the number of tripoles increased from one, the peak energy spectral density of the recorded output increased by a factor of about 1.6 with three tripoles, whereas, for 20 m s(-1), the increase was about 19, with ten tripoles. The time delays and summation act as a velocity-selective filter. With consideration of the energy spectral densities at frequencies where these are maximum (to give the best signal-to-noise ratio), the tuning curves are presented for these velocity-selective filters and show that useful velocity resolution is possible using this method. For a 30 mm cuff with nine tripoles, it is demonstrated that it is possible to resolve at least five distinct velocity bands in the range 20-120m s(-1).

Preliminary Results of Laparoscopic Modified Radical Hysterectomy in Early Invasive Cervical Cancer

Study Objective To compare laparoscopic modified radical hysterectomy (LMRH) with traditional modified radical hysterectomy (MRH) in women with early invasive cervical cancer. Design Prospective, nonrandomized study (Canadian Task Force classification II-1). Setting Chi Mei Foundation Medical Center, Tainan, Taiwan. Patients Ten women with cervical cancer stage Ia2 to Ib1 (≤2 cm). Intervention LMRH (class II radical hysterectomy) and pelvic lymphadenectomy. Measurements and Main Results The pathologist examined all specimens. The width of parametrium (mean ± SD) was 1.75 ± 0.68 cm on the right and 1.70 ± 0.54 cm on the left. The length of the vaginal cuff was 1.37 ± 0.86 cm. Operating time for LMRH (159 ± 26.4 min) was similar to that for MRH (165.7 ± 30.5 min). Postoperative hospitalization for LMRH (4.1 ± 1.5 days) and estimated blood loss (250 ± 147.2 ml) were significantly less than for MRH (8.3 ± 4.4 days and 611.5 ± 256.8 ml, respectively). No intraoperative complications occurred, and no patient experienced postoperative voiding dysfunction or constipation. Conclusion Based on preliminary results, LMRH is feasible for treatment of early invasive cervical cancer, and may become preferred for surgical staging of the disease.