One-layer Technique Research Articles

Creation and evaluation of a three-dimensional-printed synthetic vas deferens for microsurgical training.

Individuals choose to undergo vasectomy reversal for a variety of reasons, including remarriage or due to the death of a child. To be proficient in this procedure, the surgeons need to be high volume and the trainees require a safe environment to develop their microsurgical skills. To overcome this challenge, we used three-dimensional (3D) printing to create a synthetic model of the vas deferens with properties similar to the human vas deferens. We distributed this model to experienced microsurgeons for evaluation. The vas deferens model was created using thermoplastic polyurethane filament. The filament was then infused with a foaming agent to allow for temperature-dependent tuning of the material's stiffness. The model's outer diameter was 1 mm and the inner lumen was 0.5 mm. Fellowship-trained male reproductive urologists were recruited from the Society for the Study of Male Reproduction website. They used our model and judged it on several factors by completing a 13-question survey. We received completed evaluations from five microsurgeons. Eighty percent of the surgeons were able to complete a full anastomosis on the model using 9-0 and 10-0 sutures. The majority of the completed anastomoses were performed using the one-layer technique. The average responses for the model's usefulness as a practice tool, a training tool, and overall assessment ranged from 72 to 79 out of 100. Comments for the improvement included the need for a more flexible and softer model. We created a 3D-printed synthetic vas deferens that serves as a valuable training and practice tool.

Optimal design of multiuse hybrid microgrids power by green hydrogen–ammonia

The design and operation of hybrid microgrids (MGs) has attracted much interest. The creation of adaptable standalone hybrid systems that can satisfy interconnected clients’ energy needs using coupled green hydrogen–ammonia has been studied less. Additionally, the capability of scaling up hydrogen generation and fuel decarbonization is little studied. This study proposes an optimized design approach for multiuse hybrid MG supplying power gas, heat, and oxygen with green hydrogen and ammonia carriers. The suggested one-layer technique is implemented using PSO and performs both the optimal size and operation of the proposed system based on hourly data intervals to better track load variations. The proposed technique aims to minimize costs besides ensuring maximum reliability in light of load demand and RERs variations. CHMS is implemented to constantly fulfill heat loads by dispatching power and heat of ICE, FC and EBs. Decarbonization of natural gas is suggested by hybrid hydrogen–ammonia rather than hydrogen-based methanation only. The Proposed methodology is tested on a number of scenarios with various setups. The outcomes are evaluated against existing literature from both the same and different research regions. The best LCOE is 0.0519, 0.04122, and 0.05383 $/kWh, with nearly no energy supply loss and no emissions, according to the results of the vital scenarios SC6, SC8, and SC9. The obtained results reveal the following: (1) When CHMS is utilized, a significant reduction in investment cost results. (2) A single-layer optimization strategy can effectively locate the optimal solution with minimum ratios of curtailed energy. (3) The oxygen produced from hydrogen and ammonia-related conversions is essential in reducing total costs.

Hydrophobic Material: Effect of Alkyl Chain Length on the Surface Roughness

The clean technologies of self-cleaning surfaces are expanding rapidly. Highly hydrophobic coatings with strong adhesion, high durability, and dirt-free surfaces have been prepared via sol-gel deposition of SiO2-TiO2-alkylsilane. The influence of the effects of the alkyl chain length of silane on surface roughness was investigated. This deposition involved a one-layer technique to produce the rough surfaces. The bimetal oxide of SiO2-TiO2 created a high level of surface roughness. As a result, the water contact angle of the coatings increased with the increasing alkyl chain length of silane (up to C=8). However, the water contact angle decreased when the C=16 of alkylsilane was applied. It was predicted that the longer alkyl chain would cause the molecules to collapse. The higher hydrophobicity was produced by SiO2-TiO2-OTMS coatings with a water contact angle of about 140.67 ± 1.23°. The effect of the dip-coating technique (one layer and layer-by-layer) on hydrophobicity was also discussed. The results showed that coatings produced by the one-layer technique had a higher contact angle than coatings made by the layer-by-layer technique. The coatings were stable under outdoor exposure and able to hinder dirt attachment to their surfaces.

MP34-08 TWO-LAYER VASOVASOTOMY TECHNIQUE IS ASSOCIATED WITH IMPROVED PREGNANCY RATES AS COMPARED TO MODIFIED ONE-LAYER TECHNIQUE

You have accessJournal of UrologyCME1 May 2022MP34-08 TWO-LAYER VASOVASOTOMY TECHNIQUE IS ASSOCIATED WITH IMPROVED PREGNANCY RATES AS COMPARED TO MODIFIED ONE-LAYER TECHNIQUE Matt Kasson, Ashley Pittman, David Charles, Jacqueline Sehring, Peter Dietrich, and Jay Sandlow Matt KassonMatt Kasson More articles by this author , Ashley PittmanAshley Pittman More articles by this author , David CharlesDavid Charles More articles by this author , Jacqueline SehringJacqueline Sehring More articles by this author , Peter DietrichPeter Dietrich More articles by this author , and Jay SandlowJay Sandlow More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002588.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vasectomy reversal has evolved since the advent of the microscope in 1970. There has been conflicting data on superiority of 1-layer versus 2-layer anastomosis techniques. However, there are few studies comparing pregnancy rates. This study sought to evaluate the semen parameters, patency, and natural pregnancy rates of modified one-layer vs two-layer vasovasostomy. METHODS: A retrospective review of all patients undergoing vasovasostomy by a single surgeon from 2008-2021 was performed. Patients were included if they had a bilateral 2-layer anastomosis or a bilateral 1-layer anastomosis and a follow up semen analysis. Years from vasectomy, partner age, semen parameters, and confirmed biochemical pregnancy was recorded. Patients pregnant after in vitro fertilization (IVF) were noted but not included in the pregnancy analysis. Statistical analysis was performed using STATA, with a p <0.05 considered significant. RESULTS: 190 patients were included in the study. 70 patients had a modified 1-layer anastomosis and 120 had a 2-layer anastomosis, with a mean age of 39.3 and 38.1 years, respectively. The average years from vasectomy to reversal, patency rate, and partner age, and post-reversal semen parameters were all similar between groups (Table 1). A logistic regression for pregnancy rate using partner age, years from vasectomy, and type of anastomosis showed that a 2-layer anastomosis was 3.5 times as likely to result in pregnancy (p=0.003), with partner age and years since vasectomy negatively correlating with pregnancy but not significant (OR 0.93 and 0.97, respectively). IVF after reversal was done in 3 couples with modified 1-layer and 8 couples with 2-layer anastomoses. CONCLUSIONS: Vasovasostomy using a 2-layer anastomotic technique resulted in a significantly increased rate of pregnancy as compared to a modified 1-layer technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e581 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matt Kasson More articles by this author Ashley Pittman More articles by this author David Charles More articles by this author Jacqueline Sehring More articles by this author Peter Dietrich More articles by this author Jay Sandlow More articles by this author Expand All Advertisement PDF DownloadLoading ...

Two-Layer Compared With One-Layer Vaginal Cuff Closure at the Time of Total Laparoscopic Hysterectomy to Reduce Complications

To explore whether two-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy is associated with a lower rate of postoperative complications compared with a standard one-layer cuff closure. A retrospective cohort study of total laparoscopic hysterectomies performed by fellowship-trained minimally invasive gynecologic surgeons between 2011 and 2017 was performed. Surgeons sutured the vaginal cuff laparoscopically, either in a two- or one-layer closure. The primary outcome was a composite of total postoperative complications, including all medical and surgical complications within 30 days and vaginal cuff complications within 180 days. Factors known to influence laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, and immunosuppressant medications were examined and controlled for, while surgeon skill, colpotomy technique, and suture material remained standardized. We conducted statistical analyses including χ2, Fisher exact test, logistic regression, and post hoc power calculations. Of the 2,973 women who underwent total laparoscopic hysterectomies, 40.8% (n=1,213) of vaginal cuffs were closed with a two-layer closure and 59.2% (n=1,760) with a one-layer technique. Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications (3.5% vs 5.7%; P<.01). The primary difference stemmed from lower vaginal cuff complications within 180 days (0.9% vs 2.6%; P<.01); no differences in 30-day medical and surgical postoperative complications were observed between the two groups (2.6% vs 3.1%; P=.77). No patients in the two-layer vaginal cuff closure cohort experienced a vaginal cuff dehiscence or mucosal separation compared with 1.0% in the one-layer group (P<.01). Compared with a one-layer closure, a two-layer closure was protective from postoperative complications (adjusted odds ratio 0.38, 95% CI 0.19-0.74). Although postoperative complications with laparoscopic hysterectomies are rare, two-layer laparoscopic vaginal cuff closure is associated with lower total postoperative complications compared with a one-layer closure. The difference was primary driven by cuff complications.

OP25.07: Ultrasound evaluation of the cesarean scar: comparison between one and two layer uterotomy closure

Objectives: To compare the residual myometrial thickness and the size of the cesarean scar defect after oneand two layer uterotomy closure. Methods: From July 2010 a continuous two-layer uterotomy closure technique replaced a continuous one-layer technique after cesarean delivery at the Department of Obstetrics and Gynecology at Aarhus University Hospital. A total of 149 consecutively invited women (68 women with one-layer and 81 women with two-layer closure) had their cesarean scar examined with 2D transvaginal sonography (TVS) 6–16 months post partum. Inclusion criteria were non-pregnant women with one previous elective cesarean, no post-partum uterine infection or uterine re-operation, and no type 1 diabetes. Scar defect width, depth, and residual myometrial thickness were measured on the sagittal plane, and scar defect length was measured on the transverse plane. Results: The median residual myometrial thickness was 4.6 mm (interquartile range (iqr) ± 3.1) after one-layer closure and 5.8 mm (iqr ± 3.7) after two-layer closure (P = 0.04). A scar defect was visible in 66/68 women (97%) with one-layer closure, and 78/81 women (96%) with two-layer closure, respectively. Median defect width was 6.8 mm (iqr ± 4.1) after one-layer compared to 5.6 mm (iqr ± 2.9) after two-layer closure (P = 0.01). No significant differences were found in defect height and length between women with oneand two-layer closure. Conclusions: Two-layer closure of the uterotomy significantly increases residual myometrial thickness and decreases defect width. Results do not prove but imply increased scar strength after two-layer closure.

Clinical assessment and outcome of a single-layer technique for anastomosis of the small intestine in horses

In order to assess postoperative outcome in horses undergoing end-to-end anastomosis of the small intestine, performed using a one-layer technique, 15 horses that underwent exploratory coeliotomy, resection of the small...

Does the peritoneum need to be closed at laparotomy?

Closure of vertical laparotomy wounds was randomized between a two-layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one-layer technique in which the peritoneal suture line was omitted. In 162 two-layer closures there were 4 burst abdomens and 7 wound hernias (6.8 per cent wound failures); in 164 one-layer closures there were 5 burst abdomens and 7 hernias (7.3 per cent failures). Of 21 patients in this series with jaundice, the abdominal wounds dehisced in 3, and 4 patients developed incisional hernias (33.3 per cent failures) compared with a 5.2 per cent failure rate in the 305 non-jaundiced patients (P less than 0.01). Closure of the peritoneum as a separate layer, as widely advised and practised, appears to play no significant role in the healing of the laparotomy wound.

A controlled comparison of one- and two-layer techniques of suture for high and low colorectal anastomoses

A controlled trial of one- and two-layer inverting techniques of sutures for the contruction of high and low colorectal anastomoses was conducted on 137 patients, the integrity of the suture lines being assessed clinically and by routine radiological examination after a small Gastrografin enema. A clinical diagnosis of anastomotic leakage was made in 9 patients (or perhaps more accurately in 5 only), but subclinical dehiscence was demonstrated radiologically in a further 39 patients (or perhaps 43). There was a slightly greater incidence of dehiscence after the one-layer technique of suture for both high and low anterior resection.

A polymeric mini-stent designed to facilitate the vasectomy reversal operation. A rabbit model study

Vasectomy has become popular since it is the safest surgical method for contraception. It is known that approximately 6% of the men that undergo vasectomy will seek reversal (vasovasostomy). This operation is, however, technically demanding and relatively time-consuming. This study was based on the hypothesis that a polymeric mini-stent can facilitate and accelerate vasovasostomies. A mini-stent was manufactured out of a crosslinked hydrogel biomaterial, which was synthesized from N-vinyl-pyrrolidinone (NVP), n-butylmethacrylate, and (triethyleneglycol) dimethacrylate. The device was tested with 28 rabbits, which were divided over two equal groups. In one group, the vasa deferentia were dissected and reanastomosed via microsurgical one-layer technique (end-to-end group). In the other group, the vasa deferentia were dissected and reattached through implantation of the mini-stent. Sperm counts revealed 100% patency in both groups, i.e. all vasovasostomies were successful. It was experienced that the operation was easier and faster in the case of the mini-stent, probably since the mini-stent keeps the lumens of both vas ends exactly in line during suturing. This study demonstrates the feasibility of the mini-stent. Further work is necessary to evaluate the utility of this approach for clinical vasovasostomies.

Reconstruction of seminal ducts in obstructive azoospermia

Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.

Pyloroplasty in gastric replacement of the esophagus after esophagectomy: one-layer or two-layer technique?

Pyloroplasty is our routine drainage procedure performed when the stomach is used as the esophageal substitute after esophageal resection for cancer. The technique of pyloroplasty varies among surgeons and effectiveness has not been studied. Thirty-four patients with a gastric conduit whose pyloroplasty was constructed with a one-layer technique (group 1) were compared with a historical cohort of 31 patients treated with a two-layer method (group 2). Patients who had an abnormal pyloroduodenal region were excluded from the study. Perioperative morbidity and post-operative gastrointestinal symptoms within the first 6 months were evaluated. Patient demographics and the types of surgical procedures did not differ between the two groups. The median daily output from the nasogastric tube was 119 mL in group 1 and 115 mL in group 2 (p = 0.49). In 40 out of 65 patients (62%), the nasogastric tube was removed at a median of 3 days after the operation in both groups. There was no leakage from the pylorus or the esophagogastric anastomosis in this study. In both groups, the patients could resume a semisolid diet at a median of 8 days after surgery. One patient in group 1 and two patients in group 2 developed gastroparesis clinically. No patient, however, required reoperation. There was no significant difference in cardiopulmonary complications attributable to the technique of pyloroplasty. The incidence of gastrointestinal symptoms within the first 6 months after surgery did not differ. Regurgitation was the most common symptom, affecting 10 patients in each group, 29% and 32% in group 1 and group 2 respectively (p = 1.0). Pyloroplasty was an effective gastric drainage procedure after esophagectomy whether the one or two-layer method was used. The authors prefer the one-layer method, which is safe and simple.

One-Layer Closure of Low Segment Transverse Uterine Incision by the Lembert Technique

ABSTRACT We evaluated the safety of closure of the Kerr incision by one-layer, continuous unlocked suture parallel to the incision. One hundred eighteen women who had undergone cesarean section were randomly selected and divided into two groups. Sixty-three women were in the study group. The uterine incisions of 55 women in the control group were closed by two continuous layers of suture, with the first layer locked. In both groups, number 1 polyglactin 910 (Vicryl) was used as suture material. Operating time, percent hematocrit decrease from before the operation to postoperative day 2, postoperative complications, and the time spent at hospital were the parameters compared. In no outcome measures was the two-layer closure technique found to be superior to the one-layer technique. We recommend one-layer closure with continuous unlocked suture parallel to the cut edges (Lembert stitch) in cesarean section with a low segment transverse uterine incision. (J GYNECOL SURG 14:11, 1998)

Vasovasostomy: Comparison of two microsurgical techniques

An easier technique of microsurgical vasovasostomy, a modified one-layer anastomosis, is compared to double-layer anastomosis. In this preliminary report there is no difference between the modified one-layer and double-layer techniques in per cent of patients postoperatively obtaining normal sperm count and pregnancy. Since the modified one-layer technique is easier, faster, and less expensive, this technique deserves further clinical experience and evaluation.

Microsurgical vasovasostomy.

Bilateral vasovasostomy was performed in 18 dogs and in 60 rats with Ethilon 10-0 and 11-0. The techniques used were: (a) a two-layer technique: the inner muscularis layer and the mucosal layer being sutured separately from the outer muscular layer; (b) a three-point one-layer technique: full-thickness stitches that traverse muscularis and mucosa at 120 degrees, 240 degrees and 360 degrees, between these three-point full-thickness stitches the muscularis layer is closed tightly. Patency of the vasal anastomosis was determined by injection of methylene blue and by vasography. Histologic and electron microscopic studies of specimens were performed at different intervals after the procedure. In a series of 25 rats, the results of the operation were determined by the biological fertility test: there was a 96% pregnancy rate.

Simplified technique for microscopic vasovasostomy

A one-layer technique for microscopic vasovasostomy is described. There was an 83-per cent return of sperm and 50-per cent pregnancy rate using this technique. With attention to detail, both vasa can be reanastomosed within two hours.

Artificial Insemination Homologous with Oligospermic Semen Separated on Albumin Columns

Semen samples obtained from 27 infertile men were separated on human serum albumin (HSA) columns prior to artificial homologous insemination (AIH). The columns contained either a single 7.5% HSA layer or two 17.5% and 7.5% HSA layers. Separated specimens were free of seminal debris, had significantly improved motility and progressive drive, and had a decreased percentage of abnormal forms. The total sperm count was also significantly decreased after separation, especially with the two-layer technique. No conceptions occurred in 21 couples when two-layer separation was used, but four pregnancies in 12 couples resulted from AIH with semen separated on the single-layer column. The mean total count of motile sperm obtained for AIH was 5 million with the two-layer and 31 million with the one-layer technique.