Running Stitch Research Articles

Primary robot-assisted laparoscopic partial nephrectomy for hemorrhage secondary to angiomyolipoma: a retrospective study from a large tertiary hospital in China

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14–56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization.

A Pilot Study on a New Technique for Vesicourethral Anastomosis, Using Two-Knot Running after Laparoscopic Radical Prostatectomy

Background: Laparoscopic radical prostatectomy requires a significant learning curve. One area of difficulty is mastering laparoscopic suturing techniques to perform vesicourethral anastomosis. Objective: To compare the efficacy and safety of a new technique for vesicourethral anastomosis using two-knot running. Materials and Methods: Vesicourethral anastomosis was created using two Vicryl 3-0. The first running stitch was placed at the five o’clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out. Proceeding counterclockwise, the running suture was placed from the 5 o’clock to 12 o’clock position. The second running stitch was placed from 5 o’clock to 12 o’clock position, proceeding clockwise. A knot was then tied outside at the 12 o’clock position. Results: The present anastomotic technique had been used in 20 laparoscopic radical prostatectomies. The average time for the anastomosis was 47 minutes, with a range of 38 to 65 minutes. No postoperative urinary leaks occurred, and no clinically evident obstructive symptoms resulted. The urinary continence rate one month after surgery was 20%, and 55% at three months. Conclusion: Two-knot running technique is described as a safe and feasible technique for vesicourethral anastomosis without any experienced assistant. Further studies on a larger group of patients are needed to confirm the preliminary results. Keywords: Prostate cancer; Vesicourethral anastomosis

P111 HIGH RATE OF INCISIONAL HERNIA AFTER MASS CLOSURE OF BURST ABDOMEN

Abstract Aim This study investigated the long-term effect of a standardized strategy of fascial closure with a mass closure technique, using a slowly absorbable running stitch for burst abdomen and evaluated the incidence of incisional hernia in these patients. Material and Methods A single-center, retrospective study including all patients that underwent surgery for burst abdomen between June 2014 and April 2019 was followed up in October 2020 to report the rate of incisional hernias. Results 94 patients underwent surgery for burst abdomen. 80 patients was enrolled for follow up. Index surgery was acute in 78%. Incisional hernia rate was 33%. 30-day mortality rate was 24%. Conclusions Standardized surgery for burst abdomen with a standardized mass-closure technique still results in high rates of incisional hernias.

Villaste rõivaste õmblusvõtted keskaegsete arheoloogiliste leidude näitel / Stitches and seams of woollen garments based on medieval archaeological findings

Sewing by hand is certainly something that deserves researching, conserving and practising. This traditional craft might be used to make copies of items in museums or it might be used to produce modern clothing. One source of inspiration are the seams we find on archaic textile fragments. This article deals with sewing skills and techniques that are detectable on textiles recovered from urban waste from Estonian towns dating back to the 13th–16th centuries. Our article focuses on textile fragments from Tallinn chiefly, but we also look at a small assortment of finds from Tartu and Pärnu. Our main concern is with the sewing skills and the techniques used to make woollen clothes.
 Medieval sewing skills and techniques cannot really be described using contemporary terminology or manuals: any finds are only fragmentary, and establishing a link with an object is complicated because old techniques differ considerably from contemporary practice. Fragments do have their advantages, however. For example, seams can be studied more easily. The lack of adequate terminology in our contemporary language arises from the fact that many medieval techniques have been forgotten.
 The main research methods we used were visual observation with the help of magnifying tools and detailed documentation. Stitches and seams leave traces, which means we are able identify them. A thread that has rotted away leaves a row of holes behind it, and the existence of seams is revealed by imprints and by an unworn surface. Furthermore, different stitches shape the joints in a different way.
 The article is based on 174 woollen textile fragments with a total of 321 seams. Eight different types of stitches were identified on those fragments: running stitch, partial and full backstitch, hemming and overcast stitch, and buttonhole stitch. Running stitch occurs the most often, in fully one third of the cases.
 Seams can be divided into construction seams, hems and finishes, and seams for special details. Plain seam, seam with folded seam allowances, reinforced seam, lapped seam, whip stitch joins, buttonholes and buttons are studied here. English captions are provided for the illustrations of the article.
 Most of the textile fragments originate from recycling, in the course of which the seams were cut out and thrown away. Sewing waste provides information about consumption habits, and sometimes objects can be identified. Certain seams relate to certain items, e.g. the lapped seam discovered in 14 cases definitely relates to the remnants of stockings.
 The standardisation of techniques was noticeable. The length of seams and the width of seam allowances seems to be similar throughout the period under study: the running stitch is approximately 2–3 mm, the partial backstitch up to 7mm, and other stitches (zigzag) 2–3 mm long. The techniques identified with the help of medieval finds from Estonian cities are similar to those found in other European cities. We cannot tell from the fragments whether they have been made at home or by professional tailors.
 Sewing by hand should be promoted and used in the production not only of copies of artefacts, but also of contemporary items too. This would encourage us to value handicraft and good materials and to make items that have an emotional value.
 Keywords: stitches, seams, archaeology, medieval, textiles, sewing

Abstract 16204: The Use of a Novel Suture Material in Cardiac Device Implantation

Background: Cardiac implantable electric device (CIED) implantation is a minor surgical procedure. One post-surgery complication often experienced is a suture knot projecting out of the skin 1-3 months after surgery. A unidirectional barbed suture (V-Loc; Covidien, Mansfield, MA) is a suture with barbs, which enables securing sutures without knots. The conventional sutures often leave a knot protruding at the suture line end; however, V-Loc eliminates the need to tie surgical knots and leaves a clean surface. Objective: We aimed to evaluate the safety and efficacy of V-Loc use in CIED implantation. Methods: A total of 153 patients underwent CIED implantation. Eighty-one patients were sutured using conventional string (PDS; Ethicon, Somerville, NJ) and V-Loc was used in 72 cases. A conventional method is to close a wound in three layers. After approximating the subcutaneous tissue in two layers with 3/0 PDS, the skin was closed with 4/0 PDS. Meanwhile, the new technique involves an over-and-over running stitch on the subcutaneous tissue with 3/0 V-Loc, followed by skin closure with 4/0 V-Loc. Results: The average suturing time was shorter in the V-Loc group than in the conventional group (9.9±1.7 vs. 18.0±4.1 mins. P<0.01). This translated to a reduction in closure time by 45% (8.1 mins) without complications such as wound infection and dehiscence. In the conventional group, 16 of 81 patients (19.8%) had a suture knot projecting out without infection. Conclusion: V-loc suture material offers the possibility of a knotless stitch. We noted positive results in patients who were sutured with V-loc, and suggest its usefulness in CIED implantation.

Nakshi kantha – bengali traditsioonilise tikitud teki valmistamise ja tähenduse muutumine ajas / Nakshi kantha: changes in the making and meaning of a traditional Bengali embroidered blanket

Nakshi kantha is a traditional quilt typical of Bengal, a cultural-historical area in South Asia now divided between Bangladesh and India’s West Bengal. Rural women make richly-embroidered quilts by stitching together rags embellished with various stitches to form motifs and designs that have been deliberately taken from the maker’s own habitat. The composition of the motifs renders the perception of the artisans visible, and thus it becomes the maker’s autobiography.
 Once made only by joining rags embellished with endless running stitches, nowadays modern technologies (for making and decorating) and materials have been added as the blanket has reached public realms from its domestic sphere. This transition and commodification tends to elicit certain reactions either overtly or covertly.
 This article is based on my MA thesis, defended at the University of Tartu, entitled ”Transformation of a Traditional Textile Craft: A Case Study of Nakshi kantha” in which I have discussed the commodification of a traditional quilt, Nakshi kantha, focusing on how a piece of domestic craft has turned into a commercialised product, how this raises questions regarding conventional thinking about the authenticity of heritage production and how this carries the essence of its historical purposes in its contemporary form. For my thesis, I have collected qualitative data by conducting interviews with the users, artisans, and the entrepreneurs, who all shared stories of their affiliation with this form of heritage production and its transformation.
 With its various functions and metaphorical meanings, this embroidered textile craft has been valued as a part of Bengali heritage. Since undergoing commercialisation in the recent past, the quilt has become very popular as a memento of its recipient’s origins and attachment. It has enjoyed substantial market success, albeit at the price of its traditional vernacular meaning.
 Keywords: Nakshi kantha, quilt, Bengal, traditional handicraft, commercialisation, heritage

Suturing Techniques during Robotic-Assisted Myomectomy

Study Objective To help novice surgeons master robotic suturing techniques using side-by-side views of the surgical instruments and field as well as the surgeon's hands at the console during robotic-assisted myomectomy. Design Compilation of recorded video segments showing the suturing of various myometrial defects with simultaneous views of the surgeon's hands during robotic-assisted myomectomy. Setting A tertiary care hospital. Patients or Participants A total of four patients were selected to demonstrate different suture techniques after removal of leiomyoma of different sizes and locations within the uterus. Interventions Deep myometrial defects are standardly closed in three layers starting with a deep running stitch, followed by an imbricating layer, and lastly with a baseball stitch closure of the uterine serosa utilizing a unidirectional barbed suture. We demonstrate different tips and tricks for proper ergonomic placement of the hands at the console, needle handling and camera angling that can be employed, depending on the location and orientation of the hysterotomy site. The intra-abdominal surgical views are shown alongside the view of the surgeon's hands at the console. Measurements and Main Results N/A Conclusion By offering a side-by-side view of the surgical instruments and the hand orientation of the surgeon at the console, it provides an additional perspective for a surgical learner that is otherwise not achievable in the intraoperative setting for robotic surgeries. We hope that this video can serve as a helpful resource to surgeons, instructors, and trainees for suturing techniques during robotic-assisted myomectomies.

Vaginal Hysterectomy Suturing Skills Training Model and Curriculum.

Declining vaginal hysterectomy numbers in obstetrics and gynecology training programs highlights the need for innovative methods to teach vaginal surgical skills. We describe our experience with a vaginal hysterectomy skills simulation curriculum. A low-fidelity bench model was constructed to simulate four vaginal hysterectomy suturing tasks. A polyvinyl chloride downspout adapter and low-cost materials simulate the Heaney pedicle stitch, simple pedicle stitch, double ligature, and continuous running stitch. Faculty expert vaginal surgeons established proficiency levels for each task. Resident (N=30) pass rates for tasks 1, 2, and 3 were 1 of 30 (3.3%), 7 of 30 (23.3%), and 4 of 30 (13.3%), respectively, for the left side, and 3 of 30 (10%), 9 of 30 (30%), and 10 of 30 (33.3%), respectively, for the right side. For task 4, the pass rate was 14 of 30 (46.7%). The majority of residents felt that the model simulates the technical skills required for vaginal hysterectomy and agreed that vaginal skills laboratory training would improve their ability to perform procedures in the operating room. Ninety-two percent of residents felt that a vaginal surgery skills curriculum would be a useful addition to their simulation education. A proficiency-based vaginal hysterectomy skills simulation curriculum using a low-fidelity model may be an important training and evaluation tool for vaginal surgical skills training.

Sashiko Needlework Reborn: From Functional Technology to Decorative Art

ABSTRACTThe term ‘sashiko’ refers to a quilting stitch used to sew together layers of material. The stitch itself is a simple running stitch, with the beauty created by complex interlocking stitching patterns. In Japan there is a long-standing tradition of layering and re-stitching material to create a thicker, warmer more durable garment. This was particularly true in the poorer regions of Tohoku during the Edo and early Meiji period where the lower classes used this stitching to create and decorate garments made out of homespun hemp and other plant fibres. After first contextualising the sashiko tradition, both in terms of its Edo origins and decreasing popularity in late Meiji, this paper focuses on the contemporary rebirth of sashiko as a form of decorative embroidery, and increasingly as a pure art form. In discussing the rekindled interest in this form of stitching, in both the contemporary quilting world and in the context of the global revival of traditional handicrafts, the paper concludes with reference to the work of contemporary sashiko artists and also to the use of sashiko garments in the final film made by the great director, Akira Kurosawa, Yume.

Designing, Prototyping, and Testing a Flexible Suturing Robot for Transanal Endoscopic Microsurgery

Suturing and knot tying in a confined space is a technically challenging yet clinically demanding task in minimally invasive surgery, which requires the use of highly articulated instruments passing through small incisions on the patient's body. Manually operating such instruments is usually very difficult, so robot-assisted methods have been introduced to reduce the burden of the surgeon. In this letter, a robotic suturing system for simplifying suturing in a confined space is proposed. The main part of the suturing robot is a 6-mm flexible suturing instrument that consists of suturing probe and a customized flexible joint. A novel needle driving and locking mechanism have been proposed. For controlling the suturing robot with teleoperation, the kinematics of the robot and its differential Jacobian as well as inverse kinematics are provided. A working prototype of the suturing instrument is built and integrated into a teleoperated suturing system. Running stitch and knot tying experiments have been conducted to evaluate the robot's feasibility for suturing in a confined space, which mimics the transanal endoscopic microsurgery procedure.

바느질 방법 용어의 언어학적 분석

The purpose of this study is to find the etymology of terms used in sewing and tailoring in Korean. Sewing is the craft of fastening or attaching objects using stitches made with a needle and thread. The sewing terms in Old Korean were closely related to the method of sewing and the shape of stitches. The terms can be divided into two categories: one with the suffix “-jil” and the other with the suffix “-gi”. The differences between the two terms are as follows: Technically, the method with “-jil” is more basic than the one with “-gi”, historically started to be used earlier than the one with “-gi”, and syntactically, regarding the nominality of a word, the terms with “-jil” have stronger than those with “-gi”. Examples are “hom-jil” derived from “hwida;”, “bag-eum-jil” from “bagda”, “gamchim-jil” from “gamchida” or “gamachida”, “sichim-jil”, from “sichida”, “gonggreu-gi” from “gonggeulda”, “hwigamchi-gi” from “hwigamachida” or “hwigamda”, “tteu-gi” from “tteuda”, “sangchim-jil” from a word meaning “running stitch”, etc. Among several sewing terms, “baktta”, “tteuda”, and “giptta” are used in a various way with both a broad meaning and a narrow meaning.

Training Effects of Visual Stroboscopic Impairment on Surgical Performance: A Randomized-Controlled Trial

There have been numerous advances to accelerate and improve quality and dexterous proficiency of surgical training to meet the growing US demand of graduating surgeons. The authors aimed to investigate the learning effects of such limited visual input on the surgical proficiency in untrained novice surgeons. A prospective randomized-controlled study was created with 11 participants in the study and 11 in the control group. An inanimate surgical simulation lab of a tertiary academic institution (Houston Methodist Hospital, Houston, Texas). Adult medical students in the experimental group were wearing stroboscopic eyewear while performing the same tasks as students in the control group with normal vision. For 5 weeks, the subjects were scored during 3 standardized surgical tasks from the American College of Surgeons and the Association of Program Directors in Surgery Resident Skills Curriculum: knot tying, simple interrupted sutures, and a running stitch. Pretrial, we employed the State-Trait Anxiety Inventory and post-trial, the NASA Task Load Index. The demographic characteristics of our study participants were uniformly distributed between the 2 cohorts: each group had 7 males and 4 females. Average ages were 23.6 and 24.2 years (p = 0.471). The anxiety was low during all 5 sessions and indifferent between both groups. At the end of the study, no changes were observed in the stroboscopic group for the knot-tying task (p = 0.619). However, for the simple interrupted and the running stitch, the students with stroboscopic glasses performed significantly better (p = 0.001 and p = 0.024, respectively). The stroboscopic students also had significantly lower NASA workload scores (p = 0.001). Regular training with stroboscopic glasses that limit visual input has a significant positive effect on the technical skills of novice surgical trainees with regards to more complex tasks such as multiple simple interrupted suturing or running suture. Intermittently impaired vision is beneficial in the early education of students and surgical residents.

Initial experience with endoscopic sleeve gastroplasty in Poland.

Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

Initial experience with endoscopic sleeve gastroplasty in Poland.

Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

Tohtpits pole tohust pits / Birch Bark Lace is not Lace Made of Birch Bark

Birch bark lace is Estonian needle lace. Structurally it resembles needle lace as it is known elsewhere in Europe. It uses the same stitches and there are similarities in the material used in the embroidery. However, the technology employed is unique in certain remarkable respects – it has adapted to local needs and possibilities. Whereas traditionally contour thread was tightened onto a strong textile, or in earlier times also onto parchment, in Estonia a strip of birch bark was used as a base material instead. Birch bark has many advantages as a base material: it was always available on farms and cost nothing; also, it was easy to process into a suitable size. While European lace makers were forced to cover a light-coloured base material with a dark textile or paper, the lower surface of the birch bark used for making lace was naturally darker and as such provided a suitable background for the white thread. Birch bark also gave this type of lace its name – birch bark lace.Birch bark lace is characterised by a simple geometric pattern. The joining of various motifs is not used in the birch bark lace technique. To the best of our knowledge, birch bark lace was embroidered in one piece between contour threads. Of the various lace stitches, birch bark lace uses the buttonhole stitch and twisted buttonhole stitch. The pattern is formed from the holes left between tight buttonhole stitches. Birch bark lace net differs from other birch bark laces for its net-like material of paired buttonhole stitches that could be decorated with running stitch embroidery. Ornaments are characterised by geometrical motifs that can be stitched with either white or red thread.The birch bark lace technique is not particularly well known in Estonia. No distinctive surveys have been published, but birch bark lace has been comparatively discussed alongside other lace techniques used in Estonia or introduced with a brief overview in descriptions of how to make national costumes. Hence, neither the region where it was once used nor its uses are known. The problem is that Estonian language literature has never given accounts of systematic instructions on how to use the technique. Therefore, there are few experts who are familiar with the techniques of making birch bark lace and who can distinguish objects in this technique from other museum textiles. Birch bark lace may, depending on the stitches used, be visually similar to crochet lace or filet lace. For this reason, it is possible that our museums hold more objects decorated with birch bark lace than we are currently aware. This article provides an overview of the objects decorated with birch bark lace identified in the collections of the Estonian National Museum and describes three birch bark lace techniques.

Application of vascularized tunica vaginalis flap technique in repairing recurrent urethrocutaneous fistula following hypospadias surgery

0bjective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF). Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015. The mean age of the patients was 6.2 years(range 1.6 -14.0 years). All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae. There were 5 cases of fistula in the coronary sulcus, 6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm. Single fistula was present in all patients. 16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times. After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed. Results The mean follow-up time was 2.1 years(range 0.5- 4 years). The overall success rate was 96%(24/25). Penile cosmesis was excellent. There was no evidence of recurrent fistulas or urethral strictures. All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection. No postoperative complication was encountered in the testis. The testis was of normal size and position, and the ultrasound findings were normal. Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location. The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications. Key words: Vascularized tunica vaginalis flap; Hypospadias; Urethrocutaneous fistula

Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial

A recent randomized clinical trial named Management of Myelomeningocele Study (MOMS trial) showed that prenatal correction of open spina bifida (OSB) via open fetal surgery was associated with improved infant neurological outcomes relative to postnatal repair, but at the expense of increased maternal morbidity. We sought to report the final results of our phase I trial (Cirurgia Endoscópica para Correção Antenatal da Meningomielocele [CECAM]) on the feasibility, safety, potential benefits, and side effects of the fetoscopic treatment of OSB using our unique surgical technique. Ten consecutive pregnancies with lumbosacral OSB were enrolled in the study. Surgeries were performed percutaneously under general anesthesia with 3 ports and partial carbon dioxide insufflation. After appropriate surgical positioning of the fetus, the neuroplacode was released with scissors and the skin was undermined to place a biocellulose patch over the lesion. The skin was closed over the patch using a single running stitch. Preoperative, postoperative, and postnatal magnetic resonance imaging were performed to assess hindbrain herniation. Neurodevelopmental evaluation was performed before discharge and at 3, 6, and 12 months. All cases were delivered by cesarean delivery, at which time the uterus was assessed for evidence of thinning or dehiscence. The median gestational age at the time of surgery was 27 weeks (range 25-28 weeks). Endoscopic repair was completed in 8 of 10 fetuses. Two cases were unsuccessful due to loss of uterine access. The mean gestational age at birth was 32.4 weeks with a mean latency of 5.6 weeks between surgery and delivery (range 2-8 weeks). There was 1 fetal and 1 neonatal demise, and 1 unsuccessful case underwent postnatal repair. Of the 7 infants available for analysis, complete reversal of hindbrain herniation occurred in 6 of 7 babies. Three babies required ventriculoperitoneal shunting or third ventriculostomy. Functional motor level was the same or better than the anatomical level in 6 of 7 cases. There was no significant maternal morbidity and no evidence of myometrial thinning or dehiscence. However, surgeries were complicated by premature rupture of membrane and prematurity. Our study suggests that the antenatal treatment of OSB using a fetoscopic approach and our unique surgical technique can result in a watertight seal, reversal of the hindbrain herniation, and better than expected motor function. Our technique differs substantially from the classic repair of OSB used in prior open fetal surgery and fetoscopic studies, in which the dura mater is dissected and the defect is closed in multiple layers. Instead, we use a biocellulose patch placed over the lesion and simple closure of the skin. As such, our technique is an alternative to the current paradigms in the antenatal treatment of OSB. Our clinical outcomes are in line with the results of our extensive prior animal work. Maternal benefits of our approach and technique include minimal morbidity and no myometrial legacy. Current limitations of the approach include potential loss of access, premature rupture of membranes, and attendant prematurity. Phase II trials are needed to prevent these complications and to further assess the risks and benefits of our distinct surgical approach and technique.

Ureteral Reimplantation through the use of a Running Stitch

Ureteral Reimplantation through the use of a Running Stitch

Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: a case series.

To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.

Tissue reactions of abdominal integuments to surgical sutures in sonography.

Classical abdominal surgeries usually require long incisions of the abdominal integuments followed by tight closure with adequate suturing material. Nonabsorbable sutures may cause various reactions, including granuloma reactions, both sterile and inflammatory.The aim of the studyThe aim of the study was to analyze prospective ultrasound examinations of the abdominal integuments in order to detect tissue reactions to surgical sutures.Material and methodsFor 10 years, ultrasound examinations of the abdominal integuments involved the assessment of surgical scars in all patients who underwent open or closed surgeries for various reasons (in total 2254 patients). Ultrasound examinations were performed only with the use of linear probes with the frequency ranging from 7 to 12 MHz. Each scar in the abdominal integuments was scanned in at least two planes. When a lesion was detected, the image was enlarged and the transducer was rotated by approximately 180° in order to capture the dimensions of the granuloma and the most characteristic image of the suture. Moreover, vascularization of the lesion was also assessed with the use of color Doppler mode set to detect the lowest flows.ResultsAll granulomas (19 lesions, two in one patient) created hypoechoic oval or round nodules, were relatively well-circumscribed and their size ranged from 8 × 4 mm to 40 × 14 mm. In the center of the lesion, it was possible to notice a thread that was coiled to various degrees and presented itself as a double, curved hyperechoic line. In 9 out of 19 granulomas, slight peripheral vascularization was observed. The substantial majority of the lesions (n = 15) were in contact with the fascia. In seven patients, compression with the transducer induced known local pain (n = 4) or intensified pain that had already been present (n = 3); all of these granulomas infiltrated the fascia and showed slight peripheral vascularization. Cutaneous fistulae developed in two patients with purulent reactions to the running stitch (in one patient – two fistulae).ConclusionsSuture granulomas in the abdominal integuments manifest themselves as nodular hypoechoic lesions, usually localized at the edge of the fascia – subcutaneous fat. A pathognomonic sign of this type of granulomas is the presence of a thread in their center that usually manifests itself as a chaotically shaped, double hyperechoic line. In some granulomas, particularly those with clinical presentation, slight peripheral vascularization is observed.