Side Clamping Research Articles

Elective open repair with the debranch, perfuse, reconstruct technique to treat suprarenal or type IV thoracoabdominal aortic aneurysms

BackgroundOpen surgical repair of suprarenal abdominal aortic aneurysm (SRAAA) and type IV thoracoabdominal aortic aneurysm (TAAA) remains a surgical challenge because of the inducted intraoperative visceral and renal ischemia. We report a novel three-step technique named debranch, perfuse, reconstruct (DPR), using debranching and passive arterial shunt to decrease these ischemic complications. The main aim of this study was to evaluate the 30-day and 1-year mortality rates associated with these DPR technique. The secondary aim was to evaluate the impact on renal function and the primary patency of the repaired arteries. MethodsThis retrospective study included all consecutive patients who underwent elective surgery for SRAAA or type IV TAAA using the DPR technique between January 2011 and June 2022. In debranching, using partial side clamping, a multibranch graft was implanted side-to-end into the descending thoracic aorta. The left renal artery was anastomosed end-to-end to the graft. As needed, the superior mesenteric artery (SMA), the celiac trunk, and the right renal artery could also be anastomosed to the graft. In the perfusion step, cannulas were connected to the last branch of the multibranch graft to perfuse other arteries during aortic cross-clamping. For repair, a tube or bifurcated graft was used for the aortic repair. The branch used as a passive temporary arterial shunt was ligated at the end of the intervention. Clinical, radiological, and biological preoperative and postoperative factors were reviewed using a standardized database. Procedural complications and reinterventions were analyzed, as well as artery patency. ResultsThere were 40 patients who underwent DPR technique. The mean patient age was 67 ± 13 years and two were women. Twenty-three patients presented with a SRAAA and 17 with a type IV TAAA. The 30-day and 1-year mortality rates were 2.5% (one patient). Two respiratory complications (5%) and three mesenteric ischemic complications (7%) have been recorded. No patient developed signs of cardiac or spinal cord dysfunction. We did not observe a significant change in postoperative renal function. The celiac trunk, superior mesenteric artery, left renal artery, and right renal artery bypass patency rates at 1 year were 95%, 100%, 90%, and 100%, respectively. ConclusionsThe SRAAA and type IV TAAA repair with DPR technique provides short visceral and renal ischemia times with a low mortality rate. This technique could be an option to consider for visceral and renal protection during open surgical repair.

Revolutionizing Foam Cutting Efficiency in Indonesia with AutoCAD

Foam set machines are essential for cutting foam sheets in various industries, including furniture, textiles, and foam manufacturing. PT. Amangriya, using a custom foam set machine for two years, identified the need for efficiency improvements. This research aimed to enhance the foam set machine's design using AutoCAD software. Key improvements included an automatic top clamp, a flexible side clamp, and reduced machine dimensions. These modifications resulted in a more efficient and compact machine, facilitating easier manufacturing and assembly processes. The study highlights the potential for significant efficiency gains in the foam manufacturing industry through design enhancements. Highlight: Enhanced machine design with AutoCAD software improves efficiency and functionality. Key modifications include automatic top clamp and flexible side clamp. Reduced machine dimensions facilitate easier manufacturing and assembly. Keywoard: Foam set machine, design enhancement, efficiency, AutoCAD, manufacturing

Comparison of clinical outcomes of sutureless and conventional mechanical aortic valves

Aim: Aortic stenosis is a prevalent valvular disease characterized with outflow obstruction of left ventricle especially in patients with advanced ages. Definitive treatment of this disorder is valve replacement and done via different kinds of prosthetic valves. Herein we aimed to compare the clinical outcomes of the individuals underwent aortic valve replacement by using sutureless or conventional mechanical valve. Material and Methods: Between 2020-2023, totally 102 patients underwent aortic valve replacement due to severe aortic stenosis were involved in the study. Patients were seperated into two groups according to the valve prothesis used in operations, sutureless valve group (n=50) and conventional mechanical valve group (n=52). Results: The mean duration of cardiopulmonary bypass and side clamp and were significantly decreased in the sutureless valve group than conventional one (52.6±32.2 vs. 77.4±35.3 minutes and 86.4±18.5 vs. 121.8±13.45 minutes, p<.001). Duration of mechanical ventilation, intensive care unit (ICU) stay and hospitalization were also significantly lower in sutureless group. Conclusion: Although patients operated by using sutureless valve are older, they have satisfactoried intra and postoperative outcomes. Therefore, aortic valve replacement operations can be performed reliably with sutureless valves in patients with advanced ages.

Outcomes of Clampless Real Chimney Technique with Dacron Graft and Sleeve Banding of the Ascending Aorta for Total Debranching Endovascular Arch Repair

Background: Hybrid aortic arch repair with debranching of the supra-aortic vessels carries a high risk of cerebral infarction and fatal complications associated with side clamping of the ascending aorta. A previous study had reported the “real chimney” technique, a novel method for clamp-free total debranching thoracic endovascular aortic repair with the ascending aortic sleeve banding with dacron. In this study, we aim to build upon this foundation by presenting our experience with the early and midterm outcomes of this technique. Methods: We retrospectively reviewed the medical records of 61 consecutive older adult patients with aortic arch pathologies and a high risk of open repair who underwent total debranching thoracic endovascular aortic repair using the real chimney technique at our institution between January 2014 and June 2022. This technique was used to anastomose the ascending aorta with the main trunk of the triple-branched prosthetic graft. Results: The mean patient age was 75.1 years, and 54% of patients were transferred from medical facilities with cardiothoracic surgery departments. The comorbidities included chronic obstructive pulmonary disease (49.2%), chronic kidney disease (63.9%), coronary artery disease (27.9%), and history of stroke (31.1%). No 30-day mortality was observed. Complications included postoperative renal failure requiring permanent hemodialysis (4; 6.6%), stroke (modified Rankin scale score: ≥2 in 5; 8.2%), permanent paraplegia (1; 1.6%), and permanent paraparesis (4; 6.6%). The median follow-up period was 40.5±28.5 months. The postoperative survival rates at 5 years were 66.8%. No patients experienced complications associated with the aorta or anastomosis site; only 1 patient required an additional procedure for stenosis of the anastomosis site (midterm). An aneurysmal diameter reduction of ≥3 mm was observed in 37 cases (60.7%), and the mean aneurysmal diameter reduction was 5.3 mm. Conclusions: The postoperative outcome of total debranching thoracic endovascular aortic arch repair is not only acceptable but also promising, particularly in patients at high risk of open repair. Clinical Impact Our novel real chimney technique for total debranching thoracic endovascular aortic repair of aortic arch pathologies in patients who were at a high-risk for open repair resulted in no 30-day mortality and no complications related to the aorta or the real chimney anastomosis site. The real chimney technique is effective for managing aortic arch pathologies and enables less invasive total debranching thoracic endovascular aortic arch repair without the need for extracorporeal circulation and clamping of the ascending aorta

Panel Flutter Numerical Study of Thin Isotropic Flat Plates and Curved Plates with Various Edge Boundary Conditions

In this article, supersonic panel flutter analysis of flat plates and curved plates with different edge boundary conditions are studied, using efficient, high precision triangular shallow shell finite elements. The fluid on the underside of the plate was is assumed to be stationary. The linear piston theory can be applied to the top surface of the plate. The linear piston theory was used to evaluate the aerodynamic loads. The solution of a complex eigenvalue problem was formulated according to Hamilton’s principle. Lagrange’s equation of motion was obtained using standard methods for finding eigenvalues. Current finite element analysis ignores aerodynamic damping. For panels, the theory of thin and small deformed shells was taken into account. To validate the developed finite element code, the results of a square and rectangular flat-panels with simply supported edges (S-S-S-S), a square plate with four fixed edges (C-C-C-C), and a square plate with the length side clamps (C-S-C-S) were compared with the published data. The flutter results of other edge boundary conditions (S-C-S-C, C-S-C-S, and C-C-C-C) for square and rectangular flat panels are evaluated for which literature data is limited. It has been found that the fixed condition in the cross-flow direction (S-C-S-C) has a significant effect on the critical flutter pressure parameters and flutter frequencies. Further, to study the aforementioned effect, the current finite element (FE) has been extended to curved plates with S-C-S-C(constrained in the cross-flow direction and exposed to supersonic flow), SS-S-S boundary conditions to find flutter results.

Upaya Peningkatan Kualitas Produk Corrugated Box dengan Pendekatan Fault Tree Analysis (FTA) dan Failure Mode and Effect Analysis (FMEA)

PT Kreasi Kemas Indonesia is a company that produces various types of cardboard with a make to order system. The percentage of defects in the printing process on the longway machine for the 2022 production period is 2.16% of the 2% set by the company. The Fault Tree Analysis (FTA) and Failure Mode and Effect Analysis (FMEA) approaches are combined to determine the causes of defects and 5W + 1H as an improvement method. The purpose of this study is to determine the causes of defects and provide suggestions for improvement. The results showed that the causes of the largest defects with the highest RPN values were missed trial print inspection (720), imprecise sheet side clamp settings (576), and non-standard trial print (630). The recommended improvement suggestions are to conduct a more detailed and comprehensive review and sorting process during the trial printing process, provide regular socialization and assistance regarding quality assurance policies that can refer to ISO 9001: 2015 to operators, and conduct routine maintenance of all machine components

DYNAMIC CEREBRAL BLOOD FLOW CHANGES ASSOCIATED WITH OFF PUMP CORONARY ARTERY BYPASS GRAFTING (OPCAB) ASSESSED BY A NOVEL, ROBOTIC ASSISTED, AUTONOMOUS, CONTINUOUS AND BILATERAL TRANSCRANIAL DOPPLER (TCD)

<h3>Background and Objectives</h3> There is ongoing controversy regarding the clinical and physiological benefit of OPCAB. While we have reported reduced perioperative mortality, neurological outcomes have not improved. Thus, further insights are needed to fully delineate the impact of OPCAB on the cerebral circulation. Here we present a novel strategy for continuous monitoring of mid cerebral artery (MCA) blood flow using the NovaGuide Robotic TCD system (NovaSignal Corp., Los Angeles CA USA) (figure 1). We have also employed cerebral tissue oximetry (Foresight, Edwards Lifesciences) to evaluate overall tissue oxygenation. <h3>Methods</h3> 7 elective OPCAB patients with no evidence of significant carotid disease were enrolled as part of our initial service evaluation. After anaesthesia induction, the patient head was stabilised in a specific cradle and robotic TCD probes were placed onto the patient's temporal region. The NovaGuide autonomously identified a transtemporal window, located the MCA vessels bilaterally and optimised the TCD signal. Baseline mean MCA flow was established prior to surgical manipulations and subsequent signals were automatically acquired for the entire duration of surgery. Data are reported as SEM +/- STD and group comparison was performed by ANOVA or t tests, as appropriate. <h3>Results</h3> There were no adverse events related to head positioning or access to central lines or placement of transoesophageal echo probes and routine monitoring. The device did not interfere with surgical conduct. Mean MCA flows at baseline were 43 +/-12 and 42 +/-13 cm/s for left and right MCA respectively. Pre-grafting events such as skin incision, sternotomy, and pericardiotomy increased LMCA flow by 14 +/- 35 24 +/- 27 and 17 +/- 20% with similar changes in RMCA flows. Mild Trendelenburg position and graded increase in MAP as pre-optimisation measures increased cerebral blood flow. While lifting and positioning the heart for grafting and placing the Octopus stabiliser generally reduced TCD levels, they remained higher than preoperative values (14+/-20; 31 +/- 36 and 9+/- 9 % increase for LAD, OM and PDA grafts, respectively). No significant changes were observed by clamping or anastomosing or reperfusing the respective coronary arteries. There was a transient increase in TCD signals upon replacing the heart in the pericardium after completing the anastomoses (28+/-7; 20 +/- 26 and 22 +/-29 % increase for LAD, OM and PDA positions, respectively). There were minor changes upon conducting the aortic anastomoses, but rare singular embolic events were noted occasionally upon releasing the aortic side clamp. Baseline left and right cerebral StO2 was identical (67+/-4 and 67+/-2) and showed little variation throughout surgery (<5%). <h3>Conclusion</h3> Continuous monitoring of bilateral TCD using the robotic TCD system is feasible during OPCAB. There are characteristic changes in TCD values at various phases of the operation, but our current optimisation strategy appears to preserve cerebral blood flow. Future validation studies are required which should address clinical correlates in high-risk patients including those with cerebrovascular disease.

Total Debranching Plus Antegrade Thoracic Endovascular Aortic Repair without Side Clamping in a Patient with Arch Aneurysm and Ascending Aorta Calcification.

A high-risk patient with aortic arch aneurysm, associated with severe calcification of the ascending aorta and iliac arteries, was treated with total debranching and antegrade thoracic endovascular aortic repair (TEVAR) via the ascending aorta. Proximal anastomosis for a triple-branched graft to the ascending aorta was performed without side clamping using the “real chimney technique.” After bypassing the supra-aortic branches, a TEVAR was performed in an antegrade fashion through the ascending aorta. This case suggests that the approaches mentioned above should be considered in patients with arch aneurysms and severe calcified degeneration.

The Effects of Aortic Clamping Strategy on Myocardial Protection and Early Postoperative Outcomes During Coronary Artery Bypass Grafting Operations.

The purpose of the present study was to compare the effects of two different clamping strategies for the construction of the proximal aortocoronary anastomoses on myocardial protection and postoperative outcomes during coronary artery bypass grafting (CABG) operations. In this retrospective study, we examined prospectively collected data of patients who underwent CABG for a 3-year period. Two hundred consecutive patients, who were diagnosed with triple vessel coronary artery disease (CAD), were selected and divided into two groups. In Group 1 (single clamp) (N = 100), venoaortic proximal anastomoses were performed using a single aortic cross-clamp, while in Group 2 (double clamp) (N = 100), proximal anastomoses were performed by using an aortic side clamp. Operative and postoperative outcomes of the patients were compared between the two groups. The serum levels of myocardial damage biomarkers, creatine phosphokinase-MB (CPK-MB), and high sensitive Troponin (hsTnI) results were measured preoperatively, intraoperatively, and postoperatively (6, 12, 24, and 48 hours). Patient demographics and characteristics were similar between the two groups. In Group 1, cross-clamp duration time (65 min versus 49 min; P = .0001) was longer. However, perfusion time (91 min versus 85 min; P = .61) was similar between the two groups. In Group 2, postoperative CK-MB levels were significantly higher intraoperatively (P = .18), 6 hours (P = .22), 24 hours (P = .001), and 48 hours (P = .001) than in Group 1. HsTnI was only significantly higher in Group 2 versus Group 1 at 24 hours (P = .001) and 48 hours (P = .01) postoperatively. Time of intensive care unit stay, duration of extubation, and length of hospital stay were similar in both groups. The technique used for proximal anastomosis has a significant effect on perioperative results, especially on myocardial protection.

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

Surgical coronary revascularization remains the preferred strategy in a significant portion of patients with coronary artery disease due to superior long-term outcomes. However, there is a significant risk of perioperative neurologic injury that has influenced guideline recommendations. These complications occur in 1%-5% of patients, ranging from overt neurologic deficits with permanent disability, to subtle cerebral defects noted on neuroimaging that may result in slow cognitive and functional decline. The primary mechanism by which these events occur is thromboembolism from manipulation of the ascending aorta. This occurs during cardiopulmonary bypass, aortic cross-clamping, and partial occlusion clamping (side clamp). Elderly patients and patients with aortic atheroma are, therefore, at significantly increased risk. Initial surgical techniques addressed this by aggressively debriding or replacing the ascending aorta during coronary artery bypass grafting (CABG). Strategies then moved toward minimizing aortic manipulation through pump-assisted beating heart surgery and off-pump surgery with partial occlusion clamping or proximal anastomosis devices. Finally, anaortic off-pump CABG aims to avoid all manipulation of the ascending aorta through advanced off-pump grafting techniques combined with in situ and composite grafts. This has been demonstrated to result in the greatest reduction in risk. Establishing successful anaortic off-pump CABG programs requires subspecialization and focused interest groups dedicated to advancing CABG outcomes.

Acute Kidney Injury in Adult Living Donor Liver Transplantation Performed with Different Methods of Inferior Vena Cava Clamping Maneuvers

ObjectiveThe aim of this retrospective study is to evaluate and compare the incidence of acute kidney injury (AKI), defined as increase serum creatinine (SCr) of 0.3 mg/dl or increase in SCr to ≥1.5 times from baseline within 48 hour, in adult living donor liver transplantation patients performed with total cross clamp vs side clamp of the inferior vena cava (IVC). Methods and PatientsSixty adult living donor liver transplantation (LDLT) patients were divided into 2 groups: 30 patients in total IVC clamping (G1) and 30 in IVC side clamping (G2) during the anhepatic phase. Patients’ characteristic, hemodynamic changes in percentage (%) as a result of different methods of IVC clamping, urine output during anhepatic phase were compared by using the Student t test, and the incidence of AKI were compared by using the χ2 test between groups. P value <.05 was regarded as significant. ResultsThe negative impact of the 2 different ways of IVC clamping was significantly more severe in G1 compared to G2; consequently, the urine output of G1 was significantly less than G2. Although there was significantly more urine output of G2 during the anhepatic phase, the incidence of the postoperative AKI between groups was similar. ConclusionThe side clamp of the IVC had a significantly less negative impact on the hemodynamic parameters and provided sufficient urine output during the anhepatic phase (2.24 ± 3.17 vs 0.39 ± 0.33 mL/kg/h) compared to the total clamp of the IVC. But this favorable data did not protect the patient suffering from postoperative AKI in LDLT.

Transcervical LVAD Outflow Graft Implantation as Sternotomy Free Procedure: Proof-of-Concept

Minimally invasive methods to implant left ventricular assist devices (LVAD) have emerged as alternatives to the classic median sternotomy as they have been shown to decrease bleeding and periprocedural complications, plus speed up recovery and make future sternotomies easier. While implantation of a centrifugal LVAD within the LV apex can be performed via a left thoracotomy, the outflow graft anastomosis to ascending aorta is still routinely done via upper hemi-sternotomy which, although limited, has some of the above disadvantages. We present a technique of transcervical outflow graft implantation which completely avoids sternotomy. This is a proof-of-concept implantation performed on a cadaveric model. The procedure is facilitated by a novel access system (CoreVista® Retractor, CardioPrecision Ltd, Glasgow UK) designed for surgery via a transcervical approach. This device comprises a frame fixed to the operating table to which a disposable transcervical retractor with inbuilt illumination modes used for the different steps of the procedure is attached plus an HD display offering optimal views. The technique can be broken down into a number of reproducible steps: transverse neck incision, retractor insertion, sternal elevation, illumination, dissection of anterior mediastinum and exposure of aorta. The outflow graft is pulled into the field and, after trimming to avoid kinking, a side clamp is placed on the aorta and the graft is sutured in continuous fashion. This is greatly aided by the retractor illumination and HD visualisation on-screen. Sutures are tied, clamp released, haemostasis confirmed, retractor removed and the small neck incision closed. This proof of concept demonstrates that a sternotomy-free implantation of a LVAD is feasible and should prove reproducible with the help of the novel transcervical access system. The approach may also be suitable for implantation of an axial flow pump without the current limitations imposed by access vessel size.

A Clampless Aortoprosthetic End to Side Anastomotic Device with Large Diameter Aortic Puncher

IntroductionTo facilitate safe anastomosis of a vascular prosthesis onto the proximal ascending aorta without side clamping, a clampless anastomotic device with large diameter aortic puncher was developed.ReportFirst, a vascular prosthesis is anastomosed onto the aorta without making a hole, then the aortic wall within the prosthesis is punched out using the device.DiscussionAfter further refinement of the present device, endovascular surgery with debranching could be performed more safely and quickly.

Applying a clampless haemostatic device for left ventricular assist device outflow graft anastomosis.

Performing a left ventricular assist device outflow graft anastomosis in redo cases with a short ascending aorta and open vein grafts requires side clamping of the aorta and may necessitate temporary clamping of the vein grafts to optimize the surgical field. We aim to describe the technique and report our experience with applying the HeartString® device for the anastomosis of the left ventricular assist device outflow graft in 2 male patients with ischaemic cardiomyopathy following coronary artery bypass surgery. The feasibility of using the HeartString device has been shown and no procedure-related complication was documented.

Analysis and Implementation of LC Series Resonant Converter with Secondary Side Clamp Diodes under DCM Operation for High Step-Up Applications

Analysis and Implementation of LC Series Resonant Converter with Secondary Side Clamp Diodes under DCM Operation for High Step-Up Applications

Biliary intraepithelial neoplasia in liver parenchyma of the caudate lobe: honeycomb appearance

Biliary intraepithelial neoplasia (BilIN) was newly defined by the WHO in 2010 and is characterized by biliary cell atypia with an intraductal papillary lesion. It is always found in the major bile duct, but not in liver parenchyma. A 50-mm irregular tumor was detected in the paracaval portion of the hepatic caudate lobe of a 61-year-old man. He had undergone total gastrectomy for advanced gastric cancer 2 years earlier. The tumor had increased from 20 to 50 mm in the last 6 months. Abdominal CT showed an irregular hypo-enhanced tumor, with a honeycomb appearance inside the tumor. Diffusion-weighted MRI and PET showed that the tumor had malignant features, though no tumor markers were elevated. The tumor seemed to invade into the inferior vena cava (IVC) and hepatic veins. At operation, under side clamping of the IVC, a total of 10 cm of ventral side IVC was resected with the left liver. Pathologically, the tumor was an inflammatory pseudo-tumor that contained intermediate-grade BilIN of persistent liver parenchyma in the tumor. The honeycomb appearance within the tumor showed a causal relationship between the pathological and etiological representations of BilIN. Considering BilIN avoids an unnecessary operation when we encounter atypical imaging findings of liver tumors.

Simple and safe removal modification of the HEARTSTRING device.

HEARTSTRING is a useful proximal anastomosis assist device, but it has a drawback in that the removal process is irreversible. If thread cutting occurs during the tying process, repair without side clamping is difficult. We developed a simple modified technique for the safe removal of the HEARTSTRING device.

Minimally invasive surgery to the aortic arch – endovascular repair combined with debranching: 4 case reports

Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest - allowing detachment of the head vessels off the aneurysm, and their anastomosis onto the graft. The procedure is safe and reproducible, however morbidity is significant and includes air embolism, stroke, excessive bleeding and acidosis. In addition the procedures are time-consuming, and cardioplegic arrest is also necessary, resulting in the potential for low cardiac output. Aortic arch aneurysms are not typically suitable for endovascular intervention. With improving techniques of descending aortic repair with stent grafts, hybrid techniques, which involve aortic arch debranching - thereby creating a proximal landing zone of adequate length, followed by stenting over the aortic arch are becoming popular. Methods: Four cases are presented. The technique involves initial sternotomy or upper sternal split, detachment of the innominate and left common carotid arteries, and their reattachment to the ascending aorta by separate grafts (debranching procedure). During this time a side clamp is placed on the ascending aorta. The left subclavian is usually left intact for technical reasons, unless there is a dominant left vertebral artery. This is safe as the shoulder has adequate collateral circulation, and stenting over this vessel is therefore well tolerated. The aortic arch is then completely covered with a stent graft which is inserted via the femoral artery. Arteriography was performed at the end of the procedure to confirm stent graft position and exclusion of the lesion. Results: All surgical transpositions were successful, and the patients recovered without neurologic, bleeding or cardiac complications. Surgical conversion for aortic graft was never required. There were no endoleaks. Mean duration of follow up was 53.5 months (range 21-77). Conclusions: Endovascular repair of the descending thoracic aorta, initially reserved for inoperable patients, is now becoming the accepted initial management. With improved technology and endografts it is now the safest option, especially for traumatic dissection. These techniques have now extended to the aortic arch. Debranching of the aortic arch enables endovascular grafting in this area, thereby avoiding cardiopulmonary bypass and circulatory arrest. Good pre-operative planning is necessary to make the procedure feasible.

Retrospective Analysis of Type A Aortic Dissections after Debranching of the Supra Aortic Trunks and Stentgraft of the Aortic Arch: The Side Clamping of the Ascending Aorta Is Responsible

Retrospective Analysis of Type A Aortic Dissections after Debranching of the Supra Aortic Trunks and Stentgraft of the Aortic Arch: The Side Clamping of the Ascending Aorta Is Responsible

Application of Virtual Reality in Side Clamp Fixture Assembly

Background/Objectives: The main objective of this paper is dealt with the application of virtual reality in side clamp fixture assembly. Methods/Statistical Analysis: The proposed methodology utilized the geometry and assembly details of side clamp assembly and makes the fixture assembly as close as possible to the real one. It includes two stages. The first stage demonstrates the procedure used for creating virtual prototype of an assembly and the second stage includes the creation of virtual fixture assembly. Findings: VRML coding is used to simulate virtual assembly process. Based on interference analysis errors can be rectified. Fixture assembly planning in virtual environment gives better understanding of the design engineer and the virtual assembly planning gives clear detail for virtual manufacturing. It enables intuitive assembly sequences which are then evaluated by Vizard inspector module. Application/Improvement: In this paper fixture assembly sequences are simulated using VIZARD software. Future research will investigate the fixture assembly plan in a complex virtual manufacturing environment.