Principles Of Surgical Technique Research Articles

Intraomental Splenic Implant - An Attempt of Reassessment.

The permanent risk of splenectomized patients to infectious complications, the most severe being overwhelming post splenectomy infection (OPSI), determined the search for solutions in order to diminish these evolutionary possibilities. Therefore, intraomental developsplenic autotransplantation seems to be a viable option which, according to some authors, would have beneficial effects by restoring (at least partially) the functions of the spleen. The article presents the current experience related to this procedure (principles of surgical technique, implant location, complications, post-procedural evaluation) in an attempt to bring it back to the attention of trauma / general surgery surgeons. The procedure is simple, fast and with minimal or no complications and should be applied after any post-traumatic splenectomy.

Medial side knee injuries: simplifying the controversies: current concepts

Injuries to the medial side of the knee (MSK) are the most common knee ligament lesions. Historically, these injuries have been treated conservatively; however, a better understanding of the anatomy and biomechanics of the different structures of the MSK have resulted in diverse and controversial opinions about the ideal management of these lesions. A cautious analysis should be done in nomenclature because the same surgical technique principles have been differently named in the literature. The diagnostic process of MSK injuries must involve a critical thinking process to precise those lesions that imply an imminent risk of healing failure. This review article provides an evidence and clinical-based clarification of the controversies regarding injuries to the MSK and proposes an evidence-based algorithm for their management.

Contemporary Review of Buried Penis Repair

Various strategies have been developed for the surgical management of buried penis, including enhancing penile exposure and altering skin coverage. Each study has described a new surgical approach and presented a favorable outcome. This review analyzed the most recent relevant work, focusing attention on the common principles of surgical techniques and comparing their results. We found that most surgical techniques followed the same principles, such as complete degloving of the penile shaft and penile base fixation. However, controversies remain regarding classification and terminology of buried penis. Adequate surgical management requires comprehension of its various causes. Therefore, understanding the essential causes of each case and following the appropriate techniques are essential for ensuring favorable surgical outcomes.

ВАРИАНТ НЕСТАБИЛЬНОГО КИФОЗОГЕННОГО ПОРОКА ПОЗВОНОЧНИКА

The paper presents three clinical cases of a rare congenital abnormality of the cervicothoracic spine observed in patients aged 1 year 5 months to 8 years. Data on complex clinical and radiological (X-ray, CT, MRI) examinations are presented, and principles of surgical techniques and postoperative treatment features and complications are described. Hir. Pozvonoc. 2014;(1):29-34.

Principles of surgical technique

The principles in relation to gynaecological surgery are detailed. The importance of preoperative management, counselling, consent, surgical approaches, prophylaxis and proactive postoperative management are discussed. Gynaecological conditions are varied and descriptions of the individual surgical procedures are not included.

Unicompartmental Knee Arthroplasty: Mobile Magic

Unicompartmental knee arthroplasty has many advantages over total knee arthroplasty, including better function, restoration of normal kinematics, and less morbidity. This paper outlines the design features, indications, contraindications, principles of surgical technique, and long-term results of the Oxford Knee, a mobile-bearing unicompartmental knee arthroplasty. Approximately 1 in 3 patients requiring a knee replacement are appropriate for the Oxford knee. The Oxford Group believes that this is a definitive and not a pre-total knee arthroplasty option provided that appropriate indications and correct surgical technique are used.

Medial Patellofemoral Ligament Repair for Recurrent Patellar Dislocation

Background The medial patellofemoral ligament (MPFL) is the primary restraint to extreme lateral displacement and is typically disrupted with an acute lateral patellar dislocation. Patients who fail a comprehensive nonoperative program and experience recurrent lateral patellar instability episodes are candidates for surgical treatment. Current surgical procedures include a variety of proximal realignment techniques, including repair or reconstruction of the MPFL along with distal realignment of the tibial tubercle when indicated. Purpose The objective of this study was to review the clinical, functional, and radiographic outcomes of isolated MPFL repair for recurrent lateral patellar dislocation. Study Design Case series; Level of evidence, 4. Methods The records of all patients undergoing MPFL repair for recurrent patellar dislocation at the Mayo Clinic from 2001 to 2006 were retrospectively reviewed. Twenty-seven patients (29 knees) with an average age of 19 years (range, 11-32 years) were included in this study. Clinical, functional, and radiographic outcomes were assessed at an average of 4 years after surgery (range, 2-7 years), using recurrent instability as the primary end point. Results The success rate of MPFL repair for preventing recurrent dislocations was 72% (21 of 29 knees). Eight patients (28%) experienced a recurrent lateral patellar dislocation. Five of these patients required a reoperation, including two MPFL reconstructions, 1 tibial tubercle osteotomy with MPFL reconstruction, 1 tibial tubercle osteotomy with revision MPFL repair, and 1 revision MPFL repair. At final follow-up, the mean Lysholm and Kujala scores were 86 (range, 42-100) and 92 (range, 57-105), respectively. Postoperative radiographs revealed a mean patellofemoral congruence angle improvement of 27° (range, 5°-44°). The only statistically significant risk factor for failure was nonanatomical MPFL repair at the medial femoral condyle (P = .004). Conclusion Isolated repair of the MPFL for recurrent patellar instability is associated with a relatively high failure rate, but remains a viable surgical option if surgical technique principles are followed. The clinical success of this operation depends on restoration of the anatomical origin of the MPFL and careful patient selection.

Dr. Halsted at Hopkins and at High Hampton

Dr. Halsted at Hopkins and at High Hampton

Measuring Circulating Tumor Cells As a Surrogate End Point for Adjuvant Therapy of Breast Cancer: What Do They Mean and What Should We Do About Them?

Measuring Circulating Tumor Cells As a Surrogate End Point for Adjuvant Therapy of Breast Cancer: What Do They Mean and What Should We Do About Them?

Traumatismes fermés du foie Principes de technique et de tactique chirurgicales

LIVER CONTUSIONS: PRINCIPLES OF SURGICAL TECHNIQUE AND TACTICS (Abstract): The prognostic of the liver trauma is conditioned by the type of the hepatic injuries. Their anatomic and hemorhagic characteristics will influence the kind of treatment: emergency laparotomy or non-surgical treatment. The most important condition for a non-surgical treatment of the liver trauma is a stable patient. Operative option is indicated for unstable patients, when there are other visceral injuries or when the surgical unit hasn’t accurate imagistics posssibilities. For optimal operative management of the liver trauma, some principles need to be followed: 1) the patient is positioned with the arms at right angles on arm boards, wich allowes better access to intravenous or intraarterial lines; 2) skin preparation is for a toarco-abdominal approach; 3) the primary incision is a midline one wich can be branched with a right transverse. After laparotomy there are two situations: liver injuries without or with active haemorrhage. For the first situation, evacuation of the hemoperitoneum, lavage and drainge are the only procedures indicated. For the second types of injuries we also describe favorable and unfavorable injuries. When the hand compression of the liver is effective and hepatic injury is anterior, the hemostasis after clampage of the hepatic pedicle (Pringle maneuver) is indicated. Perihepatic packing is indicated in case of choagulopaty. Hepatic resection it isn’t recommended. The unfavorable situation is association of acidose-hypotermia and choagulopaty wich cause a “biological hemorrhage”. In this cases are indicated“abbreviated laparotomy” with perihepatic packing (damage control) and planned reoperation or arterial embolisation (interventional radiology). When the clampage of the hepatic pedicle it isn’t efficient, probably a hepatic vein is injured and a a perihepatic packing is also indicated. The unefficiency of the perihepatic packing, the clampage of the hepatic pedicle + inferior vena cava (under and above the liver) ± aorta it is necessary to stop the active bleeding. The closure of the laparotomy it is necessary to be made very fast, especially for the “abbreviated laparotomy”. In the case of trauma of the main hepatic duct an external billiary drainage it is recommended. The reoperation it is indicated in some cases: intraabdominal hyperpression syndrome, perihepatic packing, other intraabdominal complications. Conclusion: The prognostic of the liver trauma depends by the anatomical type of the injuries. Operative management of the liver trauma is very difficult. The clampage of the hepatic pedicle (with or without vena cava and aorta) and perihepatic packing can save the patient. Interventional radiology with arterial embolisation can solve some cases.

Principles of surgical technique G. G. Wind and N. M. Rich. 280 × 210 mm. Pp. 280 + xii. Illustrated. 1987. Baltimore: Williams And wilkins. £29.25

Principles of surgical technique G. G. Wind and N. M. Rich. 280 × 210 mm. Pp. 280 + xii. Illustrated. 1987. Baltimore: Williams And wilkins. £29.25

Stenosis of Uretero-Intestinal Anastomoses. Our Experience

The main aim of every urinary diversion is to preserve the morphological and functional integrity of the upper urinary tracts. Stenosis of the uretero-intestinal anastomosis is one of the most dreaded complications. This alone may jeopardise the success of the operation and the quality of life that remains for the patient. Material and methods From November ‘94 to December ‘97,109 patients (average age 68 years, range 48–79) underwent radical cystectomy with urinary diversion (53 VIP, 42 Bricker, 4 Reddy2, 3 USS, 2 Studer, 1 Mainz1, 1 Mainz2, 2 Indiana, 1 Camey2). 216 anti-reflux u-i anastomoses were created (93 Le Duc, 6 Leadbetter, 4 Goodwin, 2 Split-cuff, 2 Mainz, 2 Ghoneim) and 107 direct anastomoses (41 Nesbit, 35 Wallace1, 13 Bricker, 12 Polsino, 6 Wallace2). Results 18/216 (8.3%) stenoses occurred (none secondary to neoplastic recurrence): 11/109 (10%) in u-i anastomoses made with the anti-reflux technique (6 Le Duc, 2 Ghoneim, 2 Mainz, 1 Leadbetter) and 7/107 (6.5%) with direct implantation (3 Nesbit, 2 Polsino, 2 Wallace1). Stenoses occurred in 9 VAP, 3 Bricker, 2 Reddy2 (bilateral in 4 patients). Conclusions The high number of variants of uretero-intestinal anastomosis techniques demonstrates that there is as yet no commonly accepted technique, every surgeon performing the procedure that in his experience produces the best results with the fewest complications. The choice of type of anastomosis should take into account the type of urinary diversion with its urodynamic characteristics, searching as far as possible to create anti-reflux mechanisms in the orthotopic diversions. The common principles of surgical technique remain valid, i.e. to respect the anatomical structure, to avoid stretching or curving of the ureter, to create leak-proof anastomoses.

Prevention and management of ileostomy complications.

In spite of multiple advances in surgical techniques such as restorative proctocolectomy and pelvic pouch surgery, the creation of a satisfactory ileal stoma and the proper management of ileostomy complications are often overlooked. This article summarizes important principles of surgical techniques in the construction of ileostomy and care of the ileostomy and its complications. The key to management of many complications is prevention.

Principles of surgical technique in the treatment of carcinoma of the large bowel

The principles of surgical technique for the operative management of colon cancer are described. With the background of the evolution of anastomotic alternatives, the methods for reestablishing intestinal continuity and the approach to the treatment of complicated presentations of colonic cancer are reviewed. While one may construe this paper to have a certain author bias, I have tried to present diverse options where pertinent, but there should be little question as to where my opinion lies.

Principles of Surgical Technique

Principles of Surgical Technique

Principles of Surgical Technique: The Art of Surgery

As most surgeons would agree, the acquisition of surgical skills is a subtle process based largely on actual performance of the manual tasks in the operating room itself. Good surgical technique is, however, based on certain general principles and fundamentals. While difficult to teach and communicate, particularly in written form, appreciation and understanding of basic concepts relating to asepsis, tissue handling, hemostasis, and exposure should contribute to the mastery of surgical technique. It is the authors' purpose to bridge the gap between knowing and doing by presentation of a logical and unified set of basic principles of technique not found in either standard surgical textbooks or surgical atlases. Throughout this book, they stress to new surgeons the overriding principle of do no harm. The book is divided into two parts; the first outlines broad fundamental principles and includes a brief historical perspective and concise description of the key aspects of

Principles of Surgical Technique

This is a primer on technical surgery for medical students and junior surgical residents. The first half of the book is a discussion of the basic tools of the surgical trade. Their introduction is an excellent example of what is meant by a "technical misadventure." There are discussions of knot tying, suture material, and basic surgical instrument handling and maneuvers. There are chapters on history and on wound healing. There is an excellent essay on assisting in surgical procedures. A seven-page outline of surgical principles is a valuable summary. The second half of the book consists of specific discussions of the major operative procedures in general surgery, including breast biopsy, basic abdominal operations, appendectomy, hernia, cholecystectomy, and small-bowel resection. Vascular anastomosis is also included, reflecting Dr Rich's major interest. No attempt is made to be comprehensive in these treatments. Rather, the authors present techniques that work for them. This section

Principles of Surgical Technique in Knee Arthroplasty

Surgical technique in knee arthroplasty is quite demanding, requiring an understanding of arthritic deformities and meticulous attention to the principles of component insertion. Increasing clinical success in knee arthroplasty can be attributed to better designs, materials, and, most significantly, surgical technique. Although the "new generation" of instruments enhances the likelihood of a reproducible technique, anatomic variation precludes precise application of any instrumentation to all knees. The surgeon must recognize the weakness of the selected system while understanding the principles of conformity, alignment, and rotation to insure technical accuracy.

Ergebnisse der Beckenosteotomie nach Salter

With the aid of radiological and clinical functional criteria, the results of 33 hip joints, operated after the method of Salter, are analysed. As in most cases a femoral detorsion occurs as a result of the pelvic osteotomy, basic coupling of the pelvic osteotomy with a femoral osteotomy dose not appear to be necessary. The importance of necessity of exact adherence to the principles of surgical technique, as described by Salter, as well as pre and post operative care, is stressed.

Principles of Surgical Technique

Principles of Surgical Technique