Suspension Sutures Research Articles

Ovariohisterectomia videoassistida com dois portais para o tratamento de piometra em cadela

O presente trabalho descreve o tratamento de piometra em uma cadela submetida à ovariohisterectomia videoassistida por meio de dois portais. O acesso da cavidade abdominal ocorreu através de duas incisões de 1cm em linha média, sendo os ovários fixados na parede abdominal por um reparo transcutâneo e, após a visualização do leito vascular, iniciou-se a colocação de clipes de titânio para hemostasia com posterior secção dos cotos ovarianos. A incisão pré-púbica foi ampliada, sendo os ovários e útero exteriorizados e o corpo uterino ligado pelo método convencional de pediculação. O tratamento de piometra videoassistido com dois portais foi realizado em tempo cirúrgico hábil, quando comparado aos observados em procedimentos laparoscópicos na literatura, sem complicações e com perda sanguínea mínima.

The Percutaneous Suspension Suture

The Percutaneous Suspension Suture

V541 ROBOTIC INTRAVESICAL URETEROCELE EXCISION

You have accessJournal of UrologyPediatrics1 Apr 2012V541 ROBOTIC INTRAVESICAL URETEROCELE EXCISION Brian Rosman, Courtney Rowe, Alan Retik, and Hiep Nguyen Brian RosmanBrian Rosman Boston, MA More articles by this author , Courtney RoweCourtney Rowe Boston, MA More articles by this author , Alan RetikAlan Retik Boston, MA More articles by this author , and Hiep NguyenHiep Nguyen Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.615AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureterocele excision is a procedure that is typically performed in an open fashion. The robotic approach has many challenges associated with it, as well as many advantages. This video will demonstrate several techniques, including bladder fixation and port closure techniques, which can make a robotic approach a feasible, safe, and effective option for ureterocele excision. METHODS A suitable patient was selected that had a large enough bladder, clinical indication for ureterocele excision, and interest in a robotic approach. The patient had a right sided congenital multicystic kidney without much function, and underwent a right nephroureterectomy previously. He had recurrent episodes of hematuria, and a ureterocele was identified. The ureterocele was a simple orthotopic stenotic ureterocele, seen on VCUG as a filling defect, and confirmed cystoscopically. The decision was made to definitively treat the ureterocele after cystoscopic de-roofing failed to relieve the symptoms. After cystoscopy was performed, two stay sutures were placed through the rectus muscle and all bladder layers to hitch the bladder to the abdominal wall during the procedure. This prevented the bladder from falling away from the abdominal wall during surgery, and pulling out the robotic ports. The ports were placed, along with a Veress needle. The bladder was drained of urine and insufflated, and the camera and instruments placed. The ureterocele was identified, and excised with monopolar scissors. The defect in the detrusor muscle was closed in two layers. This patient had a previous nephroureterectomy on the ipsilateral side, therefore no re-implant was required. The ports were removed, and the port holes closed using a “suture suspension disc”. This disc was used before port placement, and acts as a stencil for proper port and suture placement, ensuring that the preplaced sutures are able to tightly close the port site. RESULTS This patient did very well post-operatively, with minimal pain, quick return to eating and drinking and ambulating, and was discharged from the hospital 24 hours after his procedure. He had no further hematuria or obstructive symptoms on repeat follow-up examinations. CONCLUSIONS With the techniques detailed in this video, the difficulties of robotic ureterocele excision can be easily overcome, allowing the benefits of the minimally invasive approach to be applied to intravesical ureterocele excision. Robotic intravesical ureterocele excision is a safe and effective procedure. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e222 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Rosman Boston, MA More articles by this author Courtney Rowe Boston, MA More articles by this author Alan Retik Boston, MA More articles by this author Hiep Nguyen Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lore's fascia and the platysma-auricular ligament are distinct structures

Lore's fascia and the platysma-auricular ligament are discreet fascial structures anterior and inferior to the auricle respectively. The nomenclature and descriptions of these structures have been presented inconsistently in the literature. There is also concern that placement of platysma suspension sutures into these structures may risk damage to the underlying facial nerve trunk. The aim of this study was to clarify the anatomy of Lore's fascia and the platysma-auricular ligament, and their relationship to the facial nerve trunk. A cadaveric study utilising twelve fresh cadaveric hemi-faces was undertaken, investigating the anatomy of Lore's fascia and the platysma-auricular ligament. This comprised dissection of the periauricular fascial layers and identification of the relationship of these two structures to the facial nerve trunk. A histological study of Lore's fascia was performed. Lore's fascia and the platysma-auricular ligament were identified in all 12 hemi-faces. The structures were anatomically distinct in all cases. The relationship of the facial nerve was documented in each case, with the facial nerve trunk found to lie at least 2 cm deep to the most superficial parts of both structures. Lore's fascia was demonstrable with histology. Lore's fascia and the platysma-auricular ligament are separate and consistently demonstrable structures. Both are suitable for platysma suspension sutures in terms of facial nerve trunk safety, and Lore's ligament can be used as a guide to facial nerve preservation in parotidectomy.

Safety of Multilevel Surgery in Obstructive Sleep Apnea<subtitle>A Review of 487 Cases</subtitle><alt-title>Safety of Multilevel Surgery in OSA</alt-title>

To review the safety of multilevel surgery in patients with obstructive sleep apnea (OSA). Retrospective review. A total of 487 consecutive patients with OSA and 1698 surgical procedures from January 2007 to May 2010. Multilevel OSA surgery comprising nasal surgery (endoscopic sinus surgery, septoplasty, and inferior turbinate reduction), palate surgery (traditional uvulopalatopharyngoplasty, expansion sphincter pharyngoplasty and anterior palatoplasty), and tongue surgery (hyoid suspension, radiofrequency tongue base, and tongue suspension suture). Surgical complications. The overall complication rate was 7.1%, with 1 patient having an upper airway obstruction. Complications were as follows: (1) 6 patients had postoperative oxygen desaturation within 3 hours after extubation (these patients had severe OSA [apnea-hypopnea index > 60 and lowest oxygen saturation level <80%]), (2) 15 patients had persistent hypertension (these patients had a history of hypertension), (3) 15 patients had secondary hemorrhage (7-12 days postoperatively), (4) there were 2 cases of negative pressure pulmonary edema, (5) 9 patients had tongue edema (following tongue surgery), and (6) 1 patient had upper airway obstruction requiring reintubation. Patients who had undergone tongue surgery were admitted routinely to the high-dependency unit (step-down care from the intensive care unit) overnight. Routine postoperative admission to the intensive care unit for all patients with OSA is unnecessary. These patients should be closely monitored in the postanesthesia care unit area after surgery, and based on the outcome of this period, they can be observed overnight in either the high-dependency unit or the general ward.

Hyoid advancement to the mandible (hyo-mandibular advancement)

Hyoid advancement to the mandible was first described in 1984, but was later abandoned by most surgeons for the easier to perform advancement to the laryngeal cartilage. New modifications of the hyo-mandibular advancement technique has made this approach easier to perform and are described in this paper. The hyo-mandibular advancement technique has a higher success rate for the treatment of sleep apnea, especially in women.

Effect of a suspension suture in addition to a total anatomical reconstruction in robot assisted laparoscopic prostatectomy: does it help early continence?

Introduction: Continence post robotic assisted laparoscopic radical prostatectomy (RALP) is approximately 90% and many reconstructive techniques have been described to improve early continence. We assessed whether a peri-urethral suspension stitch in addition to a total anatomical repair (TAR) improved early continence. Materials and methods: We describe our procedure and assessed 68 consecutive RALP’s over a two-year period. Complete data were collected on continence rates and incontinence modular questionnaire (ICIQ) scores in 55 patients. Results: In the “no suspension stitch” (NoSS) group continence rates at 2 weeks, 6 weeks and 3 months were 11%, 48% and 81% respectively whilst in the “suspension stitch” (SS) group continence rates were 11%, 46% and 75% respectively (lowest p-value = 0.26 seen at 2 weeks). Average ICIQ scores in the NoSS group were 9.8, 6.6 and 4.3 and in the SS group were 9.4, 6.4 and 4.8 at each time frame (lowest p-value = 0.63 at 6 weeks). Conclusions: No significant difference in continence or ICIQ scores was seen between the two groups. Overall our continence rates were comparable to the published literature. The addition of a suspension stitch did not add any further benefit in improving early continence when performing a total anatomical reconstruction.

Robotic Intravesical Ureterocele Excision

Introduction: Ureterocele excision is a procedure that is typically performed in an open fashion. The robotic approach has many challenges associated with it, as well as many advantages. This video will demonstrate a robotic intravesical ureterocele excision, highlighting several novel techniques to aid the procedure, including bladder fixation to the rectus muscle and a unique approach to effective and watertight port closure, which can make a robotic approach a feasible, safe, and effective approach to ureterocele excision. Methods: A suitable patient was selected who had a large enough bladder, clinical indication for ureterocele excision, and interest in a robotic approach. The patient had congenital multicystic kidney without much function, and underwent a right nephroureterectomy previously. He had recurrent episodes of hematuria, and a ureterocele was identified via voiding cystourethrogram (VCUG). The ureterocele was a simple orthotopic stenotic ureterocele, seen on VCUG as a filling defect, and confirmed cystoscopically. The decision was made to definitively treat the ureterocele after an attempt at cystoscopic de-roofing failed to relieve the symptoms. After initial cystoscopy was performed, two stay sutures were placed through the rectus muscle and all bladder layers to hitch the bladder to the abdominal wall during the procedure. This prevented the bladder from falling away from the abdominal wall during surgery, and pulling out the robotic ports, and was performed under cystoscopic observation. The robotic ports were placed, along with a Veress needle. The bladder was drained of urine and insufflated, and the camera and instruments placed. The ureterocele was identified, and excised with monopolar scissors. The defect in the detrusor muscle was closed in two layers with vicryl and chromic gut sutures. This patient had a previous nephroureterectomy on the ipsilateral side; therefore, no re-implant was required after the excision. The ports were removed, and the port holes closed using a suture suspension disc. This disc was used as a guide before port placement, and acts as a stencil for proper port and suture placement, ensuring that the preplaced sutures are in the correct position to be able to tightly close the port site. Results: This patient did very well postoperatively, with minimal pain and quick return to eating and drinking and ambulating, and was discharged from the hospital 24 hours after his procedure. He had no further hematuria or obstructive symptoms on repeat follow-up examinations. Conclusions: With the techniques detailed in this video, the difficulties of robotic ureterocele excision can be easily overcome, allowing the benefits of the minimally invasive approach to be applied to intravesical ureterocele excision. Robotic intravesical ureterocele excision is a safe and effective procedure. The authors have no professional or financial conflicts of interest to disclose regarding this video or procedure. Runtime of video: 7 mins 03 secs

Local Delivery of Growth Factors Using Coated Suture Material

The optimization of healing processes in a wide range of tissues represents a central point for surgical research. One approach is to stimulate healing processes with growth factors. These substances have a short half-life and therefore it seems useful to administer these substances locally rather than systemically. One possible method of local delivery is to incorporate growth factors into a bioabsorbable poly (D, L-lactide) suspension (PDLLA) and coat suture material. The aim of the present study was to establish a procedure for the local delivery of growth factors using coated suture material. Sutures coated with growth factors were tested in an animal model. Anastomoses of the colon were created in a rat model using monofilament sutures. These were either untreated or coated with PDLLA coating alone or coated with PDLLA incorporating insulin—like growth factor-I (IGF-I). The anastomoses were subjected to biomechanical, histological, and immunohistochemical examination. After 3 days the treated groups showed a significantly greater capacity to withstand biomechanical stress than the control groups. This finding was supported by the results of the histomorphometric. The results of the study indicate that it is possible to deliver bioactive growth factors locally using PDLLA coated suture material. Healing processes can thus be stimulated locally without subjecting the whole organism to potentially damaging high systemic doses.

The Percutaneous Trampoline Platysmaplasty: Technique and Experience With 105 Consecutive Patients

Controversy persists regarding the optimal procedure to rejuvenate the aging neck. More invasive procedures carry increased risks of complications, whereas less invasive approaches may deliver marginal results. The challenge is selecting the appropriate procedure for delivering consistent, durable results meeting both the patient's and surgeon's expectations. The authors describe their trampoline platysmaplasty (TPP) approach, a percutaneous suture suspension necklift that constitutes a less invasive approach for neck rejuvenation. A retrospective study was conducted of 105 consecutive patients who underwent TPP. Age, sex, procedure(s) performed, complications, and patient satisfaction were recorded. Cadaver studies were conducted to compare the tensile strength of the ligaments that anchor the TPP to the tensile strength of the sutures placed to approximate the medial platysma borders. In addition, the accuracy of light transillumination to determine depth of travel of the light-emitting diode (LED) lighted rod was evaluated. Patients underwent either TPP alone (18 women, 24 men) or TPP with a facelift (35 women, 28 men) between October 2007 and June 2009. The average age of the patients was 52 years, and average length of follow-up was 33 months. Patient satisfaction was high. Three early patients underwent immediate revision to improve results secondary to the suture matrix being too loose. Six additional patients had recurrent banding around one year postoperatively, but correction was achieved in all six by replacing the matrix with the help of the lighted rod. The results of the cadaver study revealed that the tensile strength of the retaining ligaments was statistically identical to the medial platysma borders, and the light transillumination feedback was accurate with regard to the depth of travel of the illuminated rod tip. The TPP approach for neck rejuvenation is effective and durable in properly-selected patients. It works well as a stand-alone procedure and in conjunction with facelift procedures. It also offers younger patients a less-invasive option to improve neck contours inherited through genetics. After nearly three years of follow-up of the patients in this report, the results appear to be long-lasting.

Aesthetic Sculpting for the Natal Cleft and Buttock Lift Using an Innovative Periosteal-Dermal Suture Suspension Technique

Natal cleft contouring poses a reconstructive challenge. Buttock aesthetics and the need for careful scar placement are part of the challenge faced by plastic surgeons. Various steps of the reconstructive ladder can be used with varying outcomes. We report a patient who underwent natal cleft reconstruction using a new suture technique and had a cosmetically pleasing outcome.

Three-port Laparoscopy-assisted Colectomy for Colorectal Cancer Using External Traction With Suspension Suture

Laparoscopy-assisted colectomy is accepted as a standard procedure for colorectal resection. There have been many attempts to minimize the invasiveness of the procedure by reducing the number of operating ports and changing the specimen retrieval windows. Indeed, the invasiveness of laparoscopy-assisted colectomy has been minimized with these attempts; however, the technical challenges have increased. The technical challenges are related to lack of retraction and triangulation, which is necessary to expose the appropriate surgical field for safe surgery. A new technique based on retraction and triangulation with suspension suture traction for laparoscopy-assisted colorectal surgery is presented. Between September and November 2009, 24 laparoscopy-assisted colorectal resections for adenocarcinoma were performed through 3 ports with external traction with suspension suture. The surgical technique is described herein, and the intraoperative and postoperative courses of the patients were assessed. There were no intraoperative complications, and no need to convert to open surgery. All the resection margins were clear and the mean distance of proximal and distal margins was 11.4 and 4.8 cm, respectively. The median number of lymph nodes examined was 20.7. There were 2 cases of postoperative bleeding, but no cases of leakage or strictures at the anastomosis site. This new, simple technique is feasible and safe. External suspension suture traction can create an appropriate operative field, allowing balanced traction and countertraction and meeting the needs for oncologic surgery. In addition, this technique can be applied to other types of laparoscopic surgery and will contribute to reducing the number of ports.

Suspension Suture Techniques in Nasal Valve Surgery

Impaired nasal breathing or collapse of the lateral side wall of the nasal valve region during inspiration is a frequently encountered symptom. In general, this is caused by a cross-sectional area that is too small, a weak lateral side wall, or a combination of both. Over the years, many techniques have been described to improve the nasal patency in these patients with the use of nasal grafts, repositioning techniques, devices, or suspension suture techniques. This article presents a systematic overview of different suspension suture techniques in nasal valve surgery.

11 Effect of a suspension suture in addition to a total anatomical reconstruction in robot assisted laparoscopic prostatectomy: Does it help early continence?

11 Effect of a suspension suture in addition to a total anatomical reconstruction in robot assisted laparoscopic prostatectomy: Does it help early continence?

UP-02.223 Effect of a Suspension Suture in Addition to a Total Anatomical Reconstruction in Robot-Assisted Laparoscopic Prostatectomy: Does It Help Early Continence?

Continence rate post robotic assisted laparoscopic radical prostatectomy (RALP) is approximately 90% and many reconstructive techniques have been described to improve early continence. We assessed whether a peri-urethral suspension stitch in addition to a total anatomical repair (TAR) improved early continence post RALP.

Suspension Sutures in Management of Nasal Valve Collapse

Objective: Assess the efficacy of ala suspension sutures in the management of nasal valve collapse causing nasal obstruction. Method: Retrospective study of patients with ala suspension sutures inserted for nasal valve collapse in Doncaster Royal Infirmary from January 2009 to December 2010. Subjective nasal congestion was measured using visual analogue scale (VAS 0-10), and objective measurement using Peak inspiratory flow rate (PIFR) before and after the operation was performed. Results: Twenty-six patients with ala suspension sutures inserted were identified. Five patients who had concurrent procedures carried out on septum and turbinates were excluded. Twenty-one patients were included in our study. Ninety percent of patients were satisfied with the surgery, supported by significant improvement in the VAS (0 - 10) for nasal congestion and PIFR scores. The average VAS score improvement was 4.6 points, and PIFR increased by 23.3L/min. Of the 21 patients, 4 required revision procedures to achieve satisfactory outcome. Two out of these 4 developed neuralgia, which was controlled with Amitriptyline. Conclusion: The result of our study shows a significant improvement in patient symptoms following insertion of ala suspension suture for nasal valve collapse causing nasal obstruction. This is a short and well tolerated procedure with minimal side effects.

Feasibility of single‐portal access laparoscopic ovariectomy in 17 cats

Laparoscopic ovariectomy (LapOVE) using single-portal access was attempted in 17 client-owned cats of different breeds admitted for elective ovariectomy. A 12 mm umbilical portal was placed 1 cm caudal to the umbilicus with the cat in dorsal recumbency. Then, a laparoscope with an operating channel was introduced into the portal with the cat in lateral recumbency. The right ovary was pulled to the abdominal wall using grasping forceps and fixed to the abdominal wall by a transabdominal suspension suture. The ovarian vasculature, suspensory ligament and proper ligament were progressively cauterised and transected with multifunction bipolar electrocoagulation forceps. The resected right ovary was exteriorised through the umbilical portal cannula. The left ovary was then removed from the abdomen in a similar fashion. Surgical time, intraoperative haemorrhage, amount of fat in the ovarian ligament, surgical complications and postoperative pain were recorded. The mean (sd) surgical time was 23 minutes and seven seconds (five minutes and 55 seconds). Intraoperative blood loss and fat deposition of the ovarian ligament were minimal. No intra- and postoperative complications were encountered. No cats needed rescue analgesia within 24 hours postsurgery.

PASS Palatal Ablation and Suspension Suture Technique: A Novel, Minimally Invasive UPPP Technique for Sleep Apnea

Objective: 1) Develop a minimally invasive surgical technique to treat the palatal component of OSA. 2) Ccombine a proven ablation technology to create palatal stiffening with a novel suspension technique to relieve palatal obstruction. 3) Perform a pilot trial to determine feasibility. Method: The PASS technique was used to treat the palatal component of obstruction for OSA. Palatal ablation was performed. Four permanent, submucosal, periosteal based sutures were placed from the hard palate to the palatopharyngeus muscle and free edge of the soft palate (bilateral). Gentle tension resulted in advancement of the palate. Results: Twenty patients were studied. Each patient had a preoperative/postoperative PSG. The PASS technique was used for the palatal component to treat mild apnea or as a part of multilevel surgery for moderate to severe OSA. The PASS technique proved to be a consistently reliable method to advance, suspend, and stiffen the palate without mucosal/muscular (palatal) disruption to correct the palatal component of OSA. The average palatal advancement noted bilaterally at the palatal arches was 7.5 mm. Postoperatively, the mucosal sparing technique resulted in no complications of velopharyngeal insufficiency. Isolated PASS procedures for mild apnea resulted in a 70% reduction in RDI. Conclusion: The PASS technique was proven as a functionally and anatomically superior nondestructive treatment for palatal obstruction. The PASS technique resulted in no complications of VPI. The limitations of the study are the limited number of patients and lack of a control arm with the gold standard UPPP.

Enhanced Laryngeal Suspension: A Preliminary Experience

Objective: Describe and evaluate the effectiveness of enhanced laryngeal suspension on dyspagia and aspiration secondary to skull base surgery and lower cranial nerve injuries. Method: Prospective study in a tertiary ENT unit between 2007 and 2010 of patients who underwent enhanced laryngeal suspension. Demographics, pathology, and cranial nerve injuries were documented. Nutrition, oral intake, and aspiration risk grade (G 0-3) were compared pre- and postoperatively. All patients had videofloroscopy evaluation, and aspiration-penetration scale changes were documented. Results: Enhanced laryngeal suspension involves removal of the thyroid cartilage above the vocal folds and suture suspension to the hyoid bone. It can be combined with a medialization thyroplasty and botox to cricopharyngeus if indicated. To date we performed this procedure on 9 patients. At first presentation, 77% (n = 7) were nil by mouth. Today, only 22% (n = 2) remains NBM. Gastrostomy tube dependance dropped from 77% (n = 7) to 44% (n = 4), and of those only 2 are on total enteral feed. Aspiration risk improved through the follow-up period (from 66% grade 3 down to 11%). Conclusion: Enhanced laryngeal suspension is an important tool in the multimodality approach to management of dyspagia and aspiration caused by skull base surgery and lower cranial nerve injuries. This is a preliminary study with a small sample, and results must be interpreted with this in mind.

Barbed Suture Suspension Technique for Prevention of Lower Eyelid Ectropion After Mohs Micrographic Surgery

Mohs micrographic surgery of the lower eyelid poses a risk of ectropion. Even though the lower eyelid is a very frequent location for basal cell carcinoma, prevention techniques for ectropion after Mohs micrographic surgery have rarely been introduced. After Mohs micrographic surgery of the lower eyelid, the authors applied a barbed suture suspension technique for the prevention of lower eyelid ectropion. Following primary wound closure, barbed sutures were prepared by cutting one side of a 4-0 Prolene suture and applied around the lower eyelid. Sutures were maintained for 7 days and then removed. Evaluation 10 weeks after surgery found that ectropion had been minimized or prevented entirely.