Sutureless Technique Research Articles

Outcome Analysis of Total Thyroidectomy: Conventional Suture Ligation Technique vs Sutureless Technique.

Total thyroidectomy is a common surgical procedure in endocrine surgery. However, it carries potential complications such as damage to the recurrent laryngeal nerve, permanent hypoparathyroidism, and bleeding. Methods: A prospective study was conducted at the Professorial Surgical Unit, Jaffna Teaching Hospital, involving consecutive patients who underwent total thyroidectomy. Patients with certain conditions were excluded from the study. The data collected were analyzed using IBMSPSSStatistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). This study included 59 patients who had total thyroidectomy from January 2018 to January 2021 at the Professorial Surgical Unit, Jaffna Teaching Hospital. Of these, 45 underwent conventional suture ligation (CSL), and 17 had a sutureless (SL) technique. Mean ages were 44±12.47 years (range: 23 to 68) for CSL and 47.63±13.37 years (range: 27 to 73) for SL. Operative time was 2.16 ± 0.32 hours for CSL and 1.56 ± 0.49 hours for SL. Intraoperative and postoperative bleeding occurred in 2.38% of CSL cases but not in SL. Postoperative hypocalcemia was 7.14% for CSL and 5.88% for SL. Postoperative stays averaged 3.83 ± 1.56 days for CSL and 3.41 ± 1.62 days for SL. The study found that the operative time differed significantly between the suture and SL techniques. However, there was no statistically significant difference in postoperative drainage volume or postoperative complications. The SL technique was shown to be superior to the conventional suture ligation technique for total thyroidectomy. It resulted in shorter operative time, reduced intraoperative bleeding, lower incidence of postoperative drainage, fewer postoperative voice changes, and shorter hospital stays. Therefore, the SL technique was deemed safe, efficient, and effective for total thyroidectomy compared to the conventional suture ligation technique.

Development of Novel Sutureless Balloon Expandable Fetal Heart Valve Device Using Absorbable Polycaprolactone Leaflets.

Congenital heart disease (CHD) accounts for nearly one-third of all congenital defects, and patients often require repeated heart valve replacements throughout their lives, due to failed surgical repairs and lack of durability of bioprosthetic valve implants. This objective of this study is to develop and in vitro test a fetal transcatheter pulmonary valve replacement (FTPVR) using sutureless techniques to attach leaflets, as an option to correct congenital defects such as pulmonary atresia with intact ventricular septum (PA/IVS), in utero. A balloon expandable design was analyzed using computational simulations to identify areas of failure. Five manufactured valves were assembled using the unique sutureless approach and tested in the fetal right heart simulator (FRHS) to evaluate hemodynamic characteristics. Computational simulations showed that the commissural loads on the leaflet material were significantly reduced by changing the attachment techniques. Hemodynamic analysis showed an effective orifice area of 0.08 cm2, a mean transvalvular pressure gradient of 7.52mmHg, and a regurgitation fraction of 8.42%, calculated over 100 consecutive cardiac cycles. In conclusion, the FTPVR exhibited good hemodynamic characteristics, and studies with biodegradable stent materials are underway.

ASO Author Reflections: Microwave Ablation-Assisted Clampless and Sutureless Technique for Renal Hilar Tumors.

ASO Author Reflections: Microwave Ablation-Assisted Clampless and Sutureless Technique for Renal Hilar Tumors.

Chirurgie du ptérygion par greffe conjonctivale sans suture ni colle biologique : étude préliminaire au centre hospitalier universitaire de Cocody à Abidjan

PurposeTo optimize the pterygium management by delineating the role of sutureless, glueless conjunctival graft. Materials and methodsThis was a prospective cohort study carried out at the Centre hospitalier universitaire de Cocody between October 1st, 2021 and March 31st, 2022. It analyzed a series of 36 cases of stage I, II and III pterygium by Cornand's classification, who underwent surgery by a sutureless conjunctival graft technique without biological glue. ResultsDemographically, 33.3% of our study population were between 30 and 40 years of age, with a mean of 47.86 years. The patients showed a female preponderance, 53%, with a male:female ratio of 0.89. At the clinical level, 75% of our population presented for ocular redness, 84% had a nasal pterygium, and 75% were stage 2. In terms of postoperative course and appearance, we observed 80.55% graft stability, 5.56% graft retraction, 2.78% graft displacement, and 11.11% graft loss. At the conclusion of follow-up, we noted an 8.33% recurrence rate. DiscussionThe use of intraoperative blood ensures patient safety and postoperative comfort. This technique demonstrates satisfactory results with primary, nasal pterygia. ConclusionConjunctival autograft without sutures or biological glue might be a very promising surgical alternative in the surgical treatment of pterygium.

Modified L-shaped incision technique for supracardiac total anomalous pulmonary venous connection as an alternative to sutureless technique.

The modified L-shaped incision technique (MLIT) was successfully applied to the repair of supracardiac total anomalous pulmonary venous connection (TAPVC) with promising mid-term outcomes. It is, however, unclear whether or not MLIT could be an alternative to sutureless technique (ST). All patients ( n =141) who underwent MLIT or ST repair for supracardiac TAPVC between June 2009 and June 2022 were included and a propensity score-matched analysis was performed to reduce the heterogeneity. MLIT was performed in 80.9% (114/141), whereas ST was performed in 19.1% (27/141). Patients who underwent MLIT repair had a lower incidence of pulmonary veinous obstruction (PVO)-related reintervention (1.8 vs. 18.5%, P =0.002), and late mortality (2.6 vs. 18.2%, P =0.006). Overall survival at 10 years was 92.5% (87.7-97.7%) for MLIT and 66.8% (44.4-100%) for ST ( P =0.012). Freedom from postoperative PVO at 10 years was 89.1% (83.2-95.5%) for MLIT and 79.9% (65.6-97.4%) for ST ( P =0.12). Cox proportional hazards regression identified prolonged mechanical ventilation duration, postoperative PVO, respiratory dysfunction, and low cardiac output syndrome were associated with postoperative death and PVO-related reintervention. The MLIT strategy is a safe, technologically feasible, and effective approach for supracardiac TAPVC, which is associated with more favorable and promising freedom from death and PVO-related reintervention.

Sutureless repair for vena cava bleeding using an elastomeric sealant in a porcine model.

To address the issue of bleeding from the vena cava, a common complication of cardiac and aortic surgeries, we developed a sutureless repair technique using Hydrofit, an elastomeric sealant. In a porcine model, we surgically incised the inferior vena cava and applied the elastomeric sealant with a pericardial patch, achieving complete haemostasis through manual compression. This simple and rapid technique demonstrates effective sutureless haemostasis for the vena cava.

Sutureless technique combined with vertical vein incision and pulmonary veins unroofed for correction of infracardiac total anomalous pulmonary venous connection.

We report a surgical method (sutureless technique), combined with vertical vein incision and pulmonary veins unroofed (semisutureless technique), to correct infracardiac total anomalous pulmonary venous connection (TAPVC). The clinical characteristics of 21 patients, who were diagnosed with infracardiac TAPVS between February 2017 and March 2022, were retrospectively analyzed. These patients were divided into three groups according to different surgical methods: conventional surgery group, sutureless technique group, and semisutureless technique group. The conventional surgery group enrolled five patients with a median age of 16 days (interquartile range, 9-27 days) and a median weight of 3.25 kg (interquartile range, 3.1-3.42 kg). In this group, no preoperative pulmonary vein obstruction (PVO), preoperative ventilator support, or emergency surgery were reported. The sutureless technique group enrolled seven patients with a median age of 12 days (interquartile range, 5-16 days) and a median weight of 3.04 kg (interquartile range, 2.76-3.20 kg). In this group, two patients with preoperative PVO, four patients with preoperative ventilator support, and seven patients requiring emergency operation were found. The semisutureless technique group enrolled nine patients with a median age of 14 days (interquartile range, 7-24 days) and a median weight of 3.22 kg (interquartile range, 3.15-3.50 kg). In this group, four patients with preoperative PVO, two patients with preoperative ventilator support, and seven patients requiring emergency operation were noted. In the conventional surgery group, two patients with postoperative supraventricular tachycardia, one patient with postoperative low cardiac output syndrome, one patient with PVO, and no case of postoperative death were reported. In the sutureless technique group, two patients with postoperative low cardiac output syndrome, one patient with postoperative supraventricular tachycardia, one patient with postoperative PVO, and no postoperative deaths were determined. In the semisutureless technique group, three patients had low cardiac output syndrome, two patients had supraventricular tachycardia after the operation, and one patient, who had been admitted to the hospital after cardiopulmonary resuscitation in the emergency room, died early after the operation. No case of death or PVO was noted after the operation. The semisutureless technique has positive effects. This surgery method can enlarge the anastomotic stoma, increase the volume of the left atrium, reduce the tension of the anastomotic stoma, fix the pulmonary vein to avoid distortion, and prevent postoperative hemorrhage.

Need for innovation: laser sutures

In this modern era there is dire need of awareness regarding sutureless surgical procedures. Globally 310 million surgeries are performed each year1. Using thread and needle for suturing is still as common as using legs to walk. This method is not near to ideal because of risk of contamination, infections, scar marks, needle trauma, and reopening of tissues if the stitches are not held tight2. The prevention of wound infections after surgical procedures is of great interest for every surgical discipline, in order to improve the quality of patient care. And the best way to prevent suture-related complications is to have sutureless procedures. A number of sutureless methods have developed over the time which includes fibrin glue, cyanoacrylates, scaffolds and bio-inspired adhesives3. The sutureless technique which is receiving increasing attention is Photochemical Tissue Bonding (PTB), which can also be called laser sutures. PTB is a novel tissue repair technique that causes the proteins on tissue surfaces to crosslink by using visible light and a photosensitizing dye. This technique has been successfully demonstrated in a number of tissue repair models4. This suture-replacement technique is able to close incisions nearly instantaneously without damaging tissue. It gives minimum scar, is time saving, has more accuracy, causes less infections and is less user dependent as compared with typical sutures. This technique does not provide promising results on the skin but also has been tested for vascular and nervous repairs5. Therefore I think it’s high time that surgeons should consider using this in their practice. Ethical approval None. Sources of funding None. Author contribution Misbah Kaleem: Conception of work along with final draft. Musaddiq Kaleem: Editing draft and reviewed article. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None.

Surgical Time and Postoperative Symptoms Study in Pterygium Excision and Amniotic Membrane Graft Using Celularity Triple Layer Dehydrated Amniotic Membrane.

To evaluate a novel sutureless glueless technique using a triple-layer dehydrated amniotic membrane (TLDAM) for pterygia excisions in surgical time, postoperative pain, epiphora, irritation, and FBS. Twenty eyes with pterygia underwent excision with mitomycin C. The conjunctival defect was closed with TLDAM placed on the dried scleral bed with the edges of the amniotic membrane tucked under the edges of the conjunctival defect. Surgical times were measured from injection of lidocaine to final placement of bandage contact lens. After a bandage contact lens was placed, the eye was patched until POD1. Patients graded self-administered questionnaires to rate pain, FBS, irritation, and epiphora on a scale of 1-5 (1-none; 5-severe) at POD1 and POW1. Surgical times ranged from 6:55 to 12:00, with mean of 8:29. Compared with a previous study of sutureless glueless methodology, the difference in mean surgical time was 11.9 (p < 0.0001). Mean questionnaire scores were as follows: POD1 pain 1.8, FBS 2.3, irritation 1.0, and epiphora 2.6; POW1 pain 1.5, FBS 1.6, irritation 1.6, and epiphora 1.6. Compared to previous studies, this technique showed significantly improved pain at POD1 (p=0.0086, p<0.0001, p<0.0001, p<0.0001) and POW1 (p=0.0002, p=0.0016, p<0.0001). Significant improvement in irritation and FBS was noted at POD1 and POW1. See Table 1 for full analysis. The sutureless glueless technique using TLDAM is a safe and effective technique compared to current standard methods. There appears to be a significant benefit regarding surgical time and postoperative pain, irritation, epiphora, and FBS compared to previous studies.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Comparison of efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision

To compare the efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision. A prospective observational study was conducted in thirty consecutive patients of primary progressive pterygium after taking their informed written consent and ethical clearance in a tertiary eye care centre of Northern India. Patients were randomly divided equally into group “A” and “B” each constituting fifteen patients. Group A patients underwent suture technique and group “B” patients underwent sutureless technique for conjunctivolimbal graft placement. Comparison of both groups was done in terms of intraoperative time, postoperative symptoms and recurrence over a period of one year. Data was compiled and entered into Microsoft Excel software and SPSS version 21.0 was used for data analysis.The mean duration of surgery was 42 min and 30 min in group A and B respectively and this difference was found to be statistically significant (p=0.0001). On 1 postoperative day, pain and foreign‐body sensation was present in 12 patients in group A, while only 1 patient of group B had these symptoms and this difference was statistically significant (p = 0.00014). Postoperative hyperaemia was seen in 8 patients of group A and 6 patients of group B which was statistically insignificant (p = 0.564). Only two patients in group A had conjunctival chemosis while no patients in group B developed chemosis, and the difference was statistically insignificant (p = 0.964). Subconjunctival haemorrhage was seen in 2 patients of Group A and 1 patient of Group B which resolved over a period of 2-3 weeks. Conjunctivolimbal graft was found to be more stable in group A while it was misplaced in 1 patient of group B and the difference was statistically insignificant (p = 1.000). Only 1 patient of group A developed suture related complication i.e suture granuloma. Over a period of 1 year follow up, only 1 patient of group A had recurrence of pterygium.Sutureless glue-free technique is a time saving, cost effective and better surgical modality in comparison to conventional suture technique for autogenous conjunctivolimbal grafting in primary pterygium resection.

The feasibility of debranching aortic arch and visceral arteries with sutureless telescoping anastomoses during open aortic aneurysm repair.

Open repair of aortic aneurysms frequently requires reimplantation of major aortic vessels. Traditional techniques can be time consuming, require meticulous hemostasis, and risk aneurysmal patch degeneration, which can require a challenging reoperation. We describe our experience using a stent graft to create a sutureless anastomosis that obviates these drawbacks. Between April 2018 and March 2021, all consecutive adult patients who underwent open repair of the aorta with at least one supra-aortic trunk or visceral vessel reimplanted using the sutureless anastomotic technique were included. Anastomoses were constructed by bridging a branch graft and the target artery with a Viabahn self-expanding stent (W.L. Gore & Associates, Flagstaff, AZ). Clinical information and perioperative outcomes for the patients were collected and analyzed. Among 26 patients, 50 individual aortic vessels were debranched using sutureless self-expanding stent anastomoses, including 42 visceral vessels and 8 supra-aortic trunk vessels. Technical success was 100%. The median time to complete the anastomosis was 3minutes, 12seconds (range, 2-6minutes). Perioperative mortality was 15% (n= 4). No stent-related complications, such as occlusion, bleeding, stroke, renal failure requiring hemodialysis, bowel ischemia, or the need for anastomotic reintervention, occurred. Follow-up imaging at 1 year revealed a 100% patency rate and no anastomotic stenosis, misalignment, or kinking. The sutureless anastomosis technique to debranch the aorta during open aortic aneurysm repair is technically feasible and reliably hemostatic and does not require early reintervention. The operative outcomes have been acceptable, and the short-term follow-up imaging findings demonstrated excellent patency without anastomotic kinking. In select cases, sutureless anastomoses are a possible alternative to traditional sutured anastomoses during aortic debranching. Further research is needed to compare the operative times and long-term patency of sutureless anastomosis to those of traditional sutured techniques.

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery.

To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.

Long-term analysis of intrascleral fixation of intraocular lens: trocar-cannula-based sutureless intrascleral fixation versus sutured scleral fixation.

To compare the long-term outcomes of sutureless intrascleral fixation of the intraocular lens (IOL) versus sutured scleral fixation. We retrospectively analyzed the medical records of patients who underwent intrascleral fixation of the intraocular lens using two different techniques: trocar-cannula-based sutureless fixation and sutured scleral fixation. Clinical outcomes were compared before and 1-, 3-, 6-, and 12-month follow-ups after the operation. 51 patients were followed over a 12-month period after the operation, including 28 eyes in the sutureless group and 23 eyes in the sutured group. Best-corrected visual acuity and spherical equivalent values reached targeted values faster in the sutureless scleral fixation of the intraocular lens. However, no significant difference was observed between the two groups. For IOL capture, there was a statistically significant difference observed in the incidence of postoperative complications, which was demonstrated by one eye in the sutureless group and seven in the sutured group (p=0.009). To exclude the effect of corneal astigmatism, surgically induced astigmatism (SIA) was calculated based on the astigmatism value one year after surgery. It was found that the sutureless technique significantly reduced the occurrence of astigmatism (2.43 ± 1.42 vs 1.65 ± 0.94, p=0.031). In a one-year follow-up period, the trocar-cannula-based sutureless technique was reliable and effective. Sutureless fixation was associated with fewer postoperative complications and lower SIA values than those with sutured fixation.

V05-03 CLAMPLESS AND SUTURELESS ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR THE TREATMENT OF FIFTEEN BILATERAL RENAL LESIONS IN A PATIENT WITH VON HIPPEL-LINDAU SYNDROME

You have accessJournal of UrologyCME1 Apr 2023V05-03 CLAMPLESS AND SUTURELESS ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR THE TREATMENT OF FIFTEEN BILATERAL RENAL LESIONS IN A PATIENT WITH VON HIPPEL-LINDAU SYNDROME Maria Peraire Lores, Jesús Domínguez, Angelo Mottaran, Marco Paciotti, Carlo Bravi, Luca Sarchi, Luigi Nocera, Adele Piro, Rui Farinha, Ruben De Groote, and Alexandre Mottrie Maria Peraire LoresMaria Peraire Lores More articles by this author , Jesús DomínguezJesús Domínguez More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Adele PiroAdele Piro More articles by this author , Rui FarinhaRui Farinha More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with Von Hippel-Lindau (VHL) disease have higher risk of developing renal cell carcinomas. In these patients, given the frequent presence of multiple masses and the high risk of recurrence, nephron-sparing approaches are essential to preserve renal function. In this context, technical refinements such as 3D reconstruction, off-clamp, selective suturing or sutureless techniques can be helpful to improve functional outcomes. Herein, we described our surgical management for a patient with VHL syndrome with multiple bilateral renal lesions applying these innovative techniques. METHODS: A 27-year-old man affected by VHL disease presented with 8 and 7 masses on the right and left kidney, respectively. Diameters ranged from 5 to 54 mm on the right, and from 4 on 57 mm on the left. His baseline creatinine was 1.11 mg/dl. First, the patient underwent a left RAPN which revealed 5 clear cell renal cell carcinomas (ccRCC) – the biggest one pT1bR0 – and 2 benign cysts. Six weeks later, the patient underwent a right RAPN. Both procedures were performed using a clampless and sutureless technique; when a completely sutureless resection was not possible, a selective suturing technique was utilised. Preoperative surgical planning included 3-D imaging reconstruction. We here described the surgical procedure for right RAPN and its peri- and post-operative outcomes. RESULTS: Operative and console time were 205 and 175 minutes, respectively. Blood loss was 650 ml. An off-clamp enucleation of all 8 renal masses was performed with a sutureless technique, applying an haemostatic agent (Veriset) to the resection beds. Only for the biggest lower pole mass a selective suture was required in the resection bed. There was no need for intra-operative transfusions, and no perioperative complications occurred. The patient was discharged on the second postoperative day with a creatinine of 0.99 mg/dL. The pathologic assessment revealed 8 ccRCC, the biggest one being pT1bR0. CONCLUSIONS: In patients with multiple renal masses requiring surgical treatment, the use of innovative approaches such as clampless approach, sutureless and/or selective suturing techniques can help preserving healthy parenchyma during RAPN. Further studies with longer functional follow-up are awaited to confirm these findings at long-term. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e424 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Peraire Lores More articles by this author Jesús Domínguez More articles by this author Angelo Mottaran More articles by this author Marco Paciotti More articles by this author Carlo Bravi More articles by this author Luca Sarchi More articles by this author Luigi Nocera More articles by this author Adele Piro More articles by this author Rui Farinha More articles by this author Ruben De Groote More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the effects of conventional method and primary sutureless techniques on early postoperative rhythm problems in patients with total abnormal pulmonary venous return anomaly.

Total abnormal pulmonary venous return anomaly is a CHD characterised by abnormal pulmonary venous flow directed to the right atrium. In this study, we aimed to compare the effects of these techniques on early rhythm problems in total abnormal pulmonary venous return anomaly cases operated with conventional or primary sutureless techniques. Seventy consecutive cases (median age 1 month, median weight 4 kg) who underwent total abnormal pulmonary venous return anomaly repair with conventional or primary sutureless technique between May 1 2020 and May 1 2022 were evaluated. The rate, diagnosis, and possible risk factors of postoperative arrhythmias were investigated. The results were evaluated statistically. When the total abnormal pulmonary venous return anomaly subgroup of 70 cases was evaluated, 40 cases were supracardiac, 18 cases were infracardiac, 7 cases were cardiac, and 5 cases were mixed type. Twenty-eight (40%) cases had a pulmonary venous obstruction. Primary sutureless technique (57%, supracardiac n = 24, mixed = 3, infracardiac = 13) was used in 40 patients. Median cardiopulmonary bypass time (110 versus 95 minutes) and median aortic clamp time (70 versus 60 minutes), median peak lactate (4.7 versus 4.8 mmol/l) in the first 72 hours, and median peak vasoactive inotropic score in the first 72 hours of the primary sutureless and conventional technique used cases value (8 versus 10) were similar. The total incidence of arrhythmias in the conventional group was significantly higher than in the primary sutureless group (46.7% versus 22.5%, p = 0.04). Supraventricular early beat was observed in 3 (7.5%), sinus tachycardia was seen in 6 (15%), junctional ectopic tachycardia was seen in 1 (2.5%), intra-atrial reentry tachycardia was seen in 1 (2.5%), usual supraventricular tachyarrhythmia was seen in 2 cases (5%) in the primary sutureless group. In the conventional group, supraventricular early beat was observed in six of the cases (20%), sinus tachycardia in five (16.7%), junctional ectopic tachycardia in four (13.3%), intra-atrial reentry tachycardia (10%) in three, and supraventricular tachyarrhythmia in seven cases (23.3%). In the first 30 days, there was a similar mortality rate (10% versus 10%), with four patients in the primary sutureless group and three in the conventional group. The median follow-up period of the cases was 8 months (interquartile range(IQR) 6-10 months). In the follow-up, arrhythmias were detected in two cases (one supraventricular tachyarrhythmia and one intra-atrial reentry tachycardia) in the primary sutureless group and three cases (two supraventricular tachyarrhythmia, one intra-atrial reentry tachycardia) in the conventional technique. All cases were converted to normal sinus rhythm with cardioversion and combined antiarrhythmic therapy. Different arrhythmias can be observed in the early period in patients with operated total abnormal pulmonary venous return anomaly. Although a higher rate of rhythm problems was observed in the early period in the conventional method compared to the primary sutureless technique, no significant effect was found on mortality and morbidity between the groups.

Sutureless Technique for Surgical Castration in Adult Boars: A Feasibility Study.

The heterogeneity of Italian manufacturing processes results in the production of a large variety of pork products. In Sardinia, boars are raised and butchered to produce charcuterie. These animals are castrated before slaughter as androstenone would otherwise taint the meat, rendering it unfit for human consumption. However, to date, the literature concerning surgical orchiectomy in adult boars is limited. The goal of this study is to assess whether a sutureless swine orchiectomy procedure is feasible. Additionally, this study aims to determine the appropriate traction force needed to tie knots in the deferens duct of pigs of different weights and ages. Two groups were created: the first (n = 91) underwent orchiectomy by suture ligation; the second (n = 20) was castrated using the sutureless technique. Deferens ducts of animals in the first group (n = 182) were collected following castration, and their tensile strength was measured. Pearson's linear correlation was used to determine the relationship between the maximum traction force and weight and age groups. A correlation of 0.99 and 0.96 was shown between traction force and age and traction force and weight, respectively. In accordance with these results, sutureless castration was performed on 20 animals, calibrating the pulling force needed according to the age and weight of the boars. No complications were observed during the feasibility study, thus validating sutureless orchiectomy in adult boars.

Total anomalous pulmonary venous connection in 80 patients: Primary sutureless repair and outcomes.

Total anomalous pulmonary venous connection (TAPVC) is a rare but critical cardiac anomaly, in which pulmonary veins are connected to an abnormal location rather than the left atrium. The prognosis can be extremely poor without intervention, with a mortality of 80% during infancy. The purpose of this research is to summarize the outcomes and relevant risk factors of 80 total anomalous pulmonary venous connection (TAPVC) patients who underwent primary TAPVC sutureless repair and discuss the indications and benefits of primary sutureless repair. This retrospective review included 80 patients with TAPVC who underwent primary sutureless repair at a single institution between January 2015 and December 2020. Patients were subdivided into 4 groups according to Darling's classification. Risk factors that increase the postoperative pulmonary vein flow velocity were explored by Multiple Linear regression. Anatomic TAPVC subtypes included supracardiac 35 (43.8%), cardiac 24 (30%), infracardiac 17 (21.2%), and mixed 4 (5%). Median age at repair was 16.5 days and median weight was 3.5 kg. Preoperative pulmonary venous obstruction (PVO)was presented in 20 (25%) patients. There were 2 early deaths and 1 late death. 2 patients developed postoperative PVO and none required reintervention. Prolonged cardiopulmonary bypass time (CPB) (p = 0.009), preoperative pneumonia (p = 0.022) and gender (p = 0.041) were found to be associated with the increase of postoperative pulmonary vein flow velocity. Under the primary sutureless technique, no statistical difference was observed among the 4 subgroups in terms of postoperative pulmonary vein flow velocity (p = 0.589). The primary sutureless technique may eliminate the differences between subtypes while decrease the postoperative PVO rate, which makes it applicable in any subtypes of TAPVC. Following the favorable outcomes in preventing postoperative PVO in all subtypes in this study, we advocate the indications for primary sutureless repair may expand further to all the TAPVC patients.

Robot-assisted sutureless partial nephrectomy for the treatment of fifteen bilateral renal masses in a patient with Von Hippel-Lindau syndrome: a case report from a high-volume robotic center.

Renal cell carcinoma is among major causes of death in patients with Von Hippel-Lindau (VHL) syndrome, and it usually presents with multiple and bilateral lesions that may require multiple renal surgeries. This, in turn, may compromise renal function, resulting in end-stage renal disease. To minimize renal function impairment in these patients, great importance is given to the preservation of functional parenchyma with the use of nephron-sparing techniques. Furthermore, new techniques such as off-clamp surgery, selective suturing or sutureless techniques may improve long-term functional outcomes. We described the case of a 27-year-old male patient with a family history of VHL disease affected by multiple, bilateral renal masses. He received bilateral, metachronous robot-assisted partial nephrectomies (RAPN) for a total of 15 renal lesions. No intra- or post-operative complications occurred, and the patient was discharged on the second postoperative day after both procedures. Serum creatinine after the second RAPN was 0.99mg/dl (baseline value was 1.11mg/dl). In patients with VHL syndrome and multiple renal lesions, robot-assisted partial nephrectomy, especially with the use of clampless and sutureless techniques, helps minimizing renal function impairment and should be performed when anatomically and technically feasible.

COMPARING THE IMMEDIATE QUALITY OF LIFE USING COMPLETE CLOSURE AND NON-CLOSURE TECHNIQUES IN THIRD MOLAR SURGERY

Background: Surgical extraction of the impacted mandibular third molar is associated with intraoperative and postoperative complications, subsequently affecting the patient's wellbeing and reducing the quality of life especially in the week following surgery. Quality of life records are better outcome parameters than clinical variables because it assesses multiple aspects of life. The wound closure technique is an operative factor reported to affect the severity of postoperative complications. If these affectation would translate into any difference in the overall quality of life is yet to be studied. Therefore, there was need to compare the quality of life of two widely varied techniques - the complete closure and the non-closure (sutureless). This wa Methods: s a prospective, randomised clinical study carried out at the Dental and Maxillofacial Surgery department of a tertiary hospital from December 2019 to November 2020. Seventy-four participants were randomized into a complete closure group and a sutureless technique group. They were subjected to the procedure under similar conditions and thereafter followed up for 1 week to assess the changes in their quality of life using the modied OHIP-14 questionnaire. Variables were recorded and analysed using the SPSS (v 25.0). The critical level of signicance was set at P&lt;0.05. There was no statistically signicant Results: difference in the overall QoL changes (p&lt;0.05) although the sutureless technique had less affectation in the speaking domain. There Conclusion: was no statistically signicant difference in quality of life between complete closure and sutureless techniques following impacted mandibular third molar extraction.