Sutureless Technique Research Articles

Sutureless circumcision using monopolar diathermy and 2-octyl cyanoacrylate is safe and effective in a cohort of 634 post-neonatal prepubescent boys

Circumcision is the most commonly performed surgical procedure in the world, with one-third of males circumcised globally. Post-neonatal, prepubescent sutured circumcision demonstrates complication rates ranging from 1.7% to 9.1%. We have previously reported that 2-octyl cyanoacrylate (2-OCA, Dermabond, Ethicon) primary circumcision (PC) and circumcision revision (CR) in prepubescent children demonstrated superior cosmesis, shorter operating room (OR) times and cost savings. The aim of our study is to evaluate complication and reoperation rates with a scalpel-free and suture-less technique for primary circumcision (PC) and circumcision revision (CR) using 2-OCA. Following IRB approval, we conducted a retrospective review of all boys at our institution who underwent PC or CR using 2-OCA and monopolar diathermy between January 2014 and January 2021. All procedures were performed by a single surgeon. The technique is outlined in the figure below. No aligning sutures or instruments were used in this process. Patients that required sutures or compressive dressings based on age or associated anomalies were excluded from analysis. We obtained all returns to our system within 30 days of the procedure and returns to the OR during the study period using the REDCap database. Of 1107 procedures performed during the study period, 634 procedures (479PC and 155 CR) met inclusion criteria. Median age was 12 months (range 3 months-10.4 years) with minimum follow up of 1 year. There were 3 patients (0.47%) that returned to system within 30 days for surgical site bleeding, and one patient (0.15%) required surgical intervention within 30 days. Nine patients required reoperation after 30 days, five (0.8%) for iatrogenic phimosis, 3 (0.5%) for redundant prepuce and 1 for keloid formation. We observed an overall complication rate of 1.3% (6/634) and reoperation rate of 1.6% (10/634). Since FDA approval in 1998, 2-OCA has been widely adopted as a replacement for sutures in tension-free wounds. However, it has yet to gain widespread use for circumcision given concerns for wound dehiscence and surgical site bleeding. This study demonstrates that a scalpel-free and suture-less technique demonstrates complication and reoperation rates are lower than reported circumcision using scalpel and sutures. Limitations include retrospective design, single surgeon experience, and REDCAP database only identifying patients with complications that required a return to system. Our technique for suture-less circumcision using 2-OCA offers superior cosmesis, shorter OR times, cost savings, and a lower complication rate (1.3%) compared to sutured circumcision (>1.7%) reported in post-neonatal prepubescent boys.

Artificial Roofing for Recurrent Pulmonary Vein Stenosis

Pulmonary vein stenosis occurs in up to one-fifth of patients after repair of total anomalous pulmonary venous connection and carries a poor prognosis. Current options for repair include patch venoplasty, endovenectomy, and the “sutureless” (pericardial well) technique. Approaches to repair vary and may include combinations of these techniques, but data suggest that the sutureless technique is associated with less restenosis.1 Yet, the sutureless technique is not a panacea: 30% of patients with pulmonary vein stenosis will undergo reoperation or die within 2 years.

Preclinical Comparison of Distal Off-Pump Anastomotic Remodeling: Hand-Sewn Versus ELANA Heart Bypass.

Objective: The ELANA Heart Bypass System is a new sutureless technique for coronary anastomoses. A titanium clip connects the graft with the coronary artery, whereafter the arteriotomy is performed by excimer laser. Since this anastomotic construction evidently differs from the standard hand-sewn anastomosis, we aim to evaluate the process of anastomotic healing and remodeling. Methods: Preclinical evaluation of anastomotic remodeling in 42 pigs who underwent off-pump left internal mammary artery to left anterior descending artery anastomosis by either the ELANA Heart Bypass (n = 24) or the hand-sewn (n = 18) technique. Anastomotic remodeling was evaluated by scanning electron microscopy and histology in short-term follow-up intervals up to 3 months. Anastomotic patency is determined by coronary angiography at latest follow-up before termination. Results: The nonendothelial surface of both the ELANA and the hand-sewn anastomoses were covered with neointima from 14 days onwards. Only half the amount of intima hyperplasia was present in the anastomotic surface of the patent ELANA anastomosis, compared with the hand-sewn anastomosis (98 [48–1358] vs 218 [108–296] µm, P = 0.001). Yet patency of the ELANA was inferior to the hand-sewn anastomoses (79% vs 100%, P = 0.06). Conclusions: This study shows the technical perioperative feasibility of the ELANA Heart Bypass System. Although limited intima hyperplasia was observed, hand-sewn anastomoses had superior patency during follow-up. The results of this trial suggest that an additional study with a new prototype is required before clinical implementation.

In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass

Although several commercially available sutureless anastomotic techniques are available, they are not routinely used in neurosurgery. We performed an invivo flow analysis of end-to-end anastomosis using a microvascular coupler device in rats. We report our first clinical use of the microvascular anastomotic coupler. Bilateral rat common carotid arteries (CCAs) were exposed, and a microvascular coupler was used to perform 8 anastomoses. A microflow probe provided quantitative measurement of blood-flow volume. Flow augmentation was assessed with end-to-side anastomoses connecting the distal CCA to the jugular vein (JV). A patient with chronic dominant hemisphere atherosclerotic ischemic disease and progressive symptoms refractory to medical management underwent end-to-end cerebral artery bypass using the microvascular coupler. Mean preanastomosis flow in the rat CCA was 3.95 ± 0.45 mL/min; this flow was maintained at 3.99 ± 0.24 mL/min on final measurements 54-96 minutes postanastomosis. Total occlusion time for each rat CCA was 12-19 minutes. After end-to-side anastomosis, with proximal and distal JV patent, CCA flow increased 477% to 22.8 ± 3.70 mL/min (P=0.04, proximal; P= 0.01, distal). After invivo testing, we successfully used the coupler clinically in a superficial temporal artery-to-middle cerebral artery bypass for dominant hemisphere flow augmentation. Invivo quantitative flow analysis demonstrated no flow difference between an unaltered artery and artery with end-to-end anastomosis using a microvascular coupler in rats. A 1-mm coupled anastomosis achieved a 4-fold flow increase with low-resistance venous outflow in rats, simulating increased arterial demand. The coupler was successfully used for extracranial-to-intracranial bypass in a patient.

Sutureless technique for repositioning and scleral fixation of the capsular bag-intraocular lens complex with permanent use of iris retractors.

A new sutureless technique used for repositioning and scleral fixation of the capsular bag-intraocular lens (IOL) complex in the surgical treatment of subluxated lenses is described. Iris retractors were used not only to induce a tent effect on the capsule but also to permanently fix the capsular bag to the sclera in this method, without the need to prepare scleral or conjunctival flaps. Surgery with the use of a capsular tension ring (CTR) and iris retractors, the ends of which were brought out through the sclera and cauterized, was performed in 7 eyes of 7 patients with moderate or severe subluxation of the crystalline lens. In all cases, simultaneous use of a CTR and iris retractors ensured good centration of the capsular bag-IOL complex. The method was safe and effective in fixing the capsule to the sclera in the case of significant damage to the ligamentous apparatus of the lens.

A study on stability of conjunctivo limbal autograft with autologous serum in pterygium excision surgery

Pterygium surgery has evolved a lot with newer technigues to help create better postoperative outcomes, to make the surgery time less consuming, to have fewer complications and to provide more better postoperative comfort to the patient. Our study is based on one of this new techniques of Conjuctivo Limbal Autograft with autologous serum which is comparatively less time consuming compared to its is precedessors and is a sutureless and glueless technique. The aim of the study is to find the safety, efficacy and relation of stability of intraoperative grafts (graft fixation)with their postoperative outcomes. We found that intra operative stable grafts to provide good results postoperatively having major displacement of only 1.15%.thus making this technique a faster, stable and economical technique for the patients and the doctors.

Short-term results of sutureless closure for primary total anomalous pulmonary venous connection: seventeen cases

Total anomalous pulmonary venous connection (TAPVC) is a rare condition. Mortality of TAPVC has improved dramatically in the present. Sutureless closure had initially used for congenital pulmonary venous stenosis (PVS) or post-repair PVS. Recently, it had been adopted for primary TAPVC to prevent postoperative pulmonary venous obstruction, a leading cause of death. This technique had gradually applied at our institute for primary TAPVC since 2018. Prospective case series was conducted from mid-2019. Including criteria consists of patients with primary TAPVC. These are all supracardiac, infracardiac, mixed type and intracardiac TAPVC with pulmonary venous stenosis. Excluding measures are TAPVC with single ventricle, isomerism or heterotaxy. End-point outcomes were mortality and short-term PVS. Seventeen TAPVC cases were enrolled in this study from 06/2019-12/2020 at Children’s Hospital 1. Male/female ratio was 12/5. Median age at admission was 44 (3-1010) days old. The median operative weight was 3.9 kg (2.4-11). Of those, fourteen (82.4%) cases were supracardiac TAPVC and 3 (17.6%) cases were infracardiac TAPVC. Nine (52.9%) cases were emergency operations. Median aortic clamp time was 66 (32-138) mins. Median bypass time was 112 (86-212) mins. There were 9 (52.9%) cases with arrhythmias, 2 (11.8%) cases with chylothorax. Mean ventilation time was 3.6±0.5 days; mean CICU time was 6.5 (1-20), median LOS was 14.5 (8-39). In-hospital mortality was 5.9% (1). Mean follow-up time was 12.3±6.4 months (range 4-24), there was no PVS with median pulmonary venous score of 0 (range 0-1). Sutureless technique could be a safe option for primary TAPVC repair.

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates-10-Year Experience at a Single Center.

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population.Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019.Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006).Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.

27-gauge sutureless vitrectomy under topical anesthesia: A pilot study.

The implementation of the 27-gauge (G) sutureless vitrectomy technique is associated with a marked shortening of surgery time, faster healing of scleral and conjunctival wounds, less severe conjunctival scarring, limited postoperative corneal astigmatism, and marked improvement in the postoperative comfort of patients. The traditional methods of anesthesia for vitrectomy surgery are quite varied and each has its own potential for complications. To assess the feasibility and safety of 27G pars plana vitrectomy (PPV) performed under local topical anesthesia for diabetic maculopathy, asteroid hyalosis and vitreomacular traction syndrome associated with high myopia. Three carefully selected patients with various vitreoretinal disorders underwent primary 27G PPV performed by a single surgeon under local topical anesthesia. Patients were analyzed in regard to best corrected visual acuity, intraocular pressure, intraoperative/postoperative complications, intraoperative/postoperative pain, and surgery time. All patients showed postoperative improvement in visual acuity. No decrease in intraocular pressure below 10 mm Hg was documented on postoperative day 1. Furthermore, no postoperative complications were recorded during the six-month follow-up, and evident improvement in the anatomical status was confirmed using ophthalmic coherence tomography in all cases. Our findings support that 27G PPV performed solely under local topical anesthesia is safe and effective for treating selected vitreoretinal disorders.

MP49-20 SUTURELESS TECHNIQUE IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY: RESULTS FROM A PROPENSITY-SCORE MATCHED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-20 SUTURELESS TECHNIQUE IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY: RESULTS FROM A PROPENSITY-SCORE MATCHED ANALYSIS Giuseppe Rosiello, Rui Farinha, Artur Paludo, Elio Mazzone, Stefano Puliatti, Marco Amato, Carlo Bravi, Ruben De Groote, Pietro Piazza, Camille Berquin, Francesco Montorsi, Peter Schatteman, Geert De Naeyer, Frederiek D’hondt, and Alexandre Mottrie Giuseppe RosielloGiuseppe Rosiello More articles by this author , Rui FarinhaRui Farinha More articles by this author , Artur PaludoArtur Paludo More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Marco AmatoMarco Amato More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Camille BerquinCamille Berquin More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D’hondtFrederiek D’hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) for treatment of renal mass is gaining momentum. Despite efforts aimed at preserving renal function, the functional decline after RAPN is not negligible. Based on the risk of intraparenchymal vessels injuries during renorrhaphy, with consequently loss of functional renal parenchyma, we aimed at comparing perioperative outcomes of patients undergoing sutureless RAPN (suRAPN) vs. standard RAPN (stRAPN). METHODS: Ninety-two consecutive patients treated with RAPN for clinically localized renal mass (cT1-2) from January 2019 and June 2020 by a single surgeon were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. Specifically, the matched cohorts of suRAPN and stRAPN patients were balanced according to covariates, including age at surgery, preoperative eGFR, clinical tumor size, tumor complexity, defined according to PADUA score, and any individual PADUA item. Chi-square test, t-test and Kruskal-Wallis test examined differences on perioperative outcomes between suRAPN vs. stRAPN patients. RESULTS: Overall, twenty-nine (31%) patients were treated with suRAPN. After 1:1 propensity-score matching, no residual differences remained between the two groups. Only one suRAPN patient experienced intraoperative complications(p=0.9), namely venus bleeding during hilar dissection. Two (6.9%) suRAPN vs. four (13.8%) stRAPN patients experienced 30-day postoperative complications (p=0.3). Operative time (110 vs. 150 min; p<0.01), and length of stay(2 vs. 3 days; p=0.02) were shorter in suRAPN vs. stRAPN patients. TRIFECTA outcomes were achieved in twenty-five (86%) suRAPN vs. twenty (70%) stRAPN patients. Finally, only one (3.4%) suRAPN vs. five (17%) stRAPN patients experienced postoperative AKI. CONCLUSIONS: Sutureless technique in RAPN is a feasible and safe procedure, which demonstrates similar rates of intra- andpostoperative complications compared to the standard technique. Moreover, performing suRAPN may ensure lowerimpact surgery, as demonstrated by shorter operative time and length of stay. Despite promising results on TRIFECTAand functional outcomes are shown, prospective, randomized, trials relying on a larger cohort of patients with longerfollow-up are needed to further assess the impact of sutureless technique on long-term renal function. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e884-e884 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Rosiello More articles by this author Rui Farinha More articles by this author Artur Paludo More articles by this author Elio Mazzone More articles by this author Stefano Puliatti More articles by this author Marco Amato More articles by this author Carlo Bravi More articles by this author Ruben De Groote More articles by this author Pietro Piazza More articles by this author Camille Berquin More articles by this author Francesco Montorsi More articles by this author Peter Schatteman More articles by this author Geert De Naeyer More articles by this author Frederiek D’hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Loading ...

V13-07 PROPHYLACTIC MESH PLACEMENT AT TIME OF ILEAL CONDUIT CREATION: A SIMPLE SUBLAY TECHNIQUE

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-07 PROPHYLACTIC MESH PLACEMENT AT TIME OF ILEAL CONDUIT CREATION: A SIMPLE SUBLAY TECHNIQUE Da David Jiang, Kyle Gillis, Kenneth Softness, Nicholas Chakiryan, Alison Levy, Vitaliy Poylin, Andrew Wagner, and Peter Chang Da David JiangDa David Jiang More articles by this author , Kyle GillisKyle Gillis More articles by this author , Kenneth SoftnessKenneth Softness More articles by this author , Nicholas ChakiryanNicholas Chakiryan More articles by this author , Alison LevyAlison Levy More articles by this author , Vitaliy PoylinVitaliy Poylin More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , and Peter ChangPeter Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A prospective randomized study of prophylactic mesh placement at the time of cystectomy and ileal conduit found a significant reduction the cumulative incidence of parastomal hernias by approximately 50%.We present a novel simple sutureless prophylactic sublay permanent mesh placement at the time of ileal conduit creation. METHODS: Bard VentralightTM ST mesh is a permanent medium weight monofilament propylene mesh. It has an absorbable hydrogel barrier on the posterior side based on Sepraâ Technology (ST). A circular mesh with 6cm in diameter is formed; a cruciate cut is made centrally. The space between the posterior sheath and the rectus is bluntly dissected circumferentially. The conduit is brought out of the stoma site and the mesh is thread over the conduit with the shiny ST side down; the ST side is in contact with the conduit and prevents adhesions. The mesh is then gently tucked into the dissected space. The rest of the conduit is matured in standard fashion. RESULTS: We first placed prophylactic mesh in this fashion in 3/2019; since 8/2020, we perform this technique on every ileal conduit diversion. To date, 38 cases have been done; 34 via robotic intracorporeal diversion. Median follow up is 4 months (IQR 2-8). There have been no mesh-related complications such as mesh erosion, mesh infection, mesh pain, or need for mesh explant. The follow-up is too short to determine efficacy, but no clinically apparent parastomal hernias have developed. 21 patients had postoperative imaging with a median radiographic follow-up of 5 months (IQR 3-10); of these, 1 patient (5%) had radiographic evidence of a parastomal hernia. CONCLUSIONS: We present a novel simple sutureless technique for prophylactic mesh placement at time of ileal conduit creation. With short follow-up, there are no evidence of mesh-related complications. Longer follow-up is needed to determine efficacy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1080-e1080 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Da David Jiang More articles by this author Kyle Gillis More articles by this author Kenneth Softness More articles by this author Nicholas Chakiryan More articles by this author Alison Levy More articles by this author Vitaliy Poylin More articles by this author Andrew Wagner More articles by this author Peter Chang More articles by this author Expand All Advertisement Loading ...

Balloon-Assisted Rib Graft Placement in Endoscopic Posterior Cricoid Split Procedure.

View Video S1 Laryngoscope, 132:212–214, 2022

Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques

To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Apex rotation as a risk factor for total anomalous pulmonary connection repair in single ventricle.

The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. Eighteen patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the "vertebral-apex angle (V-A angle)." The ratio of postoperative and preoperative angles, indicating the apex's lateral rotation, was compared between patients with and without PVO. The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46° [45°-50°] vs. 36° [29°-38°], p = 0.001) and the ratio of postoperative and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], p = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cut-off values of the postoperative V-A angle and ratio were 41° and 1.17, respectively. A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.

Meta‐analysis of surgical treatment for postinfarction left ventricular free‐wall rupture

BackgroundLeft ventricular free‐wall rupture (LVFWR) is one of the most lethal complications after acute myocardial infarction (AMI). The optimal therapeutic strategy is controversial. The current meta‐analysis sought to examine the outcome of patients surgically treated for post‐AMI LVFWR.MethodsA comprehensive literature review was performed to identify articles reporting outcomes of subjects who underwent LVFWR surgical repair. The primary endpoint was operative mortality. A meta‐analysis was performed to assess the associations of predefined variables of interest and clinical prognosis.ResultsOf the 3132 retrieved articles, 11 nonrandomized studies, enrolling a total of 363 patients, fulfilled the inclusion criteria and were included in this analysis. The mean age of patients was 68 years. The operative mortality rate was 32% (n = 115). Meta‐analysis revealed reduced operative risk in patients with oozing type rupture, as compared to blowout type (risk ratios [RR]: 0.47; 95% confidence interval [CI]: 0.33–0.67; p < .0001); RR was also significantly reduced in subjects in whom LVFWR was treated with sutureless technique, as compared to those undergoing sutured repair (RR: 0.59; 95% CI: 0.41–0.83; p = .002). Increased risk of operative mortality was demonstrated in patients who required postoperative extracorporeal membrane oxygenation (ECMO) support (RR: 2.39; 95% CI: 1.59–3.60; p < .0001).ConclusionsSurgical treatment of postinfarction LVFWR has a high operative mortality rate. Blowout rupture, sutured repair and postoperative ECMO support are factors associated with increased risk of operative mortality.

The novel haptic-twist method for a sutureless double-needle intrascleral haptic fixation technique.

Description of a novel modified technique known as haptic-twist method for placing a trailing haptic into a 27 G needle during double-needle intrascleral haptic fixation (Yamane technique) in the absence and/or inadequacy of capsular support. The trailing haptic was threaded into the needle lumen using a haptic-twist method in 12 eyes of 11 patients with aphakia. The haptic was grasped by a forceps 2-3mm from the tip, while the forceps was rotated by 180° counter-clockwise around its own axis. This maneuver enabled the trailing haptic to be slightly twisted without any deformation and to coordinate with the needle in the proper angle. The surgical technique has also been mentioned in a surgical video. Mean age of the patients was 62years ± 18 (range 46-78years). Although the mean pre-operative best-corrected visual acuity was 0.70 ± 0.35 logarithm of the minimum angle of resolution (logMAR) (range 1.30-0.20 logMAR), an improvement of up to 0.40 ± 0.32 logMAR (range 1.0-0.1 logMAR) was observed 3months after surgery. No trailing haptic bending or breakage was observed during the process. Furthermore, no optical tilting or decentralization was observed post-operatively. Although threading the leading haptic into the needle is reasonably straightforward, the trailing haptic positioning can be difficult due to an inappropriate gesture of both the haptic and the needle. We fervently believe that this novel haptic-twist method can provide a much simpler and easier approach, and thus contribute to better surgical outcomes.

Outcomes of Surgical Repair of Total Anomalous Pulmonary Venous Drainage: Role of Primary Sutureless Technique.

To evaluate the surgical outcomes of total anomalous pulmonary venous drainage focusing on survival, postoperative and pulmonary venous obstruction. Further investigate the role of primary sutureless technique in patients with preoperative pulmonary venous obstruction. Consecutive patients underwent total anomalous pulmonary venous drainage repair in our institution during Jan 2000 to Dec 2019 were enrolled into this retrospective analysis. Since 2016, sutureless repair was regularly applied in patients with preoperative pulmonary venous obstruction. All patients with preoperative pulmonary venous obstruction referred before 2016 had underwent traditional repair. A total of 95 patients were included. During follow-up time of 85months, main endpoints were documented in 21 patients, including 9 (9.5%) early deaths, 3 (2.3%) late deaths and 9 (9.5%) postoperative pulmonary venous obstructions. Preoperative pulmonary venous obstruction was presented in 26 (27.4%) patients with more emergent surgery (14/26 vs 3/69, P < 0.001) was required. Main endpoints occurred more in patients with preoperative pulmonary venous obstruction (4/26 vs 5/69, P = 0.004). Patients experienced sutureless technique had a lower incidence of postoperative PVO at follow-up (0/11 versus 4/11, P = 0.045). Outcomes of surgical repair for total anomalous venous drainage are satisfactory. However, preoperative pulmonary venous obstruction may be accompanying unfavorable early deaths and postoperative pulmonary venous obstruction. Propensity matching analysis showed that sutureless technique was benefit for postoperative pulmonary venous obstruction without longer cardiopulmonary bypass and aortic cross-clamp time.

Refractive outcome of trocar-assisted sutureless scleral fixation with 3-piece intraocular lenses.

Intraocular lens (IOL) implantation with a trocar-assisted sutureless scleral fixation technique is a relatively new IOL implantation approach for aphakic eyes. During this surgery, the intrascleral position of the haptics can change the location of the IOL optic and may alter the refractive outcome. This study aimed to evaluate the refractive outcome of this surgery. The files of 22 patients who had undergone IOL implantation with the trocar-assisted sutureless scleral fixation technique were retrospectively reviewed, and the patients were invited for final examination. IOL power was calculated with optical biometry (Lenstar LS900). IOL power calculations were performed according to formulas designed for in-the-bag IOL implantation. The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1). This study included 14 patients (8 male, 6 female, mean age: 62.7 ± 18.7). There were no significant differences between the preoperative and postoperative corneal astigmatism values (p = 0.16). There were also no significant differences between the postoperative corneal and total astigmatism values (p = 0.44), confirming the absence of significant IOL tilt. The difference between the implanted IOLs and the calculated IOL power for emmetropia was 0.09 D ± 0.49 D (p = 0.52). Although emmetropia was targeted, the refractive outcome shifted to hyperopia (+ 0.85 D ± 1.15 D) and was significantly different from the refractive status calculated with optical biometry (p = 0.034). The intrascleral fixation of IOLs results in increased posterior positioning of the IOL optic and can induce approximately 0.85 D of hyperopia if proper adjustments are not performed during IOL power calculations.

Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis

BackgroundDespite efforts aimed at preserving renal function, the functional decline after robot-assisted partial nephrectomy (RAPN) is not negligible. To address the risk of intraparenchymal vessel injuries during renorrhaphy, with consequent loss of functional renal parenchyma, we introduced a new surgical technique for RAPN. ObjectiveTo compare perioperative patient outcomes between selective-suturing or sutureless RAPN (suRAPN) and standard RAPN (stRAPN). Design, setting, and participantsNinety-two consecutive patients undergoing RAPN for a renal mass performed by a high-volume surgeon at a European tertiary center were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. InterventionRAPN using a selective-suturing or sutureless technique versus standard RAPN. Outcome measurements and statistical analysisPerioperative outcomes included operative time, blood loss, length of stay, and intraoperative and 30-d postoperative complications. We also evaluated trifecta achievement (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and the incidence of postoperative acute kidney injury (AKI). We applied χ2 tests, t tests, and Kruskal-Wallis tests to assess differences in perioperative outcomes between suRAPN and stRAPN. Results and limitationsOverall, 29 patients (31%) were treated with suRAPN. Only one suRAPN patient experienced intraoperative complications (p = 0.9). Two suRAPN patients (6.9%) and four stRAPN patients (13.8%) experienced 30-d postoperative complications (p = 0.3). Operative time (110 vs 150 min; p < 0.01) and length of stay (2 vs 3 d; p = 0.02) were shorter for suRAPN than for stRAPN. The trifecta outcome was achieved in 25 suRAPN patients (86%) and 20 stRAPN patients (70%; p = 0.1). Only one suRAPN patient (3.4%) versus five stRAPN patients (17%) experienced postoperative AKI (p = 0.2). Finally, the decrease in the estimated glomerular filtration rate at 6-mo follow-up was lower in the suRAPN (−5.2%) than in the stRAPN group (−9.1%; p < 0.01). Lack of randomization represents the main study limitation. ConclusionsA selective-suturing or sutureless technique in RAPN is feasible and safe. Moreover, suRAPN is a lower-impact surgical procedure. We obtained promising results for trifecta and functional outcomes, but prospective randomized trials are needed to validate the impact of selective suturing or a sutureless technique on long-term functional outcomes. Patient summaryWe assessed a new technique in robotic surgery to remove part of the kidney because of kidney cancer. Our new technique involves selective suturing or no suturing of the area from where the tumor is removed. We found that the rate of complications did not increase and the operating time and length of hospital stay were shorter using this new technique.

Clinical Outcomes, Predictors, and Surgical Management of Primary Pulmonary Vein Stenosis

BackgroundSurgical outcomes for primary pulmonary vein stenosis (PPVS) remain unfavorable, and risk factors are still poorly understood. This study evaluated outcomes and risk factors after PPVS repair. MethodsThis retrospective study included 40 patients with PPVS who underwent surgical repair in Fuwai Hospital from 2010 to 2020. Adverse outcomes included overall death, pulmonary vein (PV) restenosis, and reintervention. A univariate and multivariate risk analysis was performed to determine risk factors. ResultsThe mean follow-up duration was 37.5 ± 31.5 months. Sutureless technique was performed in 7 patients (17.5%), endovenectomy in 9 (22.5%), and patch venoplasty in 24 (60%). Bilateral PV involvement was documented in 12 patients (30%). Overall death, PV reintervention, and restenosis occurred in 15%, 12.5%, and 25% of patients, respectively. Freedom from overall death, PV reintervention, and restenosis at 5 years was 85% ± 6.3%, 88.9% ± 5.2%, and 65.1% ± 13.2%, respectively. Multivariate analysis revealed that bilateral PV involvement was an independent risk factor for death or PV reintervention (hazard ratio, 10.4; 95% confidence interval, 1.9-56; P = .006) and that involvement of the left inferior PV was an independent risk factor for postoperative restenosis of the left inferior PV (hazard ratio, 13.1; 95% confidence interval, 2.2-76.8; P = .004). ConclusionsSurgical treatment for PPVS remains a challenging issue with imperfect prognosis. Therefore, it is right and appropriate to take close surveillance on mild or moderate stenosis on a single PV. Bilateral and left inferior PV involvement are independent risk factors for adverse outcomes.