Suturing Device Research Articles

Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear

Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique.

Use of barbed suture for thoracoscopic repair of diaphragmatic hernias: Three cases

SummaryThree horses were diagnosed with a dorsally located diaphragmatic hernia/tear associated with either a penetrating injury in the first case or with signs of small intestine strangulation in the remaining two cases. After diagnosis during exploratory thoracoscopy (Case 1) or emergency laparotomy (Cases 2 and 3), closure of the dorsal defect in the diaphragm was performed through a thoracoscopic approach in all cases. Defects were closed with barbed suture with either a direct suturing technique or an automated suturing device. All horses recovered uneventfully and were alive at follow‐up (2 to 3 years after surgery). No significant complications or recurrence were reported.

Comparison of new and old all-inside suture devices in meniscal cyst formation rates after meniscal repair.

We compared the magnetic resonance imaging (MRI)-confirmed cyst formation rate after meniscal tear repair using a new all-inside suture device (N group) versus the older all-inside suture device (O group). Between October 2008 and July 2017, 94 consecutive menisci of 89 patients were diagnosed with meniscal tears and underwent arthroscopic meniscal repair using the all-inside suture device. Five of these patients were lost to follow-up within 12months and were excluded from the study. The remaining 89 menisci were followed up for at least 12months and were included in this retrospective cohort study. Older all-inside suture devices (FasT-Fix, Ultra FasT-Fix) were used until December 2012, while the new all-inside suture device (FasT-Fix 360) was used from January 2013 onwards. Meniscal cysts were detected on T2-weighted fat-suppressed MRI at 12months postoperatively. Multiple logistic regression analysis was used to identify demographic and clinical factors associated with the use of the new all-inside suture device and cyst formation. In total, 36 and 53 menisci were included in the N and O groups, respectively. The incidence of meniscal cysts was significantly greater in the O group (14 out of 53, 26.4%) than in the N group (two out of 36, 5.56%) (P = 0.012). Two patients in the O group had symptomatic cysts that required removal. Multivariate logistic analyses showed that the cyst formation risk significantly decreased after using the new all-inside suture device than the older all-inside suture devices (odds ratio = 0.139; P = 0.04). The MRI-confirmed cyst formation rate after meniscal tear repair was significantly lower using the new than the older all-inside suture devices, indicating that the use of a low-profile device may decrease the cyst formation rate.

Miniature coiled artificial muscle for wireless soft medical devices.

Wireless small-scale soft-bodied devices are capable of precise operation inside confined internal spaces, enabling various minimally invasive medical applications. However, such potential is constrained by the small output force and low work capacity of the current miniature soft actuators. To address this challenge, we report a small-scale soft actuator that harnesses the synergetic interactions between the coiled artificial muscle and radio frequency–magnetic heating. This wirelessly controlled actuator exhibits a large output force (~3.1 N) and high work capacity (3.5 J/g). Combining this actuator with different mechanical designs, its tensile and torsional behaviors can be engineered into different functional devices, such as a suture device, a pair of scissors, a driller, and a clamper. In addition, by assuming a spatially varying magnetization profile, a multilinked coiled muscle can have both magnetic field–induced bending and high contractile force. Such an approach could be used in various future untethered miniature medical devices.

A Modified Disposable Circumcision Suture Device with Application of Plastic Sheet to Avoid Severe Bleeding After Circumcision.

To evaluate the effectiveness of a modified disposable circumcision suture device (DCSD) with application of plastic sheet to avoid severe bleeding after circumcision and compare the surgical effects and other postoperative complications of two DCSDs. A total of 943 excess foreskin patients from January 2018 to January 2020 who underwent circumcision using two different DCSDs were recruited. Preoperative characteristics (patient age, height and weight), main surgical outcomes (surgical time, intraoperative blood loss, incision healing time) and postoperative complications (postoperative hemorrhage and hematoma rate, edema rate, incision infection rate, residual staples rate) were collected and analyzed. Patients' "satisfaction" or "dissatisfaction" was also investigated. Preoperative characteristics showed no significant statistical difference. The modified DCSD group has a lower intraoperative bleeding, postoperative hemorrhage or hematoma rate and residual staples rate compared with the conventional group. Incision healing time and incision infection rate between the two groups were similar. Nevertheless, conventional group has a shorter surgical time, a lower edema rate and a higher satisfaction rate. The modified DCSD with application of plastic sheet can avoid severe bleeding after circumcision effectively and can be served as a new choice for circumcision.

Closing the Gap: Applications, Tips, and Tricks for a Novel Through-the-Scope Suturing Device.

Zhang, Linda Y MBBS; Ngamruengphong, Saowanee MD; Khashab, Mouen A MD Author Information

Vascular Complications Among Patients Undergoing Trans-femoral Transcatheter Aortic Valve Implantation: Prostar vs ProGlide Parallel Technique.

Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.

Chest defects and their treatment

The experience in treatment of 69 patients with funnel and 5 with pigeon thorax is presented. Patients over 14 years prevailed. At thoracoplasty radical subcartilagenous resection of the deformed costal cartilages was compulsory. In tunnel thorax sternocostal complex was fixed by tantalum brackets using original suturing device, Paltia plate and transfer of xiphoid process on the posterior sternum surface. In pigeon thorax Ravitch-1 operation was performed. In 76%) of patients right hemothorax that might be associated with patients age and use of suturing device was noted. Authors did not consider the opening of the right pleural sheet to be serious complication believing that it could be an appropriate means for surgical zone drainage. Use of such thoracoplasty techniques enabled to achieve good immediate and long term (up to 10 years) results in 98.6% of patients.

A0985 - Capio TM Slim Suture Device x Tissue Anchoring System has different results in treatment of advanced pelvic organ prolapse? Prospective and Randomized study: Partial Results with 12 months follow-up

A0985 - Capio TM Slim Suture Device x Tissue Anchoring System has different results in treatment of advanced pelvic organ prolapse? Prospective and Randomized study: Partial Results with 12 months follow-up

Precision resection of pulmonary tuberculoma using Nd:YAG-laser

The objective of the study: a comparative study of immediate and long-term results of pulmonary tuberculoma precision resection with Nd:YAG-laser with a wavelength of 1,318 nm and atypical resection with suturing devices.Subjects and Methods. Two groups of 58 patients each were compared. The groups were comparable in terms of gender, age, the nature of the concomitant pathology and the main pathological process. In Group I, patients were operated on using precision 1,318-nm Nd:YAG-laser resection, and in Group II, the sublobar resection with suturing devices were used.Results. The mean duration of hospital stay in Groups I and II was 19.10 ± 6.02 and 19.20 ± 6.02 days respectively (p > 0.05), the duration of surgery made 65 [55; 75] and 55 [45; 60] minutes (p > 0.05), the mean volume of surgical blood loss was 50 [33; 70] and 70 [50; 165] ml (p > 0.05), and the mean duration of pleural cavity drainage after surgery was 4 [3; 5] and 4 [3; 6] days (p > 0.05). Statistically significant differences were noted in the mean volume of the resected part of the lung: 14.0 ± 7.4 mm3 in Group I versus 95.0 ± 9.7 mm3 in Group II (p ≤ 0.05). The complete clinical and radiological cure was achieved in 70% of patients in Group I and 82% in Group II. According to MSCT data, in 91.6% of cases, a thin linear scar is formed in the area of precision intervention.Conclusion: The surgical methods are comparable in terms of immediate and long-term results but precision laser resection minimizes the removal of intact tissue during the removal of tuberculomas.

Arthroscopic Subscapularis Repair Using 18-Gauge Spinal Needle as a Suture Passer to Eliminate Iatrogenic Tendon Damage from Modern Suturing Devices

Suture passing devices are frequently used for subscapularis tendon repair. However, some of these devices can further damage the tendon by creating a larger tear. Use of an 18-gauge spinal needle as a suture passer helps eliminate damage to the tendon. By using its smaller diameter, the needle prevents tendon cut-through and enhances the precision of the repair.

Effectiveness of knotless barbed sutures as an intraoral wound closure agent in Oral and Maxillofacial Surgery

Surgical knots that are placed during conventional suturing are needed to anchor the suture to allow it to maintain tissue approximation at the wound margin. They reduce the effective volume and tensile strength of all sutures by thinning and stretching the material as well as creating an uneven distribution of tension across the wound with the higher tension burden placed at the knots. The objective of this systematic review is to evaluate the effectiveness of knotless barbed sutures on intraoral wound healing and operative time in Oral and Maxillofacial Surgery procedures. The Data Bases of PubMed, Cochrane, and Google Scholar were searched for the related topics along with a complimentary manual search of all oral surgery journals till December 2020. Articles were selected based on the inclusion criteria, which included all RCTs. The knotless suture device consists of tiny barbs along its entire length surface, which arise from opposite directions on either side of a central non-barbed segment allowing the suture to be self-anchoring, allowing the close approximation of tissue while resisting the migration that can occur with swelling.

Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

Modern management of acute non-variceal upper gastrointestinal bleeding

Acute, non-varicose bleeding from the upper gastrointestinal tract remains a common clinical problem. Bleeding episodes are associated with high mortality and a significant economic burden on the health care system. Despite the continuing improvement in endoscopic treatment, recurrent bleeding and associated mortality are still a pressing issue. In addition to the well-established modalities of endoscopic hemostasis: injection, thermal, mechanical, used both as mono therapy and as part of a combination therapy, the review discusses the use of novel types of endoscopic devices. The results of the use of over-the-scope clips, coagrasper, hemostatic sprays, endoscopic angiography, radiofrequency ablation, cryotherapy and endoscopic suturing device are described. The technical aspects of their application, the issues of efficacy and safety, the advantages and limitations of methods for achieving final endoscopic hemostasis are considered. The methods of initial assessment and treatment strategies for recurrent bleeding and unsuccessful endoscopic hemostasis were also analyzed. Material and methods. Literature search was carried out using the following electronic information resources: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Results. Сombined endoscopic hemostasis is a standard therapy in the treatment of gastrointestinal tract cerebral infections with an efficiency of 95-98 %, new modalities of endoscopic hemostasis are able, in some cases, to achieve final endoscopic hemostasis both in primary endoscopic treatment and in recurrent bleeding.

Addressing Transverse Plane Instability in the Modified Lapidus Arthrodesis: A Comparative Study of Screw Versus Suture and Button Fixation Device Technique

The Lapidus arthrodesis is a powerful procedure for the correction of hallux valgus with metatarsus primus varus. Yet, first ray instability may persist despite correction of the primary deformity with 2 crossed screw fixation. A third screw is often utilized as the additional point of fixation for noteworthy residual transverse plane motion, but it is not without potential complications. The suture and button fixation device may be an appropriate alternative to the third screw construct. This retrospective cohort study identified clinical / radiographic outcomes and complication rates following a third point of fixation with either a screw or suture and button fixation device in patients undergoing a modified Lapidus arthrodesis. One surgeon performed all of the Lapidus procedure with a third screw while the other surgeon performed all with a suture and button fixation device. Of 136 consecutive patients who underwent a modified Lapidus arthrodesis, 83 (61%) patients required a third point of fixation for satisfactory stabilization of the first ray. Surgical technique was similar between the 2 surgeons; however, one utilized the suture and button fixation device method (n = 36), while the other used a third screw for fixation (n = 47). Many of the clinical outcomes, radiographic results, and the union rate were similar between the 2 methods. Nineteen (40%) complications occurred in the third screw group compared to 6 (17%) in the suture and button fixation device group. However, the third screw group demonstrated 100% maintenance of deformity correction at 1 year versus 95% in the suture and button fixation device group. Although fixation with a suture and button fixation device was associated with fewer complications, a larger study is necessary to determine if these variations are statistically significant.

Functional Outcomes Are Similar After Arthroscopic Capsular Repair of Triangular Fibrocartilage Complex Tears Between Outside-In Technique and All-Inside Technique Using Pre-Tied Suture Device

To compare outcomes of arthroscopic triangular fibrocartilage complex capsular repair at 2-year follow-up between outside-in and all-inside techniques. In total, 58 consecutive patients (wrists) with a Palmer 1B triangular fibrocartilage complex tear without symptomatic distal radioulnar joint instability underwent arthroscopic suture repair from 2011 to 2019 including 31 patients via the outside-in technique (group A) and 27 via the all-inside technique using a pre-tied needle device (group B). Two-year follow-up included visual analog scale (VAS) pain score, motion range, grip strength, Mayo Modified Wrist Score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complication rate. Correlation between functional result and patient satisfaction was analyzed. Score changes in VAS, wrist flexion-tension, supination-pronation, grip strength, MMWS, and QuickDASH at 2-year follow-up were not significantly different between group A (3.4 ± 0.8, 18.4 ± 17.5, 12.9 ± 13.3, 30.7 ± 11.2, 26.6 ± 7.9 and 19.4 ± 9.9 and group B (3.4 ± 1.0, 18.5 ± 18.3, 15.6 ± 13.7, 30.8 ± 11.4, 28.1 ± 8.6, and 7.6 ± 7.2) with P values of .400, .489, .223, .486, .240, and .223 respectively. Surgical time averaged 105 minutes (78 to 136) in group A and 94 minutes (61-126) in group B with significant difference (P= .012). Patient satisfaction averaged 1.1 (0-3.5) in group A and 1.0 (range 0-3.0) in group B. Satisfaction score was more strongly correlated with QuickDASH (coefficients: 0.863 in group A and 0.918 in group B) than with MMWS (-0.693 in group A and -0.465), grip strength (-0.619 in group A and -0.417 in group B) and VAS score (0.607 in group A and 0.222 in group B). Both techniques achieved comparable outcomes with shorter surgical time in all-inside repair using pre-tied needle device. Patient satisfaction was strongly correlated with QuickDASH score. Level III, retrospective therapeutic comparative investigation.

Simplified posterior urethroplasty utilizing laparoscopic instrumentation

BackgroundPosterior urethral stricture disease presents challenges for even the most skilled reconstructive urologists. Regardless of the surgical technique used, these are complex operations that occur in hard-to-access locations. We describe the use of a novel combination of laparoscopic instrumentation to simplify posterior urethral reconstruction.MethodsWe retrospectively identified patients undergoing a posterior urethral stricture repair utilizing a combination of the RD-180® suture device and the Securestrap®. These procedures were performed by a single surgeon at our institution. Patients with greater than or equal to 4 months of follow up were included in the analysis.ResultsFrom October 2016 to October 2020, 20 patients underwent posterior urethral stricture repair using these laparoscopic instruments. Median age was 70 years (28–90 years). Median follow up was 12 months (5–50 months). Mean stricture length was 3 cm (1.5–16 cm). Median operative time was 150 minutes (120–180 minutes). No peripheral neuropathies or positional injuries were noted. With failure defined as inability to pass a 16-Fr scope, success rate was 95% (19/20 patients).ConclusionsThe combination of the RD-180® and the Securestrap® has become essential to our posterior urethral stricture repair armamentarium. Further data and longer follow up is needed to confirm these reliable outcomes.

Richter's Hernia: Incarcerated Bowel Hernia at 5 mm Port Site

A 46-year-old woman, gravida 3 para 0, cesarean delivery = 3, underwent a total laparoscopic hysterectomy (TLH) for complex endometrial hyperplasia. Six days after the discharge, she was re-admitted with nausea, vomiting, fever, and a sharp left lower abdominal pain. Computerized tomography (CT) scan showed evidence of a bowel hernia on the 5-mm left trocar site (Fig. 1). Laparoscopic surgery was done, showing a large portion of small bowel incarcerated (Fig. 2), and a hernia repair was performed using Endo Close suturing device (Fig.

Comparison of absorbable barbed suture devices versus polyglactin 910 sutures in double-layer gastrotomy closure in A canine model

Objectives: To evaluate the safety and efficacy of a commercially available absorbable barbed suture device in double-layer gastrotomy closure in a dog model. Methods: In this experimental comparative study a gastrostomy was performed in 12 adult healthy mongrel dogs (divided into two groups A and B). The stomach was closed using polyglactin 910 (Vicryle, Ethicon) suture in group A and using absorbable barbed suture (Stratafex, Ethicon) in group B. Results: Polyglactin 910 suture produced a more inflammatory reaction around the wound which caused a delay in gastric wound healing and gastric motility as well as gastric emptying time. The ultrasonographic examination revealed a significant increase in gastric wall thickness in group A compared to group B and a highly significant decrease of gastric contraction in group A in comparison to group B. Gastric closure time was significantly shorter in group B than in group A. No postoperative complications or deaths were observed in both groups. Conclusion: Absorbable barbed suture was recommended in gastric surgery as it is minimizing the time of gastric closure and optimizing the healing of the wound with faster returning of the stomach to its normal function.

The Attitude of Practitioners Towards Endoscopic Sleeve Gastroplasty.

Despite widespread adoption and encouraging results seen over the last 5 years, no consensus exists regarding the endoscopic sleeve gastroplasty (ESG) technique, training, or preprocedure and postprocedure management of the patient. The aim of our survey was to assess practice trends and preferences of bariatric endoscopists with respect to ESG. Using a digital platform, we conducted a worldwide survey by emailing a link with an electronic questionnaire to 1200 bariatric endoscopists trained to perform endoscopic suturing using the Apollo Overstitch suturing device (Apollo Endosurgery). We received 221 responses that were included in the analysis. Fifty-one responders (36.4%) required 1 to 10 procedures, and 37 (26.4%) needed 11 to 20 procedures to become proficient at ESG. Ninety-six (68.6%) stated that lower body mass index thresholds should be adopted for Asian and Arab patients. There was no consensus on the ideal number of sutures, with 45 (32.1%), 42 (30%), 36 (25.7%), 13 (9.3%), and 4 (2.9%) recommending 4 to 6, 5 to 7, 6 to 8, 7 to 9, and 8 to 12 sutures, respectively. The primary barriers to establishing an endobariatric program were the inability to establish a cash pay model, 77 (95.1%); lack of institutional support, 61 (75.3%); and difficulty in establishing an ambulatory surgical center/hospital to perform ESG, 73 (90.1%). ESG practice trends remain heterogenous among practitioners in regard to indication, technique, and preprocedure and postprocedure management. Specific ESG guidelines are warranted, and this survey will assist in providing the framework for these guidelines to be written.