Excision Technique Research Articles

Stroboscopy evaluation of vocal folds lesions with pre and post phono surgery

BackgroundVideo laryngostroboscopy (VLS) is the most used method to visualize vocal fold vibration and mucosal wave assessment. It is used to evaluate the pliability of the vocal fold mucosa and is an indication of the health and function of the mucosal tissue and deeper layers. The aim of this work was to study the role of VLS in the evaluation of vocal fold lesions for deciding the best management plan and achieving the best post-operative voice results.MethodsThis prospective observational study was carried out on 70 patients aged more than 12 years, both sexes, with vocal fold (VF) lesions namely benign vocal fold lesions. Minimal associated pathological lesions (MAPLS) include VF nodules, VF polyps, and VF cysts.ResultsThere was no significant difference between the micro flap, excision, and truncation technique regarding any of the post-procedure VLS assessments of the patients with bilateral VF nodules and unilateral VF polyp (p > 0.05). There was no significant difference between the micro flap technique, excision technique, or marsupialization technique regarding any of the Post-procedure VLS assessments of the patients with unilateral VF cysts (p > 0.05).ConclusionsVLS provides a better guide for the phono surgeon to delineate the plane of dissection micro laryngeal surgery (MLS) which helps him in preserving the functional mucosa of the VF. This helps in achieving good voice quality and outcome after surgery. No significant difference between different surgical techniques used for their excision.

A comprehensive review of evolution of advanced follicular unit excision systems

Initially, the application of the follicular unit excision (FUE) technique for hair transplantation faced a challenge due to a significant occurrence of hair follicle damage. However, advancements in techniques, punch designs, and tools have successfully addressed this issue. The integration of motorized equipment featuring rotation, roto-oscillation, oscillation, vibration, suction, and hydration has significantly improved the successful harvesting of grafts. More recently, the adoption of robotic technology for both graft extraction and incision is becoming increasingly common in FUE procedure. Given the wide range of available devices and technologies, hair transplant surgeons may find it challenging to select the most suitable option for their specific practices. The advancements in techniques, punch shapes, and motorized devices have played a key role in reducing the rate of follicle damage and increasing the speed of FUE procedures. It is crucial for hair restoration surgeons to stay informed about the various accessible devices and understand how these tools can be customized to suit the unique hair and skin characteristics of each patient.

Adipose Stem Cells Prevent Esophageal Strictures After Extensive Endoscopic Submucosal Dissection-Experimental Research.

Endoscopic submucosal dissection (ESD) is a pivotal technique for excision of early-stage esophageal tumors. However, its primary complication, postoperative esophageal stricture, is a significant challenge owing to the absence of effective preventive measures. Adipose-derived stem cells (ADSCs) have emerged as a promising treatment modality to address this concern. In this study, we aimed to investigate, for the first time, the efficacy of allogenic ADSC injections in preventing esophageal stenosis after ESD. We administered allogeneic ADSC injections ((same-species but different individual)) to a porcine model of ESD as a way to observe the role of ADSC in preventing esophageal stricture. We also co-cultured rats ADSCs with rats esophageal fibroblasts and esophageal mucosal epithelial cells to investigate the mechanism. ADSCs notably facilitated epithelial-mesenchymal transition (EMT) of epithelial cells. Furthermore, ADSC-conditioned medium exhibited a substantial inhibitory effect on fibroblast proliferation and migration, which was mediated by the transforming growth factor-beta pathway. Our findings underscore the potential of ADSC injections as a promising therapeutic intervention to enhance recovery and prevent post-ESD complications.

Comparison of Outcomes between Marsupialization and Lay-Open Techniques in the Management of Pilonidal Sinus

Background and objectives: Different surgical strategies emerged for pilonidal disease, but no ideal one. Thus, this study aimed to compare the outcomes of marsupialization vs laying open techniques in the management of pilonidal sinus. Methods: This case series study was conducted on 200 consecutive patients with chronic pilonidal sinus who has operated either with excision and marsupialization technique (Group 1, no.=100) or excision and lay-open technique (Group 2, no.=100) in different hospitals at Sulaimaniyah city, Iraq, from January 2012 to January 2022. The patients' socio-demographics, perioperative data, complications and recurrences were collected using a special questionnaire prepared for this study. Also, the patient’s data was evaluated after surgery regarding postoperative pain, satisfaction, healing and dressing time, incapacity to work and postoperative complications. Results: Most patients aged 20-29 years (40.5%), males (71.5%), had working hours for ?6 hours (57%), with no family history of pilonidal disease (86.0%), presented with pain (44.83%), and with hirsutism (41.5%). In total, 39.5% of the patients had severe pain, 38% had moderate, and 22.5% had mild (p=0.000). Concerning patient postoperative satisfaction, most patients (32.5%) had good and least had excellent (6.0%) satisfaction (p=0.000). Moreover, for the association between the outcomes of both used techniques, a substantial correlation between both groups was found for incapacity for regular daily activity (p=0.046), healing time (p=0.000), dressing time (p=0.000), infection, dehiscence, bleeding and recurrence (p=0.045). Conclusions: Marsupialization was the preferred technique over lay-open regarding postoperative patient satisfaction/severity, healing duration, and dressing time, as it had fewer complications with a recurrence rate.

Precision excision technique for the tumor located left S1+2.

precision excision technique for the tumor located left S1+2.

Radical surgical excision of extensive perianal melanomas on standing horses: Twenty cases.

To report a radical surgical technique for perianal melanomas involving the anal margin in standing horses. Observational retrospective study. Twenty client-owned horses presented for surgical excision of extensive (≥4 cm) perianal melanomas. Demographic data, surgical technique, intraoperative, immediate- and late-postoperative complications were reviewed. All horses (median age 15, Q1-Q3 12 to 17.3 years) were operated under standing sedation and epidural anesthesia. Median hospitalization period was 6.5 days (Q1-Q3 5 to 8.3 days). The anal margin was fully resected in 14 cases. A deep perirectal dissection was performed in 16 cases. Eight cases required additional local anesthetics. One case bled profusely during and after the procedure. One case became recumbent during the procedure, showed intense postoperative pain, and was eventually euthanized 6 weeks later because of ataxia. During hospitalization, one horse displayed colic signs and 10 others required manual evacuation of the rectum because of decreased fecal output. Complications after hospital discharge included mild colic signs (n = 4), partial wound dehiscence (n = 1) and hypergranulation of the wound (n = 2). All other cases healed without complications in 6 to 12 weeks. Median follow-up period was 11.8 months (Q1-Q3 6.3 to 27.2 months). Six horses developed new melanomas with only one in the perianal region. This technique of surgical excision of extensive perianal melanomas was efficiently performed on standing horses with minimal local recurrence. This procedure led to high client satisfaction. Early postoperative pain was commonly encountered. Owners should be warned of the potentially large surgical wound that will be created. This technique allowed for removal of large perianal melanomas with limited recurrence during the long term follow up and may improve the quality of life of affected horses.

Giant Recurrent Gartner Duct Cyst: A Rare Case Report and a Simple Surgical Technique for Complete Excision Vaginally

Giant Recurrent Gartner Duct Cyst: A Rare Case Report and a Simple Surgical Technique for Complete Excision Vaginally

Staging Approaches to Lymphatic Surgery: Techniques and Considerations.

Lymphatic surgery has demonstrated promising outcomes for the treatment of lymphedema alongside nonsurgical techniques. Physiologic lymphatic surgeries including lymphovenous bypass and vascularized lymph node transplants address the fluid burden in lymphedema whereas reductive surgeries including suction lipectomy and excisional techniques address the fibroadipose component of the disease. Lymphedema patients often present with both fluid and fat components that may require different procedures for optimal results. In addition, the chronic, progressive nature of lymphedema can warrant the need for multiple procedures to address different anatomic areas as well as further improve outcomes. This paper reviews the current literature on staging different or repeated lymphatic procedures and proposes an algorithm to navigate physiologic and reductive lymphatic surgery when multiple procedures are needed to optimize surgical outcomes.

Functional Outcome of 3years Follow Up after Mini-Open Tendo- Achilles Splitting Technique for Excision of Haglund’s Deformity in Non-athletes

Functional Outcome of 3years Follow Up after Mini-Open Tendo- Achilles Splitting Technique for Excision of Haglund’s Deformity in Non-athletes

Technique of Distal Tendon Excision for the Treatment of Chronic Pain Caused by Isolated Proximal Gracilis Tears

Proximal gracilis tear is a rare sports-related injury that can easily lead to misdiagnosis and underdiagnosis. Clinical manifestations are dominated by localized pain, tenderness, and dysfunction. Here, we report a therapy of proximal segmental tear of the gracilis and demonstrate its treatment process and clinical outcome. This Technical Note describes in detail the minimally invasive distal gracilis resection technique for the treatment of chronic proximal gracilis ruptures, focusing on the most important technical aspects and thus attempting to introduce this procedure and make it more widely used in the treatment of similar muscle injuries.

Application of Polymarker Assistant External Alar Wedge Excision Combined With Internal Vestibular Floor Excision in Nasal Alar Reduction

Background: There are numerous techniques available to modify nasal alar. The combined alar base excision technique can narrow the nasal base and correct excessive alar flare at the same time. Despite its effectiveness, this procedure involves the removal of the skin of the nasal alar and the nasal mucosa, making the operation more challenging and raising the risk of postoperative asymmetry complications. Objectives: The purpose of this study is to develop a method of polymarker to assist the operation design to improve the precision of the operation and to avoid the complications discussed above. Methods: The authors conducted a retrospective review of patients undergoing nasal alar reduction using polymarker assistant external alar wedge excision combined with internal vestibular floor excision by a senior surgeon from January 2021 to April 2023. The postoperative appearance was evaluated in stratification by the patients during revisits using a VAS questionnaire. Results: The nasal alar was reduced with polymarker assistant external alar wedge excision combined with internal vestibular floor excision on 30 female patients ranging from 20 to 45 years of age, 10 of which were performed simultaneously with rib cartilage–related rhinoplasty. In all cases, the nasal alar was reduced without distortion. During the postoperative period, all the effects of the surgery were seen to persist for a lengthy period of time, and the patients were generally satisfied with the results.

Vestibular Marginal Skin Excision Technique for Minor Secondary Unilateral Cleft Nose Deformity

Vestibular Marginal Skin Excision Technique for Minor Secondary Unilateral Cleft Nose Deformity

Technique of Excision of Double Head Pterygium with Conjunctival Autograft from both Eyes

Background: Pterygium is not just a degenerative disease, but may be a proliferative disorder of the ocular surface. Objective: The aim of this study was to describe a technique of conjunctival autograft from both eyes for primary double head pterygium and evaluate its post operative result. Methodology: This retrospective study was conducted in the department of Ophthalmology at Monno Medical College, Manikganj, Bangladesh from July 2022 to December 2022 for duration of six months. After fulfill the selection criteria underwent conjunctival autograft from both eyes. Primary outcome measure was recurrence rate, graft retraction, Tenon's granuloma, dellen formation. Results: The highest patients belong to 35 to 45 years age group is about 18(60.0%) in this study. The number of male patients was 10 and that of female patient 20. There was no recurrence in this study. However, there were postoperative oedema (6.66%), sub-conjunctival haemorrhage (63.33%), graft retraction (20.0%), dellen (0.0%), Tenon’s granuloma (10.0%). Conclusion: In conclusion conjunctival autograft from both eyes appears to be successful technique with 0 recurrence rate in treating double head pterygium. Journal of Monno Medical College June, 2024;10 (1):03-06

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Hybrid approach of massive lipolymphedema of the thigh: A novel surgical technique

ObjectiveThe goal of this study was to test the hybrid technique of combined tumescent liposuction and surgical excision in patients with advanced lipolymphedema of the thigh after compression therapy as a gold standard for treatment. MethodsBetween January 2016 and April 2020, 18 female and 1 male patients with massive thigh lipolymphedema were treated with complete decongestive therapy for the whole thigh followed by selective decongestive therapy to the upper and lower thigh to make a lump on the midmedial region. Then, the patient was prepared for surgery. Skin is refashioned and sutured in a manner that leaves no furrows and a cosmetic contour is obtained. Compression therapy is maintained from the day of the surgery starting by compression bandage until full healing of the wound, followed by well-fitted garments. ResultsThis study was conducted on 18 female patients and 1 male patient who presented with massive lipolymphedema of the thigh. The age of the patients ranged from 46 to 65 years old with a mean age of 51.38 years. All patients in this study underwent compression therapy as a preparatory stage to turn the massive lipolymphedema into lumpedema, followed by hybrid technique which consisted of combined liposuction and surgical excision. ConclusionsConversion of massive thigh lipolymphedema into lumpedema followed by tumescent liposuction and surgical excision has proven to be a safe and effective treatment option with a marvelous cosmetic result and low wound morbidity and should be considered as a solution for all patients with this disorder.

Optimizing Gynecomastia Correction Surgery: Efficacy and Safety of Tumescent Local Anesthesia Approach.

Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years. Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out. The average volume of tumescent solution infiltrated during TLA was 300mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy. Follow-up time ranged from 30 days to 1 year. We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique, supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Overview of Pilonidal Cyst Treatment Methods - Review Paper

Introduction and purpose A pilonidal cyst also known as a pilondial sinus, is an inflammatory condition that occurs in the intergluteal region, which can lead to serious infections. It most commonly affects young men, with risk factors including the presence of hair in this area, excessive sweating, obesity, and poor hygiene. Symptoms include a lump, pain, and purulent discharge from openings in the skin. Diagnosis involves taking a medical history, a physical examination, and often an ultrasound. The aim of this paper is to present and compare the available methods for treating pilonidal cysts. Materials and methods Literature available in PubMed databases were reviewed using the following keywords: ‘’Pilonidal cyst’’, ‘’Hair cyst’’, ‘’Abscess’’, ‘’Treatment of pilonidal cyst’’,’’ Bascom II method’’,’’ Limberg flap’’,’’ Suchorski technique’’, ‘’V-Y or Z skin flap reconstruction’’,’’ the Karadakis’’ Results The available treatment methods can be divided into conservative and invasive approaches. Conservative methods include hair removal and improved hygiene. Among the surgical methods, there are traditional excision techniques and modern methods such as excision using the Bascom II method, Limberg flap, Suchorski technique, or V-Y or Z skin flap reconstruction. The Karadakis method, which involves shifting a skin flap, is particularly effective for obese patients. Conclusion Treatment of pilonidal cysts depends on the stage and symptoms. Abscesses require urgent surgical intervention, while asymptomatic cysts can be treated conservatively or surgically.

A Prospective European Trial Comparing Laparotomy, Laparoscopy, Robotic-Assisted, and Transanal Total Mesorectal Excision Procedures in High-Risk Patients with Rectal Cancer: The RESET Trial.

To compare total mesorectal excision (TME) techniques combined with sphincter-sparing procedure in high-risk patients (HRPs). TME is the standard treatment for rectal cancer, but can be challenging in HRPs. The available surgical approaches must be compared, especially in HRPs. Prospective, observational, multicenter trial to compare laparotomy (OTME), laparoscopy (LTME), robotic-assisted surgery (RTME), and transanal surgery (TaTME) in HRPs. The composite primary outcome included circumferential radial margin (CRM) ≥1mm, TME grade II-III, and absence of Clavien-Dindo grade III-IV complications. Three propensity score analyses were performed (LTME vs. RTME, RTME vs. TaTME, LTME vs. TaTME). 1078 HRPs (75% of men, median body mass index of 27kg/m2, 50% of tumors in the lower third of the rectum) underwent surgery. The RTME and TaTME groups included patients with more advanced and lower tumors and coloanal anastomosis (P<0.001). Operative time was longer for RTME surgery (P<0.001). Conversion rate was similar for minimally invasive procedures (4.5%). The global R0 resection rate was 96% without difference among techniques. The primary outcome rates were 82.4%, 64.3%, 74.7%, and 80.3% for LTME, OTME, RTME, and TaTME, respectively. None achieved the expected success rate (85%), and propensity score analyses found no differences. Operative results were similar between high- and low-volume inclusion centers only for RTME. The RESET trial yielded high-quality results despite focusing on HRPs. Minimally invasive procedures showed similar sphincter-sparing procedure outcomes, but LTME included patients with more favorable tumors. Oncologic and functional outcomes will be evaluated at 2 years (ClinicalTrials.gov, ID: NCT03574493).

Effectiveness of Core Excision Technique for Keloids: A Systematic Review.

The keloid core excision technique mitigates the risk of wound tension and promotes favorable morphological outcomes. However, whether residual keloid tissue or other factors increase the risk of recurrence remains unclear. This systematic review aimed to evaluate the therapeutic outcomes of core excision techniques for keloids. A systematic literature review was conducted by searching PubMed, Embase, Web of Science Core Collection, and Cochrane Library databases on July 30, 2023. The search terms employed were "keloid," "core excision," "intralesional excision," "intramarginal excision," "rind flap," and "fillet flap." The inclusion criteria for the studies were established in advance and evaluated by multiple investigators. Overall, 20 studies involving 926 keloid cases managed through core excision were included. Adjuvant therapies were used in 19 studies, with radiotherapies and steroid injections emerging as the predominant methods. The recurrence rates ranged from 0% to 28.6%. Residual scar tissue after core excision and complications, such as flap necrosis and hematoma, are the major factors contributing to recurrence. The core excision technique is a surgical treatment of keloids with a low recurrence rate when combined with adjuvant therapies. However, randomized controlled trials and conclusive quantitative studies are necessary to further investigate the effects of the core excision technique on keloids.

Abstract ID: 18Minimally Invasive Techniques for Gastric GIST excision: Analysis of a Single Institution Experience and literature review

Abstract ID: 18Minimally Invasive Techniques for Gastric GIST excision: Analysis of a Single Institution Experience and literature review