Tissue Anchor Research Articles

Biomechanical Performance of Transtibial Pull-Out Posterior Horn Medial Meniscus Root Repair Is Improved With Knotless Adjustable Suture Anchor-Based Fixation.

While posterior medial meniscus root (PMMR) techniques have evolved, there remains a need to both optimize repair strength and improve resistance to cyclic loading. Adjustable tensioning would lead to higher initial repair strength and reduce displacement with cyclic loading compared with previously described transtibial pull-out repair (TPOR) fixation techniques. Controlled laboratory study. A total of 56 porcine medial menisci were used. Eight intact specimens served as a control for the native meniscus. For the others, PMMR tears were created and repaired with 6 different TPOR techniques (8 in each group). Fixed PMMR repairs were executed using 4 different suture techniques (two No. 2 cinch sutures, two cinch tapes, two No. 2 simple sutures, and two No. 2 sutures in a Mason-Allen configuration) all tied over a cortical button. Adjustable PMMR repairs using Mason-Allen sutures were fixed with an adjustable soft tissue anchor fixation tensioned at either 80 N or 120 N. The initial force, stiffness, and relief displacement of the repairs were measured after fixation. Repair constructs were then cyclically loaded, with cyclic displacement and stiffness measured after 1000 cycles. Finally, the specimens were pulled to failure. The PMMR repaired with the 2 cinch sutures fixed technique afforded the lowest (P < .001) initial repair load, stiffness, and relief displacement. The adjustable PMMR repairs achieved a higher initial repair load (P < .001) and relief displacement (P < .001) than all fixed repairs. The 2 cinch sutures fixed technique showed an overall higher cyclic displacement (P < .028) and was completely loose compared with the native meniscus functional zone. Repairs with adjustable intratunnel fixation showed displacement with cyclic loading similar to the native meniscus. With cyclic loading, the Mason-Allen adjustable repair with 120 N of tension showed less displacement (P < .016) than all fixed repairs and a stiffness comparable to the fixed Mason-Allen repair. The fixed Mason-Allen technique demonstrated a higher ultimate load (P < .007) than the adjustable Mason-Allen techniques. All repairs were less stiff, with lower ultimate failure loads, than the native meniscus root attachment (P < .0001). Adjustable TPOR led to considerably higher initial repair load and relief displacement than other conventional fixed repairs and restricted cyclic displacement to match the native meniscus function. However, the ultimate failure load of the adjustable devices was lower than that of a Mason-Allen construct tied over a cortical button. All repair techniques had a significantly lower load to failure than the native meniscus root. Knotless adjustable PMMR repair based on soft anchor fixation results in higher tissue compression and less displacement, but the overall clinical significance on healing rates remains unclear.

Engineering a mussel-inspired hemostatic sealant with a strong tissue anchor as a first-aid tissue adhesive

During injury, achieving quick hemostasis, while maintaining adhesive performances on wet tissue and providing appropriate dynamical mechanical properties remain crucial clinical requests for the current tissue adhesives. Here, we design a double-crosslinking tissue adhesive with tunable degradation rate, adhesion strength, mechanical properties, and cell responses, using thiolated gelatin (Gel-SH) or gelatin and tannic acid (TA). We also investigate the role of different concentrations of gelatin (70 and 150 mg/ml), TA (7, 20, and 70 mg/ml), and crosslinkers (sodium periodate (11.3 and 16.8 mg/ml) and Fe3+ ions (1.7 and 4.8 mg/ml)) to provide a balance of covalent and noncovalent interactions leading to establish muscular tissue adhesive strength and superior hemostasis. Our findings reveal that the Gel-SH(gelatin)/TA adhesives have a range of swelling ability (300–700 %), compressive modulus (0.2–1.2 kPa), strength (0.1–0.8 kPa), and toughness (10–15 kJ/m3). In addition, Gel-SH/TA sample shows rapid self-healing ability and offers robust adhesiveness to wet cow skin and cardiac tissue (50–70 kPa) compared to others mainly owing to the improved cohesive strength originating from the range of chemical interaction within the adhesive network and abundant phenolic hydroxyl groups, surface water removal, and dynamic phenol-quinone balance at the tissue interfaces. Meanwhile, Gel-SH/TA adhesive also exhibits high hemocompatibility and hemostatic properties and appropriate in vitro biocompatibility. Notably, Gel-SH/TA adhesive could support attachment, viability and proliferation, of H9c2 cells. Overall, the multifunctional Gel-SH/TA adhesive hydrogel, owing to the range of molecular interactions opens a new opportunity for quick sealing hemostasis and wound healing and could potentially be harnessed for the development of clinically relevant tissue adhesives.

BIO5: Durability of HeartMate 3 Apical Cuff to Left Ventricle Anastomosis Using an Automated Rapid Anastomotic Device in a Chronic Bovine Model

Background: We developed an automated rapid anastomotic device for HeartMate 3 (HM3) standard apical cuff to Left Ventricle (AC-LV) anastomosis. Tissue anchors and compression plates axially compress the apical cuff sewing skirt to the myocardium. A low-profile delivery tool with integrated targeting system deploys all tissue anchors synchronously. The fixation mechanism minimizes myocardial impact because it confines tissue engagement to the area under the apical cuff sewing skirt. In acute bovine experiments (n=5), HM3 AC-LV anastomoses took less than 1 minute and had excellent hemostasis that was maintained at inotrope-induced supraphysiologic stresses (LV pressures 210-247 mmHg). The purpose of this study was to demonstrate HM3 AC-LV anastomotic durability in chronic bovine implants. Methods: Three calves (weight range 105-123 Kg) underwent HM3 AC-LV anastomosis on the beating heart by lower partial sternotomy with our anastomotic device. Thereafter, cardiopulmonary bypass (CPB) was initiated (ACT >400 seconds), 2 cm. diameter full-thickness LV cores were removed using an Abbott coring tool, and a custom-made sintered titanium plug was inserted to occlude the apical cuff. CPB was weaned, and AC-LV anastomotic hemostasis was assessed qualitatively by Likert Scale (1=unacceptable, 2 = poor, 3 = average, 4 = good, 5 = excellent). Pericardial and bilateral pleural chest tubes (CT) were placed. Serial hematocrit (HCT) and CT outputs were recorded. Anticoagulation was IV heparin at 12 hours, then warfarin through necropsy. Necropsies (gross and microscopic) were done at 56, 57, and 62 days by an experienced independent pathologist. Tissue anchor and compression plate position stability were assessed by acute vs. chronic photograph comparisons. Results: Implants times were 17, 20, and 17 sec. CPB time range was 6-9 min. Acute hemostasis was Likert Scale 5 (excellent) in all cases. At 24 hours, HCT exceeded intra-operative baseline in all animals (range: +2% - +3%) and remained stable. Forty-eight-hour CT output range was 514-760ml. There were no transfusions. In all cases necropsy demonstrated minimal pericardial/pleural adhesions; dense fibrous implant incorporation; stable tissue anchor/compression plate positions; no pseudoaneurysms; concentric smooth fibrous scar at the core site epicardial surface to AC junction (see figure); and implant site histology comparable to manual anastomosis. Conclusion: Rapid automated HM3 AC – LV anastomosis was hemostatic and durable. Additional advantages are greatly reduced operative time; uniform implant technique; precise apical cuff implant site targeting; guaranteed clearance for HM3 pump coupling; facilitates minimal access implant; and minimized myocardial impact (facilitates implant in smaller hearts/ potential to improve recovery). With modifications other LVADs Apical Cuffs can be accommodated, and derivative access ports can facilitate intracardiac device delivery.Figure 1. Concentric smooth fibrous scar at core site epicardial-apical cuff junction

Endoscopic gastric plication for the treatment of weight regain after Roux-en-Y gastric bypass (with video)

Gastric plication involves inverting the stomach with tissue anchor placement to achieve serosa-to-serosa apposition. One potential application of gastric plication is the treatment of weight regain after Roux-en-Y gastric bypass (RYGB), a procedure also known as plication transoral outlet reduction (P-TORe). This study aims to assess technical feasibility, safety, and efficacy of P-TORe. This was a registry study of RYGB patients who underwent P-TORe for weight regain. The primary outcome was the amount of weight loss and clinical success rate, defined as percentage of total weight loss (TWL) of at least 5% at 12 months. Secondary outcomes were technical success, adverse events (AEs), and predictors of weight loss. One hundred eleven RYGB patients underwent P-TORe. Average body mass index (BMI) was 38.5 ± 7.5 kg/m2. Baseline gastrojejunal anastomosis (GJA) and pouch sizes were 17 ± 6mm and 5 ± 2 cm, respectively. The primary outcome was total weight loss, defined as patients experiencing 9.5% ± 8.5% TWL at 12 months. Clinical success rate was 73%. Technical success rate was 100%. Argon plasma coagulation (APC) was performed around the GJA in all patients (100%) before plication placement. The total number of plications per case was 7 ± 3. Overall AE rate was 12.6%. These included GJA stenosis (9.9%), melena because of marginal ulceration (1.8%), and deep vein thrombosis (.9%). The severe AE rate was 0%. Predictors of weight loss were the amount of weight regain and baseline pouch length. This novel P-TORe technique combining APC with gastric plication appears to be technically feasible, safe, and effective at treating weight regain after RYGB.

A Strong Dual-Component Bioadhesive Based on Solventless Thiol-isocyanate Click Chemistry.

Isocyanate is an efficient tissue anchor for engineering of strong bioadhesives. However, isocyanate-containing adhesives were seldom manufactured due to their requirement of water-free administration and time-consuming moisture-induced solidification. To address this issue, here, a solventless dual-component bioadhesive based on thiol-isocyanate cross-linking chemistry is reported. This dual-component bioadhesive consists of a hyperbranched polymer with thiol groups (HBPTE) and an isocyanate-modified polyethylene glycol (PEGNCO). HBPTE and PEGNCO are low-viscosity fluids at room temperature and hence could be used directly as adhesive components, in the absence of a catalyst and a solvent. The thiol-isocyanate click chemistry of components provides the HBPTE-PEGNCO mixture with a gelation time of 1.8-3 min, which makes it acceptable for practical applications. The abundance of isocyanate groups in the adhesive molecule provides strong bonding strength through formation of chemical linkages with reactive groups on the tissue. Moreover, in vitro and in vivo evaluations showed excellent biocompatibility of the HBPTE-PEGNCO adhesive. This dual-component bioadhesive based on solventless thiol-isocyanate click chemistry displayed a fast gelation time and excellent bonding performance, providing a pioneering idea for engineering isocyanate-containing bioadhesives.

A mussel-inspired supramolecular hydrogel with robust tissue anchor for rapid hemostasis of arterial and visceral bleedings

In recent years, the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage, owing to their weak hemostatic function, inferior wet tissue adhesion, and low mechanical properties. Herein, a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property (308.47 ± 29.20 kPa) and excellent hemostatic efficiency (96.5% ± 2.1%) was constructed as a hemostatic sealant. Typically, we combined chitosan (CS) with silk fibroin (SF) by cross-linking them through tannic acid (TA) to maintain the structural stability of the hydrogel, especially for wet tissue adhesion ability (shear adhesive strength = 29.66 ± 0.36 kPa). Compared with other materials reported previously, the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models, which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS. As a superior hemostatic sealant, the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.

Strong Dual-Components Bioadhesive Based on Solventless Thiol-Isocyanate Click Chemistry

Isocyanate is an efficient tissue anchor for engineering of strong bioadhesive. However, isocyanate containing adhesives are seldom manufactured, due to their requirement of water-free administration and time-consuming moisture-induced solidification. To address this issue, herein, a solventless dual-component bioadhesive based on thiol-isocyanate crosslinking chemistry is reported. This dual-component bioadhesive consists of a hyperbranched polymer with thiol groups (HBPTE) and an isocyanate modified polyethylene glycol (PEGNCO). HBPTE and PEGNCO are low-viscosity fluids at room temperature and hence could be used directly as adhesive components, in absence of catalyst and solvent. The thiol-isocyanate click chemistry of components provide HBPTE-PEGNCO mixture with a gelation time of 1.5~3 minutes, which makes it acceptable for practical applications. The abundance of isocyanate groups in the adhesive molecule provides strong bonding strength through formation of chemical linkages with reactive groups on the tissue. Moreover, in vitro and in vivo evaluations in mice showed excellent biocompatibility of HBPTE-PEGNCO adhesive. This dual-component bioadhesive based on solventless thiol-isocyanate click chemistry displayed a fast gelation time and excellent bonding performance, providing a pioneering ideal for engineering isocyanate containing bioadhesive.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

Sa1937 ENDOSCOPIC GASTRIC PLICATION FOR THE TREATMENT OF WEIGHT REGAIN FOLLOWING ROUX-EN-Y GASTRIC BYPASS

Gastric Plication (GP) involves inverting the stomach with tissue anchor placement to achieve serosa to serosa apposition and permanent gastric remodeling that is challenging to achieve with endoscopic suturing. One potential application of GP is the treatment of weight regain following Roux-en-Y gastric bypass (RYGB) by placing plications around the gastrojejunal anastomosis (GJA) and in the pouch to reduce their sizes. To assess technical feasibility, safety and efficacy of GP at treating weight regain following RYGB. This was a prospective registry study of RYGB patients who underwent GP for weight regain. The GJA was ablated with argon plasma coagulation (APC) (forced, 0.8 L/min, 70-80 watts). Plications were then placed in the ablated area and in the pouch (Figure 1). Technical success, clinical success defined as achievement of at least 5% total weight loss (TWL) at 1 year, and adverse events (AEs) classified using the ASGE lexicon were reported. Additionally, the amount of weight loss, reported using %TWL, at 1 and 2 years was determined. 44 RYGB patients (41F, age 50±11) underwent GP for weight regain and were included. Average BMI and weight regain were 38.8±7.9 kg/m2 and 41.7±28.6% of the maximal weight loss. Pre-GP GJA and pouch sizes were 17±7 mm and 5±2 cm, respectively. Technical success rate was 100%. Average procedure time was 66±20 minutes. APC around the GJA was performed in all patients (100%) prior to plication placement (40.9% with 80 watts, 59.1% with 70 watts). The total number of plications per case was 6±3, with 3±2 and 3±2 being placed in the GJA and pouch, respectively. Clinical success rate was 79.3%. At 1 and 2 years, patients experienced 10.3±7.4% and 8.4±12.6% TWL, respectively (p=0.01 for both). Overall AE rate was 15.9%. These included GJA stenosis (13.6%) and epigastric pain due to GJA ulceration at the APC site (2.3%). All stenoses occurred with 80 watt APC and were successfully treated with endoscopic balloon dilation without or with lumen-apposing metal stent. The severe AE rate was 0%. This novel gastric plication procedure appears feasible and safe, with a high response rate and durable weight loss at two years, for the treatment of weight regain following RYGB.

Sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of complete uterovaginal eversion.

ABSTRACTIntroduction Pelvic Organ Prolapse (POP) is a common condition in elderly resulting from the weakening of the organ suspension elements of multifactorial origin. It compromises significantly the quality of life and can affect more than 50% of multiparous women. Stage IV prolapse or complete uterovaginal eversion corresponds to 10% of the cases and the only form of curative treatment is the surgical correction. The aim of this video is to demonstrate our technique of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of this challenge condition, focusing on technical details in order to prevent mesh related complications. Major, but rare complications, include: infection, prolapse recurrence, abscess formation, bladder perforation and urinary fistula. These situations are related mostly to low volume centers.Materials and Methods A 70 years old female with a stage IV POP had obstructive lower urinary tract symptoms. Only after reducing prolapse, it was possible to urinate, but without stress urinary incontinence. No topic estrogen was prescribed before the surgery and she also didn´t take any kind of hormone replacement therapy. Transvaginal ultrasound and the Pap smear screening were done with normal results. Cystoscopy wasn´t employed at anytime of this procedure. Hydrodissection of vaginal wall was followed by longitudinal incision from the level of bladder neck to the cervix. Notice that the ideal dissection should maintain the vaginal thickness, and address the plane of the connective tissue between the bladder and the vagina. Bladder base is then released from the anterior aspect of the cervix in order to create a site to pericervical ring repair and to fix the apex of the Calistar Soft® with polypropylene 3.0 stitches. A blunt dissection extended downwards through the lateral aspect of the levator ani fascia till the identification of the ischial spine and sacrospinous ligaments bilaterally. Two polypropilene 2.0 threads mounted on a specially designed tissue anchor system (TAS) are then fixed into each sacrospinous ligament 1.5 to 2 cm away from the ischial spine and repaired for further prosthesis anchoring. Then, a longitudinal incision is done at the posterior vaginal wall and the recto-vaginal fascia detachment from the posterior aspect of the pericervical ring is identified and corrected with interrupted polypropylene 2.0 stitches to the cervix and to the pericervical aspect of elongated uterosacrus ligaments bilaterally. The Calistar Soft A (anterior) and P (posterior)® prosthesis were fixed at the anterior and posterior aspects of the cervix, respectively, with interrupted polypropylene 3.0 stitches and meshes’ arms are fixed to the sacrospinous ligament using the previously implanted TAS. Then, the distal Calistar Soft A® arms were bilaterally fixed into the internal obturator muscles using its fish spine–like multipoint fix device in order to prevent mesh folding. Finally, perineal body repair was done and vaginal wall was closed with individual absorbable interrupted polyglactin 2.0 sutures and a 16 Fr Foley catheter as well as a vaginal pack embedded on neomicin-bacitracin cream were kept overnight.Results A high satisfaction rate has been computed with synthetic mesh to POP surgery correction. Approximately 10% of cases of mesh exposure may occur, most of them oligosymptomatic and easy handed by excision or with topic estrogen preparations. After 1 year follow-up, our patient is still satisfied without any complain and no relapse. Conclusion: We described a successful treatment of stage IV POP in an old female patient. This technique can be used for advanced end stage POP patients, especially those with some contraindication to sacropromontopexy, but who want to keep vaginal length and uterus. Anatomical knowledge, obedience to technical care, and intensive training are the keys for minimizing the risk of complications. Although we had success with this technique, more studies with proper randomization are necessary to compare success and complications of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh to sacropromontopexy.

Fixation Strength of Polyetheretherketone Sheath-and-Bullet Device for Soft Tissue Repair in the Foot and Ankle

Tendon transfers are often performed in the foot and ankle. Recently, interference screws have been a popular choice owing to their ease of use and fixation strength. Considering the benefits, one disadvantage of such devices is laceration of the soft tissues by the implant threads during placement that potentially weaken the structural integrity of the grafts. A shape memory polyetheretherketone bullet-in-sheath tenodesis device uses circumferential compression, eliminating potential damage from thread rotation and maintaining the soft tissue orientation of the graft. The aim of this study was to determine the pullout strength and failure mode for this device in both a synthetic bone analogue and porcine bone models. Thirteen mature bovine extensor tendons were secured into ten 4.0 × 4.0 × 4.0-cm cubes of 15-pound per cubic foot solid rigid polyurethane foam bone analogue models or 3 porcine femoral condyles using the 5 × 20-mm polyetheretherketone soft tissue anchor. The bullet-in-sheath device demonstrated a mean pullout of 280.84 N in the bone analog models and 419.47 N in the porcine bone models. (p = .001). The bullet-in-sheath design preserved the integrity of the tendon graft, and none of the implants dislodged from their original position.

Precise Longitudinal Tracking of Microscopic Structures in Melanocytic Nevi Using Reflectance Confocal Microscopy: A Feasibility Study.

Reflectance confocal microscopy (RCM), a cellular-level, in vivo imaging technique, may be potentially used for monitoring melanocytic neoplasms for microscopic stability vs changes over time. To test feasibility of using RCM to track specific microscopic structures within nevi over 1 year. This was an observational study, a review of prospectively acquired RCM images, performed at a tertiary academic medical center. Seventeen patients were enrolled from adult patients presenting to pigmented lesion clinic; from each participant, 3 confirmed benign nevi were randomly selected from the upper and lower back and from the lower extremity. Nevi underwent standardized RCM imaging at baseline and after 1 year. We tested interobserver reproducibility in recognition of tissue anchors, RCM structures that can be identified at 2 time points. We used 2 tests to measure concordance between independent readers: (1) In the multiple choice matching test (n = 43 nevi), readers were shown a tissue anchor in a baseline RCM image (≤ 1 × 1-mm field-of-view) and asked to identify the same structure in 1 of 4 equally sized RCM images obtained from the same nevus at follow-up. (2) In the annotation test (n = 29 nevi), readers were shown a tissue anchor in a follow-up RCM image (≤ 1 × 1-mm field-of-view) and asked to annotate the corresponding location of this structure in the baseline RCM mosaic image (≤ 5 × 5-mm field-of-view) from the same nevus; good agreement was defined as annotations deviant by less than 10% of the mosaic's width. In total, 17 patients (mean age, 45 years [range, 28-70 years]; 10 [59%] were women) contributed a total of 51 nevi, of which 44 nevi (86%) were used for the study. Images from 7 nevi (14%) were suboptimal in quality. Tissue anchors were identified at both time points in all 44 nevi. Selected tissue anchors were located at a mean depth of 54.3 µm; the most commonly selected anchors (37 of 44 images [84.1%]) were dermal papillae. In the multiple choice matching test, compared with a reference reader, 2 readers correctly matched baseline to follow-up tissue anchors in 40 of 43 nevi (93%; P < .01) and 42 of 43 nevi (98%; P < .01), respectively. In the annotation test, there was good agreement between 2 readers in all 29 cases (100%); the mean deviation was 2% (range, 0%-7.5%). Precise longitudinal tracking of microscopic structures in melanocytic nevi using RCM is feasible.

Endoscopic Full-Thickness Resection Using a Novel Over-the-Scope Device

Endoscopic Full-Thickness Resection Using a Novel Over-the-Scope Device

Post-traumatic dynamic hallux varus instability.

Acquired hallux varus secondary to traumatic disruption of the lateral joint structures of the 1st MTPJ is uncommon and has only been reported in the literature once previously.(4) We present a case of traumatic hallux varus that is unique since the deformity is dynamic in nature. In our patient the hallux remained reduced on standing weight bearing films, and luxated only during fluoroscopic stress testing. We also describe our surgical correction where a soft tissue anchor alone was utilized to stabilize the joint through repair of the lateral capsule and collateral ligament. One year following the described repair the patient reports no limitations in performing activities of daily living, and complains of only mild pain with recreational activities.

Multipurpose use of the over-the-scope-clip system ("Bear claw") in the gastrointestinal tract: Swiss experience in a tertiary center.

To evaluate the outcome of over-the-scope-clip system (OTSC) for endoscopic treatment of various indications in daily clinical practice in Switzerland. This prospective, consecutive case series was conducted at a tertiary care hospital from September 2010 to January 2014. Indications for OTSC application were fistulae, anastomotic leakage, perforation, unroofed submucosal lesion for biopsy, refractory bleeding, and stent fixation in the gastrointestinal (GI) tract. Primary technical success was defined as the adequate deployment of the OTSC on the target lesion. Clinical success was defined as resolution of the problem; for instance, no requirement for surgery or further endoscopic intervention. In cases of recurrence, retreatment of a lesion with a second intervention was possible. Complications were classified into those related to sedation, endoscopy, or deployment of the clip. A total of 28 OTSC system applications were carried out in 21 patients [median age 64 years (range 42-85), 33% females]. The main indications were fistulae (52%), mostly after percutaneous endoscopic gastrostomy tube removal, and anastomotic leakage after GI surgery (29%). Further indications were unroofed submucosal lesions after biopsy, upper gastrointestinal bleeding, or esophageal stent fixation. The OTSC treatments were applied either in the upper (48%) or lower (52%) GI tract. The mean lesion size was 8 mm (range: 2-20 mm). Primary technical success and clinical success rates were 85% and 67%, respectively. In 53% of cases, the suction method was used without accessories (e.g., twin grasper or tissue anchor). No endoscopy-related or OTSC-related complications were observed. OTSC is a useful tool for endoscopic closure of various GI lesions, including fistulae and leakages. Future randomized prospective multicenter trials are warranted.

EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors

Endoscopic resection of gastric subepithelial tumors (SETs) carries a high risk of perforation. New techniques such as use of the over-the-scope clip (OTSC) may enable secure endoscopic closure of perforations. We aimed to evaluate the feasibility of endoscopic resection of small gastric SETs using a grasp-and-snare technique followed by OTSC closure of the gastric wall if necessary. In this prospective study 20 consecutive patients who presented with gastric SETs ≤ 3 cm were enrolled. Endoscopic resection was performed using a double-channel endoscope, a tissue anchor and a monofilament snare. If perforation occurred, the aim was to achieve complete closure with a tissue twin grasper and the OTSC. Procedures were performed under laparoscopic control using a 5-mm optic, which was introduced via a single 5-mm trocar through the umbilicus. All patients were followed up for 3 months after the procedure. In 6 /20 patients a pure endoscopic approach was impossible and a switch to laparoscopic wedge resection was necessary (large tumor size in 2 /6 patients; mainly extraluminal growth in 4 /6 patients). Solely endoscopic resection was successfully performed in the remaining 14 patients. Amongst these, laparoscopic control was impossible in two cases. Perforation occurred in 6 /14 patients but gastric closure with the OTSC was performed successfully in all these cases. No complications occurred and follow-up was unremarkable. Endoscopic snare resection enables safe treatment of small gastric SETs (diameter ≤ 3 cm) and seems faster and easier to perform than other endoscopic resection techniques, such as endoscopic submucosal dissection (ESD) or submucosal tunneling. Perforations occurring after full-thickness resection can be adequately managed by OTSC closure. Solely endoscopic resection without laparoscopic control seems possible in selected patients with tumors known to have purely intraluminal growth.

Tissue Anchor Use in Arthroscopic Glenohumeral Surgery

Arthroscopic surgery has become the mainstay of treatment of several common glenohumeral pathologies such as tears of the rotator cuff and labrum. Arthroscopic rotator cuff and labral repair provide outcomes comparable to those achieved with traditional open techniques, with the benefits of smaller incisions and less soft-tissue disruption. Development and improvement of tissue anchors and arthroscopic instrumentation has been integral to the increased popularity of arthroscopic glenohumeral repairs. Current anchors can be categorized by design and material composition. Awareness of the advantages and limitations of these implants may influence anchor selection.

Endoscopic closure devices

Endoscopic closure devices

Pulp tissue anchor repair for the zone I flexor tendon injury: introduction of a new and cost-effective technique

Background Flexor digitorum profundus tendon (FDP) injury in zone I is one of the common findings in the hand examination when a patient presents with a hand trauma. Various repair techniques have been described in the literature with its own advantages and disadvantages. In this article, the senior author describes a new pulp tissue anchor repair for the zone I FDP injuries.

Re: Atherton MJ, Daborn JP, Tsokos N, Jeffery JT &amp; Yin MJ, Complications associated with tissue anchor migration after vaginal surgery using the tissue fixation system – a case series, ANZJOG 2012; 52 (1): 83–86

Re: Atherton MJ, Daborn JP, Tsokos N, Jeffery JT &amp; Yin MJ, Complications associated with tissue anchor migration after vaginal surgery using the tissue fixation system – a case series, ANZJOG 2012; 52 (1): 83–86