Transect Technique Research Articles

Outcomes of bulbar artery sparing during anastomotic urethroplasty for pelvic fracture urethral injury

ObjectiveTo the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al. Material and methodsAnastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique. ResultsA total of 60 patients were included, with a mean age of 37 years (IQR 22-48). The median time from trauma to urethral reconstruction was 16 weeks, and the mean stenosis length was 2.5 cm (IQR 2-3). The left bulbar artery was preserved in 27 cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14 cases (23%), but only one of them was Clavien ≥ III. With a mean follow-up of 56 months (IQR 12-87), only one patient failed due to stenosis (98% success). ConclusionPreservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.

Vessel-sparing Non-transecting Anastomotic Reconstruction of the Posterior Urethra: Single Center Experience with Long-term Follow-up

OBJECTIVETo discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future. METHODSThe bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and perform the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries. RESULTS127 patients, median age 58 years (IQR 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n=48), pelvic fracture urethral injury (PFUI) (n=61), prostate cancer treatment (n=14) and instrumentation (n=4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. 14 patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow up of 36 months, CONCLUSIONSparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.

Resultado de la preservación de las arterias bulbares durante la uretroplastia anastomótica para la lesión uretral por fractura de pelvis

ObjectiveTo the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al. Material and methodsAnastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique. ResultsA total of 60 patients were included, with a mean age of 37years (IQR: 22-48). The median time from trauma to urethral reconstruction was 16weeks, and the mean stenosis length was 2.5cm (IQR: 2-3). The left bulbar artery was preserved in 27cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14cases (23%), but only one of them was Clavien ≥III. With a mean follow-up of 56months (IQR: 12-87), only one patient failed due to stenosis (98% success). ConclusionPreservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.

Robotic Left Hepatectomy Using the Glissonean Approach and Saline-Linked Bipolar Clamp-Crush Technique.

We have previously reported a saline-linked bipolar clamp-crush technique as a novel robotic liver resection method. Herein, we present the surgical techniques and outcomes of robotic left hepatectomy using the Glissonean approach and our liver transection technique. The key procedures included the following: (1) encircling the left Glissonean pedicle using the Tip-Up fenestrated grasper, (2) dissecting the liver parenchyma using the saline-linked bipolar clamp-crush technique, (3) moving the endoscope one trocar to the right to facilitate visualisation of the liver transection plane, and (4) stapling the left pedicle and left hepatic vein. Seven robotic left hepatectomies were performed. The median operative time and estimated blood loss were 395min and 50mL, respectively. The median length of postoperative hospital stay was 9days. Pneumothorax was the only severe postoperative complication. Robotics left hepatectomy using the Glissonean approach and the saline-linked bipolar clamp-crush technique appears safe and feasible.

INVENTARISASI POTENSI PAKAN KUSKUS DI TAMAN NASIONAL MANUSELA (RESORT MASIHULAN)

This research aims to determine the types of plants that have the potential to be used as cuscus food, determine the parts of plants that function as cuscus food, and determine the availability of cuscus food in their habitat. This research uses a descriptive method using the route transect technique carried out in Manusela National Park (Masihulan Resort). The research instrument generally carried out by researchers is field observation. The data obtained consisted of the type of feed consumed by cuscus, the plants consumed by cuscus (leaves, fruit and bark), and the potential types of feed (density, dominance and frequency) at the research location. The results of data analysis show that there are 27 types of plants that are categorized as cuscus food in the research area and the most preferred cuscus are Bintanggur (Calophyllum inopyllum), Wako (Carallia brachiate merr.), Wapane, Forest Nutmeg (Knema cinerea), Redwood (Pinus sylvestris), Forest Belo (Diospyrus celebica), Siki Wood (Palaquium javense burck). The results of the research show that the part of the plant most liked and consumed by cuscus is the leaves of young shoots in very large quantities compared to the fruit and bark of the tree. Finally, the research results show that the availability and regeneration of cuscus feed is still very good, this can be seen from the dominance values ​​obtained both at tree level and at pole level.

Benthic community structure and geomorphology of uncharted nearshore reefs in Kuantan coastal waters.

The nearshore reefs play several important ecosystem functions in marine environments, especially in coastal areas. Six relatively unknown nearshore reef sites were surveyed in the southern Kuantan coastal waters using the coral video transect (CVT) technique between April 2021 and September 2022 to estimate coral reef benthic components. Data analysis on coral reef benthic components indicated that these uncharted nearshore reefs have ‘fair’ coral cover with an average percentage of 39.4 % ± 17.8 in which ST 1 recorded the highest live coral cover coverage with 68.06 %. Abiotic components (sand and rock) were the second-most abundant and the coverage of dead coral was relatively low at all stations. A total of 33 coral genera were recorded in this study in which Porites, Acropora and Montipora mean percentage cover dominated most of the reef sites. Bathymetry data indicated that some of these uncharted reefs were located on submerged shoals with a depth range between 12 – 17 meters. The variation in benthic community composition observed among reef sites highlights the importance of location-specific management and conservation strategies.

Vascularity evaluation of the equine tarsocrural and proximal intertarsal joint septum, and comparative analysis of two arthroscopic transection techniques.

To evaluate vascularity of the synovial membrane covered septum (SMS) separating the tarsocrural (TC) and proximal intertarsal (PIT) joints (Part 1) and compare two methods of transection, electrosurgical or Ferris Smith rongeur (FS rongeur) (Part 2). Experimental study. Part 1, 10 SMS (n = 5 horses). Part 2, six horses (n = 12 tarsi). In part 1, SMS harvested postmortem were each divided into eight regions of interest (ROIs), processed for histology, and immunostained with anti-α-actin antibody for blood vessel identification. Vascular density was calculated for each ROI. Data was compared within and between horses. In part 2, six horses underwent TC arthroscopy. Each limb was randomly assigned to undergo either electrosurgical or FS rongeur SMS transection. SMS transection and total operative time were recorded. Intraoperative hemorrhage was scored. Data was compared between both techniques. Significant interindividual variations in SMS vascular density were detected (p = .02), but there were no differences among ROIs. No differences in the transection time were detected between electrosurgery (4.83 ± 0.54 min) and FS rongeur (4.33 ± 0.67 min). No differences were found in intraoperative hemorrhage scores between techniques. Vascularity within the SMS varies among horses but not within its regions. Electrosurgical or FS rongeur transection of the medial SMS during tarsocrural arthroscopy is a rapid technique and improves surgical access to the dorsal compartment of the PIT.

The safety and feasibility assessment of overlap esophagojejunostomy with self-pulling and latter transection technique in totally laparoscopic total gastrectomy

BackgroundThis study presented an innovative technique in totally laparoscopic total gastrectomy (TLTG) for overlap esophagojejunostomy (E-J), termed self-pulling and latter transection (SPLT) (overlap SPLT). It evaluated the effectiveness and short-term outcomes of this novel method through a comparative analysis with the established functional end-to-end (FETE) E-J incorporating SPLT. MethodsFrom September 2018 to September 2023, this study enrolled 68 patients with gastric cancer who underwent TLTG with overlap SPLT anastomosis and 120 patients who underwent TLTG with FETE SPLT anastomosis. Clinicopathologic characteristics and surgical and postoperative outcomes data for overlap SPLT cases were gathered and retrospectively compared with those from FETE SPLT TLTG to evaluate the effectiveness and clinical safety. ResultsThe duration of anastomosis for overlap SPLT was 25.3 ± 7.4 minutes, significantly longer than that for the FETE SPLT (18.1 ± 4.0 minutes, P = .031). Perioperatively, 1 anastomosis-related complication occurred in each group, but this did not constitute a statistically significant difference (P = .682). No statistically significant differences were found between the 2 groups in terms of operative time, postoperative hospital stay, operative cost, surgical margins, or number of lymph nodes removed. Postoperative morbidity rates were similar between the groups (4.4% vs 5.8%, P = .676). ConclusionThe overlap SPLT technique is regarded as a safe and feasible method for anastomosis. There were no apparent differences in complications between overlap SPLT and FETE SPLT, but overlap SPLT costed 1 additional stapler cartridge and required a longer duration.

Exploration of mosses in urban-bogor habitats: Species identification, diversity and uniformity

This research focuses on the exploration of moss in the Bogor urban habitat, to explore the identification of moss types, measuring the level of diversity, and assessing the level of uniformity in the context of the urban environment. Data collection at the research location was divided into 3 stations with different environmental parameters. The method used in this research was an exploratory survey using the belt transect technique. The sampling method is purposive sampling with the help of a quadratic plot. The results of this research found 20 moss species identified on the green belt of Jalan Pajajaran, Bogor with a diversity index for the three stations respectively, namely 2.45; 2.02; and 1.78 which is classified into the medium category, and the uniformity index for the three stations respectively is 0.835; 0.814; 0.811 which is classified as high. These results show that the moss found can live by adapting to environmental factors in urban areas such as fluctuating temperature, humidity, and light intensity.

'Burn and Push' technique: A novel robotic liver parenchymal transection technique.

Liver parenchymal transection during robotic liver resection (RLR) remains a significant challenge due to the limited range of specialised instruments. This study introduces our 'Burn and Push' technique as a novel approach to address these challenges. A retrospective analysis was conducted on 20 patients who underwent RLR using the 'Burn and Push' technique at Virginia Commonwealth University Health System from November 2021 to August 2023. The study evaluated peri- and post-operative outcomes. The median operation time was 241.5min (range, 90-620min), and the median blood loss was 100mL (range, 10-600mL). Major complications occurred in one case, with no instances of postoperative bleeding, bile leak, or liver failure. The 'Burn and Push' technique is a viable and efficient alternative for liver parenchymal transection in RLR. Further research with larger sample sizes and consideration of the learning curve is necessary to validate these findings.

An Efficient Saline-Linked Cautery (SLiC) Method for Robotic Liver Parenchymal Transection Using Simultaneous Activation of Saline-Linked Cautery and Robotic Suctioning: Detailed Technical Aspects and Short-Term Outcomes.

Introduction While there are several advantages to utilizing robotics in liver surgery compared to traditional open and laparoscopic approaches, the most challenging part of robotic liver resection (RLR) remains the liver parenchymal transection. This is primarily due to the constraints of the existing robotic tools and the absence of a standard procedure. This study presents detailed technical aspects of our novel saline-linked cautery (SLiC) method for RLR and assesses the short-term outcomes for both non-anatomical and anatomical RLRs. Methods In this study, 82 cases that underwent RLR utilizing the SLiC method at our hospital from September 2021 to December 2023 were examined. A novel SLiC method is introduced in this study for robotically transecting the liver parenchyma utilizing bipolar cautery or monopolar scissors. The technique involves activating the SLiC and robotic suctioning simultaneously. The included patients were divided into two groups: patients undergoing robotic anatomical hepatectomy (n=39), and those receiving robotic non-anatomical hepatectomy (n=43). Short-term outcomes, including intraoperative and postoperative complications, were assessed in patients receiving both anatomical and non-anatomical hepatectomies. Results In the whole cohort, 74% of patients had performance status 1 or 2, and 24% were classified as Child-Pugh class B. RLR was performed without Pringle's maneuver in more than 80% of cases in patients receiving robotic non-anatomical hepatectomy, and more than 80% of patients undergoing robotic anatomical hepatectomy required only four or fewer 15-minute Pringle's maneuvers. There was no conversion to open hepatectomy, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the entire cohort. Four postoperative complications with CDC IIIa or higher occurred (small bowel obstruction in two cases, intraabdominal hemorrhage in one, and bile leak in another), but no differences in the frequency of complications were found between those undergoing non-anatomical and anatomical hepatectomy (p=0.342). Conclusions The SLiC method, which involves simultaneously activating SLiC and robotic suctioning with either monopolar scissors or bipolar cautery, appears to be a secure and convenient technique for liver parenchymal transection in RLR. This innovative method permits precise access to the major Glissonean and venous structures within the liver, making RLR more standardized and easily applicable in routine patient care.

Safety and Feasibility of Laparoscopic Liver Resection with the Clamp-Crush Method Using the BiSect.

Various energy devices are available for resection of the liver parenchyma during laparoscopic liver resection (LLR). We have historically performed liver resections using the Cavitron Ultrasonic Surgical Aspirator (CUSA). More recently, we have used new bipolar forceps (BiSect; Erbe Elektromedizin GmbH, Tübingen, Germany) to perform clamp-crush dissection with good results. The BiSect is a reusable bipolar forceps with a laparoscopic dissecting forceps tip and both an incision mode and coagulation mode. We evaluated the perioperative clinical course of patients who underwent LLR using the clamp-crush method with the BiSect compared with the CUSA. This single-center case control study involved patients with liver metastasis from colorectal cancer who underwent LLR using either the BiSect or CUSA at our hospital from January 2019 to December 2022. We performed the LLR using CUSA from January 2019 to early October 2020. After introduction of the BiSect in late October 2020, we used BiSect for the LLR. Before surgery, the three-dimensional liver was constructed based on computed tomography images, and a preoperative simulation was performed. We evaluated the results of LLR using the BiSect versus the CUSA and assessed the short-term results of LLR. During the study period, we performed partial liver resection using the BiSect in 26 patients and the CUSA in 16 patients. In the BiSect group, the median bleeding volume was 55 mL, the median operation time was 227 minutes, and the median postoperative length of hospital stay was 9 days. In the CUSA group, the median bleeding volume was 87 mL, the median operation time was 305 minutes, and the median postoperative length of hospital stay was 10 days. There were no statistically significant differences in the clinical course including bile leakage, bile duct stenosis, and post operative hospital stay between the two groups. Compared with LLR using the CUSA, the clamp-crush method using the BiSect in LLR is a safe and useful liver transection technique. Further study should be conducted to clarify whether BiSect is safe and useful in LLR for patients with other tumor types and patients who undergo other procedures.

Surgical techniques for robotic right donor hepatectomy, part 2: robotic parenchymal transection and bile duct division.

Robotic surgery is emerging as a feasible minimally invasive approach for donor hepatectomy at specialized centers. The aim of this article is to systematically describe the surgical techniques for robotic parenchymal transection and bile duct division in right donor hepatectomy. The setup of the robotic arms, methods of parenchymal transection using robotic instruments, and right hepatic duct division with the aid of indocyanine green dye are detailed, along with the pearls and pitfalls of these two parts of the operation.

Release or transection of superficial medial collateral ligament during open-wedge high tibial osteotomy demonstrated similar clinical outcomes and valgus laxity.

To analyse whether valgus laxity and clinical outcomes differ depending on whether the superficial medial collateral ligament (sMCL) is released or transected during medial open-wedge high tibial osteotomy (MOWHTO). Consecutive patients who underwent MOWHTO and subsequent radiological follow-up for at least 2 years were retrospectively evaluated. The patients were divided into release and transection groups, according to the sMCL manipulation technique. Each patient was assessed for the following variables on valgus stress radiographs taken before surgery and at the 12- and 24-month follow-ups: the absolute value of valgus (ABV) and side-to-side difference (SSD) between the affected and normal sides. The differences between preoperative SSD and those at 12 and 24 months were respectively calculated and defined as delta SSD (ΔSSD). The Visual Analogue Scale, Lysholm knee, International Knee Documentation Committee subjective, and Knee Injury and Osteoarthritis Outcome scores were used to evaluate patient-reported outcomes. Eighty-five patients were included in the study. Forty-two patients (49.6%) underwent sMCL release, and the remaining 43 patients (50.4%) underwent sMCL transection. No significant differences were observed in the ABV and SSD of valgus laxity at the different time points between the two groups (n.s.). Furthermore, no significant differences were observed in the ΔSSD at the 12- and 24-month follow-ups between the two groups (n.s.). Significant improvement from preoperative values was observed in all patient-reported outcomes (p < 0.001), with no significant differences between the two groups at any time point (n.s.). Significant improvements in clinical outcomes were observed, regardless of the technique used. Postoperative valgus laxity did not occur with either technique. The transection technique, which can be performed more simply and quickly, demonstrated similar clinical outcomes and valgus laxity to the release technique. Level III.

A precise approach to robotic intracorporeal rectal transection and hand-sewn purse-string anastomosis for low anterior resection.

This study presents a new technique for robotic-assisted intracorporeal rectal transection and hand-sewn anastomosis for low anterior resection that overcomes some limitations of conventional techniques. By integrating the advantages of the robotic platform, ensuring standardized exposure during rectal transection, and emphasizing the importance of avoiding complications associated with staple crossings, this innovation has the potential to significantly improve outcomes and reduce costs for patients with lower rectal tumors.

Laparoscopic right hepatectomy with clamp-crushing technique for parenchymal transection

Laparoscopic right hepatectomy with clamp-crushing technique for parenchymal transection

Seaweed Community Structure in the Waters of Kelombok Village, Lingga District, Linga District

Kelombok Village, Lingga Regency is an island with a large water area (99% of the water area) and has a high wealth of biological resources, especially algae or seaweed. This research was conducted in the coastal waters of Kelombok Village with three stations (stations 1, 2, and 3), and two zones (tide zone and low tide zone). The research was carried out for one month, namely in January 2024. Sampling was carried out using the line transect technique. Data analysis was carried out descriptively. Based on the research results, it is known that 12 types of seaweed live in the coral coastal waters of Kelombok Village, consisting of 3 types of green algae (Chlorophyta), 4 types of brown algae (Phaeophyta), and 5 types of red algae (Rhodophyta). The abundance of seaweed in zone A is 99,913 ind /m2, and in zone B is 99,981 ind /m2. Water conditions were recorded for brightness 1-1,7 m, temperature 29-30,1 oC, salinity 29,5-30‰, current speed 0,071 m/sec, DO 6,78-7,23 ppm, depth 0,75-1,7 m, pH 7,8-8, nitrate 0,01 mg/l, and phosphate 0,073 mg/l.

Robotic hepatic parenchymal transection techniques: a choice between imperfect tools

Robotic hepatic parenchymal transection techniques: a choice between imperfect tools

Parenchymal transection techniques and bile leaks following liver resections: our experience from university teaching hospital

Parenchymal transection techniques and bile leaks following liver resections: our experience from university teaching hospital

Species Diversity, Abundance, and Habitat Association of Medium‐ and Large‐Sized Mammals in Harego Forest, South Wollo, Ethiopia

Despite the importance of the knowledge of mammals’ diversity, abundance, and habitat association for designing feasible conservation measures, most of the studies so far are emphasized in protected areas which in turn affects due understanding of the faunal records and conservation endeavors. Hence, we aimed to investigate species diversity, abundance, and habitat association of medium‐ and large‐sized mammals at Harego Forest, South Wollo, Ethiopia, from November 2020 to October 2021, covering both wet and dry seasons. We classified the study area into natural forest, bushland, and Erica woodland habitat types based on the topography and vegetation cover. The line transect technique was employed to study the diversity, abundance, and distribution of mammals. The counting of mammals was carried out along 16 transect lines from 06:00 to 10:00 h in the morning and from 15:00 to 18:00 h late in the afternoon when most animals are active in the study area. A total of 260 individual of medium‐ and large‐sized mammals belonging to 15 species, 10 families, and 5 orders were recorded. Among the recorded mammal species, Theropithecus gelada was the most abundant species while Felis serval was the least in the study area. The abundance of mammals varied significantly among the different habitat types. The highest and lowest mammalian species richness was recorded in the forest and Erica woodland habitats, respectively. The highest species similarity was observed between forest and bushland habitats. The study area is home to different species of mammals including the endemic mammals of Ethiopia that urges conservation stakeholders to design effective conservation measures to sustain the habitat and the mammalian species.