Transverse Incision Group Research Articles

The effects of transverse and longitudinal incision of tunica albuginea in microdissection testicular sperm extraction

The effects of transverse and longitudinal incision of tunica albuginea in microdissection testicular sperm extraction

Nerve injury during hamstring graft harvest: a prospective comparative study of three different incisions

To compare the incidence, extent of sensory loss, its clinical effect and natural course caused by three different skin incisions used for autogenous hamstring graft harvest during anterior cruciate ligament (ACL) reconstruction. One hundred and twenty patients who underwent hamstring graft harvest during ACL reconstruction, participated in the study. All patients were randomized into 3 groups as per the 3 incisions used-vertical, transverse and oblique. The area of sensory loss was documented as per anatomical distribution of the infrapatellar branch of saphenous nerve (IPSBN) and sartorial branch of sensory nerve (SBSN) at 6 weeks, 3 months and 6 months follow-ups. The length of incision, area of sensory loss and subjective pain score (out of 10) were also noted. The incidence, area of hypesthesia and persistence at 6 months were significantly higher with vertical incision at all times, whereas it was the least with oblique incision. Injury to IPSBN was maximum with vertical incision (p = 0.000), and it was similar in the transverse and oblique incision groups. The SBSN injury incidence was not significantly different between the three groups (n.s.). Subjective cutaneous hypesthesia incidence was quite low in all the three groups. The oblique incision group had highest subjective satisfaction closely followed by the horizontal incision group. Vertical incision has highest incidence of IPBSN injury, persistent hypesthesia, largest area of sensory loss and poorest subjective outcome. Oblique and transverse incision groups had statistically comparable results, though better outcome was noted in the oblique incision group. The SBSN injury was equally common in all the three incisions used. However, the sensory loss does not impair normal daily activities in the patients. We recommend use of oblique incision for hamstring graft harvest. Therapeutic randomized controlled prospective study, level I.

Vertical transumbilical incision versus left lower transverse incision for specimen retrieval during laparoscopic colorectal surgery

This study compared the short-term surgical outcomes of the vertical transumbilical incision with the left lower transverse incision for specimen retrieval in laparoscopic colorectal cancer surgery. One hundred forty-seven consecutive patients scheduled for laparoscopic surgery for sigmoid colon and rectal cancer between April 2010 and December 2010 were classified into one of the two groups according to the site of the minilaparotomy: a transumbilical incision group (n=92) and a left lower transverse incision group (n=55). Demographic data, operation time, estimated blood loss, frequency of transfusion, size of the tumor, number of harvested lymph nodes, distal resection margins, time to first flatus, and length of hospital stay were similar between the two groups. Postoperative pain scores were also similar between the two groups. The length of the minilaparotomy incision was shorter in the transumbilical group than the left lower transverse group at operation (mean, 4.6 vs. 6.2cm, p=0.000). The postoperative mean satisfaction score was higher in the transumbilical group, but this was not statistically significant (7.6 vs. 7.1, p=0.224). Fourteen patients in the transumbilical group and 7 patients in the left lower transverse group developed wound-related complications (p=0.810), including two cases of incisional hernia, both in the transumbilical group. High body mass index (≥25kg/m(2)) and longer operative time (≥180min) were risk factors for wound complications on univariate analysis. Transumbilical minilaparotomy in laparoscopic colorectal surgery is a good alternative approach with acceptable wound complications.

A comparison of short-term outcome after laparoscopic, transverse, and midline right-sided colectomy

The aim of the present study was to compare the laparoscopy, transverse, and midline laparotomy in right-sided colectomies with respect to short- and long-term outcome. The short- and long-term results of all patients who had an elective right-sided hemicolectomy, from January 2006 to April 2009 for malignant or benign disease, were evaluated according to the surgical technique: laparoscopic, midline, or transverse incision laparotomy. The 75 included patients (41% male) had laparoscopy (n = 30), midline (n = 22), or transverse incision laparotomy (n = 23). Median operating time in the laparoscopy group was significantly longer in comparison to the midline and transverse incision groups (129, 105, and 101min respectively, p < 0.001). Short-term follow-up revealed a longer median total length of stay in the midline laparotomy group compared to the other groups (9 vs. 7days, p = 0.026). Thirty-day morbidity was less in the laparoscopy and transverse incision groups compared to the midline laparotomy group (15%, 20%, and 41%; p = 0.06). After excluding patients who had a previous midline incision, an earlier return of bowel function was seen for laparoscopy and transverse hemicolectomy (3 vs. 5days, p = 0.017). At a median follow-up of 40months (21-58), four incisional hernias occurred, two in the midline laparotomy group (one operatively corrected) and two in the laparoscopy group. Although the results of this study need to be interpreted with care, our study shows that laparoscopic and transverse right hemicolectomy are equivalent and have a significant better short-term outcome compared to an open midline approach. In particular, laparoscopy and transverse laparotomy result in >50% reduction in 30-day morbidity, no reoperations, and a shorter median total hospital stay of 2days.

A comparison of circumumbilical and transverse abdominal incisions for neonatal abdominal surgery

Purpose Although neonatal bowel surgery traditionally involves a transverse abdominal incision, several authors have reported that the circumumbilical incision is effective and cosmetically appealing. We report the first study comparing the circumumbilical incision to the transverse abdominal incision for a variety of neonatal abdominal operations. Methods Retrospective cohort analysis comparing the circumumbilical incision to the transverse abdominal incision for neonates who underwent surgical repair of malrotation, duodenal atresia/web, or intestinal atresia/web was performed between 1999 and 2009. Results One hundred thirty-two patients underwent a laparotomy through a transverse abdominal incision (n = 106) or a circumumbilical incision (n = 26). Baseline characteristics between groups were similar. No differences were found when comparing operative time, postoperative days on a ventilator, narcotic infusion, time to full feeds, length of hospital stay, incidence of surgical site infection, and bowel obstruction. Although more incisional hernias occurred in the circumumbilical incision group (38%) than the transverse abdominal incision group (6%), all hernias in the circumumbilical group resolved without intervention, whereas 33% required surgical repair in the transverse abdominal group. Conclusions Because of its cosmetic advantages and similar outcomes to the transverse abdominal incision, the circumumbilical incision should be considered as an alternative to the transverse abdominal approach in neonatal surgery.

Laparoscopic vs transverse incision right colectomy for colon carcinoma

We investigated whether laparoscopic right colectomy has short-term and ⁄ or oncological advantages compared with transverse incision right colectomy. Patients who underwent an elective laparoscopic right colectomy or an open right colectomy through a transverse incision at the VU University Medical Center or Zaans Medical Center from 2005 to 2009 were prospectively followed. Patient groups were comparable in terms of gender, body mass index and American Society of Anesthesiology classification. Patients in the transverse incision group were older (68 years vs 75 years, P = 0.07) and blood loss was greater during this procedure (60 ml vs 130 ml, P = 0.001), which cost less than the laparoscopic procedure (€6.033 vs €7.221, P = 0.03). Hospital stay for the laparoscopic group was shorter (8 days vs 9 days, P = 0.04), but laparoscopic procedures took longer (155 min vs 77 min, P < 0.001) and 8% of patients in the laparoscopic group were converted to a median laparotomy. Postoperative complications were comparable for both groups (28% vs 32%, P = 0.74), and in both groups a radical resection rate of 96% (P = 0.94) was achieved. At a median follow up of 20 months the incidence of incisional hernia was similar in both groups and no patient required additional surgery as a result. Overall survival at 60 months was 70% for the laparoscopic group and 67% for the transverse incision group (P = 0.84). There a re few clinically relevant differences between a laparoscopic right colectomy and a transverse incision right colectomy. Transverse incision right colectomy is cheaper. The study may be the first to compare these two techniques, but it is a nonrandomized trial and therefore has its limitations.

1759 TRANSVERSE VERSUS VERTICAL CAMERA PORT INCISION IN ROBOTIC RADICAL PROSTATECTOMY: IMPACT ON INCISIONAL HERNIAS AND COSMETICS

You have accessJournal of UrologyProstate Cancer: Localized VII1 Apr 20101759 TRANSVERSE VERSUS VERTICAL CAMERA PORT INCISION IN ROBOTIC RADICAL PROSTATECTOMY: IMPACT ON INCISIONAL HERNIAS AND COSMETICS Shawn Beck, Douglas Skarecky, Reina Juarez, and Thomas Ahlering Shawn BeckShawn Beck More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , Reina JuarezReina Juarez More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1608AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted or laparoscopic radical prostatectomy (RARP/LRP) has historically used a vertical incision for the camera port above or below the navel. The camera incision is also the port used to extract the prostate. The incidence of incisional hernias (IH) has not been specifically addressed. We examine our incidence of IH and propose a simple modification to reduce IHs and improve cosmesis. Additionally, we propose that the width of scar between vertical and transverse incisions should act as a visual indicator of internal forces of the fascial closure. METHODS Of 900 RARPs, 735 had a vertical and 165 have had transverse incisions. As a referral center, we don't have definitive long term follow up on all patients. We emailed 443 men of which 83 bounced. Of the successful 360 emails, 192 (53%) replied: 18 reported having an IH. We also identified 18 separate IH men followed at our institution in our electronic data base. These 36 incisional hernias occurred in patients with vertical incisions. We compared baseline factors in the IH group to the entire cohort (n=735) and the 192 email respondents without IH (n=84). In the secondary analysis our nurse (RJ) measured the maximum width of the camera port in all men presenting to our clinic for follow up. TRANSVERSE, n= 31 and VERTICAL n=82. Statistical analysis was performed using t-test. RESULTS The rate of IH could be as low as 4.9% (36/735) or as high as 9.4% (18/192). To date there has been just 1 incisional hernia in the transverse group 0.6% (1/165) although the average follow up is much shorter in this group (2.8 yrs vs 0.8 yrs). There was no difference in baseline factors between the vertical and transverse incision groups. However, baseline factors between the IH group and controls were as follows. Age 63.3 yrs vs 61.1 yrs p=.06, IIEF-5 17.1 vs 19.6 p=.06, BMI 27.2 vs 26.2 p=.11 and prostate wt. 62.2gms vs 51.1 gms p=0.01. In the analysis of vertical vs transverse incisions the average maximum scar width was 5.5 mm vs 2.1 mm (p<.0001, 95%CI, Upper limit=4.6, Lower=2.6). CONCLUSIONS In this study we attempted to specifically address our incisional hernia rate which we have estimated the risk to be potentially as low as 4.9% and as high as 9.4%. Baseline factors that appear to influence the development of incisional hernias at the camera port include direction (transverse vs vertical), prostate weight, older age, IIEF-5 and BMI. Additionally, transverse closures had much smaller scar width which we feel reflects less tension on the skin and hence the fascial closure which reasonably should result in fewer incisional hernias. Orange, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e680 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shawn Beck More articles by this author Douglas Skarecky More articles by this author Reina Juarez More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Access to the Hypertrophic Pylorus: Does It Make a Difference to the Patient?

The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS). Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS). We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 +/- 8.6 min, and for those with UI 31.8 +/- 9.3 min. Patients in the L group had a mean operative time of 29.8 +/- 11 min. Although the operative time for TI was significantly greater than that of L, the differences between the TI and UI groups and between UI and L groups did not reach statistical significance. For the TI, UI and L groups, the mean overall LOS was 3.22 +/- 0.3 days, 3.39 +/- 0.4 days and 2.94 +/- 0.2 days, and the mean postoperative LOS was 1.52 +/- 0.1 days, 1.44 +/- 0.2 days, and 1.56 +/- 0.1 days, respectively. No significant difference in LOS was found. One patient from each group had a wound infection. While three of four perforations occurred in the L group and the fourth was in the TI group, the difference in rates of perforation among the groups did not achieve statistical significance. The perforation during open surgery was typical, occurring on the duodenal end during spreading of the pyloric muscle. The perforations in the L group were atypical: one was a grasper injury to the duodenum; another was on the gastric end of the pyloric incision and the third occurred not during spreading of the pyloric muscle but during the cutting of it. The pylorus was relatively small in this particular case (12 mm in length). While the operative time of laparoscopic repair for PS is less than in either of the open approaches, laparoscopic surgery may increase the risk for atypical injuries to the bowel. Therefore, proper attention should be paid to dissection of the structures and the selection of laparoscopic instruments. Incision on the superior umbilical fold is a reasonable alternative access for the treatment of PS.

Testicular Sperm Retrieval Method: Histological Effects of Location of Incision

This research was conducted to evaluate the effects of a transverse vs. longitudinal incision for testicular sperm retrieval. Rats were divided into 4 groups: I: control, II: sham operation, III: longitudinal incision TSRM, IV: transverse incision TSRM. Group II (sham operation) had a dissection of left testis/spermatic cord, then closure of wound. Group III underwent dissection of left testis, then a "longitudinal" incision (15 mm long) of testis, which was fully opened then closed again and sutured with 5-0 Vicryl sutures. Group IV underwent dissection of the left testis, opening of the testis with a "transverse" incision, then closure with 5-0 Vicryl. The seminiferous tubule diameter was 0.118-0.224 mm in all groups. Inflammation and abscess formation occurred in one testis each in the sham and longitudinal incision groups, and in two testes in the transverse incision group. There were no differences in histopathology or scoring between the longitudinal and the transverse incision.

Choice of incision and pain following gallbladder surgery

A prospective randomized trial compared pain in the first 24 h after gallbladder surgery via an upper midline or a transverse incision. Pain was measured by the patients' self-administered consumption of pethidine, degree of postoperative respiratory impairment and a visual analogue pain scale. The upper midline incision group self-administered significantly more pethidine than the transverse incision group (P less than 0.001), but there was no difference between the groups in respiratory function or visual analogue pain scale results 24 h after operation. Length of hospital stay was not different. An upper midline incision is more painful than a transverse incision in the first 24 h following gallbladder surgery.

Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma.

Objective: To study clinical outcomes for different uterine wall incision directions, comparing vertical incision and transverse incision in laparoscopic myomectomy of the intramural myoma. Methods: Laparoscopic myomectomies were performed on 50 women with intramural myomas. Using a table of random numbers, they were randomly divided into a vertical incision group (25 women) and a transverse incision group (25 women) according to the direction of incisions in the uterine wall. The numbers of enucleated myoma, operation duration, amount of bleeding, and numbers of sutures were compared. The Mann-Whitney U-test was used for analysis. Results: For the transverse incision group, the amount of bleeding (137.6±88.1mL) was a significantly lower value (P=0.0426) than for the vertical incision group (235.8± 169.4 mL). In addition, in cases where the maximum myoma nucleus diameter was 7cm or larger, operation duration (129.0±32.5min) and amount of bleeding (158.9±87.1mL) showed significantly lower values (P=0.0067 and P=0.0002, respectively) for the transverse incision group than did operation duration (362.3±147.3min) and amount of bleeding (362.3±147.3mL) for the vertical incision group. Conclusion: Transverse incision of the uterine wall is useful to reduce the amount of bleeding in the laparoscopic myomectomy of the intramural myoma. Transverse incision also shortens operation duration in cases where the myoma nuclei are large. (Reprod Med Biol 2004; 3: 33-37).

Tracheotomy in growing rats: histological aspects

PURPOSE: To compare morphologically three different types of tracheotomy in growing rats, applying microsurgical technique. METHODS: EPM-1 Wistar growing rats (n=57) weighing 88gm and aged 35 days were randomized in four groups, according tracheotomy incision type (longitudinal, transverse and tracheal segment excision), and sham group. Following intramuscular anesthesia with ketamine and xylazine, the trachea was exposed and incised, according to the group, and a hand-made endotracheal cannula was inserted into the organ, under sterile conditions. This cannula was removed after 7 days, and animals have been sacrificed 30 days later. Tracheas samples were submitted to histological study, stained by hematoxylin-eosin and Masson trichrome, evaluating fibrosis, inflammatory infiltrate and epidermoid metaplasia. RESULTS: There was more frequency of inflammatory infiltrate at the tracheal epithelium in the tracheal segment excision group (87%) compared to the longitudinal (40%) and transverse (36%) incision groups (p=0.009). Evaluating epidermoid metaplasia, tracheal segment excision and the longitudinal groups presented 33% and 40%, respectively, compared to 0% of the transverse group (p=0.03). Concerning to fibrosis, in a global comparison (p=0.1) among the three groups there was no difference, however, compared to the longitudinal group the transverse group showed lower level of fibrosis (p=0.04). Sham group did not present any relevant morphologic alterations and it was used as reference pattern. CONCLUSION: Taken together, our data show that tracheal segment excision promotes more epithelium aggression and transverse tracheal incision shows less morphologic alterations.

STUDY OF TRANSVERSE INCISION IN THE OPERATIONS FOR GASTRIC CANCER

In the operation for gastric cancer, reversed T-shaped incision and mountain-shaped trnasverse incision (which are regarded as transverse incision in the following description) were compared with the conventional epigastric midline incision for the efficacy. Subjects were 62 resectable cases of gastric cancer undergoing transverse incision at the department in a recent 4-year period from January 1991 and 1990 resectable cases of gastric cancer undergoing midline incision in the same period. Both patients groups were compared for background, operative, and postoperative factors. Transverse incision, especially reversed T-shaped incision was often employed when expanded dissection was performed for advanced gastric cancers. The patients subjected to transverse incision predomonantly had an advanced cancer before surgery. There were no other significant background factors. As to operative factors, extended operation, prolonged operating time, and increased bleeding volume were noted in the transverse incision group compared to the other. Postoperative pain control could be easily done in the transverse incision group. Although observation period was still short, no postoperative intestinal obstruction or peritoneal hernia due to intestinal adhesion to the surgical wound in the abdominal wall occurred in the patients of transverse incision group.

Abdominal Incisions and Staging in Ovarian Cancer

• The type of abdominal incision—transverse or vertical—in 291 women with ovarian cancer and completeness of intraoperative evaluation of the extent of disease were investigated. Fourteen percent of woman had transverse incisions, 69% of which were the Pfannenstiel type. Half of the women who had transverse incisions and ovarian cancer were aged 50 years or older. A preoperative diagnosis presumptive of ovarian cancer was made in 93% of women; 71% of the transverse incision group had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. A transverse incision should never be performed in women who are suspected to have ovarian cancer or in women who have ovarian or adnexal tumors and are over 30 years of age. ( Arch Surg 1986;121:800-802)

Abdominal incisions and staging in ovarian cancer.

The type of abdominal incision--transverse or vertical--in 291 women with ovarian cancer and completeness of intraoperative evaluation of the extent of disease were investigated. Fourteen percent of woman had transverse incisions, 69% of which were the Pfannenstiel type. Half of the women who had transverse incisions and ovarian cancer were aged 50 years or older. A preoperative diagnosis presumptive of ovarian cancer was made in 93% of women; 71% of the transverse incision group had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. A transverse incision should never be performed in women who are suspected to have ovarian cancer or in women who have ovarian or adnexal tumors and are over 30 years of age.

An electromyographic study on the canine esophageal motility following transection operations for esophageal varices

By the method of esophageal varices operation in 25 dogs, esophageal myoelectric activity was compared with EMG. Five groups were used each group having 5 dogs, (1) was the control group, (2) had a transverse incision on the esophageal muscle layer, (3) had a longitudinal incision on the same muscle layer, (4) had vagotomy of the high position, and (5) had vagotomy of the low position. The esophageal myoelectric activity of the dogs was recorded after swallowing by means of chronically implanted electrodes. The following results were obtained: According to the action potential pattern, the longitudinal incision group has better esophageal motor function than the transverse incision group. For the 2nd pair of groups, the low position vagotomy group have better function than the high group.

CHOICE OF ABDOMINAL OPERATIVE INCISION IN THE OBESE PATIENT

Although many factors may influence the choice of the operative incision, physiologic safety in terms of the degree of postoperative hypoxemia should be considered. No data currently exist to delineate in markedly obese patients the effect of the operative incision on the extent or duration of this hypoxemia. Fifty-four consecutive patients of both sexes, scheduled for elective jejunoileal bypass for morbid exogenous obesity, were studied. In 23 patients the operation was performed through a transverse incision and in 25 patients through a vertical incision. In 6 patients, cholecystectomy was also performed in addition to the jejunoileal bypass. Postoperatively there was a significant fall in PAO2 both in the transverse and vertical incision groups and this continued through day 4. On day 5 statistically significant hypoxemia was present only in the vertical incision group. In addition, the decrease in PaO2 was significantly greater on days 4 and 5 in the vertical group than in the transverse group. On days 2 and 3 again the mean decrease in PaO2 was greater in the vertical group but this was not statistically significant. The effect of added cholecystectomy on PaO2 was studied in 6 women with midline incisions. The results were compared with 6 subjects who had small bowel bypass without cholecystectomy and who were matched for incision, age weight, girth/height ratio, weight/height ratio, smoking habit, and percentage of predicted ERV. In both groups there was a significant fall of PAO2 from day 1 through day 4, but there was no significant difference between the two groups. Although the numbers studied were small, these limited results would suggest that the type of incesion rather than the intraoperative procedure is the important factor in determining postoperative PAO2 changes. These studies also suggest that in patients with an increased potential for postoperative hypoxemia (i.e., markedly obese), the transverse abdominal approach shoudl always be seriously considered.