Wound Retractor Research Articles

The outcomes of treatment between primary closure and staged closure in gastroschisis in the pre and post era of the bedside wound retractor silo placement technique.

This study aimed to compare the treatment outcomes of the closure methods between pre and post-eras of bedside wound retractor silo placement technique (BSC). This retrospective cohort study included infants diagnosed with gastroschisis from 2006-2013, pre-BSC era, and from 2014-2021, BSC era. Infants who had fetal anomalies did not survive before receiving treatment and were treated with the delayed closure method were excluded. Pretreatment covariates were adjusted using propensity score in the multivariable logistic regression. From 170 patients, 5 were excluded. 111 patients underwent primary closure (PC), 54 patients were staged closure (SC). Successful early enteral feeding was achieved in 70(42%) of patients. Among these patients, 52.2% were in the PC group, and 22.2% in the SC group. PC had a significantly higher rate of successful early enteral feeding compared to SC in the pre-BSC era (OR 21.98, 95%CI 2.59-186.51, p-value 0.005). The BSC era, there was no significant difference between the groups (OR 2.04, 95%CI 0.41-1.20, p-value 0.386). There were no differences in complications between PC and SC. SC was not inferior in terms of achieving early feeding compared with PC. BSC is an acceptable procedure when a PC was not appropriate and accessible.

Fabrication and evaluation of four combinations of pullulan-based biopolymeric, microporous scaffolds impregnated with peppermint oil for management of partial thickness burn wounds and accelerated tissue regeneration

Burn injuries are common in both civilian and military settings and cause severe morbidity and mortality. The present study aimed to develop microporous bioactive scaffolds from the natural polysaccharide, pullulan, combined individually with Gelatin (Gel)/Alginate (Alg)/Chitosan (Ch)/Carboxy-methyl cellulose (CMC), and crosslinked with glutaraldehyde to form a polymeric network. The objective was to evaluate and compare their efficacy in healing second degree partial-thickness burn wounds. The scaffolds were also impregnated with peppermint oil (PEO) to provide potential analgesic and cooling effects. Scaffolds were characterized using FTIR, TGA and SEM analysis to understand the intra-and intermolecular interactions and morphological characteristics. In vitro parameters like fluid uptake ability, biodegradation and hemolytic index were also assessed. Biocompatibility studies, including cell adhesion, migration and proliferation, were conducted using L929 mouse fibroblast cell lines. The in vivo efficacy was evaluated in Sprague Dawley rats inflicted with second degree burns to assess and compare wound retraction across different experimental groups. Histology, immunohistochemistry along with gram and picrosirius staining studies were also performed. The average pore size of all biopolymeric scaffold combinations ranged between 25.6 and 298 μm. All four test combinations were non-hemolytic, with hemolytic indices between 0.3 and 2.9. Wound retraction studies in rats clearly indicated that among the four test combinations studied, Pu/Gel/PEO scaffold not only reduced local inflammation faster but also accelerated dermal regeneration in comparison to positive control as well as other test combinations (viz., Pu/Alg/PEO, Pu/Ch/PEO, and Pu/CMC/PEO). Immunohistochemistry results corroborated animal efficacy findings and demonstrated enhanced expression level of epidermal growth factor and fibroblast growth factor-2 in Pu/Gel/PEO scaffold treated group. Picrosirius staining also revealed enhanced collagen deposition in Pu/Gel/PEO scaffold treated group. The study findings suggest that biopolymeric scaffolds made from pullulan combined with gelatin and PEO (Pu/Gel/PEO) could serve as a promising substrate for skin regeneration template for second degree burns.

Bundle Implementation to Prevent Surgical Site Infections - A Study of SRN Hospitals

Background: Guidelines recommend bundles with multiple infection control elements to prevent surgical site infections (SSI). Although effective in multiple research studies, little is known about the implementation of such complex bundles in the real-world clinical setting. Methods: A survey was distributed to the SHEA Research Network (SRN) hospitals during November 2022 – December 2023, to assess processes related to the implementation of SSI prevention bundles in colorectal surgery. Results: Of the 93 US and international hospitals within SRN, 49 completed the survey (53% response rate). The mean volume of colorectal surgeries per year was 377 (median 400). Figure 1 shows the individual elements of SSI prevention bundle reported as consistently used in most surgeries. There were no significant differences between hospitals with high vs. low volume (cut-off 400 surgeries), except for wound protectors or retractors, more likely to be used in high-volume hospitals (P = 0.047). A formal process for auditing adherence was reported by 71% of respondents for antibiotic prophylaxis, and 51% for skin prep, with the remaining elements audited < 50% of the time. Feedback of audited adherence to surgeons occurred < 50% of the time for all bundle elements, except antibiotic prophylaxis (59%). Table 1 shows the most common barriers reported as either successfully mitigated or still persistent at the time of the survey. High-volume hospitals were more likely to report persistent clinicians’ low bundle adherence (P = 0.016) and inadequate bundle adherence audit and feedback (P = 0.0016). Conclusion: Implementation of guideline-recommended colorectal SSI Prevention bundles remains highly variable. Further research aiming to develop strategies that optimize implementation and adherence is needed.

Single-port intragastric wedge resection using the tunnel method: a novel surgical approach for treating endophytic gastric subepithelial tumors.

Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method." A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method. Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4years, body mass index was 26.5 ± 3.4kg/m2. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3cm. All cases had negative resection margins. Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.

Comparison of the Ventral Approach to the Canine Hip Joint Using Gelpi Retractors and an Elastic O-Ring Wound Retractor.

This study included 10 fresh adult cadavers of large breed dogs (6 males and 4 females). Their weight ranged from 25 to 45 kg (mean ± SD: 33.9 ± 6.2 kg). The breeds represented were crossbreed dogs (n = 5), German shepherds (n = 2), Bernese mountain dogs (n = 1), American Staffordshire terriers (n = 1), and Gordon setters (n = 1). Access to the target area and identification of the femoral head and neck was achieved with two Gelpi retractors inserted orthogonally and with the O-WR in all procedures. In each dog, the approach to the hip joint was made on the left and right sides. There was no significant difference in the area of the surgical wound bed between the two sides using either the Gelpi retractors (-0.52 ± 1.87 cm2; CI 95%: -1.86, 0.81 cm2; p = 0.398) or the O-WR (-0.27 ± 2.34 cm2; CI 95%: -1.94, 1.41 cm2; p = 0.729). The area of the surgical wound bed was 6.28 ± 1.72 cm2 (2.72-9.70 cm2) for the Gelpi retractors and 6.34 ± 1.81 cm2 (4.13-10.77 cm2) for the O-WR, and the difference between the Gelpi retractors and the O-WR was not significant (-0.06 ± 1.72 cm2; CI 95%: -0.86, 0.74 cm2; p = 0.879).

Copaifera langsdorffii Oleoresin-Loaded Nanostructured Lipid Carrier Emulgel Improves Cutaneous Healing by Anti-Inflammatory and Re-Epithelialization Mechanisms.

The skin is essential to the integrity of the organism. The disruption of this organ promotes a wound, and the organism starts the healing to reconstruct the skin. Copaifera langsdorffii is a tree used in folk medicine to treat skin affections, with antioxidant and anti-inflammatory properties. In our study, the oleoresin of the plant was associated with nanostructured lipid carriers, aiming to evaluate the healing potential of this formulation and compare the treatment with reference drugs used in wound healing. Male Wistar rats were used to perform the excision wound model, with the macroscopic analysis of wound retraction. Skin samples were used in histological, immunohistochemical, and biochemical analyses. The results showed the wound retraction in the oleoresin-treated group, mediated by α-smooth muscle actin (α-SMA). Biochemical assays revealed the anti-inflammatory mechanism of the oleoresin-treated group, increasing interleukin-10 (IL-10) concentration and decreasing pro-inflammatory cytokines. Histopathological and immunohistochemical results showed the improvement of re-epithelialization and tissue remodeling in the Copaifera langsdorffii group, with an increase in laminin-γ2, a decrease in desmoglein-3 and an increase in collagen remodeling. These findings indicate the wound healing potential of nanostructured lipid carriers associated with Copaifera langsdorffii oleoresin in skin wounds, which can be helpful as a future alternative treatment for skin wounds.

Study of the Antioxidant, Antimicrobial, and Wound Healing Properties of Raw Hydrolyzed Extract from Nile Tilapia Skin (Oreochromis niloticus).

Oreochromis niloticus (Nile tilapia) skin is a by-product of Brazilian fish farming, rich in collagen. The present study aims to evaluate the wound healing, antioxidant, and antimicrobial potential of the raw hydrolyzed extract of Nile tilapia skin, as well as the identification of the main compounds. The in vitro activity was performed using antioxidant, antimicrobial and scratch wound healing assays. An in vivo experiment was performed to evaluate the wound healing potential. On days 1, 7, 14 and 21, the lesions were photographed to assess wound retraction and on the 7th , 14th and 21st days the skins were removed for histological evaluation and the blood of the animals was collected for glutamic oxaloacetic transaminase and glutamic pyruvic transaminase determination. The chemical study was carried out through liquid chromatography-tandem mass spectrometry and de novo sequencing of peptides. The in vitro assays showed a reduction of the gap area in 24 h, dose-dependent antimicrobial activity for both bacteria, and antioxidant activity. The chemical analysis highlighted the presence of active biopeptides. The histological evaluation showed that the raw hydrolyzed extract of Nile tilapia skin has a healing potential, and does not present toxicological effects; therefore, is promising for the treatment of wounds.

Single-incision laparoscopic cholecystectomy using totally homemade glove port versus conventional laparoscopic approach: A cross-sectional study in a developing country

PurposeSeveral home made glove ports for single-incision laparoscopic cholecystectomy (SILC) has been proposed but no comparison in surgical outcomes with conventional laparoscopic cholecystectomy (CLC) was made. Therefore, we aimed to compare the outcomes of SILC using a totally homemade glove port versus CLC. MethodsThis cross-sectional study compared the surgical outcomes between 90 patients, who underwent SILC and 123 patients who underwent CLC. Patients with acute cholecystitis grade 3 according to the Tokyo Guidelines 2018, body mass index ≥30, and previous abdominal surgeries were excluded. Totally homemade glove port was made of a small and a big rubber ring and a surgical glove to creat the wound retractor. Trocars were inserted into the glove's fingers. ResultsThe proportion of patients with acute cholecystitis was lower in the SILC group (7.78%) than in CLC (21.79%). Intraoperative complication rate, the prevalence of additional trocar or conversion to open surgery, success rate, and postoperative complication rate were similar between the two groups. However, SILC showed a significantly longer operative time (62.9 ± 25.1 verus 50.4 ± 20.7 min) and lower postoperative pain than CLC. The discrepancy in operative time was more likely to be remarkable in acute cholecystitis (50.43 min) compared with symptomatic cholelithiasis (14.28 min). ConclusionsThe SILC using a totally homemade glove port is feasible and safe compared with the CLC. However, in the case of acute cholecystitis, SILC should be indicated with caution because of the longer operative time than CLC.

320 Surgical Site Infections (SSIs)- Are you doing your part to prevent them?

Abstract Aims (1) To evaluate the current literature regarding prevention of surgical site infections (SSIs). (2) To assess our General Surgery department SSI rate. (3) To implement changes within the department that are reflective of current evidence/guidance. (4) To re-audit our SSI rate post implementation of changes. Methods Evaluated and summarised 3 studies published in 2022 relating to the use of surgical care bundles to reduce SSIs. Collected post- operative laparotomy data within 2022; primary outcome SSI prior to discharge. Secondary outcomes: organism grown on wound culture, prolongation of hospital stay and other hospital acquired infections. Trust data and literature review presented a local department meeting. Consultant Surgeon cohort concluded which changes were to be implemented (pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy). Post-operative laparotomy wound data recollected after changes. Results Clear literature evidence in support of surgical care bundles. Pre-closure glove change, new closure equipment set, wound irrigation, anti-microbial sutures, use of wound retractors and negative pressure wound therapy all found to contribute to a statistically significant reduction in SSIs. Implementation of these changes led to a reduction of SSIs within the department. Conclusions SSIs are the most common surgical complication worldwide. They lead to increase morbidity/mortality, prolonged hospital stays and increase economic burden. Recent literature has highlighted simple measures to reduce SSIs. Implementation of these measures has led to a department wide reduction in SSIs.

Double-Wound O-Ring Retraction for Chylothorax Surgery in Dogs.

A suitable wound retraction is crucial for open surgical treatment of chylothorax in dogs. A single paracostal approach for transabdominal/transdiaphragmatic thoracic duct ligation and cisterna chyli ablation is an effective procedure. For the procedure, the use of stay sutures and handheld or automatic soft tissue retractors is recommended. However, it is often necessary to adjust the retractors several times during the surgery to provide sufficient exposure of the thoracic duct. This prolongs the operation and increases infection risk. In this report, we describe the modified application of two o-ring elastic wound retractors (O-WRs) in three large breed dogs with idiopathic chylothorax. We conclude that the O-WRs provide a static circumferential vision of the operation field and good access to the cisterna chyli, especially to the thoracic duct. The usage of other surgical instruments is not hampered by the O-WRs, and the elastic rings are not damaged by the metal instruments. Once placed in the diaphragmatic area, indeed, they do not require further manual retraction.

Single-Port Robotic Transvesical Simple Prostatectomy Step by Step

We detail the instruments required to perform a single-port robotic transvesical simple prostatectomy, as well as the surgical technique to perform this operation using the single-port robot. A 3-cm transverse incision is made three fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The roll wound retractor rolling ring is inserted into the bladder lumen, with the access port, SP Short Entry Guide, and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mm Hg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-Loc suture from apex to base at 3-o-clock and 9-o-clock; a double-arm 3-0 V-Loc suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. Prostatic adenoma specimens can be removed from the SP Access Port directly or removed from the bladder using the robotic camera for observation. The cystotomy is closed in two layers with 3-0 Vicryl suture. The patient is observed for 2 hours on continuous bladder irrigation to determine ambulatory discharge eligibility. Follow-up is in 3 to 7 days for trial of void. Disclosure: Portions of this video and title were presented at the AUA 2023 in the form of a video abstract and as an AUA Core Curriculum video. https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000003288.06 Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. There are no commercial associations during the past 3 years that might create a conflict of interest in connection with the video. Runtime of video: 7 mins 37 secs

V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP

You have accessJournal of UrologyCME1 Apr 2023V07-06 SINGLE-PORT ROBOTIC TRANSVESICAL SIMPLE PROSTATECTOMY STEP BY STEP Joshua Jue, Alexa Meyer, and Lee Richstone Joshua JueJoshua Jue More articles by this author , Alexa MeyerAlexa Meyer More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The single-port robotic transvesical simple prostatectomy was first described in 2020, but the operation has not been widely adopted. With promising early results, the single-port robotic transvesical simple prostatectomy is an alternative approach to this operation with distinct advantages. METHODS: We detail the instruments required for this procedure, as well as the surgical technique to perform a simple prostatectomy using the single-port robot. Intraoperative and robotic video demonstrates all aspects of the technique, and postoperative photos illustrate the healed wound. RESULTS: A 3 cm transverse incision is made 3 fingerbreadths above the pubic symphysis and a longitudinal cystotomy is made. The Roll Wound Retractor rolling ring is inserted into the bladder lumen, with the Access Port, SP Short Entry Guide and AirSeal trocar within it. The robot is then docked to the SP cannula, and the bladder is insufflated to 8 mmHg. A semilunar incision is made through the bladder mucosa using the monopolar scissors along the posterior aspect of the bladder neck or median lobe. The forceps can be used to retract the prostatic adenoma, while using the monopolar scissors to further bluntly dissect the adenoma from the capsule. The prostatic adenoma can be removed en bloc, but is usually removed en lobe. A vesicourethral mucosal advancement flap is performed with 3-0 V-lock suture from apex to base at 3 o-clock and 9 o-clock; a double-arm 3-0 v-clock suture is then used to approximate the bladder and urethral mucosa, by running from 6-o-clock to 12-o-clock. The cystotomy is closed in 2 layers with 3-0 vicryl suture. The patient is observed for 2 hours on continues bladder irrigation to determine ambulatory discharge eligibility. Follow up is in 3-7 days for trial of void. CONCLUSIONS: Single-port robotic transvesical simple prostatectomy is a safe and effective way to surgically remove benign glands larger than 80 cc. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Jue More articles by this author Alexa Meyer More articles by this author Lee Richstone More articles by this author Expand All Advertisement PDF downloadLoading ...

Development of panorama vision ring for thoracoscopy

Minimally invasive surgery (MIS) using a thoraco- or laparoscope is becoming a more common surgical technique. In MIS, a magnified view from a thoracoscope helps surgeons conduct precise operations. However, there is a risk of the visible area becoming narrow. To confirm that the operation field is safe, the surgeon will draw the thoracoscope back to check the marginal area of the target and insert it again many times during MIS. To reduce the surgeon's load, we aim to visualize the entire thoracic cavity using a newly developed device called "panorama vision ring" (PVR). The PVR is used instead of a wound retractor or a trocar. It is a ring-type socket with one big hole for the thoracoscope and four small holes for tiny cameras placed around the big hole. The views from the tiny cameras are fused into one wider view that visualizes the entire thoracic cavity. A surgeon can proceed with an operation by checking what exists outside of the thoracoscopic view. Also, she/he can check whether or not bleeding has occurred from the image of the entire cavity. We evaluated the view-expansion ability of the PVR by using a three-dimensional full-scale thoracic model. The experimental results showed that the entire thoracic cavity could be visible in a panoramic view generated by the PVR. We also demonstrated pulmonary lobectomy in virtual MIS using the PVR. Surgeons could perform a pulmonary lobectomy while checking the entire cavity. We developed the PVR, which uses tiny auxiliary cameras to create a panoramic view of the entire thoracic cavity during MIS. We aim to make MIS safer for patients and more comfortable for surgeons through the development of the PVR.

Lipids Fraction from Caralluma europaea (Guss.): MicroTOF and HPLC Analyses and Exploration of Its Antioxidant, Cytotoxic, Anti-Inflammatory, and Wound Healing Effects

Caralluma europaea is a medicinal plant used in Morocco to cure a variety of illnesses. This study was conducted to determine the chemical composition, the antioxidant, antiproliferative, anti-inflammatory, and wound healing activities of C. europaea lipids. The chemical composition of C. europaea was analyzed using time-of-flight mass spectrometry and high-performance liquid chromatography. The antioxidant potential was determined using the 2,2-di-phenyl-1-picryl hydrazyl (DPPH), and ferric reducing antioxidant power (FRAP) tests. The antiproliferative effect was evaluated by MTT assay against HL60, K562, Huh-7 cancer cells, and normal Vero cells. The anti-inflammatory potential was conducted against carrageenan-induced paw edema. The wound healing effect was evaluated against skin burns for 21 days. The identified phytochemical compounds were docked for their effect on nicotinamide adenine dinucleotide phosphate oxidase, caspase-3, lipoxygenase, glycogen synthase kinase-3-β, and protein casein kinase-1. The results showed the presence of some lipids, such as linoleic acid and vitamin D3. The DPPH (IC50 = 0.018 mg/mL) and FRAP (EC50 = 0.084 mg/mL) of C. europaea lipids showed an important antioxidant effect. For the anti-inflammatory test, an inhibition of 83.50% was recorded after 6 h of treatment. Our extract showed the greatest wound retraction on the 21st day (98.20%). C. europaea lipids showed a remarkable antitumoral effect against the K562 cell line (IC50 = 37.30 µg/mL), with no effect on Vero cells (IC50 > 100 µg/mL). Lignoceric acid was the most active molecule against caspase-3 (−6.453 kcal/mol). The findings indicate the growing evidence of C. europaea as a potential treatment for several diseases.

CHEMICAL AND PHARMACOLOGICAL PROPERTIES OF THE GENUS COPAIFERA IN THE TREATMENT OF INJURIES/WOUNDS: INTEGRATIVE REVIEW

Objective: To identify chemical and pharmacological properties of Copaifera in the treatment of injuries and wounds. Method: Integrative literature review conducted in the LILACS, MEDLINE, PubMed, Taylor & Francis and Scopus databases in January 2022, using the search strategy: “Chemical Properties” AND “Copaifera” AND “Wounds and Injuries” and “Pharmacology” AND “Copaifera” AND “Wounds and Injuries.” Original articles, full text, identified according to level of evidence, written in Portuguese, English or Spanish, were included. Results: In the primary search 261 articles were found. After systematized selection, 12 studies were selected for qualitative analysis. Species of the genus Copaifera have pharmacological properties favorable for wound treatment: control of inflammatory pain, reduction of inflammatory reaction, tissue reepithelialization and repair, angiogenesis, wound retraction and scar remodeling. Among the chemical properties associated with the treatment of injuries, the presence of bioactive compounds stand out: diterpenes, 3-hydroxy-copalic, sesquiterpenes, kolavic-15-methyl ester. Among the tested diterpenes, kaurenoic and copalic acids showed significant hemolytic activities. Only copalic acid and hardwickiic acid inhibited nitric oxide production in lipopolysaccharide-activated macrophages. Conclusion: Plants of the genus Copaifera have chemical and pharmacological properties favorable for the treatment of injuries and wounds.

Stoma close to the abdominal wound – A real technical problem: A description of a novel care strategy

IntroductionIn some clinical scenarios, stoma site may be located close to the abdominal wound edge impeding optimal wound management and stoma care. We present a novel strategy of utility NPWT for management of simultaneous abdominal wound healing with stoma presence. Material and methodsRetrospective analysis of seventeen patients treated with a novel wound care strategy was conducted. Application of NPWT within wound bed, around stoma site and skin between allows for: 1) separating wound from stoma site, 2) maintaining the optimal environment for wound healing, 3) protecting peristomal skin and 4) facilitating application of ostomy appliances.ResultsThe study group comprised of twelve female (70,6 %) and five male (29,4%) with the mean age of 49.1 18.4 years The most common underlying pathology was Crohn s disease (n-5; 29,4%). Since NPWT was implemented, patients had undergone from 1 to 13 surgeries. Thirteen patients (76,5%) required intensive care unit admission. The mean time of hospital stay was 65,3 28,6 days (range: 36 134). The mean session of NPWT was 10.8 5.2 (range: 5 - 24) per patient. The range of the level of negative pressure was from -80 to 125 mmHg. In all patients, progress in wound healing was achieved resulting in granulation tissue formation, minimizing wound retraction and thus reduction of the wound area. As a result of NPWT, wound was granulated entirely, tertiary intension closure were achieved or patients were qualified for reconstructive surgery.DiscussionNPWT is safe and useful therapy for complicated abdominal wounds with the presence of stoma close to wounds edges. A novel care strategy allows for simultaneous technical opportunity to separate stoma from wound bed and facilitate wound healing.

Single-port transumbilical pediatric cholecystectomy: any benefits for the patient?

To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs. LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, with a premium of 44.30 € owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.

Role of External Tissue Expansion Wound Closure in the Electrical Burn Wound to the Scalp

Electrical burns constitute 3–5% of all burn cases; in developing countries, this ratio increases up to 21–27% and the mortality rate is reported to be between 3.75% and 58.8%. Most of the acute burns are life threatening, and require various types of surgical interventions such as eschar excision or split thickness skin grafting, depending on the size, location and depth of the lesion. The deep electrical burns to the scalp were difficult to manage as it was more prone to exposure of the calvarial bone. In our case, a calvarial bone at the vertex was exposed post-eschar excision. Tissue expansion is based on the principle that all living tissues respond in a dynamic fashion to mechanical stress placed on them. Below we present a case of electrical burns wound to the calvarium utilizing the use simple cost-effective external tissue expansion technique for preventing wound retraction and for holding the dressing of the scalp wound.

7989 Cannonball Fibroid Robotic Myomectomy with Specimen Extraction Using Excite Technique

<h3>Study Objective</h3> Demonstrate a safe surgical technique used for robotic myomectomy of a large "cannonball" fibroid with specimen removal through umbilical incision, with incision retractor and protected by a contained extraction system, using Extracorporeal C-Incision Tissue Extraction (ExCITE) technique. <h3>Design</h3> Case report illustrated with a video. <h3>Setting</h3> Patient is placed in semi-gynecological position. <h3>Patients or Participants</h3> 40-year-old woman reports pelvic pain, increased abdominal volume and polyuria. Nulligest patient with reproductive desire, no previous illnesses. Physical examination revealed a palpable globose mass 2 cm under the umbilical scar. MRI showed a voluminous and globose uterus of 920 cc, due to a "cannonball" FIGO 5 fundic myoma measuring 14.3 cm. <h3>Interventions</h3> 8 mm incision was performed in the umbilical scar for endoscope robotic trocar. Other two 8mm incisions was performed in each flank to other robotic trocars. And one 5mm incision was performed in right hypochondrium for laparoscopic assistance. Inspection shows a voluminous uterus with a large fundic fibroid measuring about 14 cm. Wedge hysterotomy was performed for fibroid enucleation, with subsequent hysterorrhaphy. Then, specimen was removed through the umbilical incision, protected by a contained extraction system and using a wound retractor, under ExCITE technique. <h3>Measurements and Main Results</h3> We obtained efficient specimen extraction with safe and agile tissue fragmentation, maintaining aesthetic benefit for the patient. Patient was discharged in the second postoperative day, showing great evolution. <h3>Conclusion</h3> Extraction of big fibroids is often challenging for the minimally invasive gynecological surgeon. Using ExCITE technique inside a specimen containment bag with sharp instrumentation protector, it is possible to perform safe, agile and reproducible extraction technique, with efficient removal of tissue, avoiding the use of eletromechanic morcellator and the opening of vaginal dome.

Novel CleanCision Irrigating Wound Retractor vs Standard Alexis Wound Retractor in the Prevention of Surgical Site Infection after Colorectal Resection

Novel CleanCision Irrigating Wound Retractor vs Standard Alexis Wound Retractor in the Prevention of Surgical Site Infection after Colorectal Resection