Surgical technology international
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Standard sutures used in vaginal cuff reapproximation in total laparoscopic hysterectomies and hysterotomy closure in myomectomies require knot placement and tensioning of the suture throughout the closure. This may contribute to wound dehiscence, increased blood loss, and ischemia of tissue surrounding the knots. In 2004, the United States Food and Drug Administration approved the Quill™ bidirectional barbed suture (Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada)(Fig. 1). ⋯ The barbs minimize tissue recoil and do so with accurate soft tissue approximation, achieving hemostasis without the use of locking and figure eight sutures. Barbed suture allows for a shorter operative time, as there is an ease of suturing without the complication of knot tying. Barbed sutures are essential tools in the modern laparoscopist's toolbox.
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Review Meta Analysis
Gelatin-thrombin matrix for intraoperative hemostasis in abdomino-pelvic surgery: a systematic review.
Different hemostatic methods are available for mild to moderate intraoperative bleeding during open and laparoscopic abdomino-pelvic surgery, but topical hemostats have gained popularity. We sought to review evidence on the use of a gelatin-thrombin matrix (FloSeal®) in elective abdominal and pelvic surgery. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted. ⋯ Data were not pooled because of the heterogeneity in design. There is insufficient evidence that FloSeal provides better results than conventional hemostasis in abdominal and pelvic surgery, except for open myomectomy. Well-designed randomized trials are needed to evaluate the use of gelatin-thrombin matrix in elective abdomino-pelvic surgery outcomes.
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Standardization of the intraoperative neuromonitoring (IONM) technique is an essential aspect of modern monitored thyroid surgery. The standardized technique involves vagal nerve stimulation. VN stimulation is useful for technical problem solving, detecting non-recurrent laryngeal nerve (non-RLN), recognizing any recurrent laryngeal nerve (RLN) lesions, and precisely predicting RLN postoperative function. Herein, we present technical notes for the VN identification to achieve the critical view of safety of the VN stimulation with or without dissection.