Surgical technology international
-
The first aortic valve homograft was implanted by Sir Donald Ross in 1962. Since then, over 25,000 aortic homografts have been implanted worldwide. Unfortunately, the current cryopreservation method promotes a degenerative process leading to progressive homograft fibrosis and calcification. ⋯ Structural homograft valve deterioration translates predominately into valve insufficiency and less frequently into stenosis. Young recipient age it appears is the major determinant of reoperation. Predictors of early and late mortality are discussed.
-
Laparoscopic surgery has revolutionized the manner in which many operations are performed today. The volume of tissue to be removed during some operations can be a limiting factor for laparoscopy and is frequently a reason for converting from a minimally invasive laparoscopic surgical approach to the conventional open surgical approach. The introduction of the electronic morcellator has helped facilitate the removal of large specimens via minimally invasive surgery. ⋯ The MOREsolution™ tissue morcellator demonstrated significantly faster tissue morcellation times (544.6 ± 123.0 sec) and produced a higher number of long tissue fragments (7.44 ± 0.683) compared to the Rotocut™ G1 morcellators' time (609.7 ± 153.2 sec) and number of long tissue fragments (6.00 ± 0.638). No significant differences were found between the Gynecare Morcellex® and other morcellators in the total number of fragments obtained nor study participant opinion on the ease of use of the three morcellators. This study demonstrates that the MOREsolution™ morcellator is a faster morcellator and produces larger tissue fragments as compared to the Rotocut™ G1; however, more studies should be performed to confirm these findings in a clinical setting.
-
Bladder dysfunctions have been treated for decades through medical treatments or surgical procedures, especially in the context of prolapse conditions and stress incontinence. Over the last decade, sacral nerve modulation (SNM) has been introduced as a further option in the treatment of some urinary and fecal symptoms. Current techniques of percutaneous implantation are limited to superficial extrapelvic nerves that expose patients to lead migration and dislocation or infections, complications that cannot be ignored. ⋯ One of these methods is the implantation of neuroprothesis-a technique called the "LION procedure"-which permits selective electrical stimulation of pelvic nerves and plexuses. One very interesting site of implantation for treatment of urinary and faecal symptoms is the pudendal nerve (PN). Stimulation of this nerve induces two different actions: a strong contraction of the sphincters-treatment of urinary and faecal incontinence and an inhibitory effect on the bladder-and treatment for bladder overactivity.
-
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.
-
Randomized Controlled Trial Multicenter Study
Closure of midline laparotomies by means of small stitches: practical aspects of a new technique.
Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). ⋯ We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.