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Results for “Sutureless”

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At least 217 records · Page 12Linked to original sources

PubMed2000

Enabling sutureless vascular bypass grafting with the exovascular sleeve anastomosis.

PURPOSE: We describe a technique for end-to-end sleeve anastomosis that may enable minimally invasive bypass grafting and characterize the tensile strength, stenosis rate, durability, and healing of the anastomosis. METHOD: An anastomotic device assembly consisting of a cable tie-type band with mobile teeth elements is mounted on the outer surface of a polytetrafluoroethylene graft. The graft is drawn over the artery resulting in a sleeve of vessel within the graft. As the band is tightened over an intraluminal obturator, the independently mobile anchoring teeth are driven through the graft into the artery. The tensile strength of the anastomosis was compared with sutured anastomosis during in vitro studies using cadaveric human femoral arteries. For in vivo studies on pigs and goats, we used a proximal exovascular sleeve anastomosis along with a distal sutured aortic anastomosis. Survival animals were studied by angiogram postoperatively and at the time of explantation. RESULTS: In vitro studies showed no difference in maximal tensile strength between sutured and exovascular anastomoses (10.5 +/- 2.7 lb vs 10.2 +/- 3.0 lb, P =.83). However, loss of continuous graft to artery interface occurred at lower loads in the sutured anastomoses (6.5 +/- 0.6 lb, P <.05). In total, all 24 pigs tested in nonsurvival or survival settings sustained a successful and leakproof anastomosis. Of the 13 nonsurvival cases, maximal epinephrine-induced hypertension sustained over 15 minutes (peak systolic blood pressure > 210-250 mm Hg) was tolerated without leakage in a subgroup of five animals (100%). All 11 survival pigs had no pseudoaneurysms or stenosis relative to sutured control anastomoses at 6 week explantation (8.2 +/- 1.25 mm vs 8.5 +/- 1.6 mm, P =.21). The three long-term survival goats had no pseudoaneurysm or stenosis after 40 weeks. Histologic examination confirmed healing of the aorta to graft with minimal neointimal hyperplasia. CONCLUSION: Exovascular sutureless anastomosis appears comparable to sutured anastomosis in stenosis rate, healing, and durability, with some advantages in tensile strength and rapidity of application.

Anastomosis, Surgical↗

PubMedDate not supplied

Induction of cardiac hypertrophy by a controlled reproducible sutureless aortocaval shunt in the mouse.

Much of the understanding about the pathophysiological responses to chronic cardiac overload has been gained by the use of rat and dog models of aortocaval fistula (ACF). The use of a similar model in genetically manipulated mice may further elucidate the molecular mechanisms in these responses. The only reports about ACF in mice to date have applied a needle puncture to create the ACF, which may result in an uncontrolled and irreproducible size of the shunt, and require several weeks to induce the characteristic cardiac changes. In order to obtain a more consistent approach to characterize this mode of cardiac hyperfunction, we present a surgical murine model of ACF that results in rapid progression of the typical systemic and cardiac changes. A sutureless side-to-side infrarenal surgical anastomosis of 0.6-0.8 mm in diameter was created between the abdominal aorta and inferior vena cava in ICR (Institute of Cancer Research) mice. Six to 7 days later, significant cardiac hypertrophy developed. The heart/body weight ratio increased from 0.45 +/- 0.02% in control mice to 0.77 +/- 0.03% in mice with ACF (p < .003). The dry heart weight ratio increased from 0.099 +/- 0.0033% to 0.13 +/- 0.008% (p < .006). The ACF dramatically induced the atrial and ventricular expression of atrial natriuretic factor mRNA, and increased the total cardiac content of endothelin-1 (162.5 +/- 50.6 vs. 83.9 +/- 9.0 pg). Mean arterial pressure in anesthetized mice with ACF decreased from 69.8 +/- 4.9 to 54.8 +/- 5.5 mm Hg (p < .025). Urinary sodium excretion returned to preoperative levels several days following surgery. These results demonstrate that cardiac hypertrophy could be rapidly and reproducibly achieved in mice by the placement of a surgical ACF. This model, when applied in genetically manipulated mice, may be a valuable tool for functional genomic studies about the pathogenesis of cardiac hypertrophy and heart failure.

Animals↗

PubMed1999

Sutureless small bowel anastomoses: experimental study in pigs.

OBJECTIVE: To evaluate a new technique for experimental anastomosis with fibrin glue, and to compare the results with those of stapled and one-layer sutured anastomosis. DESIGN: Open laboratory study. SETTING: Teaching hospital, Sweden. ANIMALS: Ten Swedish domestic pigs. INTERVENTIONS: Each pig had three anastomoses made in the small bowel, one by each technique. The pigs were killed on the 4th postoperative day. MAIN OUTCOME MEASURES: Blood flow, collagen concentration, anastomotic index, breaking strength, thickness of bowel wall, and histological appearance. RESULTS: Two pigs died postoperatively, leaving 8 for analysis. The blood flow at each anastomotic site studied by the microsphere technique was similar irrespective of the type of anastomosis (p = 0.3), as was anastomotic collagen concentration (p = 0.09). The anastomotic index, however, was significantly higher in the stapled than in the glued or sutured ones (p = 0.03). The glued anastomosis was the weakest, being only one fifth the strength of the stapled and one third the strength of the sutured anastomosis. There was no sign of rejection of the glue (of human origin) on histological examination. Glued and stapled anastomoses showed signs of mild inflammation, which did not reach the intensity of that around the sutured anastomoses. CONCLUSION: It is possible to make a sutureless anastomosis that does not leak with a modified stapler using fibrin glue instead of staples, but the anastomosis has considerably lower breaking strength than either stapled or sutured anastomoses.

Anastomosis, Surgical↗

PubMed1992

Alternative wavelengths for sutureless laser microvascular anastomosis: a preliminary study on acute samples.

Attempts to improve the speed and patency of microvascular anastomosis with laser-assisted techniques have provided a modest reduction in operative time and comparable success rates. Using sutureless microvascular anastomoses, 30 end-to-end anastomoses were created in the rat carotid artery using the gallium-aluminum-arsenide diode laser (808 nm). Indocyanine green and fibrinogen were applied to enhance tissue absorption of the laser energy and strengthen the bond created. These were compared with previously reported welds using the THC:YAG laser (2150 nm). Mean welding times were 140 and 288 s, and mean bursting pressures immediately after welding were 515 and 400 mmHg for the diode and THC:YAG laser groups, respectively. Histologically, both lateral and vertical spread of thermal damage was limited. Since both lasers create welds of adequate initial strength without stay sutures and are faster and easier to use than existing systems, evaluation of long-term patency would be worthwhile.

Anastomosis, Surgical↗

PubMed1986

Use of sutureless intraluminal aortic prostheses in traumatic rupture of the aorta.

Despite wide acceptance of use of sutureless intraluminal prosthetic grafts in surgical management of acute and chronic aortic dissection, their use in traumatic aortic rupture appears not to have been specifically addressed. This report describes the use of intraluminal prostheses in two cases of aortic disruption due to blunt trauma. Aortic cross-clamp times were 21 and 28 minutes, respectively. Both patients have recovered without sequelae from their aortic injuries. Although not all traumatic aortic disruptions are suitable for repair with intraluminal prostheses, the ease and safety with which this device may be employed recommends consideration of their use in appropriate cases of traumatic rupture of the aorta.

Accidents, Traffic↗

PubMed1999

Sutureless microvascular anastomoses by a biodegradable laser-activated solid protein solder.

A new sutureless technique to successfully anastomose the abdominal aorta of rats (1.3 mm in diameter) by using a fully biodegradable, laser-activated protein solder is presented. A total of 90 rats were divided into two groups randomly. In group one, the anastomoses were performed by using conventional microsuturing technique, whereas in group two, the anastomoses were performed by using a new laser welding technique. In addition, each of the two groups were divided into five subgroups and evaluated at different follow-up periods (10 minutes, 1 hour, 1 day, 1 week, and 6 weeks). At these intervals, the anastomoses were evaluated for patency and tensile strength. Three anastomoses in each subgroup were processed for light and electron microscopy. All anastomoses were found to be patent. The mean clamp time of the anastomoses performed with conventional suturing was 20.6 minutes compared with 7.2 minutes for the laser-activated welded anastomoses (p < 0.001). The strain measurements showed a stronger mechanical bond of the sutured anastomoses in the initial phase. However, at 6 weeks the tensile strength of the laser-welded anastomoses was higher compared with the conventional suture technique. Histologic evaluations revealed a near complete resorption of the solder after 6 weeks. The junction site of the vessel ends cannot be determined on the luminal side of the artery. In conclusion, a resorbable protein used as a solder, activated by a diode laser, can provide a reliable, safe, and rapid arterial anastomosis, which could be performed by any microsurgeon faster than conventional suturing after a short learning curve.

Anastomosis, Surgical↗

PubMed2002

Office-based sutureless transconjunctival pars plana vitrectomy.

PURPOSE: This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. METHODS: In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. RESULTS: The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: "fish-egg" gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. CONCLUSION: Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.

Aged↗

PubMed1993

The construction of sutureless cataract incision and the management of corneal astigmatism.

Extrapolating information from equations that govern fluid flow, a theoretical formula is developed for a sutureless cataract incision. This theoretical formula defines the resistance of aqueous outflow as a function of three variables: length of cataract incision, the length of the scleral tunnel, the tortuosity of the outflow channel, and one constant friction factor. The nonlinear relationship of corneal incisions to length, depth, and distance from the visual axis is also examined with respect to their effect on central corneal curvature and control of astigmatism. Finite element analysis of differential equations is discussed as the most plausible technique for predicting these incisional effects.

Astigmatism↗

PubMed2005

25-gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification.

PURPOSE: To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. METHODS: Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. RESULTS: Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. CONCLUSIONS: Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.

Cataract↗

PubMed1980

Permanent cardiac pacing with sutureless myocardial electrodes: experience in first one hundred patients.

This report concerns our experience with a sutureless myocardial lead which we have used in 103 patients for establishment of permanent cardiac pacing. The electrode was inserted through a subxiphoid approach in all patients. Results to date indicate that this technique compares favorably with the presently popular transvenous technique as far as immediate or long-term morbidity is concerned. Complications were related entirely to pericardiotomy; no lead failure was seen during a maximum follow-up period of four years.

Adult↗

PubMed2005

Total iris expulsion through a sutureless cataract incision due to vomiting.

PURPOSE: To present a case of isolated total iris expulsion through a self-sealing cataract incision 2 weeks postoperatively due to vomiting. METHODS: Ophthalmological examination included visual acuity assessment, tonometry, slit-lamp examination, fundus ophthalmoscopy and ultrasound examination. RESULTS: A 65-year-old woman experienced sudden visual loss during an episode of vigorous vomiting 2 weeks after uncomplicated phacoemulsification cataract surgery with a sutureless corneal incision. Clinical examination showed a dense anterior chamber haemorrhage. When the blood had cleared, isolated total aniridia was seen. CONCLUSIONS: This is the first reported case of aniridia after cataract surgery due to vomiting.

Aged↗

PubMed1976

Fatal outcome arising from use of a sutureless "corkscrew" epicardial pacing electrode inserted into apex of left ventricle.

A 59-year-old man is described in whom the insertion of an epicardial sutureless "corkscrew" electrode resulted in fatal ventricular perforation. Fatal myocardial perforation can occur with this electrode and the apex of the left ventricle should never be used as the site of insertion. Necropsy also showed that the transvenous right ventricular electrode, inserted one year previously, had penetrated a tricuspid leaflet. This could have accounted for the ensuing pacing failure.

Electrodes, Implanted↗

PubMed1983

Sutureless skin closure for pacemaker implantation: comparison with subcuticular suture.

In 51 patients undergoing pacemaker implantation a trial was carried out to compare the results of sutureless skin closure using a new product (Op-Site skin closures) with skin closure using a continuous subcuticular absorbable (Dexon) suture. Incisions closed with Op-Site skin closures healed as well as those closed with subcuticular suture but were associated with less frequent and less extensive erythema around the skin edges one week after the procedure. They were quicker, simpler and cheaper to apply than the suture material used in this study.

Aged↗

PubMed2006

Problems associated with the 25-gauge transconjunctival sutureless vitrectomy system during and after surgery.

OBJECTIVE: To report the initial experiences with the 25-gauge transconjunctival sutureless vitrectomy (TSV) system, including intraoperative and postoperative problems. METHODS: We retrospectively reviewed the medical records and surgical videotapes of 50 consecutive patients who underwent vitrectomy performed by one surgeon using the TSV system. RESULTS: Intraoperatively, we encountered such problems as difficulty in inserting the microcannula, which led to deformity, instability of the microcannula, self-disconnection of the infusion tip and resultant lens damage, and conversion to 20-gauge conventional vitrectomy. Postoperatively, there were 8 cases with hypotony (IOP < 6 mm Hg) on day 1, 6 cases with elevated IOP, and 3 cases with retinal detachment during follow-up. CONCLUSION: Though certain problems exist during and after surgeries using TSV, this system is both convenient and safe for various vitreoretinal procedures.

Adult↗

PubMed2007

Topical anesthesia in transconjunctival sutureless 25-gauge vitrectomy for macular-based disorders.

PURPOSE: To evaluate the safety and feasibility of topical anesthesia in vitrectomy using the transconjunctival sutureless 25-gauge system (TSV 25G). METHODS: TSV 25G vitrectomy was performed prospectively in 46 eyes of 46 patients with macular-based disorders, including macular holes (n = 31), idiopathic epiretinal membranes (n = 11), and vitreoretinal traction syndrome (n = 4). Topical anesthesia was administered in each patient by instilling 2% Alcaine at 5 min intervals, three times before surgery. Additional Alcaine drops were given as a supplementation if needed during the operation. The levels of intraoperative analgesia were graded from 1 (adequate) to 3 (inadequate). RESULTS: Thirty-one patients (67.4%) tolerated the procedure well, with no additional anesthetic agent. Thirteen patients (28.3%) required additional topical anesthesia and 2 patients (4.3%) required a systemic sedative. Intraoperative pain occurred when the sclera was pierced by the microcannula and when sclera indentation was performed. No patient required additional retrobulbar or peribulbar anesthesia. There was no intraoperative complication which was specifically related to topical anesthesia. CONCLUSION: Topical anesthesia permits the successful management of some surgically less complex vitreoretinal disorders when the TSV 25G is used.

Adult↗

PubMed2004

Sutureless fixation of temporary pacing wire.

A simple sutureless technique of fixing ordinary straight insulated temporary pacing wire is described by creating a floret of the insulation of the wire. It can be easily accomplished and reproduced.

Cardiac Surgical Procedures↗

PubMed2006

Ultrasound biomicroscopy findings of 25 G Transconjuctival Sutureless (TSV) and conventional (20G) pars plana sclerotomy in the same patient.

BACKGROUND: Transconjunctival Sutureless Vitrectomy (TSV) is a recent advancement in vitreo-retinal surgical techniques involving the use of 25 G instruments through self-sealing sclerotomies. It has been hypothesized that there may be less chance of vitreous and retinal herniation in the scleral wound as compared to conventional sclerotomy incision. However there are no reports on differences in 20 gauge and 25 gauge sclerotomies using ultrasound biomicroscopy (UBM). We report herein the differences in sclerotomies undertaken with 20 gauge (G) and 25 gauge instruments in the same patient. CASE PRESENTATION: Ultrasound biomicroscopy of the sclerotomy sites was done in the same patient in whom both 20 G and 25 G sclerotomies had to be constructed during pars plana vitrectomy and the differences were studied. On day 2, we observed a wide gape at the site that had been enlarged using a 20G MVR blade. In contrast, the other two sites made transconjunctivally using the 25G trocar showed only a mild gape. Significant gape continued to persist at the subsequent evaluations on day 7 and day 14 only at the port, which had been enlarged. CONCLUSION: Healing of a 25 G sclerotomy is expectedly quite rapid, with inability to detect the site of sclerotomy in a short duration of 2 weeks post-operatively. This is as opposed to conventional sclerotomies, which might take up to 6-8 weeks post-operatively for complete opposition.

Adult↗

PubMed2006

Sutureless off-pump repair of post-infarction left ventricular free wall rupture.

Left ventricular free wall rupture after myocardial infarction has a high mortality. Suturing techniques of repair may be technically difficult and require cardiopulmonary bypass. We report a case of left ventricular rupture in a 47 year old man managed off pump employing a sutureless technique with Gelatine-Resorcin-Formalin glue and bovine pericardial patches.

Adhesives↗