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This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage complex tears that replaces traditional suture knots with ultrasonic welding of sutures. This will help eliminate potential causes of ulnar-sided wrist discomfort during the postoperative period.
BACKGROUND: Intracorporeal suturing and knot-tying in laparoscopic surgery require great manual dexterity; these techniques must absolutely be mastered by every surgeon who is interested in pursuing the minimally invasive approach. METHOD: The initial and final knot of a laparoscopic continuous suture can be accomplished in several ways and with easy technical solutions that are fully illustrated in the present study. CONCLUSION: We think it is better to perform a continuous suture than an interrupted one. It is advisable, moreover, to use traditional suture materials (not specially created for laparoscopy) that cost less than the more sophisticated ones.
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In 135 femoral vessels of rats (70 arteries, 60 veins) end-to-end anastomoses performed, using 3 different methods (anastomoses with interrupted sutures, two-suture telescopic anastomosis, sutureless telescopic anastomosis with fibrinogen adhesive). The advantages and disadvantages of these methods were investigated and valued by clinical aspects (time of anastomosing, patency rate, complications). The results showed that a combined two-suture-telescopic anastomosis using absorbable suture material and fibrinogen adhesive is very stable and causes minimal lesions of the vessel wall, so that this method will be a nearly ideal anastomosing technique.
OBJECTIVE: The use of laparoscopy in urology is increasing. Tumor of the kidney or adrenal gland and, in some cases, metastatic disease can involve the diaphragm. We describe the application of laparoscopic suturing techniques in the case of diaphragmatic involvement with a renal tumor. METHODS: After resection of the tumor and a small area of the diaphragm, a chest tube was placed under laparoscopic guidance. The tube was kept clamped until the end of the procedure. Decreasing intraabdominal pneumoperitoneum pressure made suturing easier with less tension on the edges of the diaphragmatic incision. Nonabsorbable interrupted horizontal mattress sutures were placed to close the diaphragmatic defect. RESULTS: The repair was uneventful; no intraoperative complications occurred. Extubation was done at the end of the procedure in the operating room. The chest tube was removed on postoperative day 2, and the patient was discharged on postoperative day 3. CONCLUSIONS: Laparoscopic repair of the diaphragm should be commensurate with traditional open surgical principles. In this regard, it is essential that surgeons interested in performing "advanced" laparoscopic oncologic surgery become facile in laparoscopic suturing.
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Meniscal repair, healing, and survival have been demonstrated in the literature. Meniscal preservation is, however, not always possible. We present a technique that may aid the surgeon in difficult bucket handle resections by stabilizing a portion of the meniscus with a "suture retractor" prior to resecting either a posterior or anterior meniscal horn. This technique may also be modified to prepare the inner rim when one is performing meniscal repair.
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A continuous suture technique for microvascular end-to-side anastomosis was tested in an animal model. Twenty-five Wistar rats underwent carotid-to-carotid end-to-side anastomoses using the conventional interrupted suture technique, and another 25 animals underwent similar operations using a continuous suture method. Anastomosis patency, growth, and vessel clamp time during the operation were recorded. The continuous suture technique was found to have equivalent growth and patency figures and to be much faster than the interrupted suture method.
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Ideal suturing was defined as advancing a needle along its curvature (needle circle) to minimize tissue trauma, while placing the suture with its intended span and tissue bite in the expected place. Actual suture tracks were analyzed to find the keys to produce such suturing. Correspondence of those tracks to the ideal track was then determined by the span, the initial needle angle (IA) into the tissue, and the center of the needle circle. Eight surgeons with 4-7 years of experience produced 22 ideal sutures in two types of tissue simulants: The entrance and exit points of the needle were level in flat suturing, while the entrance point was slanted 45 degrees for slant saturing. The correspondence was better with slant suturing than flat suturing (P < 0.01). The IA in flat suturing was 49.0 +/- 2.0 (mean +/- SE) degrees versus 33.0 for ideal suturing (P < 0.01), while that in slant suturing was 35.5 +/- 1.9 (P: ns). In conclusion, the IA was the key to good results, and was optimized in slant suturing, which was instinctively utilized in practice by using forceps. The forceps avoided a derangement of suturing stemming from the configuration of the needle employed and from the range of motion of the surgeon's arm (human engineering), while satisfying the surgeons inclination to take a large IA.
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Explore the source record for details and available documents.