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PubMed1994

[PMMA lens implantation in sutureless corneal cataract surgery].

BACKGROUND: Self-sealing corneal cataract procedures have been known since 1992 and are recommended for foldable silicon lenses. Our goal was a technical modification without refractive disadvantages, which would also allow for the implantation of more rigid, but less expensive PMMA lenses of high optical quality. METHODS: The "scleral stretch incision" by Freeman (1991) was applied to the corneal situation by widening the inner wound lip up to 6.5 mm; this makes it possible to implant a 5 mm optic through an outer wound opening of 4-4.2 mm. This method has been used since October 1992 on 980 patients, whereby the lamellar corneal incision was placed 1.5-1.8 mm deep to compensate for the astigmatism, if possible in the steeper meridian. RESULTS: The first 107 cases were followed up for longer than 6 months; they showed a surgically induced astigmatism of 1.18 +/- 0.79 D and a postoperative astigmatism of 0.86 +/- 0.70 D. Neither postoperative infection nor hypotony was observed in any of the cases. CONCLUSION: The modified corneal tunnel incision is recommended for 5 mm PMMA lenses; this is especially suited for cases of low to midgrade preoperative astigmatism that can be optimally improved by this procedure. In cases of pure spheric refraction, a 3 to 3.5 mm incision with foldable lens implantation is preferred.

Aged↗
PubMed1993

Sutureless biliodigestive anastomosis.

New modification of suture--free biliodigestive anastomosis was proposed. The suture--free anastomosis in our modification is performed by the help of Foley catheter. This technique was verified in dog experiments and than used for operation of four patients. Of these patients none died due to surgical intervention.

Anastomosis, Roux-en-Y↗
PubMed1993

Colonic anastomosis with sutureless biofragmentable rings.

PURPOSE OF STUDY--To evaluate the safety and applicability of a biofragmentable anastomotic ring (VALTRAC BAR) in an Asian population and report on its performance as an alternative to sutures and stapling devices. SELECTION OF STUDY SUBJECTS--A consecutive series of 20 patients undergoing colonic surgery over a 7-month period from October 1992 to April 1993. OBSERVATIONAL METHODS AND MAIN FINDINGS--A protocol was drawn up for prospective record of data from 11 male and 9 female patients (age 34 years to 83 years). Information was collected regarding length of operation (average 3 hours), actual anastomotic time (average 13.5 minutes) and problems or complications associated with the Valtrac device during surgery (none). Postoperatively, the cases were carefully documented for intestinal obstruction from faecal impaction due to Valtrac fragments (none), the timing of bowel movements (majority 4th day, range 1-7 days), and awareness of passing fragments (none). There were no mortality and no anastomotic leakage though two patients developed wound infection. PRINCIPAL CONCLUSIONS--This preliminary study confirms that the biofragmentable anastomotic ring is a simple, rapid and efficacious method of bowel anastomosis comparable to existing procedures. It has the distinct advantage of being uniformly reproducible.

Adult↗
PubMed1993

[Sutureless aortic valve replacement for peri-annular pseudoaneurysm and perivalvular leakage due to prosthetic valve endocarditis].

A 49-year-old man who had undergone AVR entered our hospital with congestive heart failure and continuing slight fever. By cardiac imaging, he was diagnosed prosthetic valve endocarditis with periannular pseudoaneurysm and perivalvular leakage. He underwent a new translocation method using a composite valve (a prosthetic valve directly sutured a ring prosthesis, which was separated from an intraluminal ringed graft). Post operative course was uneventful. He recovered well after the operation.

Aneurysm, False↗
PubMed1995

Sutureless endoscopic colposuspension with fibrin sealant.

Endoscopic colposuspension by using fibrin sealant as a substitute for sutures was performed in 17 women suffering from urodynamically verified type I-II stress urinary incontinence. Two-puncture technique was used with a 10-mm trocar for optics and a 5-mm trocar for instrumentation. The two-component fibrin sealant, Tisseel (1 ml) by using special applicator device, Duploject was applied with tube on both sides of the urethrovesical area. After that the urethrovesical junction was pressed for 5 min against the retropubic periost by the surgeon's index and middle fingers placed in the vagina. The average duration of the procedure was 20 min, excluding learning curve for the first two cases. The indwelling catheter and vaginal packing were removed and all patients discharged on the first postoperative day. All but two patients experienced excellent immediate response. Of the 12 patients followed > 6 months, 10 patients were completely dry and two were markedly improved. In our experience, laparoscopic colposuspension with fibrin sealant appears to be a promising new approach in correcting stress incontinence in women.

Adult↗
PubMed1997

[Implantation of a silicone lens through a sutureless 4.1 mm. scleral tunnel].

The author evaluates the visual acuity and postoperative astigmatism in 78 implantations of intraocular silicone lenses SI26NB of Allergan Co. via a scleral tunnel incision of 4.1 mm without suture. In 96% patients the induced astigmatism after 4-6 weeks was maximally 1 dpt. The vision was at that time in 93% 5/5-5/7.5. The authors consider the results with this lens very good. At present the firm provides a new type made from high-index silicone. Therefore the optic portion is thinner, bends more easily and can be implanted through an even smaller incision.

Aged↗
PubMed1976

Sutureless vasectomy, an improved technique: 1300 cases performed without failure.

Thirteen hundred bilateral, partial vasectomies have been performed for sterilization, without a failure. The procedure utilizes (1) a small, single incision; (2) no sutures; (3) cautery of each vas deferens lumen with a hand-held, battery-operated, disposable, hot-wire cautery; and (4) sealing of the proximal vas deferens in its sheath with a single tantalum clip. No spermatic granulomas were noted using this technique.

California↗
PubMed1998

[Reduction of astigmatism by 4mm long sutureless corneal cataract incision (stretch incision) with phacoemulsification and 5mm PMMA lens implantation].

AIM: Refractive cataract surgery using corneal incisions is aiming at neutralization of preoperative astigmatism. PATIENTS AND METHODS: 61 patients with preoperative astigmatism of 2.25 +/- 0.98 were included in the treatment. A self-sealing corneal tunnel incision measuring 4.0 to 4.1 mm in external diameter and 6.5 to 7.0 mm in internal diameter (stretch incision) was performed on the steeper axis. After capsulorhexis and phacoemulsification a 5 mm PMMA lens was implanted without suturing. Keratometry and corneal topography were performed preoperatively, 3 days and 1 year respectively following surgery. The statistical analysis was based on the Wilcoxon signed ranks test. RESULTS: Surgical induced astigmatism (IA) following superior incisions in cases of astigmatism with the rule (n = 29) amounted to 1.93 +/- 0.97, while lateral incisions in cases of astigmatism against the rule (n = 29) led to an IA of 1.35 +/- 0.73. Axial shifts by more than 30 degrees were 23% following superior incisions and 17%, after lateral incisions. We observed. astigmatic reduction of 1.3 D after superior incisions and 0.7 D following lateral incisions. CONCLUSION: By 4 mm corneal cataract incisions on the steeper axis a high preoperative astigmatism can be reduced significantly without additional keratotomies.

Astigmatism↗
PubMed1999

Simple sutureless skin graft fixation.

A simple method to enhance split-thickness skin graft immobilization without sutures is described. The method uses collodion to secure a mesh gauze to the adjacent skin preventing skin graft dislodgment. The technique is rapid and efficient.

Collodion↗
PubMed2006

Progress in cardiovascular anastomoses: will the vascular join replace Carrel's technique?

BACKGROUND: Vascular reconstructions are becoming challenging due to the comorbidity of the aging population and since the introduction of minimally invasive approaches. Many sutureless anastomosis devices have been designed to facilitate the cardiovascular surgeon's work and the vascular join (VJ) is one of these. We designed an animal study to assess its reliability and long-term efficacy. METHODS: VJ allows the construction of end-to-end and end-to-side anastomoses. It consists of two metallic crowns fixed to the extremity of the two conduits so that vessel edges are joined layer by layer. There is no foreign material exposed to blood. In adult sheep both carotid arteries were prepared and severed. End-to-end anastomoses were performed using the VJ device on one side and the classical running suture technique on the other side. Animals were followed-up with Duplex-scan every 3 months and sacrificed after 12 months. Histopathological analysis was carried out. RESULTS: In 20 animals all 22 sutureless anastomoses were successfully completed in less than 2 min versus 6 +/- 3 min for running suture. Duplex showed the occlusion of three controls and one sutureless anastomosis. Two controls and one sutureless had stenosis >50%. Histology showed very thin layer of myointimal hyperplasia (50 +/- 10 microm) in the sutureless group versus 300 +/- 27 microm in the control. No significant inflammatory reaction was detected. CONCLUSIONS: VJ provides edge-to-edge vascular repair that can be considered the most physiological way to restore vessel continuity. For the first time, in healthy sheep, an anastomotic device provided better results than suture technique.

Anastomosis, Surgical↗
PubMed1997

Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification.

PURPOSE: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. SETTING: Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA. METHODS: This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups. RESULTS: Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%). CONCLUSION: Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.

Adult↗
PubMed2004

[Left ventricular free wall rupture].

BACKGROUND: Left ventricular (LV) free wall rupture is an uncommon but catastrophic event after acute myocardial infarction and is associated with a high mortality. Some patients may be salvaged with emergent operation. Padro et al. described a sutureless technique for the treatment of postinfarction LV free wall rupture. We have adopted a similar sutureless technique using a fibrin glue-oxycellulose fixation. METHODS: A review of 32 patients during a 20-year period who were referred to coronary care unit (CCU) with postinfarction LV free wall rupture was conducted. There were 17 men and 15 women with an average age of 68.8 years. Nine patients were treated who having one-stage operation of simultaneous 7 ventricular septal perforation and 2 coronary artery bypass grafting (CABG). Nine patients were sutured directly with a felt sandwich technique with or without cardiopulmonary bypass. Five patients were treated with pericardiectomy and pericardiocentesis using direct vision. Nine patients were sealed with sutureless method using fibrin glue-oxycellurose fixation without cardiopulmonary bypass. RESULTS: Eleven hospital deaths (34.4%, 11/32) were occurred in the all patints. However, 1 death (7.1%, 1/14) occurred in the pericardiectomy and in the sutureless sealed groups. CONCLUSIONS: A sutureless technique for an oozing type of postinfarction LV free wall rupture is effective.

Adult↗
PubMed1993

Presence of calcium in the vessel walls after end-to-end arterial anastomoses with polydioxanone and polypropylene sutures in growing dogs.

The presence of calcium in the vessel walls after end-to-end arterial anastomoses performed with polydioxanone and polypropylene interrupted sutures was studied in 140 anastomoses in 35 10-week-old German shepherd dogs. Histologic examination with hematoxylin and eosin, van Gieson, and von Kossa staining techniques was performed after the animals were killed 6 months after the operation. Ketamine hydrochloride was used as an anesthetic agent. At the start of the investigation the dogs weighed 14.5 +/- 2.6 kg (mean +/- standard deviation, n = 35), and after 6 months they weighed 45.3 +/- 3.1 kg (mean +/- standard deviation, n = 35). The diameter of the sutured arteries in the first operation was 2.6 +/- 0.5 mm (mean +/- standard deviation, n = 140). With each dog, both brachial and both femoral arteries were used--one artery for each different type of suture. In different dogs, different arteries were used for the same type of suture. The prevalence of calcifications after 6 months was determined from the numeric density of calcifications with standard stereologic techniques. The sutured and sutureless parts taken from longitudinal sections from each artery were studied, and t test values were calculated as follows: In paired samples, statistically significant differences in numerical density of calcifications were seen between sutured and sutureless arterial parts for both materials (sutureless part versus part with polydioxanone sutures, p < 0.001, n = 70; sutureless part versus part sutured with polypropylene sutures, p < 0.01, n = 70); however, in independent samples no statistically significant differences in numerical density of calcifications were seen between the polydioxanone and polypropylene groups for sutured (p > 0.05, n = 70) and sutureless parts (p > 0.05, n = 70).

Anastomosis, Surgical↗