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At least 595 records · Page 33Linked to original sources

PubMed2001

Laser tissue soldering for hypospadias repair: results of a controlled prospective clinical trial.

PURPOSE: Laser tissue soldering has been shown to provide safe and effective tissue closure by creating an immediate leak-free anastomosis with minimal scar formation. We compared the results of laser tissue soldering and conventional suturing for hypospadias repair. MATERIALS AND METHODS: A consecutive group of 138 boys 4 months to 8 years old (mean age 15 months) was divided into a standard suturing (84) and a sutureless laser (54) hypospadias repair group. Urethral repair was defined as simple (Thiersch-Duplay or Snodgrass) and complex (onlay island flap or tube) in 101 and 37 cases, respectively. Laser tissue soldering was performed with 50% human albumin solder doped with 2.5 mg./ml. indocyanine green dye using an 808 nm. diode laser at 0.5 W. In the laser group sutures were used for tissue alignment only. At surgery neourethral and penile length, operative time for neourethral construction and the number of sutures or throws were measured. Postoperatively patients were examined for complications of wound healing, stricture or fistula. RESULTS: Mean patient age, urethral defect severity, type of repair, neourethral length and stenting time plus or minus standard error of mean were not significantly different in the 2 groups. Mean operative time was a fifth as long for laser tissue soldering in simple and complex hypospadias repair compared to controls (1.5 +/- 0.1 and 5.1 +/- 0.3 versus 8.5 +/- 0.8 and 26.7 +/- 1.7 minutes, respectively, p <0.001). The mean number of sutures used for tissue alignment in the laser group for simple and complex repair was significantly less than in controls (3.0 +/- 0.2 and 8.2 +/- 0.6 versus 8.5 +/- 0.8 and 23.2 +/- 1.5, respectively, p <0.001). All patients were followed a mean of 12 months (minimum 6, maximum 22). The complication rate was 4.7% in the laser group and 10.7% in controls with fistula in 2 of 54 cases, and fistula and meatal stenosis in 7 and 2 of 84, respectively. CONCLUSIONS: These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in almost sutureless fashion and more rapidly than conventional suturing. The ease of the laser technique and the lower complication rate in the laser group indicate that laser tissue soldering is an acceptable means of tissue closure in hypospadias repair.

Child↗

PubMed1998

Carotid arteriotomy closure using a vascular clip system.

PURPOSE: To compare a newly released vascular clip system (Vascular Clip-applier System; Auto Suture Company, Norwalk, CT) designed for sutureless vessel closures and anastomoses with standard suture closure of carotid arteriotomies after carotid endarterectomies. PATIENTS AND METHODS: Sixteen consecutive patients with symptomatic and severe carotid stenoses were randomly allocated to receive either standard suture (running 6-0 monofilament) or clip artery closures after undergoing carotid endarterectomies. The speed of arteriotomy closure was calculated for each procedure, and hemostasis, complications, and postoperative carotid patency were determined and recorded for each patient. RESULTS: The clip applier system performed well, and arteriotomy closure with clips was significantly faster than suture closure (0.36 cm/min in the sutured group versus 0.52 cm/min in the clipped group, P = 0.019). Carotid patency assessed by ultrasonography 4 to 8 weeks after surgery showed that all arteries in both groups were patent. Two hemostasis problems occurred in the clip closure group, one minor that was caused by the use of incorrect clip size and one major that was probably caused by a combination of sudden arterial hypertension and clip failure. This complication resulted in a large neck hematoma and cross-clamp ischemia during the ensuing suture repair of the arterial dehiscence. CONCLUSIONS: As a result of this small study, we determined that clip closure of carotid arteriotomies was feasible, but it remains questionable whether the increased speed of a sutureless closure is clinically important for this procedure. Concerns regarding the strength of clip closure of an endarterectomized vessel and the cost of clip closure compared with standard suture techniques suggest that there may be no clinically significant benefits of arterial clip closure over suture closure after carotid endarterectomy, and there is potentially some risk.

Aged↗

PubMed1976

Experiences with a new myocardial electrode for permanent cardiac pacing.

The first experiences with a new myocardial sutureless screw-in electrode for cardiac pacing are reported. A brief description of the technique is given. The electrode can be inserted quickly and safely under direct vision through a small anterior thoracotomy using a special inserter tool. The heart can be brought under pacemaker control in less than 5 minutes. The technique was employed in 15 patients. Results to date are promising and it is suggested that this method should be resorted to in cases of unstable pacing or recurrent dislocation of an endocardial lead, or when there are difficulties in the proper positioning of an electrode transvenously. In Sweden endocardial electrodes for transvenous insertion predominate. In many countries, especially the U.S.A., there is extensive experience of epi- or myocardial pacing leads (2, 4, 5). Some authors consider epicardial pacemakers safer than endocardial pacemakers for permanent cardiac pacing (8). We have observed defective or unstable pacing with endocardial electrode in a high proportion of patients in our series early after the implantation and even after many years of perfect pacing. When there are problems with an endocardial lead an epi- or myocardial electrode can be used. This paper reports experiences with a new sutureless myocardial electrode (Medtronic model 6917).

Aged↗

PubMed1984

Comparative study of leg wound skin closure in coronary artery bypass graft operations.

A prospective randomised study of four different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: (1) continuous nylon vertical mattress suture (27 patients); (2) continuous subcuticular absorbable (Dexon) suture (29 patients); (3) metal skin staples (Autosuture) (27 patients); and (4) adhesive sutureless skin closure ("Op-site") (30 patients). All wounds were examined by two independent observers at five, 10, and 45 days after operation. At five days, inflammation, extent of oedema, discharge, and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon vertical mattress suture, or Op-site. The incidence of established wound infection was 4.5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure.

Coronary Artery Bypass↗

PubMed2003

Expanded polytetrafluoroethylene membrane for prevention of adhesions in patients undergoing external decompression and subsequent cranioplasty.

Cranioplasty performed after external decompression for brain swelling may be difficult because of the development of adhesions between the temporal muscle and the dura. Membranes composed of expanded polytetrafluoroethylene (ePTFE) were inserted at external decompression to prevent such adhesions. The ePTFE membranes were placed suturelessly between the temporal muscle and the dura, covering the proximal portion of the temporal muscle at the sphenoidal ridge and the dural suture line. In addition, part of the membrane was placed directly below the skin incision to allow easy visualization at subsequent cranioplasty in 10 patients. Cranioplasty was performed 38 to 126 days (mean 63.9 days) after external decompression. No adhesions were observed, either between the ePTFE membranes and the dura, or between the membranes and the temporal muscle. No temporal muscle and dural injuries occurred during cranioplasty, and no patient showed signs of infection. Mean operating time was 71.0 minutes and mean blood loss was 75.2 ml. Sutureless insertion of ePTFE membranes at external decompression increases the ease and safety of subsequent cranioplasty, decreases operating time and blood loss, and avoids injury to the temporal muscle and dura.

Adult↗

PubMed1976

[Complications due to endocardial and epimyocardial electrodes in 171 patients with artificial pacemakers].

On the basis of experience with 171 patients the advantages and disadvantages of a sutureless, corkscrew-like myocardial electrode are compared with those of endocardial electrodes. Electrode complications were significantly less frequent in patients with sutureless myocardial electrodes and never lead to death. However, a benign postpericardiotomy syndrome was frequent (16% of cases). Electrode dislocation was the main complication in patients with endocardial electrodes.

Electrodes, Implanted↗

PubMed1997

[Clinical observation of foldable intraocular lens implantation by a small incision].

OBJECTIVE: To investigate a method of cataract operation capable of recovering normal visual acuity rapidly at early postoperative stage. METHODS: 131 eyes with senile cataract were divided into 3 groups: phacoemulsification with silicone foldable intraocular lens (IOL) implantation, phacoemulsification with one-piece IOL implantation and extracapsular cataract extraction with one-piece IOL implantation groups; the incision was 3.5 mm sutureless, 6.5 mm scleral tunnel incision and 11 mm limbal incision, respectively. RESULTS: 3 days after the operations, the average uncorrected visual acuity was 1.04, 0.51 and 0.46 and the proportion of normal visual acuity was 62.75%, 12.50% and 8.93% separately in the 3 groups. The average visual acuity and the proportion of normal visual acuity in 3.5 mm incision group was significantly higher than that of the other groups (P < 0.05). CONCLUSION: The phacoemulsification with foldable IOL implantation through a 3.5 mm sutureless incision can make good visual acuity rehabilitation at early postoperative stage.

Aged↗

PubMed1999

Expanding the scope of lamellar keratoplasty.

PURPOSE: To investigate whether applications of current technology, such as cryolathe and excimer laser, might improve outcomes and increase use of lamellar keratoplasty. METHODS: Six studies were performed, beginning with animals and progressing to human subjects. The first study compared cryolathed with hand-dissected rabbit corneas to ascertain which created a smoother donor interface. The second animal pilot study was done to determine whether thickness of donor cornea resection could be accurately predicted with the cryolathe. A prospective animal trial was then undertaken to compare lamellar keratoplasty outcomes using cryolathed versus hand-dissected tissue. The fourth work extrapolated previous animal findings to lamellar keratoplasty in human disease. Finally, two ongoing studies are described. The first explores the possibility of sutureless lamellar keratoplasty. The second utilizes the excimer laser to dissect the recipient stromal bed. RESULTS: The initial animal pilot study demonstrated a clearer stromal surface in cryolathed versus hand-dissected corneal tissue. The second pilot showed that plano-powered donor tissue could be generated to predetermined thickness. The prospective animal trial revealed that clear grafts of intended thickness could be obtained with cryolathing. Human studies suggested that lamellar keratoplasty using cryolathe-prepared donor tissue may offer superior results to free-hand dissection. Finally, one ongoing study indicates that sutureless lamellar keratoplasty is untenable, and the other shows that clear grafts can be obtained by combining cryolathed donor tissue with recipient photoablation. CONCLUSION: This body of work demonstrates that use of new lamellar keratoplasty technology may offer expanded scope and better outcomes than traditional lamellar keratoplasty techniques.

Animals↗

PubMed2002

First clinical results with a new mechanical connector for distal coronary artery anastomoses in CABG.

BACKGROUND: Coronary anastomoses are currently primarily carried out with the use of running nonabsorbable sutures. Recently, a renewed interest has developed for facilitated mechanical anastomotic devices especially for minimal invasive techniques or limited access surgery. The initial experience with the first successful creation of mechanical vein-to-coronary artery anastomoses in humans is reported. METHODS AND RESULTS: Between November 2000 and June 2001, 14 patients scheduled for multivessel coronary artery bypass grafting (CABG) procedure were investigated. One vein graft-to-coronary artery anastomosis per patient was performed with the St. Jude Medical ATG Symmetry coronary connector system (stainless steel investigational device, not yet commercially available). We evaluated the overall performance of the device. Intraoperative flow measurements of the grafts using transit time methods were measured. A postoperative angiographic control was performed immediately after the procedure in all patients. Hemostasis was instantaneous in all cases and all anastomoses (mechanical n=14, sutured n=40) were patent. Mean intraoperative flow measurements for the mechanical anastomosed vein grafts was 75+/-25 mL/min. Three month angiogram or MRI angiography is available to date in 11 patients. Ten connector grafts were patent and 1 was occluded. There were no cardiac-related adverse events or return of angina; exercise tolerance tests and stress electrocardiograms were normal in all patients. CONCLUSIONS: The St. Jude Medical ATG Symmetry coronary connector system is a new device for sutureless distal vein graft-to-coronary artery anastomoses in CABG. This system allows the construction of geometrically perfect anastomoses. This technology represents a further step in a new era of sutureless anastomoses in cardiac surgery.

Anastomosis, Surgical↗

PubMed1976

[Unusual traumatic rupture of the thoracic aorta with avulsion of the left subclavian artery].

Of the many cases of traumatic rupture of the aorta diagnosed each year at l"Hôpital du Sacré-Coeur, Montreal, most patients are already in irreversible shock when seen. However, during the period Oct. 1, 1974 to Sept. 30, 1975, prompt surgical treatment saved six patients. One of these six patients had a complete trans-section of the aortic arch between the left carotid and left subclavian arteries with avulsion and slight retraction of the left subclavian artery. Repair of the aortic arch and left subclavian artery was accomplished without extracorporeal circulation. A sutureless temporary bypass shunt was created by (a) cannulating the ascending and descending aorta, the cannulas being secured with purse-string sutures and joined by a 3/8-inch (94-mm) polyvinyl chloride (PVC) tube connected to a "double T" adapter, and (b) joining two small PVC tubes from the adapter with two straight cannulas, a no. 14 being inserted into the innominate artery and a no. 12 being inserted into the left carotid artery. With this temporary bypass created, the ascending and descending aorta and aortic arch vessels were all clamped. Aortic continuity was re-established with a tubular Dacron graft (diameter, 19 mm) to which was anastomosed a side-arm of knitted Dacron (diameter, 10 mm) to repair the left subclavian artery. Throughout the temporary perfusion the brain, spinal cord and all abdominal viscera were well protected. No sign of ventricular distension was detected. This report is the first in which complete transsection of the aortic arch has been managed by a sutureless bypass shunt allowing perfusion of all aortic arch vessels without extracorporeal circulation.

Adult↗

PubMed2004

Pseudoaneurysm formation 12 years after ringed intraluminal graft replacement for type B aortic dissection.

A sutureless ringed intraluminal graft has been used as a substitute for the diseased aorta with the advantage of decreasing the aortic cross-clamp time and blood loss. Concerns remain about implications of anecdotal accounts of late complications with this graft. We report on the experience of a 68-year-old man, successfully treated for type B aortic dissection using the sutureless technique, who developed a pseudoaneurysm and aortobronchial fistula over the distal anastomosis of the intraluminal graft 12 years after the operation.

Aged↗

PubMed2005

Major complications in thyroid surgery: utility of bipolar vessel sealing (Ligasure Precise).

In the present study the Authors tried and assess the advantages of the standard sutureless thyroidectomy performed by the Ligasure Vessel Sealing System, thanks to the use of the dedicated Precise handle. The Authors compared the efficacy of haemostasis and the economical impact of the device, in terms of drug administration and costs. The Authors comparatively analyzed 120 total extracapsular thyroidectomies (TET) performed by the standard operative technique (Group A, control) and 70 TET achieved by the "sutureless technique" (Group B, case). There was a statistically significant decrease of transient postoperative hypocalcemia (5.71% vs 7.5%) and also of mean operative time (about 20 minutes) in patients of the group B. Non significant decrease of other kind of complications (postoperative hemorrhage, transient and permanent inferior laryngeal palsy, stupor of the superior laryngeal nerve, seromas) were also observed. The use of the Ligasure Precise resulted easy, safe and efficient in the Authors' experience. It allowed the decrease of postoperative haemorrhages and mean operative time.

Case-Control Studies↗

PubMed1986

[Mechanical compression anastomosis (AKA-2) of the colon and rectum. Results of a prospective clinical study].

Based on the highly superior mechanical and functional properties of an experimental sutureless anastomosis performed without any foreign material compared to conventional anastomosis we have introduced a sutureless compression anastomosis (AKA-2) to colorectal surgery and controlled the outcome prospectively. This type of anastomosis was employed in 30 patients with sigmoid and rectal resections for carcinomatous and inflammatory bowel disease. The first 3 patients and further 3 high-risk patients got a protective colostomy. The clinical outcome was uneventful in all patients but 2 with anastomotic fistula. Radiological controls showed no further fistula. The study revealed no negative side effects of the compression anastomosis but the procedure seems to provide considerable advantages by complete mechanical relief of the anastomosis and early epithelial covering of the anastomotic line.

Colonic Diseases↗

PubMed1986

[Histopathology of the arterial wall after animal experiment microsurgical operations].

Histologic findings on microvessels of laboratory animals are reviewed. Lesions of the microvascular wall may be caused by preparation, microvascular clips and anastomosis. The intensity of the closing pressure of microclips as well as the clipping time influence the extent of the damage. Thrombosis of microarteries was not seen, even after a clipping time of 2 hours. The vascular lesions were reparable. Four different techniques of anastomosis used experimentally and clinically were compared: end-to-end suture anastomosis (absorbable and non-absorbable sutures), telescopic 2-suture anastomosis, sutureless telescopic adhesive anastomosis (fibrinogen, IMMUNO AG Wien), and telescopic 2-suture adhesive anastomosis. The tissue restitution was better in suture anastomosis carried out with absorbable sutures than performed with non-absorbable suture material. The sutureless telescopic adhesive anastomosis is a very gentle method, but the anastomoses are not always stable enough. The advantages of the telescopic 2-suture adhesive anastomosis (absorbable sutures, fibrinogen adhesive) are relatively small lesions of the vascular wall, good restitution and sufficient stability. The patency rate (96%) corresponds to that of the end-to-end suture anastomoses (94%). The clinical application of the telescopic anastomosis is estimated critically, and evidently it is more suitable for microarteries than for microveins.

Animals↗

PubMed1984

Improved neurologic function following repair of type I aortic dissection with an intraluminal prosthesis.

Repair of type I dissection of the aorta by suturing is often complicated by intraoperative and postoperative bleeding. To avoid these complications, the authors use a sutureless ringed intraluminal prosthesis. They describe the case of a 62-year-old woman who had paralysis of the lower extremities with acute type I dissection of the aorta. Emergency surgical intervention 14 hours after onset of symptoms and repair with the intraluminal graft resulted in minimal aortic insufficiency and almost complete functional recovery. An aggressive surgical approach to patients with profound neurologic deficits due to aortic dissection is justified. Repair with the sutureless intraluminal prosthesis is simple and safe and may allow recovery of neurologic function.

Aortic Diseases↗

PubMed1984

[Clinical evaluation of continuous myocardial electrostimulation of the atria in the sick sinus syndrome].

Forty-four patients with the syndrome of pacemaker weakness were subjected to the operation of the continuous electrostimulation of the right atrium from the infrasternal access using sutureless electrodes. Patients with grave attendant diseases were shown to benefit from this procedure. The use of Soviet commercially available sutureless electrodes makes it possible to considerably simplify the main stage of the operation and to ensure the reliable functioning of the biocontrolled cardiostimulators at the long-term postoperative period.

Adult↗

PubMedDate not supplied

[Initial experience with the AKA-2 and AKA-4 device for intestinal compression anastomosis in colorectal surgery].

A prospective study was undertaken to analyse the results of sutureless colorectal anastomosis, by using an anastomotic compression device designed by Russians, the AKA gun. Ten patients were submitted do colorectal resection, 5 for retrosigmoid cancer, 3 for familial adenomatous polyposis and 2 for rectal procidentia. No mortality. Anastomotic leakage occurred in 1 patient which was treated by a defunctioning colostomy and had a good recovery. Clinical, radiologic and endoscopic postoperative controls were within normality. Comparisons are made between the sutureless anastomosis technique and the traditional ones. Initial results are regarded, by the authors, as encouraging and so they intend to go on the study.

Adult↗

PubMedDate not supplied

In vitro laser nerve repair: protein solder strip irradiation or irradiation alone?

BACKGROUND: This study investigated the potential of sutureless nerve repair using two promising laser fusion methods: direct 2 microns irradiation of the epineurium, and protein solder assisted epineurial fusion using a 800 nm laser. MATERIALS AND METHODS: Laser anastomosis of the rat sciatic nerve was performed in vitro without stay sutures in two groups of six animals. In the first group, direct laser fusion used a pulsed Cr, Tm: YAG laser. In the second group an albumin-based fluid solder containing the dye indocyanine green was applied to the epineurium, then irradiated with a diode laser. These two techniques were compared with regards to coaptation success and axonal damage. RESULTS: Direct laser welding produced weak bonds despite microscopic investigation of the irradiated nerves showing fusion of the epineurium. The unsatisfactory bonding can be attributed to poor tissue overlap and insufficient protein in the thin epineurium denaturation of underlying axons was also observed. In contrast, the laser solder method produced successful welds with greatly reduced axonal damage, and significantly improved the tensile strength. CONCLUSIONS: This study confirmed the technical possibilities of sutureless nerve anastomosis. Laser activated solders enable stronger bonds, by the addition of protein to the anastomosis site, and less thermal damage to underlying tissue through selective absorption of laser energy by dye in the solder. Further in vivo studies are required before drawing final conclusions.

Anastomosis, Surgical↗