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At least 667 records · Page 37Linked to original sources

PubMed2005

A new mechanical connector for distal coronary artery anastomoses in coronary artery bypass grafting: a randomized, controlled study.

OBJECTIVE: A new mechanical anastomotic device was evaluated, aiming at its future use in minimally invasive techniques or limited access surgery in patients undergoing coronary artery bypass grafting. METHODS: Between April and December 2002, a total of 60 patients scheduled for elective multivessel bypass grafting were randomly assigned. One vein graft-coronary artery anastomosis per patient was either performed with the St Jude Medical ATG coronary connector system (n = 30; St Jude Medical Inc, St Paul, Minn) or hand sewn (n = 30). Selective coronary angiography or coronary magnetic resonance imaging of the studied graft and vessel was included in the 6-month follow-up. RESULTS: Twenty-eight of the connectors were successfully implanted. Two patients were excluded from the study because of conversion to hand-sewn anastomoses. Six connector-made anastomoses were bleeding at the anastomotic site. At the time of follow-up (190 postoperative days), all control anastomoses and grafts were patent, whereas 26% of the connector anastomoses were occluded. One graft in each group was patent but with stenosis. CONCLUSION: The St Jude Medical ATG coronary connector system for distal anastomoses represents a new concept for sutureless anastomoses in cardiac surgery. This randomized, controlled study shows lower graft patency for anastomoses performed with the connector than for hand-sewn control anastomoses. It illustrates the importance of controlled studies when evaluating new technical equipment in medicine.

Adult↗

PubMed2003

A novel technique for self-sealing, wedge-shaped pars plana sclerotomies and its features in ultrasound biomicroscopy and clinical outcome.

PURPOSE: To investigate a new type of self-sealing pars plana sclerotomy clinically and by means of ultrasound biomicroscopy and to compare the outcome with conventionally sutured sclerotomies. DESIGN: Prospective, nonrandomized clinical trial. METHODS: Twenty-one patients underwent pars plana vitrectomy either with (control group) or without suturing (study group) at the Institute of Ophthalmology, University Medical Centre Nijmegen, The Netherlands, between January 1 and March 31, 2002. One day and 6 to 8 weeks postoperatively, the sclerotomy sites were studied by clinical examination and ultrasound biomicroscopy. Results were graded according to verbal descriptor scales. RESULTS: The study included 21 patients scheduled for pars plana vitrectomy of one eye. Mean follow-up time was 6.5 weeks (range, 6-8). Three patients were lost to follow-up. Of the remaining patients, 12 had self-sealing wedge-sclerotomies and six were conventionally operated. No intraoperative complications occurred in any participant and no visual loss or postoperative hypotony was observed. On the first day after surgery there was significantly more scleral dehiscence in the control group (P =.012). This divergence disappeared during the follow-up period. All other differences noticed were not statistically significant. CONCLUSIONS: Our novel technique of sutureless wedge-shaped sclerotomy allows the creation of simple, reliable, and self-sealing pars plana openings. Clinical examination and assessment by ultrasound biomicroscopy showed results to be at least as safe as conventionally sutured sclerotomies. This new method allows stable intraoperative ocular pressure conditions and seems promising.

Adult↗

PubMed1994

Computerized statistical analysis of corneal topography for the evaluation of changes in corneal shape after surgery.

We examined 20 patients for the effect of a 3-mm sutureless temporal clear corneal incision cataract operation on corneal topography, as recorded with the computer-assisted video-keratoscope TMS-1 (Computed Anatomy, Inc., New York, New York). Each topographic image was cut into 178 fields in eight concentric rings. The refractive values of these fields were stored in a database. The mean differences between the preoperative and one-month postoperative findings were calculated and transformed into color-coded maps as output for the statistical analysis. The patients operated on showed a mean flattening of 0.4 to 1.0 diopter in the temporal region. This was statistically significant by paired Wilcoxon signed-rank tests. There was no significant vertical steepening or nasal flattening, except in two isolated fields. For control purposes, we twice examined 20 age-matched volunteers who were not operated on. The paired Wilcoxon tests of this group did not show significant changes. When compared with Cravy's vector analysis, induced topographic change analysis is better at evaluating surgically induced corneal shape changes.

Aged↗

PubMed2003

Description of M-shaped preperitoneal hernioplasty for inguinocrural hernias.

BACKGROUND: The efficacy of preperitoneal herniorrhaphy is controversial in the surgical literature. The development of totally extraperitoneal video-assisted hernioplasty has stimulated further interest in long-term results of open techniques. Some of the main advantages of the two most extended preperitoneal open approaches (Stoppa and Nyhus operations) are combined in the author's technique described here. METHODS: Between March 1995 and June 1998, 180 consecutive patients with a total of 202 inguinocrural hernias were treated by an open sutureless preperitoneal repair, using a lateral approach, with placement of a 12 x 10 cm polypropylene mesh. RESULTS: Mean operating time was 48 minutes. Overall morbidity rate was 7%. Mean hospital length of stay was 2.16 days. After an average follow up of 3.5 years, the overall recurrence rate was 0.57%. CONCLUSIONS: M-shaped preperitoneal hernioplasty is a single, safe, and easy repair for inguinocrural hernias, regardless of the type of hernia or the concomitant clinicopathological features of the patient.

Adolescent↗

PubMed2001

Minimizing aortic manipulation during OPCAB using the symmetry aortic connector system for proximal vein graft anastomoses.

BACKGROUND: Since minimal invasive techniques have become increasingly common in coronary artery bypass grafting (CABG), there has been renewed interest in facilitated mechanical anastomoses devices that might have the potential of replacing the standard suturing techniques in vascular anastomoses. We report our initial experience with the successful creation of mechanical proximal vein graft anastomoses in off-pump coronary artery bypass operations. METHODS: From August to December 2000, we investigated the first 20 consecutive patients who underwent CABG on the beating heart without extracorporeal circulation and who received at least one mechanical proximal vein graft anastomosis with the St. Jude Medical Symmetry aortic connector system without side-clamping of the aorta. We evaluated the different components of the system, the feasibility of such anastomoses, and the intraoperative flow measurements of the grafts using transit time methods. RESULTS: A total of 32 proximal vein graft anastomoses were performed with the aortic connector system. Hemostasis was instantaneous in all cases except one, in which the connector was removed and the anastomosis was hand-sewn without complications. All other vein grafts were patent at the end of the procedure; intraoperative flow measurements were 39 +/- 25 mL/min for single vein grafts (n = 20) and 69 +/- 25 mL/min for sequential grafts (n = 11). CONCLUSIONS: The St. Jude Medical Symmetry aortic connector system is a user-friendly, effective, quick, and reliable device for sutureless proximal vein graft anastomosis in CABG. This system allows the construction of uniform and geometrically perfect anastomoses and does not require aortic side-biting. This technology is attractive for all CABG procedures because aortic manipulation is reduced. In off-pump surgical procedures the connector system allows aortic manipulation to be minimized, potentially reducing embolization from aortic wall debris.

Adult↗

PubMed1986

Disruption of the ascending aorta: surgical management.

A disruptive injury to the ascending aorta during a cardiac operation is a serious and often fatal event. Such an injury is described in which the aorta disrupted at the site of the proximal aortocoronary anastomoses. It was possible to repair the aorta using an intraluminal sutureless graft after other techniques of repair failed.

Aged↗

PubMed1999

Totally endoscopic myocardial revascularization: an experimental study.

BACKGROUND: The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. METHODS AND RESULTS: The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the right coronary artery. With the help of two vacuum pods, we fixed a site of the right coronary artery and made a right gastroepiploic artery-right coronary artery anastomosis. In 20 cases, continuous Prolene suture was used, and in 26 experiments, we applied a sutureless technique. Twenty-three anastomosis were patent. CONCLUSIONS: Despite the low patency rate, the transabdominal approach of totally endoscopic bypass grafting is promising and demands further investigation.

Anastomosis, Surgical↗

PubMed1993

Transparenchymal suture fixation and testicular histology in a prepubertal rat model.

We evaluate the effect on testicular histology when fine suture materials are used for transparenchymal suture fixation of the testis during orchiopexy in immature Sprague-Dawley rats. Significant inflammatory reactions were observed in all groups of animals with suture fixation regardless of suture size and material. Only 5% of the animals in the dartos pouch control group had an inflammatory response and no inflammation was noted in the nonoperative controls. Although these findings have not been documented in humans, this evidence raises concerns about the impact of surgical technique on the future reproductive capabilities of these testes. Alternatives to transparenchymal suture fixation of the testis should be considered in patients with cryptorchidism and testicular torsion. Sutureless dartos pouch placement may provide adequate fixation during most orchiopexies without risking injury to testicular structure and function.

Age Factors↗

PubMed1986

Dismembered nonstented ureteroureterostomy using the carbon dioxide laser in the rabbit: comparison with suture anastomosis.

End-to-end laser welding of transected nonspatulated ureters was compared to conventional spatulated suture anastomosis in 3 kg. rabbits. Nonspatulated sutureless ureteral welding was achieved in 12 rabbits with low energy levels from a carbon dioxide laser. In 12 other rabbits spatulated end-to-end anastomoses were performed with interrupted 7-zero chromic catgut sutures. Patency rate in the welded ureters was 92 per cent, compared to 83 per cent for the suture anastomoses. Histological changes in welded ureters were similar to the sutured ureters. Ureteral welding is achieved in far less time than suture anastomosis.

Animals↗

PubMed1998

Giant prosthetic reinforcement of the visceral sac. The Stoppa groin hernia repair.

GPRVS is a properitoneal hernioplasty with a prosthesis composed of the polyester Dacron. The repair is anatomic, sutureless, tension-free, and the absolute weapon to eliminate all types of groin hernias. No other technique produces better results for the repair of recurrent and re-recurrent groin hernias. It also is a joy to perform.

Follow-Up Studies↗

PubMed1995

Laser tissue soldering in urinary tract reconstruction: first human experience.

OBJECTIVES: Laser tissue soldering (LTS) in the urinary tract provides an immediate leak-free seal and may avoid complications seen with conventional repair (such as fistula and stricture). We have begun a Phase I clinical trial investigating the use of LTS in performing urologic reconstructive surgery. METHODS: Ten patients (aged 3 months to 38 years) underwent urologic reconstruction using LTS with a protein solder composed of human albumin (42%) and indocyanine green dye. In each case standard microsuture repair preceded laser-soldered suture line reinforcement. Anastomotic closure time and immediate leak pressure were measured. Postoperatively, all patients were evaluated for evidence of complications, including stricture, fistula formation, or impaired healing. RESULTS: Using LTS as an adjunct to suturing added an average of 7.9 +/- 3.0 minutes (28%) to the overall mean anastomotic time of 28.3 +/- 9.4 minutes. Intraoperative leak pressure measurements for laser-soldered anastomoses (> or = 94.2 +/- 24.2 mm Hg) were significantly higher (P < 0.001) than primarily sutured anastomoses (20 +/- 2.9 mm Hg). Two instances of suture disruption (20%) occurred during laser activation, neither of which were repaired with sutures. Average follow-up for all patients was 7.1 + - 2.2 months. There were no intraoperative or postoperative complications, including the 2 patients with suture disruption. CONCLUSIONS: These initial clinical results indicate that LTS is safe, easy to perform, and, contrary to conventional suturing, provides an immediate leak-free closure. Follow-up in these and other patients, as well as those undergoing sutureless and stent-free procedures, will determine whether our method of LTS benefits patients undergoing urologic reconstruction.

Anastomosis, Surgical↗

PubMed2002

Epithelial downgrowth after clear cornea phacoemulsification: report of two cases and review of the literature.

OBJECTIVE: To report two cases of diffuse epithelial downgrowth after clear cornea phacoemulsification and to review the different treatment options for this ominous disease. DESIGN: Two interventional case reports. METHODS: Retrospective review of two eyes from two different patients in whom epithelial downgrowth developed 7 and 3 months after uneventful clear cornea phacoemulsification. In the first case, the epithelial invasion seemed to be growing from the temporal incision site onto the corneal endothelium toward the visual axis. Cryotherapy was applied to the affected cornea, with control of the growing membrane. A penetrating keratoplasty was performed to restore visual function. In the second patient, the membrane was attached to the iris and posterior cornea and was confirmed by diagnostic argon laser photocoagulation. This case was surgically treated with en bloc excision and a corneoscleral graft. MAIN OUTCOME MEASURES: Visual acuity at the final follow-up visit. RESULTS: Surgical treatment of the epithelial downgrowth was different for both patients. In the postoperative period, a best-corrected visual acuity of 20/60 and 20/30 was achieved in each case. No regrowth of the membrane was observed. CONCLUSIONS: Treatment of epithelial downgrowth is controversial. We present two cases of epithelialization of the anterior chamber with either clinical or histologic confirmation after clear cornea sutureless phacoemulsification. Surgical treatment should be attempted promptly to obtain a good visual prognosis.

Aged↗

PubMed1993

Scleral flap necrosis and infectious endophthalmitis after cataract surgery with a scleral tunnel incision.

BACKGROUND: Long scleral tunnel dissection techniques have been developed for cataract surgery incisions. These incisions reduce postoperative astigmatism and keratorefractive instability. If fashioned correctly, the internal lip of the incision produces a tight seal to the anterior chamber, permissible of sutureless surgery. The behavior of such a wound during intraocular infection is unknown. METHODS: The authors describe two elderly patients in whom postoperative bacterial endophthalmitis was accompanied by infectious scleritis, infectious sclerokeratitis or keratitis, and rapid scleral flap necrosis. One of the patients had a painless disease process. RESULTS: Intraocular isolates of Staphylococcus aureus and Streptococcus equinus were recovered from the two patients, respectively. Management was complicated by loss of tectonic integrity that followed scleral flap necrosis, by impaired vitreoretinal visualization associated with rapidly progressive sclerokeratitis or keratitis, and by bacterial scleritis in the base of the scleral flap. No light perception was retained in either eye. CONCLUSION: Scleral tunnel incisions create a potential abscess cavity. Although a rare occurrence, postoperative endophthalmitis in such an eye may present major surgical and therapeutic problems intrinsic to the wound design.

Aged↗

PubMed2005

[Postoperative acute endophthalmitis: a prospective study. Clinical presentation, management and prognostic factors].

AIMS: To assess the characteristics and visual outcome of patients with acute postoperative endophthalmitis hospitalized in a referral center. MATERIALS AND METHODS: All patients suspected of having infectious endophthalmitis were included in this study. All patients were treated with the same protocol including at least intravitreal injection of antibiotics and instillation of fortified antibiotics. Symptoms, visual acuity, and slit lamp examination were recorded before treatment, at the end of hospitalization and during clinical follow-up. Treatments and biological results were also reported. For patients developing infectious endophthalmitis after cataract surgery, intraoperative management such as location of the incision, suture or sutureless incision, and material of the intraocular lens were also noted. RESULTS: Forty-one patients were included in the study over 32 months (33 patients after cataract surgery). Intraocular inflammation and a decrease in subjective visual acuity were the most frequently reported findings (90% and 94%, respectively). Ocular pain and conjunctiva injection were less frequently reported (47% and 48%, respectively). Symptoms occurred 5 days after the surgery (median); 56% of patients needed a second intravitreal injection of antibiotics. There was a significant increase in visual acuity during and after hospitalization; median final visual acuity was 4.6/10 (0.34 log MAR = 20/43); 30% of patients had less than 20/200, but 44% more than 20/40. In endophthalmitis following cataract surgery, incisions were corneal in all cases and sutured in 62% of cases. Incisions were temporal in 55% of patients. DISCUSSION: Our results are similar to those previously published for acute endophthalmitis following ocular surgery. Intravitreal antibiotic injection remains the gold standard on the management of acute postoperative endophthalmitis.

Acute Disease↗

PubMed1988

Selection of wound closure materials.

Selection of wound closure materials (sutures, needles, staples, and skin tapes) is presented. The characteristics of commonly used suture materials and needles are discussed as a background for their rational selection and usage. The attributes of staples and sutureless skin closures (skin tapes) are also given and contrasted with those of sutures.

Absorption↗

PubMed1988

Fibrin seal adhesive versus nonabsorbable microsuture in peripheral nerve repair.

Although nonabsorbable microsuture is the material most often used in human peripheral nerve repair, it is capable of eliciting a foreign body reaction, impairing vascularity, and potentially disrupting axonal regeneration. Sutureless methods, including fibrin seal adhesive, may offer an alternative to traditional suture techniques. This study compared the efficacy of fibrin seal with nylon microsuture in tibial microneurorrhaphy on 28 adult New Zealand white rabbits (14 with 10-0 monofilament nylon suture and 14 with fibrin seal). Each rabbit was reexplored at 1, 6, 12, and 18 weeks. The criteria used to compare the two methods were operative time, clinical function, electrophysiologic measures, and histologic findings. Fibrin seal repairs required less time to execute (p less than 0.01) but were inferior in mean conduction amplitude (p less than 0.01) and with respect to histologic criteria. Fibrin seal also appeared less effective in maintaining nerve approximation. We do not believe that fibrin seal provides a superior alternative to nonabsorbable suture in primary nerve repair in this experimental model.

Animals↗

PubMed2000

Astigmatism correction with a foldable toric intraocular lens in cataract patients.

PURPOSE: To determine the efficacy and rotational stability of a toric posterior chamber silicone intraocular lens (IOL) to correct preoperative astigmatism in cataract patients. SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna Austria. METHODS: Between 1993 and 1998, foldable toric single-piece plate-haptic silicone IOLs were implanted in 37 eyes (30 patients). The cylindrical IOL power was 2.00 diopters (D) (n = 29), 3.50 D (n = 7), or 4.00 D (n = 1). Phacoemulsification was performed through a scleral or a corneal sutureless self-sealing incision. Outcomes of Snellen visual acuity (without, with spherical, and with best correction), refractive and keratometric astigmatism, and IOL rotation after early postoperative (mean 15.9 days +/- 10.1 [SD]) and long-term (mean 20.3 +/- 16.6 months) follow-ups were evaluated. RESULTS: At last follow-up, 31 eyes (83.8%) had a spherically corrected and 34 (91.9%) a best corrected visual acuity of 0.5 (20/40) or better. Mean preoperative refractive and keratometric astigmatism was 2.68 and 2.70 D, respectively. At the last postoperative follow-up, mean refractive astigmatism was reduced to 0.84 D; keratometric astigmatism was 2.30 D. In 7 eyes (18.9%), the IOL axis was rotated a maximum of 25 degrees. In all 37 eyes, the axis of the toric IOL remained within 30 degrees of rotation. CONCLUSIONS: Early postoperative and long-term follow-ups showed effective and stable correction of astigmatism after implantation of a foldable toric posterior chamber silicone IOL.

Aged↗

PubMed2000

Outcome of flap subluxation after laser in situ keratomileusis: results of 6 month follow-up.

PURPOSE: To evaluate the long-term outcome in cases with flap subluxation after laser in situ keratomileusis (LASIK). SETTING: Private clinic in Turkey. METHODS: Data of all patients who had LASIK were documented and the follow-ups of those who had flap subluxation evaluated. The number of LASIK cases was 1481 and the number of flap subluxations, 21. Laser in situ keratomileusis was performed with the Moria microkeratome and the VISX Twenty/Twenty B excimer laser using a multizone profile and the sutureless hinged corneal flap technique. RESULTS: The incidence of flap subluxation was 1.42%. Statistical analysis of uncorrected visual acuities, best corrected visual acuities, and mean spherical equivalents in eyes with and without flap subluxation was performed. No significant differences were found, although the results in eyes with flap subluxation were worse than those in eyes without flap subluxation. Additional complications were also higher in eyes with flap subluxation. CONCLUSION: Flap subluxation is a serious but manageable complication of LASIK. If it is detected early, the visual prognosis is as good as that in eyes without flap subluxation.

Adult↗