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PURPOSE: The purpose of this study was to determine whether the continuous horizontal mattress suture technique can replace the continuous simple suture technique and to compare the results with other microvascular suture procedures. METHODS: Sixty-four femoral arteries of 32 Sprague-Dawley rats were used in this study. The animals were divided equally into 4 groups with 16 anastomoses in each group. The arteries (0.8-1.0 mm diameter) were anastomosed by using the continuous horizontal mattress suture technique in group I, interrupted horizontal mattress suture technique in group II, simple interrupted suture technique in group III, and simple continuous suture technique in group IV. At the end of the anastomosis time, leakage, and patency were assessed and graded in all groups. On the 14th day after surgery the rats were killed and 5 patent specimens from each group were examined under light microscopy for histology. One specimen from each group was prepared for scanning of the endothelial surface under electron scanning microscopy. RESULTS: Group I anastomoses were performed the most quickly. Groups I and III anastomoses had 100% patency rates. Under light microscopy the edge eversion was apparent consistently and under electron microscopy all endothelial surfaces were intact and no suture material was seen in groups I and II. In group III some suture material was covered by endothelial cells and lumen surfaces were torn; endothelization also was rough compared with groups I and II. In group IV suture material was seen in the lumen because of a loose suture knot. The endothelium also was not regular. CONCLUSIONS: The horizontal mattress suturing technique is the only technique in which the suture material never contacts the lumen. Continuous horizontal mattress suture technique is superior to the other microvascular procedures and is the safest and fastest procedure for microvascular anastomosis in rats.
PURPOSE: This retrospective study was performed to assess the clinical outcome of patients who have undergone trigeminal nerve microsurgical repair of the inferior alveolar nerve. MATERIALS AND METHODS: This study includes all patients who underwent microsurgical repair of the inferior alveolar nerve at the University of Medicine and Dentistry of New Jersey from July 1, 1998 through June 30, 2003. Each patient underwent a thorough evaluation of sensory nerve function that included the type of injury, date of injury, and neurosensory testing. The evaluation was performed pre- and postoperatively to assess sensory improvement. Through chart review and quantitative statistical analysis, the outcome of inferior alveolar nerve microsurgical repair was assessed to ascertain which sensory variables were statistically significant in showing improvement from microsurgical procedures. RESULTS: Thirty-two patients underwent microsurgical repair of their inferior alveolar nerve injury by the same surgeon. The average period of time from initial nerve injury until primary surgical repair was 6.6 months. Four patients did not follow-up postoperatively and were excluded from the final data. Of the remaining 28 patients, mean follow-up period was 9.5 months. It was determined that 26 patients (92.9%) had statistically significant neurosensory improvement, with 14 reporting (50%) significant improvement, 12 patients (42.9%) with slight improvement, and 2 patients (7.1%) demonstrating no improvement. No statistical evidence was found to support that a decrease in time from injury to surgery had improved results in this limited patient population. CONCLUSION: Microsurgical repair provides an improvement in neurosensory function in patients that present with an inferior alveolar nerve injury.
OBJECTIVES: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. METHODS: A retrospective study of 103 patients with glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2) treated from October 1993 to June 2001. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. RESULTS: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 5 years after primary surgery alone was 100% for the Tis, 96.05% for the T1, and 100% for the T2. Local control at 5 years after exclusive CO2 laser salvage surgery was 98.03%. The probability of remaining free of local recurrence 5 years after any type of salvage surgery was 100%. Laryngeal preservation was achieved in 100% of the cases. CONCLUSIONS: According to the present series, endoscopic CO2 laser surgery is an effective treatment for early glottic cancer. EBM RATING: C-4.
TEM has been used effectively to treat large rectal polyps and early rectal malignancy for more than 20 years in Europe. Until recently, only a few specialized centers offered TEM in the United States, where it is now gaining popularity. Many hospitals have purchased equipment and are offering TEM; however, the equipment is expensive and the learning curve is steep. Therefore, it is essential that anyone performing TEM have an adequate number of cases to develop and maintain expertise in this technique. That being said, TEM remains unique when compared with laparoscopy and other minimally invasive techniques that incorporate less invasive methods of performing old operations. TEM allows surgeons to perform operations that were impossible before the development and acceptance of this technique.
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BACKGROUND: As minimally invasive approaches to cardiac surgery have expanded, a significant number of limitations have become apparent, particularly the lack of adequate precision with standard endoscopic instruments. We hypothesized that the use of robotics would eliminate some of these limitations. METHODS: Twenty-five coronary anastomoses on an isolated porcine heart, using an arterial conduit to the left anterior descending artery, were performed endoscopically with a microsurgical robotic system. Sophisticated robotic engineering was used to control modified endoscopic instruments under direct surgeon control. Computer tremor elimination and motion scaling allowed for precise maneuvering. An arteriotomy was placed in the left anterior descending artery, and an arterial conduit was positioned for anastomosis. The camera and port sites were placed 90 degrees from the long axis of the arteriotomy. A 7-0 Prolene (Ethicon, Somerville, NJ) suture was used to perform the anastomosis in a continuous fashion, begun at the 12 o'clock position and continued counterclockwise. After completion of half of the anastomosis, the conduits were pulled down and the final sutures were placed. The sutures were tied intracorporeally and the procedure was completed. RESULTS: The 25 conduits were successfully completed and showed good probe patency. Average time for completion of the anastomosis was 31.7 +/- 2.0 minutes. Appropriate port placement and orientation, and stabilization of the conduits were critical. The lack of tremor and motion scaling allowed for the precise movements needed to complete an endoscopic microvascular anastomosis. CONCLUSIONS: Coronary artery anastomoses are technically feasible with use of robotic instrumentation. This technology may enable the development of a truly endoscopic approach to bypass surgery.
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