Journal of the American College of Surgeons
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Randomized clinical trials (RCTs) are uncommon in pediatric surgical specialties and the quality of reporting is unknown. Our primary purpose was to analyze published surgical RCTs involving children to measure adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. ⋯ Adherence to CONSORT guidelines is low across the spectrum of children's surgical specialties, although significant differences do exist. Future RCTs in children's surgical specialties should specifically focus on areas of low adherence to reporting guidelines.
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Treatment of large Achilles tendon defects is technically demanding. Tissue engineering is an option. We constructed a collagen-based artificial tendon, covered it with a polydioxanon (PDS) sheath, and studied the role of this bioimplant on experimental tendon healing in vivo. ⋯ The implants were cytocompatible, biocompatible, biodegradable, and effective in tendon healing and regeneration. This implant may be a valuable option in clinical practice.
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Laparoscopic donor nephrectomy is preferentially performed on the left side vs the right, even in instances where more complex arterial vasculature is present on the left. This finding is significant given the observation that living donor kidneys with multiple arteries are associated with increased incidence of ureteral complications in the recipient. One common anatomic variant, retrocaval bifurcation of the right renal artery, has potential risks that prompt the decision to procure left-sided kidneys with more complex arterial anatomy. However, these risks may be mitigated by the surgical approaches that can successfully procure right kidneys with this type of arterial variant. ⋯ This study provides a detailed, technical laparoscopic methodology for procurement of right-sided kidneys with retrocaval arterial bifurcation, which was associated with outcomes similar to right and left kidneys with single arteries.
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Loss of a needle during laparoscopic surgery is a rare but potentially serious adverse event that can cause prolonged operative time and patient harm. Standard recovery techniques currently include instrument count, standard visual search, and plain abdominal x-rays. We developed a laparoscopic instrument to speed the retrieval of lost needles in the abdomen and pelvis. ⋯ Recovery of lost surgical needles during porcine laparoscopic surgery is safe and feasible with a simple articulating magnetic device. Our initial in vivo experience suggests that recovery is markedly faster using the magnetic device than the standard approach, even in the hands of experienced laparoscopic surgeons. This device will be particularly useful as minimally invasive robotic and single-site surgical techniques are adopted and, in the future, it should be integrated into the standard protocol for locating lost needles during surgery.