Surgical technology international
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As technology has evolved, so has the ability to perform a hysterectomy in a minimallly invasive fashion. Currently, total laparoscopic hysterectomy has been further advanced with the advent of uterine manipulation devices that incorporate the use of a cupped colpotomizer. ⋯ Safe completion of these steps has the potential to minimize complications such as ureteral and bladder injury in addition to vaginal cuff dehiscence. The following technical review will address methods for the safe and effective use of various cupped colpotomizer devices during total laparoscopic hysterectomy.
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Randomized Controlled Trial
Prospective randomized study comparing quality of life after shoudice or mesh plug repair for inguinal hernia: short-term results.
Postoperative pain is a major obstacle in hernia repair surgery, and the choice of clinically efficacious surgical technique should also result in the least postoperative pain and patients' quality of life (QoL). The aim of this prospective randomized study was to compare two surgical techniques for open inguinal hernia repair by assessing the patients' QoL. Men (18-to-75 years old) with primary unilateral inguinal hernia underwent Mesh Plug (MP; n = 156; Bard (PerFix Plug, CR Bard Inc, Murray Hill, NJ) and Shouldice (S; n = 144) techniques. ⋯ The QoL was also improved in patients undergoing MP on PODs 8 and 45. Total duration of operation, length of hospital stay, and cessation of normal activities were significantly shorter in the MP group. Compared to the S technique, the MP technique results in significantly less postoperative pain and improved QoL.
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Multicenter Study
Safety biocompatibility of gelatin hemostatic matrix (Floseal and Surgiflo) in neurosurgical procedures.
Adequate hemostasis in cranial and spinal surgery is of paramount importance in a neurosurgeon's daily practice. Generalized ooze bleeding from the surgical wall cavities, coming from the dura mater or nervous tissue may be troublesome and may limit visualization in minimally invasive neurosurgery. ⋯ A total of 318 patients undergoing cranial, craniospinal, and spinal procedure with the use of gelatin hemostatic matrix (Floseal and Surgiflo) were enrolled in this clinical study. We compared the different hemostatic techniques using the gelatin hemostatic matrix, and investigated indications, time to bleeding control, and its efficacy and safety in neurosurgery.
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Osteoporosis is a major global health problem, with over 10 million people currently diagnosed with the disease. Although 80% of osteoporotic patients are women, a considerable number of men are also affected. Also, due to increasing life expectancy, the number of elderly patients with osteoporosis affected by degenerative and traumatic spinal diseases will increase further. ⋯ Post-operative clinical assessment of patients was based on the VAS and ODI questionnaire at 3 months and 1 year of follow-up. Post-operative radiologic follow-up was performed after 3 days (CT, x-ray); 3 months (x-ray); 6 months (spinal CT); and 1 year (spinal CT). Expandable pedicle screws improved pull-out strength as compared to standard pedicle screws in osteoporotic patients with degenerative and traumatic spinal diseases.
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Tension-free suburethral tapes have revolutionized the surgical treatment of female stress urinary incontinence (SUI). These tapes are inserted by way of a retropubic or transobturator route. The inside-out tension-free vaginal tape transobturator approach, or TVT-Obturator system (TVT-O, Ethicon Women's Health and Urology, Somerville, NJ), was developed ten years ago with the aim of minimizing the risk of urinary tract injuries associated with retropubic and outside-in transobturator tapes while reproducibly ensuring minimal tissue dissection. ⋯ In addition, perforation of the obturator membrane with the scissors and guide is avoided in order to reduce the depth of lateral dissection, and consequently, to maximize securing of the tape within the obturator muscular/aponeurotic structures. In a comparative anatomical study, it was indeed observed that the shorter tape traversed less muscular structures (with no or only a minimal amount of tape lying in the adductor muscles) than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal. In a single-center randomized clinical trial, after a 3-year minimum follow-up, the modified TVT-O procedure with a shorter tape and reduced dissection was found to be as safe and efficient as the primal procedure for treating female SUI, with less severe and frequent groin pain in the immediate postoperative period.