Surgical technology international
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The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. ⋯ Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases.
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Laparoscopic surgery has revolutionized the manner in which many operations are performed today. The volume of tissue to be removed during some operations can be a limiting factor for laparoscopy and is frequently a reason for converting from a minimally invasive laparoscopic surgical approach to the conventional open surgical approach. The introduction of the electronic morcellator has helped facilitate the removal of large specimens via minimally invasive surgery. ⋯ The MOREsolution™ tissue morcellator demonstrated significantly faster tissue morcellation times (544.6 ± 123.0 sec) and produced a higher number of long tissue fragments (7.44 ± 0.683) compared to the Rotocut™ G1 morcellators' time (609.7 ± 153.2 sec) and number of long tissue fragments (6.00 ± 0.638). No significant differences were found between the Gynecare Morcellex® and other morcellators in the total number of fragments obtained nor study participant opinion on the ease of use of the three morcellators. This study demonstrates that the MOREsolution™ morcellator is a faster morcellator and produces larger tissue fragments as compared to the Rotocut™ G1; however, more studies should be performed to confirm these findings in a clinical setting.
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Bladder dysfunctions have been treated for decades through medical treatments or surgical procedures, especially in the context of prolapse conditions and stress incontinence. Over the last decade, sacral nerve modulation (SNM) has been introduced as a further option in the treatment of some urinary and fecal symptoms. Current techniques of percutaneous implantation are limited to superficial extrapelvic nerves that expose patients to lead migration and dislocation or infections, complications that cannot be ignored. ⋯ One of these methods is the implantation of neuroprothesis-a technique called the "LION procedure"-which permits selective electrical stimulation of pelvic nerves and plexuses. One very interesting site of implantation for treatment of urinary and faecal symptoms is the pudendal nerve (PN). Stimulation of this nerve induces two different actions: a strong contraction of the sphincters-treatment of urinary and faecal incontinence and an inhibitory effect on the bladder-and treatment for bladder overactivity.
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Standard sutures used in vaginal cuff reapproximation in total laparoscopic hysterectomies and hysterotomy closure in myomectomies require knot placement and tensioning of the suture throughout the closure. This may contribute to wound dehiscence, increased blood loss, and ischemia of tissue surrounding the knots. In 2004, the United States Food and Drug Administration approved the Quill™ bidirectional barbed suture (Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada)(Fig. 1). ⋯ The barbs minimize tissue recoil and do so with accurate soft tissue approximation, achieving hemostasis without the use of locking and figure eight sutures. Barbed suture allows for a shorter operative time, as there is an ease of suturing without the complication of knot tying. Barbed sutures are essential tools in the modern laparoscopist's toolbox.
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Standardization of the intraoperative neuromonitoring (IONM) technique is an essential aspect of modern monitored thyroid surgery. The standardized technique involves vagal nerve stimulation. VN stimulation is useful for technical problem solving, detecting non-recurrent laryngeal nerve (non-RLN), recognizing any recurrent laryngeal nerve (RLN) lesions, and precisely predicting RLN postoperative function. Herein, we present technical notes for the VN identification to achieve the critical view of safety of the VN stimulation with or without dissection.