Surgical technology international
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Comparative Study
Risk of gas embolism in hand-assisted versus total laparoscopic hepatic resection.
Laparoscopic hepatic resection represents an alternative to open surgery in patients with advanced underlying hepatic disease. Management of haemorrhage and the risk of gas embolism are the major problems in laparoscopic liver surgery. In this study, safety and efficacy of liver dissection using ultrasonic energy was investigated in hand-assisted versus total laparoscopic surgery. ⋯ The use of an ultrasound aspirator system enables an effective laparoscopic hepatic dissection. Total laparoscopic liver dissection is at increased risk for gas embolism, whereas hand-assisted laparoscopic procedure appears to reduce this risk. Due to tactile response and facilitated retraction of the liver parenchyma, the hand-assisted procedure shows impressive advantages in laparoscopic liver surgery.
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Patella baja, that can be divided into congenital, acquired, or a combination of the two, is commonly encountered in total knee arthroplasty (TKA). Congenital patella baja refers to a patella distal in relationship to the femoral trochlea and present since an early age. Acquired patella baja may occur secondary to distal positioning of the patella relative to the femoral trochlea or shortening of the patellar tendon, as a result of trauma or surgery. ⋯ Treatment of patella baja first depends on determining the cause and distinguishing between patella baja and pseudo-patella baja. Five different methods to measure patella baja are reviewed and include: (1) Blumensaat's line, (2) Insall-Salvati ratio, (3) Modified Insall-Salvati ratio, (4) Blackburne-Peel, and (5) Caton-Deschamps. Corrective measures include reestablishing the joint line by use of distal femoral augments, tibial tubercle osteotomy with proximal displacement, lengthening of the patellar tendon, shaving of the anterior portion of the tibial polyethylene, and placement of the patellar implant in a cephalad position.
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Our institution has performed over 100 robot-assisted mitral valve repairs. The procedure has shown many advantages to conventional sternotomy-based repair. However, the robotic approach leads to longer cross-clamp and bypass times than conventional sternotomy. ⋯ The animal studies show excellent tissue incorporation. Short-term echocardiographic imaging shows durability without evidence of mitral stenosis or regurgitation. Further studies are ongoing in our patient population, and the data suggest shorter, more efficient and effective robot-assisted mitral valve repairs.
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The purpose of this study was to evaluate whether an adequate prosthetic mesh fixation in laparoscopic preperitoneal inguinal hernia repair can be achieved with fibrin sealant (FS) (Tisseel trade mark, Hyland/Immuno Div., Baxter Healthcare Corp., Deerfield, IL, USA), and compare it with stapled fixation. The use of staples for prosthetic mesh fixation in laparoscopic preperitoneal hernia repair is associated with a small but significant number of complications, mainly nerve injury and hematomas. An alternative method of fixation should be as efficient as staples in preventing graft migration. ⋯ An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS, based on our experimental evidence. The FS is equivalent to fixation achieved by staples and superior to no fixation. Soft fixation with FS prevents graft migration and avoids complications associated with use of staples.
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Diabetic foot and pressure ulcers are chronic wounds by definition. They share similar pathogeneses; i.e., a combination of increased pressure and decreased angiogenic response. ⋯ The authors developed the following paradigm, which has proved to be highly effective for complete healing of these wounds: 1) recognition that all patients with limited mobility are at risk for a sacral, ischial, trochanteric, or heel pressure ulcer; 2) daily self-examination of the sacral, ischium, buttocks, hips, and heels of all bed-bound patients and the feet of patients with diabetes with risk factors (e.g., neuropathy); 3) initiation of a treatment protocol immediately upon recognition of a break in the skin (i.e., emergence of a new wound); 4) objective measurement by planimetry of every wound (at a minimum, weekly) and documentation of its progress; 5) establishment of a moist wound-healing environment; 6) relief of pressure from the wound; 7) debridement of all non-viable tissue in the wound; 8) elimination of all drainage and cellulitis; 9) cellular therapy or growth factors for patients with wounds that do not heal rapidly after initial treatment; and 10) continuous physical and psychosocial support for all patients. If this paradigm is followed, most diabetic foot and pressure ulcers are expected to heal.