scholarly journals EFFECT OF POSITIONING ON LENGTH OF THE VENTRAL ABDOMEN, ABDOMINAL INCISION, AND SUTURE TENSION IN ANESTHETISED HORSES

2021 ◽  
Vol 33 (S12) ◽  
pp. 52-52
Keyword(s):  
Abdominal Incision ◽  
Suture Tension

scholarly journals Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

2021 ◽  
Author(s):  
Eric M. Haas ◽  
Thais Reif de Paula ◽  
Roberto Luna-Saracho ◽  
Melissa Sara Smith ◽  
Jean-Paul J. LeFave
Keyword(s):  
Complicated Diverticulitis ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice ◽  
Abdominal Incision ◽  
Stepwise Approach ◽  
Stapling Device ◽  
Video Recordings ◽  
Conversion Rates ◽  
Technical Modifications ◽  
Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

Impact of Abdominal Incision Type on Postoperative Pain and Quality of Life Following Hepatectomy

2021 ◽  
Author(s):  
Genki Watanabe ◽  
Takeaki Ishizawa ◽  
Satoshi Yamamoto ◽  
Takashi Kokudo ◽  
Yujiro Nishioka ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Pain ◽  
Abdominal Incision

Biomechanics of Arytenoid Adduction Surgery in an Ex Vivo Canine Model

1998 ◽  
Vol 107 (6) ◽  
pp. 454-461 ◽  
Author(s):  
J. Pieter Noordzij ◽  
Donald F. Perrault ◽  
Peak Woo
Keyword(s):  
Vocal Fold ◽  
Ex Vivo ◽  
Canine Model ◽  
Vocal Fold Paralysis ◽  
Lateral Movement ◽  
Arytenoid Adduction ◽  
Vocal Process ◽  
Process Procedures ◽  
Suture Tension

The biomechanics of arytenoid adduction surgery are not well understood. An excised canine larynx model was used to study the effects of variable suture tension on glottal configuration and on vocal fold tension (at the midfold and the vocal process). Arytenoid adduction both medializes the vocal fold and closes a posterior glottal chink. Vocal fold tension at the midfold did not vary significantly with suture tension. As suture tension increased to approximately 100 g, vocal fold tension at the vocal process also increased. Beyond 100 g of suture tension, vocal fold tension at the vocal process did not increase. We conclude that the effects of suture tension on the resistance to lateral movement are different at the midfold compared to the vocal process. Procedures for surgical rehabilitation of vocal fold paralysis should address the biomechanical subunits of the larynx individually in order to achieve optimum results.

A Biodegradable Stent Based on Poly(L-Lactide) and Poly(4-Hydroxybutyrate) for Peripheral Vascular Application: Preliminary Experience in the Pig

2007 ◽  
Vol 14 (5) ◽  
pp. 725-733 ◽  
Author(s):  
Carsten Michael Bünger ◽  
Niels Grabow ◽  
Katrin Sternberg ◽  
Martin Goosmann ◽  
Klaus-Peter Schmitz ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Mechanical Stability ◽  
Vascular Trauma ◽  
Metal Stents ◽  
Peripheral Vascular ◽  
Abdominal Incision ◽  
Biodegradable Stent ◽  
Balloon Catheters ◽  
Future Work

Purpose: To assess the technical feasibility and biocompatibility of a novel stent based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for peripheral vascular applications. Methods: A polytetrafluoroethylene aortobi-iliac graft was implanted in 5 pigs through a midline abdominal incision. After transverse graft limb incision, 5 PLLA/P4HB stents and 5 metal stents (316L stainless steel) were randomly deployed at both iliac anastomotic sites with 6-mm balloon catheters. Angiography was performed to determine patency prior to sacrifice at 6 weeks. Stented segments were surgically explanted and processed for quantitative histomorphometry. Vascular injury and inflammation scores were assigned to the stented iliac segments. Results: No animals were lost during follow-up. All PLLA/P4HB stents were deployed within 2 minutes by balloon inflation to 8 bars without rupture of the stent struts or anastomotic suture. All stents were patent on postprocedural angiography. Histological analysis showed no signs of excessive recoiling or collapse. PLLA/P4HB stents demonstrated decreased residual lumen area and increased neointimal area after 6 weeks (12.27±0.62 and 8.40±1.03 mm2, respectively) compared to 316L stents (13.54±0.84 and 6.90±1.11 mm2, respectively) as the result of differences in stent areas (PLLA/P4HB: 4.31±0.15 mm2; 316L: 2.73±0.29 mm2). Vascular injury scores showed only mild vascular trauma for all stents (PLLA/P4HB: 0.41±0.59; 316L: 0.32±0.47). Inflammatory reaction was slightly higher around PLLA/P4HB stent struts (1.39±0.52) compared to 316L (1.09±0.50). Conclusion: Rapid balloon expansion of PLLA/P4HB stents is feasible without risk of strut rupture. PLLA/P4HB stents provide adequate mechanical stability after iliac anastomotic stenting in pigs. Smaller residual luminal areas in the PLLA/P4HB stents might have been caused by tissue ingrowth into the larger strut interspaces due to higher strut thickness (stent area) in this group. This limitation needs to be addressed in future work on the stent design.

scholarly journals Axial torsion and gangrene of Meckel’s diverticulum: Case report

2015 ◽  
Vol 143 (1-2) ◽  
pp. 79-82
Author(s):  
Sasa Radovic ◽  
Drago Albijanic ◽  
Marko Albijanic ◽  
Zoran Krstic
Keyword(s):  
Epigastric Pain ◽  
Ileocecal Valve ◽  
Postoperative Recovery ◽  
Normal Appearance ◽  
Abdominal Incision ◽  
Surgical Exploration ◽  
Axial Torsion ◽  
Abdominal Symptoms ◽  
Complete Physical Examination ◽  
Midline Abdominal Incision

Introduction. Meckel?s diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. Case Outline. An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with endto- end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. Conclusion. Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

scholarly journals Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

2021 ◽  
Author(s):  
See Liang Lim ◽  
Mohd Shahrulsalam Mohd Shah ◽  
Norsuhana Omar
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Clinical Symptoms ◽  
Simple Procedure ◽  
Bowel Perforation ◽  
Male Infant ◽  
Distal Portion ◽  
Communicating Hydrocephalus ◽  
Abdominal Incision ◽  
Abdominal Complication ◽  
Shunt Procedure

Introduction: Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common. Aim: The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion. Case study: We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication. Results and discussion: Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs. Conclusions: Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

scholarly journals Transanal Anastomosis Method and Prolapsing Technique in Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer

2021 ◽  
Vol 105 (1-3) ◽  
pp. 21-25
Author(s):  
Takuya Shiraishi ◽  
Naoki Tomizawa ◽  
Tatsumasa Andoh ◽  
Takuhisa Okada ◽  
Naoya Ozawa
Keyword(s):  
Laparoscopic Surgery ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Abdominal Cavity ◽  
Intracorporeal Anastomosis ◽  
Lower Rectal Cancer ◽  
Abdominal Incision ◽  
Laparoscopic Low Anterior Resection ◽  
Double Stapling ◽  
Totally Laparoscopic

There are some reports of totally laparoscopic surgery performed by intracorporeal anastomosis without abdominal incision. However, intracorporeal anastomosis with prolapsing technique is difficult and complicated via laparoscopic surgery alone. We found it easier to achieve totally laparoscopic low anterior resection (LAR) by anastomosis anally. Our procedure was performed in 32 patients. After the prolapsed rectum with the tumor was transected, reconstruction was performed by using a double-stapling technique (DST) or a hand-sewn technique (HST). In the DST, the proximal colon was pulled outside transanally, and the anvil head was inserted into the colon and returned to the abdominal cavity. The anal-side rectum was closed using a linear stapling device, and DST was performed. The HST was modified from intersphincteric resection anastomosis. No patient experienced complications associated with this procedure. Cosmetic satisfaction was achieved. All patients obtained disease-free margins pathologically, and none experienced local recurrence. Intracorporeal anastomosis of totally laparoscopic low anterior resection is difficult via laparoscopic ports only. It can be simplified by operating with anastomosis via the anus.

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