Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures

2021 ◽  
pp. 229255032110196
Author(s):  
Alex V. Orădan ◽  
George C. Dindelegan ◽  
Ramona C. Vinaşi ◽  
Maximilian V. Muntean ◽  
Maximilian G. Dindelegan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Operative Time ◽  
Promising Result ◽  
Tissue Adhesive ◽  
Alternative Methods ◽  
Clinical Implementation ◽  
Total Operative Time ◽  
Interrupted Suture ◽  
Group A ◽  
Magnetic Resonance Imaging Mri

Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats’ femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.

scholarly journals Outcome of Single Shot versus Serial Dilatation Technique for Percutaneous Nephrolithotomy

2020 ◽  
Vol 23 (2) ◽  
pp. 124-128
Author(s):  
AHM Mostofa Kamal ◽  
Md Shawkat Alam ◽  
Md Naushad Alam ◽  
Md Safiul Alam Babul ◽  
Anup Roy Chowdhury ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clearance Rate ◽  
Operative Time ◽  
Postoperative Hospital Stay ◽  
Access Time ◽  
Single Shot ◽  
Total Operative Time ◽  
Stone Clearance ◽  
Group A ◽  
Group B

Background: Percutaneous nephrolithotomy (PCNL) is a common procedure for the removal of renal stones larger than 2 cm size with the advantages of lower morbidity rates, decrease in post-operative pain with faster post-operative recovery & thereby less duration of postoperative hospital stay. One of the fundamental steps of PCNL is the creation of the nephrostomy access. It can be done either by single shot dilatation or by multi-increment serial dilatation technique. Objectives: To compare the outcome of PCNL done by single versus serial dilatation technique with specific reference to renal access time, total operative time, stone clearance rate, postoperative haematuria and duration of postoperative hospital stay. Methods: It was a prospective interventional study with a sample size of sixty where odd number patients were included in group A (PCNL by single shot dilatation technique) & even number patients were in group B (PCNL by serial dilatation technique). After meticulous checking and rechecking, collected data were compiled and statistical analysis was done using computer based software SPSS (statistical package for social science, Version- 16) and Students t-test and Chi-square test were applied for hypothesis testing. ‘P’ value <0.05 was considered as significant. Results: Comparison between the two groups regarding stone size, stone clearance rate, postoperative haematuria and postoperative hospital stay were not statistically significant (p> 0.05). But mean renal access time in minutes (group A was 3.43 ± 1.14 and group B was 4.20 ± 1.37) and the mean operative time in minutes (group A was 91.13 ± 19.08 and group B was 101.67 ± 15.81) between the groups were statistically significant (p < 0.05). Conclusion: Percutaneous nephrostomy access can be successfully performed by single shot dilatation technique during PCNL with the advantages of shorter renal access time and total operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.124-128

scholarly journals Comparison between Tissue Adhesive Cyanoacrylate and Suture for Palatal Fibromucosa Healing: A Randomized Controlled Study

Materials ◽  
2021 ◽  
Vol 14 (22) ◽  
pp. 7009
Author(s):  
Carlota Castro-Gaspar ◽  
Maria Victoria Olmedo-Gaya ◽  
Maria Nuria Romero-Olid ◽  
Maria Jesús Lisbona-Gonzalez ◽  
Marta Vallecillo-Rivas ◽  
...  
Keyword(s):  
Wound Healing ◽  
Postoperative Pain ◽  
Operative Time ◽  
Tissue Adhesive ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Donor Area ◽  
Group A ◽  
Gingival Graft

Cyanoacrylate tissue adhesive is proposed to promote soft tissue healing in oral surgery and minimize complications (pain, inflammation, and bleeding) associated with wound healing by secondary intention. The objective was to compare cyanoacrylate tissue adhesive (test group) with suture (control group) in terms of postoperative complications, operative time, and wound healing in the palatal donor area after harvesting a de-epithelialized gingival graft. A randomized controlled clinical trial was performed in 24 patients randomly assigned to one of two study groups. Data were gathered on wound bleeding, operative time, postoperative pain, inflammation, hyperesthesia, necrosis, and donor area healing time. Operative time was almost 50% shorter in the tissue adhesive cyanoacrylate group, a significant between-group difference (p = 0.003). Spontaneous bleeding in the donor area during the first 24 h was observed in 11.1% of the tissue adhesive cyanoacrylate group versus 88.9% of the suture group—a significant difference. No significant between-group difference was observed in postoperative pain, inflammation, or degree of healing over time. There were no cases of hyperesthesia or wound necrosis. Utilization of tissue adhesive cyanoacrylate rather than suture in palatal de-epithelialized gingival graft harvesting reduces postoperative bleeding during the first 24 h, as well as the operative time.

scholarly journals Laser Surgery for Treating Retarded Teeth Eruption in Children

2021 ◽  
Author(s):  
Dan Xu ◽  
Peipei Wang ◽  
Hualian Liu ◽  
Min Gu
Keyword(s):  
Pain Intensity ◽  
Laser Surgery ◽  
Operative Time ◽  
Healing Time ◽  
Total Operative Time ◽  
Surgery Group ◽  
Significant Difference ◽  
Pain Duration ◽  
Group A ◽  
Group B

Abstract Objective: To analyze the efficacy of laser surgery in treating retarded eruption in children.Method: Sixty-three children (age：7-13 ，30 boys and 33 girls)were selected and according to the random number table divided into three groups: Laser surgery group (group A), electrosurgery group (group B), and routine surgery group (group C).The total operative time, the duration of pain after gingival excision, and VAS pain intensity scores, gingival healing time, and intraoperative coordination were all recorded . Pain intensity was assessed using a Visual Analogue Scale (VAS) score (0 to 100mm). At six months during the follow-up, this physician checked and recorded the periodontal indicators of permanent teeth, including gum index (GI), plaque index (PLI), and probing depth (PD).Results: All teeth erupted normally in three groups after treatment, showing normal pulp and periodontal tissue. There was no significant difference in operative time, pain duration, pain intensity, healing time between group A and group B. There was a significant difference in total operative time, pain duration, pain intensity, and healing time between electrosurgery group (group B) and routine surgery group (group C) (P<0.05).There was a significant difference in total operative time, pain duration, pain intensity, and healing time between laser surgery group (group A) and routine surgery group (group C) (P<0.05).Periodontal indexes, including gingival indexes, plaque indexes, were examined in three groups at six months after treatment by the same periodontist. Then, the efficacy of the three methods was compared.Conclusion: Laser surgery and high-frequency electrosurgery has favorable efficacy, less pain, and higher operability. However, in the use of the electric knife, the paste flavor may discomfort the children, make them less cooperative, and prolong the procedures.

scholarly journals A comparative study on the use of holmium laser and pneumatic lithotripser for intracorporeal lithotripsy of upper ureteric stones

2019 ◽  
Vol 7 (1) ◽  
pp. 54
Author(s):  
Elias Sharma ◽  
Raja Langer ◽  
Bhavna Langer
Keyword(s):  
Length Of Stay ◽  
Operative Time ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Holmium Laser ◽  
Cross Sectional ◽  
Total Operative Time ◽  
Group A ◽  
The Difference ◽  
Group B

Background: In the last decade different minimally invasive modalities for management of urolithiasis have been available requiring an intelligent decision by the urologist to choose one as per patients need and preferences.Methods: The present cross sectional study was conducted among patients who underwent ureterorenoscopic lithotripsy for proximal ureteric stones in the Department of Urology. Using consecutive sampling technique, patients were randomly allocated to two groups for treatment with either pneumatic lithotripser (group A) or Holmium laser lithotripser for fragmentation of calculi (group B) and the comparison of both these techniques was done.Results: 117 patients were included (57 and 60 in group A and group B respectively) in the study. The difference in age in the two groups was found to be statistically significant (p=0.03). The total operative time, length of stay in hospital and complications were more in group A patients. The difference in two groups for total operative time and length of stay in hospital was statistically significant (p=0.00 and 0.00 respectively).Conclusions: Holmium laser lithotripser has better safety profile when compared to pneumatic lithotripser especially in stone clearance rate and retropulsion rates and could be used as modality of choice in proximal ureteric stones.

Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Ryan D McMullan ◽  
Rachel Urwin ◽  
Peter Gates ◽  
Neroli Sunderland ◽  
Johanna I Westbrook
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Random Effects ◽  
Team Performance ◽  
Operative Time ◽  
Meta Analysis ◽  
Individual Performance ◽  
Negative Effects ◽  
Total Operative Time ◽  
Operative Duration

Abstract Background The operating room (OR) is a complex environment in which distractions, interruptions, and disruptions (DIDs) are frequent. Our aim was to synthesise research on the relationships between DIDs and (a) operative duration, (b) team performance, (c) individual performance, and (d) patient safety outcomes; in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO) and reference lists were systematically searched. Included studies were required to report quantitative outcomes of the association between DIDs and team performance, individual performance, and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. A random effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n=15), of moderate quality (n=15). DIDs were often defined, measured, and interpreted differently in studies. DIDs were significantly associated with: extended operative duration (n=8), impaired team performance (n=6), self-reported errors by colleagues (n=1), surgical errors (n=1), increased risk and incidence of surgical site infection (n=4), and fewer patient safety checks (n=1). A random effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% CI 15.7-29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

scholarly journals Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery

2021 ◽  
Author(s):  
K. Nagayoshi ◽  
S. Nagai ◽  
K. P. Zaguirre ◽  
K. Hisano ◽  
M. Sada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Right Colectomy ◽  
R0 Resection ◽  
Medial Approach ◽  
Total Operative Time ◽  
Advanced Tumors

Abstract Background The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. Methods This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. Results There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36–91 years)] and 66 in the medial group [42 females, median age 72 years (range 41–91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. Conclusions The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

scholarly journals Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System

2021 ◽  
pp. 014556132110121
Author(s):  
Tzu-Hsien Yang ◽  
Chien-Liang Fang ◽  
Chong-Bin Tsai ◽  
Ming-Shan Chen ◽  
Chih-Hsuan Changchien ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Communication System ◽  
Closed Reduction ◽  
Operative Time ◽  
Nasal Bone ◽  
Plain Film ◽  
Ao Classification ◽  
Group A ◽  
Picture Archiving And Communication ◽  
Group B

Objectives: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon’s experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B ( P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B ( P < .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

scholarly journals Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

2021 ◽  
Vol 10 (13) ◽  
pp. 2742
Author(s):  
Amelia Pietropaolo ◽  
Thomas Hughes ◽  
Mriganka Mani ◽  
Bhaskar Somani
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Stone Fragmentation ◽  
System Versus ◽  
Number Of Patients ◽  
Higher Power ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Second Procedure

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

Regional blood flow in the brain and spinal cord of hypothermic rats

1989 ◽  
Vol 257 (3) ◽  
pp. H785-H790
Author(s):  
T. Sakamoto ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Brain Stem ◽  
Regional Blood Flow ◽  
Experimental Conditions ◽  
Pentobarbital Sodium ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Brain

[14C]butanol tissue uptake was used to measure simultaneously regional blood flow in three regions of the brain (cerebral and cerebellar hemispheres and brain stem) and in five levels of the spinal cord in 10 normothermic rats (group A) and in 10 rats in which rectal temperature had been lowered to 27.7 +/- 0.3 degrees C by applying ice to the torso (group B). Pentobarbital sodium anesthesia was used. Mean arterial blood pressure varied minimally between groups as did arterial pH, PO2, and PCO2. In group A, regional spinal cord blood flow (rSCBF) varied from 49.7 +/- 1.6 to 62.6 +/- 2.1 ml.min-1.100 g-1; in brain, regional blood flow (rBBF) averaged 74.4 +/- 2.3 ml.min-1.100 g-1 in the whole brain and was highest in the brain stem. rSCBF in group B was elevated in all levels of the cord by 21-34% (P less than 0.05). rBBF, however, was lowered by 21% in the cerebral hemispheres (P less than 0.001) and by 14% in the brain as a whole (P less than 0.05). The changes in calculated vascular resistance tended to be inversely related to blood flow in all tissues. We conclude that rBBF is depressed in acutely hypothermic pentobarbital sodium-anesthetized rats, as has been noted before, but that rSCBF rises under these experimental conditions. The elevation of rSCBF in hypothermic rats confirms our previous observations.

scholarly journals Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yangjing Lin ◽  
Jin Cao ◽  
Changgui Zhang ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Achilles Tendon ◽  
Recurrence Rate ◽  
Operative Time ◽  
Achilles Tendon Rupture ◽  
Tendon Lengthening ◽  
Group A ◽  
Achilles Tendon Lengthening ◽  
The Mean ◽  
Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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