Estimation of time utilized in suturing of oral flaps post-surgical wisdom teeth removal using Negus knot pusher instrument (a comparative study)

Wisdom teeth were the most common teeth affected among the rest of the teeth, these teeth need accurate evaluation and diagnosis, surgical removal of impacted wisdom needs time for incision, bone removal and suture, so the use of any instrument helps to reduce this time is essential. Objective The objectives of this study were to estimate the time needed for the suture of oral flaps post-surgical removal of the lower wisdom teeth by using Negus knot pusher and compare it with the time used for stitching in conventional manual holding single stitching. Material and Methods: Data had been collected from thirty patients through history, clinical examination and radiographic assessment, followed by classical surgical removal performed on the same principles for all patients, at the suture level patients divided arbitrarily into two groups, control group 15 patients and 15 patients Negus pusher group, using Negus knot pusher, which is usually used to hold the stitch and stop bleeding post tonsillectomy operations by ligation, time elapsed for suturing with knot tying is calculated for both groups. Results: Among the 30 patients incorporated in the clinical study, control group mean was (1 minutes and 11 seconds and 70 milliseconds) while for the pusher group was (1 minutes and 32 seconds and 57 milliseconds), the comparison by means of T-test was not significant with the (0.424) value. Conclusion: the Negus pusher instrument can be used for the knotting stiches post wisdom teeth removal as an auxiliary tool and the time can be shortened by the use of a modified handling technique and more satisfaction for patients. Keywords Time; Suturing; Wisdom teeth; Negus knot pusher.

Novel Instruments for Percutaneous Biportal Endoscopic Spine Surgery for Full Decompression and Dural Management: A Comparative Analysis

Background: Post-laminectomy syndrome is a common cause of dissatisfaction after endoscopic interlaminar approach. Our aim was to evaluate the efficacy and safety of our two newly designed instruments for laminotomy, a dural protector attached to the scope and a knot pusher for water-tight suturing of the incidental dural tears. Material and Methods: This was a multicenter evaluation. Efficacy was quantified as the pre-to-postoperative improvement in pain (visual analog scale), disability (Oswestry Disability Index), patient satisfaction (modified MacNab score), and length of hospital stay. Safety was quantified by the incidence and location of dural tears, rate of revision, and radiological outcomes. Outcomes were evaluated between the control (before instrument development) and experimental (after instrument development) groups. Results: There was a significant improvement in leg pain in the experimental group (p = 0.03), with greater patient satisfaction in the control group (p < 0.01). There was no incidence of dural tears in the area of the traversing and exiting nerve roots in the experimental group. Water-tightness of sutures was confirmed radiologically. Conclusion: The novel dural protector and the knot pusher for water-tight sutures improved the efficacy and safety of decompression and discectomy; however, a prolonged operative time was a drawback.

Right Anterior Minithoracotomy for Aortic Valve Replacement: A Widely Applicable, Simple, and Stepwise Approach

Objective A stepwise approach for right anterior minithoracotomy aortic valve replacement (RAT-AVR), without sutureless valves, special instruments, or preoperative imaging, was developed. We report our experience with this widely applicable, simplified approach. Methods Patients with a history of previous chest surgery, documented PVD, severe COPD, LVOT size <2.0 cm, and root size <2.8 cm were excluded. Chest CT was not mandatory. The stepwise surgical approach consists of 1) tolerability of single-lung ventilation; 2) 5-cm long incision on third right anterior ICS; 3) small pericardial opening to localize the aortic valve annular plane by digital palpation; 4) shingling of the correct rib to create a box field; 5) optimizing exposure with stay sutures; 6) femoral or central cannulation with right superior pulmonary vein venting and usual antegrade cardioplegia; 7) performing a standard AVR without adjunct instruments; and 8) reconstructing 1 costochondral cartilage. Results Fifty-five patients were operated. The mean age was 68.5 years (SD 10.4); 29.1% were female. Median STS PROM was 1.18 (0.4 to 6.6). Pump and cross-clamp times were 104.8 minutes (SD 27.9) and 73.2 minutes (SD 22.8), respectively. There was no need for a knot pusher. There was 1 conversion, 1 reopening for bleeding, and 1 pacemaker insertion. No patient had a stroke, MI, or death at 30 days. The median LOS was 6 days (3 to 19). Conclusion RAT-AVR can be applicable and performed safely in a wide range of patients by adopting a simple, stepwise approach with intraoperative assessment, without the need for special imaging, instrumentation, or advanced training.

Validation of Different Combination of Three Reversing Half-Hitches Alternating Posts (RHAPs) Effects on Arthroscopic Knot Integrity

Introduction. With arthroscopic techniques being used, the importanceof knot tying has been examined. Previous literaturehas examined the use of reversing half-hitches on alternatingposts (RHAPs) on knot security. Separately, there has been researchregarding different suture materials commonly used inthe operating room. The specific aim of this study was to validatethe effect of different stacked half-hitch configuration anddifferent braided suture materials on arthroscopic knot integrity. Methods. Three different suture materials tied withfive different RHAPs in arthroscopic knots were compared.A single load-to-failure test was performed andthe mean ultimate clinical failure load was obtained. Results. Significant knot holding strength improvement wasfound when one half-hitch was reversed as compared to baselineknot. When two of the half-hitches were reversed, therewas a greater improvement with all knots having a mean ultimateclinical failure load greater than 150 newtons (N). Comparisonof the suture materials demonstrated a higher meanultimate clinical failure load when Force Fiber® was used andat least one half-hitch was reversed. Knots tied with eitherForce Fiber® or Orthocord® showed 0% chance of knot slippagewhile knots tied with FiberWire® or braided fishing linehad about 10 and 30% knot slippage chances, respectively. Conclusion. A significant effect was observed in regards to bothstacked half-hitch configuration and suture materials used onknot loop and knot security. Caution should be used with tyingthree RHAPs in arthroscopic surgery, particularly witha standard knot pusher and arthroscopic cannulas. The findingsof this study indicated the importance of three RHAPsin performing arthroscopic knot tying and provided evidenceregarding discrepancies of maximum clinical failure loads observedbetween orthopaedic surgeons, thereby leading to bettersurgical outcomes in the future. KS J Med 2017;10(2):35-39.

Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy: an experience

Background: The objective of the study was to devise a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy.Methods: This prospective study was conducted in MMIMSR Ambala from September 2016 to August 2018. All operations were performed by the same surgical team. Mesoappendix was coagulated with bipolar cautery and cut with scissors. Two handmade Meltzer loops were placed on base of appendix and tightened using conventional graspers.Results: Around 50 patients were included in the study. The time spent for preparing and tying one loop was approximately 20-25 seconds. None of the patients had leakage from the appendicular stump. Only one polyglactin suture was used to make three loops. Knot pusher was not used in any of the patients.Conclusions: Handmade endoloop used in this prospective study for securing appendicular stump using conventional laparoscopic graspers was found to be equally safe and can be easily mastered by any laparoscopic surgeon, which will reduce his dependency upon preformed endoloops making the procedure cost effective.

Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy- personal experience

Aim: to devises a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy.Material and methods: This prospective study was conducted in MMIMSR Ambala from January 2015 to august 2017. All operations were performed by the same surgical team. Mesoappendix was coagulated with bipolar cautery and cut with scissors. Two handmade Meltzer loops were placed on base of appendix and tightened using conventionalgraspers.Results: 53 patients were included in the study. The time spent for preparing and tyingone loop was approximately 20-25 seconds. None of the patients had leakage from the appendicular stump. Only one polyglactin suture was used to make three loops. Knot pusher was not used in any of the patients.Conclusion: handmade endoloop used in this prospective study for securing appendicular stump using conventional laparoscopic graspers was found to be equally safe and can be easily mastered by any laparoscopic surgeon, which will reduce his dependency upon preformed endoloops making the procedure cost effective.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.255-257