Three-Axis Tension-Measuring Vitreoretinal Forceps Using Strain Sensor for Corneal Surgery

Precise motion control is important in robotic surgery, especially corneal surgery. This paper develops a new tension-measurement system for forceps used in corneal surgery, wherein contact force is applied only to a specific location for precise control, with precise movements detected by attaching a nano-crack sensor to the corresponding part. The nano-crack sensor used here customizes the working range and sensor sensitivity to match the strain rate of the tip of the forceps. Therefore, the tension in the suture can be sufficiently measured even at suture failure. The printed circuit board attached to the bottom of the system is designed to simultaneously collect data from several sensors, visualizing the direction and magnitude of the tension in order to inform the surgeon of how much tension is being applied. This system was verified by performing pig-corneal suturing.

Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques. Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic Novgorod Regional Clinical Hospital based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearsons 2-test with Yatess correction. Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 20102014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020. Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

Does intestinal peristalsis cause suture failure after instrument suture?

Introduction Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis. We reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. Methods Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row, and that there was no peristalsis in other cases. We investigated the duodenum because it is frequently observed during gastrectomy. We evaluated suture failure in cases with and without peristalsis. Results The study population included 49 patients (male, n=32; female, n=17; median age, 71 [42-82] years). Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). Discussion Anastomotic leakage remains a serious and potentially fatal complication of gastrectomy, and surgeons should make efforts to prevent anastomotic leakage. Various risk factors associated with anastomotic leakage have been reported. This is the first retrospective study to evaluate duodenal peristalsis during gastrectomy for gastric cancer. We hypothesized that duodenal peristalsis would apply extreme tension on the stapler. Peristalsis would twist and increase the pressure on the stapler. In this study, we defined a new scale to evaluate duodenal peristalsis. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.

Snodgrass procedure for distal penile and mid-shaft hypospadias repair in children

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection.

Complications classification of local cold injury

The OBJECTIVE of this work was to develop a classification of complications of local cold injury.METHODS AND MATERIALS. The study is based on the results and analysis of the treatment of 132 patients with local cold injury of the II–IV degree of the lower extremities. The victims were hospitalized in the regional center for thermal trauma on the basis of the «City Clinical Hospital № 1» in the period from 2018 to 2019. Post-traumatic complications were detected in 54 patients (40.1 %), of which 32 developed early and 22 patients developed late complications. The remaining 78 patients after discharge from the hospital did not seek medical help again and were under the supervision of a polyclinic surgeon.RESULTS. In the course of the study, it was found that in 32 out of 132 patients in the early period of local cold injury of the lower extremities, sensitivity disorders, muscle weakness, convulsions, impaired coordination of movements, graft rejection, wound suppuration and suture failure, stump necrosis were detected in the affected segments of the extremities. 22 victims developed late complications of local cold injury: trophic ulcers of the stumps of the feet, osteomyelitis with the formation of sequesters, gangrene of the stumps of both feet. As a result of the study and pathogenetic interpretation of the consequences of cryoinjury, a new classification of complications of local cold injury was formed and the criteria for the forms of «cold extremity» were identified.CONCLUSION. Post-traumatic complications were detected in almost half of the victims with local cold injury (54 patients, 40.1 %). Thus, in the early stages of cryoinjury, 32 patients were found to have impaired sensitivity of the affected limb, muscle weakness, convulsions, and impaired coordination of movements; 4 (12.5 %) had treatment complicated by graft rejection; 5 (15.5 %) had wound suppuration and suture failure; 2 (6.25 %) had stump necrosis. In the late period, complications of local cold injury were registered in 22 patients. Of these, 12 (55 %) patients were found to have trophic disorders; osteomyelitis was detected in 8 (36 %) patients; in 2 (9 %) — gangrene of the distal segment of the affected limb.

The Optimal Surgical Needle for Tendon Suture: Cutting Edge or Reverse Cutting Edge?

Background. Achieving a durable connection between the lacerated tendon ends is difficult. The outcome of treatment depends on many factors. Several authors consider the properties of the surgical needle used for suturing the tendon to be important. The aim of the study— to compare the strength of the tendon suture applied with the conventional cutting edge and reverse cutting edge surgical needles in the experiment.Materials and Methods.We used porcine tendons for the experiment. The tendon fragments were divided into 2 groups of 20 tendons each. On all 40 tendons, the same type of “injury” of the tendon was simulated — using a scalpel. In the first group, the interrupted suture of the tendon was applied with a cutting edge surgical needle, in the second group — reverse cutting edge. Laboratory tests of the tendon sutures strength were performed on the improvised stand.Results.In the first (suture made with a cutting needle edge), diastasis of 2 mm was determined at an average load of 1219.5 g (m = ±76.56, where «m» is the representativeness error). Complete suture failure occurred at an average load of 1770.8 g (m = ±100.02). In this group, the thread rupture was not recorded. In the second group (a suture made with a reverse cutting edge needle), diastasis occurs with an average load of 1754.75 g (m = ±77.32). Complete suture failure occurred at an average load of 2571.25 (at m= ± 103.78). In three cases, the thread ruptured. In the second group (reverse cutting edge needle), the tendon suture strength was statistically significantly higher than in the first group. Conclusion. The tendon suture strength depends on the surgical needle properties. In tendons reconstruction the reverse cutting edge needle use is more preferable compared to the conventional cutting edge needle use.

First results of using a bidirectional U-shaped sternal suture in patients who have suffered a deep sternal infection

Introduction. Sternomediastinitis in patients undergoing open heart operation remains a formidable complication. Treatment of a sternal infection is a complex and multi-component process. Closing of the sternal wound is one of the decisive steps in the treatment of sternomediastinitis. This is due to the fact that an insufficiently static state of the sternum in itself leads to a relapse of purulent-septic complications. At the same time, we have to work with non-native bone that has undergone inflammatory and destructive changes and multiple mechanical damage.The objective of the study was to evaluate the results of using the developed bidirectional U-shaped sternal suture for reosteosynthesis of the sternum in patients after postoperative mediastinitis.Methods and materials. The results of treatment of 16 patients with deep sternal infection in the early postoperative period were analyzed. All patients were divided into two groups according to the type of used sternal sutures. The first group consisted of 8 patients in whom a developed bidirectional U-shaped sternal suture was used for sternum reosteosynthesis. In the second group, in 8 patients, the sternal cusps were brought together using classic sternal figure-of-8 suture. A two-stage tactics of treatment was used both in the first and in the second groups of patients. Surgical debridement of the wound with removal of the primary sternal sutures was performed in the first stage. Subsequently, vacuum-assisted therapy was carried out using antiseptics. The second stage was the closure of the sternal wound after cleaning and decontamination of the wound.Results. Signs of sternal suture failure were not observed in the first group. Three patients underwent repeated plasty of the sternum due to the incompetence of the sternal sutures in the second group. One patient had relapse of wound infection.Conclusion. The developed bi-directional U-shaped sternal suture in patients after postoperative sternomediastinitis provides the prevention of inconsistency of sternum.

Thoracic esophageal injury due to a neck stab wound: a case report

Background Traumatic esophageal injury leads to severe complications such as mediastinitis, pyothorax, and tracheoesophageal fistula. Although prompt diagnosis and treatment are required, there are no established protocols to guide diagnosis or treatment. In particular, thoracic esophageal injury tends to be diagnosed later than cervical esophageal injury because it has few specific symptoms. We report a case of thoracic esophageal injury caused by a cervical stab wound; the patient was stabbed with a sharp blade. Case presentation A 74-year-old woman was attacked with a knife while sleeping at home. The patient was taken to the emergency room with an injury localized to the left section of her neck. She was suspected of a left jugular vein and recurrent laryngeal nerve injury from cervical hematoma and hoarseness. On the day following the injury, computed tomography revealed a thoracic esophageal injury. Emergency surgery was performed for an esophageal perforation and mediastinal abscesses. Although delayed diagnosis resulted in suture failure, the patient was able to resume oral intake of food a month later following enteral feeding with a gastrostomy. Esophageal injuries due to sharp trauma are rare, and most are cervical esophageal injuries. There are very few reports on thoracic esophageal injuries. Conclusions The possibility of thoracic esophageal injury should always be considered when dealing with neck stab wounds, particularly those caused by an attack.

INTRAOPERATIVE ICG FLUORESCENCE ANGIOGRAPHY: ANALYSIS OF FIRST RESULTS IN OUR SINGLE-CENTER

INTRODUCTION Anastomosis dehiscence is one of the most serious complications in colorectal surgery, influenced by many factors, especially the anastomotic ischemia. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography allows to assess the vascular perfusion of the ends anastomotic and anastomosis thus seeking to decrease the number of sutures failure. MATERIAL AND METHODS A retrospective and descriptive study of patients undergoing colorectal surgery in our centre using intraoperative indocyanine green fluorescence angiography. We analysed a total of 45 patients, including 40 cases of colorectal cancer and 5 cases with a benign pathology (4 diverticular disease and 1 Crohńs disease). RESULTS After administration of ICG, the site of resection was changed in 6 cases due to bad perfusion findings. 5 patients presented anastomotic leakage during the postoperative period. The medium hospital stay length was 10 days, increasing to 29,2 days medium stay in patients with postoperative dehiscence respect to 7’72 days in patients without postoperative complications. No deaths or adverse reactions associated with the ICG were detected. CONCLUSIONS The technique with ICG seems to be a promising tool for the colorectal surgery as a predictor of suture failure. It allows a reduction of hospital stay length and postoperative morbidity and mortality from this cause and it can serve as a good help for making decisions in the course of a surgery.