The Morphological Classification of the Penile Frenulum in Chinese's People and its Clinical Application Value in the Frenulum Malposition of Circumcision with the Disposable Circumcision Suture Device (DCSD)

Background: to conclude the clinical experience of the disposable circumcision suture device (DCSD), to describe the morphological classification of the penile frenulum in Chinese's people, to find a way to solve the malposition of the penile frenulum in the surgery with disposable circumcision suture deviceMethods: From November 2013 to April 2021, there were 2265 consecutive Chinese patients with phimosis 367(16.2%) or redundant prepuce 1898 (83.8%) who underwent circumcision in our hospital. Each patient’s penile frenulum morphological feature was recorded and grouped according to the intraoperative photo documentation. There were four type of frenulum feature: typeⅠ, the middle raphe, a middle line longitudinal from the glan to the scrotal raphe; typeⅡ,the middle double raphe or middle band; type Ⅲ, the diamond or lozenge-shaped raphe; type Ⅳ was marked by the some hyperpigmentation zone. We also reported the convexity frenulum cutting site(CFCS) which could be palpated that a small rounded eminence tissue at the ventral prepuce middle raphe during the prodedure. Other data recorded were operation time, type of anesthesia, intra-operative blood loss, incision healing time, complications, mainly focus on the frenulum distortion, patient satisfaction. RESULTS: According to our morphological classification there were 842 (37.2%) cases in type Ⅰ, 258 (11.4%) cases in type Ⅱ; 107 (4.7%) cases in typeⅢA, 885 (39.1%) cases in type ⅢB and 173 (7.6%) cases in type Ⅳ. Following the classification treatment principle reported in the text no notorious frenulum deviation was observed after the initial 100 cases. Conclusion: The morphological classification of the penile frenulum incombinating with the anatomy marker of CFCS will facilitate accurate identification of the frenulum location, better define its right position, and provide a guide for the DCSD surgery for the individualized patients. The method described in this study could improve the success of the circumcision procedures, lower the related complication and is important to make the device acceptable and popular.

Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video)

Background and aims Endoscopic resections are associated with bleeding and perforation and may be managed with through-the-scope (TTS) clips, over-the-scope clips and endoscopic suturing. The aim of this preclinical study was to compare technical success of closure using a novel TTS tissue helix tack and suture device (X-Tack) to TTS clips in a porcine model. Materials and methods Four subjects underwent 40 mucosal resections, diameter range 25–50 mm, in the stomach (n = 24) and colon (n = 16). Closures were randomized to X-Tack (n = 24) or clip (n = 16). Animals underwent weekly endoscopic follow-up for 4 weeks. Results Technical closure with X-Tack was successful in 24 of 24 (100 %) cases and with clips in 13 of 16 cases (81.3 %) (P = 0.0001). One colonic perforation occurred and was successfully managed using X-Tack. The rate of healing was not statistically different between the groups, and all sites healed at 4 weeks including the perforation and were confirmed by histology. Conclusions Compared to TTS clip, X-Tack is superior for effecting large mucosal defect closure, including durable sealing of full-thickness perforation. There was no difference in rate of healing between devices.

All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement. Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than 1 year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test” and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 min. Hook test and DRUJ arthroscopy confirmed proximal component tear in all 12 wrists. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit. Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

Case Report: Small Bowel Obstruction Owing to Self-Anchoring Barbed Suture Device After TAPP Repair

Groin hernioplasty is the most performed intervention in the adults worldwide, the minimally invasive inguinal hernia repair techniques widely used by surgeons today are transabdominal preperitoneal patch plasty (TAPP) and total extraperitoneal patch plasty (TEP). We report a 62-year-old man with bowel obstruction caused by the use of self-anchoring barbed suture to close the peritoneum 3 days after TAPP. Surgeons using the barbed suture should be alert to this possibility when encountering this complication of intestinal obstruction, so as to avoid more serious consequences.