STI Volume 32

 

$195.00

Surgical Technology International

 

32nd Edition

 

New Online Studies

 

Online First - April, 2018

 

 

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General Surgery
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Video-Assisted Subcutaneous Destruction of the Sinus Tract with Vessel-Loop Drainage as Minimally-Invasive Surgical Treatment for Pilonidal Sinus Disease
Michael Korenkov, MD, Head of Department, Department of General and Visceral Surgery, Klinikum Werra-Meissner, Eschwege, Germany

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Abstract


The video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD). This is an advancement of the previously described subcutaneous destruction of the sinus tract and the removal of hairs as well as the long-term vessel-loop drainage of the wound channel (DST).
Although the first results of this operation seemed to be promising, some of my colleagues felt that the blind approach to this procedure could be its potential “weak point”. As a result of this critique, the procedure was enhanced with the subcutaneous video-assisted inspection of the natal cleft.
Throughout most steps of VADST, like the widening of pilonidal pits with mosquito and/or Pean clamps, the subcutaneous destroying of the sinus tract, lifting the skin in a natal cleft with a curette, removing the hair with a Pean clamp and a subcutaneous vessel-loop drainage, were found to be similar to DST. The new steps involve the possibility of the video-assisted control of hair vestiges and bleedings as well as the removal of hair and debris under visual control. A rigid choledochoscope from Berci (Firma Richard Wolf GmbH, Knittlingen, Germany) was used for the subcutaneous endoscopic examination of the natal cleft area. Neither gas application nor water perfusion were necessary for this step.
Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure. The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively. The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing.
Due to the very small number of patients in this report, we were not able to asses this technique properly. Contrary to DST, we intend to use VADST, not only for the treatment of patients with simple forms (primary pilonidal sinus without abscessed inflammation with maximal three orifices, all of them inside the navicular area), but also for the treatment of complex PSD forms.

 

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Indocyanine Green (Icg)-Enhanced Fluorescence for Intraoperative Assessment of Bowel Microperfusion During Laparoscopic and Robotic Colorectal Surgery: The Quest for Evidence-Based Results

Alberto Mangano, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL,  Federico Gheza, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Liaohai Leo Chen, PhD, Visiting Research Professor, Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Eleonora Maddalena Minerva, MD, Medical Doctor, Istituto Clinico Humanitas IRCCS, Milan, Italy, Pier Cristoforo Giulianotti, MD, FACS, Vice Head Department of Surgery, Professor of Surgery: Distinguished Lloyd M. Nyhus Chair in Surgery, Chief, Division of General, Minimally, Invasive and Robotic Surgery, University of Illinois at Chicago, Chicago, IL

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Abstract


Anastomotic leakage is a severe complication after colonic/rectal surgery. One of the most important causes of anastomotic leakage is poor vascular supply. However, microvascular impairment at the anastomotic site is very often not detected intraoperatively by observation under white light. Indocyanine green (ICG)-enhanced fluorescence is a technology that may be useful for detecting microvascular alterations and potentially preventing anastomotic leakage. The aim of this Editorial-Minireview is to briefly and critically assess the literature evidence regarding the feasibility of using an ICG fluorescent tracer for detecting microvascular changes in the perianastomotic tissue and its potential role in preventing anastomotic leakage. We focused on minimally invasive (robotic and laparoscopic) colorectal surgery. Intraoperative ICG angiography and the quantification of ICG kinetics can be used to intraoperatively reveal the tissue-perfusion status during colorectal surgery. This may be useful for intraoperatively changing a previously planned resection/anastomotic level, and conceivably decreasing the degree of anastomotic leakage. At this stage, even though ICG technology appears to be very promising and some preliminary clinical studies have suggested that certain ICG pharmacokinetic parameters may be used to predict leakage, more reliable scoring and grading tools are needed. Furthermore, in minimally invasive colorectal surgery, more randomized prospective well-powered trials are needed to properly standardize this surgical technology.

 

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Intracorporeal Ileocolic Anastomosis in Laparoscopic Right Colectomy: A New Way to Make it Simple?

Giorgio Lisi, MD, Resident, Department of General and Pancreatic Surgery, University Hospital of Verona, Verona, Italy, Irene Gentile, MD, Medical Staff, Giuliano Barugola, MD, Medical Staff, Giacomo Ruffo, MD, Head of Department of Surgery, Roberto Rossini, MD, Medical Staff, Department of General Surgery, Sacro Cuore – Don Calabria Hospital, Negrar, Italy

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Abstract


Although there has been a recent increase in the use of laparoscopy in colorectal surgery, the percentage of patients who undergo surgery using entirely minimally invasive techniques is still quite low, and there are substantial differences among centers. It has been argued that the limiting factor in the use of laparoscopic procedures is not the tumor or patient characteristics, but rather the number of surgeons with adequate skills to perform an entirely laparoscopic colectomy. To address this issue, we report here our totally laparoscopic right colectomy technique, with particular focus on a new way to perform the enterotomy closure, which may simplify ileocolic anastomosis.

 

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