STI-38

 

 

Surgical Technology International

39th Edition

 

New Online Studies

Online First -July 2021

ISSN:1090-3941

Link to PubMed

1 year Institutional Subscription 

both electronic and print versions

 

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New Online Studies

Robotic Applications for Benign Gynecologic Procedures

Alexandria Connor, MD, Resad Pasic, MD, PhD, Professor of Obstetrics and Gynecology, Amira Quevedo, MD, FACOG,

Petra Chamseddine, MD, University of Louisville School of Medicine, Louisville, Kentucky

1409

 

Abstract


Introduction: Robotic systems provide a platform for surgeons to expand their capabilities, allowing them to perform complex procedures safely and efficiently. Within the field of benign gynecology, this has become an increasingly popular option since receiving Food and Drug Administration (FDA) approval in 2005. However, the appropriate indications for robotic versus laparoscopic surgery continue to be debated.
Materials and Methods: Literature was reviewed to provide a comprehensive, evidence-based evaluation of the advantages and pitfalls of robotic surgery, the applications of robotic surgery for benign gynecologic procedures in comparison to conventional laparoscopy, and the role of robotic surgery as an educational tool.
Results: Robotic surgery has favorable outcomes for surgeons in the areas of ergonomics, dexterity, and fatigue. Cost comparisons are widely varied and elaborate. Most patient outcomes are comparable between robotic and laparoscopic hysterectomies and endometriosis resections. In patients with a body mass index >30mg/m2 and uteri >750mg, hysterectomy outcomes are improved when surgery is done robotically. The use of the robotic system may be beneficial for patients undergoing myomectomy. Robotic surgery confers advantages for trainees and novice surgeons. There is no consensus on a standardized curriculum for robotic training or credentialing process for experienced surgeons.
Conclusion: Robotic surgery has distinct features that make it a valuable tool for gynecologic surgeons. There are no clear indications regarding when a robotic route should be chosen but could be considered when above average complexity is anticipated and when training new surgeons.

 

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Twenty Years’ Experience with Endovenous Laser Ablation for Varicose Veins: A Critical Appraisal of the Original Procedure

Bernardus Carolus Vincentius Maria Disselhoff, MD, PhD, Mosaderma Clinics, Hoensbroek, The Netherlands, Daan Joan der Kinderen, MD, PhD, Sanalink, The Netherlands

1453

 

Abstract


Objective: A critical appraisal of the original procedure of endovenous laser ablation (EVLA) for varicose veins.
Method: Evaluation of all practical aspects of the procedure.
Results: EVLA procedures are performed in a strictly ambulatory setting with tumescent local anesthesia (TLA). Technical improvements have resulted in the need for fewer incisions and re-punctures, less ecchymosis, and fewer technical failures. Administration of an appropriate amount of TLA via an infusion pump has reduced the risk of nerve injury, administration time, and pain during the procedure. Use of a 1470-nm diode laser and a radial fiber have significantly improved patient satisfaction and reduced the occurrence of complications such as pain, tightness, ecchymosis, and the need for additional procedures. Lastly, there are only a few indications left for high ligation and stripping.
Conclusion: Over the past 20 years, EVLA has evolved into an effective, cost-efficient, and safe procedure that provides high patient satisfaction.

 

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Laparoscopic Inguinal Hernia Repair—TAPP versus TEP: Results of 301 Consecutive Patients
Beslen Goksoy, MD,  Ibrahim F Azamat, MD,  Ibrahim H Ozata, MD,  Kazim Duman, MD,  Department of General Surgery, Sehit Prof. Dr. Ilhan Varank,  University of Health Sciences, Istanbul, Turkey,  Gokhan Yilmaz, MD,  Istanbul Medipol University, Istanbul, Turkey

1427

 

Abstract


Introduction: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repair are the two most commonly used techniques in laparoscopic inguinal hernia repair, and the results of comparative studies are conflicting. The objective of this study is to compare the two methods in unilateral inguinal hernia repair.
Materials and Methods: The data of consecutive patients who underwent TEP and TAPP due to unilateral inguinal hernia between December 7, 2017, and March 15, 2020, were analyzed retrospectively. The primary outcome was to compare the clinical outcomes of the two techniques in terms of complications, conversion, pain, and operative time. The secondary outcome was recurrence rates.
Results: A total of 301 (TEP n=234, TAPP n=67) patients were included in the study. The mean age was 43 years, and the follow-up period was two years. The groups were similar in terms of demographic characteristics and hernia type. The mean operative time was longer in the TAPP group than in the TEP group (67 min and 58 min, p=0.007). The recurrence rate was 4.3% in the TEP group and 5.9% in the TAPP group (p>0.05). The conversion rate was 6% in both groups. In total, 19 (6.3%) patients had intraoperative complications (TEP n=16, TAPP n=3), and 23 (7.6%) patients had postoperative complications (TEP n=16, TAPP n=7). Both intraoperative and postoperative complication rates were similar between the groups (p=0.31 and p=0.051, respectively). The early postoperative pain was less in the TEP group (p=0.004).
Conclusion: Less early postoperative pain and shorter operative time were detected in patients who underwent TEP.

 

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Dermal Fibroblasts from Chronic Wounds Exhibit Paradoxically Enhanced Proliferative and Migratory Activities that May be Related to the Non-Canonical Wnt Signaling Pathway
Marta Otero Vinas, PhD,  Professor in Bioscience,  Xiaofeng Lin, PhD, Assistant Professor, Vincent Falanga, MD, Professor of Dermatology and Biochemistry, Polly Carson, Research Assistant Professor, Boston University School of Medicine, Boston, MA, Susan MacLauchlan, PhD, Boston University School of Medicine, Boston, MA

1451

 

Abstract


It is generally thought that dermal fibroblasts from chronic wounds are in a state of senescence, which contributes to the failure to heal. This assumption, based on limited experimental evidence, has led to the widespread use of therapeutic approaches focused on delivering new fibroblasts and/or increasing resident fibroblast activity to promote healing. In this study, we decided to re-visit the evidence for the relative inactivity of resident chronic wound fibroblasts. We therefore evaluated the proliferative and migratory activities of matching, patient-derived dermal fibroblasts from a chronic wound (wound dermal fibroblasts, or WDF), ipsilateral thigh newly created acute wound dermal fibroblasts (ADF, Day-3 after wounding the normal thigh skin), and ipsilateral thigh normal dermal skin fibroblasts (NDF). This approach was used in each of 10 consecutive non-selected individual patients with a venous leg ulcer, and allowed us to determine whether WDF are intrinsically less active than NDF and AWD. Cell migration and proliferation were quantified by a live-cell analysis system and MTT assay, respectively, in low (0.5%) or high (10%) levels of fetal bovine serum (FBS). In addition, the ability of patient-derived fibroblasts to modulate wound re-epithelialization in vivo was analyzed by transplantation in a mouse tail full-thickness wound model. Wnt5a mRNA, its ROR1 co-receptors, and ROR2 mRNA levels were determined by qRT-PCR. We report that WDF had increased -SMA and increased levels of Wnt5a. Moreover, using live-cell imaging in a scratch assay monolayer model, WDF showed baseline migratory activity similar to those of NDF and ADF, and such activity was not stimulated by FBS. WDF showed the same capacity to increase wound re-epithelialization as NDF and ADF. Together, these results suggest that WDF are not actually less "active" than NDF and ADF. This enhanced activity of chronic wound fibroblasts may lead to high energy requirements that contribute to a failure to heal. The findings may represent a new paradigm for wound chronicity, impaired healing, and high recurrence rates.

 

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The Utility of Telehealth in the Recovery From the COVID-19 Pandemic
Zhongming Chen, MD,  John M. Tarazi, MD, Hytham S. Salem, MD, Giles R. Scuderi, MD, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York

1445

 

Abstract


Telehealth has recently been used more often in an attempt to protect practitioners and patients during the 2019 coronavirus infectious disease (COVID-19) crisis. Despite telehealth’s existence, there was no prior need to fully realize its potential. Recently, technological innovations in orthopaedic surgery have assisted in making this modality more useful. However, it is important to continually educate the medical community regarding these technologies and their interplay to improve patient care. Therefore, our purpose is to provide information on telehealth by assessing: (1) steps the hospital/system are taking to reduce COVID-19 exposure for teams and patients; (2) new technologies allowing for the optimization of patient safety; and (3) use of telehealth for postoperative follow up. We will demonstrate that telehealth and its associated strategies can be used effectively to decrease COVID-19 exposure risks for both medical staff and patients during these rapidly changing and uncertain times.

 

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Total Artificial Heart Update
Jack Copeland, MD, Emeritus Professor of Cardiothoracic Surgery, Banner University Hospital, Tucson, AZ, Steve Langford, BSEE, Joseph Giampietro, RN, BSN, John Arancio, BA, SynCardia Systems, Tucson, AZ, Francisco Arabia, MD, MBA, Banner University Medical Center, Phoenix, AZ

1449

 

Abstract


The SynCardia Total Artificial Heart (TAH, SynCardia Systems, Tucson, AZ) is the only biventricular cardiac replacement approved for bridge to transplantation by the U.S. Food and Drug Administration (FDA) and which carries the European Union CE mark. It has been implanted in about 2000 patients. In experienced centers, 60 to 80 % of implanted patients have been transplanted and over 80 % of those transplanted have lived for over 1 year.
The SynCardia TAH has supported potential cardiac recipients with irreversible biventricular failure for up to 6 years, providing physiologic pulsatile flows of 6 to 8 L/min at filling pressures of less than 10 mmHg allowing for optimal perfusion and recovery of organs such as the kidneys and liver. It is a tested device that provides a method for recovering potential transplant candidates who rapidly decompensate from biventricular failure or who have chronic cardiac failure from a variety of etiologies.
This article covers the history, mechanical function and monitoring, implantation, patient selection and management, and outpatient use. It also reviews outcome data from the original FDA study as well as contemporary data from experienced centers.

 

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Irreversible Electroporation as an Alternative to Wound Debridement Surgery

Bodhisatwa Das, PhD , Assistant Professor, Indian Institute of Technology Ropar, Punjab, India, Francois Berthiaume, PhD, Professor of Biomedical Engineering, Rutgers University, Piscataway, New Jersey

1452

 

Abstract


Debridement is a standard part of wound care that is used on both acute and chronic wounds. Current methods of wound debridement include: autolytic based on the natural immune response, surgical, enzymatic based on application of exogenous proteases, mechanical using water jets and ultrasound, and biological using live organisms such as maggots. The choice of individual methods involves a trade-off between speed of treatment, selectivity, and pain. Irreversible electroporation via the application of pulsed electric fields has been used as a novel approach for deep tissue ablation, sometimes in conjunction with chemotherapy, as in the case of tumors, and also in cases where high precision is needed in otherwise very fragile tissues, such as for treating diabetic neuropathy and in epicardial atrial ablation. This method could be readily extended to wound care as it is both rapid and relatively painless, and it is also effective at decreasing bacterial load and clearing biofilms. Furthermore, the process primarily targets cells leaving the extracellular matrix relatively intact, thus providing a suitable natural scaffold for host cellular invasion and regrowth. A unique aspect of the use of pulsed electric fields is that around the region where ablation is perfomed, electric fields of lower energy are dissipated into the healthy tissue. There is a range of electric fields that are known to stimulate cellular functions, in particular migration and proliferation, and that may contribute to the healing process after electroporation. While irreversible electroporation is a potentially useful alternative to other debridement methods, future clinical application awaits technological advances in electrode design that will enable precise delivery of the therapy in wounds of various sizes and depths.

 

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