Anatomic posterior cruciate ligament reconstruction with allograft

This article describes the anatomic posterior cruciate ligament reconstruction technique. This technique combines the double bundle technique with the tibial inlay technique in a single reconstruction using an Achilles' tendon allograft. Key technique points are described including patient positioning, graft preparation, surgical approach, and graft fixation. Immediate postoperative care and results from the author's practice are also discussed.     

A modified technique for pulmonary valve replacement with a homograft

We present a modified technique for replacement of the pulmonary valve with a pulmonary homograft. The principles of this technique are similar to the "scalloped subcoronary technique" for aortic valve replacement with a homograft. The advantages of using this technique in the pulmonary position are briefly discussed.     

Öffnende Keilosteotomie des distalen Femurs beim Valgusknie

This review presents a novel technique for open-wedge varus osteotomies of the distal femur in lateral compartment osteoarthritis in valgus knees. Indications and contraindications are discussed. The technique, its potential pitfalls, and postoperative management are presented. The authors' results with this technique are compared to the data of the literature.     

The open finger technique for the release of syndactyly

A new technique of syndactyly release is described. The technique differs from the standard methods in that more digital flaps are used, and these are longer and are not defatted. A single stitch is applied to secure the tip of the flap and the defects between the flaps are not closed or grafted, hence the term "open" technique. Eight patients had 12 webs released using this operation. We compare this technique with 12 patients who had a total of 19 webs released using the standard technique. Patients were assessed for six parameters of operative success.     

Editorial Commentary: Arthroscopic Repair of Partial Thickness Rotator Cuff Tears: What Do We Know So Far and Where Should We Put the Focus of Our Future Research?

The available evidence shows that arthroscopic repair using either the transtendon in situ repair technique or the tear completion and subsequent repair technique are associated with favorable results in the short term. Likewise, the location of the lesions (articular or bursal) does not seem to significantly influence the clinical results, regardless of the technique used. Specifically with regard to the surgical technique of choice in the case of deciding to complete the tear and then repair it, it remains to be defined more clearly in future investigations whether it is better to repair with a single- or double-row technique, whether associated subacromial decompression has any advantage and what the results of this technique are in the subgroup of athletes, especially in competitive and overhead athletes in whom repair of rotator cuff tears has shown unfavorable outcomes mainly at the expense of a low return to the same level of sport.     

超声在气道管理中的应用

背景 超声技术在临床麻醉中的应用越来越广泛,近些年关于其在气道管理中的应用也有了一些报道,并认为其安全、方便.目的 分析、总结超声在气道管理各方面应用的文献资料.内容 简要介绍上呼吸道的超声解剖以及获得满意的超声图像的方法和途径,综述超声技术在插管前评估、气管导管位置的确定、双腔气管导管和经皮扩张气管造口术(percu...     

Elective laparoscopic cholecystectomy: the limit of a dream become true

Laparoscopic technique in elective cholecystectomy is the last step in an evolutive time to minimize the abdominal access. From 1st January 2004 to 31th December 2006 we analyzed 5515 cholecystectomy procedures: 4877 laparoscopic cholecystectomy, 635 open cholecystectomy. Complications and supplementary diagnosis have been identified in SDO Lombardia's country database. Morbidity occurred in 82 patients (12.9%) with open technique and 109 patients (2.23%) with laparoscopic technique; mortality occurred in 11 patients (1.73%) with open technique and 1 patient (0.02%) with laparoscopic technique. Mean hospital stay are 14.40 days with open technique and 4.75 with laparoscopic technique. Morbidity in open technique is 6 fold more than laparoscopia technique. The difference between the two technique is present in literature and it's the result of non invasive technique compared with the incision of the laparoscopia technique. This is the critical point in the difference of hospital stay between the two technique all to the good of laparoscopy. The high mortality ratio is due to the selective criteria in laparoscopic technique. First remark is the high quality of our hospital care, compared with hospital teaching in the word. In this hospital the laparoscopic cholecystectomy is the gold standard in cholelitiasis treatment. The second remark is the limit of the open technique in severe cholelitiasis with evidence in high ratio of hospital stay, morbidity and mortality.     

Improved percutaneous slipped capital femoral epiphysis treatment: continuous biplanar fluoroscopy and proper guide wire selection

In 1990, a report was published outlining a technique of percutaneous fixation of slipped capital femoral epiphyses dramatically diminishing the morbidity associated with the open technique. Technical difficulties are still encountered with the morbidly obese child and the percutaneous technique. Two fluoroscopic units used continuously during the technique facilitate placement of the guide wire in a more acceptable anatomic location. Guide wire stiffness was also measured and used in preoperative planning. Ten hips were treated with this technique, and a prospective analysis of the surgical time and fluoroscopy time was done. Using the new technique, we found a significant reduction in surgical and fluoroscopic times.     

The surgical management of complicated spinal stenosis: spondylolisthesis

The principles of surgery in spinal stenosis follow a clear understanding of the pathology in the various types ofstenosis. This article describes how the basic technique of one-level decompression in spinal stenosis is modified to deal with the pathology in degenerative spondylolisthesis. We have provided an explanation of the pathology in spinal stenosis with degenerative spondylolisthesis, and how modifications of the basic decompressive technique are necessary to deal with these variations in pathology. The indications and technique for a concomitant lateral spinal fusion are described. Techniques of instrumentation are not covered in this article.     

The thermic vascular anastomosis (TVA)

Summary In order to unite blood vessels in a split second during a total clamping time of less than three minutes a new microsurgical technique has been developed. Heat from a high frequency electric current applied to calibrated metal loops unites the cuffs of the vessel ends instead of sutures. As a model for vascular anastomoses the new technique was used in an experiment with 320 rats. Two energy output adjustments of the power source combined with application of fibrin glue on the anastomosis are compared. The new instruments developed for this technique and the operation method are presented with reference to earlier vascular surgical procedures, and the results of patency controls of the anastomoses one day, 10 days, and 30 days postoperatively are listed. Preliminary findings of a long term study are added. This study shows that fully patent anastomoses can be obtained with this technique in much less time than with suturing.     

Quantitative analysis of errors in alveolar crest level caused by discrepant projection geometry in digital subtraction radiography: an in vivo study.

OBJECTIVE: This study compared the difference between 3 intraoral radiographic techniques on digital subtraction radiography (DSR) in vivo that are commonly used in a clinical setting. STUDY DESIGN: We evaluated and statistically analyzed the errors in the DSR image in 6 regions with 3 radiographic techniques: paralleling technique with a bite block attached to XCP, paralleling technique using XCP, and bisecting-angle technique. RESULTS: The amount of error using the bisecting-angle technique was too large for DSR, compared to that of the paralleling technique with a bite block attached to XCP. In the mandibular anterior region, the paralleling technique using XCP was not different from paralleling technique with a bite block attached to XCP. The lowest degree of error was present in the anterior region whereas the highest was present in the molar region. CONCLUSION: Bisecting-angle technique should be avoided, and paralleling technique using XCP can be used in the mandibular anterior region for DSR.     

Ethical considerations regarding the implementation of new technologies and techniques in surgery

Ethical considerations relevant to the implementation of new surgical technologies and techniques are explored and discussed in practical terms in this statement, including (1) How is the safety of a new technology or technique ensured?; (2) What are the timing and process by which a new technology or technique is implemented at a hospital?; (3) How are patients informed before undergoing a new technology or technique?; (4) How are surgeons trained and credentialed in a new technology or technique?; (5) How are the outcomes of a new technology or technique tracked and evaluated?; and (6) How are the responsibilities to individual patients and society at large balanced? The following discussion is presented with the intent to encourage thought and dialogue about ethical considerations relevant to the implementation of new technologies and new techniques in surgery.     

Less invasive anterior column reconstruction in thoracolumbar fractures

Posterior short-segment pedicle screw constructs are commonly used for reduction and fixation of traumatic thoracolumbar spine fractures. Although this technique is usually simple and effective, complications such as loss of fixation or recurrence of deformity are common because of the insufficiency of the damaged anterior column. Anterior approaches to address this deficiency are associated with high morbidity and complications. We have developed a technique to reduce and support the fractured anterior column through a transpedicular approach. Balloon-assisted-endplate-reduction (BAER) followed by vertebroplasty (VTP) with calcium phosphate cement in combination with short segment pedicle screw construct seem to be a safe and effective technique to reconstruct the anterior column in a less invasive manner. In this article, the rationale behind this technique, experimental studies, and the first clinical results are discussed.     

Comparative geometric analysis of diamond and hole techniques in end-to-side microvascular anastomosis

Although microsurgical techniques have been accepted routinely in many plastic surgical operations, many experimental studies are currently being conducted to refine the results. Most of these studies are difficult to perform and evaluate and the results are not always free of bias. Many scientific disciplines recently use the mathematics for simulation and modeling to predict the results of difficult experiments. Slit and hole end-to-side microanastomosis techniques are frequently preferred by many microsurgeons. Diamond technique recently proposed by the senior author is also a technique of end-to-side anastomosis with some advantages. The authors used mathematical simulation and modeling to compare two end-to-side microanastomosis techniques namely hole and diamond. The authors measured cross sectional areas of anastomosis in both techniques with different input data. The results showed that for end-to-side anastomosis, at angles less than 60 degrees , diamond technique yields a greater cross sectional area at anastomosis site compared with that of hole technique.     

Our choice of the method to induce pneumoperitoneum in videolaparoscopic surgery

BACKGROUND: In laparoscopic surgery, pneumoperitoneum may be obtained either by a blind or an open access technique. These two techniques and the advantages of Hasson technique are compared. METHODS: Through January 1998 and May 1999, 262 unselected patients underwent laparoscopic surgery; pneumoperitoneum was obtained with a random technique, while in the patients previously operated on the open technique was always performed. In 161 cases (61.5%) pneumoperitoneum was obtained with Hasson technique and in 101 (38.5%) with Veress technique. All the patients were clinically evaluated after surgery and then after 30-40 days. The complications encountered were always associated with the Veress needle blind access: peritoneal space insufflation in 3 cases, greater omentum insufflation in 3 cases, 4 cases of difficult management and only one case of incisional hernia on the umbilical wound. RESULTS: Our data confirm that Hasson open technique is safer than Veress blind technique as the risk of severe early and late complications is lower. CONCLUSIONS: The open laparoscopic technique with the Hasson trocar is recommended as it showed to be a quicker, safer and superior technique for obtaining pneumoperitoneum.     

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?

Patients with extensive aortic aneurysms involving the ascending aorta, aortic arch, and the descending aorta are still considered to be a challenge for many cardiovascular surgeons. The introduction of the elephant trunk technique by Borst et al. in 1983 has greatly facilitated surgery on this kind of pathology and this technique has been recognized as a standard modality for treatment of extended aortic aneurysms. As a next step, the frozen elephant trunk technique has been introduced in some institutes in the late 1990s. With this technique, surgery is performed through a median sternotomy, and an endovascular stent-graft is placed into the descending aorta in an antegrade fashion through the opened aortic arch. Then the ascending aorta and the aortic arch are replaced conventionally. The frozen elephant trunk technique enables one-stage repair of extended aortic aneurysms in a certain patient cohort with similar operative mortality as with the conventional elephant trunk technique, in which a second-stage operation is a prerequisite. Although the surgical strategy should be adjusted specifically to each patient's individual pathology, the frozen elephant trunk technique may become the next standard treatment for extended aortic aneurysm instead of its conventional variant.     

Results of microsurgical lumbar discectomy

Summary 485 patients with a lumbar disc herniation were operated upon microsurgically. The results, the rate of complications and true recurrent herniations will be presented. The results of the microsurgical technique are compared to the results of the conventional technique.The final outcome after the microsurgical operation was excellent in 39%, good in 34% and satisfactory in 19%, 9% of the patients had a poor final outcome.The results obtained with microsurgery are attained with the standard techniques only by few groups, probably highly experienced surgeons. Following microsurgery a uniformly high percentage (88–98%) of results are reported as being satisfactory, whereas the analogous figures range between 40 and 98% following the standard technique.The operations were performed in the Department of Neurosurgery, Ravensburg.     

Bone-retinaculum-bone reconstruction of scapholunate ligament injuries

This article describes the indications for the use of a bone-retinaculum-bone autograft in soft tissue reconstruction of the torn scapholunate ligament. Specific surgical technique and postoperative management are highlighted. Initial results of a primary cohort of patients undergoing this technique are described. The technique is mainly indicated for patients with scapholunate ligament tears that are moderately easy to reduce by open methods.     

Konventionelle Karotisendarteriektomie vs. Eversionsendarteriektomie

In carotid endarterectomy surgery the conventional surgical technique and increasingly more eversion endarterectomy are currently in use. The surgical technique for both methods is presented by two different working groups, according to their preference. To be able to manage all situations during surgery for carotid artery stenosis profound experience with the standard technique is mandatory. The eversion endarterectomy technique can be carried out faster and more elegantly but this process generally requires a greater level of experience in carotid surgery. The most important aspects for prevention of errors and pitfalls in the standard surgical technique and the pathoanatomical and pathophysiological conditions for eversion endarterectomy are pointed out.     

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??Application of laparoscopic technique in colorectal surgery: Controversy and consensus XIAO Yi. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730,Chnia
Abstract There are increasing evidences to support the application of laparoscopic technique in colorectal cancer surgery. With the improving devices in laparoscopic surgery, more and more surgeons like to handle the skill with enthusiasm. Laparoscopic technique has an important role in minimal invasive surgery and enhanced recovery after surgery. Compared with traditional open surgery, laparoscopic surgery has significant short-term efficacy, such as easily recognition of anatomical spaces, clearly lymphadenectomy, less intraoperative bleeding, fast recovery after operation. The technique also has comparable long-term oncological outcomes with open surgery. Lots of new concepts and operative approaches are derived from laparoscopic technique, such as natural-orifice specimen extraction (NOSES), transanal total mesorectal excision (TaTME), which expands the extent of minimal invasive surgery. How to properly implement the laparoscopic technique in colorectal surgery should become the aim to train young surgeons, which would make the technique popularized.