A Simple Novel Technique for Intragastric Balloon Retrieval

We present a novel technique for the retrieval of intragastric balloons used in the treatment of patients with morbid obesity. Although specifically-designed instruments are available for this purpose, this simple technique makes use of instruments that are readily available in an endoscopy suite equipped for simple therapeutic procedures.     

A Novel Technique for Liver Retraction in Laparoscopic Bariatric Surgery

During bariatric surgery in morbidly obese patients, the surgeon’s operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction—V-shaped liver suspension technique (V-LIST)—by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009–February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2–18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.     

A Novel Transosseous Button Technique for Rotator Cuff Repair

In an attempt to maximize stability by improving the lateral footprint compression of our repair in rotator cuff tears, we have been using a rotator cuff button (Arthrex, Naples, FL) passed through a transosseous tunnel as an anchor for our transosseous sutures. Our new innovation is to pass a rotator cuff button fully loaded with 4 strands around the central post, with 2 leading strands and 2 trailing strands on either end, through our transosseous tunnel. In this way, we can use the 4 central strands through our tunnel to obtain 2 good mattress sutures as a primary repair and the peripheral 4 strands passed around the lateral humerus as over sew mattress sutures to obtain good compression of the lateral tendon and so improve the footprint area. A double row equivalent is achieved. This technique has a good primary hold in the form of a device with proven history and avoids multiple anchors in the lateral humerus. Because it uses only a single fixation device, it is also significantly more economical. Theoretical risks to the axillary nerve or with osteoporosis have not been seen in practice. Tensioning the repair with suture passage through transosseous tunnels is readily achieved.     

A Novel Technique for Long-Term Vascular Access in the Unrestrained Rat

A new system for long-term vascular access in the unrestrained rat (n = 380) is described that combines low cost with high reliability arid free movement. It consists of a polyurethane catheter that is placed in the right atrium via the external jugular vein. A leather harness is applied to the animal and the catheter passed subcutaneously to the neck into the harness. The harness is connected to the outside of a swivel joint via a silicone tube in which the catheter runs. The catheter is connected to the inside of the swivel. The Swivel is a modified conventional 5-mL glass syringe arid is positioned in ball bearings and a Johnson joint. Swivel, ball bearings, and the Johnson joint are counterbalanced and can move up arid down. With this system all catheters functioned well until they were electively removed after 28 day. Four catheter dislocations resutlted from harness failure and three from a twisted catheter. Seven cases of septicemia arid eight of thrombosis occured. All animals gained weight (3.53 5 0.37 [SEM] g/d) during the time the system was in place. The entire apparatus is simple and inexpensive to construct. The rotary portion of the swivel and the Johnson joint avoid twisting of the catheter, and the counterbalance enables the animal to move up and down. The low thrombogenicity of polyurethane further reduced complications. This system reduces stress for the animal during long-term investigations.     

Internal Aortic Annuloplasty: A Novel Technique

ABSTRACT

Background: The purpose of this study was to define an experimental model and a reproducible surgical technique for the preclinical assessment of safety and biocompatibility of a novel intra-annular internal aortic annulus repair device. Methods: Adult sheep were implanted with HAART Inc's 19 mm aortic annulus repair device via a transverse aortotomy using standard anesthetic, surgical, and cardiopulmonary bypass techniques. Animals were closely monitored throughout the study period until the time of elective sacrifice at 30 or 60 days. Results: Six adult sheep, mean age 63.2 weeks, mean weight 68.8 kg, underwent aortic annuloplasty with a 19 mm annuloplasty frame. Five of the sheep remained stable until scheduled sacrifice. The primary outcome of this study was animal mortality. Early mortality was seen in only one animal (16.7%), due to a surgical complication. Mild-to-moderate aortic insufficiency was observed in all animals upon echocardiographic examination at the time of elective sacrifice. Conclusions: Of the six animals that underwent aortic annuloplasty, there was one early death due to surgical complication. The remaining five subjects were clinically stable at the time of elective sacrifice. Any conclusions regarding the cause of the observed aortic insufficiency are beyond the scope of this feasibility study but would need to be fully evaluated in the preclinical assessment of any internal aortic annuloplasty device. We have shown that we have developed a reproducible surgical technique in a physiologically appropriate model for the preclinical assessment of internal aortic annulus repair devices.     

A Simplified Method for Monitoring Blood Concentration of Cyclosporin by a Finger-Stab Technique

We have developed a simple method of sample collection whichallows the measurement of cyclosporin (CsA) to be made fromblood obtained from a finger stab and collected onto filterpaper. CsA concentrations estimated from blood spots and venoussamples obtained at the same time showed good correlation. Thismethod has various practical applications: peak and trough bloodCsA concentrations (as well as profiles) may be routinely measuredfrom samples collected by patients at home; it may be of particularvalue in children and other patients with poor venous access.