Anteromedial Portal Technique for the Anterior Cruciate Ligament Femoral Socket: Pitfalls and Solutions

Creating the anterior cruciate ligament (ACL) femoral socket using the anteromedial (AM) portal technique has advantages. Furthermore, the technique is ideal for anatomic double-bundle (particularly posterolateral bundle) and all-inside ACL techniques. However, although the AM portal technique has advantages, the learning curve is steep when making the transition from familiar, transtibial reaming to the AM portal technique for ACL femoral tunnel creation. Complications and challenges are many when learning the AM portal technique. The purpose of this technical note is to describe tips and pearls for surgeons contemplating the transition to the AM portal technique for the ACL femoral socket.     

Elective resection of the spleen--overview of resection technics and description of a new technic based on radiofrequency coagulation and dessication

The authors present a short overview of the development of elective splenic resections. Past and present indications are presented. Contemporary hemostatic technique for elective splenic resection are discussed. An original new technique for transsegmental partial splenic resection using RF generator Radionic Cool Tip(without any aditional hemostatic procedures is presented. This technique is inovative and when use properly it is a practically zero blood loos technique. A patient with transsegmental splenic resection using RF generator is presented. Further clinical application of the technique is necessary.     

Anesthesia for thoracoscopic thymectomy: modified non-muscle relaxant technique--case reports

Anesthesia for thymectomy in myasthenia gravis is challenging. The anesthetic experience of that technique is quite large. In involves either muscle relaxant or non-muscle relaxant techniques. However, the literature is deficient of standard anesthetic technique for thoracoscopic thymectomy. Therefore we present in this report a modified non-muscle relaxant technique for thoracoscopic thymectomy (TT). We report two cases who underwent TT under general anesthesia using sufentanil and propofol for induction and local anesthesia spray to the vocal cords to facilitate endobronchial intubation using non-muscle relaxant technique. The intubating, operating and postoperative conditions were excellent. To the best of our knowledge, this is the first report on modified non-muscle relaxant technique for TT in myasthenia gravis. Further cases have to be done to verify our technique.     

Fluoroscopic technique versus Phemister technique for epiphysiodesis.

Seventy patients were followed after epiphysiodesis for limb length discrepancy. The Phemister technique was used on 44 and the fluoroscopic technique on 26 patients. Both techniques achieved growth plate arrest in 100% of patients. The average hospital stay was 1.8 days for the fluoroscopic technique and 3.5 days for the Phemister technique. Of the Phemister technique patients, 40% required formal postoperative physical therapy compared to only 8% of the fluoroscopic technique patients. The complication rate was two of 44 (4.5%) for the Phemister technique and one of 26 (4%) for the fluoroscopic technique. The advantages of the fluoroscopic technique are a much smaller scar, less postoperative knee stiffness, and a shorter hospital stay. Because of the similar results, the fluoroscopic technique is recommended.     

Femoral impaction grafting

Femoral impaction grafting is a utilitarian technique for femoral defects. With modern implants, its role may be limited to Paprosky 3B and 4 type femoral deficiencies, especially in the younger patient. With appropriate technique, mid- and long-term results have proven this technique to be globally reliable. Periprosthetic fracture is not uncommon with this technique; however, strategies to mitigate the risk have been developed. A thorough understanding of the history, technique, results and complications of this technique is essential for the revision hip surgeon in order to obtain successful results in the most complex femoral reconstruction cases.     

肿胀技术在皮肤软组织扩张术中的应用探讨

目的:探讨肿胀技术在皮肤软组织扩张术中的临床意义。方法:在行皮肤软组织扩张术的I期手术时,在扩张器置入的区域,根据置入的部位和置入的层次注射0.06%肿胀液,然后切开皮肤皮下,按术前标记的剥离范围剥离,缝合切口,拆线后注水;在行皮肤软组织扩张术的II期手术时,取出扩张器后,将皮瓣旋转或推进,切除病变,在扩张包膜基底注射0.06%肿胀液,将扩张包膜切除,缝合切口。结果:自2000年1月～2005年1月,共治疗了50个病例100个扩张器,均获得了满意效果。结论:肿胀技术在皮肤软组织扩张术的I、II期手术中,具有便于腔隙的剥离和减少副损伤,以及减少术中和术后出血,减轻患者术后术区疼痛等优点。     

Sliding flap advancement for the treatment of high level fistulae

The technique of sliding flap advancement for the treatment of high anal fistulae is described. The technique is not suitable for cases with an acute abscess and is reserved for patients with a well-established chronic fistula track. Thirty patients with anal fistulae were treated by sliding flap advancement from 1980 to 1984. Twenty-nine patients had satisfactory results. With a follow-up ranging from 18 months to 4 years no recurrence of fistulae or abscess were observed. The advantages of the advancement flap technique over the staging division technique with application of a seton and over the rerouting technique are discussed.     

Modification of the Traditional Open Latarjet Technique with the Use of Sutures and Cortical Buttons Instead of Screws

In this article we describe a modification of the open Latarjet technique, using sutures and cortical buttons, for the fixation of the coracoid. The transfer of the coracoid to the anterior glenoid is a popular technique used for complex shoulder instability. The technique is proven to be effective with consistently good results but complications have been reported related to the screws used for the fixation of the coracoid. Recent studies confirm that the suture-button technique for the fixation of the coracoid is biomechanically comparable to the screw fixation. The proposed technique combines the advantages of the open approach and avoids the use of metal screws, potentially minimizing hardware-related complications.     

Ultrasound-guided femoral nerve block

Femoral nerve block is well suited for surgery on the anterior aspect of the thigh and knee. The primary indication of continuous femoral nerve block is pain management after major femoral or knee surgery. Ultrasound image guidance for femoral nerve block can improve block success rate and decrease complications. We describe the ultrasound scanning, needling technique, and catheter insertion technique for single-dose technique and continuous infusion technique.     

Single-layer suture to re-establish the digestive continuity following partial gastrectomy

We have introduced progressively since 1985 the single-layer continuous suture technique for gastroenteric anastomoses, since this technique has been proved to be safe in colonic anastomosis. From 117 gastrectomies performed between 1985 and 1988, 68 gastroenteric anastomoses were performed with the single-layer continuous suture technique (58%). In 1988 this technique has been applied to 92.5% of the gastroenteric anastomoses. The complication rate is low: 3% clinical leakage were found. We concluded that the single-layer continuous suture technique for gastroenteric anastomoses is safe, very simple and easy to perform. It is the logical extension to large and small bowel anastomoses that we have been doing, using this technique for over 4 years now with excellent results.     

The adventitia wrapping technique in microvascular surgery

The success of microvascular anastomosis on fine vessels is essential not only for expanding the possibility of surgical treatment in such cases as replanting severed fingers of children, and vascularized nerve and joint grafting, but also for diminishing the damage to donors as well. This report describes the details of our study on a adventitia wrapping technique in which the adventitia was utilized for wrapping anastomosis. This study demonstrates that the advantages of the adventitia wrapping technique are as follows; (1) Adventitia wrapping technique provides a higher patency rate in smaller microvascular anastomosis. (2) Adventitia wrapping technique aids in reducing operative time and stitches. (3) Adventitia wrapping technique increases tolerable pressure of the anastomosis site and prevents aneurysm. (4) Immediate postoperative hemorrhage at the anastomosis site is lesser than that of the standard suture technique. These results indicate that this technique utilizes the tissue in site, therefore, is simple and useful for microvascular anastomoses.     

Umbilical stalk technique for establishing pneumoperitoneum

The Veress needle technique for establishing pneumoperitoneum is widely used yet associated with slow insufflation and potentially life-threatening complications. The open or Hasson technique is relatively safer but considered cumbersome by many. We describe a mini-open technique that uses a 5-mm transumbilical incision and placement of a 5-mm blunt cannula without the trocar. We have employed this technique for 4 years in 600 patients without a midline laparotomy incision incorporating the umbilicus and have accessed the abdomen safely for laparoscopy without any complications. The time from skin incision to the start of the procedure is usually under 2 minutes. Our umbilical stalk technique provides rapid and safe access to the abdomen, eliminating the dangers of a blind sharp needle or trocar insertion and the need for a larger incision with placement of stay sutures. We recommend this simple technique for entry into the uncomplicated abdomen.     

男性膀胱根治切除术中血管神经束的保留

膀胱癌是泌尿系统最常见的恶性肿瘤,根治性膀胱切除是肌层浸润性膀胱癌的标准治疗方法。随着保留血管神经术在前列腺癌根治切除术中的应用,这种技术也逐渐在膀胱根治切除术中得到应用,并取得较好的临床效果。作者就保留血管神经技术在膀胱根治切除术中的应用、保留血管神经技术的解剖基础及筋膜内分离保留血管神经束手术技巧做一综述。     

Endoscopic foraminotomy using MED system in cadaveric specimens

STUDY DESIGN: Four cadavers had cervical foraminotomies performed at noncontiguous levels using either the standard open technique or the microendoscopic technique. OBJECTIVES: To evaluate the feasibility of using a minimally invasive technique for posterior decompression of cervical disc disease. SUMMARY OF BACKGROUND DATA: Even though the anterior approach is more commonly performed for the treatment of cervical disc disease, the posterior approach has distinct advantages in selected cases of foraminal stenosis and posterolateral disc herniation. Current technique, however, requires extensive muscle dissection, and is, therefore, subject to significant morbidity. METHODS: Each of four cadavers had posterior cervical foraminotomies performed using either the MICROENDOSCOPIC (MED) technique, or the standard open technique. Three noncontiguous levels were decompressed using one technique, and the other technique was used for the adjacent contralateral decompression. Each specimen was then evaluated with postoperative myelogram/CT and open dissection. Laminotomy size, length of root decompressed, and percentage of facet removed were measured. RESULTS: Average vertical diameter decompression and percentage of facet removed were significantly greater for the MED technique than for the open technique. Transverse diameter of the laminotomy area and the average length of decompressed root were not significantly different between the techniques. CONCLUSION: Posterior cervical foraminotomy, using the microendoscopic technique, is technically feasible and may be applicable to the treatment of foraminal stenosis and laterally located cervical disc herniation. Studies in live animals are currently examining techniques for hemostasis.     

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.     

Combined spinal epidural anaesthesia: a new technique

A new technique is described for delivering combined spinal epidural anaesthesia. The disadvantages of the needle-through-needle technique and the two-needle techniques are discussed. The new technique is a modification of the two-needle technique. The spinal needle is introduced and once cerebrospinal fluid is seen at the hub of the needle, the stylet is replaced. The epidural space is then identified and the epidural catheter placed. The spinal needle obturator is then removed and intrathecal injection performed. This technique avoids problems associated with placing an epidural catheter after an intrathecal injection and the potential problem of placing a spinal needle when an epidural catheter has already been placed. This technique requires further evaluation.     

A prospective randomized study of Lichtenstein open tension-free versus laparoscopic totally extraperitoneal techniques for inguinal hernia repair

Ideal technique for effective inguinal hernia repair is still controversial. Although open tension free mesh techniques of inguinal hernia repair offers good results but the superiority of laparoscopic technique was reported for postoperative pain, discomfort and earlier return back to work. A prospective, randomized study was conducted to compare Lichtenstein open tension free mesh technique with the laparoscopic totally extraperitoneal technique. 62 male patients with Lichtenstein open tension free mesh technique and 61 male patients with totally extraperitoneal technique were operated and compared postoperatively. The patients were followed-up for 24 months with a median of 18 months. In terms of recurrence, postoperative pain, analgesic requirement, complications, hospital stay length, duration of limitation of normal daily activities there were no significant differences between the two groups. Operating time for totally extraperitoneal hernia repair was 16 minutes longer than Lichtenstein open tension free technique. The totally extraperitoneal technique was considerably expensive than Lichtenstein technique, however the duration of returning back to work was shorter in patients repaired with totally extraperitoneal technique. In conclusion in primary inguinal hernia repair Lichtenstein technique should be preferred and the totally extraperitoneal technique should be considered for recurrent and bilateral hernias.     

Transaortic Cannulation for Balloon Pumping in a “Crowded Aorta”

A technique for cannulating the ascending aorta or aortic arch to introduce a balloon catheter for intraortic balloon pumping is described. It is performed without the use of a partial occlusion clamp. This technique is useful when multiple anastomoses in the ascending aorta leave no room for the application of a vascular clamp. Three patients in whom this technique was used are reported.     

Long saphenous vein harvesting techniques and their effect on graft patency

Coronary artery bypass grafting is a key cardiac surgery procedure and is the main treatment for patients with multivessel coronary artery disease. The most frequently used conduit for this procedure is the long saphenous vein (LSV). The technique of harvesting the LSV has evolved over the last 30 years from total open harvesting to endoscopic with minimal access technique. The most important determining factor for success in coronary artery surgery is the graft patency rate. The literature evidence behind each technique has been reported at different levels and there is an ongoing debate about which technique can provide optimum vein patency over the long term. This literature review aims to summarize the current evidence, the implications involved with the use of each technique for harvesting LSV and the patency rate at variable follow‐up intervals.     

Billroth I Gastrectomy Using a Circular Stapler to Treat Gastric Cancer

We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler. We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques. Received: February 23, 2000 / Accepted: July 25, 2000