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.     

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。     

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.     

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.     

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.     

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.     

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。     

单孔腹腔镜结直肠手术应用现状及展望

单孔腹腔镜技术是新兴的一种微创外科技术,随着外科医师对这一技术的不断认识和掌握,其在腹部外科领域特别是结直肠外科应用逐渐增多,笔者就单孔腹腔镜技术在结直肠外科领域的应用现状,技术特点及发展前景做一述评。     

口腔修复牙体预备不同操作模式的临床疗效比较

目的:对比四手操作与独立操作在口腔修复牙体预备中的应用价值。方法:选取笔者医院口腔科2017年8月-2018年8月收治的96例行口腔修复的患者,按随机数表法分为四手操作组与独立操作组,每组48例。四手操作组:采取四手操作,由1名医师与1名护士配合进行口腔修复牙体预备;独立操作组:由医师独立完成口腔修复牙体预备全过程。比较两组手术时间、模型牙预备标准率、医护舒适度、患者舒适度、患者满意度、医院感染率及不良事件总发生率。结果:四手操作组手术时间为(22.51±3.05)min,显著短于独立操作组的(29.67±3.48)min(P<0.05);四手操作组模型牙预备标准率为98.15%,显著高于独立操作组的88.46%(P<0.05);四手操作组医护舒适度与患者舒适度分别为97.92%与91.67%,显著高于独立操作组的83.33%与75.00%(P<0.05);四手操作患者满意度为100.00%,显著高于独立操作组的87.50%(P<0.05)。四手操作组医院感染率与不良事件总发生率显著低于独立操作组(P<0.05)。结论:口腔修复牙体预备采用四手操作有利于缩短手术时间、提高舒适度与患者满意度,且可减少医院感染与不良事件,效果优于独立操作,值得临床推广。     

Wise pattern mastectomy with immediate breast reconstruction

A new technique of immediate breast reconstruction is presented. This technique uses a silicone implant placed in a subpectoral pocket, using de-epithelialised skin from the lower breast to augment the submuscular pocket, thus producing a compound myodermal flap. The technique is simple, and the resulting scar is cosmetically satisfactory; when combined with reduction mammoplasty on the opposite breast, this technique produces satisfactory breast symmetry.     

漏斗技术置入胸椎椎弓根螺钉准确性研究

目的：对漏斗技术和徒手技术在胸椎弓根螺钉置入中的准确性和安全性进行对比研究。方法：采用8具胸椎标本,男性5具,女性3具;年龄57-82岁,平均68岁。随机分为2组,每组4具,利用漏斗技术和徒手技术分别进行椎弓根螺钉置入,然后CT扫描判断置入是否成功,对两种方法的成功率和危险性穿破率进行统计学对比分析。结果：漏斗技术置入96枚螺钉中成功84枚,徒手技术置入96枚中成功73枚,两种方法成功率比较,差异有统计学意义（P〈0．05）。漏斗技术危险性穿破2枚,徒手技术危险性穿破9枚,两种方法危险性穿破率比较,差异有统计学意义（P〈0．05）。结论：“漏斗技术”具有简单、经济、安全和实用等优点,可以减少神经根和硬膜囊的损伤机会。     

Mitral valve repair with artificial chordal creation

To achieve optimal long-term result of mitral valve repair, artificial chordae creation has got to be an important technique. Artificial chordae creation can preserve leaflet motion of the posterior mitral leaflet and soft coaptation area. Loop technique is suitable technique for creation of multiple artificial chordae, especially in minimally invasive minithoracotomy setting. Loop-in-loop technique is a new technique to realize easy adjusting of the length of the neochordae using slippery Gore-Tex suture. Loop-in-loop technique helps surgeons to afford variety of mitral valve repair techniques and manage complex mitral valve pathologies.     

Blind percutaneous renal access

We describe a technique of blind percutaneous renal access when retrograde/intravenous imaging is not possible. We present the surgical technique, the patient population, and situations in which the technique is used. Following a review of 40 accesses, we concluded that this technique is safe, simple, and effective. It also allows the urologist to act autonomously in obtaining renal access.     

A safer, simpler, classic intrafascial supracervical hysterectomy technique.

OBJECTIVES: Our aim is to introduce the technical aspects and advantages of a new classic intrafascial supracervical hysterectomy (CISH) technique over the conventional technique. METHODS: We performed a retrospective evaluation (Canadian Task Force classification II-2) of 200 women who underwent conventional CISH technique (100 cases), between March 2000 and September 2000, or the new CISH technique (100 cases) between May 2002 and November 2002. The charts of these 200 women were reviewed regarding patient characteristics, indications, uterine weight, estimated blood loss, operating time, and hemoglobin change. RESULTS: The women who underwent the new CISH had significantly shorter operating time as compared with operating time for the conventional method. Although no significant difference existed in the estimated blood loss, the hemoglobin change, which is an objective sign of blood loss, was significantly smaller using the new CISH technique than using the conventional CISH technique. CONCLUSIONS: The new CISH technique is safer, more convenient, faster, and results in less blood loss than the conventional technique, especially when the uterus is markedly enlarged by a large myoma, the ovarian ligament is too short, or the ovary and uterus are very closely adherent.     

An in vitro biomechanical study comparing the spiral linking technique against the pulvertaft weave for tendon repair

A new spiral linking technique for tendon repair in which one end of the tendon is spiralled around the other end has been developed. Using pig trotter extensor tendons, the Pulvertaft weave technique was compared with this new technique. Twenty-five repairs using each technique were tested by tensile loading with an Instron testing machine. The spiral linking technique matched the strength of Pulvertaft method: the mean peak loads were 102 and 105 N, respectively. The Pulvertaft weave was stiffer than the spiral linking technique: mean stiffness of 11.1 and 6.7 N/mm, respectively. The spiral linking technique also absorbed considerably more energy: energy absorbed prior to failure to 90% of peak load, 1.75 and 1.13 kN mm, respectively. In conclusion, the spiral linking technique appears as strong as the Pulvertaft weave and we believe it is easier to perform.     

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腹腔开放是损伤控制外科的重要组成部分,不但用于腹部外伤和感染等普外科疾病的救治,也用于救治烧伤或液体复苏过程中产生的腹腔高压。腹腔开放包括两大要素:开放腹腔和暂时性腹腔关闭,二者缺一不可。开放腹腔的主要目的是降低腹内压,暂时性腹腔关闭技术能够保护腹内脏器、引流腹腔液体,减少或避免腹壁回缩和并发症的发生。暂时性腹腔关闭方法分三类,分别为关闭皮肤法,关闭筋膜法和负压辅助关腹法。关闭皮肤法简单方便,但后期修复腹壁困难较大。负压辅助关腹技术并发症少,早期确定性腹腔关闭成功率高,应用越来越广泛。     

Vertical mammaplasty with a clamp technique

The vertical mammaplasty with a clamp technique is a personal adaptation of the clamp technique that leaves a single vertical scar in addition to the periareolar scar. This technique uses a superior pedicle from the dermal vault technique. There is no need for preoperative markings. The glandular tissue is removed with constant reference to the breast base. The skin is excised around a new clamp, which leaves only a vertical scar. This retrospective study includes 100 patients operated between 1996 and 2000. A total of 96% of the patients have been happy with the final cosmetic result. The best results were obtained when breast ptosis and moderate hypertrophy were present. The complication rate was 4%. This technique is as reliable as other procedures using the superior flap technique. A vertical scar is obtained by using a new clamp that allows a perfect match of the gland to its cutaneous cover. It is also a fast technique to perform (75 minutes).     

A technique for adequate coverage of the proximal suture line during abdominal aortic aneurysm repair

The proximal suture line is a vulnerable area after abdominal aortic aneurysm repairs. This area has been implicated in various postoperative complications, such as pseudoaneurysm formation, graft-enteric fistula, and suture line disruption. We present a technique that provides safe and adequate coverage of this suture line by using the aneurysm sac. This technique is derived from the z-plasty technique used for scar revision. The technique is illustrated with detailed line drawings. None of the patients in whom we used this technique have had any complications related to the proximal suture line.     

两种输尿管膀胱吻合术式的对照研究（附18例报告）

目的：对照研究输尿管膀胱瓣吻合术和输尿管膀胱角吻合术的优缺点.方法：通过建立离体输尿管膀胱吻合术式模型,研究两种术式术前、术后膀胱容量及膀胱容量-压力的变化情况;并回顾性分析同一时期两种手术患者的临床情况,比较两种手术的优缺点.结果：输尿管膀胱瓣吻合术模型中,膀胱瓣同侧输尿管膀胱壁内段至膀胱瓣末端距离为16 cm;输尿管膀胱角吻合术模型中,同侧输尿管膀胱壁内段至丝线标记距离为12 cm.随着膀胱容量的不断增加,输尿管膀胱瓣吻合术模型中膀胱压的增加明显大于输尿管膀胱角吻合术模型中膀胱压的增加.临床随访中发现输尿管膀胱瓣手术组患者术后尿瘘、尿频、尿急等发生率明显高于输尿管膀胱角吻合术组.结论：两种手术在安全性方面没有区别.当临床输尿管下段缺损长度在10 cm以内,可采取输尿管膀胱角手术;当临床输尿管中下段缺损长度在10～14 cm时,可采取输尿管膀胱瓣吻合术;肾移植术后患者不宜采用输尿管膀胱瓣吻合术.     

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.