Lightweight polypropylene mesh fixation in laparoscopic incisional hernia repair

Abstract

Introduction: The choice of the mesh and fixation methods in laparoscopic incisional hernia repair is a crucial issue in preventing complications and recurrence. The authors report a series of 40 consecutive laparoscopic incisional hernia repairs, focusing on the use of lightweight polypropylene mesh and on the way of mesh fixation. Material and methods: Forty laparoscopic incisional hernia repairs performed consecutively in 38 patients (16 males, 22 females) were retrospectively evaluated. Patients were divided into two groups depending on tacks used: Titanium tacks vs absorbable tacks. Results: All patients received totally laparoscopic incisional hernia repair by the use of lightweight polypropylene mesh. No major post-operative complications were reported. Post-operative pain (evaluated by VNS) was higher in Group A (titanium tacks, p < 0.05). No differences in follow-up as well as in recurrence incidence (one case in both groups, <6 months time interval) were reported. Conclusions: Securestrap? absorbable tacks are safe and effective and easy to use and did not increase the risk of mesh dislocation compared with non-absorbable tacks. The specific design well fits the lightweight polypropylene mesh Physiomesh?. Further evaluations in larger randomized studies are needed to confirm these preliminary data.     

Shape memory alloys in minimally invasive therapy

Summary

Shape memory alloys are ideally suited to minimally invasive therapy, as their shape memory and superelastic properties facilitate entry through a narrow aperture before ‘expansion’ into predetermined shapes. An increasing number of shape memory alloy devices are being designed and patented although as yet they have made little impact on minimal invasive therapeutic procedures due to the complexities of effective thermal processing and accurate transformation. Within the next few years shape memory alloy technology is likely to make a big impact on laparoscopic, endovascular and endo-scopic surgical practice.     

Is the bipolar vessel sealer device an effective tool in robotic surgery? A retrospective analysis of our experience and a meta-analysis of the literature about different robotic procedures by investigating operative data and post-operative course

Background: The latest robotic bipolar vessel sealing tools have been described to be effective allowing to perform procedures with reduced blood loss and shorter operative times. The aim of this study was to assess the efficacy and reliability of these devices applied in different robotic procedures.

Material and methods: All robotic operations, between 2014 and 2016, were performed using the EndoWrist One VesselSealer (EWO, Intuitive Surgical, Sunnyvale, CA), a bipolar fully wristed device. Data, including age, gender, body mass index (BMI), were collected. Robot docking time, intraoperative blood loss, robot malfunctioning and overall operative time were analyzed. A meta-analysis of the literature was carried out to point the attention to three different parameters (mean blood loss, operating time and hospital stay) trying to identify how different coagulation devices may affect them.

Results: In 73 robotic procedures, the mean operative time was 118.2?minutes (75–125?minutes). Mean hospital stay was four days (2–10 days). There were two post-operative complications (2.74%).

Conclusions: The bipolar vessel sealer offers the efficacy of bipolar diathermy and the advantages of a fully wristed instrument. It does not require any change of instruments for coagulation or involvement of the bedside assistant surgeon. These characteristics lead to a reduction in operative time.     

Clermont-Ferrand versus Vectec uterine manipulator for total laparoscopic hysterectomy

Objective: To compare the operation time and performance of two uterine manipulators used for total laparoscopic hysterectomy (TLH).

Material and methods: Design: Retrospective cohort analysis. Design classification: Canadian Task Force Classification II-2. Setting: Tertiary-care university-based teaching hospital and academic affiliated private hospital. Patients: All consecutive patients who underwent for TLH between January 2014 and June 2017. All operations were performed by two expert endoscopic surgeons using one of the following uterine manipulators depending on surgeon preferences: Clermont-Ferrand (CF) or Vectec (VT) MAUT60. Patients were excluded if additional surgeries such as urogynecological procedures were performed, TLH was converted to laparotomy prior to colpotomy, and when their operation records could not be obtained. A total of 169 patients were added to final analysis. Operation time, colpotomy time and the subjective performance of manipulators such as movement of the uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were evaluated by watching un-edited operation videos.

Results: A total of 169 patients (83 patients in CF group; 86 patients in VT group) were included in the final analysis. Patients’ baseline characteristics were comparable between groups. Operation time and time required for colpotomy were significantly shorter in the VT group. Lateral movements of the manipulators and elevation of the uterus were better with VT compared to CF (p?=?.001 for both). Compared to the CF, VT was superior for visualization of the vaginal fornices (p?=?.004) and maintenance of pneumoperitoneum (p?<?.001). Both surgeons had perfect agreement on the performance grading of manipulators (p?<?.001, Kappa values were between 0.86–0.92). There was no difference between groups in estimated blood loss and duration of hospital stay. Reinsertion or the need to change the manipulator was not required in either group. No pelvic or vaginal abscess, cuff cellulitis, dehiscence, or hematoma formations were noted.

Conclusion: Laparoscopic hysterectomy assisted with the VT uterine manipulator is associated with shorter operation and colpotomy time. Furthermore, the movements of uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were significantly better with VT compared to the CF manipulator.     

Robot-integrated intraoperative ultrasound: Initial experience with hepatic malignancies

Purpose: A new robotic surgery tool allows intraoperative ultrasound to be performed using a fully robotic technique. Herein, we evaluate the feasibility and reliability of robotically integrated ultrasound to guide resection of malignant hepatic tumors. Material and methods: A consecutive series of ultrasound-guided robotic resections of primary and secondary hepatic malignancies was analyzed in terms of perioperative data and specimen evaluation, focusing on the reliability of the new robot-integrated ultrasound probe. Results: Ten consecutive patients underwent 15 robotic liver resections. Two patients were resected to excise primary hepatocellular cancers and eight underwent resections of liver metastases. R0 resections were achieved for all lesions. The median operative time was 247 min, and blood loss was limited. No mortality occurred. Conclusions: Our present analysis confirmed the reliability of fully robotic liver resection guided via robotically integrated ultrasonic assessment. Robotic surgery, particularly hepatic resection, may benefit greatly from better manageability, and the fact that the surgeon can directly manage both the operative and the diagnostic parts of the procedure.     

It is time for a better clip applier – 3 mm,percutaneous, non-crushing and locking

Introduction: Since the advent of laparoscopy there have been attempts to minimize abdominal wall incisions. For this purpose smaller instruments have been produced. Our aim was to develop the first 3?mm percutaneous clip applier and to make it better than the standard clips of today.

Material and methods: The ClipTip clip is made of Nitinol and has a crocodile shaped jaws, which when apposed effectively seal vessels. The shaft operates as a retractable needle permitting percutaneous insertion. Closing, reopening and reclosing is possible. The physical properties of the device were compared to three commercially available clip appliers. Surgeries were performed on porcine animals by experienced surgeons.

Results: In comparison to available clips, the superiority of the ClipTip is a combination of wide effective length alongside the ability to withstand strong forces. In live animal studies the Cliptip was inserted into the peritoneal cavity without any injuries. Vessels were ligated successfully and no clip dislodgement or leakage occurred.

Conclusions: We developed the next generation clip applier with better properties. Advantages include its length, the needleoscopic caliber, non-crushing effect, locking mechanism and wide aperture. The device has performed safely and effectively in pre-clinical tests. Further studies are planned in humans.     

医用镍钛形状记忆合金的表面改性及生物相容性

背景:近等原子比镍钛形状记忆合金以其8%的形变率、上万次的循环次数、优异的抗腐蚀性以及低弹性模量、低磁和射线不透性,成为理想的生物植入材料之一。目的:论述医用近等原子比镍钛形状记忆合金的表面改性及其生物相容性。方法:由第一作者检索1990/2008 PubMed数据库及万方数据库有关医用镍钛形状记忆合金的表面化学处理、化学修饰及植入生物组织后镍离子溶出等方面的文献。结果与结论:近等原子比镍钛形状记忆合金中含镍量较高,对其是否能在人体内安全地长期使用一直存有争议,合金表面改性是提高植入物的生物相容性、解决这一问题的有效途径。镍钛记忆合金可通过表面改性降低镍离子释放,提高生物相容性,为此,国内外学者均做了大量研究工作。但当前对于含镍钛医用合金置入后体内镍离子的代谢过程方面的研究尚不够系统和全面。     

微创腔镜手术器械安全流程管理

目的通过对腔镜手术器械环节的管理,探讨腔镜手术器械在手术使用中的各项安全管理措施,保障手术的安全进行。方法通过对我院2009年7—12月胸腔镜、腹腔镜、宫腔镜、脑室镜、机器人1910例手术腔镜器械的灭菌后的发放、手术使用、手术后接收等各项流程环节控制管理,进行腔镜手术器械的人员培训,梳理流程,增强腔镜手术器械安全管理意识,把控腔镜手术器械质量控制环节的过程管理,进行问题差距管理,改进管理中存在的问题,提高腔镜手术器械的管理质量。结果对1910例腔镜手术的管理,进行环节的流程安全管理,保障手术的顺利进行。结论通过对腔镜物品、器械管理过程追踪临床手术使用、手术后接收、清洗、整理、检查等制定安全管理措施,有效避免腔镜器械管理中的疏漏,临床使用效果显著。     

Imaging artifacts of medical instruments in ultrasound-guided interventions.

OBJECTIVE: Real-time 3-dimensional (3D) ultrasound imaging has the potential to become a dominant imaging technique for minimally invasive surgery. One barrier to its widespread use is that surgical instruments generate imaging artifacts, which can obfuscate their location, orientation, and geometry and obscure nearby tissue. The purpose of this study was to identify and describe the types of artifacts which could be produced by metallic instruments during interventions guided by 3D ultrasound imaging. METHODS: Three imaging studies were performed. First, imaging artifacts from stainless steel rods were identified in vitro and acoustically characterized. Second, 3 typical minimally invasive instruments were imaged (in vitro and in vivo), and their artifacts were analyzed. The third study compared the intensity of imaging artifacts (in vitro and in vivo) from stainless steel rods with rods composed of 3 different materials and stainless steel rods with roughened and coated surfaces. RESULTS: For the stainless steel rods, all observed artifacts are described and illustrated, and their physical origins are explained. Artifacts from the 3 minimally invasive instruments are characterized with the use of the artifacts observed with the rods. Finally, it is shown that artifacts can be greatly reduced through the use of alternate materials or by surface modification. CONCLUSIONS: Instrument artifacts in 3D ultrasound images can be more confusing than those from the same instruments imaged in 2 dimensions. Real-time 3D ultrasound imaging can, however, be used effectively for in vivo imaging of minimally invasive instruments by using artifact mitigation techniques, including careful selection of probe and incision locations, as well as by instrument modification.     

Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures

Purpose: Vertebral body stenting (VBS) was developed to prevent loss of reduction after balloon deflation during kyphoplasty. The aim of this study is the radiological and clinical mid-term evaluation of traumatic incomplete burst fractures treated by vertebral body stenting. Material and methods: This retrospective study included patients with traumatic thoracolumbar incomplete burst fractures treated with VBS between 2009 and 2010. The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry Disability Score (ODI), the SF-36 Health Survey and radiologically assessed. Results: Eighteen patients with an average age of 74.8 years were treated with VBS. Twelve were female and six were male. Two years after the operation the ODI and SF-36 showed a moderate limitation of daily activities and quality of life without neurological deficits. VBS restored the vertebral kyphosis by 3.2° and segmental kyphosis by 5°. A minor sintering was observed at follow-up losing 0.8° vertebral kyphosis and 2.1° segmental kyphosis correction. Two asymptomatic cement leakages were detected. Conclusion: VBS provides clinical outcomes comparable with BKP. The stent allows a reconstruction of the anterior column with reduced subsequent loss of correction.     

Circular surgical stapling procedures: Design implications for MIT

Summary

As circular stapler designs evolve, they provide the means for an increasing range of surgical techniques. It appears that the long-term direction of this evolution will coincide with that of minimally invasive therapy (MIT). The range of techniques available using the current instruments is scattered throughout the literature. This range is presented as a rationalized collation. Technologists working on the development of MIT anastomotic equipment will find the core of a design specification for future development prescribed.     

Unrecognized indication for robot-assisted cardiac surgery: Patients with acute psychotic disorders

Patients with acute psychotic disorders are often considered as inappropriate candidates for cardiac surgery as well as for other surgical interventions. Post-operative care and patient compliance, which are the main problems associated with such patients, are the most important issues for conventional cardiac surgery. Robot-assisted cardiac surgery may be a new solution in this respect. In this report we aimed to present our acute psychotic patient with serious mitral insufficiency secondary to huge atrial myxoma, treated with robotic cardiac surgery.     

多模式镇痛在脊柱外科微创手术中的应用①

目的探讨多模式镇痛在脊柱外科微创手术中的应用.方法选择21例在多模式镇痛模式下接受脊柱外科微创手术的患者,观察术中血流动力学、呼吸监测指标、镇痛镇静评分、不良反应事件、术者及患者对手术过程满意度评价.结果手术过程顺利,血流动力学稳定,呼吸功能无抑制,患者及术者对手术过程满意.结论多模式镇痛能够使患者在最舒适的环境下接受脊柱外科微创手术,同时不影响术者与患者在术中进行交流.     

正中小切口全胸骨劈开术治疗心脏疾病的手术策略及应用技巧

目的:探讨正中小切口全胸骨劈开术应用于多数心脏手术策略和实施技巧。方法:总结2017年11月至2019年12月复旦大学附属中山医院302例全胸骨劈开正中小切口心脏直视手术经验,与常规正中切口手术和右侧开胸微创手术的二尖瓣修复手术的手术效果、手术时间、主动脉阻断时间、出血量和ICU停留时间进行比较。结果:正中小切口手术将胸骨全切开,但将常规的20 cm切口长度缩小到6～8 cm,胸骨只撑开6 cm,可进行多数心脏手术,取得良好效果,适应证广,且具备微创手术切口小、美观的优点,对胸廓影响小,又具备正中开胸的心脏显露清楚,手术迅速确切,心脏中心插管,手术安全性高,不增加手术时间、主动脉阻断时间、出血量和ICU停留时间,不需要单肺通气等诸多优势。结论:正中小切口这种微创手术方式,适应证广泛,操作较方便,易于临床推广。     

镍钛形状记忆合金材料在骨科的应用

背景:目前镍钛形状记忆合金使用广泛,已应用于骨科内固定物、牙科心血管材料、神经外科、泌尿外科、胃肠外科、肝胆外科以及生殖医学等医学诸多领域.目的:就镍钛形状记忆合金在骨科各方面的应用作一综述,以阐明其在骨科的应用现状.方法:由第一作者分别以"镍钛形状记忆合金,骨折"和"Nickel titanium (NiTi) shape memory alloys,fracture"为关键词进行检索,CNKI数据库的检索时限为2002/2009,PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)的检索时限为1963/2009,检索内容为镍钛形状记忆合金在骨科的应用.结果与结论:计算机初检得到57篇文献,阅读标题和摘要进行筛选,保留符合纳入标准的17篇归纳总结.结果显示,镍钛记忆合金不仅仅使用在四肢骨折中,近年来也使用在脊柱和股骨头骨折中.镍钛记忆合金生物相容性好,并具有超弹性、低磁性、耐磨损、耐疲劳、抗腐蚀的特性,已作为一种新型内固定材料被广泛使用.     

单孔腹腔镜手术操作平台及其器械的研究进展

单孔腹腔镜技术在保证手术疗效的同时,可以进一步提高美容效果和减少手术创伤.它的发展得益于手术器械的发展与手术经验的积累.该文对单孔腹腔镜手术操作平台及其器械的研究进展做一阐述.     

腹腔镜微创手术在治疗妇科疾病中的应用效果研究

目的 探讨腹腔镜微创手术在妇科疾病中的疗效。方法 选择2009年3月至2012年3月于该院就诊治疗的200例患者,按照手术方式的不同,分为实验组120例和对照组80例,对照组患者选择开腹手术治疗,实验组选择腹腔镜微创手术。观察两组患者手术后的一般情况及术后并发症。结果 两组患者的手术时间比较,差异无统计学意义（P＞0．05）;但实验组患者术中出血量明显少于对照组,差异有统计学意义（P＜0．05）,且术后患者胃肠蠕动恢复时间及下床活动时间早于对照组,差异均有统计学意义（P＜0．05）;实验组患者平均住院时间少于对照组,差异有统计学意义（ P＜0．05）。实验组患者共出现4例并发症（3．33％）,对照组患者出现9例并发症（11．25％）,两组差异有统计学意义（χ^2＝4．95,P＜0．05）。结论 腹腔镜微创手术在治疗妇科疾病中对患者的损伤较小、并发症低,可作为临床妇科疾病的良好治疗手段。     

可重复使用的消毒诊疗物品保存方法研究

目的探讨可重复使用消毒物品的保存期限,为临床应用提供依据。方法湿化瓶、面罩、呼吸机螺纹管、吸痰器连接管经清洗消毒后随机将：A组用预先经低温等离子灭菌后的食品包装袋按诊疗需求进行包装,B组放在铺好的治疗盘内;同时又将经A组包装后的诊疗物品随机分为A1组放在临床治疗室内,A2组放在供应室无菌室内,检测四组不同保存方法的污染率。结果 A组7d内未出现污染,B组1d出现污染,4d污染率达50.00%（P〈0.05）;A1组8d开始污染,A2组12d开始污染（P〈0.05）。结论可重复使用的消毒物品在干燥无菌保存条件下,治疗室内保存时限为7d,供应室保存时限为10d。