Mapping and orienting tissue during Mohs micrographic surgery. An alternate approach.

An alternate method for mapping and orienting tissue during Mohs micrographic surgery is described. This quick and simple technique eliminates the application of indelible dyes to the tissue margins.     

Running vertical mattress suture.

Various types of running sutures have been described for use in dermatologic surgery. The running vertical mattress suture is a time-saving technique that can be used alone or in combination with any running-suture technique. It is useful for wound eversion, providing hemostasis, and closing wounds under mild tension.     

Presuturing in alopecia reductions

The technique of presuturing for alopecia reductions is described. With this procedure, the area of potential reduction is sutured 12-24 hours prior to surgery to enhance the laxity of the scalp.     

Laparoscopic radical cystectomy

Open radical cystectomy with lymph node dissection remains the gold standard treatment for recurrent, high-grade, non-muscle-invasive and for muscle-invasive bladder cancer. The excellent perioperative and long-term results provided by laparoscopic surgery and the advances in instrumentation design have naturally paved the way for development of laparoscopic radical cystectomy (LRC). In this review, surgical and long-term oncological outcomes of LRC are analysed. The advantages of this technique compared with open surgery are described. The differences between pure laparoscopic technique or laparoscopic cystectomy and extracorporeal urinary diversion have also been analysed.     

Marsupial minigrafts for alopecia following surgical procedures of the scalp repaired by split-thickness skin grafts

A technique is described for treating the alopecia resulting from scalp surgery repaired by split-thickness skin grafts with the method of marsupial minigrafts. This procedure provides an uncomplicated outpatient approach for treating this type of alopecia.     

Technique chirurgicale: oncoplastie dans le traitement conservateur du cancer du sein

Management of operable breast cancer requires more and more the use of oncoplatic techniques. The concept of “anticipation“ is as the prediction of response in medical oncology a key point of the surgical management. Historically the first technique was the bilateral reduction mammoplasty, a classical platic surgery technique, for the lower quadrants tumors. Among the last ten years several new techniques were described to arrive at the concept of “one quadrant, one technique“. Externals cancers are the most frequent location of the disease and the external mammoplasty became a routine technique in expert centers. However a specific training remains necessary and there is not enough specific teaching because of the large number of surgeons asking for such training and the small number of teachers. Finally, the knowledge of chemotherapy and radiation therapy are a pre requisite for breast cancer surgery as well as the principles of surgery must be known bymedical oncologists and radiation therapists     

Actualité de la chirurgie du cancer du pancréas

Since Whipple et al. described the technique of cephalic duodenopancreatectomie in 1935; the surgical treatment of pancreatic cancer has made gains in quality of resection. The excision of the retroperitoneal margin with first approach of the superior mesenteric artery allows complete pancreatic surgery and gives a clearer idea about the prognosis, the impact of this technique on survival remains to be assessed.     

Intraoperative remote afterloading endocurietherapy with high-activity 60cobalt for treatment of glioblastoma multiforme

An intraoperative remote afterloading endocurietherapy technique with high-activity 60Co for the treatment of glioblastoma multiforme is described. The technique can be used for initial management of the unresectable tumor or for retreatment of patients with recurrent tumor who have been treated previously with surgery and postoperative radiotherapy. Neither intraoperative nor postoperative complications were encountered in our treatment of 11 patients in this Phase I toxicity study.     

Biliary reconstruction when the liver hilum is inaccessible: The anterior approach

Objective

This paper focuses on a novel approach to biliary reconstruction after previous extensive liver surgery.

Summary background data

Bile leak and subsequent biliary strictures are not uncommon after extensive liver surgery. Biliary reconstruction is then required, but the liver hilum is usually inaccessible for further surgical intervention.

Methods

A novel surgical technique is described in two patients with biliary stenosis after previous extensive liver surgery. Access to the biliary tree was obtained using an anterior approach. A previously inserted PTC drain was used as guidance to the bile duct suitable for creating a biliary-digestive anastomosis.

Results

The described technique proved to cause complete biliary drainage in both patients. There was no treatment-related morbidity nor was further biliary intervention needed during follow-up.     

A simple method of tissue embedding for Mohs micrographic surgery

A simple and reliable method for tissue embedding for Mohs micrographic surgery is described. This technique reduces the number of frozen sections necessary to evaluate a complete margin and can easily be adapted to the office setting without the need of special equipment.     

An educational device for Mohs micrographic surgery. A three-dimensional model of basal cell carcinoma

Mohs micrographic surgery for skin cancer (fresh-tissue technique) involves the processing of tissue in a complex fashion. The advantages of this method relate to the asymmetric three-dimensional growth of basal cell carcinoma (BCC). A device is described here based on published knowledge about the growth of BCC. The model demonstrates the precise way in which Mohs surgery varies from other surgical approaches to yield higher cure rates in specific circumstances. This device may be helpful in educating residents and medical students about Mohs surgery and in preparing patients for this procedure.     

Laryngeal fiberscopic surgery — an alternate approach to microlaryngeal surgery

Microlaryngeal surgery (MLS) is difficult in patients with anaesthetic and cervical contraindications. An alternative approach is proposed here using a flexible laryngeal fiberscope and specially designed laryngeal instruments under local anaesthesia. Equipment and technique of the procedure is described. Indications and contraindications are highlighted based on our experience of 117 patients. Laryngeal fibrescopic surgery (LFS) was found to be a safer alternative. But this procedure cannot be used for all laryngeal pathologies.     

食管癌的微创术

Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.     

Radiological diagnosis and management of proximal fallopian tube obstruction

Fluoroscopically guided transcervical fallopian tube catheterization is a valuable technique in the management of infertility, being applicable to occlusion of the proximal fallopian tube. It was first described in the literature in 1987. Our experience is discussed. Modifications to the usual technique are explained. The procedure has had a poor initial acceptance in Australia, but should replace tubal surgery or in vitro fertilization in a group of patients.     

Results of surgical treatment of locally enlarged cancer of the lung

Immediate and end results of surgical treatment of locally advanced lung cancer were studied in 197 patients. The technique of extensive, combined and extensive-combined operations is described. Postoperative complications associated with combined and extensive procedures were observed as frequently as those involved in standard surgery provided the technique was followed closely. Three-year survival rate for patients operated on for locally advanced squamous-cell cancer and adenocarcinoma of the lung was 15.2% as compared to 4.1% for those undergoing chemotherapy.     

The use of a combination skin hook and tissue forceps: a new instrument for dermatologic surgery ("Frankel-Adson forceps")

The dermatologic surgeon frequently uses both skin hook and tissue forceps to accomplish atraumatic wound closure. Since this requires the surgeon to change instruments frequently during the course of the procedure, a combination skin hook and tissue forceps has been developed to make possible the simultaneous use of these two instruments. In addition, using a new technique that combines the two capabilities of this instrument, the surgeon can further reduce the risk of tissue trauma during surgery. The instrument and this technique are described.     

Cerebral radiation surgery using moving field irradiation at a linear accelerator facility

A modified irradiation technique at a linear accelerator facility for radiation surgery within the brain is described consisting of several moving field irradiations in non-coplanar planes. Using collimated narrow beams, a localization system and special computer programs for precise patient positioning, a high concentration of dose within small, well circumscribed volumes is obtained. Resulting dose distributions were studied experimentally and by calculations. A simple algorithm for treatment planning was developed and based on CT images. Radiation surgery within the brain is now technically feasible at our linear accelerator. Seventeen patients have now been treated.     

Dermabrasion by wire brush

While many physicians choose the fraise for all dermabrasive surgery, others prefer the faster abrasiveness and reduced friction of the brush for deep full-faced abrasions, removal of tattoos, and revision of scars. In addition to preoperative preparation and postoperative care of the patient, the author's technique for full-face abrasion with the power-driven rotary brush is described.     

Minimal Invasive Surgery for Esophageal Cancer

Thoracoscopic esophagectomy is only established in some centers and affords a cervical anasto-mosis because intrathoracic anastomosis as a routine is technically too difficult.Laparoscopic mobilisationof the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the constructionof a comparable gastric conduit like by open surgery.The technique of laparoscopic gastrolysis as prepa-ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brieflymentioned.     

Nuances in ophthalmic plastic surgery. A dermatologic surgeon's perspective.

BACKGROUND. Presented several nuances in the performance of cosmetic upper, lower, and lateral eyelid surgery. OBJECTIVE. To provide slight modifications in the performance of cosmetic upper and lower eyelid surgery that may be timesaving and outcome-enhancing. Lateral eyelid tightening is discussed. The expected outcomes and best candidates for surgery are also described. METHODS. Methods vary with the individual procedure. However, expertise in the traditional methods of cosmetic eyelid surgery is integral to success with the modified techniques. RESULTS. Results vary with the individual procedure, the surgeon's expectations, and the surgeon's interpretation of the patient's expectations, as well as other factors. CONCLUSION. Modifications of traditional cosmetic eyelid surgical procedures may benefit the patient following careful planning and technique execution.