Spearheading Advancements in Surgical Sealants
Surgeons and clinicians have used surgical sealants for closing or reconnecting ruptured tissues, or as an adjunct to sutures and staples, for years. However, advancements in technology have led general surgeons and specialists to consider sealants for a wider range of applications and with increased frequency. Increasing Ease of Use Surgical sealants aren't as easy to use as a tube of Crazy Glue. Surgeons must mix and use some agents precisely and promptly to be effective. Delivery systems vary from a syringe, proprietary applicator, or through an endoscope. Most require special training. Sylys®, an elastic, resorbable, synthetic sealant developed by Cohera Medical, requires no mixing. The single-part sealant uses a chemistry that produces rapid curing initiated by contact with tissue moisture. Its custom applicator allows surgeons to use the product in either open or laparoscopic procedures. "We wanted doctors to be doctors, not engineers," said Cohera president and CEO Patrick Daly. "We wanted to create a great product that's easy to use and straightforward to apply." Cohera designed Sylys to help reduce anastomotic leakage in gastrointestinal surgical procedures. Used in conjunction with sutures or staples, Sylys supports anastomosis during the first few days post-surgery—a time when patients run the highest risk of bowel leakage. Daly said the sealant, in preclinical studies, reduced leakage by nearly 60 percent. "A bowel leak...
CONCLUSION: Careful histopathological examination of the surgical specimen and diligent monitoring of β-human chorionic gonadotropin to zero is crucial to prevent potentially missing this very malignant, but highly curable disease. Early systemic metastases are common and presentation can include bleeding from vaginal metastases. PMID: 29032067 [PubMed - as supplied by publisher]
CONCLUSION: In our study laparoscopic surgery for acute cholecystitis is a safe procedure with low intraoperative complication rate and with a reduced hospital stay. KEY WORDS: Acute cholecystitis, Intraoperative adhesion, Intraoperative bleeding, Laparoscopic cholecystectomy. PMID: 29026059 [PubMed - as supplied by publisher]
CONCLUSIONS: Over-sewing of the staple line was associated with fewer leaks but no conclusions can be drawn regarding the effects of over-sewing on staple line bleedings. Before standardizing surgical techniques further, trials are necessary to improve our knowledge about over-sewing in LSG. PMID: 29029355 [PubMed - as supplied by publisher]
Conclusion Barbed sutures ease the repair of uterine scar defects and can provide ideal reapproximation of thick myometrial tissue. Laparoscopic treatment of a scar pregnancy and isthmocele repair are effective and safe modes of treatment.
Publication date: Available online 9 October 2017 Source:Journal of Minimally Invasive Gynecology Author(s): Antonio Setubal, João Alves, Filipa Osório, Adalgisa Guerra, Rodrigo Fernandes, Jaime Albornoz, Zacharoula Sidiroupoulou Isthmocele appears as a fluid pouch-like defect in the anterior uterine wall at the site of a prior Cesarean section and ranges in prevalence from 19% to 84%, a direct relation to the increase in Cesarean sections performed worldwide. Many definitions have been suggested for the dehiscence resulting from Cesarean section, and we propose standardization with a single term for all cas...
AbstractBackgroundLaparoscopic pancreaticoduodenectomy (LPD) is technically demanding, and its impact on postoperative outcomes remains controversial.ObjectiveTo compare short-term outcomes between laparoscopic versus open pancreaticoduodenectomy (OPD) in order to assess the safety of LPD.MethodsFrom 2002 to 2014, all consecutive patients undergoing LPD or OPD at two tertiary centers were retrospectively analyzed. Patients were matched for demographics, comorbidities, pathological diagnosis, and pancreatic texture. Results for the two groups were compared for postoperative outcomes.ResultsSixty-five LPD were performed and ...
This video reviews a robotic isthmocele repair with hysteroscopic guidance in a patient with prior cesarean sections. Isthmoceles are described in the literature as defects in the anterior uterine surface at the site of a prior hysterotomy creating a pouch-like effect and repair is often performed for treatment of bleeding, pain, and secondary infertility. Approaches include hysteroscopic, vaginal, or laparoscopic repair with many women experiencing improvement in symptoms and satisfaction following surgery.
Cervical fibroids are rare but may result in bulk symptoms or heavy menstrual bleeding. Laparoscopic hysterectomies can be challenging in patients with cervical fibroids due to anatomical distortion of the uterine vessels and inability to place a uterine manipulator. In this video, we demonstrate surgical tips to perform a safe laparoscopic hysterectomy in a patient with a large cervical fibroid extending to the pelvic sidewall. Surgical techniques demonstrated include: utilization of a Breisky-Navratil retractor for uterine manipulation and colpotomy guide, ligation of the uterine arteries at their vascular origin via a p...
Our patient is a 21 year old G1P0 who presented with bleeding and pain after a therapeutic abortion and was found to have retained products of conception. An ultrasound also showed a complex left adnexal mass. After her dilation and curettage, she had a diagnostic laparoscopy and was noted to have a left rudimentary uterine horn. In this video, we review the anatomy of this anomaly and demonstrate our technique for laparoscopic removal of the rudimentary horn and associated fallopian tube. To delineate the anatomy, ultrasound, magnetic resonance imaging, and diagnostic hysteroscopy and laparoscopy were used.
This is a video showing localization, debridement, and repair of a cesarean scar defect with associated broad ligament hematoma. The patient is a 37 year old G4P3013 with history of cesarean section x3 who presented with pelvic pain and abnormal uterine bleeding following D&C for a missed abortion. Perforation of the cesarean scar defect during D&C was suspected. Hysteroscopy and single-incision robotic-assisted laparoscopy was performed. Bladder adhesions were taken down and the cesarean scar defect was repaired.
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