STI XIX - Upcoming Articles

 

Laparoscopic Single-Site Surgery for Placement of Adjustable Gastric Band

Julio Teixeira M.D., F.A.C.S. Chief Division of Minimally Invasive Surgery, St. Luke's-Roosevelt Hospital Center Associate Clinical Professor of Surgery, Columbia University College of Physicians & Surgeons New York, NY

 

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Abstract

We present a series of patients who have undergone laparo-endoscopic single-site (LESS) surgery for placement of an adjustable gastric band. From December 2007 to December 2008, LESS surgery to place an adjustable gastric band was performed via a trans-umbilical incision. Essentially, multiple ports were placed through a single incision in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard pars flaccida technique were not altered. Twenty-two patients were carefully selected, including 20 women and 2 men ranging in age from 18 to 67 with a mean age of 42. All patients were discharged home within the 23-hour admission window, and there were no perioperative complications noted. In addition, there were no wound-related complications. LESS surgery for adjustable gastric band shows this technique to be both feasible and safe in selected patients to date. Although technical limitations exist that will undoubtedly be improved upon, further studies must be performed to compare LESS surgery for placement of an adjustable gastric band to traditional laparoscopic techniques.

The Technique of Intraoperative Neuromonitoring in Thyroid Surgery

Gianlorenzo Dionigi, M.D., F.A.C.S. Associate Professor of Surgery, Director, Endocrine Surgery Research Center, Alessandro Bacuzzi, M.D. Endocrine Surgery Research Center, Luigi Boni, M.D., F.A.C.S., Associate Professor of Surgery, Endocrine Surgery Research Center, Francesca Rovera, M.D., Endocrine Surgery Research Center, Stefano Rausei, M.D., Endocrine Surgery Research Center, Francesco Frattini, M.D., Endocrine Surgery Research Center, Renzo Dionigi, F.A.C.S., F.R.C.S. (Hon. Edin.), Full Professor of Surgery, Endocrine Surgery Research Center, Director

 

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Abstract

Recurrent laryngeal nerve (RLN) palsy during thyroidectomy is associated with multiple risk factors as patient- and surgeon-related bailiff. The risk is greater for thyroid cancer, Graves' disease, re-operation, and mediastinal goiter in less experienced centers and in patients in whom the RLN could not be identified during operation. Anatomical landmarks exist to identify RLN. Nevertheless, transient and permanent RLN injuries still exist. Intraoperative neuromonitoring (IONM) has been introduced to facilitate identification and verify functional integrity of the RLN in thyroid surgery. In this chapter, we present relevant medical literature and personal experience on thyroid surgery with IONM. Technical, medical, and legal aspects of monitoring are discussed.

Transforaminal Endoscopic Lumbar Procedure for Disc Herniations: A "Between" Technique

Kai-Xuan Liu, M.D, Ph.D., Atlantic Spinal Care, Edison, New Jersey, USA, Bryan Massoud, M.D., New Jersey Back Institute, Fairlawn, New Jersey, USA

 

 

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Abstract

Despite the advancement of surgical techniques in endoscopic spine surgeries, treatment of central and paracentral disc herniations, especially disc extrusions and disc sequestrations, remains challenging. On the basis of our experience with treating disc tears, disc herniations, and other spinal diseases, we have developed a new technique we call the "between" technique. This technique involves positioning the opening of the endoscope access cannula at the edge of the targeted disc with half of the opening being positioned inside the disc and the other half positioned in the epidural space. The "between" technique uses a blunt-ended dilator as a navigating tool in the epidural space to find the ideal access path and initial location for the access cannula. The technique is safe, effective, and easy to use. It has been proven particularly efficacious for the treatment of central and paracentral extruded disc herniations and sequestered disc herniations. The purpose of this Chapter is to describe this technique and introduce its application in removing central and paracentral disc extrusions and sequestrations.

Single Radius Total Knee Arthroplasty: PCL Sacrifice Without Substitution Yields Excellent Outcomes: Minimum 8-Year Follow-Up

Steven F. Harwin, MD, FACS, Chief of Adult Reconstructive Surgery of the Hip and Knee, Beth Israel Medical Center, Associate Professor of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA, Mark Kester, PhD, Senior Director Research, Stryker Orthopaedics, Mahwah, New Jersey, USA

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Abstract

Posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA) is bone conserving and relies on the retained ligament to provide posterior stability. PCL sacrifice allows for easier correction of deformity, a better range of motion, and predictable kinematics. It was hypothesized that using a novel single radius TKA design, coupled with a double-dished articular geometry, would yield satisfactory stability and outcomes by sacrificing the PCL without substitution. A consecutive series of 94 cemented Scorpio (Stryker Orthopaedics) single radius PCL retaining total knee arthroplasties using that strategy, with a minimum 8-year follow-up, is presented. An early return of range of motion and extensor mechanism function was also demonstrated. No cases of instability and no revisions related to the technique occurred. As predicted, clinical and radiographic outcomes were excellent regarding pain relief and functional activities.

Expanded Clinical Experience with 4DDome® Composite Prosthesis In Elective Open Inguinal Herniorrhaphy

Didier Mutter, M.D., Ph.D, F.A.C.S., Clinical Professor, Gastrointestional Surgery, Cosimo Callari, M.D., Resident, General and Laparoscopic Surgery, Jacopo D'Agostino, M.D. , Resident, General and Laparoscopic Surgery, Ronan A. Cahill, M.D., F.R.C.S., Consultant Surgeon, Colorectal and Laparoscopic Surgery, Antonello Forgione, M.D., Consultant Surgeon, Laparoscopic Surgery, Michel Vix, M.D., Clinical Professor, Laparoscopic Surgery, Joël Leroy, M.D., F.R.C.S., Clinical Professor, Colorectal and Laparoscopic Surgery, Jacques Marescaux, M.D., F.R.C.S., F.A.C.S., Professor and Chief of Digestive Surgery, All authors are affiliated with IRCAD/EITS, Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg

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Abstract

Prosthetic material composition is implicated in the phenomenon of postoperative chronic groin pain that has undermined elective open inguinal herniorrhaphy. Reported herein are our 'all-comers' experiences with a novel dual component mesh (4DDome®). A prospective cohort (Phase II) study was performed that involved all patients undergoing elective open inguinal herniorrhaphy during a four-year period. Conventional operative technique was used except for choice of prosthesis. The 4DDome mesh comprises a molded dome-shaped composite (10% polypropylene, 90% poly-L-lactic acid) with a lightweight polypropylene mesh overlay. Short- (1 week) and intermediate-term (18 months) clinical follow-up with examination and symptom questionnaire judged outcome while surgeons rated their approval using a visual analogue scale. One hundred ninety-six patients (mean age, 65.5 years; Mean BMI, 25.5; Mean ASA, 1.8, 178 males) underwent repair of 201 inguinal hernias by six surgeons (three residents). The majority of patients had an indirect hernia (n=119) 93 being combined with a posterior wall defect [Nyhus IIIa], whereas 66 had a direct hernia [Nyhus IIIb], and 11 had a recurrent hernia.) Mean operative time was 44.6 minutes with 92 patients being operated under local anesthesia. Ten patients developed seromas and two had hematomas early postoperatively. Median intermediate-term follow-up is currently 19 (range: 3-72) months for the 147 (75%) patients still available for contact. The incidence of chronic groin pain is 8.8%, whereas there has been one hernia recurrence. Surgeon satisfaction and confidence were high. The 4DDome provides appropriate clinical results and, therefore, appears valid for use in routine practice.

Bearing Mobility Affects Tibial Strain in Mobile-Bearing Unicompartmental Knee Arthroplasty

Scott R. Small, M.S., Engineering Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Michael E. Berend, M.D., Fellowship Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Merrill A. Ritter, M.D., Research Director, Joint Replacement Surgeons of Indiana Research Foundation, Mooresville, IN, Christine A. Buckley, Ph.D., Associate Professor of Applied Biology and Biomedical Engineering, Rose-Hulman Institute of Technology, Terre Haute, IN

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Abstract

Mobile-bearing unicompartmental knees facilitate decreased polyethylene wear and restoration of knee kinematics. The purpose of this study was to quantify tibial strains during bearing mobility in UKA. Composite tibiae were implanted with cemented metal-backed tibial components and coated with photoelastic material, allowing "full-field" strain analysis. A fully congruent mobile polyethylene bearing was loaded in six separate locations on the tibial tray, simulating bearing translation during knee motion. Strains were noted to be greatest in the anteromedial tibia, 2 cm distal to the joint line, which correlates with the area occasionally noted to have residual pain following UKA. This study demonstrates the important role that bearing movement plays in load distribution throughout the tibia after UKA and may illuminate a biomechanical process of tibial remodeling that influences pain and implant loosening.

Introducing the Proceed™ Ventral Patch as a New Device in Surgical Management of Umbilical and Small Ventral Hernias: Preliminary Results

Tim Tollens, M.D., Consultant, General Surgery, David Struyve, M.D., Registrar, General Surgery, Chris Aelvoet, M.D., Consultant, General Surgery, Jean Pierre Vanrijkel, M.D., Head of Department, General Surgery, Imelda Hospital, Bonheiden, Belgium

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Abstract

Surgical treatment of umbilical and small ventral hernias ranges from a simple suture repair to the placement of large intra-abdominal or retromuscular meshes. Several articles report a lower incidence of recurrence after mesh repair, whether this is positioned onlay, retromuscular, or intraperitoneally. Often, a simple suture repair fails in the longterm, whereas a laparoscopic or retromomuscular approach seems too extensive for these rather small hernias. In between those two treatment options exists a go-between repair that carries the idea of posterior repair without being so aggressive in its approach. In this study, the authors examined a new device called the Proceed™ Ventral Patch (PVP) (Ethicon, Inc., Sommerville, NJ, USA). It is a self-expanding, partially absorbable, flexible laminate mesh device that allows an easy, quick and minimal invasive, tension-free, and standarized approach to umbilical hernia treatment. No data nor publication exist on this new device. Reported herein is our early and first experience with this novel technique.