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Perrone EE, Galganski LA, Tarantal AF, Olstad KJ, Treadwell MC, Berman DR, Jarboe MD, Mychaliska GB, Farmer DL. Fetal Surgery in the Primate 4.0: A New Technique 30 Years Later. Fetal Diagn Ther 2020; 48:43-49. [PMID: 33108788 DOI: 10.1159/000511355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Open fetal surgery requires a hemostatic hysterotomy that minimizes membrane separation. For over 30 years, the standard of care for hysterotomy in the gravid uterus has been the AutoSuture Premium Poly CS*-57 stapler. OBJECTIVE In this study, we sought to test the feasibility of hysterotomy in a rhesus monkey model with the Harmonic ACE®+7 Shears. METHODS A gravid rhesus monkey underwent midgestation hysterotomy at approximately 90 days of gestation (2nd trimester; term = 165 ± 10 days) using the Harmonic ACE®+7 Shears. A two-layer uterine closure was completed and the dam was monitored by ultrasound intermittently throughout the pregnancy. At 58 days after hysterotomy (near term), a final surgery was performed to evaluate the uterus and hysterotomy site. RESULTS A 3.5-cm hysterotomy was completed in 2 min 7 s. The opening was hemostatic and the membranes were sealed. Immediately after closure and throughout the pregnancy, ultrasound revealed intact membranes without separation and normal amniotic fluid levels. At term, the scar was well healed without signs of thinning or dehiscence. CONCLUSIONS The Harmonic ACE®+7 Shears produced a hemostatic midgestation hysterotomy with membrane sealing in the rhesus monkey model. Importantly, healing was acceptable.
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Affiliation(s)
- Erin E Perrone
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA, .,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA,
| | - Laura A Galganski
- Department of Surgery, UC Davis Children's Hospital, University of California, Davis, Sacramento, California, USA
| | - Alice F Tarantal
- Departments of Pediatrics and Cell Biology and Human Anatomy, School of Medicine, and California National Primate Research Center, University of California, Davis, California, USA
| | - Katie J Olstad
- Laboratory Animal Pathology, California National Primate Research Center, University of California, Davis, California, USA
| | - Marjorie C Treadwell
- Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah R Berman
- Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - George B Mychaliska
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Fetal Diagnosis and Treatment Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana L Farmer
- Department of Surgery, UC Davis Children's Hospital, University of California, Davis, Sacramento, California, USA.,Fetal Care and Treatment Center, University of California, Davis, Davis, California, USA
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Abstract
Several refinements in performing a cesarean delivery have been proposed in recent years. The surgeon is now more aware of the potential of HIV virus exposure and is inclined to use techniques to minimize contact with sharp objects. Wide incisions of the skin and fascia are encouraged for greater ease in delivering the fetus. When possible, a low transverse uterine incision is attempted to allow for an improved chance of undergoing successful labor with any subsequent pregnancy. Spontaneous delivery of the placenta may reduce blood loss and decrease the chance of postoperative endometritis. Single layer closure of the uterus without closure of the peritoneum is as safe and effective as a two-layer closure. Not closing the visceral or parietal peritoneum appears to be an acceptable alternative. Superficial wound disruption may be minimized by either closing large, nondraining subcutaneous spaces or using continuous drainage. Limitations with descriptive experiences and randomized clinical trials should be appreciated when translating this information into routine surgical practice.
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Affiliation(s)
- W F Rayburn
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, USA
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Villeneuve MG, Khalifé S, Marcoux S, Blanchet P. Surgical staples in cesarean section: a randomized controlled trial. Am J Obstet Gynecol 1990; 163:1641-6. [PMID: 2240118 DOI: 10.1016/0002-9378(90)90643-l] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This randomized controlled trial compares the use of the Auto Suture Poly CS 57 disposable surgical stapler (n = 98) with standard hysterectomy (n = 102) in low transverse cesarean sections. Subjective assessment of blood loss by the surgeon resulted in lower mean (+/- SEM) total blood loss estimates in the stapled group (492 +/- 24 ml) than in the nonstapled group (579 +/- 38 ml) (p = 0.05). However, surgeon's estimation of blood loss as a result of the hysterotomy and blood loss estimated by the hemoglobin deficit measured on the second postoperative day did not significantly differ between the two groups. The use of the stapling device tended to lengthen the total operating time, which averaged 42.5 minutes in the group with the staples and 39.2 minutes in the group with the standard hysterotomy (p = 0.05). The risk of febrile morbidity, the frequency of endometritis, and the length of hospitalization were similar in the two groups. Our results do not support the routine use of the Auto Suture Poly CS 57 disposable surgical stapler in low transverse cesarean sections.
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Affiliation(s)
- M G Villeneuve
- Department of Obstetrics and Gynecology, Laval University, Quebec, Canada
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