Vaso-Lock for sutureless anastomosis in a pig arteriovenous loop model

A vascular anastomosis is a critical surgical skill that involves connecting blood vessels. Traditional handsewn techniques can be challenging and resource intensive. To address these issues, we have developed a unique sutureless anastomotic device called Vaso-Lock. This intraluminal device connects free vascular ends using anchors to maintain traction and enable a rapid anastomosis. We tested the anastomotic capability of Vaso-Locks in a pig common carotid-internal jugular arteriovenous model. The use of Vaso-Lock allowed us to accomplish this procedure in less than 10 min, in contrast to the approximately 40 min required for a handsewn anastomosis. The Vaso-Lock effectively maintained patency for at least 6 weeks without causing significant tissue damage. Histological analysis revealed that the device was successfully incorporated into the arterial wall, promoting a natural healing process. Additionally, organ evaluations indicated no adverse effects from using the Vaso-Lock. Our findings support the safety and effectiveness of the Vaso-Lock for arteriovenous anastomosis in pigs, with potential applicability for translation to humans. Our novel sutureless device has the potential to advance surgical practice and improve patient outcomes.

Fusion-Flanged Intrascleral Intraocular Lens Fixation Technique: Simple, Safe, Efficient

PURPOSE

To develop a new, sutureless intrascleral intraocular lens (IOL) fixation technique based on the Yamane double-needle and Canabrava 4-flanged techniques.

METHODS

The Fusion-Flanged technique involves using a 7-0 polypropylene suture loop threaded through the eyelets of the IOL. Afterward, both ends of the suture are passed outside the eye through a 27-gauge needle. This technique creates a single flange by joining the 2 suture ends through handheld cautery, and this flange is then embedded into the scleral tunnel to securely fix the IOL in place.

RESULTS

This technique was performed on a total of 7 aphakic patients. Four of them had encountered complications following manual small incision cataract surgery, while the remaining 3 experienced complications after phacoemulsification. The results indicated a significant improvement in visual acuity, with mean preoperative and postoperative corrected distance visual acuities of 0.77 ± 0.11 and 0.27 ± 0.08 (logarithm of the minimum angle of resolution [logMAR] units), respectively.

CONCLUSIONS

The Fusion-Flanged intrascleral IOL fixation technique offers improvements in simplicity, safety, and the overall efficiency when compared to existing sutureless intrascleral fixation techniques. Notably, this technique is versatile and can be applied to both non-foldable and foldable IOLs.

Sutureless Repair of Extracardiac Univentricular Total Anomalous Pulmonary Venous Connection

BACKGROUND

This study aimed to evaluate the results of sutureless repair of extracardiac total anomalous pulmonary venous connection (TAPVC) with a functional single ventricle at a single institution, including changes in the anastomotic site over time.

METHODS

The database contained 98 patients with single-ventricle anatomy who underwent extracardiac TAPVC repair from 1996 to 2022. The median age and body weight at surgery were 59 days and 3.8 kg, respectively. Eighty-seven patients had heterotaxy syndrome, and 42 had preoperatively obstructed TAPVC. Primary sutureless repair was performed in 18 patients, 13 of whom were neonates. The cross-sectional area of the anastomotic site of the atrium and pericardium was divided by the body surface area, and the changes in this value over time were assessed. The median follow-up was 5.2 years (range, 0-19.4 years).

RESULTS

Operative mortality and late mortality occurred in 2 (2.0%) and 38 (38.8%) patients, respectively. The actuarial survival rate at 5 years postoperatively was 56.2%. Multivariate analysis identified preoperatively obstructed TAPVC as a risk factor for mortality. Recurrent pulmonary venous stenosis (PVS) developed in 25 patients, thus giving a 5-year rate of freedom from PVS of 64.9%. Multivariate analysis revealed that sutureless repair significantly decreased the incidence of recurrent PVS. The cross-sectional anastomotic area tended to grow in accordance with the patients' growth.

CONCLUSIONS

Sutureless repair of extracardiac TAPVC with univentricular anatomy achieved acceptable results. The anastomotic site tended to grow over time and contributed to a decline in the rate of recurrent PVS.

A sutureless overlapped anastomosis technique using linear staplers with reinforced bioabsorbable material in robotic right colectomy with intracorporeal anastomosis

AIM

Creation of an overlapped anastomosis using handsewn sutures for common enterotomy is very popular in robotic right colectomy (RRC) with intracorpareal anastomosis (IA). The aim of this study is to present a simple method for constructing a sutureless overlapped anastomosis using a 60 mm linear stapler with a reinforced bioabsorbable material in RRC with IA.

METHOD

The distal ileum and proximal colon were put in overlapping positions. Enterotomies were created 2 cm proximal to the ileal stump and 8 cm distal to the colonic stump on the antimesenteric side. Subsequently, a 60 mm linear stapler with a reinforced bioabsorbable material was inserted into each lumen and fired. Finally, the bowel was elevated while holding the bioabsorbable material, and the common enterotomy was grasped with the robotic instrument in the middle and closed using a linear stapler with a reinforced bioabsorbable material.

RESULTS

This technique was applied to 10 patients with tumours of the caecum, ascending colon, or transverse colon. The median operating time, anastomosis construction time, blood loss, and postoperative stay were 281 min (range 228-459 min), 12 min (range 11-17 min), 10 mL (range 0-110 mL), and 10 days (range 8-15 days), respectively. No adverse intraoperative events were observed. Postoperatively, one patient developed chylous ascites, but there were no other complications.

CONCLUSION

The simple technique for constructing a sutureless overlapped anastomosis using a 60 mm linear stapler with a reinforced bioabsorbable material in robotic right colectomy with intracorporeal anastomosis appears to be safe and feasible.

The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology

OBJECTIVE

The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR).

METHODS

PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023.

RESULTS

SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary.

CONCLUSIONS

SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.

INTRAOCULAR LENS IMBRICATION FOR RECURRENT PUPILLARY CAPTURE AFTER SUTURELESS INTRASCLERAL FIXATION

PURPOSE

To demonstrate a novel surgical technique (intraocular lens imbrication) for persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.

METHODS

Case report and supplemental digital content demonstrating salient steps of a novel surgical technique.

RESULTS

The patient did not suffer any further episodes of pupillary capture after intraocular lens imbrication with aforementioned surgical technique five months after the procedure. Postoperative best-corrected visual acuities were 20/40 in both eyes.

CONCLUSION

Intraocular lens imbrication is an effective method to address persistent postoperative pupillary capture after sutureless scleral intraocular lens fixation.

Sutureless Repair with Extended Atriotomy for Post-repair Pulmonary Venous Obstruction

Post-repair pulmonary venous obstruction (PR-PVO) is a common cause of reoperation following total anomalous pulmonary venous return repair. Herein, we report three cases of specific type of PR-PVO with eccentric stenosis of pulmonary vein ostium due to retained composite neo-septum and the technique used for subsequent repair. Post-repair pulmonary venous obstruction (PR-PVO) after total anomalous pulmonary venous return (TAPVR) repair is a common complication and represents a significant surgical challenge with a high recurrence rate. One pattern of PR-PVO includes eccentric stenosis of pulmonary vein ostium with a stenotic residual leftward-displaced anastomotic orifice and prominent retained partition between the pulmonary veins and the left atrium composed of pulmonary vein and overlying left atrium and atrial septum - hereby termed "retained composite neo-septum". We describe three patients with this pattern and describe a surgical technique applicable for this subset.

TWENTY-FIVE AND TWENTY-SEVEN-GAUGE SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENSES: Clinical Outcomes and Comparative Effectiveness of Haptic Flanging in a Large Single-Surgeon Series of 488 Eyes

PURPOSE

To describe the clinical outcomes and surgical technique in transconjunctival sutureless intrascleral fixation of intraocular lenses, including the effectiveness of haptic flanging and peripheral iridotomy.

METHOD

Retrospective series of patients who underwent sutureless intrascleral fixation of three-piece intraocular lenses by a single surgeon.

RESULTS

A total of 488 eyes were included in this study. Mean follow-up was 444 days. Mean preoperative best-corrected visual acuity was 20/355, and mean postoperative best-corrected visual acuity was 20/39 (P < 0.001). Intraocular lens dislocation occurred during the postoperative period in 67 (13.7%), with the majority (65.7%) occurring within 3 months after surgery. Dislocation occurred in 13 of 196 (6.6%) flanged haptics versus 54 of 292 (18.5%) unflanged haptics (P < 0.001). Reverse pupillary block occurred in 7 of 231 eyes (3.0%) without intraoperative peripheral iridotomy but only in 1 of 257 eyes (0.4%) with iridotomy (P = 0.0297). Other complications included haptic exposure (1.2%), retinal detachment (1.0%), and endophthalmitis (0.4%).

CONCLUSION

This is the largest reported series of sutureless intrascleral fixation of intraocular lenses using trocar cannulas. This technique is an effective surgical option with low complication rates. The authors recommend that haptic flanging and peripheral iridotomy be performed in all cases.

Early and Two-year Outcomes after Sutureless and Conventional Aortic Valve Replacement: a Nationwide Population-based Study

BACKGROUND

We compared early and 2-year clinical outcomes of sutureless aortic valve replacement (SAVR) with conventional aortic valve replacement (CAVR) in a nationwide study based on claims data.

METHODS

From December 2016 to November 2018, 3,173 patients underwent bioprosthetic aortic valve replacements. SAVR and CAVR were performed in 641 and 2,532 patients, respectively. Propensity score-matched analysis was performed in 640 patient pairs.

RESULTS

Operative mortality rate was 2.8% without significant differences between the SAVR (3.4%) and CAVR (2.3%) groups (P = 0.324). There were no significant differences in postoperative morbidities between the groups except for permanent pacemaker (PPM) implantation. PPM implantation rate was significantly higher in the SAVR (3.8%) than in the CAVR group (0.9%) (P < 0.001). One- and two-year overall survival was 89.1% and 87.5%, respectively, without significant differences between the groups (SAVR group vs. CAVR grouP = 89.9% and 90.5% vs. 87.2% and 88.7%, respectively; P = 0.475). There were no significant differences in the cumulative incidence of cardiac death, stroke, aortic valve reoperation and infective endocarditis between the groups. Cumulative PPM implantation incidence at 6 months in the CAVR was 1.1%, and no patient required PPM implantation after 6 months. In the SAVR, the cumulative PPM implantation incidence at 0.5, one, and two years was 3.9%, 5.0% and 5.6%, respectively. The cumulative PPM implantation rate was higher in the SAVR group than in the CAVR group (P < 0.001).

CONCLUSION

Early and 2-year clinical outcomes between SAVR and CAVR were not different except for a high rate of permanent pacemaker implantation in the SAVR group.

Results in comparison between 30 gauge ultrathin wall and 27 gauge needle in sutureless intraocular lens flanged technique in diabetic patients: 24-month follow-up study

AIMS

Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle.

METHODS

Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients' records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed.

RESULTS

IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p < 0.001). Mean time until IOL displacement was 10.5 ± 7.0 months (range: 7 days-24 months). IOL centricity was significantly better in the 30G ultrathin wall needle group compared to 27 G (p = 0.001). Additional surgical interventions were necessary only in the 27G group (n = 14).

CONCLUSIONS

Sutureless IOL flanged technique using a 30G UTW needle is more predictable and has less complications in aphakic diabetic patients, compared to a 27G needle technique.

Comparison of peripheral nerve repair using ethyl-cyanoacrylate and conventional suture technique in a rat sciatic nerve injury model

OBJECTIVE

The aim of this study was to compare the outcomes of primary nerve repair using either ethyl-cyanoacrylate or conventional microsuture technique in a rat peripheral nerve injury model.

METHODS

In this study, a total of 30 Wistar Albino rats weighing between 220 and 275 g were used. The rats were randomly divided into three groups (10 in each), including one control (group 1) and two experimental groups (group 2, conventional microsuture repair; group 3, cyanoacrylate repair). In each group, the sciatic nerve was identified and transected. No further intervention was performed in group 1. The nerve was repaired using the epineural technique with a 10/0 atraumatic nylon in group 2 and synthetic cyanoacrylate adhesive in group 3. At the fifth postoperative week, needle electromyography (EMG) was performed to measure distal latency, combined muscle action potential (CMAP), and motor nerve conduction velocity (MNCV). Following the EMG recordings, animals were euthanized. Nerve samples were collected to evaluate vacuolar degeneration, fibrosis, and foreign body reaction histopathologically.

RESULTS

In the EMG analysis, mean distal latency was significantly shorter in group 1 (0.85±0.09 ms) than in groups 2 (1.17±0.25 ms) (p=0.0052) and 3 (1.14±0.14 ms) (p=0.0026) while no significant differences existed between groups 2 and 3 (p>0.9999). The mean CMAP was greater in group 1 (10.5±0.35 mV) than in groups 2 (2.86±1.28 mV) (p=0.011) and 3 (2.16±1.34 mV) (p=0.0002), but there was no significant difference between groups 2 and 3 (p>0.9999). The mean MNCV was 53.5±5.95, 39.62±7.31, and 39.84±4.73 mm/sec in groups 1, 2, and 3, respectively. There was a significant difference between groups 1 and 2 (p=0.0052) and between 1 and 3 (p=0.0026), but not between 2 and 3 (p>0.9999). In the histopathological evaluation, the mean vacuolar degeneration score was 0, 2.12, and 1.88 in groups 1, 2, and 3, respectively. No obvious difference was observed between groups 2 and 3 (p=0.743). The mean fibrosis score was 0, 1.62, and 1.77 in groups 1, 2, and 3, respectively. There was no significant difference between groups 2 and 3 (p=0.888). The mean foreign body reaction score was 0, 2.5, and 2.44 in groups 1, 2, and 3, respectively. No difference was present between groups 2 and 3 (p=0.743).

CONCLUSION

Primary nerve repair using the cyanoacrylate adhesive may provide similar electrophysiological and histopathological results as compared to the conventional microsuture repair.

Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic Valves in Patients With Aortic Stenosis: A Meta-Analysis

BACKGROUND

Suture-less aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross-clamp time, which is an independent predictor of postoperative outcomes, especially in patients with serious comorbidities. By reducing the number of sutures, the time for suture placement is reduced. Our meta-analysis tried to assess the safety and haemodynamic performance of the suture-less aortic valve prostheses to ascertain their benefits as a viable alternative to current established measures.

METHOD

From their inceptions to February 2017, six electronic databases were searched. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognised. Based on the predefined endpoints, data were collected and analysed.

RESULTS

For incorporation in qualitative and quantitative analyses, 24 studies were recognised, with a total number of 5,073 patients undergoing suture-less aortic valve replacement. Mortality incidence at the 30-day and 12-month follow-ups were 2.5% and 2.7%, respectively, while the incidences of thromboembolic events (1.6%) and paravalvular leak (0.5%) were acceptable.

CONCLUSIONS

Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory haemodynamic performance.

Novel technique of explantation of rigid phakic iris-claw lens and cataract extraction by sutureless manual small-incision surgery

A 38-year-old patient presented to us with complaints of blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/400, improving to 20/60 with pinhole. The patient underwent phakic iris-claw lens surgery 15 years ago for high myopia. On examination, there was anterior chamber rigid phakic iris-claw lens along with complicated cataract. We planned for sutureless self-sealing 6.5 mm sclerocorneal tunnel for explantation of rigid phakic iris-claw lens along with cataract extraction with irrigating vectis. There was postoperative reduction in astigmatism due to incision planned on steep axis, and visual acuity improved to 20/30 uncorrected. This technique provides significant advantages from the previously described techniques in terms of decreased postop astigmatism, no need for sutures, no issues of chamber instability and iris trauma and without the need for phacoemulsification.

Comparison of Two Modified Sutureless Techniques of Scleral Fixation of Intraocular Lens

BACKGROUND AND OBJECTIVE

To compare the visual outcome and complications of two different sutureless scleral-fixated intraocular lens (IOL) implantation techniques, that is, intrascleral IOL fixation technique and modified Yamane's technique of scleral fixation of IOL.

PATIENTS AND METHODS

Patients who underwent scleral fixation of IOL (SFIOL) from June 2015 to February 2017 with more than 6 months of follow-up were examined retrospectively. Improvement in visual acuity (VA), intraocular pressure (IOP) measurements, endothelial cell count, central macular thickness (CMT), and intraoperative/postoperative complications were compared at 6 months follow-up.

RESULTS

Seventy eyes were analyzed. The mean follow-up was 10.5 months ± 1.5 months. The final visual outcomes in both groups, modified intrascleral IOL fixation technique (Group A, n = 30) and modified Yamane's technique (Group B, n = 40), were comparable. The indications for surgery were aphakia (n = 15), subluxated/dislocated cataract (n = 31), and dislocated/subluxated IOL (n = 24). The majority of the eyes (92%) improved to VA 0.3 logMAR units or better. The uncorrected distance visual acuity (UDVA), endothelial cell density, and CMT at the 6-month follow-up were comparable in both groups. Postoperatively, transient IOP rise occurred in 18 eyes, retinal detachment in one eye, vitreous hemorrhage in one eye, cystoid macular edema in two eyes, and mild IOL decentration in two eyes.

CONCLUSION

Both techniques have favorable visual outcomes; however, modified 27-gauge needle-assisted Yamane's technique is technically superior because of its transconjunctival approach and less surgical time, and its needle-assisted approach for haptic externalization prevents haptic damage during externalization. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e129-e134.].

Sutureless repair of corneal injuries using naturally derived bioadhesive hydrogels

Corneal injuries are common causes of visual impairment worldwide. Accordingly, there is an unmet need for transparent biomaterials that have high adhesion, cohesion, and regenerative properties. Herein, we engineer a highly biocompatible and transparent bioadhesive for corneal reconstruction using a visible light cross-linkable, naturally derived polymer, GelCORE (gel for corneal regeneration). The physical properties of GelCORE could be finely tuned by changing prepolymer concentration and photocrosslinking time. GelCORE revealed higher tissue adhesion compared to commercial adhesives. Furthermore, in situ photopolymerization of GelCORE facilitated easy delivery to the cornea, allowing for bioadhesive curing precisely according to the required geometry of the defect. In vivo experiments, using a rabbit stromal defect model, showed that bioadhesive could effectively seal corneal defects and induce stromal regeneration and re-epithelialization. Overall, GelCORE has many advantages including low cost and ease of production and use. This makes GelCORE a promising bioadhesive for corneal repair.

Outcomes of transconjunctival 23-gauge vitrectomy for diabetic tractionnal retinal detachment

INTRODUCTION

The transconjunctival 23-gauge vitrectomy without sutures (VTCSS) combines the advantages of the 20 and 25-gauge system. It currently represents the gold standard for the surgical management of vitreoretinal pathologies, especially in diabetic patients.

AIM

Evaluate the anatomical and functional results of the VTCSS 23 gauge in diabetic tractionnal retinal detachment (DRT).

METHODS

This is a retrospective study of patients undergoing vitrectomy 23 gauges from February 2015 to February 2017. Each patient a complete ophthalmological examination with collection of  pre operative peroperative and postoperative data. The vitrectomy was performed by 3 ways through the 23-gauge cannula system Results :We collected 52 eyes presenting a DRT. The average age of patients was 50.62 years old. The average glycated hemoglobin (HBA1C) was 9.3%. The average time to treatment was 76.92 days. The results were as follows: For anatomical results: anatomical success rate was 92.30%. Functionally: A significant improvement in mean AV from 1/80 to 1.25 / 10 after surgery (p = 0.022), a statistically significant correlation between the final postoperative VA and the management delay (p <0.001); significant correlation between preoperative VA and final postoperative VA (p <0.001).

CONCLUSION

The VTCSS 23 gauge is an effective and safe surgery for DRT  surgery in diabetic patients with a gain in time and comfort for the patient.

The Value of Fusional Convergence Amplitudes in Esodeviation Surgery Without Adjustable Sutures

PURPOSE

To explore the application of preoperative fusional convergence amplitudes in the selection of a target angle for non-adjustable suture strabismus surgery with deteriorated intermittent esotropia and diplopia.

METHODS

Thirty-one consecutive cases of presumed acquired non-accommodative, deteriorated intermittent esotropia managed surgically between 2005 and 2016 were reviewed retrospectively. For each individual, a target angle (deviation angle for which surgery was based) was selected preoperatively after analysis of fusional convergence amplitudes. Outcomes in patients selected for overcorrection at 6 meters (target angle > angle in primary position at 6 meters) were compared to those who had planned surgery based on a target angle that did not exceed their measured angle (target angle ≤ angle in primary position) at 6 meters.

RESULTS

All 31 patients achieved binocular single vision in primary position at both near and 6 meters without prisms, orthoptic therapy, or additional surgery at 4 to 6 months postoperatively. Greater mean correction in the target angle > angle in primary position group compared to the target angle ≤ angle in primary position group was observed, but this difference was not statistically significant (P = .57).

CONCLUSIONS

Among this diagnostically specific cohort with intermittent esotropia with symptomatic diplopia and measurable binocular single vision preoperatively, targeted surgery based on an analysis of preexisting fusional convergence amplitudes had an outcome that compared favorably to that of documented adjustable suture strabismus surgery. [J Pediatr Ophthalmol Strabismus. 2018;55(6):375-381.].

Comparison of Leukosan SkinLink with surgical suture for traumatic laceration repair: A randomized controlled trial

BACKGROUND

Leukosan SkinLink (LS), which combines non-woven textile strips and tissue adhesive, offers the advantage of atraumatic treatment while effectively shortening the procedure time. We hypothesized that wound closure would be faster with LS than with surgical suture (SS) and the wound infection and dehiscence would be similar.

METHODS

A prospective, open label, single-center, randomized controlled trial was performed. Between November 2014 and April 2016, 49 patients with traumatic lacerations who presented to the emergency department were eligible for study inclusion.

RESULTS

The mean wound closure time was significantly lower in the LS group than in the SS group (1.48 ± 0.2 seconds vs 8.8 ± 3.6 minutes, P < .001). After adjusting the wound closure time according to the lacerations length, the time remained significantly lower in the LS group than in the SS group (1.0 ± 0.8 seconds vs 5.03 ± 2.5minutes, P < .001). During follow-up for 14 days, no significant differences in dehiscence and wound infection were observed between the 2 groups.

CONCLUSION

Wound closure was approximately 4minutes faster with LS and there were no differences in wound infection and dehiscence rates. Thus, the LS could be used as a timesaving suture technique for acute traumatic lacerations in emergency department (ED).

TRIAL REGISTRATION

ClinicalTrials.gov NCT02333877.

Conventional repair of total anomalous venous drainage without primary sutureless technique: surgical tips to prevent pulmonary vein obstruction

OBJECTIVES

Although primary sutureless technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary sutureless technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by "intima-to-intima" using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage.

METHODS

Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary sutureless technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed.

RESULTS

Mean follow-up period was 4.6 ± 3.7 years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation.

CONCLUSIONS

Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary sutureless technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.

Sutureless versus Conventional Aortic Valve Replacement: Outcomes in 70 High-Risk Patients Undergoing Concomitant Cardiac Procedures

In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all P=0.001), postoperative drainage amounts were lower (P=0.009), hospital stays were shorter (P=0.004), and less red blood cell transfusion was needed (P=0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; P=0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

Retrospective Study of Visual Outcomes and Complications After Sutureless, Flapless, and Glueless Intrascleral Fixation of Posterior Chamber Intraocular Lens in Children and Young Adults

PURPOSE

To evaluate the visual outcomes and complications after sutureless, flapless, and glueless intrascleral fixation of a posterior chamber intraocular lens (IOL) in patients between the ages of 5 and 20 years.

METHODS

Children with gross subluxated lenses and aphakia following intracapsular cataract extraction with inadequate posterior capsular support underwent intrascleral fixation of a standard three-piece posterior chamber IOL without sutures, flaps, or glue. A retrospective study of 15 eyes of 11 patients with a mean follow-up period of 6 months was performed. The main outcome measures were improvement in visual acuity (best corrected [BCVA] and uncorrected [UCVA]) and early and late postoperative complications.

RESULTS

Preoperative to postoperative mean UCVA changed from 1.34 ± 0.35 to 0.36 ± 0.18 logarithm of the minimum angle of resolution (logMAR), respectively (P < .001). Preoperative to postoperative mean BCVA changed from 0.69 ± 0.37 to 0.19 ± 0.19 logMAR, respectively (P < .001). Two patients showed early postoperative complications within 1 week. One patient presented with vitreous hemorrhage and the other with hyphema on postoperative day 1. Both patients were treated conservatively and recovered by the first follow-up visit. None of the patients showed late postoperative complications during the 6-month follow-up period. The final visual outcome between the complication (n = 2) and no complication (n = 13) groups showed no statistically significant difference (P = .91). The final visual outcome between the eyes with primary and secondary implantation was similar with no statistically significant difference (P = .857).

CONCLUSIONS

The technique of flapless, glueless, and sutureless scleral fixation of a three-piece IOL has shown significant improvement in visual acuity and does not cause significant complications postoperatively. [J Pediatr Ophthalmol Strabismus. 2017;54(6):381-386.].

Use of 2-Octyl Cyanoacrylate Adhesive and Polyester Mesh for Wound Closure in Primary Knee Arthroplasty

Wound closure in primary knee arthroplasty is important both for surgical success, by minimizing the risk of wound complications and infection, and for patient satisfaction with wound care and cosmesis. This article reports the use of a topical self-adhering, pressure-sensitive polyester mesh combined with 2-octyl cyanoacrylate adhesive for final skin closure of primary knee arthroplasty without external staples or sutures. During a 2.5-year period, 360 consecutive primary knee arthroplasty procedures (321 total knee arthroplasty procedures and 39 partial knee arthroplasty procedures) performed by 1 surgeon at 1 institution were reviewed. For all primary arthroplasty procedures, closure was performed with a standardized method. Final skin closure was performed with 2-octyl cyanoacrylate adhesive and polyester mesh. Patients returned at 6 weeks and 1 year postoperatively. The study found a 0.8% rate of superficial wound complications, no cases of dehiscence, no wound complications requiring operative irrigation and debridement, and no prosthetic joint infections. One patient had a reaction consistent with previously reported localized contact dermatitis that was believed to be related to the 2-octyl cyanoacrylate adhesive. In 2 cases, treatment with cephalexin was required, in 1 case for 2 small suture abscesses and in the other case for periincisional cellulitis. All wound complications resolved by 6 weeks. The results showed that 2-octyl cyanoacrylate adhesive and polyester mesh can be used successfully in the setting of primary knee arthroplasty for closure of high-tension knee arthroplasty wounds. This series found a 0.8% rate of superficial wound complications, no cases of dehiscence, and no infections. [Orthopedics. 2017; 40(5):e784-e787.].

Consolidative Technique Otoplasty: Comprehensive Approach in Combining Techniques

BACKGROUND

This study aimed to present the long-term results of the consolidative technique otoplasty (CTO).

METHODS

Patient age, sex, duration of follow-up, and how the deformity (bilateral-unilateral) occurred were determined. The kind of anesthesia, duration of surgery, surgical techniques used during the operation were reported, and the preoperative and postoperative distances between the ear and head were measured at four points (SUP: The highest point of the helix; SCA: the concha superior sticking points; ICA: stick point of Concha at the inferior; and lobular). Early- and late-term complications were recorded in the postoperative period.

RESULTS

A total of 63 (21M-42FM) patients whose average age of 21:41 ± 8.96 (7-41), 119 ears (Right: 58/Left: 61) were operated on with this technique between 2013 and 2015. Mean follow-up was 18:22 ± 9:42 months. Anterior scoring was performed for three patients; concha resection was performed in 17 patients. Fifty-five patients were operated on as primary otoplasties and eight were secondary otoplasties. When the preoperative and postoperative SUP, SCA, ICA, and lobule measurements for both ears were compared, the postoperative values were found to be significantly decreased (p < 0.001).

CONCLUSIONS

This technique may be an alternative in the repairs of prominent ears, and it provides an intervention opportunity for all the anatomical structures.

LEVEL OF EVIDENCE V

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Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification

Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

A Complete Sutureless, Hernia Repair for Primary Inguinal Hernia The Trabucco Repair: A Tribute to Ermanno Trabucco

Since 1989, the authors have been using the Trabucco tension-free and sutureless technique for the repair of primary groin hernia with a pre-shaped mesh in more than 8,000 surgical procedures for complex and "simple" abdominal and inguinal hernias; over 4,000 cases have been considered in this study. The great majority of these procedures were performed under local anaesthesia and with a complete and careful nerve sparing. Compared to the Lichtenstein's technique, which is currently the golden standard treatment worldwide, there are no significant differences in the observed recurrence rate (below 2%). For the Law of Pascal, the pre-shaped prosthesis developed by Trabucco remains stretched uniformly in the inguinal canal, without the need to be secured with sutures and without forming dead space, which is a cause of infections, pain, and recurrence. The main advantage of a tension-free and sutureless repair is given by the relevant reduction in postoperative chronic neuralgia, which is not an uncommon complication and, depending on its intensity, can also potentially jeopardize a patient's work and social activities. The identification and the sparing of the three nerves of the inguinal region is of crucial importance to reduce the rate of neuralgia in the short and long term. Furthermore, the use of a local anaesthesia imposes the surgeon to properly recognize those nerves and to respect them during the repair. It goes without saying that the complete exposition of the right anatomy of inguinal canal is mandatory. The intentional section of one or more nerves, when it is not technically possible to achieve a satisfactory nerve sparing, or special tricks to create proper fenestrations (small window) on the edge of the prosthesis to prevent the scar tissue to involve the spared nerves, ensures a further reduction of the rate of neuralgia and excellent patient outcomes.

Immediate Outcomes of Aortic Valve Replacement with Sutureless versus Stentless Bioprosthesis

BACKGROUND

Aortic valve replacement (AVR) with a sutureless valve is an innovative therapy in high-risk elderly patients. The study aim was to compare the early results of AVR using sutureless aortic valves or stentless aortic bioprostheses.

METHODS

A retrospective analysis was conducted of 55 patients who underwent AVR with either a sutureless valve (Perceval S; n = 24 or Edwards Intuity; n = 9) or a stentless valve (Sorin Freedom SOLO™; n = 22).

RESULTS

Baseline patient characteristics were similar in both groups, except for NYHA class. Concomitant procedures were performed in 17 patients (51.5%) of the sutureless group and in nine patients (40.9%) of the stentless group (p = 0.44). The aortic cross-clamp time was 55 ± 23 min in the sutureless group and 102 ± 36 min in the stentless group (p <0.0001), while the postoperative peak aortic gradient was 19.5 ± 5.0 mmHg and 29.3 ± 15.4 mmHg for the sutureless group and stentless group, respectively (p = 0.037). The postoperative mean gradient was 9.3 ± 3.4 mmHg for the sutureless group and 15.1 ± 10.5 mmHg for the stentless group (p = 0.06). Blood product transfusion was required less frequently by the sutureless group, but drainage and bleeding was similar in both groups. The intensive care unit and hospital stays were significantly shorter in favor of the sutureless group. One sutureless patient (3.0%) and two stentless patients (9.1%) died in hospital (p = 0.557).

CONCLUSIONS

Early results of the present study suggested that surgical AVR with a sutureless valve is associated with a good hemodynamic performance and an improved early outcome.