BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumul...BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.展开更多
BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing...BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(...BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.展开更多
BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the ab...BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.展开更多
AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string p...AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.展开更多
BACKGROUND Schwannomas,also known as neurinomas,are tumors that derive from Schwann cells.Gastrointestinal schwannomas are extremely rare,but the stomach is the most common site.Gastric schwannomas are usually asympto...BACKGROUND Schwannomas,also known as neurinomas,are tumors that derive from Schwann cells.Gastrointestinal schwannomas are extremely rare,but the stomach is the most common site.Gastric schwannomas are usually asymptomatic.Endoscopy and imaging modalities might offer useful preliminary diagnostic information.However,to diagnose schwannoma,the immunohistochemical positivity for S-100 protein is essential,whereas CD117,CD34,SMA,desmin,and DOG-1 are negative.CASE SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination,which was diagnosed as a gastric schwannoma.We performed endoscopic full-thickness resection and endoscopic purse-string suture.Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein.Furthermore,to exclude the misdiagnosis of gastrointestinal stromal tumor,we performed a mutational detection of the c-Kit and PDGFRA genes.Postoperative follow-up revealed that the patient recovered well.CONCLUSION Immunohistochemical staining is essential for the diagnosis of schwannoma.Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.展开更多
AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:Thi...AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.展开更多
Automatic identificationof discontinuities is a key focus in rock slope research.Conventional methods typically target small areas,which limits efficiencyand applicability for complex discontinuities in large-scale ro...Automatic identificationof discontinuities is a key focus in rock slope research.Conventional methods typically target small areas,which limits efficiencyand applicability for complex discontinuities in large-scale rock slopes.This study uses multi-angle unmanned aerial vehicle(UAV)nap-of-the-object photogrammetry to construct a high-definitionthree-dimensional(3D)point cloud model of the slope.The edge-firstconnection algorithm identifiesall edge points of discontinuities in the point cloud and completes recognition through simple connection analysis.This method avoids the complex calculations required for sequentially identifying discontinuity edges in conventional methods and achieves significantacceleration through algorithm optimization and parallel computation support.Based on this algorithm,the RockDiscontinuity Identification(RD ID)software is developed and applied to identify numerous highly disordered discontinuities on the Xulong slope in the Jinsha River suture zone.Processing tens of millions of point clouds within approximately 2 h demonstrates exceptional computational efficiency.The automatic algorithm accurately identifiesnearly 80%of planar discontinuities,with orientations and trace lengths closely matching manual results,highlighting its potential for large-scale rock outcrop applications.Comparisons with region growing algorithms further emphasize its effectiveness and accuracy.However,the algorithm struggles to identify linear discontinuities,which are a major source of error.Additionally,high roughness and smooth edges of discontinuities affect recognition accuracy,indicating areas for further improvement.展开更多
AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for ...AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.展开更多
Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented d...Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.展开更多
AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a ...AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.展开更多
Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the E...Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the Early Palaeozoic. The Ili and Toksun-Yamansu terranes had been split from the Tarim plate before the Middle Devonian and then went close to Angaraland in the late Early Permian. The Beishan area on the northeastern margin of the Tarim plate came close to Angaraland first in the early Early Permian. The suturing age between the Tarim and Kazakhstanian-Siberian plates is generally the same as that between the Turkey-Central Iran-Gangdise and South China-Southeast Asian plates. The suturing event took place in the early Early Permian, while the corresponding tectogeny occurred between the Early and Late Permian.展开更多
Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable sutur...Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable suture staples should be developed for the single-arm stapling robots to avoid a secondary operation.For this aim,a new type of Mg-3Zn-0.2Ca-2Ag biodegradable alloy wire was developed in this study applied as suture staples.Its tensile strength,yield strength,and elongation are 326.1 MPa,314.5 MPa,and 19.6%,respectively.Especially,the alloy wire attains the highest yield strength value reported among all the biodegradable Mg wires,which is mainly attributed to fine grain strengthening and second phase strengthening such as Mg_(2)Zn_(11) nano phase strengthening.Moreover,the corrosion rate of this alloy wire in simulated body fluid(SBF)reaches 26.8 mm/y,the highest value among all the biodegradable Mg alloy wires reported so far,which is mainly from the intensified galvanic corrosion between the Ag17Mg54 phase and the Mg matrix.In vitro studies demonstrate that the alloy wire exhibits good blood compatibility and low cytotoxicity.The cone beam computed tomography(CBCT)data shows that the suture staple made of the Mg alloy wire provides better mechanical support in the early postoperative period.From the single arm robot tests,it confirms that suture staples can close the wound tightly and remain stable over time.This research provides a good material selection for the automated suturing in oral and throat surgery robots.展开更多
AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 an...AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.展开更多
Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alt...Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors.To date,various techniques have been used for the closure of the transmural postEFTR defect,mainly consisting in clip-and endoloop-assisted closure methods.However,the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure.The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance,also considering the recent advent of flexible endoscopic suturing.展开更多
BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid E...BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid ESD using a multifunctional snare(SOUTEN)has been reported to be effective for colorectal lesions,as it can reduce treatment duration.Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.CASE SUMMARY This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN,followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man.On referral for ESD,a 10-mm flat,depressed lesion was found on the posterior wall of the gastric antrum,the depth of which was expected to be mucosal.Given his history of delirium,we performed outpatient endoscopic treatment.The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications.The procedure time was 62 min and the lesion was completely resected based on histopathological examination,with no reported postoperative complications.CONCLUSION This safe and useful procedure may be especially important for outpatient endoscopic treatment.展开更多
This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017...This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.展开更多
Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 1...Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.展开更多
Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of p...Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.展开更多
BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a th...BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).展开更多
基金Supported by Jinhua City Science and Technology Plan Projects“Improve the Polarization of Cancer-related Fatigue:Clinical Efficacy Study”,No.2018-4-049.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.
基金the National Natural Science Foundation of China,No.82172737 and 82003277Shanghai Municipal Education Commission,No.16411950403 and 19411951605。
文摘BACKGROUND Large or transmural defects induced by gastrointestinal endoscopic manipulations are difficult to close,although complete closure is recommended for better recovery.Endoscopic purse-string assisted suturing(EPSS)has been used in clinical practice and has proven to be an effective and safe technique for the closure of large mucosal defects.However,details regarding the efficacy of endoscopic pre-purse-string suture(P-EPSS)are unknown,especially that it offers several advantages over conventional EPSS(C-EPSS).AIM To elucidate the outcomes of EPSS-assisted closure in different clinical situations,and evaluate the efficacy of P-EPSS.METHODS This retrospective observational study included a total of 180 patients who underwent closure assisted by P-EPSS(n=63)or C-EPSS(n=117)between July 2014 and June 2020.The P-EPSS and C-EPSS groups were compared and the intergroup differences in aspects such as the lesion size,location,and morphology,incidence of complete closure,intraoperative perforation,and delayed adverse events were evaluated.Data on the features and clinical course of cases with adverse events were collected for further analysis.RESULTS Patients with lesion size larger than 3 cm,lesions located at the fundus of stomach,or submucosal tumors originating from the deep mucosa were more likely to undergo P-EPSS-assisted closure.The P-EPSS group showed a significantly higher proportion of intraoperative perforation(56%vs 17%)and a much shorter procedure time(9.06±6.14 min vs 14.84±7.25 min).Among adverse events,the incidence of delayed perforation(5%vs 4%;P=0.82)and delayed bleeding(3%vs 4%;P=0.96)did not differ significantly between the groups.Multivariate analysis revealed that lesions with incomplete closure[odds ratio(OR)=21.33;95%confidence interval(CI):5.45-83.45;P<0.01]or size greater than 3 cm(OR=3.14;95%CI:1.08-9.18;P=0.039)showed a statistical tendency to result in an increase in delayed adverse events.CONCLUSION The present study revealed that EPSS could achieve secure complete closure of mucosal defect.PEPSS could shorten the procedure and yield complete closure of mucosal defects.Rather than closure-type selection,incomplete closure or lesion size larger than 3 cm were associated with worse outcomes.
基金This observational study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.
文摘BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.
基金Supported by the Changzhou Science and Technology Bureau(No.CJ20239004).
文摘AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.
文摘BACKGROUND Schwannomas,also known as neurinomas,are tumors that derive from Schwann cells.Gastrointestinal schwannomas are extremely rare,but the stomach is the most common site.Gastric schwannomas are usually asymptomatic.Endoscopy and imaging modalities might offer useful preliminary diagnostic information.However,to diagnose schwannoma,the immunohistochemical positivity for S-100 protein is essential,whereas CD117,CD34,SMA,desmin,and DOG-1 are negative.CASE SUMMARY A 45-year-old female was found to have a gastric mass during a medical examination,which was diagnosed as a gastric schwannoma.We performed endoscopic full-thickness resection and endoscopic purse-string suture.Pathology and immunohistochemical staining confirmed the diagnosis of gastric schwannoma through the positivity of S-100 protein.Furthermore,to exclude the misdiagnosis of gastrointestinal stromal tumor,we performed a mutational detection of the c-Kit and PDGFRA genes.Postoperative follow-up revealed that the patient recovered well.CONCLUSION Immunohistochemical staining is essential for the diagnosis of schwannoma.Endoscopic full-thickness resection is an effective treatment method for gastric schwannoma.
文摘AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.
基金supported by the National Key R&D Program of China(Grant No.2022YFC3080200)the China Postdoctoral Science Foundation(Grant No.2023M731264)the Science and Technology Development Plan Project of Jilin Province,China(Grant No.20250602007RC).
文摘Automatic identificationof discontinuities is a key focus in rock slope research.Conventional methods typically target small areas,which limits efficiencyand applicability for complex discontinuities in large-scale rock slopes.This study uses multi-angle unmanned aerial vehicle(UAV)nap-of-the-object photogrammetry to construct a high-definitionthree-dimensional(3D)point cloud model of the slope.The edge-firstconnection algorithm identifiesall edge points of discontinuities in the point cloud and completes recognition through simple connection analysis.This method avoids the complex calculations required for sequentially identifying discontinuity edges in conventional methods and achieves significantacceleration through algorithm optimization and parallel computation support.Based on this algorithm,the RockDiscontinuity Identification(RD ID)software is developed and applied to identify numerous highly disordered discontinuities on the Xulong slope in the Jinsha River suture zone.Processing tens of millions of point clouds within approximately 2 h demonstrates exceptional computational efficiency.The automatic algorithm accurately identifiesnearly 80%of planar discontinuities,with orientations and trace lengths closely matching manual results,highlighting its potential for large-scale rock outcrop applications.Comparisons with region growing algorithms further emphasize its effectiveness and accuracy.However,the algorithm struggles to identify linear discontinuities,which are a major source of error.Additionally,high roughness and smooth edges of discontinuities affect recognition accuracy,indicating areas for further improvement.
文摘AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.
文摘Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.
文摘AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.
文摘Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the Early Palaeozoic. The Ili and Toksun-Yamansu terranes had been split from the Tarim plate before the Middle Devonian and then went close to Angaraland in the late Early Permian. The Beishan area on the northeastern margin of the Tarim plate came close to Angaraland first in the early Early Permian. The suturing age between the Tarim and Kazakhstanian-Siberian plates is generally the same as that between the Turkey-Central Iran-Gangdise and South China-Southeast Asian plates. The suturing event took place in the early Early Permian, while the corresponding tectogeny occurred between the Early and Late Permian.
基金supported by the National Key R&D Program of China(grant number:2020YFB1312801)the National Natural Science Foundation of China(No.51971020,No.52171097)+4 种基金the Opening Research Fund of State Key Laboratory for Advanced Metals and Materials(2021-Z08)the Fundamental Research Funds for the Central Universities(grant number:PKU2022XGK005)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2022-JKCS-24)the Key Scientific Research Project in Shanxi Province(202102050201003)the“Dingxinbeike”Project(G20200001105).
文摘Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable suture staples should be developed for the single-arm stapling robots to avoid a secondary operation.For this aim,a new type of Mg-3Zn-0.2Ca-2Ag biodegradable alloy wire was developed in this study applied as suture staples.Its tensile strength,yield strength,and elongation are 326.1 MPa,314.5 MPa,and 19.6%,respectively.Especially,the alloy wire attains the highest yield strength value reported among all the biodegradable Mg wires,which is mainly attributed to fine grain strengthening and second phase strengthening such as Mg_(2)Zn_(11) nano phase strengthening.Moreover,the corrosion rate of this alloy wire in simulated body fluid(SBF)reaches 26.8 mm/y,the highest value among all the biodegradable Mg alloy wires reported so far,which is mainly from the intensified galvanic corrosion between the Ag17Mg54 phase and the Mg matrix.In vitro studies demonstrate that the alloy wire exhibits good blood compatibility and low cytotoxicity.The cone beam computed tomography(CBCT)data shows that the suture staple made of the Mg alloy wire provides better mechanical support in the early postoperative period.From the single arm robot tests,it confirms that suture staples can close the wound tightly and remain stable over time.This research provides a good material selection for the automated suturing in oral and throat surgery robots.
文摘AIM： To compare the results of the anoscope of the PPH kit and a modified anoscope during stapled haemorrhoidopexy. METHODS： The hospital records of 37 patients who underwent stapled haemorrhoidopexy between 2001 and 2006 were reviewed. The purse-string suture anoscope in the PPH kit was used on 15 patients （Group 1）, and the modified anoscope was used on 22 patients （Group 2）. Demographic characteristics of the patients, operation time, surgeon＇s performance, analgesic requirement, and complications were compared. RESULTS： Operation time was significantly longer in Group 1 （42.0 4- 8.4 min vs 27.7 4- 8.0 min, P = 0.039）. The surgeons reported their operative performance as significantly better in Group 2 （the results of the assessments were poor in ten, medium in four and good in one in Group 1, while good in all patients in Group 2, P 〈 0.001）. The need for haemostatic sutures was significantly higher in Group 1 （six cases） and was needed in two cases in Group 2 （P = 0.034）. CONCLUSION： Operation time decreased and the surgeon＇s satisfaction increased with use of the modified anoscope, and fewer haemostatic sutures were required if the surgeon waited longer before and after firing the stapler.
文摘Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors.To date,various techniques have been used for the closure of the transmural postEFTR defect,mainly consisting in clip-and endoloop-assisted closure methods.However,the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure.The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance,also considering the recent advent of flexible endoscopic suturing.
文摘BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid ESD using a multifunctional snare(SOUTEN)has been reported to be effective for colorectal lesions,as it can reduce treatment duration.Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.CASE SUMMARY This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN,followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man.On referral for ESD,a 10-mm flat,depressed lesion was found on the posterior wall of the gastric antrum,the depth of which was expected to be mucosal.Given his history of delirium,we performed outpatient endoscopic treatment.The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications.The procedure time was 62 min and the lesion was completely resected based on histopathological examination,with no reported postoperative complications.CONCLUSION This safe and useful procedure may be especially important for outpatient endoscopic treatment.
文摘This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.
文摘Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.
文摘Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.
文摘BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).
