Validating the Use of Rectus Muscle Fragment Welding to Control Presacral Bleeding During Rectal Mobilization

The incidence of presacral bleeding during rectal mobilization is low, but such bleeding may be massive and even fatal. Haemostasis can be difficult to achieve using conventional methods because of the complex interlacing of the venous network at the sacral periosteum. Historically, pelvic packing and metallic thumbtacks have been the more commonly used methods in our institution. However, the need for repeat surgery to remove the packs and the difficulties encountered in tack application have forced us to explore other methods. In 1994, the procedure termed muscle fragment welding, which uses electrocautery through a rectus muscle fragment, was introduced to control presacral bleeding. From January 1999 to February 2002, six of 416 patients undergoing pelvic surgery in our institution developed massive presacral haemorrhage and, therefore, this technique was used. Haemostasis was immediate and permanent. No major untoward postoperative events such as re-bleeding or infection were noted. One case developed a second-degree burn in the right elbow due to a misplaced ground conduction plate. Rectus muscle fragment welding is, in our experience, an effective and practical method of controlling presacral haemorrhage

3-D Incubator Principle in Nikelid-Titanium Porous Plates Hemostasis

Biological liquids (blood particularly) imbibe 3-D construction of nikelid-titan porous plates easily. Clot formation takes place in large porous volume, its retraction by fibrin fibers forming and then maturation of connective tissue all together additionally fix the implant in bleeding zone

An update of electro surgery devices options in minimal invasive surgery: a review

The rate and variety of advances in energy sealing technology in the last two decades has heralded new opportunities in laparoscopic and minimally invasive surgery. Reduced operating times, lower postoperative pain scores, and shorter length of stay are offset by the additional cost of such instruments. Critical to obtaining optimal clinical effects and reducing potential complications, is a thorough understanding of the proper use of each energy modality. No single device has shown a significant superiority over the other. However best combination to have is harmonic along with ligasure or perhaps now the latest wireless sonicision with ligasure to undertake most of the surgeries. Thunderbeat has advantages like faster cutting speed and minimal instrument changes. Ferromagnetic wand is the fastest available instrument with unique features. Argon beam coagulation has certain specific uses and is best for fulguration and it is definitely advantageous to have it in OT. Sonicision offered wireless ergonomics and better manoeuvrability, cheapest VSD was the conventional bipolar

ЭВОЛЮЦИЯ МЕТОДОВ ОСТАНОВКИ КРОВОТЕЧЕНИЯ ИЗ ПРЕСАКРАЛЬНОГО ВЕНОЗНОГО СПЛЕТЕНИЯ В ХИРУРГИИ ТАЗА: ОБЗОР ЛИТЕРАТУРЫ

The purpose of the study was to analyze various methods of stopping bleeding from the presacral venous plexus.Material and Methods. Literature search was carried out using Elibrary, Medline, Embase databases from January 1960 to November 2018.Results. Bleeding from the presacral venous plexus is a rare but potentially life-threatening complication in pelvic surgery. The inferior vena cava, the veins of the presacral and internal spinal plexuses are dilated under general anesthesia, and act as a large venous “blood pool” in the pelvis because of the lack of functional valves. Hydrostatic pressure in this venous pool can reach two to three times the pressure of the inferior vena cava. Thus, rupture of even a small presacral vein may result in heavy bleeding. Among the many reported methods of stopping this bleeding, the most effective are as follows: mechanical tamponade; technique of pressing the bleeding site; ectrocoagulation; the use of hemostatic materials.Сonclusion. The variety of methods used for stopping bleeding from the presacral venous plexus indicate a need of searching for more effective methods.Целью исследования является анализ литературы, посвященной проблеме остановки кровотечения из пресакрального венозного сплетения. Материал и методы. Поиск источников литературы осуществлялся по базам данных  elibrary, medline, embase с периодом охвата от января 1960 по ноябрь 2018 г. Результаты. Кровотечение из пресакрального венозного сплетения хоть и не частое, но потенциально летальное осложнение в хирургии таза. Нижняя полая вена, вены пресакрального и внутреннего позвоночного сплетений расширены под общим наркозом  и действуют как крупный венозный «бассейн» в малом тазу из-за отсутствия функциональных клапанов. Гидростатическое давление в этом венозном бассейне может достигать два-три показателя давления нижней полой вены. Таким образом, разрыв даже небольшой пресакральной вены приводит к обильному кровотечению.  Среди множества предложенных способов остановки такого рода кровотечений  наиболее эффективными являются: механические тампонада; прижатие зоны;  электрокоагуляция, наложение кровоостанавливающих швов как в монорежиме, так и в комбинации с биологическим материалом; применение гемостатических материалов. Заключение. Разнообразие используемых способов, публикации новых статей свидетельствуют не только об относительной их эффективности, но и о постоянном поиске более надежного метода.

Новый метод остановки кровотечения из пресакрального венозного сплетения при операции на прямой кишке по поводу рака (клиническое наблюдение)

Presacral venous bleeding is a rare but potentially fatal complication in pelvic surgery. This type of bleeding is difficult to control. Existing methods are not without shortcomings, therefore, the search for a more reliable method. We are present a case of successful bleeding control using by plates of medium-porous nitinol (pore size of 300–450 μm, permeability of 12 × 10–9). Hemostasis was carried out by pressing  a plate to the bleeding zone for 4 minutes.Кровотечение из пресакрального венозного сплетения – редкое, но потенциально фатальное осложнение в хирургии таза. Данный вид кровотечения тяжело контролируется. Существующие методики не лишены недостатков, поэтому продолжается поиск более надежного метода. Приведен случай успешной остановки кровотечения с использованием пластин среднепористого никелида титана (с порами размером 300–450 мкм и проницаемостью 12 × 10–9). Гемостаз осуществлялся прижатием пластины к зоне кровотечения в течение 4 мин

Robotic rectal surgery: State of the art

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words “rectum”, “rectal”, “cancer”, “laparoscopy”, “robot”. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients

The biological effect of cyanoacrylate-combined calcium phosphate in rabbit calvarial defects

PURPOSE: The purpose of this study was to determine the biological effects of cyanoacrylate-combined calcium phosphate (CCP), in particular its potential to act as a physical barrier - functioning like a membrane - in rabbit calvarial defects. METHODS: In each animal, four circular calvarial defects with a diameter of 8 mm were prepared and then filled with either nothing (control group) or one of three different experimental materials. In the experimental conditions, they were filled with CCP alone (CCP group), filled with biphasic calcium phosphate (BCP) and then covered with an absorbable collagen sponge (ACS; BCP/ACS group), or filled with BCP and then covered by CCP (BCP/CCP group). RESULTS: After 4 and 8 weeks of healing, new bone formation appeared to be lower in the CCP group than in the control group, but the difference was not statistically significant. In both the CCP and BCP/CCP groups, inflammatory cells could be seen after 4 and 8 weeks of healing. CONCLUSIONS: Within the limits of this study, CCP exhibited limited osteoconductivity in rabbit calvarial defects and was histologically associated with the presence of inflammatory cells. However, CCP demonstrated its ability to stabilize graft particles and its potential as an effective defect filler in bone augmentation, if the biocompatibility and osteoconductivity of CCP were improved.ope

Protective ostomies in ovarian cancer surgery: a systematic review and meta-analysis

Objective: To assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery. Methods: A systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients. Results: A total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60–1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35–1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies. Conclusion: Protective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases

Management Of Peritoneal Effusion by Sealing with a Self-Assembling Nanofiber Polypeptide Following Pelvic Surgery

Background/Aims: PuraMatrix is a synthetic material consisting of 16-amino acid peptides that self-assemble into nanofibers, previously used as a scaffold for functional cell cultures. We conducted a clinical study to determine the safety and sealing properties of PuraMatrix in post-operative lymphorrhea following pelvic surgery in humans. Methodology: A total of 20 patients who underwent rectal cancer resection were analyzed. The study group (n = 10) consisted of patients who received PuraMatrix, matched with a control group (n = 10) of patients operated on conventionally. Results: During the 2 to 3 month follow-up period, there were no abnormal findings or adverse events in any the patients who received PuraMatrix. We found that the patients who received PuraMatrix had significantly reduced post-operative drainage volumes compared with the patients in the control group. Conclusions: PuraMatrix is a safe and effective bio-compatible sealing material for the management of post-operative peritoneal effusion following pelvic surgery