The uppercut needle holding technique for facilitating second suture placement during back wall microvascular anastomosis

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 280-281
Author(s):  
Mehmet Cömert ◽  
Hidehiko Yoshimatsu
Keyword(s):  
Microvascular Anastomosis ◽  
Back Wall ◽  
Suture Placement

An Expedited Transition to the Back Wall Suturing for Side-to-Side In Situ Microvascular Anastomosis: A Technique Update

2020 ◽  
Author(s):  
Kristine Ravina ◽  
Vance L Fredrickson ◽  
Daniel A Donoho ◽  
Jonathon M Cavaleri ◽  
Ben A Strickland ◽  
...  
Keyword(s):  
Microvascular Anastomosis ◽  
Back Wall ◽  
Technical Modification ◽  
Stay Suture ◽  
Vessel Lumen ◽  
Suture Placement

Abstract BACKGROUND The side-to-side in situ microvascular anastomosis is an important tool in the cerebrovascular neurosurgeon's armamentarium. The execution of the side-to-side anastomosis, however, can be limited by the inability to acquire sufficient visualization and approximation of the recipient and donor vessels. OBJECTIVE To expedite the transition to the back wall suturing of the donor and recipient vessels during side-to-side in situ microvascular anastomosis. METHODS Incorporation of the first suture throw from the outside to the inside of the vessel lumen with the initial stay suture at the proximal apex of the arteriotomy is described. The apical knot is tied between one limb of the resultant loop and the free end of the suture. The remainder of side-to-side anastomosis can then be completed in a standard fashion starting from the inside of the lumen. RESULTS This modification allows for an expedited transition to the back wall suturing of the 2 arterial segments and avoids difficulties associated with taking the first bite from behind the knot at the proximal apex of the arteriotomy or the transfer of the needle between the approximated vessels. This updated technique is illustrated with a case example, illustration, and video. CONCLUSION This technical modification for the side-to-side anastomosis helps optimize microsurgical efficiency by limiting needle, suture, and vessel handling after the initial suture placement, which has classically been a challenge of this bypass.

scholarly journals Histopathology of Microvascular Anastomosis—Comparison of Patent and Nonpatent Anastomosis: An Experimental Study

2021 ◽  
Author(s):  
Dhaval Gohil ◽  
Nasser Mohammed ◽  
Anita Mahadevan ◽  
Nupur Pruthi
Keyword(s):  
Femoral Artery ◽  
Classical Method ◽  
Single Case ◽  
Microvascular Anastomosis ◽  
Sprague Dawley ◽  
Tunica Media ◽  
Skills Laboratory ◽  
The Mean ◽  
End To End ◽  
The Right

Abstract Objective To compare the histopathology of patent and nonpatent microvascular anastomosis using rat femoral artery end-to-end anastomosis model. Materials and Methods In 15 Sprague–Dawley rats, end-to-end anastomosis was performed on the right femoral artery. The classical method was used in four cases and one-way up method in 11 cases. The animals were sacrificed after 2 weeks and the anastomosis was subjected to histopathology. The pathological changes in patent and nonpatent cases were compared. Results The immediate patency rate and delayed patency (after 2 weeks) rate was 86.7% and 66.7%, respectively. The mean follow-up was 3 months. At sacrifice, 5/15 anastomosis were not patent. Marked subintimal thickening was noted in ⅘ (80%) of the nonpatent group, which was absent in the patent group. Severe loss or fibrosis of tunica media and marked adventitial inflammation were noted in all nonpatent cases (5/5, 100%). As much as ⅘ of the nonpatent cases had poor or indeterminate apposition; in contrast, good apposition was seen in 6/10 (60%) of the patent group. The mean clamp time and mean suturing time were significantly longer in the nonpatent group (69.2 minutes and 53.8 minutes, respectively) as compared with the patent group (48.8 minutes and 31.8 minutes, respectively). A single case that was initially nonpatent was found to have recanalized at 6 months. Conclusion Minimal intimal injury and reaction, minimal thinning of tunica media, mild-to-moderate adventitial changes, good apposition, and equidistant sutures were associated with a successful microvascular anastomosis. Short duration of vessel clamping time and suturing comes with experience and dedicated practice in a skills laboratory.

scholarly journals Supermicrosurgical Suture-Stent Technique for A Lymphaticovenular Bypass

2021 ◽  
Vol 10 (12) ◽  
pp. 2595
Author(s):  
Ryo Karakawa ◽  
Hidehiko Yoshimatsu ◽  
Keisuke Kamiya ◽  
Yuma Fuse ◽  
Tomoyuki Yano
Keyword(s):  
Lower Extremity ◽  
Success Rate ◽  
Infrared Camera ◽  
Conventional Technique ◽  
Minimal Risk ◽  
Exclusion Criteria ◽  
Back Wall ◽  
Camera System ◽  
Good Patency

Background: Lymphaticovenular anastomosis (LVA) is a challenging procedure and requires a sophisticated supermicrosurgical technique. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the “suture-stent technique”. Methods: Forty-eight LVA sites of twenty patients with lower extremity lymphedema who had undergone LVA between July 2020 and January 2021 were included in this study. LVA was performed with the conventional technique or with the suture-stent technique. The patency of the anastomoses was evaluated using an infrared camera system intraoperatively. The success rate on the first try and the final success rate for each group were compared. Results: After full application of the exclusion criteria, 35 LVAs of 16 patients including 20 limbs were included in the analysis. The ratio of good patency findings after anastomosis in the suture-stent technique group was 100%. The incidences of leakage or occlusion on the first try were statistically greater in the conventional technique group (29.4%) than in the suture-stent technique group (0%) (p = 0.0191). All anastomoses achieved good patency in the final results. Conclusion: With its minimal risk of catching the back wall during the anastomosis, the suture-stent technique can be considered an optimal anastomosis option for LVA.

Toe-First Technique for End to Side Microvascular Anastomosis – A Technical Note

2021 ◽  
Author(s):  
Gaurav Tyagi ◽  
Dhaval Gohil ◽  
Gyani Jail Singh Birua ◽  
A.R. Prabhuraj ◽  
Nupur Pruthi
Keyword(s):  
Technical Note ◽  
Microvascular Anastomosis

scholarly journals Randomized controlled trial comparing the effectiveness of mass and spaced learning in microsurgical procedures using computer aided assessment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wendy Z. W. Teo ◽  
Xiaoke Dong ◽  
Siti Khadijah Bte Mohd Yusoff ◽  
Soumen Das De ◽  
Alphonsus K. S. Chong
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Participant Satisfaction ◽  
Learning Group ◽  
Technical Performance ◽  
Randomized Controlled ◽  
Spaced Learning ◽  
Suturing Skills ◽  
Suture Placement ◽  
Better Than

AbstractSpaced-learning refers to teaching spread over time, compared to mass-learning where the same duration of teaching is completed in one session. Our hypothesis is that spaced-learning is better than mass-learning in retaining microsurgical suturing skills. Medical students were randomized into mass-learning (single 8-h session) and spaced-learning (2-h weekly sessions over 4 weeks) groups. They were taught to place 9 sutures in a 4 mm-wide elastic strip. The primary outcome was precision of suture placement during a test conducted 1 month after completion of sessions. Secondary outcomes were time taken, cumulative performance, and participant satisfaction. 42 students (24 in the mass-learning group; 18 in spaced-learning group) participated. 3 students in the spaced-learning group were later excluded as they did not complete all sessions. Both groups had comparable baseline suturing skills but at 1 month after completion of teaching, the total score for suture placement were higher in spaced-learning group (27.63 vs 31.60,p = 0.04). There was no statistical difference for duration and satisfaction in either group. Both groups showed an improvement in technical performance over the sessions, but this did not differ between both groups. Microsurgical courses are often conducted in mass-learning format so spaced learning offers an alternative that enhances retention of complex surgical skills.

The external ring technique for end-to-side microvascular anastomosis

1985 ◽  
Vol 10 (1) ◽  
pp. 151
Author(s):  
Tahseen A. Cheema ◽  
Robert R. Schenck ◽  
Harry P. Weinrib
Keyword(s):  
Microvascular Anastomosis ◽  
External Ring
Sign in / Sign up

Export Citation Format

Share Document