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Ali Yesiltas M, Gokkurt Y, Ketenciler S, Yucel C, Yilmaz M, Ozgol I, Kursat Kurt M, Gulbudak S. Iatrogenic Vascular Injuries in Elective Abdominal and Pelvic Surgery Patients: Retrospective, Single Center, 30-Day Results. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:319-324. [PMID: 39411032 PMCID: PMC11472199 DOI: 10.14744/semb.2024.19971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 10/19/2024]
Abstract
Objectives Although rare, vascular injuries are common in elective abdominal or pelvic surgeries. When encountered, any problem in the relevant artery/vein (occlusion, stenosis, dissection, pseudoaneurysm or arteriovenous fistula) is associated with mortality and morbidity in both the short and long term. We aimed to share our treatment approach and short-term results for vascular injuries in elective surgery. Methods In this study, the clinical data of patients who underwent elective abdominal and pelvic surgery performed by a vascular surgeon and who sustained iatrogenic vascular injury between January 2018 and July 2023 were retrospectively examined. All patients with no iatrogenic vascular injuries were excluded from the study. Results In the present study, a total of 72 patients had iatrogenic vascular injuries and underwent vascular surgery. The average age of the patients was 50.8±14.6 years. Twenty-eight (38.8%) of the patients were male, and 44 (61.1%) were female. Iatrogenic vascular injury occurred in 21 (29.2%) patients who underwent urologic surgical interventions, 35 (48.6%) who underwent gynecologic surgical treatments, and 16 (22.2%) who underwent abdominal surgeries. Twenty-nine patients had isolated arterial injuries, 37 patients had isolated venous injuries, and 6 patients had both arterial and vein injuries. Embolectomy was performed on 24 patients. Primary sutures were applied in 22 patients, end-to-end anastomosis with a vein graft was performed in 13 patients, and end-to-end anastomosis with Dacron/PTFE was performed in 11 patients. In 10 patients, native vein end-to-end anastomosis was performed. During the 30-day follow-up period, 3 patients experienced arterial occlusion, and 2 patients experienced venous thrombosis. There was no mortality in the hospital or during the 30-day follow-up period. Conclusion Vascular injuries rarely occur in elective abdominal and pelvic surgeries. However, when they happen, they are fatal. For this reason, preoperative, multidisciplinary evaluation will minimize the risk of vascular complications, especially in patients requiring mass excision and lymph node dissection with close vascular proximity.
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Affiliation(s)
- Mehmet Ali Yesiltas
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Yasar Gokkurt
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Serkan Ketenciler
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Cihan Yucel
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Melek Yilmaz
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Ilhan Ozgol
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Mehmet Kursat Kurt
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
| | - Seran Gulbudak
- Deparment of Cardiovascular Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
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Di Nuzzo MM, Boccia G, Visconti M, Magno G, Bracale U, Corcione F. Totally laparoscopic management of inferior mesenteric artery injuries in colorectal surgery - a video vignette. Colorectal Dis 2023; 25:2459-2460. [PMID: 37872847 DOI: 10.1111/codi.16777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023]
Affiliation(s)
| | - Giuseppe Boccia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Marco Visconti
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giuseppe Magno
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Lawani I, Costantino F, Souaibou YI, Morelli U, Dossou FM, Keller P. Laparoscopic management of a left hepatic vein injury during one -step laparoscopic Roux-en-Y gastric bypass after adjustable gastric banding removal: A case report. Int J Surg Case Rep 2022; 94:107043. [PMID: 35658274 PMCID: PMC9093008 DOI: 10.1016/j.ijscr.2022.107043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 10/26/2022] Open
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Miranda J, Dongarwar D, Salihu HM, Montero-Baker M, Gilani R, Pallister ZS, Mills JL, Chung J. Gender, Racial and Ethnic Disparities in Iatrogenic Vascular Injuries among the Ten Most Frequent Surgical Procedures in the United States. Ann Vasc Surg 2021; 80:18-28. [PMID: 34780954 DOI: 10.1016/j.avsg.2021.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Iatrogenic vascular injuries (IaVI's) appear to be increasing, with disparate prevalence across gender, race and ethnicity. We aim to assess the risk of IaVI's across these characteristics. METHODS Using the Nationwide Inpatient Sample for the years 2008 to 2015, we identified rates of IaVI's among the top ten most frequently performed inpatient procedures in the United States. Joint point regression was employed to examine the trends in the rates of IaVI's. We also calculated the adjusted odds ratios for IaVI's using survey logistic regression. RESULTS During the eight-year study period, a total of 29,877,180 procedures were performed (33.6% hip replacement, 14% knee arthroplasty, 11.2% cholecystectomy, 10.3% spinal fusion, 8.9% lysis of adhesions, 8% colorectal resection, 7.9% partial bone excision, 5% appendectomy, 0.6% percutaneous coronary angioplasty, 0.6% laminectomy). A total of 194,031 (0.65%) IaVI's were associated with these procedures. The incidence of IaVI's increased over time with an average annual percentage change (AAPC) of 4.2% (95% CI: 3.1, 5.4; P < 0.01). More females (105,747; 54.5%) than males (88,284; 45.5%) suffered IaVI's during their hospital admission (P < 0.01). Patients 70 years of age and older had the highest incidence of IaVI's (12,244,082; 34.3%; P ≤ 0.01). Among the ten index procedures, Non-Hispanic (NH) Whites underwent the highest proportion of procedures (14.1 procedures/100 hospitalizations; P < 0.01) and cholecystectomy was associated with the highest rate of IaVI's (19.4 per 1000 hospitalizations, P ≤ 0.01). Overall, patients from the lowest income quartile were least likely to suffer IaVI's (0.83 95% CI 0.79-0.88, P < 0.01) compared to the highest income quartile. All form of healthcare coverage increased the odds of IaVI's: Medicaid (1.07 95% CI 1.07-1.13, P < 0.01); Private insurance (1.35 95% CI 1.3-1.39, P < 0.01); Self-pay or no charge (1.45 95% CI 1.38-1.52, P < 0.01). IaVI's increased the odds of in-hospital mortality in all groups (1.25 95% CI 1.14-1.35, P < 0.01) and more pronounced in NH-Blacks (1.51 95% CI 1.15-1.99, P < 0.01). In the overall cohort, urban teaching hospitals observed the highest odds of in-hospital mortality (1.11 95% CI 1.07-1.15, P < 0.01). CONCLUSION Between 2008 to 2015, IaVI's rates for the top ten most frequently performed inpatient procedures increased by 33.6% (4.2% annually; P < 0.01). The elderly, females, and Hispanics more frequently had hospitalizations complicated by IaVI's. Overall, IaVI's independently increased the adjusted odds of mortality by 25%. IaVI's were most fatal among Blacks, about 50% elevated risk of death compared to NH-Whites. These benchmarks will be critical to future efforts to reduce IaVI, and associated healthcare disparities.
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Affiliation(s)
- Jorge Miranda
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston Texas; Department of Family and Community Medicine, Baylor College of Medicine, Houston Texas
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Ramyar Gilani
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Zachary S Pallister
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas.
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Teste B, Rullier E. Intraoperative complications during laparoscopic total mesorectal excision. Minerva Surg 2021; 76:332-342. [PMID: 33944516 DOI: 10.23736/s2724-5691.21.08691-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative complication during laparoscopic mesorectal excision for rectal cancer is a common complication occurring in 11% to 15% of the cases. They are probably underestimated because not systematically reported. The most frequent intraoperative complications are haemorrhage (3-7%), tumour perforation (1-4%), bowel injury (1-3%), ureter injury (1%), urogenital injury (2%), other organ injury (<1%), and anastomotic complications (1%). The mechanisms, management and prevention of vascular port injury, inferior mesenteric artery bleeding, small bowel and colon perforation, ureteral and urethral injury, pelvic nerve damage, tumour perforation and anastomotic failure are described. This review underlines the necessity to prevent intraoperative complication to avoid operative death and severe side-effects.
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Affiliation(s)
- Blanche Teste
- Department of Colorectal Surgery, Haut-Levèque Hospital, University of Bordeaux, Pessac, France
| | - Eric Rullier
- Department of Colorectal Surgery, Haut-Levèque Hospital, University of Bordeaux, Pessac, France -
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Filis K, Sigala F, Stamatina T, Georgia D, Zografos G, Galyfos G. Iatrogenic Vascular Injuries of the Abdomen and Pelvis: The Experience at a Hellenic University Hospital. Vasc Endovascular Surg 2019; 53:541-546. [DOI: 10.1177/1538574419858809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The aim of this study is to present the experience of a Vascular Division at a Hellenic University hospital concerning the management of iatrogenic vascular injuries (IVIs) of the abdomen or pelvis. Patients and Methods: This is a retrospective study evaluating all IVIs reported during a 10-year period in our institution. Only injuries warranting a vascular surgeon consultation were included in the study. Non-iatrogenic injuries were not included. Mortality and major complications within 30 days were evaluated. Results: Overall, 70 cases were recorded, with 41% being venous and 59% being arterial injuries. Iliac arteries (51%) were the most common location and rupture/lacerations (73%) were the most common type of injury. General surgery (61.5%) and cardiology (30%) procedures were the most frequently involved procedures. A 30-day mortality was 5.7%, with 30% of cases treated conservatively. Synthetic bypass grafting (odds ratio [OR] = 65.0; 95% confidence interval [CI], 4.022-1050.358; P = .003) and male gender (OR = 83.77; 95% CI, 4.040-1736.738; P = .004) were associated with death. Conclusions: Iatrogenic vascular injuries of the abdomen or pelvis are usually associated with general surgery and endovascular procedures. When vascular consultation is requested early, mortality could remain low. However, a selected number of stable patients with retroperitoneal or pelvic hematomas could be treated conservatively, yielding satisfying results.
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Affiliation(s)
- Konstantinos Filis
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Triantafyllou Stamatina
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Doulami Georgia
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Zografos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Chavarriaga A, Wyrzykowski A, Feliciano DV. Minimally invasive surgery? Trauma Surg Acute Care Open 2019; 3:e000290. [PMID: 30687787 PMCID: PMC6326355 DOI: 10.1136/tsaco-2018-000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Amy Wyrzykowski
- Department of Surgery, WellStar Atlanta Medical Center, Atlanta, Georgia, USA
| | - David V Feliciano
- Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Abstract
Vascular laparoscopic injuries are rare (0.2/1000), however, they are associated with 6-13% morbidity and mortality. Commonest sites for catastrophic haemorrhage are the right iliac vessels, inferior vena cava and less commonly the abdominal aorta. The injuries commonly occur at entry using a Veress needle or insertion of trocars. These risks are inherent to all laparoscopic surgery. A systematic approach for managing these includes prompt recognition, communication within the operative team, immediate resuscitation and specific operative strategies for the control of vascular haemorrhage based on the location and severity of the injury. Major vascular injuries may require midline laparotomy and vascular surgeons. 1:1:1 resuscitation and adjunct haemostatic agents may help. Major vascular injury is a rare but a potentially fatal complication. We propose a skills and drills approach to improve outcomes. We also propose a practical algorithms for the management of haemorrhage in the acute situation.
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Affiliation(s)
- Victoria Asfour
- a Department of Urogynaecology , St Mary's Hospital, Imperial College London , London , UK
| | - Edward Smythe
- b Department of General Surgery , Musgrove Park Hospital , Taunton , UK
| | - Rizwan Attia
- c Department of Cardiothoracic Surgery , Kings College Hospital , London , UK
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Abstract
Background The purpose of the present study was to analyse the impact of patient-related risk factors and medication drugs on haemorrhagic complications following cholecystectomy. Methods All cholecystectomies registered in the Swedish population-based Register for Gallstone Surgery and ERCP (GallRiks) were identified. Risk factors for bleeding were assessed by linking data in the GallRiks to the National Patient Register and the Prescribed Drug Register, respectively. The risk of haemorrhage leading to intervention was determined by variable regression, and Kaplan–Meier analysis assessed survival rate following perioperative haemorrhage. Results A total of 94,557 patients were included between 2005 and 2015, of which 799 (0.8%) and 1192 (1.3%) patients were registered as having perioperative and post-operative haemorrhage, respectively. In multivariable analysis, an increased risk of haemorrhagic complications was seen in patients with cerebrovascular disease (p = 0.001), previous myocardial infarction (p = 0.001), kidney disease (p = 0.001), heart failure (p = 0.001), diabetes (p = 0.001), peripheral vascular disease (p = 0.004), and obesity (p = 0.005). Prescription of tricyclic antidepressant (p = 0.018) or dipyridamole (p = 0.047) was associated with a significantly increased risk of perioperative haemorrhage. However, this increase in risk did not remain significant following Bonferroni correction for mass significance. Perioperative haemorrhage increased the risk of death occurring within the first post-operative year [Hazard Ratio, (HR) 4.9, CI 3.52–6.93] as well as bile duct injury (OR 2.45, CI 1.79–3.37). Conclusion The increased risk of haemorrhage associated with comorbidity must be taken into account when assessing patients prior to cholecystectomy. Perioperative bleeding increases post-operative mortality and is associated with an increased risk of bile duct injury.
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Affiliation(s)
- J Strömberg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - G Sandblom
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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LB01 SIX WEEKS OF SOFOSBUVIR/LEDIPASVIR TREATMENT OF ACUTE HEPATITIS C VIRUS GENOTYPE 1 MONOINFECTION: FINAL RESULTS OF THE THE GERMAN HEPNET ACUTE HCV IV STUDY. United European Gastroenterol J 2016. [DOI: 10.1177/2050640616678364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
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[Intraoperative complications of the lower gastrointestinal tract : Prevention, recognition and therapy]. Chirurg 2015; 86:319-25. [PMID: 25687814 DOI: 10.1007/s00104-014-2849-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Every surgical intervention is associated with the risk of intraoperative complications. These occur in approximately 2-12% of patients but significantly influence the postoperative outcome, overall complication and mortality rates. This article presents the treatment of typical intraoperative complications during surgery of the lower gastrointestinal tract with a focus on the prevention and identification of risk factors. Especially changes in the regular anatomy caused by previous surgery, inflammation, tumors and emergency situations carry the risk of iatrogenic injuries to the bowels, spleen, ureter and blood vessels. These risk factors must be considered when choosing a surgical procedure, a surgical approach or an appropriate surgeon. The early detection of complications with a definitive restoration is the essential step for a successful treatment without long-term sequelae. Every delay in therapy is associated with an increased morbidity and mortality and should be avoided.
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Nam KW, Lee SB, Kim IY, Kim KG, Park SJ. A new hemostatic clip for endoscopic surgery that can maintain blood flow after clipping. World J Gastroenterol 2014; 20:1325-1331. [PMID: 24574807 PMCID: PMC3921515 DOI: 10.3748/wjg.v20.i5.1325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/08/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a new hemostatic device for endoscopic surgery that can control the bleeding without completely occluding the bleeding vessel.
METHODS: A hemostatic clip and its applier that can stanch bleeding while maintaining blood flow through the clipped vessel was introduced, and the performance of the proposed clip was evaluated using in vitro and in vivo experiments.
RESULTS: During in vitro experiments, no leakage was found after clipping at cuts made in artificial vessels, and flow was maintained through the clipped artificial vessels. In experiments on rats, all the implanted clips occluded the target vessels successfully, and no bleeding or tissue damage was observed at the operative site after the rats were euthanized on postoperative day 7. In experiments on pigs, bleeding stopped immediately after partial clipping of a damaged vessel, and some amount of blood flow was consistently maintained through the clipped vessel after hemostasis.
CONCLUSION: We believe that the proposed hemostatic clip and clip applier can enhance patient safety during laparoscopic surgery.
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Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature. Surg Endosc 2013; 27:3021-7. [DOI: 10.1007/s00464-013-2845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Brunaud L, Angelos P. Robot-assisted endoscopic thyroidectomy: should Theodore Kocher's approach be definitively buried? J Visc Surg 2011; 148:e403-4. [PMID: 22130073 DOI: 10.1016/j.jviscsurg.2011.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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