Hemostasis, Surgical ; Hepatectomy ; methods ; Humans ; Laparoscopy

Adult ; Hemostasis, Surgical ; methods ; Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Liver ; blood supply ; Middle Aged ; Treatment Outcome

This article introduces the basic structure, features and the priciples of a portable automatic pneumatic tourniquet and its prospects of applications.
Anastomosis, Surgical ; methods ; Automation ; Bandages ; Extremities ; surgery ; Hemostasis, Surgical ; instrumentation ; Humans ; Intraoperative Care ; Tourniquets

OBJECTIVETo discuss the safety and the feasibility of laparoscopic selective portal inflow occlusion.

METHODSFrom January 2005 to February 2006, 7 patients were performed by laparoscopic hepatectomy with selective portal inflow occlusion. The patients included 1 male and 6 females, the mean age was 48.9 years, ranged from 31 to 70 years. Procedure included left lateral segmentectomies (4 patients), left hemihepatectomies (2 patients), and right hemihepatectomies (1 patient). Portal vein, hepatic artery and their branches were exposed by blunt dissection and performed selective portal occlusion with absorbable clips.

RESULTSThere is no conversion, no mortality, and no postoperative complication. Seven selective portal inflow occlusions were performed successfully. The mean operating time was 188.7 min (range 70 min to 300 min), the mean intraoperative blood loss was 625 ml (range 350 ml to 1000 ml), and the mean postoperative hospital stay was 8.4 days.

CONCLUSIONSLaparoscopic selective portal inflow occlusion is a safe and feasible technique.

Adult ; Aged ; Female ; Follow-Up Studies ; Hemostasis, Surgical ; methods ; Hepatectomy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged

PURPOSE: To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. MATERIALS AND METHODS: We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. RESULTS: In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. CONCLUSIONS: From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT.
Adult ; Aged ; Female ; Hemostasis, Surgical/methods ; Humans ; Kidney Neoplasms/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrectomy/*methods ; Patient Positioning/methods ; Robotic Surgical Procedures/*methods ; *Suture Techniques ; Treatment Outcome

OBJECTIVETo establish new techniques on the control of vessel dividing and bleeding in minimally invasive video-assisted thyroid surgeries.

METHODSOne hundred and seventy volunteer patients with nodular goiter, adenoma and Graves' disease consecutively received the endoscopic thyroid operation according to Miccoli's mode from April 2002 to June 2003. The approach was designed to use ultrasonically activated scalpels [Harmonic Scalpel (R), Johnson & Johnson, USA] as a major, suction-dissector or others as supplementary instruments during the whole process. During the operations, two methods, "sequenced dissect-coagulate-cut" and "pre-coagulation + interlaced cut-suck-coagulate-dissect", were employed and separately evaluated for their safety or efficacy.

RESULTSAll of the procedures, except that 2 (their lesions were proven to be "cancer" by frozen section and need different treatment), were successfully completed. None of them were interrupted and converted to open surgery due to uncontrolled bleeding or severe postoperative hematoma. Branches of major thyroid vessels can be directly divided by ultrasonic scalpel without ligation or using hemoclips, supposing the technique of "sequenced dissect-coagulate-cut" method was strictly used. Bleeding during intra-gland dissection can be effectively controlled by the combined techniques of precoagulation of the vessels and the capsule vessel network near and around the incision, and then, by coordinating manipulation with a special multiple functional ultrasonic scalpel and a suction-dissector, supposing the technique of "interlaced cut-suck-coagulate-dissect" was properly employed.

CONCLUSIONSUsing ultrasonic scalpels as major, suction-dissector or others as supplementary instruments, manipulating cooperatively during the whole process, can be an ideal fashion in the site of a narrow gasless working space via a small single incision in anterio-inferior neck. And this may dramatically simplify the manipulation, and hence greatly reduce the operative difficulty. The reforms resolved two key technique problems in Miccoli's endoscopic operation: vessel-dividing and bleeding-control, therefore, laying a sound basis for the clinical application of this special approach.

Adolescent ; Adult ; Aged ; Hemostasis, Surgical ; methods ; Humans ; Middle Aged ; Thyroid Gland ; blood supply ; Thyroidectomy ; instrumentation ; methods ; Video-Assisted Surgery ; methods

OBJECTIVETo evaluate the effect of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy.

METHODSFrom October 2002 to October 2012, 52 patients with rectal cancer received neoadjuvant radiotherapy and developed presacral venous plexus hemorrhage during rectectomy, included 36 male and 26 female cases. Their age were 36-65 years. The hemostasis time and blood loss were analyzed.

RESULTSAll 52 patients achieved R0 resection. Of which 13 patients achieved suture hemostasis within 15 minutes, whereas 22 patients unsuccessfully treated within 15 minutes received compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx. The median blood loss was (196 ± 44)ml and hospitalization time was (15.2 ± 1.7)days in this group. Additionally, 7 patients achieved suture hemostasis within 20 minutes except 4 patients who received compression hemostasis, with a median blood loss of (1016 ± 86)ml and hospitalization time of (21.7 ± 6.3)days. Other 6 patients achieved suture hemostasis within 30 minutes except 3 patients who received compression hemostasis, with a median blood loss of (2508 ± 73)ml and the hospitalization time was (28.8 ± 3.3)days. There was statistically significant difference of bleeding (F = 4289.562) and hospitalization time (F = 50.121) in 3 groups of patients (P = 0.000).

CONCLUSIONSOnce intraoperative presacral venous plexus hemorrhage can't be stopped timely, compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx is an effective alternative for the patients with rectal cancer who received neoadjuvant radiotherapy.

Adult ; Aged ; Blood Loss, Surgical ; prevention & control ; Female ; Hemostasis, Surgical ; methods ; Humans ; Male ; Middle Aged ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; surgery

Ever since mankind has had blood, efforts to stop bleeding have never ceased and so numerous methods for hemostasis have been developed. In recent decades, minimally invasive surgical techniques have led patients to less-bleeding surgery but, hemostatic agents, devices and techniques still play an important role in medical side. A number of hemostatic agents and devices have been developed and they can be classified by their mechanism of action. That classification of the coagulants includes mechanisms with physical, caustic, bio-physical, biologic actions. Hemostatic devices are divided into categories such as dressings, glue, clips, electrocoagulations and so on. Based on the concept of minimally invasive surgical procedures, variously developed surgical techniques are divided by the number of ports used and auxiliary instruments. However, there are advantages and disadvantages to each of the hemostatic agents and minimally invasive methods, and the belief in the classical method also prevents the application of new hemostatic methods. The knowledge and understanding of the benefits and costs of these newly developed hemostatic methods will make it easier for medical personnel to manage patient's blood.
Adhesives ; Bandages ; Bloodless Medical and Surgical Procedures* ; Classification ; Coagulants ; Cost-Benefit Analysis ; Electrocoagulation ; Hemorrhage ; Hemostasis ; Humans ; Methods ; Minimally Invasive Surgical Procedures

Adolescent ; Adult ; Child ; Female ; Hemostasis, Surgical ; methods ; Humans ; Male ; Middle Aged ; Subclavian Artery ; injuries ; Subclavian Vein ; injuries ; Vascular Surgical Procedures ; methods ; Wounds and Injuries ; surgery

OBJECTIVETo examine the utility of the Ligasure vessel-sealing system in D(2) lymphadenectomy of gastric cancer, and compare with conventional hand tie method.

METHODSOne hundred and twenty-four consecutive patients undergone D(2) lymphadenectomy of gastric cancer from Jan. to Oct. 2005 were enrolled in this study. Operations of 62 patients were performed with Ligasure, whereas the other 62 patients with hand tie method. Operative duration, volume of intraoperative hemorrhage and postoperative course were analyzed.

RESULTSThere was significant difference in operative duration (187.3 min vs 210.5 min, P< 0.05) and no significant differences in volume of intraoperative hemorrhage, postoperative course, or duration of postoperative drainage between Ligasure group and conventional method group. No significant difference was observed in the frequency of postoperative complications between the two groups.

CONCLUSIOND(2) lymphadenectomy of gastric cancer using Ligasure instead of conventional hand tie method appears to be technically feasible and easy.

Female ; Hemostasis, Surgical ; methods ; Humans ; Ligation ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Staging ; Stomach Neoplasms ; pathology ; surgery