Surg. Tech. Dev., Volume 1, Issue 2 (October 2011) – 15 articles

A series of 80 patients with histopathologically confirmed juvenile nasopharyngeal angiofibroma were treated surgically over a period of ten years (1995–2004). The lateral rhinotomy approach was used to expose the tumor and its extensions. Lateral rhinotomy with its extensions provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and temporal fossa. Most intracranial, extradural extensions can also be approached. There were no major operative or post-operative complications. Longterm follow up from one to ten years showed only 8 recurrences. The added advantage of this approach is that it can be combined with all the other anterior and lateral skull base approaches. The cosmetic outcome is satisfactory if nasal aesthetic subunits are taken into considerations while making the incision. The lateral rhinotomy approach is the most direct route to the body of the tumor and can be used to approach all the possible extensions of the tumor. Full article

We present the results of a pure retroperitoneoscopic/ extraperitoneal nephroureterectomy (RENU) for upper urinary tract transitional cell cancer (UT-TCC). After establishment of RENU in benign indications (n = 21 Patients), 14 patients (age range 51–92 years, mean 71.6) with UT-TCC have undergone the technique in our clinic from October 2005 to October 2008. This paper reports the operative procedure, clinical results and follow up. Total operative time was 110-240 minutes (median 154.5). Average blood loss was 132 mL. Tumor localization in oncology patients was renal pelvis (63.6%), ureter (18.2%) or both (18.2%). Postoperative tumor stages were Ta (n = 2), Tis (n = 2), T1 (n = 3), T2 (n = 3) and T3 (n = 4) without lymph node involvement. No perioperative complications were observed. Urethral catheters were removed on Day 6-8 post surgery (median Day 7). Recovery to normal life activity ranged from 8 to 30 days (mean 17.8). During the 4–36 month (median 23) follow-up period, there was one mortality due to cancer progression. Four patients had developed superficial bladder cancer disease requiring regular cystoscopic resections. One patient had coincidental Bellini duct renal tumor and developed psoas metastasis after eight months. The 2-year tumor specific survival rate is 91%. The retroperitoneoscopic/ extraperitoneal nephroureterectomy is a lowrisk and minimally invasive procedure to be used whenever nephroureterectomy is indicated. It is an attractive alternative to both laparoscopic and open techniques and adheres to the oncological principles of radical nephroureterectomy. Short-term follow-up data showed no increased risk of tumor recurrence. However, long-term results are needed before this technique can be established as standard UT-TCC therapy. Full article

In this study, the technique and results of iris-claw intraocular lens (IOL) implantation with corneal incision and single paracentesis were presented. Eighteen eyes of 18 patients who underwent iris-claw implantation surgery with a single paracentesis were included in this prospective study. Iris-claw lens was grasped by its forceps and placed into the anterior chamber through superior corneal opening. While IOL was held by forceps, a blunt enclavation spatula was introduced through inferior paracentesis. Then the spatula was directed toward underneath of iris through pupil and toward sides where iris was entrapped into the claw by gentle push of iris through the slotted center of the lens haptics. Mean age of patients was 54.28 ± 25.21 years (7–76 years). Mean anterior chamber depth was 4.07 ± 0.32 mm and mean keratometric power was 43.01 ± 2.73 D. Preoperative BCVA was 20/63 or better in 8 (44.4%) patients. At the first postoperative month BCVA was 20/63 or better in 14 (77.8%) patients. Preoperative mean spherical refraction was +11.05 ± 2.62 D, preoperative astigmatism was 2.15 ± 0.85. Postoperative mean spherical refraction was −0.58 ± 0.25 D and mean astigmatism was −1.92 ± 0.67 D. The most frequent postoperative complication was mild corneal edema seen in three patients that resolved completely during the first week with medical treatment. Irisclaw IOL implantation can be performed easily with corneal incision and single paracentesis. Single paracentesis does not increase surgical time or cause inconvenience during the procedure. Full article

Cone beam CT (CBCT) produces threedimensional information on the facial skeleton, teeth and their surrounding tissues; and is increasingly being used in many of the dental specialties. This is usually achieved with a substantially lower effective dose compared with conventional medical computed tomography (CT). Periapical pathologies, root fractures, root canal anatomy and the true nature of the alveolar bone topography around teeth may be assessed. CBCT scans are desirable to assess posterior teeth prior to periapical surgery, as the thickness of the cortical and cancellous bone can be accurately determined as can the inclination of roots in relation to the surrounding jaw. The relationship of anatomical structures such as the maxillary sinus and inferior dental nerve to the root apices may also be clearly visualized. Measurements on CBCT are more accurate when compared with OPG. Therefore, CBCT permits the clinician to have all necessary information when planning dental implants. The purpose of this article is to provide an overview of the unique image display capabilities of maxillofacial CBCT systems and to illustrate specific applications in clinical practice. Full article

Several surgical options have been described to manage persistent dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe. We describe a minimally invasive technique for the management of this deformity. We perform a plantar closing wedge osteotomy of the 5th toe at the base of its proximal phalanx associated with a lateral condylectomy of the head of the proximal phalanx and at the base of the middle phalanx. Lastly, a complete tenotomy of the deep and superficial flexor tendons and of the tendon of the extensor digitorum longus is undertaken. Correction of cock-up fifth toe deformity is achieved using a minimally invasive approach. Full article

The authors demonstrate the effective drainage of presacral sepsis following low anterior resection surgery using the novel approach of both the Heald anal stent and a Foley catheter combined. The Heald stent was placed trans-anally without the need for anaesthetic and an 18Fr Foley was placed through this. A presacral collection was drained through the stent, allowing the patient to be discharged after a week without the need to return to the operating theatre. The Heald stent may be used to successfully drain a presacral collection by double decompression of the rectum and the presacral space. Full article

Removal of locking plates in many ways poses novel challenges compared to conventional plates. None of the techniques described for the removal of locking plates are adequate for all situations. We report our experience of 27 patients from whom a total of 33 locking plates were removed. We also describe a novel technique for the removal of locking plates which in our experience could be used in most of these patients because it is appropriate for all situations and, from a technical point of view, is easy to use. Our new technique consists of removing the problematic locking screw by cutting the plate on both sides of the screw hole and using the screw head-plate hole unit for removal. We analyzed all these patients for the location of the plate, number of locking screws, time of implant removal since the initial surgery, reason for removal of the plate, nature of the difficulties encountered during surgery, and any perioperative complications. A total of 43 (17.34%) screws were difficult to remove. Twenty screws were found to be stripped, 15 were jammed and 8 were broken. Fourteen of the 20 stripped screws and all 15 jammed screws were removed using our technique. We found this technique of locking plate removal to be very versatile and useful in most of the cases in which removal was difficult. At the same time, it also causes less damage to the bone compared to other techniques. Full article

The psychological and social impact of the lipodystrophy syndrome on HIV-infected individuals may be quite considerable and adversely affect their quality of life. Currently no validated assessment tool for facial lipoatrophy is available. The main objective of this paper is to evaluate the reliability of interactive anthropometric landmark localization based on digitized 3D facial images. By comparing both computed tomography (CT) and structured light scanning we try to demonstrate that surface scanning shows a higher sensitivity in measuring facial reference points. Besides, we evaluate the reproducibility of facial 3D white-light scans. Three HIVpositive men attending our plastic surgery outpatient clinic for treatment of facial lipodystrophy were enrolled in the study. Localization of anthropometric landmarks measurements was performed on the patients. All patients underwent a facial CT and a facial white-light scanning on the same day. The inter-landmark distances measured on facial models developed from CT aided with VirSSPA 3D software and structured light scanning were compared to the real human models. We found that facial distances measured in the CT 3D reconstruction showed a mean error margin of 0.357 cm from the real distances measured on patients. On the contrary, mean error margin with the white-light scanning was of 0.096 cm. In both cases, measurements were found to be statistically significant (p < 0.05). When compared to CT reconstructions, white-light surface scanning offers a more accurate landmark localization as well as reliable reconstructions of up to less than the tenth of a millimetre as average when compared to real measurements on facial human models. Full article

The most commonly encountered complication after haemorrhoidectomy is post-operative pain. Relief of this pain may aid earlier recovery. A literature search was performed examining the different surgical and medical agents for the relief of post haemorrhoidectomy pain using Pubmed, MEDLINE, EMBASE, CINAHL and Cochrane library databases. Pain can be relieved by surgical or medical agents. Surgery incorporates a risk of incontinence. A number of studies examine the role of medical agents. A variety of surgical techniques and medical agents are available to the clinician in the treatment of post haemorrhoidectomy pain. Tailored management to individual patients should ensure appropriate symptomatic control and prompt recovery. Full article

Flail chest complicates about 10% of patients with chest trauma and is associated with a mortality rate of 10–20% in older series, while a recent one reports no mortality. The majority of the cases are treated conservatively with internal pneumatic stabilization and pain control. In recent years, nevertheless, we assisted in the resurgence of chest wall fixation due to the availability of new devices. We report our experience in the use of mouldable titanium clips (STRACOS, Strasbourg Thoracic Osteosyntheses System; MedXpert, Heitersheim, Germany) to fix traumatic rib fracture. This device presents an advantage over previous strategies, as it is easy to apply and doesn’t require drilling and screwing of the ribs. Full article

There are many suturing techniques available for the closure of skin incisions. The authors present a continuous suturing technique which is simple and quick to perform, eliminates the need for an assistant to follow, is easy to remove, and produces an everted wound margin with evenly distributed tension. The authors believe this technique produces a cosmetically superior scar, which is beneficial to the patient and to the surgeon. Full article

Current treatment modalities for snoring may include mucosal removal, coblation or radiofrequency palatoplasty, injection snoreplasty and placement of palatal implants with described disadvantages. We introduce a new laser assisted method avoiding intraoral injury. A pilot study treating 13 loud snorers having an RDI < 8 was conducted. A diode laser coupled to a flexible fiberand a handle with curved needle was used. The fiber was introduced into the nasal surface of soft palate between palatoglossal and glossopharyngeal arches and advanced progressively anteriorly after pulling the uvula forward three times to create palatal scarring and stiffening. All responded to a phone survey. Six patients reported significant improvement, 4 had some improvement, 2 had mild improvement and one patient had no change. Pain score was moderate for 3 patients while the rest had mild pain. The laser harbors many advantages over other methods. Results with this technique are encouraging further studies. Full article

We describe the novel use of a cannula in decompressing a large tension pneumoperitoneum secondary to perforated sigmoid diverticulum, in which the patient did not subsequently require an emergency laparotomy. Needle decompression was successfully used as part of a conservative regimen, thus avoiding potentially high-risk surgery. Full article