Suturing intraabdominal organs: when do we cause tissue damage?
Identifieur interne : 002968 ( Main/Merge ); précédent : 002967; suivant : 002969Suturing intraabdominal organs: when do we cause tissue damage?
Auteurs : Sharon P. Rodrigues [Pays-Bas] ; Tim Horeman [Pays-Bas] ; Jenny Dankelman [Pays-Bas] ; John J. Van Den Dobbelsteen [Pays-Bas] ; Frank-Willem Jansen [Pays-Bas]Source :
- Surgical Endoscopy [ 0930-2794 ] ; 2011.
Abstract
It is generally assumed that safety of tissue manipulations during (laparoscopic) surgery is related to the magnitude of force that is exerted on the tissue. To provide trainees with performance feedback about tissue-handling skills, it is essential to define objective criteria for judging the safety of applied forces. To be of clinical relevance, these criteria should relate the applied forces to the risk of tissue damage. This experimental study was conducted to determine which tractive forces during suturing cause tissue damage in different types of porcine tissues.
Tractive forces were applied on eight different tissue types (fascia, aorta, vena cava, peritoneum, small and large bowel, uterus, and fallopian tube) of 10 different pigs by placing increasingly higher loads on sutures in the tissue. We determined the load at what tissue damage occurred through visual inspection of the tissue. For each tissue sample, three consecutive measurements were performed.
The average maximum acceptable force varied between 11.43 N for fascia to 1.25 N for fallopian tube. The difference in allowable force between these two structures is almost tenfold. Small bowel can be handled with a tractive force almost 1.5-fold higher than large bowel.
Each tissue type was found to have its own individual range of acceptable maximum forces before visual tissue damage occurs. With the results presented in this study, it is possible to provide clinically relevant and validated feedback to trainees about their tissue-handling skills.
Url:
DOI: 10.1007/s00464-011-1986-5
PubMed: 22028014
PubMed Central: 3310984
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Rodrigues</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Horeman, Tim" sort="Horeman, Tim" uniqKey="Horeman T" first="Tim" last="Horeman">Tim Horeman</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author><author><name sortKey="Dankelman, Jenny" sort="Dankelman, Jenny" uniqKey="Dankelman J" first="Jenny" last="Dankelman">Jenny Dankelman</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author><author><name sortKey="Van Den Dobbelsteen, John J" sort="Van Den Dobbelsteen, John J" uniqKey="Van Den Dobbelsteen J" first="John J." last="Van Den Dobbelsteen">John J. 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Rodrigues</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Horeman, Tim" sort="Horeman, Tim" uniqKey="Horeman T" first="Tim" last="Horeman">Tim Horeman</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author><author><name sortKey="Dankelman, Jenny" sort="Dankelman, Jenny" uniqKey="Dankelman J" first="Jenny" last="Dankelman">Jenny Dankelman</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author><author><name sortKey="Van Den Dobbelsteen, John J" sort="Van Den Dobbelsteen, John J" uniqKey="Van Den Dobbelsteen J" first="John J." last="Van Den Dobbelsteen">John J. Van Den Dobbelsteen</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author><author><name sortKey="Jansen, Frank Willem" sort="Jansen, Frank Willem" uniqKey="Jansen F" first="Frank-Willem" last="Jansen">Frank-Willem Jansen</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Gynecology, Leiden University Medical Center, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3 mE), Delft University of Technology, Mekelweg 2, 2628 CD Delft</wicri:regionArea><wicri:noRegion>2628 CD Delft</wicri:noRegion></affiliation></author></analytic><series><title level="j">Surgical Endoscopy</title><idno type="ISSN">0930-2794</idno><idno type="eISSN">1432-2218</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>It is generally assumed that safety of tissue manipulations during (laparoscopic) surgery is related to the magnitude of force that is exerted on the tissue. To provide trainees with performance feedback about tissue-handling skills, it is essential to define objective criteria for judging the safety of applied forces. To be of clinical relevance, these criteria should relate the applied forces to the risk of tissue damage. This experimental study was conducted to determine which tractive forces during suturing cause tissue damage in different types of porcine tissues.</p></sec><sec><title>Methods</title><p>Tractive forces were applied on eight different tissue types (fascia, aorta, vena cava, peritoneum, small and large bowel, uterus, and fallopian tube) of 10 different pigs by placing increasingly higher loads on sutures in the tissue. We determined the load at what tissue damage occurred through visual inspection of the tissue. For each tissue sample, three consecutive measurements were performed.</p></sec><sec><title>Results</title><p>The average maximum acceptable force varied between 11.43 N for fascia to 1.25 N for fallopian tube. The difference in allowable force between these two structures is almost tenfold. Small bowel can be handled with a tractive force almost 1.5-fold higher than large bowel.</p></sec><sec><title>Conclusions</title><p>Each tissue type was found to have its own individual range of acceptable maximum forces before visual tissue damage occurs. With the results presented in this study, it is possible to provide clinically relevant and validated feedback to trainees about their tissue-handling skills.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Seymour, Ne" uniqKey="Seymour N">NE Seymour</name></author><author><name sortKey="Gallagher, Ag" uniqKey="Gallagher A">AG Gallagher</name></author><author><name sortKey="Roman, Sa" uniqKey="Roman S">SA Roman</name></author><author><name sortKey="O Rien, Mk" uniqKey="O Rien M">MK O’Brien</name></author><author><name sortKey="Bansal, Vk" uniqKey="Bansal V">VK Bansal</name></author><author><name sortKey="Andersen, Dk" uniqKey="Andersen D">DK Andersen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grantcharov, Tp" uniqKey="Grantcharov T">TP Grantcharov</name></author><author><name sortKey="Kristiansen, Vb" uniqKey="Kristiansen V">VB Kristiansen</name></author><author><name sortKey="Bendix, 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Dankelman</name></author><author><name sortKey="Gouma, Dj" uniqKey="Gouma D">DJ Gouma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De, S" uniqKey="De S">S De</name></author><author><name sortKey="Rosen, J" uniqKey="Rosen J">J Rosen</name></author><author><name sortKey="Dagan, A" uniqKey="Dagan A">A Dagan</name></author><author><name sortKey="Hannaford, B" uniqKey="Hannaford B">B Hannaford</name></author><author><name sortKey="Swanson, P" uniqKey="Swanson P">P Swanson</name></author><author><name sortKey="Sinanan, M" uniqKey="Sinanan M">M Sinanan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosen, J" uniqKey="Rosen J">J Rosen</name></author><author><name sortKey="Brown, Jd" uniqKey="Brown J">JD Brown</name></author><author><name sortKey="De, S" uniqKey="De S">S De</name></author><author><name sortKey="Sinanan, M" uniqKey="Sinanan M">M Sinanan</name></author><author><name sortKey="Hannaford, B" uniqKey="Hannaford B">B Hannaford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Snedeker, Jg" uniqKey="Snedeker J">JG Snedeker</name></author><author><name sortKey="Barbezat, M" uniqKey="Barbezat M">M Barbezat</name></author><author><name sortKey="Niederer, P" uniqKey="Niederer P">P Niederer</name></author><author><name sortKey="Schmidlin, Fr" uniqKey="Schmidlin F">FR Schmidlin</name></author><author><name sortKey="Farshad, M" uniqKey="Farshad M">M Farshad</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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