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Blunt Dissection (blunt + dissection)
Selected AbstractsIntraoral Extraction of Cheek Skin CystDERMATOLOGIC SURGERY, Issue 12 2005Richard Bennett MD Background. When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. Objective. To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. Method. An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. Result. The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. Conclusion. A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin. RICHARD BENNETT, MD, MUBA TAHER, MD, AND JUSTINE YUN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] The use of water-jet dissection in open and laparoscopic liver resectionHPB, Issue 4 2008H. G. RAU Abstract Background. We intend to give an overview of our experiences with the implementation of a new dissection technique in open and laparoscopic surgery. Methods. Our database comprises a total of 950 patients who underwent liver resection. Three hundred and fifty of them were performed exceptionally with the water-jet dissector. Forty-one laparoscopic partial liver resections were accomplished. Results. Using the water-jet dissection technique it was possible to reduce the blood loss, the Pringle- and resection time in comparison to CUSAź and blunt dissection. In the last five years we could reduce the Pringle-rate from 48 to 6% and the last 110 liver resections were performed without any Pringle's manoeuvre. At the same time, the transfusion-rate decreased from 1.86 to 0.46 EC/patient. In oncological resections, the used dissection technique had no influence on long-time survival. Conclusions. The water-jet dissection technique is fast, feasible, oncologically safe and can be used in open and in laparoscopic liver surgery. [source] Accidental displacement of a mandibular third molar crown into the parapharyngeal space during extractionORAL SURGERY, Issue 2 2008K. Kamburo Abstract An unusual accidental displacement of a mandibular third molar crown into the parapharayngeal space in an adult female patient is reported. In combination with clinical examination, conventional and advanced radiographic techniques were utilised in order to locate the crown for retrieval surgery. Under general anaesthesia, an incision starting from buccal sulcus towards distobuccal angle of the second molar at gingival margin was extended to the coronoid process. The dislodged crown was found by means of blunt dissection and grasped with a pair of artery forceps and removed. [source] Flexible Endoscopic Clip-Assisted Zenker's Diverticulotomy: The First Case Series (With Videos),THE LARYNGOSCOPE, Issue 7 2008Shou-jiang Tang MD Abstract Background: In treating Zenker's diverticulum (ZD), there are potential risks associated with performing flexible endoscopic diverticulotomy without suturing or stapling. We recently introduced flexible endoscopic clip-assisted diverticulotomy (ECD) in treating ZD by securing the septum prior to dissection. Objective: To evaluate the feasibility and safety of ECD for complete septum dissection. Study Design: Case series at an academic center. Seven consecutive patients (mean age 71 y; range 48,91 y) with symptomatic ZD of various craniocaudal sizes based on radiographic measurements (mean 2.6 cm; range 0.8 cm,4.5 cm) were included. The mean depth of the septum was 1.73 cm (range 0.3 cm,3.1 cm). The mean duration of symptoms was 4.8 years (range 0.5,10 y). Methods: After endoclips were placed on either side of the cricopharyngeal bar, the septum was dissected between these two clips down to the inferior end of the diverticulum with a needle-knife. Procedures including "one-step ECD" (n = 1), "stepwise ECD" (n = 3), and "bottom ECD" (n = 2) were performed based on the septum depth of the ZD during endoscopy. ECD was not performed on one patient due to severe mucosal fragility of the esophageal inlet. Iatrogenic blunt dissection of the septum by the endoscopic hood occurred secondary to patient retching during the procedure. Main outcome measurements were symptom resolution and complications. Results: All patients (n = 6) who underwent ECD had complete resolution of esophageal symptoms at a minimum 6-month follow-up. There were no procedural complications. The patient who did not undergo ECD developed an esophageal perforation. She was managed conservatively without surgical intervention. On follow-up, her dysphagia was completely resolved. Conclusions: ECD is feasible, safe, and effective for complete septum dissection. ECD and endoscopic stapler-assisted diverticulotomy are complimentary rather than competing strategies in approaching ZD. Study limitations include the case series design and limited follow-up period. [source] Local recurrence following surgical treatment for carcinoma of the lower rectumANZ JOURNAL OF SURGERY, Issue 9 2004Adrian L. Polglase Background: The present paper examines the local recurrence rate following surgical treatment for carcinoma of the lower rectum with principally blunt dissection directed at tumour-specific mesorectal excision (including total mesorectal excision when appropriate). Methods: During the period April 1987,December 1999, 123 consecutive resections for carcinoma of the middle and distal thirds of the rectum were performed. The patients had low anterior resection, ultra low anterior resection or abdomino-perineal resection. Ninety-six eligible patients underwent curative resection. The mean follow-up period was 66.8 months ±44.3 (range 3,176 months). Data were available on all patients having been prospectively registered and retrospectively collated and computer coded. Results: The overall rate of local recurrence was 5.2% (four recurrences following ultra low anterior resection and one following abdomino-perineal resection. No local recurrence occurred after low anterior resections.). Local recurrences occurred between 16 and 52 months from the time of resection, and the cumulative risk of developing local recurrence at 5 years for all patients was 7.6%. The overall 5-year cancer specific survival of the 96 patients was 80.8%, and the overall probability of being disease free at 5 years, including both local and distal recurrence, was 71.8%. Conclusion: The results of the present series confirm the safety of careful blunt techniques combined with sharp dissection for rectal mobilization along fascial planes resulting in extraction of an oncologic package with tumour-specific mesorectal excision (or total mesorectal excision when appropriate). [source] | ||||||||||