Conventional versus endoscopic free gracilis muscle harvest

Compared with conventional techniques, the endoscopically assisted harvest of free tissue has advantages such as minimal interference with cosmesis and reduced donor-site morbidity. However, the procedure also requires training and has an extensive learning period. In this series of 22 patients, the initial gracilis muscle flaps were harvested using a conventional method; the subsequent flaps were harvested with the aid of endoscopic instrumentation. Endoscopically assisted gracilis muscle harvest in 16 patients was compared with open method harvest in six patients. The endoscopically assisted group had an average incision length of 6.5 cm; that of the conventional group was 15.5 cm. There was one reexploration in the endoscopically assisted group, but all flaps were transferred successfully. Using this minimally invasive technique of vascular and muscular dissection, assisted by endoscopic instruments designed for distal muscle dissection and transection, the gracilis muscles can be harvested within 40 minutes. We consider endoscopically assisted harvest of free gracilis muscle to be safe, relatively simple, and cost-effective.     

Minimally invasive surgery. Neurosurgery.

The introduction of minimally invasive techniques has greatly improved results for intracranial neurosurgery. Stereotaxy and improved imaging techniques have reduced surgical trauma by allowing surgeons to plan the least damaging route to operative sites and by increasing surgical precision. Stereotaxy has also allowed brain biopsies to be taken from sites such as the brain stem, which were rarely sampled before because free hand biopsy was so dangerous. Brain tumours can now be treated by interstitial radiotherapy--stereotactic insertion of catheters into the lesion for loading of radioactive iodine--or radiosurgery--focusing of intense beams of radiation on lesions without needing surgical incisions. Endoscopic neurosurgery can be used to reach cavities such as the ventricular system or cystic tumours. With interventional neuroradiology fine catheters can be introduced into most vessels in the cranium for embolisation or dilatation. The development of augmentative functional neurosurgery means that movement disorders, epilepsy, and intractable pain can be treated with implanted neurostimulating electrodes. Future developments will probably include frameless stereotaxy, when the rigid attachment of stereotactic apparatus to the patient''s head can be dispensed with, and at least partial automation of procedures such brain biopsy.     

Minimally invasive surgery. Future developments.

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.     

Flow-induced dilation of the dog gracilis muscle artery

The external diameter of the artery (1.08 +/- 0.04 mm) predominantly supplying the gracilis muscle was monitored in situ in 12 dogs under thiopental anaesthesia using a contact inductive transformer. The blood flow in the artery could be controlled by an arteriovenous shunt. After a latency of 10.6 +/- 0.7 s, an increase of blood flow through the artery from 4.0 +/- 0.3 to 45.0 +/- 3.4 ml.min-1 induced an increase in its diameter by 44.9 +/- 3.6% of the resting value (p less than 0.001). When the blood flow-rate was reduced to the initial level, the artery constricted with a half-recovery time of 307.2 +/- 30.7 s. The amplitude and the time course of the arterial dilation were identical when the blood pressure at the site of diameter measurement decreased or remained unchanged. The dilation became maximal at blood flows corresponding to the peak of reactive hyperaemia in the gracilis muscle after 2 min arterial occlusion. It is being suggested that the blood flow-induced dilation ensures autostabilization of conduit artery function.     

Surgical anatomy of the gracilis muscle of the thigh

As demonstrates the investigation of 100 preparations, the main vascular-nervous "hilus" of the muscle is situated on the superior third of its lateral part. They contain the transversal branch of the medial artery, circumflexing the femoral bone with the accompanying vein, having the same name, and the anterior branch of the obturative nerve (92 preparations), or muscle branch of the femoral nerve (8 preparations). The muscle has a well developed network of intrasystemic and intersystemic anastomoses. Beginning from the first period of childhood, for sphincter plasticity either the whole muscle, or a graft, cut out from its lateral part, can be used.     

Bradykinin facilitates noradrenaline spillover during contraction in the canine gracilis muscle.

Noradrenaline spillover from skeletal muscle vascular areas increases during exercise but the underlying mechanisms are not well understood. Muscle contraction itself causes changes in many factors that could affect noradrenaline spillover. For instance, it has been reported that bradykinin is synthesized in skeletal muscle areas during contraction. Because the B2 bradykinin receptor facilitates noradrenaline spillover, it may be involved in the increase associated with contraction. In this experiment, we studied the effect of bradykinin on noradrenaline spillover in the in situ canine gracilis muscle, using the specific B2 antagonist HOE 140. The drug did not modify noradrenaline spillover at rest, but did cause a significant decrease during muscle contraction, from 558 to 181 pg min(-1). As reported previously in the literature, fractional extraction of noradrenaline decreased during muscle contraction. This effect was independent of HOE 140 treatment. In light of our results, it seems that bradykinin formation during muscle contraction may play an important part in the observed increase in noradrenaline spillover but does not affect fractional extraction.     

Minimally invasive surgery in the field of gynecologic oncology

The aim of this paper was to present the results in minimal invasive surgery in the field of gynecologic oncology at General hospital Zabok, Croatia. 381 laparoscopic procedures were performed between 1994 and 1998. There were 263 operations of the benign adnexal masses, and 107 operations due to benign tumors of corpus uteri (there were 18 LAVH, 12 LH and 77 TLH). There were 11 laparoscopic operations due to carcinoma (1 ovary, 6 corpus and 4 cervix). Operations were: 3 LAVH (laparoscopically assisted vaginal hysterectomy), 5 TLH (total laparoscopic hysterectomy) with pelvic lymphadenectomy, 1 LAVH with pelvic lymphadenectomy, 1 coelio Shauta operation with laparoscopic pelvic lymphadenectomy and paraaortal lymphadenectomy, and 1 laparoscopic adnexectomy. Among laparoscopic procedures in 370 patients operations were successfully performed as planed, while in 11 patients it was necessary to switch to laprotomy. Among serious complications of laparscopic operations it is necessary to note 2 lesions of the ureter and 1 lesion of the bladder. Laparoscopic lymphadenectomies were performed successfully; there were no serious early or late postoperative complications. There was no operative mortality. Even though many authors claim that laparoscopic operations in the field of gynecologic oncology are safe and have the same results as in open surgery, patients benefit from shorter recovery and better quality of life during laparoscopic procedures.     

Minimally invasive method for murine brain fixation

Complete brain fixation can be achieved with transthoracic cardiac infusion without thoracotomy. Light and electron microscopy tissue sections reveal preservation of cytoplasmic and nuclear structure at all magnification levels. Punched samples were obtained from the fixed tissue specimens in precisely localized areas for study using electron microscopy. This perfusion fixation technique provides both faster tissue harvesting capability and higher quality tissue preservation, without the artifacts of brain swelling and ventricular dilation observed in direct cardiac perfusion. Acute, discrete change in brain tissue can be studied.