G. Trombatore

Usefulness of microsurgery in the training of the general surgeon

It is a common opinion that general surgery is the first step for whoever approaches a surgical discipline, and that whoever practices training in general surgery should learn the rudiments of each surgical branch. The role of microsurgery in the training of the general surgeon has not been well‐established. Clinical applications of microsurgery in general surgery are few and are rarely required, and have been connected strictly to restricted indications. However, we think that microsurgery could be very useful to the general surgeon because it allows the execution of experimental research on rats, the only possibility permitted by law. In these studies the microsurgeon can perform many times and in a short time the same surgical operation, thus improving his skill, and easily getting familiarity with surgical instruments and sutures.

Pancreas Transplantation in the Rat Using Lee's Technique: A Reliable Model in Experimental Microsurgery

Numerous unresolved problems, both technical and immunological, in pancreas transplantation stimulate experimental studies. Dogs have been routinely used in experimental studies but today rats are more commonly used. However, pancreas transplantation in the rat presents complex technical problems and requires a good knowledge of microsurgical techniques. In 1983 Squifflet undertook an experimental study aimed at evaluating the technical aspects of pancreas transplantation in the rat and calculating the success rates using different methods. The comparison of four methods revealed to our surprise that 100% of the rats operated on using Lees technique had complications, with a 0% survival rate. In our study we report our experience using Lees technique which we had the opportunity of mastering directly under the supervision of Professor Lee. We performed 100 pancreas transplantations using Lees technique and divided our study in two phases. In the first phase we performed 70 pancreas transplantations and overall survival, after 1 week, was 42 rats (60%). In the second phase on 30 rats diabetes was induced by administering 70 mg/kg of streptozotocin. These 30 diabetic rats underwent pancreas transplantation and overall survival, after 1 week, was 25 (83.3%). We believe that our successful survival rates could probably be explained by the close collaboration between Lee and our department. Moreover, we noted the importance of constant training in obtaining better results, and in our opinion Lees technique of pancreas transplantation is a reliable experimental model which can be used to resolve problems linked to pancreas transplantation.

FEASIBILITY OF A PORTO-INTRACAVAL SHUNT FOR LIVER TOTAL VASCULAR EXCLUSION IN THE RABBIT: PRELIMINARY REPORT

The animals do not tolerate prolonged caval and/or portal clamping which induces negative pathophysiological events such as release of chinines, damage of the intestinal mucosa, and bacterial translocation. In human liver surgery, these problems have been solved by bio‐pump for veno‐venous bypass. In order to find a simple method to reproduce a veno‐venous bypass, we developed the porto‐intracaval shunt and used it in six adult rabbits. The shunt tested was a self constructed 7‐french polyurethane shunt modeled as an inverted Y. The inferior vena cava vein below the diaphragm and below the liver and the portal vein were gently dissected. The two longer branches of the shunt were inserted in the cava vein, while the remaining branch of the Y shunt was inserted in the portal vein. After clamping the hepatic artery, the liver was partially resected in three animals and after 60 min the shunt was removed. The insertion of the shunt was always easy and the animals tolerated well the procedure and the anhepatic phase. Our study has been performed in order to test especially the technical feasiblity of this shunt in an effort to reduce portal and caval stasis during the anhepatic phase of the surgical procedures that require caval and portal clamping. The technical feasibility has been obtained but we believe that the materials and dimensions of the shunt have to be perfected and adapted depending on the size of the cava and portal veins.

Microsurgery and varicocele : State of the art

Many surgical procedures have been proposed in the treatment of varicocele; however, the rate of recurrence and of postoperative complications, together with important correlation of this disease with male sterility, has played an important role in determining the success of microsurgery. In the present brief review, the indications for microsurgery and microsurgical dissection and/or anastomosis are described in comparison to traditional surgery.

Calibration of Papillotomy in the Surgical Treatment of Papillary Stenosis : the "Little Train"

Although laparoscopic and endoscopic surgery have brought about an indisputable revolution in biliary surgery, many surgeons still prefer open surgery for lithiasis of the common bile duct, and if it is associated with a papillary pathology, they perform a papillotomy. However, great controversy regarding the site, modalities, and extension of the papillary section has now developed among surgeons. Our technique is not original; however, we do propose a “calibration” of the papillotomy, carried out by constructing a “little train” made up of several consecutive Nélatons of increasing caliber to identify the sphincter fibers and to obtain sections proportionate to the size of the bile duct. Of the 115 patients in this series who were treated by open papillotomy, only 1 developed acute pancreatitis; 2 demonstrated bleeding, 1 of whom required surgical exploration.

Misplacement of a jugular line in a facial vein

We report an exceptional misplacement of a central venous catheter, from the right jugular vein where it was introduced, into the right thyro-lingual-facial trunk. A brief description of the clinical course and a literature review on catheter misplacement is presented. This case illustrates the importance of routine use of a chest X-ray, and when necessary contrast medium, to verify the correct location of the catheter tip.