Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion Using the Fluoroscopy and Minimal Skin Incision

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant number of complications and catheter failures in CAPD are due to mechanical pro-blems and peritonitis. We describe our experience with CAPD with using fluoroscopy and a minimal incision technique to reduce complications. METHODS: We reviewed 57 CAPD patients at Dong-A University Medical Center from June 2004 to March 2005. All the procedures were standardized and performed by a single surgeon with using a flexible guide wire under aseptic fluoroscopic control through a minimal incision. Antibiotic treatment was done for three days after the surgery. RESULTS: The patients consisted of 30 males and 27 females. The common reasons for CAPD insertion were diabetic nephropathy (25 patients) and hypertension (9 patients). The mean operation time was 52.2+/-15.8 minutes. All the initial procedures were carried out under local anesthesia. Four of the patients needed their catheter repositioned during their postoperative course, which was done under local anesthesia in three cases and under spinal anesthesia in one case. Catheter malfunction occurred in 4 patients, and peritonitis developed in 8 patients (for wound related peritonitis in 1 patient and for catheter related peritonitis in 7 patients). CONCLUSION: Making a minimum incision and catheter insertion under fluoroscopic control for CAPD is a safe and highly effective method to reduce the incidence of catheter related complications. Furthermore, strict patient education is crucial for optimum catheter care, which is closely associated with development of peritonitis in CAPD patients.

Full sternotomy through minimal incision for cardiac surgery: A report of 38 cases / 中国微创外科杂志

Objective To summarize the clinical experience of 38 cases of cardiac surgery with full sternotomy through minimal skin incision.Methods A total of 38 cases of selective cardiac surgery were performed from June 2004 to December 2005.The operation was conducted under full sternotomy through a skin mini-incision.Results The operation was successfully completed in all the 38 cases.The total operation time was 175~359 min(mean,84 min),the drainage volume was 110~760 ml(median,380 ml),and the postoperatine hospital stay,7~32 d(mean,10 d).Postoperative short-term complications included 1 case of arrhythmia and 2 cases of pyrexia,all of which were cured.No thoracotomy for hemostasis was required.The incision healed by first intention without infection or separation.Follow-up examinations for 3~18 months(mean,9 months) in 38 cases showed significat improrement of symptoms.The left ventricular ejection fraction after operation was 0.45~0.73(mean,0.62).Conclusions Full sternotomy through minimal skin incision for cardiac surgery is safe and micro-traumatic.This procedure provides advantages of simplicity of performance,no need of special surgical instruments,and good cosmetic outcomes.

Minimal Skin Incision with Full Sternotomy for Congenital Heart Surgery / 대한흉부외과학회지

BACKGROUND: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. MATERIAL AND METHOD: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. RESULT: The proportion of the skin incision length to the sternal length was 63.1+/-3.9%(5.2~11cm, mean 7.3cm) in children, and 55.0+/-3.5%(10~13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. CONCLUSION: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.