[Double-channel expansion of the subcutaneous lower abdominal tunnel for sequential inguinal lymph node dissection in penile cancer - Report of six cases].

OBJECTIVE: To investigate the safety and efficacy of the two-channel dilatation procedure for subcutaneous tunneling in the lower abdomen during pelvic lymph node dissection for penile cancer. METHODS: A retrospective analysis was conducted on the clinical data of 6 patients treated from January 2020 to December 2022 using the dual-channel expansion technique for penile cancer lymph node dissection. RESULTS: All 6 cases ( 12 sides) successfully underwent prophylactic inguinal lymph node dissection. The average laparoscopic dissection time was ( 82.50 ± 12.08) minutes per side, with an average blood loss of （28.33 ± 10.95） ml. The number of lymph nodes dissected was （11.16 ± 1.02） for the superficial group and ( 0.67 ± 0.74 ) for the deep group. Postoperative pathology was negative in all cases. The average postoperative hospital stay was （7.33 ± 1.60 ） days, with a catheter removal time of （12.00 ± 2.06）days. Postoperative complications included abnormal skin sensations in 5 sides, lower limb edema in 3 sides, lymphedema in 3 sides, and cellulitis in 1 side. During a follow-up period of （20.60 ± 12.51）months, there were no instances of tumor recurrence or metastasis in the inguinal region among the patients. CONCLUSION: The dual-channel expansion technique for inguinal lymph node dissection via a subcutaneous tunnel is a safe and feasible treatment for penile cancer. It has a low complication rate, allows for thorough dissection of inguinal lymph nodes, and offers advantages in terms of surgical time.

Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization.

BACKGROUND: Femorally inserted central catheters are increasingly used, especially after the COVID-19 pandemic, also thanks to widespread of tunneling techniques that allow the exit site to be moved away from the groin. METHODS: In this retrospective observational study, femorally inserted catheters, with exit site at mid-thigh and the tip in Inferior vena cava or in Inferior vena cava at the junction with right atrium, have been observed and complications have been analyzed. All catheters were inserted by trained Nurses of a tertiary hospital Vascular Access Team. RESULTS: In 142 catheters (126 inserted via common femoral vein and 16 inserted via superficial femoral vein) and 3060 catheter days, we observed an infection rate of 1.3 events/1000 catheter days (all of them in oncologic patients and up to 30 days of catheterization), 2 cases of thrombotic events (1.41%) and 17 cases of accidental removal (11.97%). Other rare complications, as primary malposition, tip migration, arterial pseudoaneurysm, have been recorded. The average length of catheters inserted, from the exit site to the tip, was 47.6 ± 2.4 cm. CONCLUSION: The attention to the correct position of the tip, the exit site at mid-thigh and the new techniques during insertion make these femoral catheters as safe as other central vascular access devices. For this kind of central access device, a catheter at least 50 cm long is needed.

Long Tunneled External Ventricular Drains with Shunt Valves: A Technical Note.

BACKGROUND: External ventricular drain (EVD) is a basic operation in neurosurgery. Due to the limitation of its safe duration, some patients need to receive multiple drainage operations. We describe the long tunneled EVD (LTEVD) with shunt valves that effectively avoid multiple operations as a technical note. METHODS: The difference is that the middle part of the drainage tube is connected by an externalized shunt valve. The drainage tube is buried under the skin and the outlet is in the abdomen. The technique and more details are described. RESULTS: The connection between the LTEVD and the shunt valve is simple and the required materials are easily accessible. Externalized valves allow the cerebrospinal fluid to be visualized and more controllable, making it easier for physicians to manage the cerebrospinal fluid. No drainage tube failure or secondary infection was observed. The indwelling time of the drainage tube was greatly extended. CONCLUSIONS: LTEVD is effective and simple. It allows visual control of drainage flow, prolonging catheter indwelling time and eliminating the need for multiple surgeries.

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit.

OBJECTIVE: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). METHODS: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018-2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. RESULTS: Placement of ST-FICCs were successful in 100% of neonates (n = 82/82) with 94% to the right (n = 77/82) and 6% to the left common femoral veins (n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr (n = 80/82), 2.6Fr (n = 1/82), and 3-Fr (n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) (n = 33/82), IVC/right atrial junction (n = 31/82), or right atrium (n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins (n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. CONCLUSION: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

The "Arm-to-Chest Tunneling" technique: A modified technique for arm placement of implantable ports or central catheters.

PURPOSE: Central venous catheters or "venous access devices" include totally implantable venous access devices or "ports," peripherally inserted central catheters, and tunneled lines. Venous access devices are now the standard of care in patients requiring long-term intravenous drug administration. Arm venous access device placement is a valuable option for vascular access yet often complicated or rendered practically impossible by the condition and size of peripheral veins. We describe a modification of the arm venous access device implantation technique that we use in our department in order to offer this option to our patients, regardless of their peripheral veins condition. METHODS: After ultrasound guided venous access of a suitable neck vein, we create a port pouch-in case of a totally implantable vascular access device-or a skin nick-in case of a venous access device-in the inner aspect of the mid-arm. Using a straight metal tunneler, we tunnel the line from the neck to the arm in two stages, externalizing and re-inserting the line into a skin nick made on the deltopectoral groove. We call this technique "Arm-to-Chest Tunneling" and use it to place venous access devices in the arm using a neck venous access. RESULTS: The Arm-to-Chest Tunneling technique allows us to use larger arm venous access device catheters irrespective of the arm veins condition. Thus, this technique has the advantages of arm venous access device placement, with the added benefit of saving the arm veins. CONCLUSION: The "Arm-to-Chest Tunneling" method offers the alternative to place a venous access device in a more discreet site in the arm, even in cases in which arm veins are inadequate.

Clinical application of located subcutaneous jugular vein inserted central catheter in cancer patients / 中华护理杂志

Objective To explore the clinical application of located subcutaneous jugular vein inserted central catheter (LSJICC) in patients with malignant tumors. Methods The patients with malignant tumors treated in our hospital from January 2013 to December 2016 were enrolled and divided into the experimental group and the con-trol group according to the order of catheterization. Two groups were catheterized with LSJICC and PICC,respective-ly. Indwelling time of the catheter and incidence of complications were compared between two groups. The Kaplan-Meier survival curve was used to reflect the occurrence of CRBSIs in both groups,and the log-rank test was used to compare the results. The pathogenicity distribution of CRBSIs was analyzed and multivariate Cox regression analysis was performed. Results A total of 450 patients were enrolled in this study,including 228 patients in the experimental group and 222 patients in the control group. The average indwelling time of the catheter in the ex-perimental group(212.24 ± 79.80) was significantly longer than that in the control group(79.73 ± 34.86). The in-cidence of complications in the experimental group was significantly lower than that in the control group. The CRBSIs Kaplan-Meier survival curve of the experimental group was significantly better than that of the control group(P<0.01). The top three pathogens of CRBSIs were staphylococcus aureus,candida and klebsiella pneumoniae. Multivariate Cox regression analysis of CRBSIs showed that the site of catheter placement,the method of catheter placement and the type of tumor were independent risk factors for infection. Conclusion The incidence of compli-cations are significantly reduced with LSJICC,and indwelling time of the catheter is significantly prolonged,which is more in line with the actual needs of cancer patients undergoing chemotherapy.

Clinical application of independently designed subcutaneous tunnel in endoscopic thyroid operation / 重庆医学

Objective To investigate the clinical application effect of independently designed subcutaneous tunnel in endo‐scopic thyroid operation .Methods A total of 480 cases of endoscopic thyroid operation were completed in our department from February 2005 to December 2014 ,in which 315 cases adopted the independently designed subcutaneous tunnel for separating the subcutaneous tissues in anterior thoracic region and the other 165 cases used the puncture stick for separating and constructing the subcutaneous tunnel .Results Using independently designed subcutaneous tunnel for constructing the subcutaneous tunnel in the anterior thoracic region had statistical difference in the operative time and intraoperative bleeding amount compared with the punc‐ture stick(P<0 .05) ,and the difference of postoperative complications between the two groups was statistically signifficant (P<0 .05) .Conclusion Adopting the independently designed subcutaneous tunnel for constructing subcutaneous tunnel has the advan‐tages of short time consuming ,less bleeding and fewer complications .The level and size of the constructed subcutaneous tunnel are easy to grasp ,so which is more convenient for endoscopic thyroid operation .

Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts.

AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions. This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining. METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between 2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized, leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate. RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible. The defects were repaired completely, and the evaluations showed satisfactory function and appearance. CONCLUSION: This technique is an improved single-stage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.

Laparoscopic hepaticoplasty using gallbladder as a subcutaneous tunnel for hepatolithiasis.

AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis. METHODS: From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed. RESULTS: All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up. CONCLUSION: Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.

How do I do it? Passing a Pedicled Flap Through a Subcutaneous Tunnel.

Latissimus dorsi myocutaneous flaps are used to cover body structures or replace tissue that has been lost due to trauma, infection, or surgical excision for tumor. Transfer of these flaps from donor to recipient site is a vital step of surgery as forceful passage of flap may cause damage to blood supply of flap or devitalize the tissue by excessive shearing force. Use of polyvinyl chloride bag for transfer of latissimus dorsi flap through subcutaneous tunnel has been found to be very effective in dealing with this problem.

External Ventricular Drainage System with Long Subcutaneous Tunnel

OBJECTIVE: The goal of this study is to introduce a new method of external ventricular drainage system to reduce the complications of infections by making a long subcutaneous tunnel. METHODS: Between January 2002 and March 2003, 59 cases of ventriculostomy including 44 cases of short subcutaneous tunnel and 15 cases of long subcutaneous tunnel were performed and analysed. Subarachnoid hemorrhage and intraventricular hemorrhage were major indications for ventriculostomy. RESULTS: No infection was noted in the group of 15 patients with long subcutaneous tunnel. Whereas, 6 cases(13.6%) of infection was diagnosed in the group of 44 patients with short subcutaneous tunnel. The ventriculostomy was kept maximally for 11(mean 7.4)days without infection in the patients with long subcutaneous tunnel. CONCLUSION: To reduce the infection as a complication of ventriculostomy, we devise a new drainage system that involves the long subcutaneous tunnel.

Subcutaneous Tunnel and Hepatocholangioplasty Using the Gallbladder for Hepatolithiasis / 中国微创外科杂志

Objective To assess the efficacy of subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) in the treatment of hepatolithiasis. Methods A retrospective analysis was done on 43 patients with hepatolithiasis who underwent STHG between June 2001 and May 2008. The strictured bile duct at the hilus was opened after removing the stones or cutting the damaged liver segments. The gallbladder was anastomosed to the widely opened bile duct in the hilus to form a widened pass way through the intrahepatic to the extrahepatic ducts. And the fundus of the gallbladder was mobilized and pulled to the abdominal wall to form a subcutaneous tunnel as a re-entry to the biliary tree. Results Totally 18 patients (41.9%) underwent resection of the liver,17 patients (39.5%) had residual stones. The rate of residual stone was 27.8% (5/18) in those treated by STHG combined with hepatectomy,and 48.0% (12/25) in those received STHG only. One patient developed biliary leakage and 1 patient had fungous infection after the operation. The 43 patients were followed up for a mean of 27.6 months (range,1-83). During the period,3 patients had recurrence of cholangitis and hepatolithiasis,1 showed cholangitis,and 1 had recurrent stones. The recurrent cases were cured by drainage or removing the stones through the subcutaneous tunnel. Conclusion STHG is safe,effective,minimally invasive and easy to manipulate for the treatment of hepatolithiasis.