Reduction in incidence of glove perforation during laparotomy wound closure by 'no touch' technique.

Intact surgical gloves provide an efficient barrier against the HIV and Hepatitis B viruses but glove perforations are common, particularly during mass closure of laparotomy wounds. Attempts to develop gloves immune to perforation have failed. A series of 100 consecutive laparotomy wounds were randomised to mass closure by either the 'hand in' technique currently favoured by many surgeons, or a 'no touch' technique manipulating the wound edges with instruments only. The two groups were similar with regard to grade of surgeon and assistant, proportion of routine and emergency cases, and proportion of clean or dirty cases. The wound lengths in each group were similar, and the time taken to close the abdominal wall was similar in both groups. Although a similar number of perforated gloves occurred in each group while the operative procedure was being performed ('hand in', 9 of 50 vs 'no touch', 12 of 50; P = 0.62); a significantly reduced number of glove perforations occurred in the 'no touch' group during wound closure ('hand in', 16 of 50 vs 'no touch', 3 of 50, P = 0.0017). No touch closure of the abdominal wall may provide protection to surgeons against blood-borne viruses such as HIV and hepatitis B.

The effect of pancreatic warm ischemia on islet isolation in rats and dogs.

Warm ischemia (WI) has been shown to be detrimental to organ function following transplantation. We investigated the effect of increasing warm ischemic time (WIT) on islet isolation in rats and dogs. Rat isolations were performed by collagenase digestion and Ficoll purification after increasing periods of WI. Dog isolations were performed after similarly increasing periods of WI by ductal perfusion with collagenase, counts being performed on unpurified tissue. Viability studies were performed on isolated purified rat islets by in vitro perifusion. Islet counts decreased as WIT increased such that after 45 min WI islet counts were only 45.7% of those at 0 WIT (P less than 0.001) in rats and 52.5% in dogs (P less than 0.002). Islet volumes decreased to 47.0% in rats (P less than 0.001) in rats and 52.5% in dogs (P less than 0.002). period. After 90 min WIT islet counts were down to 15.6% (P less than 0.001) in rats and 23.9% in dogs (P less than 0.001) and volumes were down to 16.0% (P less than 0.001) in rats and 10.9% (P less than 0.001) in dogs. The increased release of insulin in response to dextrose stimulation was abolished after only 30 min WIT as assessed by perifusion. This work suggests that if successful islet isolation is to be performed for clinical transplantation, WI during donor pancreatectomy must be minimized, or techniques must be developed to prevent or reverse the ensuing effects.