Correspondence Quantitative measure of small vessel anastomotic contour using corrosion resin cast models
Laser-assisted laparoscopic excision of liver cyst Sir
Sir
I read with interest the article by Messrs John, Hornick, Rees and Edmondson ( B r JSurg 1991; 78: 1384-5). The necessity for technical precision in vascular anastomosis is of vital importance and the principal of anastomotic casts as an aid to surgical training is obviously desirable. There are, however, some aspects of the described methodology that might limit its usefulness. I have attempted similar studies using epoxy resins, which I found very difficult to handle. Fortunately I discovered a cheap, ‘user-friendly’ alternative. Dow Corning make a white bath and kitchen seal (silicone rubber) ideal for the purpose. It is sold in syringe-like containers, cures relatively quickly, gives off no heat and is not compromised by moisture. It is possible to pressurize the cast using a small volume ( 17 pnol/l, alkaline phosphatase > 199 units/l, alanine transaminase >40 units/l) or a CBD > 7 mm in diameter on ultrasonography. Five of the 22 cases undergoing IVC had evidence of CBD stones and therefore proceeded to ERCP. Stones were identified and cleared in two patients, while three others were found to have clear duct systems with evidence that stones had recently passed. The remaining 17 cases had normal ducts on IVC and have therefore been able to avoid unnecessary ERCP. None of the patients has developed clinical features of retained CBD stones after a median follow-up of 5 months. We are pleased with the quality of IVC and, as yet, have recorded no adverse reactions apart from one patient who reported nausea on infusion of contrast. On the basis of these early results, we intend to continue with our policy of using selective preoperative IVC in preference to operative cholangiography. Further follow-up and repeated auditing of our results will be required before the long-term effects of this policy become known.
B. R. Tulloh D. C. R. A d a m S. Haynes K. R. Poskitt Department of Surgery Cheltenham General Hospital Cheltenham GL53 7 A N UK
T. J. Egan P. V. Delaney Limerick Regional Hospital Limerick Ireland
1.
Huddy SPJ, Southam J. Is intravenous cholangiography an alternative to the routine per-operative cholangiogram? Postgrad Med J 1989; 65: 896-9.
Br. J. Surg., Vol. 79, No. 6, June 1992
Laser-assisted laparoscopic excision of liver cyst Sir
Sir
I read with interest the article by Messrs John, Hornick, Rees and Edmondson ( B r JSurg 1991; 78: 1384-5). The necessity for technical precision in vascular anastomosis is of vital importance and the principal of anastomotic casts as an aid to surgical training is obviously desirable. There are, however, some aspects of the described methodology that might limit its usefulness. I have attempted similar studies using epoxy resins, which I found very difficult to handle. Fortunately I discovered a cheap, ‘user-friendly’ alternative. Dow Corning make a white bath and kitchen seal (silicone rubber) ideal for the purpose. It is sold in syringe-like containers, cures relatively quickly, gives off no heat and is not compromised by moisture. It is possible to pressurize the cast using a small volume ( 17 pnol/l, alkaline phosphatase > 199 units/l, alanine transaminase >40 units/l) or a CBD > 7 mm in diameter on ultrasonography. Five of the 22 cases undergoing IVC had evidence of CBD stones and therefore proceeded to ERCP. Stones were identified and cleared in two patients, while three others were found to have clear duct systems with evidence that stones had recently passed. The remaining 17 cases had normal ducts on IVC and have therefore been able to avoid unnecessary ERCP. None of the patients has developed clinical features of retained CBD stones after a median follow-up of 5 months. We are pleased with the quality of IVC and, as yet, have recorded no adverse reactions apart from one patient who reported nausea on infusion of contrast. On the basis of these early results, we intend to continue with our policy of using selective preoperative IVC in preference to operative cholangiography. Further follow-up and repeated auditing of our results will be required before the long-term effects of this policy become known.
B. R. Tulloh D. C. R. A d a m S. Haynes K. R. Poskitt Department of Surgery Cheltenham General Hospital Cheltenham GL53 7 A N UK
T. J. Egan P. V. Delaney Limerick Regional Hospital Limerick Ireland
1.
Huddy SPJ, Southam J. Is intravenous cholangiography an alternative to the routine per-operative cholangiogram? Postgrad Med J 1989; 65: 896-9.
Br. J. Surg., Vol. 79, No. 6, June 1992
