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Papers by kevin skinner

Pelvic Surgery, 1997

To effectively evaluate adhesion prevention modalities, a consistent and reproducible animal mode... more To effectively evaluate adhesion prevention modalities, a consistent and reproducible animal model must be employed. We have developed a model for the formation of abdominal adhesions using a mechanical abrading device to limit variability between surgeons. This study was designed to evaluate surgeon differences in both the formation and evaluation of adhesions in a rat cecal abrasion model.

PubMed, 1997

Objective: To characterize Seprafilm bioresorbable membrane and assess its efficacy and safety in... more Objective: To characterize Seprafilm bioresorbable membrane and assess its efficacy and safety in reducing adhesions. Design: In vitro and animal studies designed to provide precise control of tissue trauma and closely approximate clinically relevant conditions in abdominal surgery. Setting: Experimental laboratories, USA. Subjects: Experimental animals, principally rats and rabbits. Interventions: The rat cecal abrasion or sidewall injury model evaluated the efficacy of seprafilm in the presence of blood and irrigation solutions, in multiple layers, under ischemic conditions, and in adhesion reformation. A rabbit anastomosis model tested the effect of the membrane on wound healing, and a series of challenge tests determined its toxicology, immunogenicity, and biocompatibility. Main outcome measures: Incidence and severity of adhesions; mutagenicity; pyrogenicity; irritation effects; systemic toxicity. Results: Seprafilm significantly reduced the number of cecal adhesions (p < 0.001) and the number of animals with severe adhesions (p < 0.001) when compared with nontreated controls, even in the presence of bleeding. The membrane also significantly decreased the number of animals with any adhesions (p < 0.001). Seprafilm maintains efficacy when used with excess irrigation solutions, when layered, and under ischemic conditions. Among rats tested for adhesion reformation, the treated group had a significantly larger proportion of adhesion-free animals than the untreated group, 72% versus 28%, (p = 0.007). Seprafilm did not impair wound healing in anastomosis and is nontoxic, nonmutagenic, nonimmunogenic, nonpyrogenic, nonirritating, and biocompatible. Conclusion: Preclinical studies have shown that Seprafilm is safe and effective in reducing postsurgical adhesions. Seprafilm meets the requirements of an ideal barrier and can be a useful adjuvant in abdominal and pelvic surgery.

Springer eBooks, 1997

A number of methods and agents to prevent postsurgical adhesions have been investigated in animal... more A number of methods and agents to prevent postsurgical adhesions have been investigated in animal surgery models and in human clinical studies. These methods include pharmacologic agents, such as fibrinolytics which disrupt early fibrin matrix formation [1, 2] viscous solutions, such as Dextran, and carboxymethylcellulose, which separate tissues after injury via hydroflotation [3, 4]; surgical tissue lubricants that reduce tissue damage during surgery [5]; and barrier membranes, which mechanically separate injured serosal surfaces until remesothelialization occurs [6, 7].

Acta Ophthalmologica Scandinavica, 2007

Purpose: To highlight a surgical technique using sodium hyaluronate and tissue glue in the repair... more Purpose: To highlight a surgical technique using sodium hyaluronate and tissue glue in the repair of corneal holes. Methods: Case Report Results: An 86 year old man was referred to clinic with a cataract. The other eye was normal after cataract surgery. When he was seen in clinic it was noted that actually he had a small hole in the cornea at the 5 o'clock position off axis. Visual acuity was 6/60. The iris was incarcerated and there was marked inflammation with posterior synechiae and cataract. The hole was felt too be small enough to attempt closure with tissue glue. To perform this a small "doughnut" of sodium hyaluronate was placed around the hole. A very important step was to ask the gentleman to look up so that the "doughnut"would not slide off. The glue was then carefully placed within the "doughnut". When felt to be dry a bandage lens was placed over the eye. The cataract was also removed at the same time. The cornea healed very quickly and within 10 days post op was half of normal thickness. The gentleman now has 6/18 vision and a quiet eye with normal AC and IOP. Conclusions: The use of tissue glue is widespread, it was first documented in use by midwives and then by medics in Vietnam. Their use in corneal perforations is also well documented. The problem however with their use is that the glue can tend to "stick" to everything and cause complications. This is a marked problem with use on cornea due to the wet nature of the eye. Here we highlight a method whereby sodium hyaluronate is used to create a "doughnut" to limit the spread of the glue and localise it to the area of need. What is also important to note is asking the patient to position their eye accordingly before placing the glue to achieve maximum effect as highlighted in other cases.

Hydrogels formed from natural or synthetic polymers find important applications in medical device... more Hydrogels formed from natural or synthetic polymers find important applications in medical devices and drug delivery. Early medical uses of hydrogels included soft contact lenses and wound dressings, with the latter exemplifying one form of tissue engineering, guided tissue regeneration, promoted by moist healing.(2) Subsequently, implantable hydrogel products were developed, including surgical sealants, tissue adhesives, hemostats, cell scaffolds and drug delivery systems.(1) Hydrogels induce beneficial tissue responses based on their physical and chemical properties. Because of their high water content, they are generally quite compatible with cells and may enter into specific or non-specific binding with cell receptors. Proteins and polysaccharides that form hydrogels contain ligands for specific binding to certain cells and form useful scaffolds for cell incorporation. Synthetic hydrogels generally do not support the anchorage that matrix-forming cells require, but encapsulate c...

Fertility and Sterility, 1996

Osteoarthritis and Cartilage, 2010

Clearance and biocompatibility studies were conducted on radiolabeled and unlabeled crosslinked h... more Clearance and biocompatibility studies were conducted on radiolabeled and unlabeled crosslinked hylastan gels, respectively. This study objective was to determine the temporal distribution and concentration of 14 C-labeled gel in rabbit hindlimbs following a single intra-articular injection. Biocompatibility testing of the unlabeled gel was conducted according to standard ISO 10993 methods to determine safety of the medical device. Methods: Hylastan gels were prepared by crosslinking high molecular weight HA at an initial polymer concentration of 5.25% using 0.035 Meq of unlabeled or 14 C-labeled divinyl sulfone. The gels were washed with acid and saline then swollen in phosphate buffered saline (pH 7.5) to a concentration of 9.1 mg/mL. In the clearance study, a total of 12 male New Zealand White rabbits, approximately three months of age with a body weight of 1.8 to 2.3 kg, were given a single intra-articular injection of 14 C-labeled gel (0.1 μCi/animal) into both hindlimbs. Two animals were euthanized at 1 hour and 7, 28, 56, 84 and 85 days post-dose. Following sacrifice, each carcass was deep frozen. The left hindlimbs were removed and solubilized in-toto and radioactivity determined by liquid scintillation spectroscopy. The right hindlimbs were removed and embedded in carboxymethylcellulose and frozen. Each block was sectioned serially at a 30 μm thickness and freeze-dried for quantification. Radioactivity distribution in tissues was determined by quantitative whole body autoradioluminography (QWBA). Biocompatibility testing with non-radiolabeled gel was performed in accordance with ISO 10993 guidelines for bone and tissue contacting medical devices. All the testing was conducted pursuant to GLP 21 CFR 58. All non-clinical animal studies were reviewed and approved by IACUC. Results: Following intra-articular administration of 14 C-labeled gel, any clinical signs observed throughout the study were considered to be incidental. The highest mean radioactivity concentration values were observed in the saccus (5218 μg eq/g) and the fat pad (798 μg eq/g) at 1 hour post-dose. Moderate levels of radioactivity were also seen in the lymph node (popliteal) at 7 days post-dose and meniscus (medial) at 1 hour post-dose. The mean limit of quantification for tissues analyzed by QWBA generally ranged from 21.6 to 27.3 μg eq/g with the exception of the 56 day timepoint where the mean limit of quantification was 1213 μg eq/g. The left hindlimb which included the bone marrow (femur and tibia), condyle of the femur (distal) and condyle of the tibia (proximal) and patella had concentration values that were below the limit of quantification at all timepoints. Although radioactivity could still be detected in images from animals up to the 56 day timepoint, radioactivity concentrations were below the limits of quantification for all tissues of interest by 28 days post-injection. The calculated half-life of the gel was 6.23 days. Overall, the mean content of radioactivity in the left hindlimbs was 99.6% at 1 hour post-injection, 45.9% at 7 days post-injection and below the limit of quantification for subsequent timepoints. Therefore, most of the radioactivity administered was eliminated by 28 days post-injection. The limit of quantification for the hindlimbs was approximately 8% of the administered dose. Biocompatibility testing showed the unlabeled hylastan gel to be noncytotoxic, non-sensitizing, non-mutagenic, slightly reactive (short and long term implantation), a negligible irritant (intradermal), non-toxic (acute systemic) and non-pyrogenic. Conclusions: Following a single intra-articular injection of 14 C-hylastan gel, the test material cleared from the joint space with a half-life of 6.23 days. There were no adverse events related to the administration of the gel. The battery of biocompatibility testing on the crosslinked hylastan gel showed that the material was safe.

The Journal of the American Association of Gynecologic Laparoscopists, 1994

A useful laparoscopic product for adhesion prevention must be easy to apply with minimal handling... more A useful laparoscopic product for adhesion prevention must be easy to apply with minimal handling and manipulation of tissue and product. With this objective in mind, we have developed an injectable gel (HALTM) based on hyaluronic acid that is intended to limit adhesion formation after laparoscopic and open surgical procedures. We tested the effectiveness of HALTM gels in a rat sidewall defect model. In 50 adult female rats a 1 cm x 1 cm peritoneal defect was made along the abdominal wall. The defect was enclosed with #3-0 silk suture to induce ischemia. The animals were randomized to gel treatment (0.5 ml placed on defect) or non-treatment control groups. Seven days after surgery the extent (0-4 scale) and severity (0-3 scale) of adhesions were scored. HALTM gel significantly reduced the extent and severity of sidewall adhesions. Moreover, the number of animals with no adhesions was significantly increased compared with non-treatment. These results indicate that HALTM gel, which is easily applied to tissue and organs, may be a useful adjuvant for adhesion prevention in open and laparoscopic surgical procedures. The effectiveness and safety of HALTM gels will be tested in human clinical studies.

The Journal of the American Association of Gynecologic Laparoscopists, 1998

from operation to pregnancy was shorter after laparoscopy (3.6 + 2.7 mo) than after laparotomy (5... more from operation to pregnancy was shorter after laparoscopy (3.6 + 2.7 mo) than after laparotomy (5.0 + 5.0 too, p = 0.2). Operating time was significantly longer for laparoscopy (201.9 + 33.8 min) than for laparotomy (148.7 + 32.5 rain, p <0.05), and mean hospital stay was significantly shorter (p <0.05). Conclusion. Given fertility outcomes, laparoscopic tubal anastomosis could be an effective alternative to conventional open microsurgical laparotomy in patients requesting reversal of sterilization.

Fertility and Sterility, 2005

contrast, the primordial follicles were well preserved using this cryopreservation protocol. The ... more contrast, the primordial follicles were well preserved using this cryopreservation protocol. The cryopreservation process appeared having no effect on the apoptosis of primordial or primary follicles in cryopreserved human ovarian tissues.

Surgical Laparoscopy …, 1996

Although decreased adhesion formation is one of the accepted advantages of laparoscopic colorecta... more Although decreased adhesion formation is one of the accepted advantages of laparoscopic colorectal surgery, no prospective studies have been done to support this claim. Therefore, we prospectively assessed adhesion formation following laparoscopic anterior resection of the rectum in a porcine model. Five domestic female pigs underwent the procedure with a double-stapled intracorporeal anastomosis. After completion of the laparoscopic procedure, 50 cm of ileum was retrieved through the right lower port site. Controlled serosal abrasion of the antimesenteric surface was performed using a fresh knife. The abraded loop was returned into the peritoneal cavity and the fascia closed at all port sites. All animals underwent a midline laparotomy 3 weeks later to assess adhesions using a 0-3 score according to the density vascularity, and extent of adhesions. All animals survived the study period. The mean level of the anastomosis was 8 cm (range, 7-10) above the anal verge; all anastomoses were intact and completely healed. None of the animals had adhesions to the port sites. The anastomotic site was completely free of adhesions in four animals, and only one animal (20%) had grade 1 adhesions between the urine horns and the anastomosis. Conversely, all animals had adhesions of the abraded loop involving 60 cm (range, 40-75) of bowel and 7 cm (range, 4-9) of the abdominal wall (remote to the port sites); no other adhesions were noted. In this pilot study, serosal abrasion of the small bowel resulted in severe adhesion formation in the porcine model. However, laparoscopic anterior resection of the rectum in the same animals was associated with only minimal insignificant adhesions. Furthermore, unlike in laparotomy incisions, adhesions to port sites did not occur.

Journal of Surgical Research, 1995

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International journal of sociology of the family, 1998

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Pelvic Surgery, 1997

To effectively evaluate adhesion prevention modalities, a consistent and reproducible animal mode... more To effectively evaluate adhesion prevention modalities, a consistent and reproducible animal model must be employed. We have developed a model for the formation of abdominal adhesions using a mechanical abrading device to limit variability between surgeons. This study was designed to evaluate surgeon differences in both the formation and evaluation of adhesions in a rat cecal abrasion model.

PubMed, 1997

Objective: To characterize Seprafilm bioresorbable membrane and assess its efficacy and safety in... more Objective: To characterize Seprafilm bioresorbable membrane and assess its efficacy and safety in reducing adhesions. Design: In vitro and animal studies designed to provide precise control of tissue trauma and closely approximate clinically relevant conditions in abdominal surgery. Setting: Experimental laboratories, USA. Subjects: Experimental animals, principally rats and rabbits. Interventions: The rat cecal abrasion or sidewall injury model evaluated the efficacy of seprafilm in the presence of blood and irrigation solutions, in multiple layers, under ischemic conditions, and in adhesion reformation. A rabbit anastomosis model tested the effect of the membrane on wound healing, and a series of challenge tests determined its toxicology, immunogenicity, and biocompatibility. Main outcome measures: Incidence and severity of adhesions; mutagenicity; pyrogenicity; irritation effects; systemic toxicity. Results: Seprafilm significantly reduced the number of cecal adhesions (p < 0.001) and the number of animals with severe adhesions (p < 0.001) when compared with nontreated controls, even in the presence of bleeding. The membrane also significantly decreased the number of animals with any adhesions (p < 0.001). Seprafilm maintains efficacy when used with excess irrigation solutions, when layered, and under ischemic conditions. Among rats tested for adhesion reformation, the treated group had a significantly larger proportion of adhesion-free animals than the untreated group, 72% versus 28%, (p = 0.007). Seprafilm did not impair wound healing in anastomosis and is nontoxic, nonmutagenic, nonimmunogenic, nonpyrogenic, nonirritating, and biocompatible. Conclusion: Preclinical studies have shown that Seprafilm is safe and effective in reducing postsurgical adhesions. Seprafilm meets the requirements of an ideal barrier and can be a useful adjuvant in abdominal and pelvic surgery.

Springer eBooks, 1997

A number of methods and agents to prevent postsurgical adhesions have been investigated in animal... more A number of methods and agents to prevent postsurgical adhesions have been investigated in animal surgery models and in human clinical studies. These methods include pharmacologic agents, such as fibrinolytics which disrupt early fibrin matrix formation [1, 2] viscous solutions, such as Dextran, and carboxymethylcellulose, which separate tissues after injury via hydroflotation [3, 4]; surgical tissue lubricants that reduce tissue damage during surgery [5]; and barrier membranes, which mechanically separate injured serosal surfaces until remesothelialization occurs [6, 7].

Acta Ophthalmologica Scandinavica, 2007

Purpose: To highlight a surgical technique using sodium hyaluronate and tissue glue in the repair... more Purpose: To highlight a surgical technique using sodium hyaluronate and tissue glue in the repair of corneal holes. Methods: Case Report Results: An 86 year old man was referred to clinic with a cataract. The other eye was normal after cataract surgery. When he was seen in clinic it was noted that actually he had a small hole in the cornea at the 5 o'clock position off axis. Visual acuity was 6/60. The iris was incarcerated and there was marked inflammation with posterior synechiae and cataract. The hole was felt too be small enough to attempt closure with tissue glue. To perform this a small "doughnut" of sodium hyaluronate was placed around the hole. A very important step was to ask the gentleman to look up so that the "doughnut"would not slide off. The glue was then carefully placed within the "doughnut". When felt to be dry a bandage lens was placed over the eye. The cataract was also removed at the same time. The cornea healed very quickly and within 10 days post op was half of normal thickness. The gentleman now has 6/18 vision and a quiet eye with normal AC and IOP. Conclusions: The use of tissue glue is widespread, it was first documented in use by midwives and then by medics in Vietnam. Their use in corneal perforations is also well documented. The problem however with their use is that the glue can tend to "stick" to everything and cause complications. This is a marked problem with use on cornea due to the wet nature of the eye. Here we highlight a method whereby sodium hyaluronate is used to create a "doughnut" to limit the spread of the glue and localise it to the area of need. What is also important to note is asking the patient to position their eye accordingly before placing the glue to achieve maximum effect as highlighted in other cases.

Hydrogels formed from natural or synthetic polymers find important applications in medical device... more Hydrogels formed from natural or synthetic polymers find important applications in medical devices and drug delivery. Early medical uses of hydrogels included soft contact lenses and wound dressings, with the latter exemplifying one form of tissue engineering, guided tissue regeneration, promoted by moist healing.(2) Subsequently, implantable hydrogel products were developed, including surgical sealants, tissue adhesives, hemostats, cell scaffolds and drug delivery systems.(1) Hydrogels induce beneficial tissue responses based on their physical and chemical properties. Because of their high water content, they are generally quite compatible with cells and may enter into specific or non-specific binding with cell receptors. Proteins and polysaccharides that form hydrogels contain ligands for specific binding to certain cells and form useful scaffolds for cell incorporation. Synthetic hydrogels generally do not support the anchorage that matrix-forming cells require, but encapsulate c...

Fertility and Sterility, 1996

Osteoarthritis and Cartilage, 2010

Clearance and biocompatibility studies were conducted on radiolabeled and unlabeled crosslinked h... more Clearance and biocompatibility studies were conducted on radiolabeled and unlabeled crosslinked hylastan gels, respectively. This study objective was to determine the temporal distribution and concentration of 14 C-labeled gel in rabbit hindlimbs following a single intra-articular injection. Biocompatibility testing of the unlabeled gel was conducted according to standard ISO 10993 methods to determine safety of the medical device. Methods: Hylastan gels were prepared by crosslinking high molecular weight HA at an initial polymer concentration of 5.25% using 0.035 Meq of unlabeled or 14 C-labeled divinyl sulfone. The gels were washed with acid and saline then swollen in phosphate buffered saline (pH 7.5) to a concentration of 9.1 mg/mL. In the clearance study, a total of 12 male New Zealand White rabbits, approximately three months of age with a body weight of 1.8 to 2.3 kg, were given a single intra-articular injection of 14 C-labeled gel (0.1 μCi/animal) into both hindlimbs. Two animals were euthanized at 1 hour and 7, 28, 56, 84 and 85 days post-dose. Following sacrifice, each carcass was deep frozen. The left hindlimbs were removed and solubilized in-toto and radioactivity determined by liquid scintillation spectroscopy. The right hindlimbs were removed and embedded in carboxymethylcellulose and frozen. Each block was sectioned serially at a 30 μm thickness and freeze-dried for quantification. Radioactivity distribution in tissues was determined by quantitative whole body autoradioluminography (QWBA). Biocompatibility testing with non-radiolabeled gel was performed in accordance with ISO 10993 guidelines for bone and tissue contacting medical devices. All the testing was conducted pursuant to GLP 21 CFR 58. All non-clinical animal studies were reviewed and approved by IACUC. Results: Following intra-articular administration of 14 C-labeled gel, any clinical signs observed throughout the study were considered to be incidental. The highest mean radioactivity concentration values were observed in the saccus (5218 μg eq/g) and the fat pad (798 μg eq/g) at 1 hour post-dose. Moderate levels of radioactivity were also seen in the lymph node (popliteal) at 7 days post-dose and meniscus (medial) at 1 hour post-dose. The mean limit of quantification for tissues analyzed by QWBA generally ranged from 21.6 to 27.3 μg eq/g with the exception of the 56 day timepoint where the mean limit of quantification was 1213 μg eq/g. The left hindlimb which included the bone marrow (femur and tibia), condyle of the femur (distal) and condyle of the tibia (proximal) and patella had concentration values that were below the limit of quantification at all timepoints. Although radioactivity could still be detected in images from animals up to the 56 day timepoint, radioactivity concentrations were below the limits of quantification for all tissues of interest by 28 days post-injection. The calculated half-life of the gel was 6.23 days. Overall, the mean content of radioactivity in the left hindlimbs was 99.6% at 1 hour post-injection, 45.9% at 7 days post-injection and below the limit of quantification for subsequent timepoints. Therefore, most of the radioactivity administered was eliminated by 28 days post-injection. The limit of quantification for the hindlimbs was approximately 8% of the administered dose. Biocompatibility testing showed the unlabeled hylastan gel to be noncytotoxic, non-sensitizing, non-mutagenic, slightly reactive (short and long term implantation), a negligible irritant (intradermal), non-toxic (acute systemic) and non-pyrogenic. Conclusions: Following a single intra-articular injection of 14 C-hylastan gel, the test material cleared from the joint space with a half-life of 6.23 days. There were no adverse events related to the administration of the gel. The battery of biocompatibility testing on the crosslinked hylastan gel showed that the material was safe.

The Journal of the American Association of Gynecologic Laparoscopists, 1994

A useful laparoscopic product for adhesion prevention must be easy to apply with minimal handling... more A useful laparoscopic product for adhesion prevention must be easy to apply with minimal handling and manipulation of tissue and product. With this objective in mind, we have developed an injectable gel (HALTM) based on hyaluronic acid that is intended to limit adhesion formation after laparoscopic and open surgical procedures. We tested the effectiveness of HALTM gels in a rat sidewall defect model. In 50 adult female rats a 1 cm x 1 cm peritoneal defect was made along the abdominal wall. The defect was enclosed with #3-0 silk suture to induce ischemia. The animals were randomized to gel treatment (0.5 ml placed on defect) or non-treatment control groups. Seven days after surgery the extent (0-4 scale) and severity (0-3 scale) of adhesions were scored. HALTM gel significantly reduced the extent and severity of sidewall adhesions. Moreover, the number of animals with no adhesions was significantly increased compared with non-treatment. These results indicate that HALTM gel, which is easily applied to tissue and organs, may be a useful adjuvant for adhesion prevention in open and laparoscopic surgical procedures. The effectiveness and safety of HALTM gels will be tested in human clinical studies.

The Journal of the American Association of Gynecologic Laparoscopists, 1998

from operation to pregnancy was shorter after laparoscopy (3.6 + 2.7 mo) than after laparotomy (5... more from operation to pregnancy was shorter after laparoscopy (3.6 + 2.7 mo) than after laparotomy (5.0 + 5.0 too, p = 0.2). Operating time was significantly longer for laparoscopy (201.9 + 33.8 min) than for laparotomy (148.7 + 32.5 rain, p <0.05), and mean hospital stay was significantly shorter (p <0.05). Conclusion. Given fertility outcomes, laparoscopic tubal anastomosis could be an effective alternative to conventional open microsurgical laparotomy in patients requesting reversal of sterilization.

Fertility and Sterility, 2005

contrast, the primordial follicles were well preserved using this cryopreservation protocol. The ... more contrast, the primordial follicles were well preserved using this cryopreservation protocol. The cryopreservation process appeared having no effect on the apoptosis of primordial or primary follicles in cryopreserved human ovarian tissues.

Surgical Laparoscopy …, 1996

Although decreased adhesion formation is one of the accepted advantages of laparoscopic colorecta... more Although decreased adhesion formation is one of the accepted advantages of laparoscopic colorectal surgery, no prospective studies have been done to support this claim. Therefore, we prospectively assessed adhesion formation following laparoscopic anterior resection of the rectum in a porcine model. Five domestic female pigs underwent the procedure with a double-stapled intracorporeal anastomosis. After completion of the laparoscopic procedure, 50 cm of ileum was retrieved through the right lower port site. Controlled serosal abrasion of the antimesenteric surface was performed using a fresh knife. The abraded loop was returned into the peritoneal cavity and the fascia closed at all port sites. All animals underwent a midline laparotomy 3 weeks later to assess adhesions using a 0-3 score according to the density vascularity, and extent of adhesions. All animals survived the study period. The mean level of the anastomosis was 8 cm (range, 7-10) above the anal verge; all anastomoses were intact and completely healed. None of the animals had adhesions to the port sites. The anastomotic site was completely free of adhesions in four animals, and only one animal (20%) had grade 1 adhesions between the urine horns and the anastomosis. Conversely, all animals had adhesions of the abraded loop involving 60 cm (range, 40-75) of bowel and 7 cm (range, 4-9) of the abdominal wall (remote to the port sites); no other adhesions were noted. In this pilot study, serosal abrasion of the small bowel resulted in severe adhesion formation in the porcine model. However, laparoscopic anterior resection of the rectum in the same animals was associated with only minimal insignificant adhesions. Furthermore, unlike in laparotomy incisions, adhesions to port sites did not occur.

Journal of Surgical Research, 1995

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International journal of sociology of the family, 1998

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