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Intrapartum Fetal Monitoring
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Nandini Raghuraman, Alison G. Cahill
Allis clamp and scalp puncture have been used to elicit an acceleration but are less safe. Digital scalp stimulation (gentle stroking of the fetal scalp for 15 seconds) is the test with the best predictive accuracy among these four techniques [30]. There are currently no RCTs that address the safety and efficacy of digital scalp or vibroacoustic stimulation used to assess fetal well-being in labor in the presence of NRFHT.
Management of peritoneal metastases using cytoreductive surgery and perioperative chemotherapy
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
An Allis clamp is placed on the posterior vagina leaving the peritoneum of the cul-de-sac to be included with the intact specimen of the pelvic peritoneum, uterus, and rectum plus the rectosigmoid colon. The perirectal fat is divided on the rectal musculature working from distal to proximal rectum in an attempt to pressure as long a rectal stump as possible. After the rectal musculature is skeletonized using electrosurgery, a stapler is used to close off the rectal stump and free the specimen.
Transanal Techniques
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
A line of excision is marked around the carcinoma, with at least a 1cm grossly normal margin, using electrocautery (Fig. 10A). The crucial part of the technique is to grasp the internal sphincter muscle at the inferior margin with an Allis clamp (Fig. 10B). An incision is made using an electrocautery blade (coagulation current). The Allis clamp is used for traction and exposure and should be moved around as appropriate. This technique is simpler and more precise than using multiple sutures around the lesion for traction. The tissue is incised all around in the perianorectal plane (deeper then the internal sphincter and rectal wall) until the entire carcinoma is removed. It is important that the excision is full thickness, exposing the fat (Fig. 10C). The wound is closed transversely with running 3-0 or interrupted monofilament or braided synthetic absorbable material (Fig. 10D). No packing or drain is placed.
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
Failing conservative management, any mesh extrusion/erosion into the urinary tract and or debilitating pelvic pain requires mesh removal. Varying approaches have been described to address these particularly challenging surgeries depending on the degree of exposure and institutional experience. Our practice is for maximal mesh removal as the exposed vaginal mesh is likely to be infected in our estimation. Each patient is placed in the dorsal lithotomy position, prepped, and draped in standard fashion. A thorough vaginoscopy is performed to confirm the location of mesh in all vaginal compartments (Figure 6). Ideally, this should be marked with a marking pen. Cystoscopy is performed at the commencement of the procedure and where necessary ureteric stents are placed for identification. Efflux of urine from both ureteric orifices is confirmed. A Lonestar retractor, headlights, and a weighted vaginal speculum are utilized for optimal operative exposure. If the posterior compartment is affected, we will routine placed a betadine-soaked pack into the rectum to facilitate the identification and recognize an injury during mesh removal surgery. The incision will vary depending on the site of the mesh exposure or location of pain for which the mesh is being removed. Vaginal sulcus incision, apical incision, or broad-based U-shaped incision can be considered. The goal is to allow for dissection laterally to gain maximal access to the mesh arm(s); in addition, a large vaginal flap allows for easier tissue interposition later if required. Once the mesh is identified, dissection is carried out superficially to undermine the vaginal wall from the mesh, and then with the mesh placed on tension with an Allis clamp, dissection can be continued laterally into the paravaginal space using long scissors or a long tip bovie cautery to aid in hemostasis as the dissection progresses to free the mesh.