Future trends in endoscopic suturing.

This paper deals with future aspects and developments in endoscopic sutures, needles, needle drivers, and sewing devices. Shape memory alloys such as superelastic nickel-titanium can be used for surgical needles and hingeless needle drivers. A sewing device consists of a T-Needle which can be shuttled between the jaws of specially designed instruments.

Wittmoser's technique of thoracoscopic sympathectomy and vagotomy.

His extensive developmental and clinical work made Raimund Wittmoser a major trailblazer in endoscopic surgery from the 1950s on. His single-puncture technique for operative thoracoscopy permitted surgical interventions of peerless quality on the sympathetic and vagal nerves. His basic surgical principle was to achieve the greatest possible selectivity by a segmental approach to the sympathetic rami communicantes or the individual branches of the vagus nerve.

Conversion to mucoidy in Pseudomonas aeruginosa.

Chronic respiratory complications in cystic fibrosis, compounded by recurring infections with mucoid Pseudomonas aeruginosa and the associated inflammation, are the primary cause of high mortality in this inheritable disease. Since the conversion of P. aeruginosa into the exopolysaccharide alginate overproducing strains plays a critical role in the establishment of chronic infection, studies are directed towards understanding the processes underlying this phenomenon.

Mechanism of conversion to mucoidy in Pseudomonas aeruginosa infecting cystic fibrosis patients.

Chronic respiratory infections with mucoid Pseudomonas aeruginosa are the leading cause of high mortality and morbidity in cystic fibrosis (CF). The initially colonizing strains are nonmucoid, but in the CF lung they invariably convert into the mucoid, exopolysaccharide alginate-overproducing form causing further deterioration and poor prognosis. Here we report the molecular basis of conversion to mucoidy.

Differentiation of Pseudomonas aeruginosa into the alginate-producing form: inactivation of mucB causes conversion to mucoidy.

Mucoidy in Pseudomonas aeruginosa is a critical virulence factor associated with chronic respiratory infections in cystic fibrosis. A cluster of three tightly linked genes, algU, mucA and mucB located at 67.5 min, controls development of mucoid phenotype.

Intelligent surgical instrument system ISIS. Concept and preliminary experimental application of components and prototypes.

The recent progress in endoscopic surgery, which is highlighted by the complexity of fundoplication, stomach surgery and colorectal surgery, has revealed major restrictions with difficult surgical manipulations. Mobilisation, dissection and suturing techniques are hampered mainly by the limited degrees of freedom of the conventional rigid instruments (translation along and rotation around the longitudinal axis and the limited play in the access channel). The frequent interchange of instruments such as coagulation forceps, scissors and suction-irrigation probe is time-consuming.

Development of steerable instruments for minimal invasive surgery in modular conception.

The augmenting complexity of minimal invasive interventions requests a continuous improvement of technologies. Extended endoscopic procedures, e.g.

Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument.

In order to save time for changing instruments and minimize thermal damage in underlying tissue caused by monopolar high frequency in transanal endoscopic microsurgery (TEM), we have developed a new electrosurgical instrument, in which four functions are integrated: bipolar cutting, monopolar coagulation, suction and irrigation. The new device and the conventional monopolar knife were tested during both in vitro and in vivo experiments to compare the thermal alterations and effects on operating time. In vitro experiments demonstrated that the extent of thermal alterations created by bipolar cutting was less than in the case of monopolar cutting in the fresh porcine liver and bovine rectum.

3-D video techniques in endoscopic surgery.

Three-dimensional visualisation of the operative field is an important requisite for precise and fast handling of open surgical operations. Up to now it has only been possible to display a two-dimensional image on the monitor during endoscopic procedures. The increasing complexity of minimal invasive interventions requires endoscopic suturing and ligatures of larger vessels which are difficult to perform without the impression of space.

The algD promoter: regulation of alginate production by Pseudomonas aeruginosa in cystic fibrosis.

Pseudomonas aeruginosa mutants that overproduce the exopolysaccharide alginate and assume mucoid phenotype are associated with the establishment of chronic respiratory disease in cystic fibrosis. The initially invading strains are nonmucoid and frequently convert into the mucoid form. Mucoidy is regulated at the transcriptional level, mainly at the promoter of the algD gene.

In vitro fragmentation of gallstones with lithotriptors for use in laparoscopic cholecystotomy.

In preliminary in vitro experiments, five different lithotriptors for use in laparoscopic cholecystotomy were tested to determine the fragmentation time and rate of a defined group of gallstones. The Alexandrit laser and the ultrasonic lithotriptor were too ineffective to warrant further investigation. In phantom tests with pig gallbladders, the pulsed dye laser and the electrohydraulic lithotriptor had a fragmentation rate of 100%, but the rate of clearing of the gallbladder was 0% as stone debris always remained in the gallbladder.

A rapid procedure for isolating mitochondrial DNA.

A technique for the rapid isolation of mitochondrial DNA (mtDNA) from animal tissues is described that eliminates the time-consuming separation of nuclear and mtDNAs using cesium chloride gradient ultracentrifugation. The procedure utilizes digestion of the nuclear DNA with DNase, after which lysis of mitochondria and subsequent extraction of proteins results in relatively pure mtDNA. Up to 5 micrograms of mtDNA per gram of liver tissue resulted, a suitable yield for five digests with restriction enzymes and staining with ethidium bromide.