Complications of choledochal cysts in adulthood 48 Diamond T, Panesar KJ. Biliary peritonitis due to choledochal cyst presenting in late pregnancy. Ulster Med J 1986;55: 190-2. 49 Angel JL, Knuppel RA, Trabin J. Choledochal cyst complicating a twin gestation. South Med J 1985;78:463-6. 50 Taylor TV, Brigg JK, Russell JG, Torrance B. Choledochal cyst of pregnancy. J Roy Coll Surg Edinb 1977;22:424-7. S1 Kitahama A, Harkness SO, Moynihan PO, Webb WR. A large choledochal cyst with impending rupture postpartum. Br J Surg 1984;71:156.
52 Todani W, Watanabe Y, Mizuguchi T, Fujii T, Toki A. Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. AmJI Surg 1981;142:584-7. Received 9 November 1989
A new microsurgical suction switch Key words: Microsurgery, surgical instruments
Precise suction control is desirable but often difficult to achieve during microsurgical procedures. The removal of small volumes of blood or secretions may be complicated by the adherence of solid material to the suction tip and delicate tissues, sutures or prostheses can easily become displaced or damaged. A finger-operated cutout aperture incorporated in the suction tube will act as a vent and reduce the power of the sucker. However, it will not usually overcome the problem of tissue adherence to a fine tip owing to residual surface tension. Footswitches have been designed to control suction during microsurgery, but most require constant pressure which may be tedious and tiring during a long procedure. Moreover, the surgeon may simultaneously wish to activate a diathermy, motorised operating microscope, laser or drill using foot pedals. A compact foot operated suction switch has been designed which overcomes many of these disadvantages, and is easy to use and maintain (Fig. 1). It consists of a polypropylene body enclosing a stainless steel piston with 0-ring seals set on a non-slip base. The few moving parts are easily removed for cleaning by unscrewing the base with a coin. The switch allows continuous suction after connection into the vacuum line. When required, pressure on the pedal immediately stops the suction allowing precise control. If a tissue pledget or prosthesis adheres to the sucker a sharp depression of the pedal produces a small pressure surge along the distal line which is sufficient to overcome surface tension at the working tip. This releases the material without damage or displacement and is a feature that has proved especially useful during the micromanipulation of grafts and prostheses.
235
..........T.-
2
.............
3
4
Figure 1. The microsurgical footswitch.
The footswitch has applications in middle ear reconstruction, endolaryngeal microsurgery, microvascular anastomoses, neurosurgical and ophthalmological procedures. It is available from Rimmer Brothers, 18 Aylesbury St, London ECIR ODD. Malcolm Keene FRCS Consultant ENT Surgeon
Kathryn L Evans FRcs Senior Registrar, ENT ENT Unit, St Bartholomew's Hospital London
B Ashley Senior Technician Mechanical Section of the Department of Medical Electronics St Bartholomew's Hospital, London
52 Todani W, Watanabe Y, Mizuguchi T, Fujii T, Toki A. Hepaticoduodenostomy at the hepatic hilum after excision of choledochal cyst. AmJI Surg 1981;142:584-7. Received 9 November 1989
A new microsurgical suction switch Key words: Microsurgery, surgical instruments
Precise suction control is desirable but often difficult to achieve during microsurgical procedures. The removal of small volumes of blood or secretions may be complicated by the adherence of solid material to the suction tip and delicate tissues, sutures or prostheses can easily become displaced or damaged. A finger-operated cutout aperture incorporated in the suction tube will act as a vent and reduce the power of the sucker. However, it will not usually overcome the problem of tissue adherence to a fine tip owing to residual surface tension. Footswitches have been designed to control suction during microsurgery, but most require constant pressure which may be tedious and tiring during a long procedure. Moreover, the surgeon may simultaneously wish to activate a diathermy, motorised operating microscope, laser or drill using foot pedals. A compact foot operated suction switch has been designed which overcomes many of these disadvantages, and is easy to use and maintain (Fig. 1). It consists of a polypropylene body enclosing a stainless steel piston with 0-ring seals set on a non-slip base. The few moving parts are easily removed for cleaning by unscrewing the base with a coin. The switch allows continuous suction after connection into the vacuum line. When required, pressure on the pedal immediately stops the suction allowing precise control. If a tissue pledget or prosthesis adheres to the sucker a sharp depression of the pedal produces a small pressure surge along the distal line which is sufficient to overcome surface tension at the working tip. This releases the material without damage or displacement and is a feature that has proved especially useful during the micromanipulation of grafts and prostheses.
235
..........T.-
2
.............
3
4
Figure 1. The microsurgical footswitch.
The footswitch has applications in middle ear reconstruction, endolaryngeal microsurgery, microvascular anastomoses, neurosurgical and ophthalmological procedures. It is available from Rimmer Brothers, 18 Aylesbury St, London ECIR ODD. Malcolm Keene FRCS Consultant ENT Surgeon
Kathryn L Evans FRcs Senior Registrar, ENT ENT Unit, St Bartholomew's Hospital London
B Ashley Senior Technician Mechanical Section of the Department of Medical Electronics St Bartholomew's Hospital, London
