This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry of Health &amp; Welfare, Republic of Korea (1320270).

伦理学声明:此过程涉及人类受试者曾在亚洲大学医院批准了机构审查委员会（IRB）。 1.准备手术<ol><li>允许软食手术的前一天，什么也没有用嘴巴午夜后在手术前。 注:前和手术过程中不要插入鼻饲管。该协议不使用任何管放气的肚子。替代的是，在胃内气体可通过腹腔镜穿刺针，如果胃鼓起导致腹腔镜手术有限视图吸出。 </li><li>把病人躺在手术台上后，管理代理人上岗（硫喷妥钠，100毫克）。 </li><li>静脉注射肌肉松弛剂的（罗库溴铵，溴化1.0毫克/千克）后，通过口腔插入气管内管。 </li><li>通过气管插管，然后监视第 - 启动麻醉气体（3％七氟烷，2）手术过程中稳定性ê病人。 </li></ol> 2.术前胃镜手术过程<ol><li>放置在反向头低脚高位置的患者，和立在患者的右侧。 </li><li>打10毫米的切口在infraumbilical区，插入第一个套管针进入腹腔。 </li><li>一旦套管针插入时，与套管针连接为二氧化碳气体管以创建15的气腹 - 29毫米汞柱。 </li><li>穿过套管针插入的刚性30°腹腔镜，并探索与腹腔镜系统相连接的监视器上的腹腔。 </li><li>将4个额外的套管（一个12毫米和三个5毫米）的作为工作的端口。在脐的右上侧插入物12 mm套管。将在脐和腹部的两个上端外象限的左上方其他3节5 mm套管。 </li><li>解剖结肠韧带一起向着阴横结肠或脾极超声内镜剪刀。 </li><li>结扎左胃动脉并用腹腔镜夹在根静脉从脾血管始发和使用超声波内窥镜剪刀，胰尾上缘的曝光后切除它们。 </li><li>使用超声波内窥镜剪刀，解剖周围幽门和胰腺的头部peripyloric淋巴结，并在其原籍切除胃网膜右血管。 </li><li>切除十二指肠的第一部分的前，夹紧用腹腔镜钳以防止气体迁移胃镜过程（ 图1）期间，进入小肠十二指肠。 </li></ol> 3.术中胃镜检查<ol><li>移动到病人的头部的左侧进行术胃镜。 </li><li>插入胶状屏蔽术胃镜期间保护牙齿和牙龈。 </li><li>打开老天患者到左侧的胃镜插入的d-。 </li><li>将胃镜插入胃小心通过嘴和食道，以避免伤害到口腔，食道和胃的粘膜。 </li><li>通过胃镜注入气体来定位原发病灶吹进胃部。 注意:大多数胃镜具有特定的按钮的过程期间将气体注入肠道。 </li><li>近似肿瘤的近端边缘和使用标记在胃镜的刻度食管胃结合部之间的距离（ 图2），并进行全胃切除术（如前所述），如果距离太短打捞近端胃10 </li><li>如果全胃切除术是没有必要的，通过胃镜的一个小孔插入内窥镜注射器，并注入2 - 使用的内窥镜注射器在区域2 3立方厘米靛蓝胭脂红的入胃壁 - 3厘米PROX从肿瘤边缘进制，避免内或腔外泄漏（ 图3A）。 <ol><li>插入注射器的针插入胃壁倾斜由针以避免胃壁的穿孔。此外，注入靛蓝胭脂红非常缓慢注射期间识别腔内泄漏。 </li></ol></li><li>染料注射后，通过胃镜抽吸充气气体以使腹腔镜手术更容易。 注意:大多数胃镜具有特定的按钮的过程中抽吸充气气体。 </li></ol> 4.术中胃镜检查程序后， <ol><li>返回到患者的右侧的胃镜过程之后。 </li><li>在腹腔镜下视图，通过由蓝色染料（ 图3B）鉴定浆膜染色确认肿瘤的近侧部分。 </li><li>马克与内窥镜夹切除脏的部分，避免在重新肿瘤介入部裕度（ 图4A）。 注意:我们建议5中执行此过程 - 10分钟手术开始后，由于染料有时会在随后的程序被淘汰。 </li><li>如果染料不能在浆膜进行检测，立即重新注入下胃镜可视的染料。 </li></ol> 5.术中胃镜检查程序后， <ol><li>切除十二指肠，并根据日本治疗指南为淋巴结清扫执行其他的程序。11 </li><li>淋巴结清扫后，在切除距肿瘤边缘，被标记的剪辑指导正确的位置相距至少3 cm近端胃，用2内窥镜缝合。 </li><li>只要远端胃切除，插入检体插入的内窥镜袋，并通过一个2从腹腔撤回 - 3厘米延伸infraumbilical套管针部位。 </li><li>从近端余量来发送所述组织对于病理组织学术评估。 </li><li>在切除胃的近端部分无肿瘤组织的确认后，执行剩余的胃和带体内线性缝合器（ 图4B）的近端空肠之间吻合。 </li></ol>

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The authors have no conflicts of interest or financial ties to disclose.

在这个协议中，我们介绍了一个程序，胃镜检查术准确，可靠地识别在胃中的中间三分之一肿瘤的位置。我们能够成功地执行根据术胃镜检查的结果远端胃大部切除术。 迄今为止，各种方法已经被应用，以确定在腹腔镜视图早期胃癌的位置。最常用的方法术前用胃镜的剪裁，和外科医生可以检测到使用腹腔镜超声或便携式X线平片剪辑的位置。7,9术前术前额外胃镜一?...

腹腔镜手术已成为东亚国家，包括韩国，日本早期胃癌治疗的选择。1这种手术的优点已为早期胃癌（EGC）几个临床试验已得到充分证明。2-4大多数在这些试验的过程中通过腹腔镜完成，但在肿瘤部位的鉴定，通过小切口进行胃，包括原发肿瘤和重建术。因此，需要手术小切口打出了"腹腔镜辅助胃切除术"。 然而，最近的外科手术已经发展到最小创伤，改善患者生活术后质量。由于这一概念也得到了腹腔镜手术治疗胃癌的应用，一些有经验的医生的腹腔镜曾试图避免小切口。完全腹腔镜下胃大部切除术（TLG）为gastriç癌症要求所有的程序只使用腹腔镜设备完成后，无需对标本切除吻合的额外小切口。由于痛苦少和恢复速度相对这类手术的结果打开或腹腔镜辅助手术，这需要剖腹探查，医生更喜欢它。但5,6，阻碍TLG胃癌是肿瘤的定位没有直接的可视化触诊或以确定胃切除的面积。 肿瘤缺席的切缘是很重要的，以实现胃癌手术的成功。如果肿瘤累及在胃癌远端胃切除术在切除边缘，需要额外的手术切除，以免留下肿瘤在余下的胃。在开放和腹腔镜辅助的手术，原发肿瘤可以容易地通过触诊或直接可视化通过一个临时胃本地化。但是，由于表面RY肿瘤没有在腹腔镜视图容易地检测，确定切缘为EGC在TLG可能很困难。 几个需要额外的术前胃镜确定切缘的其它方法已经被提出。7-9然而，更多的术前胃镜可能是不方便的患者。我们推出了一个程序，术中胃镜TLG期间直接标记肿瘤在胃的中间三分之一胃癌。 在这个协议中，我们采用患者在术前研究早期胃癌，这是不包括在内镜黏膜下剥离术绝对指征的腹腔镜手术。

<table border="0" cellpadding="0" cellspacing="0" width="717">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Pentothal Sodium</td>
			<td style="width:157px;">JW pharmatheutical Co.</td>
			<td style="width:119px;">644912100</td>
			<td style="width:225px;">It was used as induction asgent</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Rocumeron</td>
			<td style="width:157px;">&#160;Ilsung pharmatheutical Co.</td>
			<td style="width:119px;">655402960</td>
			<td style="width:225px;">It was used for general anesthestia as muscle relaxant.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">SevoFRAN</td>
			<td style="width:157px;">Hana pharmatheutical Co.</td>
			<td style="width:119px;">657801060</td>
			<td style="width:225px;">It was used as general anesthetics</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Endoscopy system</td>
			<td style="width:157px;">Olympus Corp.</td>
			<td style="width:119px;">CLV-260</td>
			<td style="width:225px;">It was used for intraoperative GFS</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic surgery system</td>
			<td style="width:157px;">Striker Endoscopy</td>
			<td style="width:119px;">1488 HD 3-CHIP</td>
			<td style="width:225px;">It was a system for laparoscopic surgery</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Ultrasonic scissor</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">HAR23</td>
			<td style="width:225px;">It was used during tissue dissection</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic clip</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ER420</td>
			<td style="width:225px;">It was used for ligation of the vessels.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Indigo carmine</td>
			<td style="width:157px;">Korea United Pharma</td>
			<td style="width:119px;">Carmine</td>
			<td style="width:225px;">It was injected into the gastric wall</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:216px;">Linear stapler</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ECHELON FLEX Powered Endopath Stapler</td>
			<td style="width:225px;">It was used for resection the stomach</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Gastroscopic injector</td>
			<td style="width:157px;">TaeWoong Medical</td>
			<td style="width:119px;">Cobra injector</td>
			<td style="width:225px;">I was used for gastroscopic injection of blue dye</td>
		</tr>
	</tbody>
</table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

确定切缘胃癌，其不暴露于胃的浆膜面，是完全的腹腔镜胃切除（TLG）中的最重要的过程。此协议的目的是介绍一个程序，术中胃镜，要想在胃的中间三分之一TLG过程中直接​​标记肿瘤胃癌。谁在胃的中间三分之一诊断为腺癌的患者在这种情况下系列的患者。手术前，不进行对肿瘤的定位额外胃镜。在全身麻醉下，胃的腹腔镜动员首先执行。后十二指肠的第一部分从胰腺动员并夹紧，外科医生移动到另一侧的胃镜过程。在胃镜的通过口腔进入胃的插入，2 - 3立方厘米靛蓝胭脂红的经由内窥镜注射器施用到胃亩在胃的近端缘SCLE层。在腹腔镜下视图染色浆膜的位置是用来指导远端胃大部切除术，但是，如果肿瘤太靠近胃食管结合进行全胃切除。远端胃切除术后的样品进行采样，确认从切缘肿瘤改造前有足够的长度。在我们的案例系列中，所有患者无瘤利润率，不需要额外的手术。没有涉及到胃镜程序发病率，并为过程具有逐渐下降至约五分钟的时间。对于肿瘤定位术胃镜检查是完全接受腹腔镜胃切除远端胃癌患者准确和耐受性的方法。

20例患者谁接受胃镜检查术中，18行远端胃大部切除术，在通过胃镜发现指导。但是，我们对两名患者进行全胃切除术，因为近端肿瘤边缘过于接近胃食管结合，如术中胃镜检查确定。从肿瘤到近端切除边缘的距离为3.5厘米，2.5厘米这两个患者中，分别为（ 表1）。 总的平均手术时间为远端胃切除术为188分钟。的?...

Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

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JoVE Journal

Medicine

12.6K 次观看.  Ajou University, School of Medicine. In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

视频: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Roux-en-Y Gastric Bypass Operation in Rats

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality benefit is bariatric surgery1,2. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation3. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation4,5, increased energy expenditure6,7, altered preference for food high in fat and sugar8,9, altered salt and water handling of the kidney10 as well as alterations in gut microbiota11. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating12.
During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail 13-15. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%15. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly.
Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

空肠Roux-en-Y胃搭桥手术大鼠

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality ...

科研

医学

Screening for Melanoma Modifiers using a Zebrafish Autochthonous Tumor Model

Genomic studies of human cancers have yielded a wealth of information about genes that are altered in tumors1,2,3. A challenge arising from these studies is that many genes are altered, and it can be difficult to distinguish genetic alterations that drove tumorigenesis from that those arose incidentally during transformation. To draw this distinction it is beneficial to have an assay that can quantitatively measure the effect of an altered gene on tumor initiation and other processes that enable tumors to persist and disseminate. Here we present a rapid means to screen large numbers of candidate melanoma modifiers in zebrafish using an autochthonous tumor model4 that encompasses steps required for melanoma initiation and maintenance. A key reagent in this assay is the miniCoopR vector, which couples a wild-type copy of the mitfa melanocyte specification factor to a Gateway recombination cassette into which candidate melanoma genes can be recombined5. The miniCoopR vector has a mitfa rescuing minigene which contains the promoter, open reading frame and 3'-untranslated region of the wild-type mitfa gene. It allows us to make constructs using full-length open reading frames of candidate melanoma modifiers. These individual clones can then be injected into single cell Tg(mitfa:BRAFV600E);p53(lf);mitfa(lf)zebrafish embryos. The miniCoopR vector gets integrated by Tol2-mediated transgenesis6 and rescues melanocytes. Because they are physically coupled to the mitfa rescuing minigene, candidate genes are expressed in rescued melanocytes, some of which will transform and develop into tumors. The effect of a candidate gene on melanoma initiation and melanoma cell properties can be measured using melanoma-free survival curves, invasion assays, antibody staining and transplantation assays.

A rapid way to screen for melanoma modifiers using a zebrafish autochthonous tumor model is presented. It takes advantage of the miniCoopR vector which allows for expression of candidate melanoma genes in melanocytes. A method to obtain melanoma-free survival curves, an invasion assay, a protocol for antibody staining of scale melanocytes and a melanoma transplantation assay are described.

对黑色素瘤修饰符一个斑马鱼原地肿瘤模型的筛选

Genomic studies of  human cancers have yielded a wealth of information about genes that are altered  in tumors1,2,3. A challenge arising from these ...

Assessing Specificity of Anticancer Drugs In Vitro

A procedure for assessing specificity of anticancer drugs in vitro using cultures containing both tumor and non-tumor cells is demonstrated. The key element is the quantitative determination of a tumor-specific genetic alteration in relation to a universal sequence using a dual-probe digital PCR assay and the subsequent calculation of the proportion of tumor cells. The assay is carried out on a culture containing tumor cells of an established line and spiked-in non-tumor cells. The mixed culture is treated with a test drug at various concentrations. After the treatment, DNA is prepared directly from the survived adhesive cells in wells of 96-well plates using a simple and inexpensive method, and subjected to a dual-probe digital PCR assay for measuring a tumor-specific genetic alteration and a reference universal sequence. In the present demonstration, a heterozygous deletion of the NF1 gene is used as the tumor-specific genetic alteration and a RPP30 gene as the reference gene. Using the ratio NF1/RPP30, the proportion of tumor cells was calculated. Since the dose-dependent change of the proportion of tumor cells provides an in vitro indication for specificity of the drug, this genetic and cell-based in vitro assay will likely have application potential in drug discovery. Furthermore, for personalized cancer-care, this genetic- and cell-based tool may contribute to optimizing adjuvant chemotherapy by means of testing efficacy and specificity of candidate drugs using primary cultures of individual tumors.

Assessing Specificity of Anticancer Drugs In Vitro

The goal of this protocol is to assess specificity of anticancer drugs in vitro using mixed cultures containing both tumor and non-tumor cells.

评估抗癌药物的特异性<em&gt;体外</em

A procedure for assessing specificity of anticancer drugs in vitro using cultures containing both tumor and non-tumor cells is demonstrated. The key ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Intraoperative Ultrasound in Spinal Surgery

Since the 1980s, there have been several reports for the use of intraoperative ultrasound as a useful adjunct in spinal surgery. However, with the advent of newer cutting-edge imaging modalities, the use of intraoperative ultrasound in spine surgery has largely fallen out of favor. Despite this, intraoperative ultrasound continues to provide several advantages over other intraoperative techniques such as magnetic resonance imaging and computed tomography including being more cost-effective, efficient, and easy to operate and interpret. Additionally, it remains the only method for the real-time visualization of soft tissue and pathologies. This paper focuses on the advantages of using intraoperative ultrasound, especially in cases of intradural lesions and lesions ventral to the thecal sac when approaching posteriorly.

Here, we present a protocol on the use of intraoperative ultrasound in spinal surgery, particularly in cases of intradural lesions and lesions in the ventral spinal canal when using a posterior approach.

脊柱外科术中超声

Since the 1980s, there have been several reports for the use of intraoperative ultrasound as a useful adjunct in spinal surgery. However, with the advent ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological resection of left-sided pancreatic cancer. Several surgical techniques have been described in recent years, but few were specifically designed for minimally invasive approaches. This study describes and demonstrates a standardized and reproducible technique for an adequate oncological resection of pancreatic cancer: laparoscopic radical left pancreatectomy (LRLP).
A 61-year-old woman presented with an incidental finding of a 3 cm mass in the left pancreas suspect for malignancy. Imaging did not reveal distant metastases, central vascular involvement, or morbid obesity, hence the patient was suitable for LRLP. This study describes the main steps of LRLP for pancreatic cancer. First, the lesser sac is opened by transecting the gastrocolic ligament. The splenic flexure of the colon is mobilized and the inferior border of the pancreas including Gerota&#39;s fascia is dissected down to the inferior border of the spleen. The pancreas is tunneled and hung, including Gerota&#8217;s fascia with a vessel loop. At the pancreatic neck, a tunnel is created between the pancreas and the portal vein, likewise a vessel loop is passed. The pancreas is then transected using the graded compression technique with an endostapler. Both the splenic vein and artery are transected before completing the resection. The entire specimen is extracted in a retrieval bag via a small Pfannenstiel incision.
Duration of the surgery was 210 min with 250 mL blood loss. Pathology revealed a R0-resection (&#62;1 mm) of a well-to-moderately differentiated adenocarcinoma originating from an intraductal papillary mucinous neoplasm. A total of 15 tumor-negative lymph nodes were resected. This is a detailed description of LRLP for left-sided pancreatic cancer as is currently being used within the international, multicenter randomized DIPLOMA (Distal Pancreatectomy Minimally Invasive or Open for PDAC) trial.

Oncologically safe left pancreatectomy requires radical resection (R0), Gerota&#8217;s (perirenal) fascia resection, and adequate lymph node dissection. This study describes the technical details of laparoscopic radical left pancreatectomy (LRLP), used in the first international multicenter randomized trial comparing minimally invasive with open left pancreatectomy for pancreatic cancer, the DIPLOMA trial.

胰腺癌的腹腔镜根左造影切除术:手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and metabolic changes are not well understood. Multiple factors are thought to play a role, including reduced caloric intake, decreased nutrient absorption, increased satiety, the release of satiety-promoting hormones, shifts in bile acid metabolism, and alterations in the gut microbiota.
The rat RYGB model presents an ideal framework to study these mechanisms. Prior work on mouse models have had high mortality rates, ranging from 17 to 52%, limiting their adoption. Rat models demonstrate more physiologic reserve to surgical stimulus and are technically easier to adopt as they allow for the use of surgical staplers. One challenge with surgical staplers, however, is that they often leave a large gastric pouch which is not representative of RYGB in humans. 
In this protocol, we present a RYGB protocol in rats that result in a small gastric pouch using surgical staplers. Utilizing two stapler fires which remove the forestomach of the rat, we obtain a smaller gastric pouch similar to that following a typical human RYGB. Surgical stapling also results in better hemostasis than sharp division. Additionally, the forestomach of the rat does not contain any glands and its removal should not alter the physiology of RYGB.
Weight loss and metabolic changes in the RYGB cohort were significant compared to the sham cohort, with significantly lower glucose tolerance at 14 weeks. Furthermore, this protocol has an excellent survival of 88.9% after RYGB. The skills described in this protocol can be acquired without previous microsurgical experience. Once mastered, this procedure will provide a reproducible tool for studying the mechanisms and effects of RYGB.

Roux-en-Y gastric bypass (RYGB) is performed to treat obesity and diabetes. However, the mechanisms underlying RYGB's efficacy are not fully understood, and studies are limited by technical difficulty leading to high mortality in animal models. This article provides instructions on how to perform RYGB in rats with high success rates.

使用线性压花器在老鼠身上进行胃旁路的规程

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

荧光腹腔镜中央肝切除术使用吲哚菁绿阴性染色治疗肝癌

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...