El proyecto C-sello es una parte de la colaboración entre el departamento de cirugía del Centro Médico Universitario de Groningen (UMCG) y BV Polyganics. El proyecto fue inicialmente apoyado por una beca de SenterNovem del Ministerio holandés de Asuntos Económicos. Propiedad intelectual, los intereses comerciales y de patentes están en manos de Polyganics BV. Interés intelectual está en manos de la UMCG. Polyganics BV ha fabricado los dispositivos para este estudio. El estudio se realizó en el UMCG.

La fabricación del C-sello El C-Seal está hecho de poliuretano biodegradable, compuesto de componentes moleculares duros y blandos. El componente de disco duro proporciona el material de las propiedades deseables elásticas y mecánicas. El componente duro consiste en enlaces de poliuretano (HNCO 2) compuesto por un di-isocianato (OCN-NCO) y un. Diol (HO-OH) El segmento blando determina el comportamiento de la degradación del poliuretano. El segmento blando se llama el prepolímero y se compone de las cadenas de poliéter-éster. El segmento duro se incorpora en el segmento blando. Esta incorporación se llama &quot;cadena de extensión&quot; de la polimerización. Una vez que estos dos segmentos de interactuar, un poli-éter-éster-uretano se sintetiza el polímero y está listo para ser procesado en un C-Seal: <ol><li> El polímero se diluye a una concentración adecuada para el recubrimiento por pulverización. </li><li> La solución de poliuretano se aplica sobre un molde giratorio para un cierto espesor. </li><li> El molde se coloca en un baño de agua a fin de liberar la C-sello de seguridad del molde sin causar daños. </li><li> El C-sello se seca. </li><li> El C-Seal se envasa en una bolsa de Tyvek y esterilizado con gas ETO. </li><li> Después de la esterilización, el C-Seal está listo para su uso. </li></ol> Procedimiento Quirúrgico El paciente ha dado su consentimiento informado para la participación en el estudio C-sello. <ol><li> Se coloca al paciente en posición supina en los estribos, el abdomen y el perineo se desinfecta y el paciente se cubre con paños estériles. </li><li> Establecimiento del neumoperitoneo o laparotomía por incisión mediana. </li><li> La inspección del hígado y la cavidad abdominal. </li><li> Movilización del colon sigmoide y la movilización de la flexura esplénica. </li><li> En la cirugía abierta: la división del colon sigmoide en el nivel del margen de resección proximal. </li><li> Incisión paramediana derecha del peritoneo, la apertura del plano presacra, la ligadura y división de la arteria y la vena rectal superior. </li><li> Movilización del mesorrecto. </li><li> División del recto distal. </li><li> En un ambiente laparoscópico: una incisión suprapúbica se realiza para extraer la muestra. División del colon sigmoide proximal. </li><li> El C-sello se puede utilizar si la longitud del muñón rectal es max. 15 centímetros. </li><li> El diámetro del intestino determina el diámetro de la grapadora, se prefiere usar una grapadora CEA con un diámetro de 29 o 33 mm. </li><li> El C-sello y una esterilización de mármol de 12 mm de acero inoxidable se descomprimen en una superficie limpia y estéril con guantes quirúrgicos limpios y estériles. </li><li> Abra el archivo C-seal, inserte el mármol y la inserción en el yunque con el pasador de la primera conexión. Las dos aletas en la apertura de la C-sello se adjunta al yunque con las dos tiras de cinta adhesiva. </li><li> El yunque se avanza en el C-sello para que &#39;pinchazos&#39; de la pines del extremo abierto en punta de la C-sello. Suavemente desplegar el C-sellar completamente y asegúrese de que el mármol termina en el interior del C-sellarlo del yunque. </li><li> Cualquier tipo de anastomosis (de extremo a extremo, de extremo a lado, de lado a fin y de lado a lado) se puede realizar cuando se usa el C-sello, que prefieren crear una anastomosis de lado a fin . Hay varias estrategias para insertar el yunque en el asa de intestino proximal. El C-sello no interfiere con ninguna de estas estrategias (al final del intestino abierto con jareta / incisión longitudinal del intestino) </li><li> Inserte el yunque, junto con la C-sello en el bucle de intestino proximal, en primer lugar avanzar en la C-sello con la ayuda del mármol y, si es necesario, una pinza roma. Asegúrese de que la cola del C-sello se coloca arriba en el intestino y comprobar que la cola del C-sello se estira, comprobar la posición de la bola (la bola debe estar a una distancia adecuada del yunque). Luego penetran en la pared del intestino con el pasador del yunque y crear una sutura en bolsa de tabaco alrededor de la clavija. </li><li> Suavemente dilatar el ano y la inserción de la grapadora en el muñón rectal. Conecte el yunque de la grapadora. Compruebe que la torsión del intestino. </li><li> El fuego de la grapadora circular. Ahora, los extremos del intestino están conectados y la C-sello se adjunta a las grapas </li><li> Tire suavemente de la grapadora por el ano. No apague la grapadora más de 180 grados cuando salga (el giro C-sello de mayo). Mediante la eliminación de la grapadora en el recto, la C-sello se tira a través del ano. Cortar la C-sello a una distancia de aproximadamente 4 cm del ano. </li><li> Quitar el mármol por el recto. A menudo, el mármol, sale junto con el C-sello. Si no es así, suavemente quitar manualmente el mármol que se encuentra entre la C-sello y la pared intestinal. </li><li> Verificar la anastomosis. Opcionalmente, realice una prueba de aire, llenando la pelvis con una solución salina y se inyecta aire en el canal anal (en el C-sello y entre el C-sello y el intestino). Los abdominalespresencia de burbujas confirma una anastomosis completa. </li><li> Si está indicado, crear un estoma de protección. </li><li> En un ambiente laparoscópico: exsuflación de la cavidad abdominal y la extracción de los trócares. </li><li> Cerrar la incisión (s) </li><li> Postoperatorio: La recuperación postoperatoria es de acuerdo con el ERAS (recuperación mejorada después de la cirugía) del protocolo 9. El C-sello se debe dejar el terreno durante al menos una semana. El paciente no tiene restricciones y puede perder las heces a través de la C-sello. Cuando el paciente se ha recuperado bien y sin complicaciones anastomóticas son sospechosos, el C-sello puede ser cortada a nivel del ano. El resto de C-sello se degrada y el paciente perderá la C-sello, junto con las heces por la vía natural. </li></ol> Resultados representante Cuando el C-sello se aplica correctamente (figura 2 y 3), que cubre la anastomosis. Si una dehiscencia se forma en el sitio de la anastomosis o distal de la anastomosis proximal del muñón rectal, extravasación de las heces es prevenir desde la C-sello cubre el defecto y se dirige a la materia fecal a través del ano. En la fase postoperatoria, el C-sello sobresale por el ano (figura 3). <img src="/files/ftp_upload/2223/2223fig1.jpg" alt="Figura 1" /> Figura 1: Esquema de la C-sello. <img src="/files/ftp_upload/2223/2223fig2.jpg" alt="Figura 2" /> Figura 2: Representación esquemática de fijación de la C-sello a la cabeza de la grapadora. <img src="/files/ftp_upload/2223/2223fig3.jpg" alt="Figura 3" /> Figura 3: Después de insertar la grapadora de cabeza junto con el adjunto C-sello en el intestino proximal y la grapadora en el muñón rectal, la grapadora se disparó y tiró suavemente a través del ano junto con la C-sello.

<ol>
	<li>Peeters, K. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+anastomotic+failure+after+total+mesorectal+excision+of+rectal+cancer.">Risk factors for anastomotic failure after total mesorectal excision of rectal cancer.</a> Br. J. Surg. 92, 211-216 (2005).</li><li>Dehni, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+a+defunctioning+stoma+on+leakage+rates+after+low+colorectal+anastomosis+and+colonic+J+pouch-anal+anastomosis.">Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis.</a> Br. J. Surg. 85, 1114-1117 (1998).</li><li>Matthiessen, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+anastomotic+leakage+after+anterior+resection+of+the+rectum.">Risk factors for anastomotic leakage after anterior resection of the rectum.</a> Colorectal Dis. 8, 366-366 (2006).</li><li>Laxamana, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+results+of+anterior+resection+using+the+double-stapling+technique.">Long-term results of anterior resection using the double-stapling technique.</a> Dis. Colon Rectum. 38, 1246-1250 (1995).</li><li>Jung, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+and+oncologic+impact+of+anastomotic+leakage+after+rectal+cancer+surgery.">Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery.</a> Dis. Colon Rectum. 51, 902-908 (2008).</li><li>Ravo, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+intracolonic+bypass+procedure.">The intracolonic bypass procedure.</a> Int. J. Colorectal Dis. 2, 38-42 (1987).</li><li>Ye, F., Wang, D., Xu, X., Liu, F., Lin, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+intracolonic+bypass+secured+by+a+biodegradable+anastomotic+ring+to+protect+the+low+rectal+anastomosis.">Use of intracolonic bypass secured by a biodegradable anastomotic ring to protect the low rectal anastomosis.</a> Dis. Colon Rectum. 51, 109-115 (2008).</li><li>Hawley, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Causes+and+prevention+of+colonic+anastomotic+breakdown.">Causes and prevention of colonic anastomotic breakdown.</a> Dis. Colon Rectum. 16, 272-277 (1973).</li><li>Lassen, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+review+of+optimal+perioperative+care+in+colorectal+surgery:+Enhanced+Recovery+After+Surgery+(ERAS)+Group+recommendations.">Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations.</a> Arch. Surg. 144, 961-969 (2009).</li><li>Kolkert, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protection+of+stapled+colorectal+anastomoses+with+a+biodegradable+device:+the+C-seal+feasibility+study.">Protection of stapled colorectal anastomoses with a biodegradable device: the C-seal feasibility study.</a> Am J of Surg. , .</li></ol>

Aprobación de la IRB: Procedimientos en seres humanos han sido aprobados por la Junta de Revisión Institucional (IRB) en el Centro Médico Universitario Groningen holandés y el Comité Central de Investigación de inv. Sujetos Humanos (CCMO). No hay conflictos de interés declarado.

El C-sellado es una técnica dirigida a impedir la fuga de la anastomosis en la anastomosis colorrectal grapada. Puede ser utilizado en la cirugía laparoscópica, así como durante una laparotomía. El C-sello no impide dehiscencia de la anastomosis, sin embargo, evita las fugas de materia fecal fuera de la luz intestinal. Al aplicar la C-seal, cuidado se debe tomar en el momento de la C-sello se introduce en el asa de intestino proximal. Posicionamiento adecuado de la C-sello en el asa de intestino proximal es importante, ya que teóricamente es posible duplicar la grapa C-sello. Grapado doble de la C-sello se produce cuando la cola del C-sello se dobla y se termina entre la grapadora y el cabezal de la grapadora. El mármol ayuda a determinar la posición de la C-sello en el asa de intestino proximal. El mármol se debe colocar a una distancia adecuada de la cabeza de la grapadora, para garantizar que la cola C-sello se estira y no puede ser grapadas con la anastomosis. El C-sello se puede colocar en el asa de intestino proximal de diferentes maneras. Si una anastomosis de lado a fin se prefiere, se aconseja llevar a cabo este acuerdo con el siguiente protocolo: El C-sello se introduce por el extremo del intestino abierto, la cola primero, seguido por el jefe de la grapadora. El pasador de conexión se penetraba a través de la pared intestinal por apuñalamiento en la dirección de la final del intestino abierto. Posteriormente, al final del intestino abierto se cierra y una sutura en bolsa de tabaco se coloca alrededor de la clavija de conexión para la ayuda adicional. El pin está conectado a la grapadora, la posición de la bola está marcada y la grapadora es despedido. Si una anastomosis término-a-extremo se prefiere, el C-foca se inserta en el extremo del intestino proximal abierto, primero la cola. A jareta rodea el extremo del intestino alrededor de la clavija de conexión. El pin está conectado a la grapadora, la posición de la bola está marcada y la grapadora es despedido. En un estudio piloto iniciado por el Centro Médico Universitario de Groningen, el C-sello se utilizó en 15 pacientes sometidos a resección del recto seguido por una anastomosis grapada 10. No hay clínica o subclínica AL fue diagnosticado en estos pacientes. En la actualidad, un estudio de fase II de prueba de la C-sello en otros 35 pacientes que está reclutando.

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<td>Stainless Steel Marble</td>
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<td>C-seal</td>
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the c-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage

Dehiscencia de la anastomosis colorrectal (AL) es una complicación grave en la cirugía colorrectal que conduce a una alta morbilidad y una mortalidad. La incidencia de AL varía entre el 2,5 y el 20% 2-5. Con los años, muchas de las estrategias destinadas a reducir la incidencia de dehiscencia de la anastomosis se han examinado 6, 7. La causa de la AL es probablemente multifactorial. Los factores etiológicos incluyen el suministro insuficiente de sangre arterial, la tensión en la anastomosis, hematoma y / o infección en el sitio de la anastomosis, y co-mórbidas factores del paciente como la diabetes y la aterosclerosis 8. Además, algunos anastomosis puede ser insuficiente desde el principio debido a un fallo técnico. En la actualidad un nuevo dispositivo se desarrolla en nuestro instituto destinado a proteger la anastomosis colorrectal y la reducción de la incidencia de la Liga Americana. Este llamado C-sello es una fuga de biofragmentable, que se grapa a la anastomosis con la grapadora circular. Se cubre la cara luminal de la anastomosis colorrectal evitando fugas. El C-sello es una forma de tubo de pared delgada de drenaje, con un diámetro aproximado de 4 cm y una longitud aproximada de 25 cm (figura 1). Es un dispositivo tubular compuesto de poliuretano biodegradable. Dos solapas con cinta adhesiva se encuentran en un extremo del tubo. Estas aletas se utilizan para fijar el C-sello con el yunque de la grapadora circular, por lo que después de la anastomosis se realiza el C-sello puede ser forzado a través del ano. El C-sello se mantiene en terreno durante al menos 10 días. A partir de entonces, perderá fuerza y ​​se degrada al ser secretadas por el cuerpo, junto con los contenidos naturales gastrointestinal. El C-sello no prevenir la formación de dehiscencias. Sin embargo, se evita la extravasación de las heces en la cavidad peritoneal. Esto significa que una brecha en el sitio de la anastomosis no conduce a la fuga. En la actualidad, un estudio de fase II de prueba de la C-sello en 35 pacientes sometidos a (colo) resección del recto con anastomosis grapada está reclutando. El C-sello puede ser utilizado tanto en los procedimientos abiertos, así como los procedimientos laparoscópicos. El C-sello sólo se aplica en las anastomosis grapada en 15 cm del margen anal. En el video, la aplicación de la C-sello se muestra en una resección abierta extendida sigmoidea en un paciente que sufre de la enfermedad diverticular del colon con una estenosis.

Watch this Scientific Journal Video about The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage at JoVE.com

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

El C-sello es una fuga de biofragmentable la protección de la anastomosis colorrectal grapada. En este video, los detalles de la fabricación de despliegue y uso se muestran.

El C-sello: Un drenaje Biofragmentable protección de la anastomosis colorrectal grapada de fuga

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL ...

the-c-seal-biofragmentable-drain-protecting-stapled-colorectal

Research

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Medicine

21.7K vistas.  University Medical Center Groningen. El C-sello es una fuga de biofragmentable la protección de la anastomosis colorrectal grapada. En este video, los detalles de la fabricación de despliegue y uso se muestran.

Video: The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System

The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental endoscopy has been highly useful for studies that require repeated assessments in a single laboratory animal, such as those evaluating mechanisms of chronic inflammatory bowel disease and the progression of colorectal cancer. However, the methods used across studies are highly variable. At least three endoscopic scoring systems have been published for murine colitis and published protocols for the assessment of colorectal tumors fail to address the presence of concomitant colonic inflammation. This study develops and validates a reproducible endoscopic scoring system that integrates evaluation of both inflammation and tumors simultaneously. This novel scoring system has three major components: 1) assessment of the extent and severity of colorectal inflammation (based on perianal findings, transparency of the wall, mucosal bleeding, and focal lesions), 2) quantitative recording of tumor lesions (grid map and bar graph), and 3) numerical sorting of clinical cases by their pathological and research relevance based on decimal units with assigned categories of observed lesions and endoscopic complications (decimal identifiers). The video and manuscript presented herein were prepared, following IACUC-approved protocols, to allow investigators to score their own experimental mice using a well-validated and highly reproducible endoscopic methodology, with the system option to differentiate distal from proximal endoscopic colitis (D-PECS).

Over the past few years, new generation endoscopes have emerged as important diagnostic research aids for evaluating murine colitis and colorectal tumors. We present herein a detailed protocol for endoscopic assessment of inflammation and colorectal tumors in mice, as well as a novel scoring system that uses decimal identifiers to document the endoscopic severity of colitis and colorectal tumors.

La colonoscopia flexible en ratones para evaluar la gravedad de la colitis y colorrectal tumores utilizando un sistema validado de puntuación endoscópica

The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental ...

Investigación

Medicina

Molecular Profiling of the Invasive Tumor Microenvironment in a 3-Dimensional Model of Colorectal Cancer Cells and Ex vivo Fibroblasts

Invading colorectal cancer (CRC) cells have acquired the capacity to break free from their sister cells, infiltrate the stroma, and remodel the extracellular matrix (ECM). Characterizing the biology of this phenotypically distinct group of cells could substantially improve our understanding of early events during the metastatic cascade.

Tumor invasion is a dynamic process facilitated by bidirectional interactions between malignant epithelium and the cancer associated stroma. In order to examine cell-specific responses at the tumor stroma-interface we have combined organotypic co-culture and laser micro-dissection techniques.
Organotypic models, in which key stromal constituents such as fibroblasts are 3-dimentioanally co-cultured with cancer epithelial cells, are highly manipulatable experimental tools which enable invasion and cancer-stroma interactions to be studied in near-physiological conditions.

Laser microdissection (LMD) is a technique which entails the surgical dissection and extraction of the various strata within tumor tissue, with micron level precision.
By combining these techniques with genomic, transcriptomic and epigenetic profiling we aim to develop a deeper understanding of the molecular characteristics of invading tumor cells and surrounding stromal tissue, and in doing so potentially reveal novel biomarkers and opportunities for drug development in CRC.&#160;&#160;&#160;

Molecular Profiling of the Invasive Tumor Microenvironment in a 3-Dimensional Model of Colorectal Cancer Cells and Ex vivo Fibroblasts

Molecular profiling of laser microdissected cells and stroma from synthetic, tissue-engineered colorectal cancer models represents a novel and manipulatable approach to characterize and dissect the distinctive biology at the interface between tumor cells at the invasive front and cancer associated stromal cells. &#160;

Molecular Profiling del microambiente tumoral invasiva en un modelo de 3 dimensiones de las células del cáncer colorrectal y<em&gt; Ex vivo</em&gt; Los fibroblastos

Invading colorectal cancer (CRC) cells have acquired the capacity to break free from their sister cells, infiltrate the stroma, and remodel the ...

Isolation and Propagation of Circulating Tumor Cells from a Mouse Cancer Model

Cancer metastasis is the foremost cause of cancer-associated deaths. Recent studies have shown that circulating tumor cells (CTCs) are important in cancer metastasis. Indeed, the number of CTCs correlates with tumor size. Here, a detailed description is provided of a methodology for isolation and propagation of CTCs from a syngeneic mouse model of hepatocellular carcinoma (HCC) which allows for downstream analysis of potentially important molecular mechanisms of solid organ tumor metastasis. This method is efficient and reproducible. It is a non-invasive technique and, therefore, has potential to replace the invasive biopsy of tissues from humans which may be associated with complications. Therefore, the method discussed here allows for the isolation and propagation of CTCs from whole blood samples such that they can be examined and characterized. This has potential for future adaptation for clinical applications such as diagnosis, and personalized targeted therapy.

Circulating tumor cells (CTCs) have been shown to play an important role in tumor metastasis. Here, a method for the isolation and propagation of CTCs from the whole blood of a syngeneic mouse tumor model of hepatocellular carcinoma (HCC) metastasis is described.

El aislamiento y la propagación de células tumorales circulantes de un Cáncer de ratón

Cancer metastasis is the foremost cause of cancer-associated deaths. Recent studies have shown that circulating tumor cells (CTCs) are important in cancer ...

Vessel-sparing Excision and Primary Anastomosis

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Here, we present an elaborate and efficient protocol to treat isolated short bulbar or posterior urethral strictures with vessel-sparing excision and primary anastomosis.

La supresión conservadora de vasos y Anastomosis primaria

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

Creation of Colonic Anastomosis in Mice

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of colonic surgeries and can occur in up to 26% of surgical anastomoses, with mortality being up to 39% for patients with such a leak. Currently, there remains a paucity of data detailing the cellular mechanisms of anastomotic healing. Devising preventative strategies and treatment modalities for anastomotic leak could be greatly potentiated by a better understanding of appropriate anastomotic healing.
A murine model is ideal as previous studies have shown that the murine anastomosis is the most clinically similar to the human case as compared with other animal models. We offer an easily reproducible murine model of colonic anastomosis in mice that will allow for further illustration of anastomotic healing.

Anastomotic leak or breakdown after surgery is a major cause of postoperative morbidity and mortality. Our surgery for creating a colonic anastomosis is a reliable and reproducible method for studying the healing mechanisms of anastomoses.

Creación de Anastomosis de colon en ratones

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of ...

One-anastomosis Gastric Bypass (OAGB) in Rats

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical model, longitudinal studies can be carried out to provide an improved understanding of the mechanisms underlying the outcomes seen after bariatric surgery in humans. For this purpose, rats are operated on through a laparotomy under general anesthesia with isoflurane. First, the surgeon creates a long and tubular gastric pouch: after greater curve and hiatal dissection, the nonglandular stomach is stapled and removed. Then, the remaining stomach is also stapled in order to create a gastric tube and exclude the antrum of the stomach. After that, the surgeon performs a single end-to-side gastrojejunostomy 35 cm from the duodenojejunal angle. This limb length has been chosen in order to reproduce the same ratio between the biliopancreatic limb (BPL) and common limb (CL) length as in human bariatric surgery. The operation ends by aponeurotic and cutaneous closure. The early postoperative management consists of subcutaneous hydration, an intramuscular prophylactic antibiotic injection, a parietal injection of xylocaine, the administration of painkillers, and a progressive reintroduction of diet.

One-anastomosis Gastric Bypass OAGB in Rats

This protocol is for the performance of one-anastomosis gastric bypass (OAGB) on rat. The operator performs a long and tubular-stapled gastric pouch followed by hand-sewn anastomosis. For this model, the operator reproduces the same ratio between biliopancreatic and common limb in humans; therefore, the biliopancreatic limb measures 35 cm.

Bypass gástrico de una anastomosis (OAGB) en ratas

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...

Murine Appendectomy Model of Chronic Colitis Associated Colorectal Cancer by Precise Localization of Caecal Patch

The human appendix has been recently implicated to play important biological roles in the pathogenesis of various complex diseases, such as colorectal cancer, inflammatory bowel disease, and Parkinson&#8217;s disease. To study the function of the appendix, a gut disease-associated murine appendectomy model has been established and its step-by-step protocol is described here. This report introduces a facile protocol for caecal patch removal in mice followed by the chemical induction of chronic colitis-associated colorectal cancer using a combination of dextran sulfate sodium (DSS) and azoxymethane (AOM). IgA specific cells and IgA concentration were significantly reduced upon removal of the caecal patch in male C57BL/6 mice&#160;compared to those in the sham group. Simultaneously administering 2% DSS and AOM resulted in nearly 80% mice survival in both sham and appendectomy groups without significant body weight loss. Histological results confirmed colonic inflammation and different degrees of adenocarcinoma. This model can be used for the study of the functional role of the appendix in maintaining gut microbiota homeostasis and pathogenesis of gut colitis and malignancies, as well as for the potential development of drug targeting therapies.

The presented protocol describes a facile surgical removal of the appendix (caecal patch) in a mouse followed by the induction of inflammatory bowel disease-associated colorectal cancer. This murine appendectomy model enables investigation of the biological role of the appendix in the pathogenesis of human gastrointestinal disease.

Modelo de apendicectomía murine del cáncer colorrectal asociado a la colitis crónica por localización precisa del parche de Caecal

The human appendix has been recently implicated to play important biological roles in the pathogenesis of various complex diseases, such as colorectal ...

Establishing In Situ Closed Circuit Perfusion of Lower Abdominal Organs and Hind Limbs in Mice

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small size of mouse organs, ex vivo perfusion of bone, bladder, skin, prostate, and reproductive organs is challenging or not feasible. Here, we report for the first time an in situ lower body perfusion circuit in mice that includes the above tissues, but bypasses the main clearance organs (kidney, liver, and spleen). The circuit is established by cannulating the abdominal aorta and inferior vena cava above the iliac artery and vein and cauterizing peripheral blood vessels. Perfusion is performed via a peristaltic pump with perfusate flow maintained for up to 2 h. In situ staining with fluorescent lectin and Hoechst solution confirmed that the microvasculature was successfully perfused. This mouse model can be a very useful tool for studying pathological processes as well as mechanisms of drug delivery, migration/metastasis of circulating tumor cells into/from the tumor, and interactions of immune system with perfused organs and tissues.

A protocol is described for in situ perfusion of the mouse lower body, including the bladder, the prostate, sex organs, bone, muscle and foot skin.

Establecimiento de la perfusión de circuito cerrado en situ de órganos abdominales inferiores y extremidades traseras en ratones

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small ...

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing incisional hernias. The laparoscopic IPOM involves implanting the mesh into the abdominal cavity through laparoscopy to repair an abdominal wall hernia. In the IPOM surgery, after the closure of the hernia ring, an anti-adhesion mesh is placed laparoscopically. The correct placement of this mesh is critical to the success of the method, and surgical skills are required to achieve perfect placement. If the mesh placement is not mastered properly, the operation and anesthesia time will be prolonged. In addition, improper placement of the mesh can lead to serious consequences, such as intestinal obstruction and mesh infection. A "contraposition and alignment" mesh fixation method is described in this study, which involves pre-marking the fixation position of the mesh to reduce the difficulty of mesh placement. A properly placed mesh is completely flat on the peritoneum, the edges are not curled or wrapped, and the mesh is adhered firmly such that there is no displacement after removing the pneumoperitoneum pressure. The "contraposition and alignment" mesh fixation technique offers the advantages of reliable placement of the mesh and fewer complications than other techniques, and it is easy to learn and master. It also allows for positioning the nail gun in advance based on the anatomy of the incisional hernia. This enables the use of the minimum number of nails possible while still ensuring good fixation, which can reduce the occurrence of complications and reduce the cost of surgery. Thus, the mesh fixation method described here is highly suitable for clinical applications based on the aforementioned advantages.

Presented here is a method for improving the mesh placement in laparoscopic incisional hernia repair, which can shorten the time required for mesh fixation and reduce the occurrence of postoperative chronic pain.

Aplicación de un nuevo método de fijación de malla en la reparación laparoscópica de hernia incisional

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing ...

Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of &gt;40% in cirrhotic patients and &gt;30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.

This protocol describes the laparoscopic resection of colorectal cancer liver metastases combined with ultrasound-guided microwave ablation. This technique can safely, effectively, and accurately treat refractory liver metastases &lt;3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Aplicación de la hepatectomía laparoscópica combinada con ablación intraoperatoria por microondas en la metástasis hepática del cáncer colorrectal

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to ...