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).

Declaración de Ética: Este procedimiento en seres humanos ha sido aprobado por la Junta de Revisión Institucional (IRB) en el Hospital de la Universidad Ajou. 1. Preparación para la Cirugía <ol><li> Permitir una dieta blanda un día antes de la cirugía, sin nada por la boca después de la medianoche antes de la cirugía. Nota: No inserte una sonda nasogástrica antes y durante la cirugía. Este protocolo no utiliza ningún tubo para desinflar el estómago. En lugar de eso, el gas intra-gástrico puede ser aspirado por aguja de punción laparoscópica si el estómago se distiende causando visión limitada para la cirugía laparoscópica. </li><li> Después de colocar al paciente en la mesa de operaciones, administrar el agente de inducción (tiopental sódico, 100 mg). </li><li> Después de la inyección intravenosa de un relajante muscular (bromuro de rocuronio, 1,0 mg / kg), insertar el tubo endotraqueal a través de la cavidad oral. </li><li> Iniciar el gas anestésico (Sevoflurane, 2-3%) a través del tubo endotraqueal, a continuación, controlar THe paciente para la estabilidad durante la cirugía. </li></ol> 2. Procedimiento quirúrgico antes intraoperatoria gastroscopia <ol><li> Colocar al paciente en posición de Trendelenburg inversa, y de pie en el lado derecho de la paciente. </li><li> Hacer 10 mm incisión en la zona infraumbilical, e insertar el primer trocar en la cavidad abdominal. </li><li> Tan pronto como se inserta el trocar, conectar el tubo de gas de dióxido de carbono con el trocar para crear un neumoperitoneo de 15 - 18 mm Hg. </li><li> Insertar un laparoscopio rígido de 30 ° a través del trócar, y explorar la cavidad abdominal en un monitor conectado con el sistema laparoscópico. </li><li> Inserte 4 trócares adicionales (uno de 12 mm y tres 5 mm) como puertos de trabajo. Inserte 12 mm trocar en el lado superior derecho del ombligo. Insertar otros tres trócares de 5 mm en el lado superior izquierdo del ombligo y los dos cuadrantes superiores externos del abdomen. </li><li> Diseccionar el ligamento gastrocólico a lo largo del colon transverso hacia el inferio un poste del bazo con unas tijeras endoscópicas ultrasónicas. </li><li> Ligar la arteria y la vena gastroepiplóica izquierdo procedente de los vasos esplénicos en la raíz con una pinza laparoscópica y la resección de ellas con unas tijeras endoscópicas ultrasónicos, después de la exposición del borde superior de la cola del páncreas. </li><li> Con unas tijeras endoscópicas ultrasónicos, diseccionar los ganglios linfáticos peripyloric todo el píloro y la cabeza del páncreas, y resecar los vasos gastroepiploicos correctas en su origen. </li><li> Antes de la resección de la primera porción del duodeno, sujetar el duodeno con una pinza laparoscópica para evitar la migración de gas en el intestino delgado durante el procedimiento gastroscópico (Figura 1). </li></ol> 3. intraoperatoria gastroscopia <ol><li> Muévase hacia el lado izquierdo de la cabeza del paciente para realizar una gastroscopia intraoperatoria. </li><li> Insertar un protector de la goma para proteger los dientes y las encías durante gastroscopia intraoperatoria. </li><li> Gire el head del paciente hacia el lado izquierdo para la inserción del gastroscopio. </li><li> Insertar el gastroscopio en el estómago cuidadosamente a través de la boca y el esófago, para evitar lesiones en la mucosa de la cavidad oral, el esófago y el estómago. </li><li> Insuflar el estómago mediante la inyección de gas a través del gastroscopio para localizar la lesión primaria. Nota: La mayoría de los gastroscopios tienen un botón específico para inyectar gas en el intestino durante el procedimiento. </li><li> Aproximar la distancia entre el borde proximal del tumor y la unión esofagogástrica utilizando la escala marcada en el gastroscopio (Figura 2), y llevar a cabo una gastrectomía total (como se ha descrito anteriormente) si la distancia es demasiado corta para salvar el estómago proximal. 10 </li><li> Si gastrectomía total no es necesario, inserte un inyector endoscópica a través de un pequeño agujero del gastroscopio, e inyectar 2-3 cc de índigo carmín en la pared gástrica utilizando un inyector endoscópica en un área 2-3 cm proximal desde el margen del tumor, evitando intra o fugas extraluminal (Figura 3A). <ol><li> Insertar la aguja del inyector en la pared gástrica oblicuamente para evitar la perforación de la pared gástrica por la aguja. Además, inyectar índigo carmín muy lentamente para identificar fugas intraluminal durante la inyección. </li></ol></li><li> Después de la inyección de colorante, gas de inflado aspirado a través del gastroscopio para hacer más fácil el procedimiento laparoscópico. Nota: La mayoría de los gastroscopios tienen un botón específico para aspirar gas de inflación durante el procedimiento. </li></ol> 4. Procedimiento después de la gastroscopia intraoperatoria <ol><li> Volver al lado derecho de la paciente después del procedimiento gastroscopia. </li><li> En la vista laparoscópica, confirmar la porción proximal del tumor mediante la identificación de tinción serosal por colorante azul (Figura 3B). </li><li> Marque la parte manchada de ser resecado con una pinza endoscópica, evitando la participación de un tumor en la remargen sección (Figura 4A). Nota: Se recomienda realizar este procedimiento en un plazo de 5 - 10 minutos después del inicio de la cirugía, porque el tinte a veces se puede lavar a cabo durante los procedimientos posteriores. </li><li> Si el colorante no se puede detectar en la serosa, inmediatamente volver a inyectar el medio de contraste bajo visualización gastroscopia. </li></ol> 5. Procedimiento después de la gastroscopia intraoperatoria <ol><li> Resecar el duodeno, y realizar otros procedimientos para la disección de los ganglios linfáticos de acuerdo con las directrices de tratamiento japoneses. 11 </li><li> Después de la disección de los ganglios linfáticos, resecar el estómago en la ubicación adecuada, al menos, 3 cm proximal desde el margen del tumor, guiado por el clip de marcado, usando 2 grapadoras endoscópicas. </li><li> Tan pronto como el estómago distal se reseca, insertar la muestra en una bolsa endoscópica y retirarlo de la cavidad abdominal a través de una 2 - cm de extensión 3 del sitio trocar infraumbilical. </li><li> Enviar el tejido desde el margen proximal depatología para su evaluación histológica intraoperatoria. </li><li> Después de la confirmación de tejido libre de tumor en la porción proximal del estómago resecado, realizar una anastomosis entre el estómago restante y el yeyuno proximal con grapadoras lineales intracorpórea (Figura 4B). </li></ol>

<ol>
	<li>Kim, Y. W., Yoon, H. M., Eom, B. W., Park, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+minimally+invasive+surgery+for+gastric+cancer+in+Korea.">History of minimally invasive surgery for gastric cancer in Korea.</a> J Gastric Cancer. 12, 13-17 (2012).</li><li>Kim, H. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morbidity+and+mortality+of+laparoscopic+gastrectomy+versus+open+gastrectomy+for+gastric+cancer:+an+interim+report--a+phase+III+multicenter,+prospective,+randomized+Trial+(KLASS+Trial).">Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial).</a> Ann Surg. 251, 417-420 (2010).</li><li>Kim, M. C., Kim, K. H., Kim, H. H., Jung, G. 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Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+totally+laparoscopic+gastrectomy+less+invasive+than+laparoscopy-assisted+gastrectomy?:+prospective,+multicenter+study.">Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.</a> J Gastrointest Surg. 12, 1015-1021 (2008).</li><li>Hyung, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+tumor+localization+using+laparoscopic+ultrasonography+in+laparoscopic-assisted+gastrectomy.">Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy.</a> Surg Endosc. 19, 1353-1357 (2005).</li><li>Jeong, O., Cho, S. B., Joo, Y. E., Ryu, S. Y., Park, Y. 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The authors have no conflicts of interest or financial ties to disclose.

En este protocolo, se introdujo un procedimiento para gastroscopia intraoperatoria para identificar con precisión y fiabilidad localización del tumor en el tercio medio del estómago. Hemos sido capaces de realizar con éxito gastrectomía subtotal distal sobre la base de los resultados de la gastroscopia intraoperatoria. Hasta la fecha, se han aplicado varios métodos para identificar la ubicación de cáncer gástrico precoz en la vista laparoscópica. Métodos más comunes utilizados re...

La cirugía laparoscópica se ha convertido en el tratamiento de elección para el cáncer gástrico precoz en los países del Este de Asia, incluyendo Corea y Japón. 1 La ventaja de esta cirugía ha sido bien demostrado en varios ensayos clínicos para el cáncer gástrico temprano (CGT). La mayoría de 2-4 los procedimientos en estos ensayos se realizaron por laparoscopia, pero la identificación de la localización del tumor, la resección del estómago, incluyendo el tumor primario, y la reconstrucción se realizaron a través de la minilaparotomía. Por lo tanto, una cirugía que requiera minilaparotomía ha sido etiquetado como &quot;gastrectomía asistida por laparoscopia.&quot; Recientemente, sin embargo, los procedimientos quirúrgicos han evolucionado para minimizar el trauma, la mejora de la calidad de vida postoperatoria de los pacientes. Dado que este concepto también se ha aplicado en la cirugía laparoscópica para el cáncer gástrico, algunos cirujanos laparoscópicos experimentados han tratado de evitar la minilaparotomía. Totalmente gastrectomía laparoscópica (GTL) para gastricáncer de c requiere que todos los procedimientos se realicen mediante únicos dispositivos laparoscópicos, sin necesidad de una minilaparotomía adicional para la resección de la pieza y la anastomosis. Dado que este tipo de resultados de la cirugía en menos dolor y una recuperación más rápida con relación a abrir o cirugía asistida por laparoscopia, que requieren la laparotomía, más cirujanos prefieren. 5,6 Sin embargo, un obstáculo para TLG para el cáncer gástrico es la localización del tumor y sin visualización directa o palpación para determinar el área de la resección del estómago. Tumor ausencia en el margen de resección es muy importante para lograr el éxito en la cirugía del cáncer gástrico. Si hay afectación tumoral en el margen de resección durante la gastrectomía distal para el cáncer gástrico, es necesaria la resección adicional para evitar dejar tumor en el estómago restante. En la cirugía abierta y la laparoscopia asistida, el tumor primario puede ser fácilmente localizado por palpación o la visualización directa a través de una gastrostomía temporal. Sin embargo, debido a que la primatumor ry no se detecta fácilmente en la vista laparoscópica, la determinación de los márgenes de resección de EGC en TLG puede ser difícil. Se han propuesto varios otros métodos que requieren la gastroscopia preoperatoria adicional para determinar los márgenes de resección. 7-9 Sin embargo, gastroscopia preoperatoria adicional puede ser un inconveniente para los pacientes. Hemos introducido un procedimiento para la gastroscopia intraoperatoria para marcar directamente a los tumores durante el TLG para el cáncer gástrico en el tercio medio del estómago. En este protocolo, se aplicó la cirugía laparoscópica para los pacientes con cáncer gástrico en los primeros estudios preoperatorios, que no están incluidos en la indicación absoluta para la disección endoscópica de la submucosa.

<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

La determinación de los márgenes de resección de cáncer gástrico, que no estén expuestos a la superficie serosa del estómago, es el procedimiento más importante durante la gastrectomía total laparoscópica (GTL). El objetivo de este protocolo es dar a conocer un procedimiento para la gastroscopia intraoperatoria, con el fin de marcar directamente a los tumores durante el TLG para el cáncer gástrico en el tercio medio del estómago. Los pacientes que fueron diagnosticados con adenocarcinoma en el tercio medio del estómago se inscribieron en esta serie de casos. Antes de la cirugía, no se realiza gastroscopia adicional para la localización del tumor. Bajo anestesia general, la movilización laparoscópica del estómago se realiza en primer lugar. Después de la primera porción del duodeno se moviliza desde el páncreas y se sujeta, el cirujano mueve hacia el otro lado para el procedimiento gastroscópico. En la inserción de un gastroscopio a través de la cavidad oral en el estómago, 2-3 cc de carmín de índigo se administra a través de un inyector endoscópica en la mu gástricocapa Escleritos en el margen proximal del estómago. La ubicación de la serosa de colores en la visión laparoscópica se utiliza para guiar subtotal gastrectomía distal, sin embargo, gastrectomía total se lleva a cabo si el tumor está demasiado cerca de la unión esofagogástrica. Un espécimen se muestrea después de la gastrectomía distal confirmar longitud suficiente del margen de resección de tumor antes de la reconstrucción. En nuestra serie de casos, todos los pacientes tenían márgenes libres de tumor y no requiere la resección adicional. No hubo morbilidad relacionada con el procedimiento gastroscópico, y el tiempo requerido para el procedimiento ha disminuido gradualmente a aproximadamente cinco minutos. gastroscopia intraoperatoria para la localización del tumor es un método preciso y tolerado por los pacientes con cáncer gástrico sometidos a gastrectomía distal laparoscópica totalmente.

De los 20 pacientes que fueron sometidos a gastroscopia intraoperatoria, 18 fueron sometidos a una gastrectomía subtotal distal, guiada por los hallazgos en la gastroscopia. Sin embargo, se les practicó una gastrectomía total en dos pacientes, debido a que el margen del tumor proximal estaba demasiado cerca de la unión esofagogástrica, según se determine en la gastroscopia intraoperatoria. La distancia desde el tumor al borde de resección proximal fue de 3,5 cm y 2,5 cm en estos d...

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.

Gastroscopia intraoperatoria para la localización del tumor en la cirugía laparoscópica para el adenocarcinoma gástrico

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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12.6K vistas.  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.

Video: 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.

Roux-en-Y Gastric operación de bypass en las ratas

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

Investigación

Medicina

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.

La detección de Modificadores melanoma utilizando un modelo de pez cebra Tumor autóctona

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.

La especificidad de la evaluación de Medicamentos contra el cáncer<em&gt; In Vitro</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.

Guía de imagen basada en tomografía computarizada intraoperatoria de haz de cono para fusión de imágenes transforaminales mínimamente invasiva

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.

Ecografía intraoperatoria en cirugía espinal

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.

Localización de nódulos transtorácicos de navegación electromagnética para cirugía torácica mínimamente invasiva

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.

Pancreatectomía Izquierda Radical Laparoscópica para Cáncer de Páncreas: Estrategia Quirúrgica y Video Técnica

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.

Un Protocolo Para Roux-en-Y Bypass Gástrico En Ratas Usando Grapadoras Lineales

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.

Cirugía cooperativa laparoscopia-endoscopia para el tratamiento de tumores del estroma gástrico gastrointestinal

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.

Hepatectomía central laparoscópica fluorescente para el cáncer de hígado con tinción negativa con verde de indocianina

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