Name: a technique for subcutaneous abdominal adipose tissue biopsy via a non-diathermy method
Uploaded: 2017-09-30T13:00:00
Description: Watch this Scientific Journal Video about A Technique for Subcutaneous Abdominal Adipose Tissue Biopsy via a Non-diathermy Method at JoVE.com

This work received funding from the European Union&#39;s Horizon 2020 (grant agreement no. 645710) and 7th Framework (grant agreements no. 612547 and 319010) Programmes. The&#160;authors wish to thank Dr. Fotini Sourli-Chasioti for the assistance with the biopsy procedure. The authors also thank Mr. Yiorgos Paterakis for his valuable help in the preparation of the video.

The study conformed to the standards set by the Declaration of Helsinki and was approved by the University of Thessaly, Department of Exercise Science, &#914;i&#959;ethics Committee.
1. Preparation of the Surgery Equipment and Consumables
<ol>
	<li>Position a disinfected surgical field on a 4-wheel surgical Mayo stand.</li>
	<li>Position the following consumables and surgical equipment on a 4-wheel surgical Mayo stand: 
	One pair of straight operating scissors (15 cm) 
	One scalpel...

<ol>
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The aim of this study was to standardize a surgical technique for subcutaneous abdominal adipose tissue biopsy, performed under local anesthesia with a non-diathermy method in healthy men. Diathermy is commonly used in the operating room; however, possible side effects (i.e., flash fires and environmental toxicity)9 and delays in healing10 may occur. These unwanted effects of diathermy can generate health risks for both the operating staff and the patients/particip...

Adipose tissue biopsies offer tissue samples that, upon analysis, may provide an insightful overview of mechanisms relating to metabolism and disease. For instance, they are used for breast cancer tumor identification1, fatty acid composition examination2, and research on important metabolic and hormonal disease pathways3. To obtain subcutaneous adipose tissue biopsies in the abdominal area, researchers and physicians use either a surgical or a needle-based technique. However, surgical subcutaneous fat biopsies can offer tissue samples that may provide a more comprehensive overview of complex biological mechanisms [e.g., messenger ribonucleic acid (mRNA) expression, histological analysis, etc.]4. They have previously been used in healthy adults4 and can be safely performed at the bedside5.
The needle-based biopsy technique requires intense liposuction that may destroy the integrity of the tissue, and it usually retrieves a small amount of tissue (100-500 mg)6. These tissue samples may not be appropriate for complex research studies. Furthermore, compared to the needle-based technique, surgical subcutaneous fat biopsies can offer tissue samples that may draw a more complete picture of several inflammatory indices (e.g., B- and T-cell signaling); cytoskeleton regulation; cellular pathways; metabolic pathways of lipids, carbohydrates and amino acids; and oxidative phosphorylation pathways4. Also, the needle-based technique includes a higher risk for blood cell contamination than the surgical one4, while providing little information about the fibrotic regions of the tissue4,7,8.
Usually, a surgical adipose tissue biopsy includes a diathermy treatment for cauterizing blood vessels to prevent excessive bleeding9. A diathermy is also used to burn and destroy tissues affected by neoplasms and warts or tissues that are infected by disease9. This technique is particularly applicable in neurosurgery and eye surgery9.
The excessive use of diathermy may lead to the formation of necrotic tissue, causing infections and delaying the healing process10. Indeed, side effects such as flash fires and skin lesions in the tissue have been reported following diathermy9. Additionally, concerns have been raised about the toxicity of surgical smoke released by diathermy into the surgery environment, which may be inhaled by the participant/patient and the operating staff9. Indeed, the use of diathermy may cause air toxicity in the operating room equal to that produced by smoking six cigarettes11 and, although operating rooms typically have good ventilation systems, the contamination can last for at least 20 min12. However, in patients undertaking a tonsillectomy surgery, the diathermy method has shown less, but non-significant, post-operative pain13 and bleeding14 than the classic ligation hemostasis method. Overall, evidence regarding differences in the post-operative pain and bleeding rates after adipose tissue biopsies in healthy individuals barely exists. Given the lack of evidence and the side effects of diathermy, standardization of a non-diathermy method for adipose tissue biopsy is warranted. Accordingly, the aim of this study was to standardize a surgical technique for subcutaneous abdominal adipose tissue biopsy, performed under local anesthesia using a non-diathermy method in healthy men. Moreover, we outline the procedures for tissue collection to determine mRNA expression and protein concentration and to perform histological analyses.

<table border="0" cellpadding="0" cellspacing="0" width="981">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:327px;">&#160;Disinfected surgical field&#160;</td>
			<td style="width:183px;">Hartmann</td>
			<td style="width:175px;">23516-00</td>
			<td style="width:296px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Stainless Steel Instrument Stands (surgical Mayo)</td>
			<td>Medical Device Depot Inc.</td>
			<td>32000</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Operating Scissors straight 15 cm</td>
			<td>Karl Storz</td>
			<td>791903</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Scalpel No 11&#160;</td>
			<td>Swann-Morton</td>
			<td>203</td>
			<td>Bipolar, catalog number 429011</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Scarpel handle No 3</td>
			<td>Karl Storz</td>
			<td>488090</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Scissors curved 14 cm</td>
			<td>Karl Storz</td>
			<td>511514, 752918</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Mosquito forceps</td>
			<td>Karl Storz</td>
			<td>535012</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Tweezers Kocher&#160;</td>
			<td>Karl Storz</td>
			<td>530416</td>
			<td>Bipolar, catalog number 830316</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Surgical tweezers</td>
			<td>Karl Storz</td>
			<td>793216</td>
			<td>Bipolar, catalog number 831016</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Povidone-iodine&#160;</td>
			<td>Various</td>
			<td>Not applicable</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Suture 4.0 Vicryl</td>
			<td>Johnsons</td>
			<td>V4970H&#160;</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Scissors straight 11 cm</td>
			<td>Karl Storz</td>
			<td>512511 DS</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Needle holder 15 cm</td>
			<td>Karl Storz</td>
			<td>515515</td>
			<td>Bipolar, catalog number 213015</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">&#160;Sterile gauzes</td>
			<td>Hartmann</td>
			<td>3021</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">&#913;dhesive sterile gauze&#160;</td>
			<td>Digas medical equipment</td>
			<td>2889</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">10 mL syringe with disinfected needle</td>
			<td>Alpha medical solutions</td>
			<td>10310-55-0010</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">2%-xylocaine (no adrenaline)</td>
			<td>Various</td>
			<td>Not applicable</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Sterile surgical gloves&#160;</td>
			<td>Sempermed</td>
			<td>10001</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Eppendorf tubes</td>
			<td>Kartell</td>
			<td>16283</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">10% formalin&#160;</td>
			<td>Alpha medical solutions</td>
			<td>11016-30-2909</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Tubes 120 mL</td>
			<td>Digas medical equipment</td>
			<td>9025</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Liquid nitrogen at -190&#176;C</td>
			<td>Revival</td>
			<td>Not applicable</td>
			<td></td>
		</tr>
	</tbody>
</table>

a technique for subcutaneous abdominal adipose tissue biopsy via a non-diathermy method

Adipose tissue biopsies offer tissue samples that, upon analysis, may provide insightful overviews of mechanisms relating to metabolism and disease. To obtain subcutaneous adipose tissue biopsies in the abdominal area, researchers and physicians use either a surgical or a needle-based technique. However, surgical subcutaneous fat biopsies can offer tissue samples that may provide a more comprehensive overview of the complexities of biological indices in white adipose tissue. Usually, a surgical adipose tissue biopsy includes a diathermy treatment for cauterizing blood vessels to prevent excessive bleeding. Nevertheless, side effects, such as flash fires and skin lesions in the tissue, have been reported after diathermy. Therefore, we aimed to standardize a surgical abdominal adipose tissue biopsy performed under local anesthesia using a non-diathermy method. We conducted 115 subcutaneous adipose tissue biopsies in healthy men using a non-diathermy abdominal surgical biopsy method. Our results showed three cases of excessive post-operation bleeding out of 115 operations (2.61%).In conclusion, our standardized subcutaneous abdominal adipose tissue surgical biopsy using a non-diathermy method can be safely applied to healthy men at the bedside, with minimal side effects.

The characteristics of the participants are provided in Table 1. The stitches in the area of the incision fell off within the next 8-12 days. We completed a total of 115 subcutaneous adipose tissue biopsies using the non-diathermy abdominal surgical biopsy method in healthy adult men (age: 35.2 &#177; 6.9 years; body mass index: 27.3 &#177; 4.4; and body fat percentage: 27.0 &#177; 9.0%). Post-biopsy excessive bleeding was observed in three cases (prevalence: 2.61%) two d...

Watch this Scientific Journal Video about A Technique for Subcutaneous Abdominal Adipose Tissue Biopsy via a Non-diathermy Method at JoVE.com

A Technique for Subcutaneous Abdominal Adipose Tissue Biopsy via a Non-diathermy Method

We standardized an abdominal adipose tissue biopsy using a non-diathermy method performed under local anesthesia. Three cases of excessive post-operation bleeding out of 115 operations (2.61%) occurred.We conclude that an abdominal adipose tissue surgical biopsy using a non-diathermy method can be safely applied to healthy men.

Adipose tissue biopsies offer tissue samples that, upon analysis, may provide insightful overviews of mechanisms relating to metabolism and disease. To ...

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