Il C-seal progetto è una parte della collaborazione tra il dipartimento di chirurgia della University Medical Center di Groningen (all&#39;UMCG) e Polyganics BV. Il progetto è stato inizialmente sostenuto da una borsa SenterNovem del Ministero olandese degli Affari Economici. Proprietà intellettuale, interesse commerciale e brevetti sono detenuti da Polyganics BV. Interesse intellettuale è detenuto dal all&#39;UMCG. Polyganics BV ha prodotto i dispositivi per questo studio. Lo studio è stato eseguito nel all&#39;UMCG.

Realizzazione della C-seal Il C-Seal è in poliuretano biodegradabile, composto da componenti molecolari duri e molli. La componente dura fornisce il materiale le proprietà benefiche elastiche e meccaniche. La componente rigida è composta da associazioni di poliuretano (HNCO 2) composto da un di-isocianato (OCN-NCO) e un diolo (HO-OH). Infine, nei soft determina il comportamento degradazione del poliuretano. Infine, nei soft si chiama prepolimero e consiste in polietere-estere catene. Il segmento rigido è incorporato nel segmento morbido. Questa incorporazione si chiama &#39;catena estensione&#39; della polimerizzazione. Una volta che questi due segmenti interagire, un poli-etere-estere-uretano è sintetizzata e il polimero è pronto per essere trasformato in un C-Seal: <ol><li> Il polimero viene diluita a una concentrazione adatta per verniciatura a spruzzo. </li><li> La soluzione è in poliuretano spruzzato in uno stampo a rotazione per un certo spessore. </li><li> Lo stampo viene messo in un bagno d&#39;acqua al fine di rilasciare il C-seal in tutta sicurezza dallo stampo senza causare danni. </li><li> Il C-seal è asciugato. </li><li> Il C-Seal è confezionato in un sacchetto Tyvek e sterilizzati con ossido di etilene. </li><li> Dopo la sterilizzazione, il C-Seal è pronto per l&#39;uso. </li></ol> Procedura chirurgica Il paziente ha dato il consenso informato per la partecipazione al C-seal studio. <ol><li> Il paziente viene posizionato in posizione supina in staffe, l&#39;addome e perineo viene disinfettato e il paziente viene coperto con teli sterili. </li><li> Istituzione di pneumoperitoneo o laparotomia attraverso un&#39;incisione mediana. </li><li> Ispezione del fegato e della cavità addominale. </li><li> Mobilitazione del sigma e la mobilitazione della flessura splenica. </li><li> In chirurgia a cielo aperto: la divisione del sigma a livello dei margini di resezione prossimale. </li><li> Paramediana destra incisione del peritoneo, l&#39;apertura del piano presacrale, legatura e divisione dell&#39;arteria rettale superiore e la vena. </li><li> Mobilitazione del mesoretto. </li><li> Divisione del retto distale. </li><li> In una cornice laparoscopica: un&#39;incisione sovrapubica si esegue per estrarre il campione. Divisione del colon prossimale sigma. </li><li> Il C-sigillo può essere utilizzato se la lunghezza del moncone rettale è di max. 15 centimetri. </li><li> Il diametro intestinale determina il diametro cucitrice, preferiamo usare una cucitrice CEA con un diametro di 29 o 33 mm. </li><li> Il C-seal e sterilizzato 12 millimetri in marmo in acciaio inox vengono decompressi su una superficie pulita e sterile, usando guanti chirurgici pulito e sterile. </li><li> Aprire la cartella C-seal, inserire il marmo e inserire l&#39;incudine con il perno prima connessione. I due lembi in apertura del C-seal sono attaccati al incudine utilizzando le due strisce di nastro adesivo. </li><li> L&#39;incudine è avanzato nel C-sigillo in modo che il &#39;punture&#39; il perno di collegamento estremità aperta appuntita del C-seal. Delicatamente aprire il C-seal completamente e assicurarsi che il marmo finisce dentro il C-seal lontano dal incudine. </li><li> Qualsiasi tipo di anastomosi (end-to-end, end-to-side, side-to-end e da lato a lato) può essere eseguita quando si utilizza il C-seal, noi preferiamo creare un side-to-end anastomosi . Ci sono strategie multiple per inserire l&#39;incudine nel ciclo dell&#39;intestino prossimale. Il C-seal non interferisce con nessuna di queste strategie (fine intestino aperto con sutura a borsa / incisione longitudinale intestinale) </li><li> Inserire l&#39;incudine insieme al C-seal in ansa de prossimale in primo luogo avanzare il C-sigillo con l&#39;aiuto del marmo e, se necessario, una pinza smussato. Garantire la coda del C-seal è posizionato verso l&#39;alto nell&#39;intestino e verificare che la coda del C-seal è allungato; verificare la posizione del marmo (il marmo deve essere ad una distanza adeguata l&#39;incudine). Poi penetrare la parete intestinale con perno l&#39;incudine e creare una sutura a borsa intorno al perno. </li><li> Delicatamente dilatare l&#39;ano e inserire la cucitrice nel moncone rettale. Collegare l&#39;incudine con la cucitrice. Verificare la presenza di torsione dell&#39;intestino. </li><li> Fuoco la cucitrice circolare. Ora, le estremità intestinali sono collegati e il C-seal è collegato al graffette </li><li> Estrarre delicatamente la cucitrice fuori l&#39;ano. Non girare la cucitrice più di 180 gradi quando si tira fuori (il C-seal torsione maggio). Eliminando la cucitrice dal retto, il C-seal è tirato attraverso l&#39;ano. Tagliare il C-sigillo ad una distanza di circa 4 cm dal ano. </li><li> Rimuovere il marmo dal retto. Spesso il marmo esce insieme al C-seal. In caso contrario, delicatamente rimuovere manualmente il marmo che si trova tra il C-seal e la parete intestinale. </li><li> Verificare l&#39;anastomosi. Facoltativamente, eseguire un test di aria riempiendo il bacino con una soluzione salina e iniettare aria nel canale anale (all&#39;interno del C-seal e tra il C-seal e intestino). Gli addominalimento di bolle conferma un anastomosi completo. </li><li> Se indicato, creare uno stoma di protezione. </li><li> In un ambiente laparoscopica: exsufflation della cavità addominale e l&#39;estrazione trequarti. </li><li> Chiudere l&#39;incisione (s) </li><li> Fase postoperatoria: Recupero post-operatorio è secondo le ere (recupero maggiore dopo l&#39;intervento) il protocollo 9. Il C-seal deve essere lasciato in situ per almeno una settimana. Il paziente non ha limitazioni e può perdere feci attraverso il C-seal. Quando il paziente ha recuperato bene e senza complicazioni anastomotiche sono sospettati, il C-seal può essere tagliato al livello dell&#39;ano. I restanti C-seal si degrada e il paziente perde la C-seal con le feci per via naturale. </li></ol> Rappresentante Risultati Quando il C-seal è applicata correttamente (figura 2 e 3), copre l&#39;anastomosi. Se una deiscenza si forma presso il sito anastomotiche o distale dalla anastomosi nel moncone prossimale del retto, stravaso di feci è impedito in quanto il C-seal copre il difetto e dirige la materia fecale attraverso l&#39;ano. Nella fase post-operatoria, il C-seal sporge dall&#39;ano (figura 3). <img src="/files/ftp_upload/2223/2223fig1.jpg" alt="Figura 1" /> Figura 1: Schema del C-seal. <img src="/files/ftp_upload/2223/2223fig2.jpg" alt="Figura 2" /> Figura 2: Rappresentazione schematica di fissaggio della C-seal alla testa cucitrice. <img src="/files/ftp_upload/2223/2223fig3.jpg" alt="Figura 3" /> Figura 3: Dopo aver inserito la cucitrice a testa con l&#39;allegata C-seal nell&#39;intestino prossimale e la cucitrice nel moncone rettale, la cucitrice è licenziato e delicatamente tirato attraverso l&#39;ano con il C-seal.

<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>

Approvazione IRB: Procedure che coinvolge soggetti umani sono stati approvati dalla Institutional Review Board (IRB) presso l&#39;University Medical Center Groningen e gli olandesi Comitato Centrale per la Ricerca inv. Soggetti umani (CCMO). Nessun conflitto di interessi dichiarati.

Il C-seal è una tecnica volta a prevenire perdite anastomotica in pinzati anastomosi colon-retto. Può essere utilizzato in chirurgia laparoscopica, così come durante una laparotomia. Il C-seal non impedisce deiscenza anastomotica, tuttavia, impedisce le perdite di feci al di fuori del lume intestinale. Quando si applica il C-seal, particolare attenzione deve essere assunto al momento in cui viene inserito il C-seal nel ciclo intestino prossimale. Posizionamento adeguato del C-sigillo nel circuito intestino prossimale è importante, dal momento che è teoricamente possibile doppio di base del C-seal. Pinzatura doppio del C-seal si verifica quando la coda del C-seal è piegato e finisce tra la cucitrice e la testa cucitrice. Il marmo aiuta a determinare la posizione del C-sigillo nel circuito intestino prossimale. Il marmo deve essere posizionato ad una distanza adeguata della testa cucitrice, per garantire che il C-seal coda è tesa e non può essere pinzati insieme al anastomosi. Il C-seal può essere posizionato nel circuito intestino prossimale in modi diversi. Se un side-to-end anastomosi è preferito, si consiglia di eseguire questo secondo il seguente protocollo: Il C-seal è inserita attraverso la parte dell&#39;intestino aperta, coda primo seguito da capo cucitrice. Il perno di connessione è poi penetrato attraverso la parete intestinale a coltellate nella direzione della fine dell&#39;intestino aperto. Successivamente, alla fine dell&#39;intestino aperto viene chiuso e una sutura a borsa è collocato intorno al perno di connessione per un sostegno supplementare. Il pin è collegato al cucitrice, la posizione del marmo viene controllata e la cucitrice è licenziato. Se una soluzione end-to-end anastomosi si preferisce, il C-seal è inserita nella estremità aperta dell&#39;intestino prossimale, coda per primo. Una sutura a borsa circonda la fine dell&#39;intestino intorno al perno di collegamento. Il pin è collegato al cucitrice, la posizione del marmo viene controllata e la cucitrice è licenziato. In uno studio pilota avviato dalla University Medical Center di Groningen, il C-seal è stata impiegata in 15 pazienti sottoposti a resezione del retto seguita da un pinzati anastomosi 10. Nessun clinica o subclinica è stata diagnosticata AL in questi pazienti. Attualmente, uno studio di fase II test del C-seal in altri 35 pazienti è di reclutamento.

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

Colorettale perdite anastomotiche (AL) è una grave complicanza in chirurgia colorettale porta alla alta morbilità e mortalità 1. L&#39;incidenza di AL varia tra il 2,5 e il 20% 2-5. Nel corso degli anni, molte strategie tese a ridurre l&#39;incidenza delle perdite anastomotiche sono stati esaminati 6, 7. La causa di AL è probabilmente multifattoriale. Fattori eziologici includono insufficiente apporto di sangue arterioso, la tensione sul anastomosi, ematoma e / o infezione nella sede anastomotica, e co-morbidità fattori del paziente come il diabete e aterosclerosi 8. Inoltre, alcuni anastomosi può essere insufficiente fin dall&#39;inizio a causa di un guasto tecnico. Attualmente un nuovo dispositivo è stato sviluppato nel nostro istituto volto a proteggere l&#39;anastomosi colon-retto e riducendo l&#39;incidenza di AL. Questo cosiddetto C-seal è uno scarico biofragmentable, che è cucito con punti metallici per l&#39;anastomosi con la cucitrice circolare. Esso copre il lato luminale delle anastomosi colon-retto evitando così perdite. Il C-seal è una parete sottile tube-like di scarico, con un diametro di circa 4 cm e una lunghezza di circa 25 cm (figura 1). Si tratta di un dispositivo tubolare composto di poliuretano biodegradabile. Due lembi con il nastro adesivo si trovano ad una estremità del tubo. I battenti sono utilizzati per collegare il C-seal per l&#39;incudine della cucitrice circolare, in modo che dopo l&#39;anastomosi è il C-seal può essere tirato attraverso l&#39;ano. Il C-seal rimane in situ per almeno 10 giorni. Successivamente perderà forza e si degradano ad essere secreto dal corpo insieme con il contenuto gastrointestinale naturale. Il C-seal non impedisce la formazione di deiscenze. Tuttavia, impedisce stravaso di feci nella cavità peritoneale. Ciò significa che una lacuna nel sito anastomotica non causare perdite. Attualmente, uno studio di fase II test del C-seal in 35 pazienti sottoposti (colo-) resezione del retto con anastomosi pinzato sta reclutando. Il C-sigillo può essere utilizzato in entrambe le procedure aperte e procedure laparoscopiche. Il C-seal è applicata unicamente in anastomosi pinzati entro 15 cm dal margine anale. Nel video, l&#39;applicazione della C-seal è mostrato in modo aperto resezione estesa del sigma in un paziente affetto da malattia diverticolare del colon con una stenosi.

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

Il C-seal è uno scarico biofragmentable proteggere l&#39;anastomosi colon-retto pinzati. In questo video, dettagli della produzione, diffusione e l&#39;uso sono mostrati.

Il C-sigillo: un drenaggio Biofragmentable Proteggere l&#39;anastomosi colorettale pinzati da dispersione

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

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Research

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Medicine

21.7K Views.  University Medical Center Groningen. Il C-seal è uno scarico biofragmentable proteggere l'anastomosi colon-retto pinzati. In questo video, dettagli della produzione, diffusione e l'uso sono mostrati.

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 colonscopia flessibile in topi per valutare la gravità della colite e colon-retto Tumori Utilizzo di un sistema Validated endoscopica Scoring

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

Ricerca

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 tumorale invasiva in un modello 3-Dimensional delle cellule del cancro colorettale e<em&gt; Ex vivo</em&gt; fibroblasti

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.

Isolamento e propagazione di cellule tumorali circolanti da un mouse cancro modello

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.

Nave-con parsimonia l'asportazione e l'anastomosi 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.

Creazione dell'anastomosi colica in topi

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.

Esclusione gastrica di un-anastomosi (OAGB) in ratti

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.

Murine Appendectomy Modello di Cronica Colite Associata Cancro Colorettale da Localizzazione precisa di Patch 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.

Creazione in Situ Circuito Chiuso Perfusione di Organi Addominali Inferiori e Arti Hind in Topi

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.

Applicazione di un nuovo metodo di fissazione della rete nella riparazione dell'ernia incisionale laparoscopica

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.

Applicazione dell'epatectomia laparoscopica combinata con l'ablazione intraoperatoria a microonde nelle metastasi epatiche del cancro del colon-retto

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