C -シールのプロジェクトは、大学医療センターグローニンゲン（UMCG）とPolyganics BVの外科の部門間のコラボレーションの一部です。プロジェクトは当初、経済のオランダ省のSenterNovemのグラントによってサポートされていました。知的財産、商業的な関心や特許はPolyganics BVによって行われています。知的な関心はUMCGによって保持されます。 Polyganics BVは、この研究のための装置を製造しています。研究はUMCGで行われた。

C -シールの作製 C -シールは、ハードとソフトの分子成分から構成される、生分解性ポリウレタンで作られています。剛性の高い部品は、材料の望ましい弾性と機械的特性を提供します。ハードコンポーネントは、ジイソシアネート（OCN - NCO）と（HO - OH）ジオールから構成されるポリウレタンのバインディング（HNCO 2）で構成されています。 ソフトセグメントは、ポリウレタンの劣化の動作を決定します。ソフトセグメントは、プレポリマーと呼ばれ、ポリエーテル - エステルの鎖から構成されています。ハードセグメント、ソフトセグメントに組み込まれています。この組み込みは、重合の&quot;鎖延長&quot;と呼ばれています。 この2つのセグメントが相互作用すると、ポリエーテル - エステル - ウレタンが合成され、ポリマーは、C -シールに処理可能な状態です。 <ol><li>ポリマーは、スプレー塗装に適した濃度に希釈される。 </li><li>ポリウレタン溶液を一定の厚さまで回転する金型に噴霧される。 </li><li>金型が損傷を引き起こすことなく金型から安全にC -シールを解放するために水浴中に配置されます。 </li><li> C -シールを乾燥させる。 </li><li> C -シールは、タイベックのポーチにパッケージ化し、エチレンオキサイドガスを用いて滅菌される。 </li><li>滅菌後、C -シールが使用できる状態になります。 </li></ol>外科手術患者は、C -シールの研究への参加のためのインフォームドコンセントを与えている。 <ol><li>患者は、鐙に仰臥位に配置され、腹部と会陰部の消毒で、患者は、無菌ドレープで覆われている。 </li><li>正中切開を介して気腹や開腹の設立。 </li><li>肝臓と腹腔の検査。 </li><li> S状結腸と脾彎曲部の動員の動員。 </li><li>開腹手術で：近位切除マージンのレベルでS状結腸の一部門。 </li><li>仙骨面の開口腹膜の右傍切開、、上直腸動脈と静脈の結紮と分裂。 </li><li>直腸間膜の動員。 </li><li>遠位直腸の一部門。 </li><li>腹腔鏡下の設定で：恥骨上部の切開は、標本を抽出するために実行されます。近位S状結腸の一部門。 </li><li>直腸断端の長さが最大の場合、C -シールを使用することができます。 15センチメートル。 </li><li>腸の直径は、ステープラーの直径を決定し、我々は29または33 mmの直径でCEAステープラーを使用することを好む。 </li><li> C -シール、滅菌12ミリメートルのステンレス鋼の大理石は、清潔で滅菌外科用手袋を使用して、清潔で滅菌表面にアンパックされます。 </li><li> C -シールを開いて、大理石を挿入し、最初の接続端子でアンビルを挿入します。 C -シールの開口部の2つのフラップは、粘着テープの2つのストリップを使用して、アンビルに取り付けられている。 </li><li>アンビルは、C -シールのように接続端子&quot;穿刺&quot;C -シールの開放先端ことが進んでいる。ゆっくりと完全にC -シールを展開し、大理石が離れてアンビルからCシールの内側まで終わることを確認してください。 </li><li> C -シールを使用する際に吻合の任意のタイプ（エンドツーエンド、エンドツーサイド、サイドツーエンドとサイドツーサイド）を行うことができます。我々はサイドツーエンドの吻合を作成することを好む。近位腸管ループ内にアンビルを挿入する複数の方法があります。 C -シールは、これらの方法のいずれか（縫合/縦腸の切開をpursestringのオープン腸の端）を妨害しない</li><li>第一大理石の助けを借りて、C -シールと、必要に応じて、鈍鉗子を進めることによって、デ近位腸管ループ内にC -シールと一緒にアンビルを挿入します。 C -シールのテールが腸内で上方に配置されていることを確認し、C -シールの尾が引き伸ばされていることを確認し、（大理石はアンビルの適切な距離にあるはず）大理石の位置を確認する。その後、アンビルのピンで腸壁を貫通し、ピンの周りpursestringの縫合糸を作成する。 </li><li>ゆっくりと肛門を拡張させると直腸断端でステイプラを挿入します。ステープラーでアンビルを接続します。腸のねじれをチェックします。 </li><li>円形のステープラーを発射。今、腸の両端が接続されており、C -シールは、ステープルに接続されている</li><li>静かに肛門の外ステープラーを引き出します。 （C -シール月のツイストを）引き出すときより180度以上のステープルを切らないでください。直腸からステープルを除去することにより、C -シールが肛門からプルされます。肛門から約4cmの距離でC -シールをカット。 </li><li>直腸から大理石を削除します。多くの場合、大理石は、C -シールと一緒に出てくる。されていない場合は、軽く手動でC -シールと腸壁の間に位置している大理石を削除します。 </li><li>吻合を確認してください。オプションで、生理食塩水で骨盤を充填することにより空気のテストを実行し、肛門管（C -シール内とC -シールと腸間）に空気を注入する。 ABS気泡のENCEは、完全な吻合を確認する。 </li><li>示されている場合、保護ストーマを作成してください。 </li><li>腹腔およびトロカールの抽出の強制排気：腹腔鏡下の設定で。 </li><li>切開（s）を閉じる</li><li>術後の段階： 術後の回復は、ERAS（手術後の復旧性能を向上させた）プロトコル9によればです。 C -シールは、少なくとも1週間現場に残しておく必要があります。患者は制限がなく、C -シールを介して便を失う可能性があります。患者は順調に回復しておらず、吻合部の合併症が疑われていない場合、C -シールは、肛門のレベルで切断することができる。残りのC -シールが低下しますと、患者は自然な経路を介して便と一緒にCはシールが失われます。 </li></ol>代表的な結果 C -シールが（図2および3）が正しく適用されると、それは吻合をカバーしています。裂開が吻合部または近位直腸断端の吻合から遠位に形成されている場合は、C -シールが欠陥をカバーし、肛門から糞便を指示するので、糞便の血管外漏出が防止される。術後の段階で、肛門（図3）からC -シール突出している。 <img src="/files/ftp_upload/2223/2223fig1.jpg" alt="図1" /> 図1：C -シールの模式図。 <img src="/files/ftp_upload/2223/2223fig2.jpg" alt="図2" /> 図2：ステープラーの頭にC -シールを添付の模式図。 <img src="/files/ftp_upload/2223/2223fig3.jpg" alt="図3" /> 図3：直腸断端の近位腸管とホッチキスでC -シール添付と一緒にホチキスヘッドを挿入後、ホッチキスはC -シールと一緒に肛門から発射し、穏やかに引っ張られている。

<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>

IRBの承認：人間を対象とする手順については、大学医療センターグローニンゲンとINV研究のオランダの中央委員会での治験審査委員会（IRB）によって承認されている。人間の被験者（CCMO）。利害の衝突は宣言されません。

C -シールは、ステープル結腸直腸吻合における吻合部の漏れを防止を目的とした技術です。それは、開腹時に腹腔鏡手術でだけでなく、使用することができます。 C -シールは、吻合部裂開を防ぐわけではありませんが、それは腸の内腔の外側糞便の漏洩を防ぎます。 C -シールを適用する場合、特別な注意は、C -シールが近位腸管ループ内に挿入された時点では注意が必要です。それは主食C -シールを倍増することは理論上可能ですので、近位腸管ループ内にC -シールの適切なポジショニングは、重要です。 C -シールのダブルステープルは、C -シールの尾が折り畳まれている場合に発生し、ホッチキスとステープラーヘッドとの間に終わります。大理石は、近位腸管ループ内にC -シールの位置を決定する際に役立ちます。大理石は、C -シールのテールが引き伸ばされると吻合と一緒にホチキス止めになることができないことを保証するために、ステープラーの頭の十分な距離で配置する必要があります。 C -シールは、さまざまな方法で近位腸管ループ内に配置することができます。 C -シールが開いている腸の端を介して挿入され、尾は最初のステープラーのヘッドに続く：サイドツーエンドの吻合を優先する場合は、我々はこの以下のプロトコールにしたがって実行するように助言する。接続端子は、開放性腸端の方向にそれを刺すことで腸壁を貫通しています。その後、開いている腸の端が閉じられ、pursestringの縫合糸は、余分なサポートのための接続端子の周囲に配置されます。ピンがステープラーに接続され、大理石の位置がチェックされ、ステープラーが起動されます。 エンドツーエンドの吻合を優先する場合は、C -シールは、尾が最初に、オープンな近位腸管の端に挿入されます。 pursestringの縫合糸は、接続端子の周囲に腸の端を囲む。ピンがステープラーに接続され、大理石の位置がチェックされ、ステープラーが起動されます。 大学医療センターグローニンゲンで開始されたパイロットスタディでは、C -シールは、ステープル吻合10で続いて直腸の切除を受けた患者15例で採用した。臨床的または無症状のALは、これらの患者で診断された。現在、別の35例で、C -シールをテストする第II相試験は募集しています。

<table border="1">
		<thead>
		<tr>
		<th>Material Name</th>
		<th>Type</th>
		<th>Company</th>
		<th>Catalogue Number</th>
		<th>Comment</th>
		</tr>
		</thead>
		<tbody>
		
<tr>
<td>Stainless Steel Marble</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>C-seal</td>
<td>&nbsp;</td>
<td>Polyganics</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
		</tbody>
		</table>

the c-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage

結腸直腸吻合部のリーク電流（AL）は、高い罹患率と死亡率を1につながる結腸直腸手術における重篤な合併症である。 ALの発生率は、2.5〜20％2-5異なります。長年にわたり、吻合部リーク電流の発生率を下げることを目的とした多くの戦略が評価される6、7となっている。 ALの原因はおそらく多因子性である。病因の要因が不足して動脈血の供給、吻合部での吻合、血腫および/ ​​または感染症にかかる張力、および糖尿病とアテローム性動脈硬化症8と患者の共同病的な要因が含まれています。さらに、いくつかの吻合は技術的な障害のため、最初から不十分な場合があります。 現在、新しいデバイスは、結腸直腸吻合を保護し、ALの発生率を下げることを目的とした当研究所で開発されています。そのC -シールと呼ばれるこれは、円形のステープラーとの吻合にホチキス止めされbiofragmentableドレイン、です。それは、それによって漏れを防ぐ大腸吻合の管腔側をカバーしています。 C -シールは4cmのおおよその直径は25センチメートル（図1）のおおよその長さで、ドレイン薄肉状のチューブです。それは、生分解性ポリウレタンから成る管状デバイスです。粘着テープで二つのフラップは、チューブの一端に発見されています。これらのフラップは、吻合が行われた後、C -シールが肛門からプルできるように、円形のステープラーのアンビルにC -シールを添付するために使用されます。 C -シールは、少なくとも10日間その場に残ります。その後、それは強さを失うことになると胃腸の自然の内容と一緒に体内から分泌されることが低下します。 C -シールはdehiscencesの形成を妨げることはありません。しかし、それが腹腔内に糞便の血管外漏出を防ぎます。これは吻合部でのギャップが漏洩につながるしないことを意味します。 現在、ステープル吻合と（結腸）直腸切除が募集して受けている35人の患者におけるC -シールを第II相試験のテスト。 C -シールは、両方のオープン手順と同様に腹腔鏡手順で使用することができます。 C -シールは、肛門縁から15センチメートル内のステープル吻合に適用されます。ビデオでは、C -シールのアプリケーションは、狭窄コロンと憩室疾患を患っている患者で開いて拡張されたS状結腸切除術に示されています。

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

C -シールは、結腸直腸器械吻合を保護biofragmentableドレインです。このビデオでは、製造、導入と使用の詳細が表示されます。

C -シール：漏れから結腸直腸器械吻合を保護Biofragmentableドレイン

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

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

Research

JoVE Journal

Medicine

21.7K ビュー.  University Medical Center Groningen. C -シールは、結腸直腸器械吻合を保護biofragmentableドレインです。このビデオでは、製造、導入と使用の詳細が表示されます。

ビデオ: 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.

検証済みの内視鏡スコアリングシステムを使用して、大腸炎および結腸直腸腫瘍の重症度を評価するためにマウスでの柔軟な大腸内視鏡検査

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

医学

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;

大腸癌細胞の3次元モデルにおける侵襲性腫瘍微小環境の分子プロファイリングと<em&gt;生体外</em&gt;線維芽細胞

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.

マウス癌モデルからの循環腫瘍細胞の単離と伝播

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.

血管温存切除と吻合

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.

マウスの消化管吻合の作成

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.

ラットにおける 1 吻合胃バイパス (OAGB)

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.

慢性大腸炎関連大腸癌のマウス虫垂切除モデル、ケーカルパッチの正確な局在化

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.

マウスにおける下腹部および後肢の脳閉回路灌流における確立

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.

腹腔鏡下切開ヘルニア修復における新しいメッシュ固定法の適用

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.

大腸癌肝転移における腹腔鏡下肝切除術と術中マイクロ波焼灼術の併用

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