私達は私達がビデオを制作し、公開する許可の適用を通じてこの作業をサポートするための医療と無制限の教育助成金を感謝したい。

<dt&gt;シングルポートドナー腎摘出：</dt&gt;<ol&gt;<li左側上で右側臥位での&gt;プレース患者</li&gt;<li&gt;オペレーティング外科医は外科医の右側と尾の方にに立って、アシスタントのカメラドライバと腹部に直面して立って、</li&gt;<li&gt;ストレッチで臍上の5cmの切開を測定</li&gt;<li&gt;臍に切開を作成し、腹腔を入力します。</li&gt;<li&gt;アレクシス巻トラクターを置いて</li&gt;<liジェルポイントシール（2 5ミリメートルポートと1 15ミリメートルポート）としてビデオにdisrectedと示されるの&gt;プレース適切な腹腔鏡ポート</li&gt;<li&gt;アレクシスリトラクタでゲル化点のシールを配置し、腹部をInsuffolate</li&gt;<li&gt;後腹膜のオフ降順コロンを動員</li&gt;<li&gt;脾臓と腎臓の上極との間の平面を作成するために外側から内側に脾臓を動員</li&gt;<li&gt;腎臓の下極まで腸骨血管のレベルから尿管や性腺静脈を摘出</li&gt;<li&gt;へその領域における腎静脈に性腺静脈に従ってください。必要に応じて性腺静脈を結紮し、腎静脈の近くに分けることができます。</li&gt;<li&gt;どんな腰椎静脈を特定し、分割</li&gt;<li&gt;クリップの間に副腎静脈を識別および除算</li&gt;<li&gt;円周腎静脈を摘出</li&gt;<li&gt;腎動脈を特定し、円周方向にそれを細かく分析</li&gt;<li&gt;後腹膜の全体の腎臓をオフMobilze</li&gt;<li&gt;ペースより低い5ミリメートルポートはゲル化点のシールに配置されていた5〜12ミリメートルポート</li&gt;<li&gt;腸Vesselswith遠藤- ​​GIAステープラーで尿管や性腺静脈をライゲーションし、分割</li&gt;<li&gt; endoshearsで除算して遠藤- TA血管ステープラーと腎動脈をライゲーションし、</li&gt;<li&gt;遠藤- GIAステープラーで腎静脈をライゲーションし、分割</li&gt;<li&gt;の腎臓と大きなEndocatchの袋を置き、</li&gt;<li&gt;ジェルポイントシールとアレクシスのトラクターを削除します。</li&gt;<li&gt;腹腔から腎臓を削除します。</li&gt;<li&gt;ジェルポイントシールを交換してください</li&gt;<li&gt;止血のための調査および脾臓とともに、適切な位置で下行結腸を交換してください</li&gt;<li&gt;皮膚切開後、腹壁の筋膜を閉じて、</li&gt;<li&gt;場所のドレッシング</li&gt;</ol

<ol>
	<li>Canes, D., Berger, A., Aron, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparo-endoscopic+single+site+(LESS)+versus+standard+laparoscopic+left+donor+nephrectomy:+matched-pair+comparison.">Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison.</a> Eur Urol. 57, 95-101 (2010).</li><li>Skrekas, G., Papalois, V. E., Mitsis, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+live+donor+nephrectomy:+a+step+forward+in+kidney+transplantation.">Laparoscopic live donor nephrectomy: a step forward in kidney transplantation.</a> JSLS. 7, 197-206 (2003).</li><li>Giessing, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+living-donor+nephrectomy.">Laparoscopic living-donor nephrectomy.</a> Nephrol Dial Transplant. 19, iv36-iv40 (2004).</li><li>Eng, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+laparoscopic+donor+nephrectomy+in+renal+transplantation.">The role of laparoscopic donor nephrectomy in renal transplantation.</a> Am Surg. 76, 349-353 (2010).</li><li>Kommu, S. S., Kaouk, J. H., Rane, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparo-endoscopic+single-site+surgery:+preliminary+advances+in+renal+surgery.">Laparo-endoscopic single-site surgery: preliminary advances in renal surgery.</a> BJU Int. 103, 1034-1037 (2009).</li><li>Canes, D., Desai, M. M., Aron, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transumbilical+single-port+surgery:+evolution+and+current+status.">Transumbilical single-port surgery: evolution and current status.</a> Eur Urol. 54, 1020-1029 (2008).</li><li>Desai, M. M., Berger, A. K., Brandina, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoendoscopic+single-site+surgery:+initial+hundred+patients.">Laparoendoscopic single-site surgery: initial hundred patients.</a> Urology. 74, 805-812 (2009).</li><li>Ganpule, A. P., Dhawan, D. R., Kurien, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoendoscopic+single-site+donor+nephrectomy:+a+single-center+experience.">Laparoendoscopic single-site donor nephrectomy: a single-center experience.</a> Urology. 74, 1238-1240 (2009).</li><li>Gill, I. S., Canes, D., Aron, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single+port+transumbilical+(E-NOTES)+donor+nephrectomy.">Single port transumbilical (E-NOTES) donor nephrectomy.</a> J Urol. 180, 637-641 (2008).</li><li>Raman, J. D., Bensalah, K., Bagrodia, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laboratory+and+clinical+development+of+single+keyhole+umbilical+nephrectomy.">Laboratory and clinical development of single keyhole umbilical nephrectomy.</a> Urology. 70, 1039-1042 (2007).</li><li>Raybourn, J. H., Rane, A., Sundaram, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoendoscopic+single-site+surgery+for+nephrectomy+as+a+feasible+alternative+to+traditional+laparoscopy.">Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy.</a> Urology. 75, 100-103 (2010).</li><li>Dindo, D., Demartines, N., Clavien, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Classification+of+surgical+complications:+a+new+proposal+with+evaluation+in+a+cohort+of+6336+patients+and+results+of+a+survey.+Ann+Surg.">Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg.</a> 240, 205-213 (2004).</li><li>Bargman, V., Sundaram, C. P., Bernie, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Randomized+trial+of+laparoscopic+donor+nephrectomy+with+and+without+hand+assistance.">Randomized trial of laparoscopic donor nephrectomy with and without hand assistance.</a> J Endourol. 20, 717-722 (2006).</li><li>El-Galley, R., Hood, N., Young, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Donor+nephrectomy:+A+comparison+of+techniques+and+results+of+open,+hand+assisted+and+full+laparoscopic+nephrectomy.">Donor nephrectomy: A comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy.</a> J Urol. 171, 40-43 (2004).</li><li>Velidedeoglu, E., Williams, N., Brayman, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+open,+laparoscopic,+and+hand-assisted+approaches+to+live-donor+nephrectomy.">Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy.</a> Transplantation. 74, 169-172 (2002).</li><li>Raman, J. D., Bagrodia, A., Cadeddu, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-incision,+umbilical+laparoscopic+versus+conventional+laparoscopic+nephrectomy:+a+comparison+of+perioperative+outcomes+and+short-term+measures+of+convalescence.">Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence.</a> Eur Urol. 55, 1198-1204 (2009).</li></ol>

博士デビッドLeeserとジョセフデルピッツォは両方応用医が主催する講座で、単一のポートのテクニックを教える。

シングルポートのドナー腎摘出は、ドナーの腎摘出術の進化で実行可能な次のステップです。時には、手順のステップは、ビデオで説明したようにサイドの撤回と機動性に側を制限する、単一のポートに固有の課題のために正しい順序で達成されなければならない。美容術が優れていると患者は非常に迅速な活動に戻ります。手順が進化するにつれ、新しい楽器が開発されることも、単一のポートのエントリを介してより多くの複雑なタスクの多くの達成の補佐官になります。

single port donor nephrectomy

2007年には、RANEはEndourologyのWorld Congressで小さな非機能腎臓のための最初のシングルポート腎摘除術を紹介。その時以来、腎摘出術のための単一ポートの手術の使用は、ドナー腎摘除を含むように拡張しました。今後2年間で技術は、ドナーの腎摘出を含むようにnephrectomiesの他の多くの種類のために採用された。我々はGelpointデバイスを使用して単一のポートのドナー腎摘出術のための私たちのテクニックを紹介。私たちは正常に100以上の患者ではこの手術を行い、1000人以上の腹腔鏡nephrectomiesの私たちの経験にこの経験を追加している。適切な設備と技術で、単一のポートのドナー腎摘除術は、ライブドナーの大半に安全かつ効果的に行うことができる。私たちは、手術時間と最も重要なことは私たちの移植の成果は、単一のポートのドナー腎摘除術の採用で大幅に変更されていないことを発見した。我々は、シングルポートのドナー腎摘出は、生体ドナーのケアで一歩前進を表すと考えています。

Watch this Scientific Journal Video about Single Port Donor Nephrectomy at JoVE.com

Single Port Donor Nephrectomy

腹腔鏡技術は20年前に導入されて以来、シングルポート腹腔鏡手術は、何のような外科的治療の標準治療を変えている。我々はGelpointデバイスを使用して単一のポートのドナー腎摘出のテクニックを紹介。私たちは正常に100人の患者にこの手術を実施した。

シングルポートのドナー腎摘出

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology.  Since that time, the ...

Research

JoVE Journal

Medicine

48.2K ビュー.  Weill Cornell Medical College of Cornell University. 腹腔鏡技術は20年前に導入されて以来、シングルポート腹腔鏡手術は、何のような外科的治療の標準治療を変えている。我々はGelpointデバイスを使用して単一のポートのドナー腎摘出のテクニックを紹介。私たちは正常に100人の患者にこの手術を実施した。

ビデオ: Single Port Donor Nephrectomy

Corneal Donor Tissue Preparation for Endothelial Keratoplasty

Over the past ten years, corneal transplantation surgical techniques have undergone revolutionary changes1,2. Since its inception, traditional full thickness corneal transplantation has been the treatment to restore sight in those limited by corneal disease. Some disadvantages to this approach include a high degree of post-operative astigmatism, lack of predictable refractive outcome, and disturbance to the ocular surface. The development of Descemet's stripping endothelial keratoplasty (DSEK), transplanting only the posterior corneal stroma, Descemet's membrane, and endothelium, has dramatically changed treatment of corneal endothelial disease. DSEK is performed through a smaller incision; this technique avoids 'open sky' surgery with its risk of hemorrhage or expulsion, decreases the incidence of postoperative wound dehiscence, reduces unpredictable refractive outcomes, and may decrease the rate of transplant rejection3-6.
Initially, cornea donor posterior lamellar dissection for DSEK was performed manually1 resulting in variable graft thickness and damage to the delicate corneal endothelial tissue during tissue processing. Automated lamellar dissection (Descemet's stripping automated endothelial keratoplasty, DSAEK) was developed to address these issues. Automated dissection utilizes the same technology as LASIK corneal flap creation with a mechanical microkeratome blade that helps to create uniform and thin tissue grafts for DSAEK surgery with minimal corneal endothelial cell loss in tissue processing.
Eye banks have been providing full thickness corneas for surgical transplantation for many years. In 2006, eye banks began to develop methodologies for supplying precut corneal tissue for endothelial keratoplasty. With the input of corneal surgeons, eye banks have developed thorough protocols to safely and effectively prepare posterior lamellar tissue for DSAEK surgery. This can be performed preoperatively at the eye bank. Research shows no significant difference in terms of the quality of the tissue7 or patient outcomes8,9 using eye bank precut tissue versus surgeon-prepared tissue for DSAEK surgery. For most corneal surgeons, the availability of precut DSAEK corneal tissue saves time and money10, and reduces the stress of performing the donor corneal dissection in the operating room. In part because of the ability of the eye banks to provide high quality posterior lamellar corneal in a timely manner, DSAEK has become the standard of care for surgical management of corneal endothelial disease.
The procedure that we are describing is the preparation of the posterior lamellar cornea at the eye bank for transplantation in DSAEK surgery (Figure 1).

Endothelial corneal transplantation is a surgical technique for treatment of posterior corneal diseases. Mechanical microkeratome dissection to prepare tissue results in thinner, more symmetric grafts with less endothelial cell loss and improved outcomes. Dissections can be performed at the eye bank prior to corneal transplantation surgery.

内皮角膜移植のために角膜ドナー組織の準備

Over the past ten years, corneal transplantation surgical techniques have undergone revolutionary changes1,2. Since its inception, traditional full ...

医学

Modeling Spontaneous Metastatic Renal Cell Carcinoma (mRCC) in Mice Following Nephrectomy

One of the key challenges to improved testing of new experimental therapeutics in renal cell carcinoma (RCC) is the development of models that faithfully recapitulate early- and late-stage metastatic disease progression. Typical tumor implantation models utilize ectopic or orthotopic primary tumor implantation, but few include systemic spontaneous metastatic disease that mimics the clinical setting. This protocol describes the key steps to develop RCC disease progression stages similar to patients. First, it uses a highly metastatic mouse tumor cell line in a syngeneic model to show orthotopic tumor cell implantation. Methods include superficial and internal implantation into the sub-capsular space with cells combined with matrigel to prevent leakage and early spread. Next it describes the procedures for excision of tumor-bearing kidney (nephrectomy), with critical pre- and post- surgical mouse care. Finally, it outlines the steps necessary to monitor and assess micro-and macro-metastatic disease progression, including bioluminescent imaging as well provides a detailed visual necropsy guide to score systemic disease distribution. The goal of this protocol description is to facilitate the widespread use of clinically relevant metastatic RCC models to improve the predictive value of future therapeutic testing.&#160;

Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy

Models of spontaneous metastatic renal cell carcinoma (RCC) disease progression can be used for evaluating treatments in a clinically relevant setting. This protocol demonstrates different procedures for orthotopic kidney tumor cell implantation, proper nephrectomy, and finally outlines a necropsy guide for visual and bioluminescent scoring of metastatic burden and localization.

腎摘出後のマウスにおける自発転移性腎細胞癌（MRCC）をモデル化する

One of the key challenges to improved testing of new experimental therapeutics in renal cell carcinoma (RCC) is the development of models that faithfully ...

Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty

Descemet&#8217;s Membrane Endothelial Keratoplasty (DMEK) is a form of corneal transplantation in which only a single cell layer, the corneal endothelium, along with its basement membrane (Descemet&#39;s membrane) is introduced onto the recipient&#39;s posterior stroma3. Unlike Descemet&#8217;s Stripping Automated Endothelial Keratoplasty (DSAEK), where additional donor stroma is introduced, no unnatural stroma-to-stroma interface is created. As a result, the natural anatomy of the cornea is preserved as much as possible allowing for improved recovery time and visual acuity4. Endothelial Keratoplasty (EK) is the procedure of choice for treatment of endothelial dysfunction. The advantages of EK include rapid recovery of vision, preservation of ocular integrity and minimal refractive change due to use of a small, peripheral incision1. DSAEK utilizes donor tissue prepared with partial thickness stroma and endothelium. The rapid success and utilization of this procedure can be attributed to availability of eye-bank prepared precut tissue. The benefits of eye-bank preparation of donor tissue include elimination of need for specialized equipment in the operating room and availability of back up donor tissue in case of tissue perforation during preparation. In addition, high volume preparation of donor tissue by eye-bank technicians may provide improved quality of donor tissue. DSAEK may have limited best corrected visual acuity due to creation of a stromal interface between the donor and recipient cornea. Elimination of this interface with transplantation of only donor Descemet&#39;s membrane and endothelium in DMEK may improve visual outcomes and reduce complications after EK5. Similar to DSAEK, long term success and acceptance of DMEK is dependent on ease of availability of precut, eye-bank prepared donor tissue. Here we present a stepwise approach to donor tissue preparation which may reduce some barriers eye-banks face in providing DMEK grafts.

Corneal Donor Tissue Preparation for Descemet&#039;s Membrane Endothelial Keratoplasty

Endothelial keratoplasty is a surgical technique continuously evolving as advancements result in transplantation of thinner grafts with each succession1. Here we present a technique for controlled manual tissue dissection to allow safe and repeatable separation of endothelium and Descemet&#39;s membranes from donor corneoscleral buttons for transplantation2.

デスメ膜内皮角膜移植のための角膜ドナー組織の準備

Descemet&#8217;s Membrane Endothelial Keratoplasty (DMEK) is a form of corneal transplantation in which only a single cell layer, the corneal endothelium, ...

Ex Situ Normothermic Machine Perfusion of Donor Livers

In contrast to conventional static cold preservation (0-4 &#176;C), ex situ machine perfusion may provide better preservation of donor livers. Continuous perfusion of organs provides the opportunity to improve organ quality and allows ex situ viability assessment of donor livers prior to transplantation. This video article provides a step by step protocol for ex situ normothermic machine perfusion (37 &#176;C) of human donor livers using a device that provides a pressure and temperature controlled pulsatile perfusion of the hepatic artery and continuous perfusion of the portal vein. The perfusion fluid is oxygenated by two hollow fiber membrane oxygenators and the temperature can be regulated between 10 &#176;C and 37 &#176;C. During perfusion, the metabolic activity of the liver as well as the degree of injury can be assessed by biochemical analysis of samples taken from the perfusion fluid. Machine perfusion is a very promising tool to increase the number of livers that are suitable for transplantation.

Ex Situ Normothermic Machine Perfusion of Donor Livers

Here we present a protocol describing oxygenated ex situ machine perfusion of donor liver grafts. This article contains a step by step protocol to procure and prepare the liver graft for machine perfusion, prepare the perfusion fluid, prime the perfusion machine and perform oxygenated normothermic machine perfusion of the liver graft.

In contrast to conventional static cold preservation (0-4 &#176;C), ex situ machine perfusion may provide better preservation of donor livers. Continuous ...

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

低侵襲性経食道術における経子宮頸アプローチのための低コストシングルポート(LoCoSP)デバイス

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death

Controlled donation after circulatory death (cDCD) has contributed to increasing donor numbers all over the world. Experiences published in the last years confirm that the outcomes after lung transplantation from cDCD are similar to those from brain death donors; however, the utilization of lungs from asystole donors remains low. Several reasons may be involved: different legal frameworks among countries and centers with different premortem interventions, inadequate lung donor care before procurement, or even poor experience with cDCD procedures and protocols.
Initially, the rapid recovery technique was commonly employed for the procurement of thoracic and abdominal organs in cDCD, but, in the last decade, abdominal normothermic regional perfusion (ANRP) with extracorporeal membrane oxygenation devices has become a useful method to restore blood flow to abdominal organs, allowing their quality improvement and their functional assessment prior to transplantation. This makes the donation procedure more complex and generates doubts about injury to the grafts due to dual temperature.
The aim of this article is to describe a protocol based on a single center experience with Maastricht III donors combining lung cooling rapid recovery in the thorax and abdominal normothermic regional perfusion. Tips and tricks focused on premortem interventions and lung procurement procedure techniques are explained. This may help to minimize the reluctance among professionals to use this combined technique and encourage other donor centers to use it, despite the increased complexity of the procedure.

The protocol combines a lung cooling rapid recovery technique with abdominal normothermic regional perfusion for abdominal graft procurement in controlled asystole donors, which is a safe and useful method to expand the donor pool.

循環器死後の管理された提供における腹部正常局所灌流と組み合わせた肺の急速な回復の調達

Controlled donation after circulatory death (cDCD) has contributed to increasing donor numbers all over the world. Experiences published in the last years ...

Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft failure, ongoing organ donor shortages, and the increased use of marginal grafts call for the improvement of current concepts, such as the implementation of organ machine perfusion. In order to evaluate new methods of graft reconditioning and modulation, translational models are required. With respect to anatomical and physiological similarities to humans and recent progress in the field of xenotransplantation, pigs have become the main large animal species used in transplantation models. After the initial introduction of a porcine orthotopic liver transplant model by Garnier et al. in 1965, several modifications have been published over the past 60 years.
Due to specifies-specific anatomical traits, a veno-venous bypass during the anhepatic phase is regarded as a necessity to reduce intestinal congestion and ischemia resulting in hemodynamic instability and perioperative mortality. However, the implementation of a bypass increases the technical and logistical complexity of the procedure. Furthermore, associated complications such as air embolism, hemorrhage, and the need for a simultaneous splenectomy have been reported previously.
In this protocol, we describe a model of porcine orthotopic liver transplantation without the use of a veno-venous bypass. The engraftment of donor livers after static cold storage of 20 h - simulating extended criteria donor conditions - demonstrates that this simplified approach can be performed without significant hemodynamic alterations or intraoperative mortality and with regular uptake of liver function (as defined by bile production and liver-specific CYP1A2 metabolism). The success of this approach is ensured by an optimized surgical technique and a sophisticated anesthesiologic volume and vasopressor management.
This model should be of special interest for workgroups focusing on the immediate postoperative course, ischemia-reperfusion injury, associated immunological mechanisms, and the reconditioning of extended criteria donor organs.

In this protocol, a model of porcine orthotopic liver transplantation after static cold storage of donor organs for 20 h without the use of a veno-venous bypass during engraftment is described. The approach uses a simplified surgical technique with minimization of the anhepatic phase and sophisticated volume and vasopressor management.

拡張基準ドナーモデルとしての静脈バイパスなしのブタ肝移植

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

天然オリフィス検体抽出による大腸癌に対する単一外科医、3ポート、腹腔鏡下切除術の臨床応用

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Surgical Preparation and Heterotopic Transplantation of the Neonatal Donor Heart in the Recipient Rat

Begin harvesting the neonatal donor heart by anesthetizing and sterilizing the rat, and making a horizontal incision at the xiphoid with a 15 blade scalpel under a 12.5x surgical microscope. Next, use scissors to create vertical incisions laterally up to the axillae, on both sides. Remove the anterior thoracic wall with another horizontal incision beneath the neck.Dissect the inferior vena cava, or IVC, right and left superior venae cavae, or SVC, and pulmonary vessels with scissors. Encircle and ligate dull vessels using a 7-0 silk suture. Slightly push the diaphragm down with forceps and administer three milliliters of ice-cold, high-potassium modified Krebs-Henseleit solution to the right atrium by puncturing the IVC with a 30-gauge needle.Cut the IVC, SVC, and pulmonary vessels using scissors. Ensure proper length by transecting the pulmonary arteries as far as possible, and the aorta, distal to the brachiocephalic trunk, using a number 11 blade scalpel. Flush the heart with the ice-cold cardioplegic solution using a three milliliter syringe.Place the anesthetized rat on an oblique shelf. Secure its front teeth with a string, and position the head towards the surgeon. Place the light on the outside of the neck onto the area of the vocal cords.Grasp the tongue with two fingers and gently push it upwards and to the left for optimal intubation visibility. Now, use an 18-gauge, two-inch cannula for a 100 to 150 gram rat and secure the intratracheal tube with tape. Connect the intubation cannula to the small animal ventilator, and adjust the settings based on the animal's size, following the manufacturer's instructions.After intubating the rat, perform a midline laparotomy using a 15 blade scalpel to make the skin incision. Open the anterior abdominal wall with scissors and mobilize the intestines toward the right upper quadrant. Next, expose the retroperitoneal abdominal aorta and IVC, using cotton tip applicators.Cover the intestines with warm, saline-soaked gauze and use retractors to maintain optimal exposure of the IVC and abdominal aorta. Now, perform blunt dissection of the infrarenal IVC and abdominal aorta up to the bifurcation. Ligate dull infrarenal branching arteries and veins with a 10-0 nylon suture.Transport the harvested donor's heart in a sterile surgical basin containing Krebs-Heneseleit buffer to the surgical field. Ensure to irrigate the donor heart intermittently with ice-cold cardioplegic solution. Next, separate the pulmonary trunk and descending aorta using micro scissors, and irrigate the donor heart with ice-cold cardioplegic solution.Next, apply four atraumatic vascular clamps to the distal and proximal segments of the infrarenal aorta and IVC. Perform an aortotomy using micro scissors to make two small horizontal cuts. Then, place the donor heart on the left side of the aorta.Secure the recipient's infrarenal aorta and the donor's ascending aorta and to side at the 12 and six o'clock positions of the aortotomy with sutures. Proceed with the third and fourth sutures at the three and nine o'clock positions, gently flipping the heart to the left side of the aorta after the third suture. Finalize the arterial anastomosis by adding one to two sutures to each interspace.Now, rotate the rat counterclockwise, so the head faces the surgeon's left hand. Shift the donor's heart to the left side of the abdominal aorta for an optimal view of the IVC. Perform a venotomy on the IVC, slightly proximal to the aortic anastomosis.Using an 11 blade for puncture and micro scissors to adjust the size according to the donor's pulmonary trunk diameter, flush the intracoval lumen with heparinized saline. Next, perform the venous anastomosis between the recipient's IVC and the donor's pulmonary trunk by placing interrupted 11-0 nylon sutures on the back wall of the vessel, starting at the 12 and six o'clock positions. Place a continuous 11-0 nylon suture on the front wall, place absorbable gelatin sponge strips over the anastomoses, and remove the microvascular clamps, beginning with the distal ones.Ensure that the coronary vessels fill and that the donor's heart begins beating shortly upon release of the proximal clamps. Apply light pressure using a cotton tip applicator on the sponges to achieve optimal hemostasis. Carefully place the intestines back into the abdomen, being cautious not to distort the arterial and venous anastomosis.Close the abdominal wall and allow the animal to recover. A horizontal slice of the donor graft resected at the mid ventricular level of the right and left ventricles is shown. Histological analysis indicated that the endocardial fibroelastosis tissue had high amounts of organized collagen and elastin fibers.Endocardial fibroelastosis tissue, double stained for VE-Cadherin and alpha-SMA. CD-31, phospho-SMAD2 and SMAD3, CD-31 and slug or snail indicated endothelial to mesenchymal transition.

レシピエントラットにおける新生児ドナー心臓の外科的準備と異所性移植

Midline Laparotomy Surgery in Donor Mice for Orthotopic Liver Transplantation 

To begin, place the anesthetized donor mouse under the high-powered microscope. Using a pair of scissors, perform a midline laparotomy from the xiphoid process to the pubic synthesis. Then make a transverse incision below the ribs to create a cross like pattern.After retracting the xiphoid process, eviscerate the intestines, and place them on the wet gauze sponge on the left side of the abdominal cavity. To mobilize the liver, separate it from all its ligamentous attachments. Once the proper hepatic artery or PHA is exposed, using curved forceps, skeletonize it.After ligating the PHA, dissect the entire length of the common bile duct, or CBD. Insert the bile duct stent in the CBD and secure it with a 10-O nylon suture, then ligate the distal aspect of CBD. Using a wet gauze sponge, retract the right hepatic lobe toward the xiphoid and expose the inferior vena cavo, or IVC.Mobilize the infra hepatic inferior vena cava, or IHIVC, away from the retroperitoneum and cauterize the right adrenal vein. Once the right renal artery and vein are dissected and ligated, cut both and the remaining ligamentous attachments. After removing the right kidney, inject 0.5 milliliters of cold histidine trytophan ketoglutarate solution with 100 units of heparin through the portal vein, or PV.After one minute of injection, cut the portal vein superior to the splenic and superior mesenteric veins.To perfuse the liver, slowly inject a cold histidine trytophan ketoglutarate preservation solution into the IHIVC until the fluid coming from the PV is clear. Place a micro clamp or fine suture on the IHIVC just superior to the right renal vein, and cut just inferiorly to the clamp. Once the CBD is cut distally to the stent, identify and ligate the cystic duct with a 10-O nylon suture.With forceps, grasp the dome of the gallbladder, and using spring scissors, cut the cystic duct above the suture to complete the cholecystectomy. Retract the liver inferiorly to expose the supra hepatic inferior vena cava, or SHIVC, and cut it, preserving an adequate length for the anastomosis in the recipient mice. After removing the additional ligamentous attachments.Place the liver in cold saline.