We would like to acknowledge the funding contributions of the Canadian Surgical Research Fund, the Edmonton Civic Employees Research Assistance Fund, and the Alberta IBD Consortium through a grant from Alberta Innovates.

動物使用プロトコルはアルバータ大学の健康科学動物管理使用委員会によって承認された。 楽器、動物および手術のセットアップの調製<ol><li>手続きの前に、すべての固形食24 hrの新しい、クリーンなケージ不在に動物を転送します。彼らは、手続きの時間になるまで水に自由にアクセスし、液体ダイエットアドリブを持っている場合があります。 </li><li>手続きに必要なすべての楽器をオートクレーブ。クリーン操作面、70％エタノールで麻酔ノーズコーン。 </li><li>執刀医のための快適な方法で手術用顕微鏡、麻酔器や電源で操作面を設定します。外科医の肘、手と用具を遮るもののない腕で、手術台の上で快適休ませなければならない。楽器、縫合糸、綿棒、および10ミリリットルの注射器は、手順の間に簡単にアクセスを許可した場所に配置する必要があります。 </li><li>セットアップオーバーヘッド加熱ランプは、操作面の手順と光の間の動物のための暖かさの両方を提供する。 </li><li> 0.9％食塩水で50ml円錐管、および操作面の近くにワセリンと場所との1.5mlチューブを埋める。 注：すべての楽器や外科用品を滅菌する。腸が離断されているので、手続き自体は無菌ではありません。これは、クリーンで汚染されたと考えられている。感染の外因性源の導入を回避するための措置をとる。 </li></ol>吻合2.回結腸切除術<ol><li>動物の呼吸数が約30〜40回/分に減速するまで、イソフルラン気化器からノーズコーンを介して、2リットル/分の酸素流量で4％イソフルランを投与することにより麻酔を誘導する。手順を開始する前に、痛みの応答がないことを確認するには、マウスの後肢足に適度な圧力を適用します。この時点で、0.5L /分に2％イソフルランと酸素の流れを下げてください。断続的に処置中に痛みの応答を確認し、それに応じて、イソフルラン流量を調節。 </li><li>手術中の乾燥を防止し、透明テープを用いて固定手足と仰臥位でマウスを固定化するために眼にワセリンを適用する。 </li><li> povodine /ヨウ素溶液で腹部をきれいにし、新しい滅菌手袋に着替える。 </li><li>筋膜と腹膜を露出するためにハサミを解剖鋭いポイントを使用して腹部の上部正中1.5センチの皮膚切開を行います。腹膜内容を公開する白線を通して同様の方法で筋膜/腹膜層を開きます。 </li><li>ヒトとは対照的に、マウスの盲腸は、典型的には、腹部の左上腹部に見られる。特定されたら、優しく鉗子で盲腸を把握し、切開を通してそれを実現します。腹部の表面にドレープ滅菌ガーゼ（ 図1A）上で盲腸から延びるファンアウトに回腸末端の約3cmを湿らせた綿棒を使用してください。暴露腸がプロシージャの全体の間に0.9％生理食塩水で湿った保たれていることを確認。 </li><li>手術用顕微鏡を用いて、コロン（ 図1A）に沿って上腸間膜動脈から分岐回盲動脈を識別します。回盲動脈に隣接する無血管組織を切開、5-0絹のネクタイで動脈を包囲し、連結する。次に、回腸末端に地域の血液供給を見つけ、回盲部に離断点1.5-2センチ近位の順に選択します。上記のように回腸のこのセクションに枝を結紮。はさみを解剖ミクロと動脈を分割します。 </li><li>離断終了する（ 図1B）に十分な血液供給があるの確保回腸および結腸の虚血性部分を分ける。それはより密接にコロンと一致するように内腔の直径を増加させるために30度の角度で分割して回腸をへらすることがしばしば有用である。腸の回盲部が除去されて、一度、整列各腸間膜の国境を確保ガーゼ上の回腸および結腸の離断端は、整列している。 </li><li> 8-0ポリプロピレン縫合糸（ 図1C）を使用して中断し、コロンの離断最後に回腸の離断終わりを近似することにより吻合を構築します。最初のステッチは、回結腸吻合水密になるまで、すべての0.5ミリメートルを置いその後の縫合糸で、腸間膜の国境に配置されます。回腸および結腸を通して縫合針を渡すとき、切り口がロールバックされていないことを確認し、針に刺されは、腸の切断端から0.5ミリメートルである。典型的な吻合は14から16に中断縫合が必要になります。吻合を通じて内容を強制的に回腸遠位の上、綿棒の近位を圧延することにより完了時に吻合の整合性と開存性をテストします。小腸の内容は自由に吻合漏れなく結腸に渡す必要があります。 </li><li> 10ミリリットルの注射器から0.9％食塩水3〜4 mlの暴露腸をすすぐ腸の表面から糞便を洗い流し、および腹腔内に戻って腸を提供します。 0.9％生理食塩水2 mlを用いて、腹膜腔を洗浄し、次いで横方向に腹壁に穏やかな圧力を適用することによって、この流体を排出する。 </li><li> 3-0絹ランニング縫合糸で切開を閉じ、イソフルランの流れを中止してください。術後疼痛管理のために-buprenorphine-皮下に長時間作用性アヘン剤の0.1 mg / kgをを管理します。 </li><li>彼らがモバイルになるまで継続的に温めてケージに転送した後、熱ランプの下で動物を観察します。 </li></ol> 3.術後ケアとモニタリング<ol><li>その日の残りのための苦痛の徴候のために継続的に温めケージに動物を監視します。背中流動食と水アドリブへのアクセス権を持つ新たな無菌ケージ内の動物飼育施設に動物を転送します。動物は3-4の群で収容することができる。 </li><li>翌朝術後動物のチェックを実行し、動物は苦痛には表示されないように。唯一の流動食を供給。彼らは不快に表示された場合（ すなわち、猫背の姿勢、または最小活性）皮下ブプレノルフィンの追加の用量を投与。術後1日目の午後に一回より多くの動物に確認してください。 </li><li>術後2日目の朝に動物が完全に回復し表示されるはずです。食料消費とstoolingの証拠は回復の明るい兆しである。さて、動物用固形飼料食を再開します。 注：苦痛の徴候は​​猫背の姿勢、貧しいグルーミング、および最小限のアクティビティが含まれます。苦痛の徴候が顕著である場合には、動物を安楽死させなければならない。 </li><li>動物が足圧に反応しないようになるまで2 L / minのO 2流量で4％イソフルランで深く麻酔を誘発することによって動物を安楽死させる。頸椎脱臼を行い、適切な安楽死の兆候を観察する。 </li><li>ガイドラインは異なりますので、適応症に関する機関の勧告を参照してください。用とマウスでの安楽死の適切な方法。 </li></ol>

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The authors have nothing to disclose

ICRマウスは、腸疾患における手術の効果を研究するために使用できる強力なモデルである。この記事では、95％の成功率と28日後の手順まで安定重みによって反映されるように成長障害と問題なくマウスではICRを行う方法を説明しています。成功したICRへの最も重大な課題は、吻合と吻合リークで腸閉塞を避けることが含まれる。 閉塞を防ぐための手術への技術要素は吻...

Ileocolic resection (ICR) is a common procedure performed in both emergent and elective situations for a variety of illnesses. Crohn&#8217;s disease and colon cancers are the two most common indications for ICR. In both illnesses, recurrence in the bowel at the site of surgery represents a major clinical problem. Local recurrence rates for colon cancer remain an issue even with the most aggressive resections1. Following ICR in Crohn&#8217;s disease, the disease most frequently (in up to 80%) recurs in the neo-terminal ileum at 1 year after surgery2. Given the impact of these two illnesses and their recurrence after surgery, it is important to understand local intestinal factors after ICR, which may have intrinsic influences on the natural history of these diseases. Further, it is also important to consider anastomotic healing after ICR. In the early post-operative period, anastomotic leaks can have devastating consequences for patients resulting in repeat surgeries, stoma creations, significant morbidity, and even mortality3. Despite the importance of this topic, our current understanding of anastomotic healing remains in its infancy as a subject of research. Animal models of ICR, in particular mice, are an excellent platform for studying the intestinal and anastomotic healing following surgery.
A mouse model of ICR was initially developed by Helmrath et al. to be used as a model of short gut syndrome4. The authors experimented with various diet regiments and suture sizes to optimize animal survival following ICR. They concluded that feeding with liquid diet in the perioperative period and using 9-0 monofilament sutures resulted in an optimal post-operative survival of 88%. Since this initial publication, ICR in mice removing 50% of the small bowel has been used in several studies to explore the dynamics of massive small bowel resection and the adaptive growth response in attempt to develop new therapies for short gut syndrome5,6.
The first application of the ICR mouse model to Crohn&#8217;s disease used the IL-10-/- mouse model, which spontaneously develops colitis7. The authors found that after ICR these animals developed inflammation in the neo-terminal ileum similar to that seen in post-operative Crohn&#8217;s disease patients, and that this inflammation was dependent on the presence of bacteria7. More recently, this model was used to explore bacterial changes induced by ICR. In Crohn&#8217;s disease there is an associated dysbiosis with relative decreases in bacteria known to have anti-inflammatory properties and increases in invasive species of bacteria8,9. The association holds true in cases of post-operative recurrence10. Two studies sought to identify microbial changes resulting from ICR. The first used IL-10 null mice, and performed denaturing gel electrophoresis to compare bacterial similarity between the small bowel and colon after ICR11. This study demonstrated that bacterial populations became similar in the small intestine and colon following ICR. A subsequent study used wild type mice and 16s pyrosequencing for phylogenetic classification of bacterial species post-operatively. This study demonstrated a marked shift in bacterial species resulting from surgery alone with Clostridium species becoming dominant as well as an increase in &#978;-proteobacteria. The results also confirmed the findings of the previous study with similar populations found in the small bowel and colon after ICR12. 
ICR is a common procedure for patients with colon cancer involving the cecum and ascending colon, and it is becoming increasingly recognized that the host-response to surgery likely contributes to both local and distant tumor recurrence13. Despite this observation, models of ICR have not been utilized for the study of colorectal cancer and post-operative recurrence. Understanding both the systemic and local immunologic changes resulting from ICR will be important in investigating future therapies. Potential pathways involved in cancer recurrence post ICR include up regulation of growth factors, which may rescue cells from apoptosis and stimulate proliferation, mechanical tumor disruption with cell shedding, and loss of immune surveillance through post-operative immunosuppression13,14. 
Mouse models of ICR have the potential to be a powerful tool for the investigation of short bowel syndrome, Crohn&#8217;s disease, and colon cancer. They may also provide lessons on how to prevent early post-operative anastomotic complications by further defining the cellular and biochemical pathways involved in healing the newly constructed anastomosis. A major barrier in utilizing the murine ICR model is the technical difficulty. The intestinal anastomosis requires the use of 8-0 or 9-0 suture, an operating microscope, and training in microsurgical techniques. The goal of this article is to provide clear instructions on how to perform ICR in mice with the goal of utilizing this procedure in models of disease.

<table border="0" cellpadding="0" cellspacing="0" width="665">
	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:163px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">LD101 liquid rodent diet</td>
			<td style="width:163px;">testdiet.com</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">0.9% NaCl</td>
			<td>Baxter</td>
			<td>FKE1324</td>
			<td>Injection quality saline</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Operating Microscope</td>
			<td>Ziess</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Isoflurane Anesthetic Vaporizer</td>
			<td>Harvard Apparatus</td>
			<td>34-0483</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Isoflurane</td>
			<td>Abbott&#160;</td>
			<td>05260-05</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Glass plate</td>
			<td></td>
			<td></td>
			<td>For operating surface</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Cotton swabs</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Micro Castroviejo Needle holder, curved</td>
			<td>World Precision Instruments</td>
			<td align="right">503377</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Castroviejo straight scissors</td>
			<td>World Precision Instruments</td>
			<td>555530S</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Dissecting Scissors</td>
			<td>World Precision Instruments</td>
			<td align="right">15922</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Dressing Forceps x 2</td>
			<td>World Precision Instruments</td>
			<td align="right">500363</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">5-0 silk pre-cut sutures</td>
			<td>Ethicon</td>
			<td>A182H</td>
			<td>For vessel ligation</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">8-0 Prolene on BV130-5 needle</td>
			<td>Ethicon</td>
			<td>8732H</td>
			<td>For anastomosis</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">3-0 Silk on FS-2 needls</td>
			<td>Ethicon</td>
			<td>8665G</td>
			<td>For abdominal wall closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Petroleum Jelly</td>
			<td>Vaseline</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
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murine ileocolic bowel resection with primary anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

死亡率と体重変化術後。 129S1野生型マウスをICRに続く死亡率は〜5％、一般的である。道徳の最も一般的な原因は、吻合で腸閉塞である。死亡率の他の原因は、吻合部の漏れや閉塞を腸につながる内部ヘルニアが含まれています。 体重減少は術後14日まで見られるが、一般的に非有意であることができます。マウスが完全に術後28日目（ 図2）によ...

Watch this Scientific Journal Video about Murine Ileocolic Bowel Resection with Primary Anastomosis at JoVE.com

Murine Ileocolic Bowel Resection with Primary Anastomosis

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

プライマリ吻合とネズミ回結腸腸切除

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

murine-ileocolic-bowel-resection-with-primary-anastomosis

Research

JoVE Journal

Medicine

16.3K ビュー.  University of Alberta. Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

ビデオ: Murine Ileocolic Bowel Resection with Primary Anastomosis

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7. 
The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis8. Furthermore, some anastomoses may be insufficient from the start due to technical failure.
Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.
The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.
The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.
Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.

The C-seal is a biofragmentable drain protecting the stapled colorectal anastomosis. In this video, details of the manufacturing, deployment and use are shown.

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 ...

医学

Orthotopic Small Bowel Transplantation in Rats

Small bowel transplantation has become an accepted clinical option for patients with short gut syndrome and failure of parenteral nutrition (irreversible intestinal failure). In specialized centers improved operative and managing strategies have led to excellent short- and intermediate term patient and graft survival while providing high quality of life 1,3. Unlike in the more common transplantation of other solid organs (i.e. heart, liver) many underlying mechanisms of graft function and immunologic alterations induced by intestinal transplantation are not entirely known6,7. Episodes of acute rejection, sepsis and chronic graft failure are the main obstacles still contributing to less favorable long term outcome and hindering a more widespread employment of the procedure despite a growing number of patients on home parenteral nutrition who would potentially benefit from such a transplant. The small intestine contains a large number of passenger leucocytes commonly referred to as part of the gut associated lymphoid system (GALT) this being part of the reason for the high immunogenity of the intestinal graft. The presence and close proximity of many commensals and pathogens in the gut explains the severity of sepsis episodes once graft mucosal integrity is compromised (for example by rejection). To advance the field of intestinal- and multiorgan transplantation more data generated from reliable and feasible animal models is needed. The model provided herein combines both reliability and feasibility once established in a standardized manner and can provide valuable insight in the underlying complex molecular, cellular and functional mechanisms that are triggered by intestinal transplantation. We have successfully used and refined the described procedure over more than 5 years in our laboratory 8-11. The JoVE video-based format is especially useful to demonstrate the complex procedure and avoid initial pitfalls for groups planning to establish an orthotopic rodent model investigating intestinal transplantation.

Small bowel transplantation has become an accepted treatment option for patients with irreversible intestinal failure. Our experimental model of orthotopic small bowel transplantation in rats serves as a reliable tool to address underlying immunologic and inflammatory processes that complicate intestinal transplantation.

ラット同所性小腸移植

Small  bowel transplantation has become an accepted clinical option for patients with  short gut syndrome and failure of parenteral nutrition ...

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of pancreatic body. With technological development, the robotic surgical system has shown its advantage in minimally invasive surgery and been increasingly applied in central pancreatectomy. However, reconstruction of the continuity of pancreas with end-to-end anastomosis after robotic central pancreatectomy has not been applied. In this study, we report surgical techniques for robotic central pancreatectomy with end-to-end anastomosis. The pancreas is reconstructed by duct-to-duct anastomosis of the pancreatic duct with a pancreatic stent inserted in the two stumps of pancreatic duct, and by end-to-end anastomosis of the pancreatic parenchyma. Compared with traditional central pancreatectomy with pancreaticoenteric anastomosis, this approach decreases the operative injury to the patient, and also conserves the integrity and continuity of the digestive duct and pancreatic duct. The robotic surgical system integrated with multiple instruments with flexible and precise movement is particularly suitable for the dissection and reconstruction of the pancreatic duct. We found that robotic central pancreatectomy with end-to-end anastomosis is safe and feasible, and we need more experience to evaluate its best indications and long-term outcomes.

The robotic central pancreatectomy with end-to-end anastomosis is feasible and safe for tumor in the pancreatic neck and proximal portion of pancreatic body. The operative techniques of this operation are presented.

ロボット中央膵の吻合をエンド ツー エンドのアプリケーション

Central pancreatectomy is carried out for the treatment of benign or low-malignant potential tumors located in the pancreatic neck or proximal part of ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal deviation. It has a long history with multiple variations. In this article, a modified endoscopic septoplasty procedure using the limited two-line resection (2LoRs) technique at the posterior and inferior junction of the cartilaginous and bony septum is presented based on embryologic and anatomic knowledge of the nasal septum and the biomechanics of cartilaginous behavior. With this procedure, the quadrangular cartilage can be preserved as much as possible, which is helpful in retaining the supporting framework and rigidness of the septum. 2LoRs has been proven effective and sound for the correction of nasal septal deviation with rare complications. This modified procedure can be applied to correct the deviated nasal septum in the absence of any external nasal deformity to improve nasal patency or to improve access to the middle meatus or to the axillary region of the middle turbinate. It may also be used to expand the indications of septoplasty to children and adolescents because of its minimally invasive approach.

Endoscopic septoplasty is a time-honored surgical procedure with multiple variations. This paper focuses on a step-by-step surgical approach to perform a modified septoplasty procedure known as limited two-line resection. This surgical technique can be applied to correct a deviated nasal septum in the absence of an external nasal deformity.

2 回線切除と内視鏡 Septoplasty: 隔偏差の低侵襲手術

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

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 ...

Studying Murine Small Bowel Mechanosensing of Luminal Particulates

Gastrointestinal (GI) motility is critical for normal digestion and absorption. In the small bowel, which absorbs nutrients, motility optimizes digestion and absorption. For this reason, some of the motility patterns in the small bowel include segmentation for mixing of luminal contents and peristalsis for their propulsion. Physical properties of luminal contents modulate the patterns of small bowel motility. The mechanical stimulation of GI mechanosensory circuits by transiting luminal contents and underlying gut motility initiate and modulate complex GI motor patterns. Yet, the mechanosensory mechanisms that drive this process remain poorly understood. This is primarily due to a lack of tools to dissect how the small bowel handles materials of different physical properties. To study how the small bowel handles particulates of varying sizes, we have modified an established in vivo method to determine small bowel transit. We gavage live mice with fluorescent liquid or tiny fluorescent beads. After 30 minutes, we dissect out the bowels to image the distribution of fluorescent contents across the entirety of the GI tract. In addition to high-resolution measurements of the geometric center, we use variable size binning and spectral analysis to determine how different materials affect small bowel transit. We have explored how a recently discovered "gut touch" mechanism affects small bowel motility using this approach.

To study how the small bowel handles particulates of varying sizes, we have modified an established in vivo method to determine small bowel transit.

管腔微粒子のマウス小腸メカノセンシングの研究

Gastrointestinal (GI) motility is critical for normal digestion and absorption. In the small bowel, which absorbs nutrients, motility optimizes digestion ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

胸腰椎後弯変形症に対する修正後脊柱切除術

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Model in Mice

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, cardiovascular events, and cancers) through restrictive and malabsorptive mechanisms. Understanding the mechanisms by which these procedures allow such improvements often require their transposition into animals, especially in mice, because of the ease of generating genetically modified animals. Recently, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a procedure that uses both restrictive and malabsorptive effects, which is being used as an alternative to gastric bypass in case of major obesity. Thus far, this procedure has been associated with strong metabolic improvements, which has led to a marked increase in its use in daily clinical practice. However, the mechanisms underlying these metabolic effects have been poorly studied as a result of a lack of animal models. In this article, we present a reliable and reproducible model of SADI-S in mice, with a special focus on perioperative management. The description and use of this new rodent model will be helpful for the scientific community to better understand the molecular, metabolic, and structural changes induced by the SADI-S and to better define the surgical indications for clinical practice.

Single-anastomosis duodeno-ileal bypass (SADI-S) is an emerging bariatric procedure with important metabolic effects. In this article, we present a reliable and reproducible model of SADI-S in mice.

マウスにおけるスリーブ状胃切除モデルを用いた単一吻合十二指腸回腸バイパス術

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes ...