This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry of Health &amp; Welfare, Republic of Korea (1320270).

倫理文：ヒトを対象とするこの手順では、亜洲大学校病院の治験審査委員会（IRB）によって承認されています。 外科1.準備<ol><li>手術前に真夜中の後、口から何も、1日の手術前にソフトな食を許可します。 注：前と手術中に経鼻胃管を挿入しないでください。このプロトコルは、胃を収縮するために、任意のチューブを使用していません。その代わりに、胃が腹腔鏡手術のための制限されたビューを引き起こして膨張している場合、胃内ガスは、腹腔鏡下穿刺針で吸引することができます。 </li><li>手術台に患者を配置した後、誘導剤（チオペンタールナトリウム、100 mg）を投与します。 </li><li>筋弛緩薬（臭化ロクロニウム、1.0ミリグラム/キログラム）の静脈内注射した後、口腔を介して気管内チューブを挿入します。 </li><li>その後、目を監視、気管内チューブを介して - 麻酔ガス（3％セボフルラン、2）を起動します手術中の安定性のための電子患者。 </li></ol>術中胃内視鏡の前に2.手術手順<ol><li>逆トレンデレンブルグの位置に患者を置き、患者の右側に立っています。 </li><li>臍下の面積で10ミリメートルの切開を行い、腹腔内に最初にトロカールを挿入します。 </li><li> 18ミリメートルHgの - とすぐにトロカールが挿入されるように、15の気腹を作成するために、トロカールと二酸化炭素ガス管を接続します。 </li><li>トロカールを通して剛性の30°腹腔鏡を挿入し、腹腔鏡システムに接続されたモニターに腹腔を探ります。 </li><li>ワーキングポートとして4追加のトロカール（1 12ミリメートルと3 5ミリメートル）を挿入します。臍の右側上部に12ミリメートルのトロカールを挿入します。へそと腹部の両方の上部外側象限の左上側の他の3 5ミリメートルのトロカールを挿入します。 </li><li> inferiに向けて横行結腸に沿って胃結腸靭帯を解剖または脾臓のポールは、超音波内視鏡のはさみを使用して。 </li><li>腹腔鏡クリップでルートに脾臓の血管由来の左胃大網動脈と静脈を結紮し、膵臓の尾部の上縁の露光後に、超音波内視鏡のはさみを使用してそれらを切除。 </li><li>超音波内視鏡のはさみを使用して、幽門と膵臓の頭の周り幽門周囲のリンパ節を分析し、その原点に右胃の血管を切除します。 </li><li>十二指腸の第1の部分の切除前に、胃内視鏡手順（ 図1）の間に小腸へのガスの移動を防止するために、腹腔鏡鉗子で十二指腸をクランプします。 </li></ol> 3.術中胃内視鏡<ol><li>術中胃鏡検査を実行するために、患者の頭部の左側に移動します。 </li><li>術中胃の間、歯と歯茎を保護するためのガムシールドを挿入します。 </li><li>ょんを回し胃カメラの挿入のための左側に患者のd-。 </li><li>口腔、食道、胃の粘膜への損傷を避けるために、慎重に口と食道を通って胃の中へ胃鏡を挿入します。 </li><li>原発巣を見つけるために胃鏡を通してガスを注入することによって胃を吹き込み。 注：ほとんどの胃鏡は、処置中に腸内にガスを注入するための特定のボタンを持っています。 </li><li>距離が近位胃をサルベージするには短すぎる場合（前述のように）（ 図2）腫瘍の近位マージンと胃にマークスケールを用いて食道胃接合部の間の距離を近似し、胃全摘術を行う。10 </li><li>胃全摘術が必要でない場合は、胃カメラの小さな穴から内視鏡注射器を挿入し、2注入 - 3センチPROX - エリア2で、内視鏡注射器を使用して胃壁にインジゴカルミンの3ccのを腫瘍マージンからimal、イントラ回避又は管腔外漏れ（ 図3A）。 <ol><li>針によって胃壁の穿孔を避けるために、斜めに胃の壁に注射器の針を挿入します。また、注入中に管腔内の漏れを識別するために、非常にゆっくりとインジゴカルミンを注入します。 </li></ol></li><li>染料注入した後、胃鏡を通して吸引膨張ガスは、腹腔鏡処置を容易にします。 注：ほとんどの胃鏡は、手順の間に膨張ガスを吸引する特定のボタンを持っています。 </li></ol>術中胃内視鏡後4.手順<ol><li>胃内視鏡処置後の患者の右側に戻ります。 </li><li>腹腔鏡ビューでは、青色色素（ 図3B）によって漿膜染色を識別することにより、腫瘍の近位部を確認します。 </li><li>再で腫瘍の関与を避け、内視鏡クリップで切除する染色された部分をマークセクションマージン（ 図4A）。 注：我々は5以内に、この手順を実行するお勧めします - 手術開始後に色素が時々、その後の処置中に洗い流すことができるので、10分。 </li><li>染料が漿膜に検出することができない場合は、すぐに胃内視鏡可視化の下で色素を再注入します。 </li></ol>術中胃内視鏡後5.手順<ol><li>十二指腸を切除し、日本の治療ガイドラインに従って、リンパ節郭清のための他の手順を実行します。11 </li><li>リンパ節郭清後に、2の内視鏡用ステープラーを使用して、マーキングクリップによって導か腫瘍マージン、から適切な場所で少なくとも3センチメートルの近位で胃を切除。 </li><li>すぐ遠位胃を切除されるように、内視鏡袋に試料を挿入し、2を介して腹腔からそれを撤回 - 臍下のトロカール部位の3センチ延長。 </li><li>近位のマージンから組織を送ります術中組織学的評価のための病理学。 </li><li>切除胃の近位部における無腫瘍組織を確認した後、残りの胃及び体内リニアステープラー（ 図4B）と近位空腸の間の吻合を行います。 </li></ol>

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The authors have no conflicts of interest or financial ties to disclose.

このプロトコルでは、我々は正確かつ確実に胃の中央三分の一に腫瘍の位置を特定するために術中胃内視鏡検査のための手順を導入しました。我々が正常に術中胃の知見に基づいて、遠位小計胃切除を行うことができました。 現在までに、様々な方法が、腹腔鏡視で早期胃癌の位置を特定するために適用されています。最も一般的な方法は、術前の胃内視鏡クリッピン?...

腹腔鏡手術は、韓国と日本を含む東アジア諸国、早期胃癌のための選択の治療法となってきた。1、この手術の利点を十分に早期胃癌（EGC）のためのいくつかの臨床試験で実証されている。2-4ほとんどのこれらの試験の手順は、腹腔鏡検査によって達成されたが、腫瘍の位置、原発腫瘍を含む胃の切除、および復興の同定はminilaparotomyを介して行われました。したがって、minilaparotomyを必要とする手術は「腹腔鏡補助胃切除を。」と記されたされていますしかし最近では、外科手術は、患者の生活の術後の質を改善する、外傷を最小限にするために進化してきました。この概念はまた、胃癌のための腹腔鏡手術に適用されているので、いくつかの経験豊富な腹腔鏡外科医はminilaparotomyを回避しようとしています。ガストリのための完全腹腔鏡下胃切除術（TLG）C癌はすべての手続きが試料の切除と吻合のための追加minilaparotomyを必要とせず、唯一の腹腔鏡デバイスを使用して完了している必要があります。開腹手術を必要とし、この開くには痛みが少なく、より速く回復相対での手術の結果の種類や腹腔鏡補助手術、以来、より多くの外科医がそれを好む。5,6しかしながら、胃がんのためTLGに障害物が直接可視化または触診することなく、腫瘍の局在があります胃切除の領域を決定します。 切除縁で腫瘍の不在は、胃癌手術の成功を達成することが非常に重要です。胃癌のため幽門側胃切除時に切除縁に腫瘍の関与がある場合は、追加の切除は、残りの胃に腫瘍が残らないように必要とされています。オープンと腹腔鏡補助手術では、原発腫瘍が容易に一時的胃瘻造設術を通じて、触診または直接可視化することによってローカライズすることができます。しかし、プリマ理由RY腫瘍が容易に腹腔鏡視野内で検出されない、TLGにEGCのための切除マージンを決定することは困難な場合があります。 切除マージンを決定するために、追加の術前胃を必要とする他のいくつかの方法が提案されている。7-9しかし 、付加的な術前の胃の患者のために不便です。私たちは、直接胃の中央3に胃癌のためにTLG中に腫瘍をマークする術中胃内視鏡検査のための手順を導入しました。 このプロトコルでは、我々は内視鏡的粘膜下層剥離術のための絶対的適応には含まれていない術前の研究では、早期胃癌の患者のための腹腔鏡手術を適用しました。

<table border="0" cellpadding="0" cellspacing="0" width="717">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Pentothal Sodium</td>
			<td style="width:157px;">JW pharmatheutical Co.</td>
			<td style="width:119px;">644912100</td>
			<td style="width:225px;">It was used as induction asgent</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Rocumeron</td>
			<td style="width:157px;">&#160;Ilsung pharmatheutical Co.</td>
			<td style="width:119px;">655402960</td>
			<td style="width:225px;">It was used for general anesthestia as muscle relaxant.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">SevoFRAN</td>
			<td style="width:157px;">Hana pharmatheutical Co.</td>
			<td style="width:119px;">657801060</td>
			<td style="width:225px;">It was used as general anesthetics</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Endoscopy system</td>
			<td style="width:157px;">Olympus Corp.</td>
			<td style="width:119px;">CLV-260</td>
			<td style="width:225px;">It was used for intraoperative GFS</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic surgery system</td>
			<td style="width:157px;">Striker Endoscopy</td>
			<td style="width:119px;">1488 HD 3-CHIP</td>
			<td style="width:225px;">It was a system for laparoscopic surgery</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Ultrasonic scissor</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">HAR23</td>
			<td style="width:225px;">It was used during tissue dissection</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Laparoscopic clip</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ER420</td>
			<td style="width:225px;">It was used for ligation of the vessels.</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Indigo carmine</td>
			<td style="width:157px;">Korea United Pharma</td>
			<td style="width:119px;">Carmine</td>
			<td style="width:225px;">It was injected into the gastric wall</td>
		</tr>
		<tr height="60">
			<td height="60" style="height:60px;width:216px;">Linear stapler</td>
			<td style="width:157px;">Johnson and Johnson Medical Corp.</td>
			<td style="width:119px;">ECHELON FLEX Powered Endopath Stapler</td>
			<td style="width:225px;">It was used for resection the stomach</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:216px;">Gastroscopic injector</td>
			<td style="width:157px;">TaeWoong Medical</td>
			<td style="width:119px;">Cobra injector</td>
			<td style="width:225px;">I was used for gastroscopic injection of blue dye</td>
		</tr>
	</tbody>
</table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

胃の漿膜表面に露出していない胃癌切除縁を、決定する、完全腹腔鏡下胃切除術（TLG）中に最も重要な手順です。このプロトコルの目的は、直接胃の中央3に胃癌のためにTLG中に腫瘍をマークするために、術中胃のための手順を導入することです。胃の中央3分の1で腺癌と診断された患者は、このケースシリーズに参加しました。手術前に、腫瘍局在化のための追加の胃内視鏡検査が行われていません。全身麻酔下で、胃の腹腔鏡動員が最初に実行されます。十二指腸の第1の部分は膵臓から動員し、胃内視鏡手順のために、他の側に外科医の動きをクランプされた後。胃の中に口腔を通して胃カメラの挿入時に、2 - インジゴカルミンの3 ccが胃ムーに、内視鏡インジェクタを介して投与されます胃の近縁でSCLE層。腹腔鏡視で染色漿膜の位置は、腫瘍が食道胃接合部に​​近すぎる場合は、胃全摘術が行われ、遠位小計胃切除を案内するために使用されます。試料は、再構成の前に腫瘍を切除縁から十分な長​​さを確認するために幽門側胃切除後にサンプリングされます。私たちのケースシリーズでは、すべての患者が無腫瘍マージンを持っていたし、追加の切除を必要としません。胃内視鏡手順に関連する一切の罹患率、徐々に約5分に減少していた手順に必要な時間はありませんでした。腫瘍局在化のための術中胃内視鏡検査は完全腹腔鏡下幽門側胃切除術を受けた胃癌患者のための正確かつ許容方法です。

術中胃内視鏡検査を受けた20人の患者のうち、18は、胃での所見によって導かれ、遠位小計胃切除術を施行しました。術中胃に決定されるように、近位腫瘍マージンは、食道胃接合部に​​近すぎだったのでしかし、我々は、2人の患者の胃全摘術を行いました。近位切除マージンに対する腫瘍からの距離は、それぞれ、これら2人の患者に（ 表1）3.5センチ...

Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

胃腺癌のための腹腔鏡下手術で腫瘍局在化のための術中胃内視鏡

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

intraoperative-gastroscopy-for-tumor-localization-laparoscopic

Research

JoVE Journal

Medicine

12.6K ビュー.  Ajou University, School of Medicine. In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

ビデオ: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Roux-en-Y Gastric Bypass Operation in Rats

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality benefit is bariatric surgery1,2. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation3. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation4,5, increased energy expenditure6,7, altered preference for food high in fat and sugar8,9, altered salt and water handling of the kidney10 as well as alterations in gut microbiota11. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating12.
During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail 13-15. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%15. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly.
Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

ラットにおけるルー-en-Y法胃バイパス手術

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality ...

医学

Screening for Melanoma Modifiers using a Zebrafish Autochthonous Tumor Model

Genomic studies of human cancers have yielded a wealth of information about genes that are altered in tumors1,2,3. A challenge arising from these studies is that many genes are altered, and it can be difficult to distinguish genetic alterations that drove tumorigenesis from that those arose incidentally during transformation. To draw this distinction it is beneficial to have an assay that can quantitatively measure the effect of an altered gene on tumor initiation and other processes that enable tumors to persist and disseminate. Here we present a rapid means to screen large numbers of candidate melanoma modifiers in zebrafish using an autochthonous tumor model4 that encompasses steps required for melanoma initiation and maintenance. A key reagent in this assay is the miniCoopR vector, which couples a wild-type copy of the mitfa melanocyte specification factor to a Gateway recombination cassette into which candidate melanoma genes can be recombined5. The miniCoopR vector has a mitfa rescuing minigene which contains the promoter, open reading frame and 3'-untranslated region of the wild-type mitfa gene. It allows us to make constructs using full-length open reading frames of candidate melanoma modifiers. These individual clones can then be injected into single cell Tg(mitfa:BRAFV600E);p53(lf);mitfa(lf)zebrafish embryos. The miniCoopR vector gets integrated by Tol2-mediated transgenesis6 and rescues melanocytes. Because they are physically coupled to the mitfa rescuing minigene, candidate genes are expressed in rescued melanocytes, some of which will transform and develop into tumors. The effect of a candidate gene on melanoma initiation and melanoma cell properties can be measured using melanoma-free survival curves, invasion assays, antibody staining and transplantation assays.

A rapid way to screen for melanoma modifiers using a zebrafish autochthonous tumor model is presented. It takes advantage of the miniCoopR vector which allows for expression of candidate melanoma genes in melanocytes. A method to obtain melanoma-free survival curves, an invasion assay, a protocol for antibody staining of scale melanocytes and a melanoma transplantation assay are described.

ゼブラ土着腫瘍モデルを用いたメラノーマの修飾のためのスクリーニング

Genomic studies of  human cancers have yielded a wealth of information about genes that are altered  in tumors1,2,3. A challenge arising from these ...

Assessing Specificity of Anticancer Drugs In Vitro

A procedure for assessing specificity of anticancer drugs in vitro using cultures containing both tumor and non-tumor cells is demonstrated. The key element is the quantitative determination of a tumor-specific genetic alteration in relation to a universal sequence using a dual-probe digital PCR assay and the subsequent calculation of the proportion of tumor cells. The assay is carried out on a culture containing tumor cells of an established line and spiked-in non-tumor cells. The mixed culture is treated with a test drug at various concentrations. After the treatment, DNA is prepared directly from the survived adhesive cells in wells of 96-well plates using a simple and inexpensive method, and subjected to a dual-probe digital PCR assay for measuring a tumor-specific genetic alteration and a reference universal sequence. In the present demonstration, a heterozygous deletion of the NF1 gene is used as the tumor-specific genetic alteration and a RPP30 gene as the reference gene. Using the ratio NF1/RPP30, the proportion of tumor cells was calculated. Since the dose-dependent change of the proportion of tumor cells provides an in vitro indication for specificity of the drug, this genetic and cell-based in vitro assay will likely have application potential in drug discovery. Furthermore, for personalized cancer-care, this genetic- and cell-based tool may contribute to optimizing adjuvant chemotherapy by means of testing efficacy and specificity of candidate drugs using primary cultures of individual tumors.

Assessing Specificity of Anticancer Drugs In Vitro

The goal of this protocol is to assess specificity of anticancer drugs in vitro using mixed cultures containing both tumor and non-tumor cells.

抗がん剤の特異性を評価します<em&gt;インビトロ</em

A procedure for assessing specificity of anticancer drugs in vitro using cultures containing both tumor and non-tumor cells is demonstrated. The key ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

最小侵襲性トランスフォラミン間融合のためのコーンビーム術内コンピュータ断層撮影ベースの画像ガイダンス

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Intraoperative Ultrasound in Spinal Surgery

Since the 1980s, there have been several reports for the use of intraoperative ultrasound as a useful adjunct in spinal surgery. However, with the advent of newer cutting-edge imaging modalities, the use of intraoperative ultrasound in spine surgery has largely fallen out of favor. Despite this, intraoperative ultrasound continues to provide several advantages over other intraoperative techniques such as magnetic resonance imaging and computed tomography including being more cost-effective, efficient, and easy to operate and interpret. Additionally, it remains the only method for the real-time visualization of soft tissue and pathologies. This paper focuses on the advantages of using intraoperative ultrasound, especially in cases of intradural lesions and lesions ventral to the thecal sac when approaching posteriorly.

Here, we present a protocol on the use of intraoperative ultrasound in spinal surgery, particularly in cases of intradural lesions and lesions in the ventral spinal canal when using a posterior approach.

脊椎手術における術中超音波

Since the 1980s, there have been several reports for the use of intraoperative ultrasound as a useful adjunct in spinal surgery. However, with the advent ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

低侵襲胸部手術のための電磁航法経胸結節局在

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological resection of left-sided pancreatic cancer. Several surgical techniques have been described in recent years, but few were specifically designed for minimally invasive approaches. This study describes and demonstrates a standardized and reproducible technique for an adequate oncological resection of pancreatic cancer: laparoscopic radical left pancreatectomy (LRLP).
A 61-year-old woman presented with an incidental finding of a 3 cm mass in the left pancreas suspect for malignancy. Imaging did not reveal distant metastases, central vascular involvement, or morbid obesity, hence the patient was suitable for LRLP. This study describes the main steps of LRLP for pancreatic cancer. First, the lesser sac is opened by transecting the gastrocolic ligament. The splenic flexure of the colon is mobilized and the inferior border of the pancreas including Gerota&#39;s fascia is dissected down to the inferior border of the spleen. The pancreas is tunneled and hung, including Gerota&#8217;s fascia with a vessel loop. At the pancreatic neck, a tunnel is created between the pancreas and the portal vein, likewise a vessel loop is passed. The pancreas is then transected using the graded compression technique with an endostapler. Both the splenic vein and artery are transected before completing the resection. The entire specimen is extracted in a retrieval bag via a small Pfannenstiel incision.
Duration of the surgery was 210 min with 250 mL blood loss. Pathology revealed a R0-resection (&#62;1 mm) of a well-to-moderately differentiated adenocarcinoma originating from an intraductal papillary mucinous neoplasm. A total of 15 tumor-negative lymph nodes were resected. This is a detailed description of LRLP for left-sided pancreatic cancer as is currently being used within the international, multicenter randomized DIPLOMA (Distal Pancreatectomy Minimally Invasive or Open for PDAC) trial.

Oncologically safe left pancreatectomy requires radical resection (R0), Gerota&#8217;s (perirenal) fascia resection, and adequate lymph node dissection. This study describes the technical details of laparoscopic radical left pancreatectomy (LRLP), used in the first international multicenter randomized trial comparing minimally invasive with open left pancreatectomy for pancreatic cancer, the DIPLOMA trial.

膵臓癌のための腹腔鏡下左膵切れ切れ:手術戦略と技術ビデオ

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and metabolic changes are not well understood. Multiple factors are thought to play a role, including reduced caloric intake, decreased nutrient absorption, increased satiety, the release of satiety-promoting hormones, shifts in bile acid metabolism, and alterations in the gut microbiota.
The rat RYGB model presents an ideal framework to study these mechanisms. Prior work on mouse models have had high mortality rates, ranging from 17 to 52%, limiting their adoption. Rat models demonstrate more physiologic reserve to surgical stimulus and are technically easier to adopt as they allow for the use of surgical staplers. One challenge with surgical staplers, however, is that they often leave a large gastric pouch which is not representative of RYGB in humans. 
In this protocol, we present a RYGB protocol in rats that result in a small gastric pouch using surgical staplers. Utilizing two stapler fires which remove the forestomach of the rat, we obtain a smaller gastric pouch similar to that following a typical human RYGB. Surgical stapling also results in better hemostasis than sharp division. Additionally, the forestomach of the rat does not contain any glands and its removal should not alter the physiology of RYGB.
Weight loss and metabolic changes in the RYGB cohort were significant compared to the sham cohort, with significantly lower glucose tolerance at 14 weeks. Furthermore, this protocol has an excellent survival of 88.9% after RYGB. The skills described in this protocol can be acquired without previous microsurgical experience. Once mastered, this procedure will provide a reproducible tool for studying the mechanisms and effects of RYGB.

Roux-en-Y gastric bypass (RYGB) is performed to treat obesity and diabetes. However, the mechanisms underlying RYGB's efficacy are not fully understood, and studies are limited by technical difficulty leading to high mortality in animal models. This article provides instructions on how to perform RYGB in rats with high success rates.

リニア・ステープラーを用いたラットにおけるルー・アン・Y胃バイパスのプロトコル

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

The present protocol describes fluorescent negative staining in laparoscopic central hepatectomy. This technique can make hepatectomy more accurate and precise.

インドシアニングリーンネガティブ染色を用いた肝癌に対する蛍光腹腔鏡下中央肝切除術

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ...