We would like to acknowledge the Division of Thoracic and Foregut Surgery and the Department of Surgery at the University of Minnesota for helping us proceed with this study.

The protocol and methods described here were approved and followed the ethical guidelines of the Institutional Review Board (IRB) of the University of Minnesota. Described here is a reoperative hiatal hernia repair and takedown of a previous Nissen fundoplication in a 73-year-old woman. The patient presented to the clinic with a history of laparoscopic hiatal hernia repair and a fundoplication 5 years ago at an outside hospital for epigastric pain and fullness after meals. She also complained of significant reflux and dy...

Reoperative Hiatal Hernia Repair

<ol>
	<li>Awais, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reoperative+antireflux+surgery+for+failed+fundoplication:+an+analysis+of+outcomes+in+275+patients.">Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients.</a> The Annals of Thoracic Surgery. 92 (3), 1083-1089 (2011).</li><li>Furnee, E. J., Draaisma, W. A., Broeders, I. A., Gooszen, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+reintervention+after+failed+antireflux+surgery:+a+systematic+review+of+the+literature.">Surgical reintervention after failed antireflux surgery: a systematic review of the literature.</a> Journal of Gastrointestinal Surgery. 13 (8), 1539-1549 (2009).</li><li>Singhal, S., Kirkpatrick, D. R., Masuda, T., Gerhardt, J., Mittal, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+and+redo+antireflux+surgery:+outcomes+and+lessons+learned.">Primary and redo antireflux surgery: outcomes and lessons learned.</a> Journal of Gastrointestinal Surgery. 22 (2), 177-186 (2018).</li><li>van Beek, D. B., Auyang, E. D., Soper, N. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comprehensive+review+of+laparoscopic+redo+fundoplication.">A comprehensive review of laparoscopic redo fundoplication.</a> Surgical Endoscopy. 25 (3), 706-712 (2011).</li><li>Witek, T. D., Luketich, J. D., Pennathur, A., Awais, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+recurrent+paraesophageal+hernia.">Management of recurrent paraesophageal hernia.</a> Thoracic Surgury Clinics. 29 (4), 427-436 (2019).</li><li>Bathla, L., Legner, A., Tsuboi, K., Mittal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+feasibility+of+laparoscopic+redo+fundoplication.">Efficacy and feasibility of laparoscopic redo fundoplication.</a> World Journal of Surgery. 35 (11), 2445-2453 (2011).</li><li>Pessaux, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+antireflux+surgery:+five-year+results+and+beyond+in+1340+patients.">Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients.</a> The Archives of Surgery. 140 (10), 946-951 (2005).</li><li>Skinner, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+after+failed+antireflux+operations.">Surgical management after failed antireflux operations.</a> World Journal of Surgery. 16 (2), 359-363 (1992).</li><li>Nandipati, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reoperative+intervention+in+patients+with+mesh+at+the+hiatus+is+associated+with+high+incidence+of+esophageal+resection--a+single-center+experience.">Reoperative intervention in patients with mesh at the hiatus is associated with high incidence of esophageal resection--a single-center experience.</a> Journal of Gastrointestinal Surgery. 17 (12), 2039-2044 (2013).</li><li>Parker, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hiatal+mesh+is+associated+with+major+resection+at+revisional+operation.">Hiatal mesh is associated with major resection at revisional operation.</a> Surgical Endoscopy. 24 (12), 3095-3101 (2010).</li><li>Ashfaq, A., Rhee, H. K., Harold, 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=Revision+of+failed+transoral+incisionless+fundoplication+by+subsequent+laparoscopic+Nissen+fundoplication.">Revision of failed transoral incisionless fundoplication by subsequent laparoscopic Nissen fundoplication.</a> World Journal of Gastroenterology. 20 (45), 17115-17119 (2014).</li><li>Bell, R. C., Kurian, A. A., Freeman, K. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+anti-reflux+revision+surgery+after+transoral+incisionless+fundoplication+is+safe+and+effective.">Laparoscopic anti-reflux revision surgery after transoral incisionless fundoplication is safe and effective.</a> Surgical Endoscopy. 29 (7), 1746-1752 (2015).</li><li>Puri, R., Smith, C. D., Bowers, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+spectrum+of+surgical+remediation+of+transoral+incisionless+fundoplication-related+failures.">The spectrum of surgical remediation of transoral incisionless fundoplication-related failures.</a> Journal of Laparoendoscopic &amp; Advanced Surgical Techniques. 28 (9), 1089-1093 (2018).</li><li>Del Campo, S. E. M., Mansfield, S. A., Suzo, A. J., Hazey, J. W., Perry, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+redo+fundoplication+improves+disease-specific+and+global+quality+of+life+following+failed+laparoscopic+or+open+fundoplication.">Laparoscopic redo fundoplication improves disease-specific and global quality of life following failed laparoscopic or open fundoplication.</a> Surgical Endoscopy. 31 (11), 4649-4655 (2017).</li><li>Smith, C. D., McClusky, D. A., Rajad, M. A., Lederman, A. B., Hunter, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=When+fundoplication+fails:+redo.">When fundoplication fails: redo.</a> Annals of Surgery. 241 (6), 861-869 (2005).</li><li>Wilshire, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+of+reoperation+for+failed+antireflux+operations.">Clinical outcomes of reoperation for failed antireflux operations.</a> The Annals of thoracic surgery. 101 (4), 1290-1296 (2016).</li><li>Zundel, N., Melvin, W. S., Patti, M. G., Camacho, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Benign Esophageal Disease: Modern Surgical Approaches and Techniques. , (2021).</li><li>Addo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+revision+paraesophageal+hernia+repair:+a+16-year+experience+at+a+single+institution.">Laparoscopic revision paraesophageal hernia repair: a 16-year experience at a single institution.</a> Surgical Endoscopy. 37 (1), 624-630 (2023).</li><li>Autorino, R., Zargar, H., Kaouk, J. 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G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=635+robotic+redo+funduplication+for+a+two+time+recurrent+hiatal+hernia.+How+we+do.">635 robotic redo funduplication for a two time recurrent hiatal hernia. How we do.</a> Diseases of the Esophagus. 34 (Supplement_1), (2021).</li><li>Soliman, B. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+hiatal+hernia+repair+demonstrates+favorable+short-term+outcomes+compared+to+laparoscopic+hiatal+hernia+repair.">Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair.</a> Surgical Endoscopy. 34 (6), 2495-2502 (2020).</li><li>Tolboom, R. C., Draaisma, W. A., Broeders, I. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+conventional+laparoscopic+versus+robot-assisted+laparoscopic+redo+hiatal+hernia+and+antireflux+surgery:+a+cohort+study.">Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.</a> Journal of robotic surgery. 10, 33-39 (2016).</li><li>Jamieson, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ambulatory+24-h+esophageal+pH+monitoring:+normal+values,+optimal+thresholds,+specificity,+sensitivity,+and+reproducibility.">Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility.</a> American Journal of Gastroenterology. 87 (9), 1102-1102 (1992).</li><li>Johnson, L. F., DeMeester, T. 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Reoperative foregut surgery is technically challenging but can be performed safely with a well-planned and thoughtful surgical approach. A thorough preoperative evaluation is essential to determine the etiology of symptoms and to guide diagnostic adjuncts. It is of utmost importance to determine the correct diagnosis prior to reintervention in order to determine the proper surgery and approach. For example, in patients undergoing redo&#160;anti-reflux&#160;surgery (ARS) after Nissan fundoplication, one should understand ...

Over the past century, improvements in the understanding and diagnosis of foregut disorders have led to the evolution of better procedures and surgical approaches. This innovation brings new challenges related to complications and reoperation for the foregut surgeon. Surgical reinterventions are particularly challenging from a technical perspective due to multiple factors, including dense adhesions, scarring, obliteration of tissue planes, and altered anatomy1,2,3,4,5. These redo foregut surgeries&#160;have increased morbidity in patients with higher incidences of esophageal perforation, delayed gastric emptying, and vagal nerve injury1,6,7,8. Mesh repairs at the hiatus complicate reintervention further, having higher rates of major resection requiring complex reconstruction9,10. The advent of advanced endoscopic therapies creates ever-evolving challenges for foregut surgeons when dealing with their associated complications or failures11,12,13. Furthermore, redo foregut operations are associated with worsening success rates and patient satisfaction with successive reoperations compared with primary intervention14,15,16,17. This highlights the importance of patient selection and accurate diagnosis prior to redo surgery for optimal outcomes.
While traditionally performed using an open approach, laparoscopic approaches to redo foregut surgery are safe and efficacious14,18. However, due to the greater difficulty associated with altered anatomy and adhesions, conversion to open surgery is still a possibility. With the emergence of robot-assisted surgery in urology and gynecologic surgery19,20, the superior visualization and dexterity compared to laparoscopy would appear to likely have some benefit in redo foregut surgery as well. Indeed, emerging research has shown safety and improved outcomes, including less conversions to open surgery and decreased hospital stays compared with the laparoscopic approach for redo foregut surgery21,22,23.
Although it is ultimately up to the foregut surgeon to determine the safest procedure, this article aims to demonstrate the approach and technical considerations for redo foregut surgery to provide a &#34;framework&#34; when confronted with this challenge. While a robotic-assisted approach is described, the principles described could be similarly applied to laparoscopy.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bravo calibration-free reflux testing system</td>
			<td>Medtronic</td>
			<td>FGS-0635</td>
			<td>Wireless esophageal pH testing system</td>
		</tr>
		<tr>
			<td>Cadiere forceps</td>
			<td>IS</td>
			<td>470049</td>
			<td>Used as a grasper</td>
		</tr>
		<tr>
			<td>da Vinci Surgeon Console</td>
			<td>IS</td>
			<td>SS999</td>
			<td>Used to control surgical robot</td>
		</tr>
		<tr>
			<td>da Vinci Vision Cart</td>
			<td>IS</td>
			<td>VS999</td>
			<td>Houses advanced vision and energy technologies to provide communication across the platform components</td>
		</tr>
		<tr>
			<td>da Vinci Xi</td>
			<td>IS</td>
			<td>K131861</td>
			<td>The surgical robot</td>
		</tr>
		<tr>
			<td>da Vinci Xi Endoscope with Camera, 8 mm, 30&#176;</td>
			<td>IS</td>
			<td>470027</td>
			<td>The camera for the da Vinci robot</td>
		</tr>
		<tr>
			<td>Lapro-Flex Articulating Retractors</td>
			<td>Mediflex</td>
			<td>91682</td>
			<td>Used as liver retractor</td>
		</tr>
		<tr>
			<td>Large needle driver</td>
			<td>IS</td>
			<td>470006</td>
			<td>Used as a needle driver</td>
		</tr>
		<tr>
			<td>Maloney Tapered Esophageal Bougie, 56 Fr</td>
			<td>Pilling</td>
			<td>507956</td>
			<td>Esophageal bougie for hiatal repair</td>
		</tr>
		<tr>
			<td>Maloney Tapered Esophageal Bougie, 58 Fr</td>
			<td>Pilling</td>
			<td>507958</td>
			<td>Esophageal bougie for wrap creation</td>
		</tr>
		<tr>
			<td>Mega SutureCut needle driver</td>
			<td>IS</td>
			<td>470309</td>
			<td>Used as a needle driver</td>
		</tr>
		<tr>
			<td>Monolithic FlexArm Plus</td>
			<td>Mediflex</td>
			<td>99045-QC</td>
			<td>Used to hold liver retractor to OR bed</td>
		</tr>
		<tr>
			<td>Round tip scissors</td>
			<td>IS</td>
			<td>470007</td>
			<td>Used for cutting</td>
		</tr>
		<tr>
			<td>Shiley Hi-Lo oral/nasal endotracheal tube cuffed, 8.0 mm</td>
			<td>Covidien</td>
			<td>86113</td>
			<td>Endotracheal tube for intubation</td>
		</tr>
		<tr>
			<td>SynchroSeal</td>
			<td>IS</td>
			<td>480440</td>
			<td>Used for dissecting, vessel sealing, and dividing</td>
		</tr>
		<tr>
			<td>Tip-Up fenestrated grasper</td>
			<td>IS</td>
			<td>470347</td>
			<td>Used as a grasper</td>
		</tr>
	</tbody>
</table>

technical considerations and approach to redo foregut surgery

Foregut surgical techniques have advanced significantly over the years and have become increasingly popular. However, new challenges and technical considerations have arisen when dealing with reoperation for complications or surgical failure. This study focuses on the technical considerations and approach when dealing with reoperative foregut surgery, particularly redo&#160;hiatal hernia repair. We describe our approach starting from the preoperative workup to the procedural steps of the surgery. The present study describes the main steps for robotic reoperative hiatal hernia repair in a patient who had previously undergone laparoscopic hiatal hernia repair with Nissen fundoplication but did not present a recurrence of reflux and dysphagia symptoms. The patient is positioned supine with arms out and a footboard for steep Trendelenburg. We place six trocars, including an assistant port and a liver retractor port,&#160;to facilitate visualization and retraction. After docking the robot, we use a combination of electrocautery and sharp dissection&#160;to free the hernia sac and reduce the hiatal hernia. The previous fundoplication is then taken down carefully and the esophagus is mobilized through a transhiatal approach with a combination of blunt and sharp dissection until at least 3 cm of intra-abdominal esophageal length is achieved, after which a leak test is performed. We then perform a crural repair to reapproximate the hiatus with two posterior stitches and one anterior stitch. Lastly, a redo Nissen fundoplication is performed over a bougie, and endoscopy is used to confirm a loose stack-of-coin appearance. By emphasizing the crucial steps of redo hiatal hernia repair, including preoperative evaluation, our goal is to provide an approach for the foregut surgeon to maximize patient outcomes.

Author Spotlight: Recent Advancements in Reoperative Foregut Surgery

Technical Considerations and Approach to Redo Foregut Surgery

Our research focuses on thoracic surgery with specific regard to reoperative foregut operations. A large portion is surgical outcomes-based research, but we also emphasize quality improvement in surgery, such as with this protocol. In this video, we discuss our approach to reoperative foregut surgery.In foregut surgery, technological advances continue to be made in the intraop and pre-op settings. Improvements in diagnostic technology, such as with the Endoflip system and high resolution manometry provide more accurate information in diagnoses of the foregut, while robotic technology and intraop monitoring help us provide the best care possible in surgery. Most literature, looking at reoperative foregut surgery emphasizes the outcomes but not necessarily the approach to performing the operation.We describe a step-by-step approach to the operation, while maintaining the general principles broadly, and thus, providing a reference for other foregut surgeons. In the future, we will continue to focus on reviewing outcomes of other reoperative foregut surgeries with the goal of developing guidelines and standardizing the management of these cases.

The patient had an uneventful postoperative course. She slowly advanced to a full liquid diet over a period of 3 days and was then discharged on a liquid diet with instructions to advance to a soft diet after 1 week.
By virtue of being a quaternary referral center and a major university hospital, we frequently manage patients needing reoperative foregut surgery. Our data from the last 5 years with 43 patients undergoing reoperative hiatal hernia repairs showed a mean length of stay of 7 days a...

Watch this Scientific Journal Video about Technical Considerations and Approach to Redo Foregut Surgery at JoVE.com

Redo foregut surgery is associated with increased patient morbidity and presents a technical challenge for the surgeon. We describe our approach and considerations when performing a redo hiatal hernia repair to provide a guide for other surgeons and improve patient outcomes.

Foregut surgical techniques have advanced significantly over the years and have become increasingly popular. However, new challenges and technical ...

technical-considerations-and-approach-to-redo-foregut-surgery

Research

JoVE Journal

Medicine

311 ビュー.  University of Minnesota. 当研究室では、胸部外科、特に前腸再手術に関する研究を行っています。その大部分は手術結果に基づく研究ですが、このプロトコルのように、手術の質の向上も重視しています。このビデオでは、再手術前腸手術に対する私たちのアプローチについて説明します。前腸手術では、術中および術前の設定で技術の進歩が続けられています。Endoflipシステムや高解像?...

ビデオ: 著者スポットライト:再手術前腸手術の最近の進歩

Redo foregut surgery is associated with increased patient morbidity and presents a technical challenge for the surgeon. We describe our approach and considerations when performing a redo hiatal hernia repair to provide a guide for other surgeons and improve patient...

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performing repeated intraoperative impedance telemetry measurements during cochlear implantation

Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery

Here we present a protocol to conduct repeated impedance telemetry measurements during cochlear implantation (CI). They may allow conclusions on the electrode's and implant's function. Repeated impedance measurements enable objective feedback on whether the electrode is positioned inside the perilymph or outside the inner...

Real-Time Telemetric Impedance Measurements During Cochlear Implantation

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correction of presbyopia by monocular bi-aspheric ablation profile

Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity

This article provides a step-by-step guide to correcting presbyopia with a monocular bi-aspheric ablation...

Excimer Laser Multifocal Double Aspheric Ablation for Presbyopia Correction

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two-photon calcium imaging of forebrain activity in behaving adult zebrafish

Author Spotlight: Advancements in Adult Zebrafish Brain Research 

Here, we present a protocol to perform two-photon calcium imaging in the dorsal forebrain of adult...

Behavior Tracking and Neural Activity Pattern in the Zebrafish Forebrain

ex vivo calcium imaging for drosophila model of epilepsy

Author Spotlight: Insights into the Techniques and Findings of Recent Advancements in Epilepsy Research 

Here, we present a protocol for ex vivo calcium imaging in GCaMP6-expressing adult Drosophila to monitor epileptiform activities. The protocol provides a valuable tool for investigating ictal events in adult Drosophila through ex vivo calcium imaging, allowing for exploration of the potential mechanisms of epilepsy at the cellular...

Monitoring Epileptiform Events in &lt;em&gt;Drosophila&lt;/em&gt; via Calcium Imaging

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retroperitoneal laparoscopic debridement and drainage for pancreatic abscess

Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis

To improve the drainage of patients with necrotizing pancreatitis complicated with peripancreatic abscess and reduce the mortality of patients with necrotizing pancreatitis, we adopted a retroperitoneal approach for peripancreatic abscess debridement and drainage by...

Laparoscopic Retroperitoneal Treatment of Necrotizing Pancreatitis Complications

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the third channel-assisted unilateral biportal endoscopic technique for lumbar spinal stenosis combined with contralateral disc herniation

Author Spotlight: Unveiling the Potential of TUBE Technique in Spinal Surgery

Here, we present the third channel-assisted UBE technique, which allows for the vertical removal of herniated disc fragments. This technique can effectively address the limitations of traditional UBE techniques. This article will systematically elaborate on this...

A 3-Channel Endoscopic Technique for Lumbar Stenosis and Contralateral Herniation

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three-dimensional modeling of the left atrium and pulmonary veins with a precise intracardiac echocardiography approach

Author Spotlight: Advancements in Intracardiac Echocardiography for Atrial Anatomy Assessment 

Accurate intracardiac echocardiography (ICE) shows significant accuracy in estimating the left atrial structure, a prospective and promising cardiac structure estimation method. Here we propose a protocol for three-dimensional modeling of the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter...

ICE-Based 3D Remodeling for the Left Atrium and Pulmonary Vein

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targeted muscle reinnervation: surgical protocol for a randomized controlled trial in postamputation pain

Author Spotlight: Advancements and Challenges in Surgical Treatments for Postamputation Pain

The protocol outlines the surgical procedure&#160;for the treatment of postamputation pain using Targeted Muscle Reinnervation (TMR). TMR will be compared with two other surgical techniques, specifically Regenerative Peripheral Nerve Interface (RPNI) and neuroma excision, followed by immediate burying within muscle under the context of an international, randomized controlled...

Procedure for Targeted Muscle Reinnervation for Treating Postamputation Pain

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comparison of two representative methods for differentiation of human induced pluripotent stem cells into mesenchymal stromal cells

Author Spotlight: Advancements in iPSCs and Genetic Disease Research 

This protocol describes and compares two representative methods for differentiating hiPSCs into mesenchymal stromal cells (MSCs). The monolayer method is characterized by lower cost, simpler operation, and easier osteogenic differentiation. The embryoid bodies (EBs) method is characterized by lower time...

Characterizing Surface Antigens and Proliferation Ability in hiPSC-Driving MSCs

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modeling cataract surgery in mice

Author Spotlight: Unraveling the Molecular Mechanisms in PCO and Fibrosis Following Cataract Surgery

This method models cataract surgery in vivo by removing lens fiber cells from adult mice and leaving behind the capsular bag with attached lens epithelial cells (LECs). The injury response is then assessed at various times post-surgery using molecular and morphological criteria.

Replicating Cataract Surgical Techniques in a Mouse Model Through LEC Extraction

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stabilized window for intravital imaging of the murine pancreas

Author Spotlight: Revolutionizing Pancreatic Disease Understanding Through Advanced Intravital Imaging 

We present a protocol for the surgical implantation of a stabilized indwelling optical window for subcellular-resolution imaging of the murine pancreas, allowing serial and longitudinal studies of the healthy and diseased...

Murine Pancreatic Imaging Using Implanted Stabilized Window

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preservation of porcine donation after circulatory death (dcd) liver by perfusion and orthotopic liver transplantation

Author Spotlight: Advancements and Challenges in Machine Perfusion for Liver Transplantation

This protocol outlines the methodology of establishing a porcine model utilizing variable temperature-controlled Machine Perfusion (MP) for the preservation of the donor liver, followed by orthotopic liver transplantation (OLTx). It aims to promote the success rate of OLTx using donor donation after circulatory death (DCD) liver and establish a stable...

Orthotopic Pig Liver Transplant Preservation Using Machine Perfusion

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epithelial cell infection analyses with shigella

Author Spotlight: Advancements in Understanding and Combatting &lt;em&gt;Shigella&lt;/em&gt; Infections

The present protocol describes infection assays to interrogate Shigella adherence, invasion, and intracellular replication using in vitro epithelial cell...

Protocols for Analyzing &lt;em&gt;Shigella&lt;/em&gt; Infection in Colonic Epithelial Cells

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ultrafast laser-ablated nanoparticles and nanostructures for surface-enhanced raman scattering-based sensing applications

Author Spotlight: Advancements and Applications in Nanoparticle Synthesis Through Laser Ablation in Liquids 

Ultrafast laser ablation in liquid is a precise and versatile technique for synthesizing nanomaterials (nanoparticles [NPs] and nanostructures [NSs]) in liquid/air environments. The laser-ablated nanomaterials can be functionalized with Raman-active molecules to enhance the Raman signal of analytes placed on or near the...

Synthesizing Nanoparticles and Nanostructures via Laser Ablation

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generation of induced pluripotent stem cell-derived itenocytes via combined scleraxis overexpression and 2d uniaxial tension

Author Spotlight: Advancements in Cell and Tissue Engineering for Tendon Repair 

This article describes a procedure to produce iTenocytes by generating iPSC-derived mesenchymal stromal cells with combined overexpression of Scleraxis using a lentiviral vector and uniaxial stretching via a 2D...

Harnessing iPSC-Derived iTenocytes for Effective Cell-Based Therapy

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development of multiplex real-time rt-qpcr assays for the detection of sars-cov-2, influenza a/b, and mers-cov

Author Spotlight: Advancements in Multiplex Detection of Respiratory Viruses 

We present two probe-based in-house one-step RT-qPCR kits for common respiratory viruses. The first assay is for SARS-CoV-2 (N), Influenza A (H1N1 and H3N2), and Influenza B. The second is for SARS-Cov-2 (N) and MERS (UpE and ORF1a). These assays can be successfully implemented in any specialized laboratory.

Multiplex RT-qPCR Assay for Respiratory Virus Detection

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optimized protocol for generating functional pancreatic insulin-secreting cells from human pluripotent stem cells

Author Spotlight: Advancements and Challenges in &amp;#946;-Cells Differentiation from Pluripotent Stem Cells

This article presents a protocol for directed differentiation and functional analysis of &#946;-cell like cells. We describe optimal culture conditions and passages for human pluripotent stem cells before generating insulin-producing pancreatic cells. The six-stage differentiation progresses from definitive endoderm formation to functional &#946;-cell like cells secreting insulin in response to...

Differentiating Human Pluripotent Stem Cells into Pancreatic ?-Cells

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real-time polymerase chain reaction-based detection and quantification of hepatitis b virus dna

Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection 

Real-time polymerase chain reaction (PCR)-based detection and quantification of hepatitis B virus (HBV) DNA is a sensitive and accurate method for diagnosing and monitoring HBV infection. Here, we present a protocol for HBV DNA detection and the viral load measurement of a...

Detection and Quantification of Hepatitis B Virus DNA in Human Serum

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Robotic Reoperative Hiatal Hernia Repair After Post-Laparoscopic Procedure

To begin, position the anesthetized patient supine with arms out and a footboard to facilitate steep reverse Trendelenberg positioning. Using the open hasson technique, enter the peritoneal cavity in the left supra umbilical space to insert the camera port. Next, insert one eight millimeter port in the right upper quadrant, 10 centimeters above the umbilicus, and one port in the left upper quadrant.Place the assistant port in the right lower quadrant. Insert the liver retractor through a five millimeter port, placed in the extreme lateral part of the right upper quadrant. Then dock the surgical robot.To reduce hiatal hernia, begin by removing the adhesions of the bowel to the abdominal wall. Then, using a robotic bipolar surgical energy device, open the gastrohepatic ligament. Open the lesser sac by removing adhesions and additional short gastric artery branches.Using a combination of blunt and electrocautery dissection with the robot, dissect the hernia sac, circumferentially at the hiatus. Then use laparoscopic scissors to carefully dissect the dense adhesions between the liver and stomach. To note previous fundoplication, perform sharp dissection with laparoscopic scissors and undo the wrap to completely free the stomach.Next, using the combination of blunt and sharp dissection, mobilize the esophagus, transhiatally in the mediastinum. Under endoscopy, identify the gastroesophageal junction, then measure the esophagus from the hiatus to the gastroesophageal junction. Next, perform endoscopy and visualize the mucosa clearly to ensure no injuries and insufflate the esophagus in stomach to ensure no air leakage.Begin hiatal repair by performing accrual repair using O silk sutures, applying two to three posterior crural stitches. Pass a 56 French bougie into the esophagus, and with the bougie in place, pass a grasper comfortably into the hiatus. Next for Nissen fundoplication, bring the fundus across the right side, posterior to the esophagus and beneath the vagus nerve.Pass a 58 French bougie into the esophagus and perform a loose fundoplication over the bougie, using three 2/0 silk sutures.