O projeto C-selo é uma parte da colaboração entre o departamento de cirurgia do Centro Médico Universitário de Groningen (UMCG) e BV Polyganics. O projeto foi inicialmente apoiado por uma Grant SenterNovem do Ministério holandês dos Assuntos Económicos. Propriedade intelectual, interesse comercial e patentes são detidas por Polyganics BV. Interesse intelectual é realizada pela UMCG. Polyganics BV fabrica os dispositivos para este estudo. O estudo foi realizado na UMCG.

Fabricação do C-seal O C-Seal é feita de poliuretano biodegradável, composto de hard e soft componentes moleculares. O componente duro fornece o material as propriedades desejáveis ​​elástica e mecânica. O componente rígido consiste em ligações de poliuretano (HNCO 2) composto por um di-isocianato (OCN-NCO) e um diol (HO-OH). O segmento macio determina o comportamento de degradação do poliuretano. O segmento macio é chamado de pré-polímero e consiste de poliéster-éster de cadeias. O segmento rígido é incorporado ao segmento flexível. Essa incorporação é chamada &#39;cadeia-extensão &quot;da polimerização. Uma vez que estes dois segmentos interagem, um poli-éter-uretano-éster é sintetizado eo polímero está pronto para ser transformado em um C-Seal: <ol><li> O polímero é diluída a uma concentração adequada para o revestimento de pulverização. </li><li> A solução de poliuretano é pulverizado sobre um molde giratório a uma determinada espessura. </li><li> O molde é colocado em um banho de água a fim de liberar o selo de segurança C-do molde sem causar danos. </li><li> O C-selo é seco. </li><li> O C-Seal é embalado em uma bolsa de Tyvek e esterilizado com gás EtO. </li><li> Após a esterilização, o C-Seal está pronto para uso. </li></ol> Procedimento Cirúrgico O paciente deu consentimento para a participação no estudo C-selo. <ol><li> O paciente é posicionado em decúbito dorsal em estribos, do abdômen e do períneo é desinfetada eo paciente é coberta com campos estéreis. </li><li> Estabelecimento de pneumoperitônio ou laparotomia através de incisão mediana. </li><li> Inspeção do fígado e cavidade abdominal. </li><li> Mobilização do cólon sigmóide e mobilização da flexura esplênica. </li><li> Na cirurgia aberta: a divisão do cólon sigmóide ao nível da margem de ressecção proximal. </li><li> Incisão paramediana direita do peritônio, a abertura do plano pré-sacral; ligadura e divisão da artéria e veia retal superior. </li><li> Mobilização da mesorectum. </li><li> Divisão do reto distal. </li><li> Em um cenário laparoscópica: uma incisão suprapúbica é realizado para extrair a amostra. Divisão do cólon sigmóide proximal. </li><li> O C-selo pode ser usado se o comprimento do coto retal é max. 15 centímetros. </li><li> O diâmetro do intestino determina o diâmetro grampeador; nós preferimos usar um grampeador CEA com um diâmetro de 29 ou 33 mm. </li><li> O C-selo e um esterilizados em mármore de aço inoxidável 12 milímetros são descompactados em uma superfície limpa e estéril limpo e usando luvas cirúrgicas estéreis. </li><li> Abrir o C-selo, insira o mármore e inserir a bigorna com o pino primeira conexão. Os dois flaps na abertura da C-selo estão ligados à bigorna usando as duas tiras de fita adesiva. </li><li> A bigorna é avançado no C-vedação para que end &#39;furos&#39; o pino de conexão ao ar livre apontado do C-selo. Gentilmente se revelará o C selo completamente e certifique-se o mármore acaba dentro do C-selo de distância da bigorna. </li><li> Qualquer tipo de anastomose (end-to-end, end-to-side, lado-a-ponta e lado-a-lado) pode ser realizada quando se utiliza o C-selo; nós preferimos criar uma anastomose lateral-de-final . Existem várias estratégias para inserir a bigorna no circuito do intestino proximal. O C-seal não interfere com qualquer uma dessas estratégias (final do intestino aberto com sutura em bolsa / incisão longitudinal do intestino) </li><li> Inserir a bigorna em conjunto com o C-selo de alças intestinais em proximal, primeiro avanço do C-selo com a ajuda do mármore e, se necessário, uma pinça sem corte. Garantir a cauda do C-selo é colocado para cima no intestino e verificar que a cauda do C-selo é esticada; verificar a posição do mármore (o mármore deve ser a distância adequada da bigorna). Em seguida, penetrar na parede do intestino com o pino a bigorna e criar uma sutura em bolsa ao redor do pino. </li><li> Suavemente dilatar o ânus e inserir o grampeador no coto retal. Conectar a bigorna com o grampeador. Verifique se há torção do intestino. </li><li> Fogo o grampeador circular. Agora, as extremidades do intestino estão conectados e os C-selo é anexado ao grampos </li><li> Puxe o grampeador para fora do ânus. Não vire o grampeador mais de 180 graus quando puxar (o C-selo pode torcer). Ao remover o grampeador do reto, o C-selo é puxada através do ânus. Cortar o C selo a uma distância de aproximadamente 4 cm do ânus. </li><li> Remover o mármore do reto. Muitas vezes, o mármore vem em conjunto com o C-selo. Se não, delicadamente remover manualmente o mármore que se situa entre o C-selo ea parede intestinal. </li><li> Verificar a anastomose. Opcionalmente, realizar um test-ar preenchendo a pelve com uma solução salina e injetar ar no canal anal (dentro do C-lacre e selo entre o C-e intestino). O abssença de bolhas confirma uma anastomose completa. </li><li> Se indicado, criar um estoma de proteção. </li><li> Em um cenário laparoscópica: exsuflação da cavidade abdominal e extração trocartes. </li><li> Fechar a incisão (s) </li><li> Pós-operatório: Recuperação pós-operatória é de acordo com o ERAS (aprimorados de recuperação após a cirurgia) protocolo 9. O C-selo deve ser deixado no local por pelo menos uma semana. O paciente não tem restrições e pode perder fezes através do C-selo. Quando o paciente se recuperou bem e sem complicações de anastomose são suspeitos, o C-selo pode ser cortado ao nível do ânus. Os restantes C selo e irá degradar o paciente perderá o C-selo juntamente com as fezes por via natural. </li></ol> Resultados representante Quando o C-selo é aplicado corretamente (figura 2 e 3), que abrange a anastomose. Se uma deiscência é formada no local da anastomose ou distal da anastomose do coto proximal do reto, o extravasamento de fezes é impedido desde o C-selo cobre o defeito e dirige a matéria fecal através do ânus. Na fase pós-operatória, o projeta C-selo do ânus (figura 3). <img src="/files/ftp_upload/2223/2223fig1.jpg" alt="Figura 1" /> Figura 1: Desenho esquemático do C-selo. <img src="/files/ftp_upload/2223/2223fig2.jpg" alt="Figura 2" /> Figura 2: Representação esquemática de prender o C selo para a cabeça do grampeador. <img src="/files/ftp_upload/2223/2223fig3.jpg" alt="Figura 3" /> Figura 3: Depois de inserir o grampeador de cabeça juntamente com o anexo C selo no intestino proximal e do grampeador no coto retal, o grampeador é demitido e gentilmente puxado através do ânus junto com o C-selo.

<ol>
	<li>Peeters, K. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+anastomotic+failure+after+total+mesorectal+excision+of+rectal+cancer.">Risk factors for anastomotic failure after total mesorectal excision of rectal cancer.</a> Br. J. Surg. 92, 211-216 (2005).</li><li>Dehni, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+a+defunctioning+stoma+on+leakage+rates+after+low+colorectal+anastomosis+and+colonic+J+pouch-anal+anastomosis.">Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis.</a> Br. J. Surg. 85, 1114-1117 (1998).</li><li>Matthiessen, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+anastomotic+leakage+after+anterior+resection+of+the+rectum.">Risk factors for anastomotic leakage after anterior resection of the rectum.</a> Colorectal Dis. 8, 366-366 (2006).</li><li>Laxamana, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+results+of+anterior+resection+using+the+double-stapling+technique.">Long-term results of anterior resection using the double-stapling technique.</a> Dis. Colon Rectum. 38, 1246-1250 (1995).</li><li>Jung, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+and+oncologic+impact+of+anastomotic+leakage+after+rectal+cancer+surgery.">Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery.</a> Dis. Colon Rectum. 51, 902-908 (2008).</li><li>Ravo, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+intracolonic+bypass+procedure.">The intracolonic bypass procedure.</a> Int. J. Colorectal Dis. 2, 38-42 (1987).</li><li>Ye, F., Wang, D., Xu, X., Liu, F., Lin, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+intracolonic+bypass+secured+by+a+biodegradable+anastomotic+ring+to+protect+the+low+rectal+anastomosis.">Use of intracolonic bypass secured by a biodegradable anastomotic ring to protect the low rectal anastomosis.</a> Dis. Colon Rectum. 51, 109-115 (2008).</li><li>Hawley, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Causes+and+prevention+of+colonic+anastomotic+breakdown.">Causes and prevention of colonic anastomotic breakdown.</a> Dis. Colon Rectum. 16, 272-277 (1973).</li><li>Lassen, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+review+of+optimal+perioperative+care+in+colorectal+surgery:+Enhanced+Recovery+After+Surgery+(ERAS)+Group+recommendations.">Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations.</a> Arch. Surg. 144, 961-969 (2009).</li><li>Kolkert, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protection+of+stapled+colorectal+anastomoses+with+a+biodegradable+device:+the+C-seal+feasibility+study.">Protection of stapled colorectal anastomoses with a biodegradable device: the C-seal feasibility study.</a> Am J of Surg. , .</li></ol>

Aprovação IRB: Procedimentos envolvendo seres humanos foram aprovados pelo Institutional Review Board (IRB) no Centro Médico Universitário de Groningen e do Comité Central Holandês de Pesquisa inv. Seres Humanos (CCMO). Não há conflitos de interesse declarados.

O C-selo é uma técnica destinada a evitar deiscência de anastomose grampeada em anastomoses colo-retal. Ele pode ser usado na cirurgia laparoscópica, bem como durante uma laparotomia. O C-vedação não impede a deiscência da anastomose, no entanto, impede o vazamento de fezes fora do lúmen intestinal. Ao aplicar o C-selo, cuidado extra deve ser tomada no momento em que o C-selo é inserido no circuito do intestino proximal. Posicionamento adequado do C selo no circuito do intestino proximal é importante, uma vez que é teoricamente possível dobrar o grampo C selo. Grampeamento duplo do C-selo ocorre quando a cauda do C-Seal é dobrada e acaba entre o grampeador ea cabeça do grampeador. O mármore ajuda a determinar a posição do C-selo no circuito do intestino proximal. O mármore deve ser posicionado a uma distância adequada da cabeça grampeador, para garantir que a cauda C-selo é esticada e não pode tornar-se grampeada em conjunto com a anastomose. O C-selo pode ser posicionado no circuito do intestino proximal de diferentes maneiras. Se uma anastomose lado-a-fim é o preferido, aconselha-se realizar este acordo com o protocolo a seguir: A C-selo é inserido através da extremidade do intestino aberto, cauda primeiro, seguido pelo chefe grampeador. O pino de conexão é então penetrado através da parede intestinal por esfaqueá-la na direção da extremidade do intestino aberto. Posteriormente, no final do intestino aberta é fechada e uma sutura em bolsa é colocada em volta do pino de conexão para apoio extra. O pino é ligado ao grampeador, a posição do mármore é verificado e do grampeador é acionado. Se uma anastomose fim-de-final é o preferido, o C-selo é inserido na extremidade do intestino proximal aberta, cauda primeiro. A sutura em bolsa envolve o final do intestino em torno do pino de ligação. O pino é ligado ao grampeador, a posição do mármore é verificado e do grampeador é acionado. Em um estudo-piloto iniciado pelo Centro Médico Universitário de Groningen, o C-selo foi empregada em 15 pacientes submetidos a ressecção do reto seguido por um anastomoses agrafado 10. Não AL clínica ou subclínica foi diagnosticada nestes pacientes. Atualmente, um estudo de fase II de testes do C-selo em outros 35 pacientes está recrutando.

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<td>Stainless Steel Marble</td>
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<td>C-seal</td>
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<td>Polyganics</td>
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the c-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage

Deiscência de anastomose colorretal (AL) é uma complicação séria da cirurgia colorectal levando a uma alta morbidade e mortalidade 1. A incidência de AL varia entre 2,5 e 20% 2-5. Ao longo dos anos, muitas estratégias que visem reduzir a incidência de deiscência de anastomose foram examinados 6, 7. A causa da AL é provavelmente multifatorial. Fatores etiológicos incluem fornecimento insuficiente de sangue arterial, a tensão na anastomose, hematoma e / ou infecção no local da anastomose, e co-mórbidas fatores do paciente como diabetes e aterosclerose 8. Além disso, alguns anastomoses pode ser insuficiente, desde o início devido a uma falha técnica. Atualmente um novo dispositivo é desenvolvido em nosso instituto que visa proteger a anastomose colo-retal e diminuição da incidência da AL. Este assim chamado C-selo é um dreno biofragmentável, que é grampeado para a anastomose com o grampeador circular. Ele cobre o lado luminal da anastomose colorretal evitando fugas. O C-selo é um tubo de paredes finas, como drenagem, com um diâmetro aproximado de 4 cm e uma duração aproximada de 25 cm (figura 1). É um dispositivo tubular composto de poliuretano biodegradável. Duas abas com fita adesiva são encontrados em uma extremidade do tubo. Estes retalhos são usados ​​para prender o selo C para a bigorna do grampeador circular, de modo que após a anastomose é feita a C selo pode ser retirado através do ânus. O C-vedação permanece no local por pelo menos 10 dias. A partir daí ele vai perder força e irá degradar a ser secretada a partir do corpo juntamente com o conteúdo gastrointestinal natural. O C-vedação não impede a formação de deiscências. No entanto, ele evita o extravasamento de fezes para a cavidade peritoneal. Isto significa que uma lacuna no local da anastomose não levar a fugas. Atualmente, um estudo de fase II de testes do C-selo em 35 pacientes submetidos (colo) ressecção retal com anastomose grampeada está recrutando. O C-selo pode ser usado em ambos os concursos públicos, bem como os procedimentos laparoscópicos. O C-selo só é aplicada em anastomoses agrafado dentro de 15 centímetros da borda anal. No vídeo, a aplicação do C-selo é mostrado em uma ressecção estendida aberta sigmóide em um paciente que sofre de doença diverticular do cólon com uma estenose.

Watch this Scientific Journal Video about The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage at JoVE.com

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

O C-selo é um dreno biofragmentável proteger a anastomose grampeada colo-retal. Neste vídeo, detalhes da produção, implantação e utilização são mostrados.

O C-selo: A Drenagem biofragmentável Proteção da anastomose grampeada colo-retal de fuga

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

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Medicine

21.7K visualizações.  University Medical Center Groningen. O C-selo é um dreno biofragmentável proteger a anastomose grampeada colo-retal. Neste vídeo, detalhes da produção, implantação e utilização são mostrados.

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

Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System

The use of modern endoscopy for research purposes has greatly facilitated our understanding of gastrointestinal pathologies. In particular, experimental endoscopy has been highly useful for studies that require repeated assessments in a single laboratory animal, such as those evaluating mechanisms of chronic inflammatory bowel disease and the progression of colorectal cancer. However, the methods used across studies are highly variable. At least three endoscopic scoring systems have been published for murine colitis and published protocols for the assessment of colorectal tumors fail to address the presence of concomitant colonic inflammation. This study develops and validates a reproducible endoscopic scoring system that integrates evaluation of both inflammation and tumors simultaneously. This novel scoring system has three major components: 1) assessment of the extent and severity of colorectal inflammation (based on perianal findings, transparency of the wall, mucosal bleeding, and focal lesions), 2) quantitative recording of tumor lesions (grid map and bar graph), and 3) numerical sorting of clinical cases by their pathological and research relevance based on decimal units with assigned categories of observed lesions and endoscopic complications (decimal identifiers). The video and manuscript presented herein were prepared, following IACUC-approved protocols, to allow investigators to score their own experimental mice using a well-validated and highly reproducible endoscopic methodology, with the system option to differentiate distal from proximal endoscopic colitis (D-PECS).

Over the past few years, new generation endoscopes have emerged as important diagnostic research aids for evaluating murine colitis and colorectal tumors. We present herein a detailed protocol for endoscopic assessment of inflammation and colorectal tumors in mice, as well as a novel scoring system that uses decimal identifiers to document the endoscopic severity of colitis and colorectal tumors.

A colonoscopia flexível em camundongos para avaliar a gravidade da colite e colorretal Tumores Usando um sistema validado endoscópica Scoring

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

Medicina

Molecular Profiling of the Invasive Tumor Microenvironment in a 3-Dimensional Model of Colorectal Cancer Cells and Ex vivo Fibroblasts

Invading colorectal cancer (CRC) cells have acquired the capacity to break free from their sister cells, infiltrate the stroma, and remodel the extracellular matrix (ECM). Characterizing the biology of this phenotypically distinct group of cells could substantially improve our understanding of early events during the metastatic cascade.

Tumor invasion is a dynamic process facilitated by bidirectional interactions between malignant epithelium and the cancer associated stroma. In order to examine cell-specific responses at the tumor stroma-interface we have combined organotypic co-culture and laser micro-dissection techniques.
Organotypic models, in which key stromal constituents such as fibroblasts are 3-dimentioanally co-cultured with cancer epithelial cells, are highly manipulatable experimental tools which enable invasion and cancer-stroma interactions to be studied in near-physiological conditions.

Laser microdissection (LMD) is a technique which entails the surgical dissection and extraction of the various strata within tumor tissue, with micron level precision.
By combining these techniques with genomic, transcriptomic and epigenetic profiling we aim to develop a deeper understanding of the molecular characteristics of invading tumor cells and surrounding stromal tissue, and in doing so potentially reveal novel biomarkers and opportunities for drug development in CRC.&#160;&#160;&#160;

Molecular Profiling of the Invasive Tumor Microenvironment in a 3-Dimensional Model of Colorectal Cancer Cells and Ex vivo Fibroblasts

Molecular profiling of laser microdissected cells and stroma from synthetic, tissue-engineered colorectal cancer models represents a novel and manipulatable approach to characterize and dissect the distinctive biology at the interface between tumor cells at the invasive front and cancer associated stromal cells. &#160;

Profiling Molecular do microambiente do tumor invasivo em um modelo 3-Dimensional de células de câncer colorretal e<em&gt; Ex vivo</em&gt; Os fibroblastos

Invading colorectal cancer (CRC) cells have acquired the capacity to break free from their sister cells, infiltrate the stroma, and remodel the ...

Isolation and Propagation of Circulating Tumor Cells from a Mouse Cancer Model

Cancer metastasis is the foremost cause of cancer-associated deaths. Recent studies have shown that circulating tumor cells (CTCs) are important in cancer metastasis. Indeed, the number of CTCs correlates with tumor size. Here, a detailed description is provided of a methodology for isolation and propagation of CTCs from a syngeneic mouse model of hepatocellular carcinoma (HCC) which allows for downstream analysis of potentially important molecular mechanisms of solid organ tumor metastasis. This method is efficient and reproducible. It is a non-invasive technique and, therefore, has potential to replace the invasive biopsy of tissues from humans which may be associated with complications. Therefore, the method discussed here allows for the isolation and propagation of CTCs from whole blood samples such that they can be examined and characterized. This has potential for future adaptation for clinical applications such as diagnosis, and personalized targeted therapy.

Circulating tumor cells (CTCs) have been shown to play an important role in tumor metastasis. Here, a method for the isolation and propagation of CTCs from the whole blood of a syngeneic mouse tumor model of hepatocellular carcinoma (HCC) metastasis is described.

Isolamento e propagação de células tumorais circulantes de um cancro do modelo do rato

Cancer metastasis is the foremost cause of cancer-associated deaths. Recent studies have shown that circulating tumor cells (CTCs) are important in cancer ...

Vessel-sparing Excision and Primary Anastomosis

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Here, we present an elaborate and efficient protocol to treat isolated short bulbar or posterior urethral strictures with vessel-sparing excision and primary anastomosis.

Excisão de poupadores de navio e anastomose primária

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.

Criação de uma anastomose colônica em ratos

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.

1-anastomose Bypass gástrico (OAGB) em ratos

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...

Murine Appendectomy Model of Chronic Colitis Associated Colorectal Cancer by Precise Localization of Caecal Patch

The human appendix has been recently implicated to play important biological roles in the pathogenesis of various complex diseases, such as colorectal cancer, inflammatory bowel disease, and Parkinson&#8217;s disease. To study the function of the appendix, a gut disease-associated murine appendectomy model has been established and its step-by-step protocol is described here. This report introduces a facile protocol for caecal patch removal in mice followed by the chemical induction of chronic colitis-associated colorectal cancer using a combination of dextran sulfate sodium (DSS) and azoxymethane (AOM). IgA specific cells and IgA concentration were significantly reduced upon removal of the caecal patch in male C57BL/6 mice&#160;compared to those in the sham group. Simultaneously administering 2% DSS and AOM resulted in nearly 80% mice survival in both sham and appendectomy groups without significant body weight loss. Histological results confirmed colonic inflammation and different degrees of adenocarcinoma. This model can be used for the study of the functional role of the appendix in maintaining gut microbiota homeostasis and pathogenesis of gut colitis and malignancies, as well as for the potential development of drug targeting therapies.

The presented protocol describes a facile surgical removal of the appendix (caecal patch) in a mouse followed by the induction of inflammatory bowel disease-associated colorectal cancer. This murine appendectomy model enables investigation of the biological role of the appendix in the pathogenesis of human gastrointestinal disease.

Modelo de apendicectomia Murina de colite crônica câncer colorretal associado por localização precisa do remendo de Caecal

The human appendix has been recently implicated to play important biological roles in the pathogenesis of various complex diseases, such as colorectal ...

Establishing In Situ Closed Circuit Perfusion of Lower Abdominal Organs and Hind Limbs in Mice

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small size of mouse organs, ex vivo perfusion of bone, bladder, skin, prostate, and reproductive organs is challenging or not feasible. Here, we report for the first time an in situ lower body perfusion circuit in mice that includes the above tissues, but bypasses the main clearance organs (kidney, liver, and spleen). The circuit is established by cannulating the abdominal aorta and inferior vena cava above the iliac artery and vein and cauterizing peripheral blood vessels. Perfusion is performed via a peristaltic pump with perfusate flow maintained for up to 2 h. In situ staining with fluorescent lectin and Hoechst solution confirmed that the microvasculature was successfully perfused. This mouse model can be a very useful tool for studying pathological processes as well as mechanisms of drug delivery, migration/metastasis of circulating tumor cells into/from the tumor, and interactions of immune system with perfused organs and tissues.

A protocol is described for in situ perfusion of the mouse lower body, including the bladder, the prostate, sex organs, bone, muscle and foot skin.

Estabelecendo in Situ Circuito Fechado Perfusão de Órgãos Abdominais Inferiores e Membros Traseiros em Camundongos

Ex vivo perfusion is an important physiological tool to study the function of isolated organs (e.g. liver, kidneys). At the same time, due to the small ...

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing incisional hernias. The laparoscopic IPOM involves implanting the mesh into the abdominal cavity through laparoscopy to repair an abdominal wall hernia. In the IPOM surgery, after the closure of the hernia ring, an anti-adhesion mesh is placed laparoscopically. The correct placement of this mesh is critical to the success of the method, and surgical skills are required to achieve perfect placement. If the mesh placement is not mastered properly, the operation and anesthesia time will be prolonged. In addition, improper placement of the mesh can lead to serious consequences, such as intestinal obstruction and mesh infection. A "contraposition and alignment" mesh fixation method is described in this study, which involves pre-marking the fixation position of the mesh to reduce the difficulty of mesh placement. A properly placed mesh is completely flat on the peritoneum, the edges are not curled or wrapped, and the mesh is adhered firmly such that there is no displacement after removing the pneumoperitoneum pressure. The "contraposition and alignment" mesh fixation technique offers the advantages of reliable placement of the mesh and fewer complications than other techniques, and it is easy to learn and master. It also allows for positioning the nail gun in advance based on the anatomy of the incisional hernia. This enables the use of the minimum number of nails possible while still ensuring good fixation, which can reduce the occurrence of complications and reduce the cost of surgery. Thus, the mesh fixation method described here is highly suitable for clinical applications based on the aforementioned advantages.

Presented here is a method for improving the mesh placement in laparoscopic incisional hernia repair, which can shorten the time required for mesh fixation and reduce the occurrence of postoperative chronic pain.

Aplicação de um Novo Método de Fixação de Malha no Reparo de Hérnia Incisional Laparoscópica

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing ...

Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

Laparoscopic hepatectomy is a common treatment for colorectal cancer liver metastasis. Previously, a sufficient number of functional liver masses had to be maintained during laparoscopic hepatectomy, with a residual liver volume of &gt;40% in cirrhotic patients and &gt;30% in non-cirrhotic patients. The high incidence of complications such as bleeding, bile leakage, or liver failure due to the exposure and difficulty of the resection of specific liver segments such as S2 and S7 reduces the success rate of liver resection. At present, microwave ablation is mainly applied in the treatment of liver metastasis using a percutaneous approach, which makes it difficult to identify hidden parts or small lesions. For some liver segments, the percutaneous puncture of liver segment 7 (S7) is likely to pass through the thoracic cavity, and the percutaneous puncture of liver segment 2 (S2) adjacent to the diaphragm is likely to injure the diaphragm and heart; these issues restrict the application of percutaneous ablation in colorectal cancer liver metastasis. Considering multiple lesions, laparoscopic microwave ablation combined with hepatectomy was performed in this study. The location of the lesions was determined by contrast-enhanced ultrasound under laparoscopy, and small lesions that were difficult to detect before the operation were identified. For the scattered lesions, which had diameters less than 3 cm and were difficult to resect, ablation was adopted to substitute hepatectomy. This technique helped to more explicitly locate the tumors, simplified the operation procedures, reduced the risk of complications such as bleeding and bile leakage, shortened the operation time, accelerated the postoperative recovery, significantly improved the success rate of operation, and enhanced the clinical prognosis of colorectal cancer liver metastasis by surgical resection.

This protocol describes the laparoscopic resection of colorectal cancer liver metastases combined with ultrasound-guided microwave ablation. This technique can safely, effectively, and accurately treat refractory liver metastases &lt;3 cm, reduce postoperative complications, and accelerate the postoperative rehabilitation of patients.

Aplicação da Hepatectomia Laparoscópica Combinada com Ablação por Micro-ondas Intraoperatória em Metástases Hepáticas de Câncer Colorretal

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