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).

Declaração de Ética: Este procedimento envolvendo seres humanos foi aprovado pelo Institutional Review Board (IRB) no Hospital Universitário Ajou. 1. Preparação para a cirurgia <ol><li> Permitir que uma dieta leve um dia antes da cirurgia, com nada por boca após a meia-noite antes da cirurgia. Nota: Não insira uma sonda nasogástrica antes e durante a cirurgia. Este protocolo não utiliza qualquer tubo para esvaziar o estômago. Em vez disso, o gás intra-gástrico pode ser aspirado através de uma agulha de punção laparoscópica se o estômago está distendido causando visão limitada para a cirurgia laparoscópica. </li><li> Depois de colocar o paciente na mesa de operação, administrar o agente de indução (tiopental sódico, 100 mg). </li><li> Após a injecção intravenosa de um relaxante muscular (brometo de rocurónio, 1,0 mg / kg), inserir o tubo endotraqueal através da cavidade oral. </li><li> Comece o gás anestésico (sevoflurano, 2-3%) através do tubo endotraqueal, em seguida, monitorar the do paciente para a estabilidade durante a cirurgia. </li></ol> 2. Procedimento cirúrgico antes Intraoperative Gastroscopia <ol><li> Colocar o paciente na posição de Trendelenburg reversa, e ficam no lado direito do paciente. </li><li> Adicione 10 milímetros incisão infra-umbilical na área, e inserir o primeiro trocarte dentro da cavidade abdominal. </li><li> Logo que o trocarte é inserido, ligar o tubo de gás de dióxido de carbono com o trocarte para criar um pneumoperitoneu de 15-18 mm Hg. </li><li> Inserir uma rígida 30 ° laparoscópio através do trocarte, e explorar a cavidade abdominal em um monitor conectado com o sistema laparoscópica. </li><li> Insira 4 trocartes adicionais (um de 12 mm e três 5 mm) como portos de trabalho. Insira mm trocar 12 no lado superior direito do umbigo. Inserir outros três trocartes 5 mm no lado esquerdo superior do umbigo e os dois quadrantes exterior superior do abdômen. </li><li> Dissecar o ligamento gastrocolic ao longo do cólon transverso em direção ao inferiou poste do baço utilizando tesoura endoscópica ultra-sônicas. </li><li> Ligar a artéria gastroepiplóica esquerda e veia proveniente de vasos esplênicos na raiz com um clipe de laparoscópica e ressecar-los usando tesoura endoscópica ultra-sônicas, após a exposição da borda superior da cauda do pâncreas. </li><li> Com uma tesoura endoscópica ultra-sônicas, dissecar os gânglios linfáticos peripyloric ao redor do piloro e da cabeça do pâncreas, e ressecar os vasos gastroepiplóicos certas na sua origem. </li><li> Antes de ressecção da primeira porção do duodeno, prender o duodeno com um grampo laparoscópica para impedir a migração de gás para dentro do intestino delgado durante o procedimento gastroscópico (Figura 1). </li></ol> 3. Intraoperative Gastroscopia <ol><li> Mover-se para o lado esquerdo da cabeça do paciente para realizar gastroscopia intra-operatória. </li><li> Insira um escudo goma para proteger os dentes e gengivas durante gastroscopia intra-operatória. </li><li> Vire o head do paciente para o lado esquerdo para a inserção do endoscópio. </li><li> Inserir o endoscópio dentro do estômago cuidadosamente através da boca e do esófago, para evitar a lesão da mucosa da cavidade oral, esófago, estômago e o. </li><li> Insuflar o estômago através da injecção de gás através do endoscópio para localizar a lesão primária. Nota: A maior parte dos gastroscopia tem um botão específico para injectar gás dentro do intestino durante o procedimento. </li><li> Aproximar a distância entre a margem proximal do tumor e a junção esofagogástrica utilizando a escala marcada no gastroscópio (Figura 2), e realizar gastrectomia total (como descrito anteriormente), se a distância for demasiado curta para salvar o estômago proximal. 10 </li><li> Se gastrectomia total não é necessário, inserir um injector endoscópica através de um pequeno orifício do endoscópio, e injectar 2-3 cc de carmim de indigo na parede gástrica utilizando um injector endoscópica num 2 Área - 3 cm, Proximal a partir da margem do tumor, evitando fugas intra- ou extraluminal (Figura 3A). <ol><li> Inserir a agulha do injector na parede gástrica obliquamente para evitar a perfuração da parede gástrica pela agulha. Além disso, injectar indigotina muito lentamente para detectar fugas intraluminal durante a injecção. </li></ol></li><li> Após a injeção de corante, aspirado gás inflação através do endoscópio para fazer o procedimento laparoscópico mais fácil. Nota: A maioria gastroscopia tem um botão específico para aspirar o gás inflação durante o procedimento. </li></ol> 4. Procedimento após Intraoperative Gastroscopia <ol><li> Retornar para o lado direito do paciente após o procedimento gastroscópico. </li><li> Na vista laparoscópica, confirmar a porção proximal do tumor por meio da identificação de coloração por corante azul serosa (Figura 3B). </li><li> Marcar a parte manchada a ser ressecado com um clipe endoscópica, evitando o envolvimento do tumor na remargem secção (Figura 4A). Nota: Recomenda-se realizar este procedimento no prazo de 5 - 10 min após a cirurgia começa, porque o corante pode às vezes ser lavados durante os procedimentos subsequentes. </li><li> Se o corante não pode ser detectado na serosa, imediatamente re-injectar o corante, sob visualização gastroscópico. </li></ol> 5. Procedimento após Intraoperative Gastroscopia <ol><li> Ressecar o duodeno, e executar outros procedimentos para a dissecção de linfonodos de acordo com as diretrizes de tratamento japoneses. 11 </li><li> Após a dissecção dos linfonodos, ressecção do estômago no local apropriado pelo menos 3 cm proximal a partir da margem do tumor, guiado pelo clipe de marcação, usando 2 grampeadores endoscópicos. </li><li> Assim que o estômago distai é ressecado, inserir a amostra para um saco de endoscópica e retirá-lo da cavidade abdominal através de uma 2-3 cm de extensão do sítio de trocarte infra-umbilical. </li><li> Enviar o tecido a partir da margem proximalpatologia para a avaliação histológica intra-operatória. </li><li> Após a confirmação de tecidos livres de tumores na porção proximal do estômago ressecado, executar uma anastomose entre o estômago e o restante jejuno proximal com grampeadores lineares intracorpóreas (Figura 4B). </li></ol>

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Y., 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=Is+totally+laparoscopic+gastrectomy+less+invasive+than+laparoscopy-assisted+gastrectomy?:+prospective,+multicenter+study.">Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.</a> J Gastrointest Surg. 12, 1015-1021 (2008).</li><li>Hyung, W. J., 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=Intraoperative+tumor+localization+using+laparoscopic+ultrasonography+in+laparoscopic-assisted+gastrectomy.">Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy.</a> Surg Endosc. 19, 1353-1357 (2005).</li><li>Jeong, O., Cho, S. B., Joo, Y. E., Ryu, S. Y., Park, Y. 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The authors have no conflicts of interest or financial ties to disclose.

Neste protocolo, que introduziu um procedimento para gastroscopia intra-operatória para identificar com precisão e confiabilidade localização do tumor no terço médio do estômago. Fomos capazes de realizar com sucesso a gastrectomia subtotal distal com base nas conclusões de gastroscopia intra-operatória. Até à data, vários métodos foram aplicados para identificar a localização de cancro gástrico precoce na vista laparoscópica. Métodos mais comuns utilizados recorte gastrosc...

A cirurgia laparoscópica tem se tornado o tratamento de escolha para o câncer gástrico precoce em países do leste da Ásia, incluindo Japão e Coréia. 1 A vantagem desta cirurgia tem sido bem demonstrada em diversos ensaios clínicos para câncer gástrico precoce (EGC). 2-4 A maioria dos os procedimentos nestes ensaios foram realizados por laparoscopia, mas a identificação da localização do tumor, a ressecção do estômago, incluindo o tumor primário, e reconstrução foram realizadas através minilaparotômica. Portanto, a cirurgia que exijam minilaparotômica foi rotulada de &quot;gastrectomia laparoscopia assistida&quot;. Recentemente, no entanto, os procedimentos cirúrgicos têm evoluído para minimizar o trauma, melhorando a qualidade de pós-operatório de vida dos pacientes. Uma vez que este conceito também tem sido aplicada em cirurgia laparoscópica para o câncer gástrico, alguns cirurgiões laparoscópicos experientes têm tentado evitar minilaparotomia. Totalmente gastrectomia laparoscópica (TLG) para gastricancer c exige que todos os procedimentos sejam concluídos usando somente dispositivos de laparoscopia, sem a necessidade de uma minilaparotomia adicional para ressecção de amostras e anastomose. Como este tipo de cirurgia resulta em menos dor e recuperação mais rápida em relação ao abrir ou cirurgia assistida por laparoscopia, que requerem laparotomia, mais cirurgiões preferem. 5,6 No entanto, um obstáculo para a TLG para o câncer gástrico é a localização do tumor, sem a visualização direta ou palpação para determinar a área de ressecção do estômago. ausência de tumor na margem de ressecção é muito importante para alcançar o sucesso na cirurgia do câncer gástrico. Se há envolvimento do tumor na margem de ressecção durante gastrectomia distai para o cancro gástrico, ressecção adicional é necessário para evitar deixar tumor no estômago remanescente. Na cirurgia aberta e acompanhada por laparoscopia, o tumor primário pode ser facilmente localizada por palpação ou visualização directa através de uma gastrostomia temporária. No entanto, porque a primatumor ry não é facilmente detectado na visão laparoscópica, determinando margens de ressecção para EGC em TLG pode ser difícil. Vários outros métodos que requerem gastroscopia pré-operatória adicional para determinar as margens de ressecção foram propostos. 7-9 No entanto, gastroscopia adicional pré-operatória pode ser inconveniente para os pacientes. Nós introduzimos um procedimento para gastroscopia intra-operatória para marcar diretamente os tumores durante TLG para câncer gástrico no terço médio do estômago. Neste protocolo, foi aplicada a cirurgia laparoscópica para pacientes com câncer gástrico precoce a estudos pré-operatórios, que não estão incluídos na indicação absoluta para dissecção submucosa endoscópica.

<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

Determinando margens de ressecção para câncer gástrico, que não são expostos à superfície serosa do estômago, é o procedimento mais importante durante a gastrectomia total laparoscópica (TLG). O objectivo deste protocolo é a introdução de um procedimento para a gastroscopia intra-operatório, a fim de marcar diretamente os tumores durante TLG para câncer gástrico no terço médio do estômago. Os pacientes que foram diagnosticados com adenocarcinoma no terço médio do estômago estavam matriculados nesta série. Antes da cirurgia, não é executada gastroscopia adicional para a localização do tumor. Sob anestesia geral, a mobilização laparoscópica do estômago é realizada pela primeira vez. Após a primeira porção do duodeno é mobilizado a partir do pâncreas e apertado, o cirurgião move-se para o outro lado para o procedimento gastroscópico. Na inserção de um endoscópio através da cavidade oral para o estômago, 2-3 cc de carmim de indigo é administrado através de um injector endoscópica para o mu gástricacamada LECS na margem proximal do estômago. A localização do serosa manchado na visão laparoscópica é usado para guiar subtotal distal gastrectomia, no entanto, gastrectomia total é realizada se o tumor é muito perto da junção esofagogástrica. Uma amostra é amostrado após gastrectomia distal para confirmar comprimento suficiente de margem de ressecção de tumor antes da reconstrução. Em nossa casuística, todos os pacientes tiveram margens livres de tumor e não necessitaram de ressecção adicional. Não houve morbidade relacionada com o procedimento gastroscópico, e o tempo necessário para o procedimento diminuiu gradualmente até cerca de cinco minutos. gastroscopia intra-operatória para a localização do tumor é um método preciso e tolerada por pacientes com câncer gástrico submetidos a gastrectomia distal totalmente laparoscópica.

De 20 pacientes que foram submetidos a gastroscopia intra-operatório, 18 foram submetidos a gastrectomia subtotal distal, guiado por descobertas em gastroscopia. No entanto, foi realizada a gastrectomia total em dois pacientes, porque a margem de tumor proximal estava muito perto da junção esofagogástrica, como determinado em gastroscopia intra-operatória. A distância a partir do tumor à margem de ressecção proximal foi de 3,5 cm e 2,5 cm de estes dois doentes, respectivamente <...

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.

Gastroscopia intra-operatória para localização do tumor na cirurgia laparoscópica para gástrica Adenocarcinoma

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

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12.6K visualizações.  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.

Vídeo: 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.

Roux-en-Y operação de bypass gástrico em ratos

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

Medicina

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.

Triagem para Modificadores Melanoma usando um modelo de tumor Zebrafish autóctone

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.

Avaliando Especificidade de Anticancer Drugs<em&gt; In Vitro</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.

Orientação de imagem baseada no tomography computado intraoperativo do feixe do cone para a fusão Interbody minimamente invasora do transforaminal

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.

Ultrassom intraoperatório em cirurgia espinhal

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.

Localização do nódulo transtorácico de navegação eletromagnética para cirurgia torácica minimamente invasiva

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.

Pancreatectomia esquerda radical laparoscópica para câncer pancreático: estratégia cirúrgica e vídeo técnico

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.

Um protocolo para bypass gástrico Roux-en-Y em ratos usando grampos lineares

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.

Cirurgia Cooperativa de Laparoscopia-endoscopia para o Tratamento de Tumores Estrômicos Gástricos

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.

Hepatectomia Central Laparoscópica Fluorescente para Câncer de Fígado Usando Coloração Verde Negativa de Indocianina

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