C-mühür proje Üniversitesi Tıp Merkezi Groningen (UMCG) ve Polyganics BV cerrahi departman arasındaki işbirliğinin bir parçası. Proje, başlangıçta, Hollanda Ekonomik İşler Bakanlığı SenterNovem Grant tarafından desteklenmiştir. Fikri mülkiyet, ticari faiz ve patent Polyganics BV tarafından yapılmaktadır. Fikri ilgi UMCG tarafından yapılır. Polyganics BV, bu çalışma için cihazlar üretmiştir. UMCG çalışma yapıldı.

C-conta imalatı C-Seal, sert ve yumuşak moleküler bileşenleri oluşan biyolojik olarak parçalanabilen poliüretan, yapılır. Sabit bileşen malzeme arzu elastik ve mekanik özellikleri sağlar. Sabit bileşeni bir di-izosiyanat (OCN-Astsubay) ve diol (HO-OH) oluşan poliüretan bağları (HNCO 2) Yumuşak segment poliüretan bozulması davranışını belirler. Yumuşak segment prepolimer denir ve polieter ester zincirleri oluşur. Sabit segment yumuşak segment içine dahil edilmiştir. Bu birleşme polimerizasyonu zincir uzantısı &#39;denir. Bir kere bu iki kesimi bir poli-eter-ester-üretan sentezlenen ve polimer bir C-Seal içine işlenmiş hazır, etkileşim: <ol><li> Polimer sprey kaplama için uygun bir konsantrasyona seyreltilir. </li><li> Poliüretan çözüm dönen bir kalıp üzerinde belirli bir kalınlığa kadar püskürtülür. </li><li> Kalıp kalıp zarar vermeden güvenli bir şekilde C-mührü serbest bırakmak için bir su banyosu içine yerleştirilir. </li><li> C-mühür kurutulur. </li><li> C-Seal Tyvek bir kese içinde paketlenmiş ve ETO gazı ile steril edilmektedir. </li><li> Sterilizasyon sonrasında, C-Seal kullanıma hazırdır. </li></ol> Cerrahi Prosedür Hastanın C-mühür çalışmaya katılım için bilgilendirilmiş onam verdi. <ol><li> Hasta stirrups yatar pozisyonda konumlandırılmış, karın ve perine dezenfekte ve hasta steril örtüler ile kaplıdır. </li><li> Pnömoperiton veya orta hat kesi ile laparotomi kurulması. </li><li> Karaciğer ve karın boşluğunda Teftiş. </li><li> Sigmoid kolon ve splenik fleksura seferberlik seferberlik. </li><li> Açık cerrahi: proksimal rezeksiyon sınırı düzeyinde sigmoid kolon bölümü. </li><li> Presakral düzlemde açılması Karın sağ paramedian kesi, superior rektal arter ve ven ligasyonu ve bölme. </li><li> Mesorectum seferberlik. </li><li> Distalde rektum Anabilim Dalı. </li><li> Laparoskopik ayarı: suprapubik insizyon örnek çıkarmak için yapılır. Proksimal sigmoid kolon Anabilim Dalı. </li><li> Rektal güdük uzunluğu max ise C-mühür kullanılabilir. 15 santimetre. </li><li> Bağırsak çapı zımba çapı belirler; 29 veya 33 mm çapında bir CEA zımba kullanmayı tercih. </li><li> C-mühür ve sterilize 12mm paslanmaz çelik mermer, temiz ve steril cerrahi eldiven kullanarak, temiz ve steril bir yüzey üzerinde çözdükten. </li><li> C-mühür açın, mermer takın ve ilk bağlantı iğne ile örs yerleştirin. C-mühür açılışında iki flep iki şeritler yapışkan bant kullanarak örs bağlıdırlar. </li><li> Örs, C-seal ileri C-mühür bağlantı pin &#39;delikler&#39; açık uçlu ki sonunda. Tamamen C-mührü yavaşça açın ve mermer örs uzakta C-mühür içinde biter emin olun. </li><li> C-conta ile anastomoz herhangi bir tipi (uçtan-uca, uç-yan, yan-uç ve yan-yan) yapılabilir, bir yan-uca anastomoz oluşturmak için tercih . Proksimal barsak döngü içinde örs eklemek için birden fazla strateji vardır. C-mühür, bu stratejilerin (pursestring sütür / uzunlamasına bağırsak kesi ile açık bağırsak sonu) herhangi bir engel değildir </li><li> Örs de proksimal barsak döngü içinde C-conta ile birlikte ilk mermer yardımı ile C-mühür ilerleyen ve gerekirse, künt forseps yerleştirin. C-mühür kuyruk bağırsak yukarı doğru yerleştirilmiş olduğundan emin olun ve C-mühür kuyruk gergin olup olmadığını kontrol edin; mermer (mermer örs yeterli mesafe olmalıdır) konumunu kontrol edin. Sonra örs iğne ile bağırsak duvarına nüfuz ve pin etrafında pursestring dikiş oluşturmak. </li><li> Anüs hafifçe dilate ve rektal güdük zımba eklemek. Örs zımba ile bağlayın. Barsak torsiyonu olup olmadığını kontrol edin. </li><li> Dairesel zımba Yangın. Şimdi, bağırsak uçları bağlı ve C-mühür zımba bağlı </li><li> Zımba, anüs hafifçe dışarı doğru çekin. (C-yapışabilir büküm) çekerek zımba fazla 180 derece açmak değil. Rektum zımba kaldırarak, C-seal, anüs yoluyla çekilir. C-mühür anüs yaklaşık 4 cm mesafede kesin. </li><li> Rektum mermer çıkarın. Genellikle mermer C-mührü ile birlikte gelir. Eğer değilse, C-mühür ve bağırsak duvarı arasında yer almaktadır mermer elle hafifçe kaldırın. </li><li> Anastomoz olun. İsteğe bağlı olarak, tuzlu su çözeltisi ile pelvis doldurarak bir hava testi gerçekleştirmek ve (C-mühür içinde ve C-mühür ve bağırsak arasında) anal kanal içine hava enjekte. Abskabarcıkları varlığı tam bir anastomoz onaylar. </li><li> Belirtildiği takdirde, koruyucu bir stoma oluşturun. </li><li> Laparoskopik ayarı: karın boşluğu ve trokarlar çıkarma exsufflation. </li><li> Kesi (s) kapat </li><li> Ameliyat sonrası faz: Ameliyat sonrası iyileşme ERAS (ameliyattan sonra gelişmiş kurtarma) protokolü 9 göre. C-mühür, en az bir hafta yerinde bırakılmalıdır . Hasta herhangi bir kısıtlama vardır ve C-sızdırmazlık sistemi ile dışkı kaybedebilir. Hasta kurtarıldı ve herhangi bir anastomoz komplikasyon olduğu düşünüldüğünde, C-mühür anüs düzeyde kesilebilir. Kalan C-seal düşer ve hasta doğal yolla dışkı ile birlikte C-mühür kaybedersiniz. </li></ol> Temsilcisi Sonuçlar C-mühür doğru uygulandığında (Şekil 2 ve 3), anastomoz kapsar. Bir ayrışma anastomoz veya proksimal rektal güdük anastomoz distalinde oluşur C-mühür kusur kapsar ve anüs yoluyla dışkı yönlendirir, dışkı ekstravazasyonu önlenmiş olur. Postoperatif dönemde, anüs (Şekil 3) C-seal çıkıntı. <img src="/files/ftp_upload/2223/2223fig1.jpg" alt="Şekil 1" /> Şekil 1: C-mühür şematik çizim. <img src="/files/ftp_upload/2223/2223fig2.jpg" alt="Şekil 2" /> Şekil 2: C-mühür zımba baş bağlama şematik. <img src="/files/ftp_upload/2223/2223fig3.jpg" alt="Şekil 3" /> Şekil 3: zımba, zımba kafa ekli rektal güdük proksimal bağırsak ve zımba C-mühür ile birlikte taktıktan sonra, C-conta ile birlikte anüs yoluyla ateş ve yavaşça çekilir .

<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>

IRB onayı: insan denekleri Usul Groningen Üniversitesi Tıp Merkezi ve Araştırma Hollanda Merkez Komitesi inv Kurumsal Değerlendirme Kurulu (KİK) tarafından onaylanmıştır. İnsan Başlık (CCMO). Çıkar çatışması ilan etti.

C-seal zımbalanmış kolorektal anastomozlarına anastomoz kaçağı önlemeyi amaçlayan bir tekniktir. Bir laparotomi sırasında laparoskopik cerrahinin yanı sıra kullanılabilir. C-seal anastomoz açılması engellemez; ancak, bağırsak lümeni dışında dışkı dışarıya sızmasını önler. C-mühür uygulayarak, ekstra bakım C-mühür proksimal barsak döngü içinde eklenir anda alınmalıdır. Zımba C-mühür çift teorik olarak mümkün, çünkü yeterli proksimal barsak döngü içinde C-mühür konumlandırma önemlidir. C-mühür Çift zımbalama katlanmış C-mühür kuyruk oluşur ve zımba ve zımba baş arasında biter. Mermer proksimal barsak döngü içinde C-mühür konumunu belirlemede yardımcı olur. Mermer C-mühür kuyruk gerilir ve anastomoz ile birlikte zımbalanmalı olamaz garanti etmek için, zımba kafa yeterli mesafede yerleştirilmelidir. C-mühür proksimal barsak döngü içinde farklı şekillerde yerleştirilmiş olabilir. Bir yan-uca anastomoz tercih edilirse, bu aşağıdaki protokole göre gerçekleştirmek için tavsiye: C-seal açık bağırsak ucu ile eklenir, kuyruk ilk zımba başkanı tarafından izledi. Bağlantı pimi açık barsak sonu yönünde bıçaklama, barsak duvarı üzerinden penetre olur. Daha sonra, açık bağırsak sonuna, kapalı ve bir pursestring dikiş, ekstra destek için bağlantı pimi etrafına yerleştirilir. Pim zımba bağlı, mermer pozisyonu kontrol edilir ve zımba ateş. Bir uçtan-uca anastomoz tercih edilirse, C-seal, kuyruk ilk açık proksimal bağırsak sonuna eklenir. Pursestring dikiş bağlantı pin etrafında bağırsak sonu çevreler. Pim zımba bağlı, mermer pozisyonu kontrol edilir ve zımba ateş. Groningen Üniversitesi Tıp Merkezi tarafından başlatılan bir pilot çalışmada, C-seal zımbalanmış anastomozlar 10 takip rektum rezeksiyonu yapılan 15 hasta istihdam edilmiştir. Bu hastalarda klinik veya subklinik AL tanısı kondu. Şu anda, faz II çalışmada, 35 hasta başka bir C-sızdırmazlık test bir işe.

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		<th>Material Name</th>
		<th>Type</th>
		<th>Company</th>
		<th>Catalogue Number</th>
		<th>Comment</th>
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<tr>
<td>Stainless Steel Marble</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
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<tr>
<td>C-seal</td>
<td>&nbsp;</td>
<td>Polyganics</td>
<td>&nbsp;</td>
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the c-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage

Kolorektal anastomoz kaçağı (AL), kolorektal cerrahi, yüksek morbidite ve mortalite oranları 1 giden ciddi bir komplikasyondur. AL insidansı% 2.5 ile 20 arasında 2-5 değişir. Yıllar geçtikçe, anastomoz kaçağı insidansı azaltmayı amaçlayan birçok stratejileri incelendiğinde 6, 7 olmuştur. AL nedeni büyük olasılıkla multifaktöryel. Etyolojik faktörler yetersiz arteryel kan temini, anastomoz gerginlik, hematom ve / veya anastomoz yerinde enfeksiyon, diyabet ve ateroskleroz 8 gibi hastanın ko-morbid faktörler içerir. Ayrıca, bazı anastomozlar, teknik bir arıza nedeniyle başından itibaren yetersiz olabilir. Şu anda yeni bir cihaz kliniğimizde kolorektal anastomoz korunması ve AL insidansı düşürücü yönelik geliştirilmiştir. Bu nedenle C yapışma olarak adlandırılan anastomoz dairesel zımba ile zımbalanmış bir biofragmentable drenaj,. Böylece kaçağı önlemek kolorektal anastomoz luminal yan kapaklar. C-mühür, yaklaşık 4 cm çapında ve yaklaşık uzunluğu 25 cm (Şekil 1), tahliye ince duvarlı bir tüp gibi. Bu, biyolojik olarak parçalanabilen poliüretandan oluşan tübüler bir cihazdır. Yapışkan bant ile iki flep tüpün bir ucunda bulunur. Bu flep anastomoz yapıldıktan sonra C-mühür anüs yoluyla çekilebilir ve böylece, dairesel zımba örs C-mühür takmak için kullanılır. C-mühür, en az 10 gün boyunca yerinde kalır . Bundan sonra gücünü kaybedecek ve gastrointestinal doğal içeriği ile birlikte vücuttan salgılanan düşer. C-mühür yapışıklıkları oluşumuna engel değildir. Ancak, periton boşluğuna dışkı ekstravazasyonu engeller. Bu anastomoz yerinde bir boşluk kaçağı yol anlamına gelir. Şu anda, zımbalanmış anastomoz (Colo) rektal rezeksiyon işe geçiren 35 hastada C-mühür, bir faz II çalışmada test. C-mühür, hem açık işlemlerin yanı sıra, laparoskopik prosedürler kullanılabilir. C-mühür anal eşiğinde 15cm içinde zımbalanmış anastomozlar uygulanır. Video, C-mühür uygulama stenotik bir iki nokta üst üste ile bir hasta divertiküler hastalık açık bir genişletilmiş sigmoid rezeksiyon gösterilmiştir.

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

C-mühür zımbalanmış kolorektal anastomoz koruyan bir biofragmentable tahliye. Bu videoda, üretim, dağıtım ve kullanım ayrıntıları gösterilir.

C-mühür: Kaçak Zımbalanmış Kolorektal Anastomoz korunması Biofragmentable Tahliye

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

the-c-seal-biofragmentable-drain-protecting-stapled-colorectal

Research

JoVE Journal

Medicine

21.7K Görüntüleme.  University Medical Center Groningen. C-mühür zımbalanmış kolorektal anastomoz koruyan bir biofragmentable tahliye. Bu videoda, üretim, dağıtım ve kullanım ayrıntıları gösterilir.

Video: 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.

Bir Geçerliliği Endoskopik Puanlama Sisteminin Kullanılması Kolit ve Kolorektal Tümörlerin Şiddetini Değerlendirmek için Farelerde esnek Kolonoskopi

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

Tıp

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;

Moleküler Kolorektal Kanser Hücrelerinin bir 3-Boyutlu Modeli İnvaziv tümör mikro Profili ve<em&gt; Ex vivo</em&gt; Fibroblastlar

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.

Fare Kanser Modeli Tümör Hücreleri Sirkülasyon İzolasyonu ve Yayılım

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.

Gemi tutumlu eksizyon ve birincil anastomoz

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.

Farelerde kolon anastomoz oluşturulması

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.

Sıçanlarda bir anastomoz Gastrik Bypass (OAGB)

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

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.

Kaekal Patch Kesin Lokalizasyonu ile Kronik Kolit İlişkili Kolorektal Kanser Murine Apendektomi Modeli

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.

Farelerde Alt Karın Organları nın ve Arka Ekstremitelerin Situ Kapalı Devre Perfüzyonunun Oluşturulması

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.

Laparoskopik Kesi Fıtığı Onarımında Yeni Bir Mesh Fiksasyon Yönteminin Uygulanması

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.

Kolorektal Kanser Karaciğer Metastazında İntraoperatif Mikrodalga Ablasyon ile Kombine Laparoskopik Hepatektomi Uygulaması

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