CDM Amerikan Cerrahlar Koleji (AKS) Resident Araştırma Bursu ile desteklenmiştir. MSH California Rejeneratif Tıp Enstitüsü (CIRM) Klinik Fellow eğitim bursu TG2-01159 tarafından desteklenmiştir. MSH, HPL ve MTL Maksillofasiyal Cerrahi American Society (ASMS) / Maksillofasiyal Cerrahlar Vakfı (MSF) Araştırma Bursu Ödülü tarafından desteklendi. HPL NIH hibe R01 GM087609 ve Anthony Shu onuruna Ingrid Lai ve Bill Shu bir hediye ile desteklenmiştir. HPL ve MTL Pediatrik Rejeneratif Tıp Hagey Laboratuvarı ve Meşe Vakfı tarafından desteklenmiştir. MTL Gunn / Olivier Fonu tarafından desteklenmiştir.

Aşağıdaki protokol Stanford Üniversitesi Kurumsal Hayvan Bakım ve Kullanım Komitesi (IACUC) tarafından onaylanmış ve araştırma hayvanların kullanımı ile ilgili tüm kurumsal etik kurallara uygun olmuştur. Karın Adezyonların 1. Yaratılış <ol><li> bir hafta önce prosedüre antibiyotik chow diyet fare başlatın. </li><li> cerrahi aletler ve öncesi ılık tuzlu su sulama çözümü Otoklav. </li><li> % 2 solunan izofluran kullanarak fare anestezisi. </li><li> Hızlı bir uygulama tarafından izlenen bir saç kesme makinesi kullanılarak - tüy dökücü ajan (5 10 sn), karın yüzeyinin çoğunluğu saç kaldırmak. İyice yavaşça dikkatle ılık suya fare alt yarısını dunking, opsiyonel olarak ıslak gazlı bez ve silerek tüy dökücü ajan kaldırın. İyice hayvan kurulayın. </li><li> anestezik burun konisi içine hayvanın burun yerleştirin. Tüm Ameliyat sırasında dikkatlice r izlemekGerektiğinde hayvanın espiratory hızı ve anestezik akış hızı titre edilir. </li><li> hipotermiyi önlemek için, bu tür bir ısıtma yastığı veya ısıtıcı bir lamba gibi ısıtıcı bir cihazın kullanımı. </li><li> Önce karın prepping için, ameliyat sırasında kaymasını önlemek için fareyi karın üstünde ve altında yer bant şeritler ile fare sabitleyin. betadin ile karın dezenfekte edin, sonra% 70 etanol ile takip edin. traş edilmiş bölgeye kenarlarında saç dahil hazırlık mümkün olduğu kadar alanı içerir. fare üzerinde bir steril örtüyü yerleştirin. (Şekil 1) </li><li> Subkutan 0.1 mg / kg buprenorfin veya 30 g fare için 3 mikrogram enjekte. </li><li> cilt kesi olun. <ol><li> alt karın orta hatta başlayarak, forseps ile cilt kavramak ve keskin bir makas kullanarak deride sığ dikey kesim yapmak. </li><li> makasla xiphoid superiorda kesim taşıyın. sadece cildi girmek için özen gösterin. </li></ol></li><li> karın kaslarının n olarakiç organları kaplayan ow görünür, forseps ile kas orta hat kavramak ve çok dikkatli bir şekilde keskin bir makas kullanarak içine küçük bir kesim yapmak. yanlışlıkla bir abdominal organ içine kesmek için değil emin olun. </li><li> Küçük bir kesim ile periton alana giren ve kas tabakası abdominal organlar uzak çekin gördükten sonra ağzına makas ekleme ve dikkatle her iki yönde keserek superior ve altta kesim uzatmak. xiphoid gelen superior için inferiora mesane üzerinde kesi uzatın. (Şekil 2) </li><li> Şimdi bağırsak maruz kaldığı, çekum bulun ve hafifçe exteriorize. Dişli veya keskin forseps ile çekum tutmaktan kaçının. Bunun yerine, böyle bir Adson dişli forseps gibi atravmatik forseps kullanabilir. </li><li> zımpara kağıdı ile çekum aşındırmak. <ol><li> yüzey daha az parlak ve peteşiler appea oluncaya kadar 60 saniye - Yavaşça 30 100 zımpara kağıdı ile çekum iki tarafın tüm yüzeyini aşındırmakyüzeyde r. Cerrah sağ elini ise, sağa dönük ucu ile çekum yönlendirmek ve cerrahın sol işaret parmağı üzerinde çekum asmak için yardımcı olur. (Şekil 3) </li><li> yanlışlıkla ince sekum duvarının bir perforasyona neden kolay olduğu gibi, yavaşça zımpara yapın. zımpara çekal yüzeyi boyunca hareket ettirildiğinde grittiness az miktarda hissedilebilir olmalıdır. zımpara çekum üzerinde alıcı art arda hissedilir, bu büyük olasılıkla çekal duvardaki bir gözyaşı neden olacaktır. zımpara tanecikleri çıkarmak ve bu aşırı yabancı cisim reaksiyonuna neden olabilir, karın kalmaz emin olmak için dikkatle izleyin. </li><li> çekal duvardaki bir gözyaşı oluşursa, işlemi sonlandırmak ve hayvan euthanize. </li><li> Bir çekal kan damarı zımpara tarafından kesilmesi ve kanama neden olur ise, gazlı bez ile en fazla iki dakika basıncı tutun. kanama, bu saatten sonra devam ederse Ancak, etrafında bir figür-of-sekiz 7-0 monofilament sütür koyunKanama nokta. Bu güvenilir hemen hemen her durumda kanamayı durduracak. Bu duvarın dahil kısmının nekroz sebep olma riski olarak, sütür içine çekal duvarın büyük miktarda dahil özen gösterin. </li></ol></li><li> sağ karın yan duvar zarar. <ol><li> sağ karın yan duvarın kas periton yüzeyine aşındırmak için zımpara şeridi kullanın. zımparalama ile burada daha çekum daha agresif olun ve sağ karın yan duvarın tüm yüzeyi tartakladığı görünene kadar devam eder. Cilt kas tabakasında deliklerden görünür şekilde sert zımpara kaçının. (Şekil 4) </li><li> Bir Castro-Viejo iğne sürücüsünü kullanma, sağ karın yan duvarın kas tabakası içine 4-0 figure-of-sekiz iki ila dört ipek dikiş yerleştirin. yaklaşık 5 mm uzunluğunda kuyrukları bırakın. yanlışlıkla sütür içine bağırsak duvarı yakalamak için özen gösterin. (Şekil 5) </li></ol></li><li> W doldurulmuş bir 10 ml şırınga kullanılaraki, tuz ısındı bağırsakları birkaç kez sulanması. yanı sıra içini sulamak için karın boşluğuna tuzlu akışı yönlendirin. Fare altında yüzey batırılmış hale gelirse, fareyi üzerinde taşımak veya hipotermi önlemek için, yüzey değiştirin. </li><li> Aşırı sulama emmek için kesi üzerine yerleştirilen bir steril gazlı bez kullanın. </li><li> nişasta bir tutam alın ve sağ karın yan duvarın yüzeyine ve çekum her iki tarafında üzerine serpin. (Şekil 6) </li><li> aktif kanama olmadığından emin olun. varsa, durana kadar kanama noktasına doğrudan baskı uygulamak için bir gazlı bez sünger kullanın. Kanama kolaylıkla durmaz, yukarıda tarif edildiği gibi bir hemostatik dikiş yerleştirin. </li><li> forseps ve parmak künt ucunu kullanarak, yavaşça karın boşluğuna geri bağırsak itin. adezyon oluşumunu maksimize etmek için hemen yanında karın yanağında dikişlerle için çekum yerleştirin. </li><li> CKarın kesi kaybedersiniz. <ol><li> 6-0 emilebilir örgülü sütür kullanılarak, kesi üstündeki kas tabakası içine çalışan bir dikiş yerleştirin. </li><li> kas tabakasını bir araya getirerek, aşağı insizyon altına doğru dikiş çalıştırın. yaklaşık 3 mm seyahat ve her yeni dikiş ile 3 mm sokması alır. sütürler yerleştirirken özen yanlışlıkla bağırsağın bir ısırık almak değil. </li><li> kesi alt kısmında, önceki ısırık sütür bir döngü bırakmak ve dikiş kravat enstrüman için bunu kullanabilirsiniz. 5 mm kuyrukları bırakarak dikiş kesin. </li><li> Cildi kapatmak için 6-0 naylon monofilament sütür ile yukarıdaki üç adımları tekrarlayın. </li></ol></li><li> 20 ml / kg deri altı serum fizyolojik bolus (30 g fare için yaklaşık 0.5 ml) uygulayınız. </li><li> dorsal kürk sulama sırasında ıslak olsun eğilimi gibi kuru gazlı bez kullanarak, iyice tüm hayvan kurutun. </li><li> Gevşek kesi karşılamak için karın etrafında soyunma bir yapıştırıcı sarın. a sınırlamak vermemeye özenNimal bacakları ya da sargı ile nefes mekaniği. </li><li> anestezi kurtarır dikkatle hayvan izlemek. Ağrı kontrolü için işlem sonrası buprenorfin 2-3 gün boyunca her 12 saat uygulayın. </li></ol> 2. Hasat Yapışma Doku <ol><li> İlk ameliyattan sonra yedi gün en az bekleyin. Yine, cerrahi aletler otoklav ve izofluran ile fare uyutmak. </li><li> % 70 etanol, ardından betadin ile karın sterilize edin. Tıraş ve histoloji zorlaştıran cildi içeren yapışma örnek saç kaplı olmayacak şekilde karın, sağ tarafında başka saç atmaktadır. </li><li> bağırsak genellikle orijinal kesi yapışmış olduğundan, bir sol paramedian kesi kullanın. karın alt ucunda başlayarak, orijinal kesi alt solunda yaklaşık 5 mm, küçük dişli forseps ile cilt kavramak ve keskin bir makas ile deri içine kesti. Bu üstün kesim uzatıngöğüs kafesi için ly. (Şekil 7) </li><li> makas kullanarak, kas tabakası içine ve periton boşluğu girdikten sonra kesilmiş, kesi üst ve alt kesim uzatmak. Orijinal kesi muhtemelen de karnın sağ yan duvarına yapışır ve çekum ve ince bağırsak neden yapışkan doku olacaktır. (Şekil 8) </li><li> Çekum seviyesinden, makas kullanılarak ve insizyon kenarında başlayan, bağırsak yapışık olduğu alanın çevresinde bir daire karın duvarı içine kesme başlar. </li><li> Yukarıda Alternatif ve çekum seviyesinin altında, yavaş yavaş barsak deri ve karın duvarı yapışık bir &quot;ada&quot;, sonuçta tüm yol yapışma etrafını kesin ve daire tamamlayın. (Şekil 9) </li><li> Yine deri ve karın duvarı oluşan bir doku sandviç vererek, barsak oyulmuş ve barsak geri kalanından yapışık kısmını ayırmak, makas kullanarakbir tarafta, diğer tarafta bağırsak ve yapışkan dokuya arasındaki iki bağlantı. (Şekil 10) </li><li> İsteğe bağlı olarak, keskin karın duvarı kas cilt ayırmak için sivri makas kullanın. histoloji için ekli cildi düşünün, ama sindirim ve hücre izolasyonu için cilt kaldırılabilir. doku histolojisi için kullanılacaksa, aşırı yapışkan arayüzü bozmadan mümkün olduğunca sütür materyali kaldırmak için emin olun. sindirim ve hücre izolasyonu için o kadar uzun sindirmek süzülür doku olarak yerine sütür bırakmak kabul edilebilir. </li><li> yapışma dokusu eksize sonra, kurumsal hayvan kullanımı komitesi tarafından onaylanmış bir insani yöntemi kullanarak fare euthanize. </li></ol>

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Yazarlar hiçbir rakip mali çıkarları olduğunu beyan ederim.

Bu prosedürde kritik adımlar şunlardır: iyice, perforasyon neden karın yanağında sütür yerleştirerek, ve nişasta doğru miktarda uygulamadan çekum aşındırma. Sadece çekum, ya da barsak küçük bir özel bölümüne zımpara kağıdı uygulayın. ince bağırsağın büyük miktarlarda zımpara yaygın kullanımı önemli ileus neden olmaktadır. yüzeyi pürüzlü hale yeterli kuvvetle çekum aşındırmak için özen, ancak duvar gözyaşları o kadar çok değil. Bu dengeyi bulmak biraz zaman alabilir...

Karın yapışıklıklar genellikle cerrahi veya karın içi enfeksiyonu takiben, inflamasyon yanıt olarak karın içinde formu skar dokusu bir form vardır. Yapışıklıklar kronik karın ağrısı ve kısırlık başlıca nedenidir ve ince bağırsak tıkanması 1 en sık nedenidir. Yapışıklıklar varlığı, ikinci bir karın operasyonu daha zor performans ve komplikasyonların 2 olasılığını artırır yapar. Yıllar süren araştırmalara rağmen, yapışıklık oluşumunu altında yatan mekanizmaları yeterince anlaşılamamıştır. Peritoneal bir başlangıç ​​yaralanma ardından barsak ve karın duvarı birlikte, 3 yüzeylerini bağlayan bir pıhtı oluşturan fibrin bakımından zengin sıvının, bir eksudasyon neden olduğu bilinmektedir. Daha sonra, fibroblastlar ve diğer hücreler yapışkan uzaya göç ve bağ dokusunu 4 salgılar. yıllara aylarda yapışma kan damarlarını ve sinirleri geliştirerek olgunlaşır <sup&gt; 5. Çeşitli ticari ürünler abdominal cerrahi (örneğin, Seprafilm) sonrasında doku kaynaşması oluşumunu azaltmak için tasarlanmış ürünler mevcuttur. Tüm bu ürünlerin mekanik bariyerler olarak hareket ve bağırsak döngüler ve karın duvarı 6,7 arasındaki fiziksel teması engelleyerek yapışma oluşumunu durdurmak. Cerrahi adhezyon bariyeri yapışıklık 8 oluşumunu azaltır kontrollü çalışmadan kanıtlara rağmen, pek çok cerrah anekdotal mekanik bariyer ürünlerin etkinliği ile hayal kırıklığı olmuştur. Şu anda yapışıklık oluşumunda rol kesin süreçler tam olarak anlaşılamamıştır olduğu gerçeğini yansıtır herhangi bir ilaç tabanlı anti-yapışma tedaviler vardır. Özellikle yapışma oluşumunda yer olayların gelişmiş bir anlayış gerektirir yapışıklıkların oluşumuna katılan hücresel veya moleküler ajanlar hedefleyen bir terapi geliştirilmesi. çeşitli grups yapışıklık oluşumu 9-11 için önemli olabilir moleküler yollar belirledik. Hayvan modelleri yapışıklıklar oluşumunu incelemek için mükemmel bir ortam sağlar. Birçok çalışma, çok sayıda hayvan, özellikle de sıçan ve fare 6,12-14 yapışkanlıktaki cerrahi oluşturulmasını tarif yayınlanmıştır. Fare ve transgenik fareler ve fare tabanlı antikorların geniş yer fibrozis okuyan bizim deneyim göz önüne alındığında, yapışıklıklar çalışma için model olarak fare seçti. Bu yazıda, biz tekrarlanabilir ve güvenilir fare karın yapışıklıklar oluşturmak için geliştirilen tekniği rapor.

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			<td height="63" style="height:63px;width:152px;">Buprenex buprenorphine&#160; 0.3 mg/mL</td>
			<td style="width:136px;">Reckitt Benckiser Pharmaceuticals Inc.</td>
			<td style="width:116px;">NDC 12496-0757-5</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">1 cc insulin syringe, 27G</td>
			<td style="width:136px;">Becton&#160; Dickinson</td>
			<td style="width:116px;">329412</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Povidone Iodine Prep Solution</td>
			<td style="width:136px;">Medline</td>
			<td style="width:116px;">MDS093944H</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Webcol alcohol prep swabs</td>
			<td style="width:136px;">Covidien</td>
			<td style="width:116px;">6818</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:152px;">General-Purpose Labarotory Labeling tape</td>
			<td style="width:136px;">VWR</td>
			<td style="width:116px;">89097-912</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">BioGel PI surgical gloves</td>
			<td style="width:136px;">M&#246;lnlycke Health Care</td>
			<td style="width:116px;">ALA42675Z</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Micro Forceps with teeth</td>
			<td style="width:136px;">Roboz</td>
			<td style="width:116px;">RS-5150</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">Fine scissors- sharp</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">14060-09</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Straight serrated forceps</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">11050-10</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">Castro-Viejo needle driver</td>
			<td style="width:136px;">Fine Science Tools</td>
			<td style="width:116px;">12565-14</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">100 grit 1/4 sheet sandpaper</td>
			<td style="width:136px;">ACE Hardware</td>
			<td style="width:116px;">1010446</td>
			<td style="width:208px;">Cut into strips</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">4-0 silk suture, 30&#34;, SH needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">K831</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:152px;">7-0 PDS II absorbable monofilament suture, 30&#34;, BV-1 needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">Z135</td>
			<td style="width:208px;">Usually comes double-armed. Cut the suture at the midway point to generate two usable sutures.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">Rice starch</td>
			<td style="width:136px;">MP Biomedicals</td>
			<td style="width:116px;">102955</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:152px;">0.9% Sodium Chloride Irrigation</td>
			<td style="width:136px;">Baxter</td>
			<td style="width:116px;">BHL2F7121</td>
			<td style="width:208px;">Warm to 37&#176; C prior to use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:152px;">10 mL syringe</td>
			<td style="width:136px;">Becton Dickinson</td>
			<td style="width:116px;">309604</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:152px;">6-0 Vicryl absorbable braided suture, 18&#34;, RB-1 taper needle</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">J212H</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:152px;">6-0 Ethilon nylon monofilament&#160; suture, 18&#34;, P-3 needle,&#160;</td>
			<td style="width:136px;">Ethicon</td>
			<td style="width:116px;">1698G</td>
			<td style="width:208px;"></td>
		</tr>
		<tr height="84">
			<td height="84" style="height:84px;width:152px;">Tegaderm Transparent Film Dressing Frame Style, 6 cm x 7 cm</td>
			<td style="width:136px;">3M</td>
			<td style="width:116px;">1624W</td>
			<td style="width:208px;">Cut in half lengthwise</td>
		</tr>
	</tbody>
</table>

creation of abdominal adhesions in mice

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or intraabdominal infection. The precise mechanisms underlying adhesion formation are poorly understood. Many compounds and physical barriers have been tested for their ability to prevent adhesions after surgery with varying levels of success. The mouse and rat are important models for the study of abdominal adhesions. Several different techniques for the creation of adhesions in the mouse and rat exist in the literature. Here we describe a protocol utilizing abrasion of the cecum with sandpaper and sutures placed in the right abdominal sidewall. The mouse is anesthetized and the abdomen is prepped. A midline laparotomy is created and the cecum is identified. Sandpaper is used to gently abrade the surface of the cecum. Next, several figure-of-eight sutures are placed into the peritoneum of the right abdominal sidewall. The abdominal cavity is irrigated, a small amount of starch is applied, and the incision is closed. We have found that this technique produces the most consistent adhesions with the lowest mortality rate.

<html> cerrahi, çekum ve muhtemelen artan kolon, karaciğer ve ince bağırsağın döngüler sonra yedi gün sağ taraflı karın duvarına yapışık olmalıdır. (Şekil 8) Kesilen doku gömüldü, kesit ve mükemmel histolojik slaytlar verecektir edilebilir. (Şekil 11, 12) Prosedür doğru gerçekleştirildiğinde, farelerin% 100 yedi gün sonra dikkate değer adezyonlar olmalıdır. Öl?...

Watch this Scientific Journal Video about Creation of Abdominal Adhesions in Mice at JoVE.com

Creation of Abdominal Adhesions in Mice

Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

Farelerde Karın Adezyonların Oluşturulması

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or ...

Research

JoVE Journal

Medicine

12.5K Görüntüleme.  Stanford University School of Medicine. Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

Video: Creation of Abdominal Adhesions in Mice

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

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7. 
The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis8. Furthermore, some anastomoses may be insufficient from the start due to technical failure.
Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.
The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.
The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.
Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.

The C-seal is a biofragmentable drain protecting the stapled colorectal anastomosis. In this video, details of the manufacturing, deployment and use are shown.

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 ...

Tıp

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

Karın Tümörler Tedavi için Termal Ablasyon

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

Creation of Reversible Cholestatic Rat Model

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and affect the nutritional status and surgical outcomes. Study of the pathophysiological changes occurring in the liver and other organs is of importance. Various studies have been done in cholestatic rat models.
We used a reversible cholestatic rat model in our recent study looking at the role of methylprednisolone in the ischemia reperfusion injury. Various techniques for creation of a reversible cholestatic model have been described. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.
This model can be used in various studies, such as looking at the changes in nutritional, physiological, pathological, histological and immunological changes in the gastrointestinal tract. This model can also be used to see the effects of cholestasis and various therapeutic interventions on major hepatic surgeries.

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Creation of a reversible cholestatic rat model can be challenging in view of the smaller size and unique hepatopancreatobiliary anatomy in rats. This video article demonstrates the creation of a reversible cholestatic model.

Tersinir kolestatik Rat Modeli Yaratılış

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and ...

Orthotopic Liver Transplantation in Rats

Clinical progress in the field of liver transplantation has been largely supported by animal models1,2. Since the publication of the first orthotopic rat liver transplantation in 1979 by Kamada et al.3, this model has remained the gold standard despite various proposed alternative techniques4. Nevertheless, its broader use is limited by its steep learning curve5.
In this video paper, we show a simple and easy-to-establish revision of Kamada's two-cuff technique. The suprahepatic vena cava anastomosis is performed manually with a running suture, and the vena porta and infrahepatic vena cava anastomoses are performed utilizing a quick-linker cuff system6. Manufacturing the quick-linker kit is shown in a separate video paper.

We present an easy-to-establish revision of the classical two-cuff technique for orthotopic liver transplantation in rat.

Sıçanlarda Ortotopik Karaciğer Nakli

Clinical progress in the field of liver transplantation has been largely supported by animal models1,2. Since the publication of the first orthotopic rat ...

Ascending Aortic Constriction in Rats for Creation of Pressure Overload Cardiac Hypertrophy Model

Ascending aortic constriction is the most common and successful surgical model for creating pressure overload induced cardiac hypertrophy and heart failure. Here, we describe a detailed surgical procedure for creating pressure overload and cardiac hypertrophy in rats by constriction of the ascending aorta using a small metallic clip. After anesthesia, the trachea is intubated by inserting a cannula through a half way incision made between two cartilage rings of trachea. Then a skin incision is made at the level of the second intercostal space on the left chest wall and muscle layers are cleared to locate the ascending portion of aorta. The ascending aorta is constricted to 50&#8211;60% of its original diameter by application of a small sized titanium clip. Following aortic constriction, the second and third ribs are approximated with prolene sutures. The tracheal cannula is removed once spontaneous breathing was re-established. The animal is allowed to recover on the heating pad by gradually lowering anesthesia. The intensity of pressure overload created by constriction of the ascending aorta is determined by recording the pressure gradient using trans-thoracic two dimensional Doppler-echocardiography. Overall this protocol is useful to study the remodeling events and contractile properties of the heart during the gradual onset and progression from compensated cardiac hypertrophy to heart failure stage.

We describe a stepwise procedure for creating pressure overload and left ventricular hypertrophy in Wistar rats by constriction of the ascending aorta using a small metallic clip. This model is extensively used for studying remodeling changes during cardiac hypertrophy and for identifying and evaluating strategies for regression of such changes.

Basınç Aşırı Kardiyak hipertrofi Modeli Oluşturma Ratlarda Aort daralma, Artan

Ascending aortic constriction is the most common and successful surgical model for creating pressure overload induced cardiac hypertrophy and heart ...

Carotid Artery Infusions for Pharmacokinetic and Pharmacodynamic Analysis of Taxanes in Mice

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study model. As the use of mouse models are often a vital step in preclinical drug discovery and drug development1-8, it is necessary to design a system to introduce drugs into mice in a uniform, reproducible manner. Ideally, the system should permit the collection of blood samples at regular intervals over a set time course. The ability to measure drug concentrations by mass-spectrometry, has allowed investigators to follow the changes in plasma drug levels over time in individual mice1, 9, 10. In this study, paclitaxel was introduced into transgenic mice as a continuous arterial infusion over three hours, while blood samples were simultaneously taken by retro-orbital bleeds at set time points. Carotid artery infusions are a potential alternative to jugular vein infusions, when factors such as mammary tumors or other obstructions make jugular infusions impractical. Using this technique, paclitaxel concentrations in plasma and tissue achieved similar levels as compared to jugular infusion. In this tutorial, we will demonstrate how to successfully catheterize the carotid artery by preparing an optimized catheter for the individual mouse model, then show how to insert and secure the catheter into the mouse carotid artery, thread the end of the catheter out through the back of the mouse&#8217;s neck, and hook the mouse to a pump to deliver a controlled rate of drug influx. Multiple low volume retro-orbital bleeds allow for analysis of plasma drug concentrations over time.

This method was developed with the goal of delivering a steady drug solution via the carotid artery, to assess the pharmacokinetics of novel drugs in mouse models.

Farelerde Taksanlar Farmakokinetik ve Farmakodinamik Analiz Karotis Arter İnfüzyonlar

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study ...

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and fluid retention. Changes in myocardial structure, electrical conduction, and energy metabolism develop with heart failure, leading to contractile dysfunction, increased risk of arrhythmias, and sudden death. Hypertensive heart disease is one of the key contributing factors of cardiac remodeling associated with heart failure. The most commonly-used animal model mimicking hypertensive heart disease is created via surgical interventions, such as by narrowing the aorta. Abdominal aortic constriction is a useful experimental technique to induce a pressure overload, which leads to heart failure. The surgery can be easily performed, without the need for chest opening or mechanical ventilation. Abdominal aortic constriction-induced cardiac pathology progresses gradually, making this model relevant to clinical hypertensive heart failure. Cardiac injury and remodeling can be observed 10 weeks after the surgery. The method described here provides a simple and effective approach to produce a hypertensive heart disease animal model that is suitable for studying disease mechanisms and for testing novel therapeutics.

A rat model of abdominal aortic constriction that induces cardiac hypertrophy and remodeling is described. An efficient, highly-reproducible, and minimally-invasive method is used to provide a simple yet useful platform for research in myocardial hypertrophy and dysfunction.

Sıçanlarda Karın Aort Konstrüksiyon sayesinde Kardiyak Yaptırma Bir Model

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Creation of a Rodent Model of Abdominal Aortic Aneurysm by Blocking Adventitial Vasa Vasorum Perfusion

The adventitial vasa vasorum (VV) provides oxygen and nourishment to the aortic wall. Hypoxia in the aortic wall can cause enlarged abdominal aortic aneurysms (AAAs). This article introduces and describes a standard protocol used to induce AAAs through adventitial VV hypoperfusion created with a combination of polyurethane catheter insertion into the aortic lumen and suture ligation of the infrarenal abdominal aorta.
The protocol involves the use of male rats weighing 300-400 g, which are provided food and water ad libitum. After laparotomy with a ventral midline abdominal incision, exfoliation of the aorta is performed, which blocks blood flow from the perivascular tissue. Aortotomy involving a small incision adjacent to the renal artery branches is performed, and a polyurethane catheter is inserted using an 18-gauge indwelling needle. After repairing the incision, tight ligation of the aorta over the catheter blocks VV blood flow from the proximal direction through the aortic wall without disturbing the aortic blood flow. This technique can induce an AAA with progressive aortic dilatation.
The greatest benefit of this model is that VV hypoperfusion causes tissue hypoxia and the development of an infrarenal AAA, which has morphological and pathological characteristics similar to those of a human AAA.

Polyurethane catheter insertion into the aortic lumen and suture ligation of the aorta induce chronic hypoxia due to hypoperfusion of the adventitial vasa vasorum. This article describes a novel animal model of abdominal aortic aneurysm (AAA) with characteristics similar to those of AAA in humans.

Abdominal aort anevrizması Adventitial Vasa Vasorum perfüzyon engelleyerek kemirgen bir Model oluşturulması

The adventitial vasa vasorum (VV) provides oxygen and nourishment to the aortic wall. Hypoxia in the aortic wall can cause enlarged abdominal aortic ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

Fare Abdominal aort Myointimal Hiperplazi ikna etmek için balon tabanlı yaralanma

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

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 ...