Name: a two-step method for percutaneous transhepatic choledochoscopic lithotomy
Uploaded: 2022-09-13T12:30:00
Description: Watch this Scientific Journal Video about A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy at JoVE.com

Studien ble godkjent av etikkkomiteen ved det andre tilknyttede sykehuset i Shantou University Medical College (Shantou, Kina).
1. Forberedelser
<ol><li>Bruk strenge eksklusjonskriterier for å selektere pasienter og innhente signerte informert samtykkeskjema12 (tabell 1).</li>
	<li>Bruk følgende opptakskriterier:<ol><li>Velg pasienter som frivillig fikk totrinns PTCSL-behandling.</li>
		<li>Velg de pasientene som ble bekreftet å ha...

<ol>
	<li>Shu, 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=Robotic-assisted+laparoscopic+surgery+for+complex+hepatolithiasis:+a+propensity+score+matching+analysis.">Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis.</a> Surgical Endoscopy. 33 (8), 2539-2547 (2019).</li><li>Korkes, F., 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=Percutaneous+treatment+of+complex+biliary+stone+disease+using+endourological+technique+and+literature+review.">Percutaneous treatment of complex biliary stone disease using endourological technique and literature review.</a> Einstein. 13 (4), 611-615 (2015).</li><li>Gamal, E. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+video+choledochoscopic+treatment+of+retained+biliary+stones+via+dilated+t-tube+tract.">Percutaneous video choledochoscopic treatment of retained biliary stones via dilated t-tube tract.</a> Surgical Endoscopy. 15 (5), 473-476 (2001).</li><li>Khalid, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+endoscopic+biliary+exploration+in+complex+biliary+stone+disease:+Case+series+study.">Percutaneous endoscopic biliary exploration in complex biliary stone disease: Case series study.</a> International Journal of Surgery. 24, 73-78 (2020).</li><li>Kim, J. H., 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=Percutaneous+transhepatic+cholangioscopic+treatment+of+patients+with+benign+bilio-enteric+anastomotic+strictures.">Percutaneous transhepatic cholangioscopic treatment of patients with benign bilio-enteric anastomotic strictures.</a> Gastrointestinal Endoscopy. 58 (5), 733-738 (2003).</li><li>Hwang, J. H., 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=Risk+factors+for+recurrent+cholangitis+after+initial+hepatolithiasis+treatment.">Risk factors for recurrent cholangitis after initial hepatolithiasis treatment.</a> Journal of Clinical Gastroenterology. 38 (4), 364-367 (2004).</li><li>Bonnel, D. H., 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=Common+bile+duct+and+intrahepatic+stones:+results+of+transhepatic+electrohydraulic+lithotripsy+in+50+patients.">Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients.</a> Radiology. 180 (2), 345-348 (1991).</li><li>Kondo, S., 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=A+clinicopathologic+study+of+primary+cholesterol+hepatolithiasis.">A clinicopathologic study of primary cholesterol hepatolithiasis.</a> Hepato-gastroenterology. 42 (5), 478-486 (1995).</li><li>Williams, E., 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=Updated+guideline+on+the+management+of+common+bile+duct+stones+(CBDS).">Updated guideline on the management of common bile duct stones (CBDS).</a> Gut. 66 (5), 765-782 (2017).</li><li>Makuuchi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonically+guided+cholangiography+and+bile+drainage.">Ultrasonically guided cholangiography and bile drainage.</a> Ultrasound in Medicine &amp; Biology. 10 (5), 617-623 (1984).</li><li>Jeng, K. S., 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=Percutaneous+transhepatic+cholangioscopy+in+the+treatment+of+complicated+intrahepatic+biliary+strictures+and+hepatolithiasis+with+internal+metallic+stent.">Percutaneous transhepatic cholangioscopy in the treatment of complicated intrahepatic biliary strictures and hepatolithiasis with internal metallic stent.</a> Surgical Laparoscopy. 10 (5), 278-283 (2000).</li><li>Zhuo, H., 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=Percutaneous+transhepatic+choledochoscopic+lithotomy+(PTCSL)+is+effective+for+the+treatment+of+intrahepatic+and+extrahepatic+choledocholithiasis.">Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis.</a> Surgical Laparoscopy, Endoscopy &amp; Percutaneous Techniques. 31 (3), 326-330 (2020).</li><li>Hazey, J. W., McCreary, M., Guy, G., Melvin, W. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+percutaneous+treatment+of+biliary+tract+calculi+using+the+holmium:+YAG+laser.">Efficacy of percutaneous treatment of biliary tract calculi using the holmium: YAG laser.</a> Surgical Endoscopy. 21 (7), 1180-1183 (2007).</li><li>Ozturk, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+surgical+technique+applied+with+urological+instruments+in+bilobar+multiple+hepatolithiasis:+Ultra-mini+percutaneous+hepatolithotomy.">New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy.</a> Turkish Journal of Urology. 43 (3), 371-377 (2017).</li><li>Ozcan, N., 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=Percutaneous+transhepatic+removal+of+bile+duct+stones:+results+of+261+patients.">Percutaneous transhepatic removal of bile duct stones: results of 261 patients.</a> Cardiovascular and Interventional Radiology. 35 (3), 621-627 (2012).</li><li>Kint, J. F., 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=Percutaneous+treatment+of+common+bile+duct+stones:+results+and+complications+in+110+consecutive+patients.">Percutaneous treatment of common bile duct stones: results and complications in 110 consecutive patients.</a> Digestive Surgery. 32 (1), 9-15 (2015).</li><li>Yeh, Y. H., 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=Percutaneous+trans-hepatic+cholangioscopy+and+lithotripsy+in+the+treatment+of+intrahepatic+stones:+a+study+with+5+year+follow-up.">Percutaneous trans-hepatic cholangioscopy and lithotripsy in the treatment of intrahepatic stones: a study with 5 year follow-up.</a> Gastrointestinal Endoscopy. 42 (1), 13-18 (1995).</li><li>Jan, Y. 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=Percutaneous+trans-hepatic+cholangioscopic+lithotomy+for+hepatolithiasis:+long-term+results.">Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results.</a> Chang Gung Medical Journal. 17 (1), 149 (1994).</li><li>Cheon, Y. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+long-term+results+and+recurrent+factors+after+operative+and+nonoperative+treatment+for+hepatolithiasis.">Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis.</a> Surgery. 146 (5), 843-853 (2009).</li><li>Tsutsumi, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparative+evaluation+of+treatment+methods+for+bile+duct+stones+after+hepaticojejunostomy+between+percutaneous+transhepatic+cholangioscopy+and+peroral,+short+double-balloon+enteroscopy.">A comparative evaluation of treatment methods for bile duct stones after hepaticojejunostomy between percutaneous transhepatic cholangioscopy and peroral, short double-balloon enteroscopy.</a> Therapeutic Advances in Gastroenterology. 10 (1), 54-67 (2017).</li></ol>

Intrahepatisk og ekstrahepatisk koledokolitasis bidrar til galleveisobstruksjon, og tilhørende kolangitt kan føre til gramnegativ endotoksemi med kliniske manifestasjoner av septisk sjokk eller multiorgandysfunksjon. Dermed representerer gallestein en kompleks sykdom som kan være utfordrende for kirurger, spesielt i tilfeller av pasienter som tidligere har hatt komplekse abdominale operasjoner eller pasienter med unormal anatomisk struktur. PTCSL blir mye brukt over hele verden, men det er fortsatt behov for innovativ...

Intrahepatisk og ekstrahepatisk choledocholithiasis er et komplekst medisinsk problem som kirurger står overfor og er svært vanlig i østasiatiske land1. For tiden er kirurgisk inngrep nødvendig for de fleste choledocholithiasis, mens de viktigste behandlingene for gallegangstener inkluderer åpen kirurgi, perkutan transhepatisk koledokoskopisk litotomi (PTCSL), laparoskopisk litotomi2, perkutan endoskopisk biliær leting 3,4 og endoskopisk retrograd kolangiopankreatografi. Pasienter med bilioenterisk anastomose eller Billroth II-rekonstruksjon, med en unormal anatomisk struktur som et duodenalt periampullært divertikulum, som gjør galdekanalen vanskelig tilgjengelig gjennom en endoskopisk tilnærming 5,6,7,8, eller som tidligere har hatt komplekse abdominale operasjoner, inkludert delvis gastrektomi, kunne imidlertid ikke gjennomgå endoskopisk behandling eller laparoskopisk litotomi. Endoskopisk terapi kan heller ikke være egnet for hepatolithiasis med store og berørte steiner. Derfor kan PTCSL generelt være et bedre valg9.
Den tradisjonelle PTCS-tilnærmingen følger en slik prosedyre for å utvide sinus gradvis og utføre perkutan transhepatisk biliær drenering10,11, noe som krever en relativt lang sykehusinnleggelsessyklus, vanligvis mellom 2 og 3 uker, noe som fører til potensialet for biliær fistel, galdeveisinfeksjon, blødning og peritonitt, med flere ekspanderende kappestørrelser. Prosedyren består av to deler. I det første trinnet punkteres målgallekanalen, og føringstråden settes inn mens du observerer galleutstrømningen. Deretter brukes en dilatator til å sakte utvide kanalen langs føringsledningen. Etter at kanalen er vellykket etablert, trekkes dilatatoren ut, et avløp plasseres i målgallekanalen, og ledetråden trekkes ut.
Den perkutane leverpunksjonen og dreneringen (PTCD) er fullført hvis galledreneringen er uhindret og avløpet er løst uten blodutstrømning. Sinuskanalen blir stabil 1 uke etter PTCD, når den deretter kan utvides. Føringstråden plasseres i avløpsrøret og utvides gjennom sinuskanalen langs føringstråden med en 10F-dilatator, og til slutt plasseres i et 10F-avløp. Sinuskanalen utvides en gang i uken etter operasjonen, med en 2F-størrelse øker hver gang, slik at sinuskanalen kan utvides til 16F ved 4 uker etter PTCD. I det andre trinnet, etter utvidelse av sinuskanalen til 16F, utføres operasjonen for å fjerne steinen ved hjelp av en galdefiberlinse. Derfor krever den tradisjonelle PTCSL beskrevet ovenfor en behandlingssyklus og bidrar til høyt økonomisk press for pasientene. Videre er lav steinutvinningseffektivitet og gjentatte og flere kirurgiske prosedyrer for steinfjerning også uunngåelige ulemper ved tradisjonell PTCS, noe som begrenser bruken av denne teknologien.
Fra januar 2013 begynte vi å bruke PTCS for minimal invasiv behandling av pasienter med kompleks intrahepatisk og ekstrahepatisk choledocholithiasis på sykehuset vårt, men endret noen viktige trinn i tradisjonell PTCS. I det første trinnet ble operasjonen utført 1 uke etter PTCD, akkurat da sinuskanalen ble stabil, og sinus ble utvidet til 16F direkte, ved hjelp av en 16F expander som sterkt reduserte preoperativ forberedelsestid. I det andre trinnet, forskjellig fra den tradisjonelle teknologien, ble et Wolf-nefroskop brukt i stedet for et tradisjonelt koledokoskop for å utføre operasjonen, som vi refererer til som "to-trinns PTCSL-metoden." For å avgjøre om PTCSL-prosedyren var trygg, minimal invasiv og effektiv, gjennomgikk denne studien retrospektivt 81 pasienter med intrahepatisk og ekstrahepatisk choledocholithiasis behandlet med to-trinns PTCSL-metoden fra januar 2013 til januar 2020.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% Normal saline solution</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>16-F series fascia dilator</td>
			<td></td>
			<td>type PLVW, Cook Medical</td>
			<td></td>
		</tr>
		<tr>
			<td>adjustable pressure pump</td>
			<td></td>
			<td>type APL; Guangzhou Jielun Medical Equipment Co. , Ltd, Guangdong Province, China</td>
			<td></td>
		</tr>
		<tr>
			<td>biliary balloon dilator</td>
			<td></td>
			<td>ATB advance; Cook Medical</td>
			<td></td>
		</tr>
		<tr>
			<td>blade</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>camera system</td>
			<td></td>
			<td>1088i HD Camera Control Unit, PAL 220 V; Stryker Corporation</td>
			<td></td>
		</tr>
		<tr>
			<td>Cavity mirror protective sleeve</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>clamp</td>
			<td></td>
			<td>5Fr, Richard Wolf GmbH, Germany</td>
			<td></td>
		</tr>
		<tr>
			<td>color ultrasound machine</td>
			<td></td>
			<td>DC-N2S, Mindray</td>
			<td></td>
		</tr>
		<tr>
			<td>Cook net basket</td>
			<td></td>
			<td>NGE-017115-MB, COOK Medical Inc. , Bloomington, USA</td>
			<td></td>
		</tr>
		<tr>
			<td>drainage pack</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>expander</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>guide wire</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>hydroelectric lithotripter</td>
			<td></td>
			<td>Aymed Medical, <img alt="Equation 1" src="/files/ftp_upload/63206/63206eq01.jpg" style="margin: auto;" />stanbul, Turkey</td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;Iodophor</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;Kidney basin</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>light source</td>
			<td></td>
			<td>Voice-control compatible X8000 Xenon Light Source of 300 W;Stryker Corporation, MI</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical syringe</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>puncture needle</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>suction apparatus</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>surgical gauze</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>trocar</td>
			<td></td>
			<td>-</td>
			<td></td>
		</tr>
		<tr>
			<td>Wolf nephroscope</td>
			<td></td>
			<td>12-degree Ultra-Wide-Angle Ureteroreno-scope; Richard Wolf GmbH, Germany</td>
			<td></td>
		</tr>
		<tr>
			<td>zebra guide wire</td>
			<td></td>
			<td>type HAW; Cook Medical, Bloomington, IN</td>
			<td></td>
		</tr>
	</tbody>
</table>

a two-step method for percutaneous transhepatic choledochoscopic lithotomy

Intrahepatisk og ekstrahepatisk koledokolithiasis er en utfordring innen biliær kirurgi. Vi presenterer vår erfaring med å bruke en to-trinns perkutan transhepatisk koledokoskopisk litotomi (PTCSL) prosedyre for å behandle utfordrende gallestein. Vi gjennomgikk retrospektivt 81 pasienter med intrahepatisk og ekstrahepatisk koledokolithiasis behandlet med denne to-trinns PTCSL fra januar 2013 til januar 2020, inkludert 40 menn og 41 kvinner, med en gjennomsnittsalder på 66 år. I motsetning til tradisjonell perkutan transhepatisk kolangioskopi (PTCS) ble det etablert en kanal direkte gjennom en 16F Amplatz-skjede, og steinen i kanalen ble fjernet ved hjelp av et nefroskop. Den kliniske effekten og komplikasjonene til alle pasientene ble analysert. Åttien pasienter (81/81, 100%) hadde sine gallesteiner vellykket fjernet; 62/81 pasienter (76,5%) hadde gallestein helt fjernet etter den første operasjonen; 17/81 pasienter (21%) gjennomgikk en ny operasjon; 2/81 pasienter (2,5%) trengte en tredje operasjon for å fjerne steinene helt. Forekomsten av alvorlig blødning under operasjonen var 0%, og det var ingen dødsfall. Bruken av to-trinns PTCSL-metoden er sikker og effektiv, og bidrar til en bedre prognose for intrahepatisk og ekstrahepatisk koledokolithiasis.

Alle pasientene fikk fjernet gallegangssteinene sine vellykket, med 58 pasienter (58/81, 72%) som hadde gallegangsstein helt fjernet etter den første operasjonen, 18 pasienter (18/81, 22%) som krevde en annen operasjon, og fem pasienter (5/81, 6%) gjennomgikk en tredje operasjon for å fjerne steinene helt. Tre pasienter hadde residiverende intrahepatisk kolelithiasis i 5. og 6. postoperative år. Det var 56 pasienter (56/81, 68,7 %) som gjennomgikk perkutan leverkirurgi, samt 25 pasienter (25/81, ...

Watch this Scientific Journal Video about A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy at JoVE.com

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

Denne "to-trinns metoden" forbedret suksessraten for perkutan transhepatisk koledokoskopi betydelig og oppnådde en bedre prognose for intrahepatisk og ekstrahepatisk koledokolithiasis.

En to-trinns metode for perkutan transhepatisk koledoskopisk lithotomi

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous ...

Denne protokollen forbedrer suksessraten for perkutan transhepatisk koledokoskopi betydelig og oppnår en bedre prognose for intrahepatisk og ekstrahepatisk koledokolithiasis. Denne teknikken reduserer tilbakefall av intrahepatisk og ekstrahepatisk choledocholithiasis og forkorter hele litotripsyperioden, operasjonstiden og avstanden mellom hudinngangssteder og målrettede galdekanaler. PTCSL kan være et bedre valg for behandling av komplekse intrahepatiske og ekstrahepatiske koledokoolithiasis, for eksempel hos pasienter som tidligere hadde gjennomgått komplisert abdominal kirurgi eller som hadde anatomiske abnormiteter og ikke kunne gjennomgå en endoskopisk undersøkelse.Denne teknikken kan også brukes til perkutan nefrolitotomi for å håndtere nyresteinproblemer. Strukturen i den intrahepatiske gallekanalen er kompleks og sårbar for skade, noe som øker den kirurgiske risikoen, og den visuelle demonstrasjonen kan bedre unngå disse farlige komplikasjonene. En uke før operasjonen, utfør prosedyren for perkutan transhepatisk kolangiodrenering, eller PTCD.Sett inn et inneliggende 8F biliært dreneringsrør for å drenere og redusere hevelsen i galdekanalen. Vent til bihulekanalen blir stabil en uke etter denne prosedyren. Injiser 20 ml saltvann inn i gallekanalen langs dreneringsrøret.Etter at en føringsledning er satt inn i den, trekk ut PTCD-røret. For å plassere fascia dilator i skjede, utvide sinus ved hjelp av en 16F expander og bli med en 16F belte dilatator slik at 16F skjeden kan nå gallekanalen der steinen kan ha blitt plassert. Finn steinene.Bruk klemme tang for å bryte og fjerne steinene. Vask ut små steiner og pulveriserte steiner ved hjelp av en justerbar trykkpumpe. Ved slutten av prosedyren, la et dreneringsrør være inne i pasienten i en uke.Ved hjelp av PTCSL fikk alle pasientene renset gallesteinene sine med hell. 72% av pasientene hadde gallegangsteinene helt fjernet etter den første operasjonen, mens 28% av pasientene krevde mer enn en operasjon. 56 pasienter gjennomgikk perkutan leverkirurgi og 25 pasienter gjennomgikk kirurgi ved å innebygge en sinus dannet av et T-rør.Antall steiner var lik en av 70 pasienter. Gjennomsnittlig sykehusopphold var 11 dager. Det var en komplikasjon av en liten mengde reaktiv pleural effusjon.Mindre intraoperativ galleblødning ble observert hos to pasienter, og én pasient hadde galleinfeksjon etter operasjon. Imidlertid ble det ikke observert massiv blødning av galdeveiene. Preoperativ ultralyd ble brukt til å nøyaktig lokalisere steinplasseringen og for å beholde 8F-avløpet, og sinus ble direkte utvidet ved hjelp av en 16F-ekspander.

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Medicine

A Modified Method for Heterotopic Mouse Heart Transplantion

Mice are often used as heart transplant donors and recipients in studies of transplant immunology due to the wide range of transgenic mice and reagents available. A difficulty is presented due to the small size of the animal and the considerable technical challenges of the microsurgery involved in heart transplantation. In particular, a high rate of technical failure early after transplantation may result from recipient death and post-operative complications such as hind limb paralysis or a non-beating heart. Here, the complete technique for heterotopic mouse heart transplantation is demonstrated, involving harvesting the donor heart and its subsequent implantation into a recipient mouse. The donor heart is harvested immediately following in situ perfusion with cold heparinized saline and transection of the ascending aorta and pulmonary artery. The recipient operation involves preparation of the abdominal aorta and inferior vena cava (IVC), followed by end-to-side anastomosis of the donor aorta with the recipient aorta using a single running 10-0 microsuture and a similar anastomosis of the donor pulmonary artery with the recipient IVC. Following the operation the animal is injected with 0.6 ml normal saline subcutaneously and allowed to recover on a 37&#160;&#176;C heating pad. The results from 227 mouse heart transplants are summarized with a success rate at 48 hr of 86.8%. Of the 13.2% failures within 48 hr, 5 (2.2%) experienced hind limb paralysis, 10 (4.4%) had a non-beating heart due to graft ischemic injury and/or thrombosis, while 15 (6.6%) died within 48 hr.

A technique is demonstrated for the microsurgical procedure for heterotopic transplantation of hearts in mice, including simplified methods for donor harvesting and recipient vessel anastomosis.

En modifisert metode for Heterotop Mouse Hjerte Transplantion

Mice are often used as heart transplant donors and recipients in studies of transplant immunology due to the wide range of transgenic mice and reagents ...

Preparation and Respirometric Assessment of Mitochondria Isolated from Skeletal Muscle Tissue Obtained by Percutaneous Needle Biopsy

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining samples of human Vastus lateralis, isolating mitochondria from minimal amounts of skeletal muscle tissue, and plate based respirometric profiling using an extracellular flux (XF) analyzer. Comparison of respirometric profiles obtained using 1.0, 2.5 and 5.0 &#956;g of mitochondria indicate that 1.0 &#956;g is sufficient to measure respiration and that 5.0 &#956;g provides most consistent results based on comparison of standard errors. Western blot analysis of isolated mitochondria for mitochondrial marker COX IV and non-mitochondrial tissue marker GAPDH indicate that there is limited non-mitochondrial contamination using this protocol. The ability to study mitochondrial respirometry in as little as 20 mg of muscle tissue allows users to utilize individual biopsies for multiple study endpoints in clinical research projects.

Methods for biopsy of Vastus lateralis, preparation of purified mitochondria, and respirometric profiling are described. The use of small muscle volume makes this technique suitable for clinical research applications.

Forberedelse og respirometrisk Vurdering av Mitokondrier Isolert fra Skeletal Muscle Tissue Oppnådd ved perkutan Needle Biopsi

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining ...

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real time images with a 15 &#181;m axial resolution at an effective tissue penetration of 2-3 mm. Within the OCT images the loss of signal intensity per millimeter of tissue penetration, the attenuation coefficient, is calculated. The attenuation coefficient is a tissue specific property, providing a quantitative parameter for tissue differentiation. 
Until now, renal mass treatment decisions have been made primarily on the basis of MRI and CT imaging characteristics, age and comorbidity. However these parameters and diagnostic methods lack the finesse to truly detect the malignant potential of a renal mass. A successful core biopsy or fine needle aspiration provides objective tumor differentiation with both sensitivity and specificity in the range of 95-100%. However, a non-diagnostic rate of 10-20% overall, and even up to 30% in SRMs, is to be expected, delaying the diagnostic process due to the frequent necessity for additional biopsy procedures. 
We aim to develop OCT into an optical biopsy, providing real-time imaging combined with on-the-spot tumor differentiation. This publication provides a detailed step-by-step approach for percutaneous, needle based, OCT of renal masses.

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is a high resolution imaging technique that allows analysis of tissue specific optical properties providing the means for tissue differentiation. We developed needle based OCT, providing real-time imaging combined with on-the-spot tumor differentiation. This publication describes a method for percutaneous, needle based OCT of renal masses.

I Vivo, Percutaneous, Needle Basert, Optical Coherence Tomography av nyre Masses

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

Perkutan Lever Perfusjons (PHP) med melfalan som en behandling for unresectable metastaser begrenset til leveren

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model

Cell and gene therapy are exciting and promising strategies for the purpose of cardiac regeneration in the setting of heart failure with reduced ejection fraction (HFrEF). Before they can be considered for use, and implemented in humans, extensive preclinical studies are required in large animal models to evaluate the safety, efficacy, and fate of the injectate (e.g., stem cells) once delivered into the myocardium. Small rodent models offer advantages (e.g., cost effectiveness, amenability for genetic manipulation); however, given inherent limitations of these models, the findings in these rarely translate into the clinic. Conversely, large animal models such as rabbits, have advantages (e.g., similar cardiac electrophysiology compared to humans and other large animals), whilst retaining a good cost-effective balance. Here, we demonstrate how to perform a percutaneous contrast echocardiography-guided intramyocardial injection (IMI) technique, which is minimally invasive, safe, well tolerated, and very effective in the targeted delivery of injectates, including cells, into several locations within the myocardium of a rabbit model. For the implementation of this technique, we also have taken advantage of a widely available clinical echocardiography system. After putting in practice the protocol described here, a researcher with basic ultrasound knowledge will become competent in the performance of this versatile and minimally invasive technique for routine use in experiments, aimed at hypothesis testing of the capabilities of cardiac regenerative therapeutics in the rabbit model. Once competency is achieved, the whole procedure can be performed within 25 min after anaesthetizing the rabbit.

Novel therapeutic strategies in cardiac regenerative medicine require extensive and detailed studies in large preclinical animal models before they can be considered for use in humans. Here, we demonstrate a percutaneous contrast echocardiography-guided intramyocardial injection technique in rabbits, which is valuable for hypothesis testing the efficacy of such novel therapies.

PCI kontrast Echocardiography-guidede Intramyocardial injeksjon og celle levering i en stor prekliniske modell

Cell and gene therapy are exciting and promising strategies for the purpose of cardiac regeneration in the setting of heart failure with reduced ejection ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

Tredimensjonal utskrift guide mal assistert perkutan Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

A Revised Method for Inducing Secondary Lymphedema in the Hindlimb of Mice

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore potential treatment options. This mouse model allows researchers to induce significant lymphedema lasting at least 8 weeks. Lymphedema is induced using a combination of fractioned radiotherapy and surgical ablation of lymphatics. This model requires that the mice get a dose of 10 Gray (Gy) radiation before and after surgery. The surgical part of the model involves ligation of three lymph vessels and extraction of two lymph nodes from the mouse hindlimb. Having access to microsurgical tools and a microscope is essential, due to the small anatomical structures of mice. The advantage of this model is that it results in statistically significant lymphedema, which provides a good basis for evaluating different treatment options. It is also a great and easily available option for microsurgical training. The limitation of this model is that the procedure can be time consuming, especially if not practiced in advance. The model results in objectively quantifiable lymphedema in mice, without causing severe morbidity and has been tested in three separate projects.

This animal model enables researchers to induce statistically significant secondary lymphedema in the hindlimb of mice, lasting at least 8 weeks. The model can be used to study the pathophysiology of lymphedema and to investigate novel treatment options.

En revidert metode for å indusere sekundær lymfødem i Hindlimb bentap av mus

Animal models are of paramount importance in the research of lymphedema in order to understand the pathophysiology of the disease but also to explore ...

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Percutaneous transcatheter edge-to-edge reconstruction of the mitral valve is a safe and well-established therapy for severe symptomatic mitral regurgitation in patients with high surgical risk. Echocardiographic guidance in addition to fluoroscopy is the gold standard and should be performed using a standardized technique.
This article lays out our reproducible step by step echocardiographic guide including views, measurements as well as highlighting possible difficulties that may arise during the procedure.
This article provides detailed and chronological echocardiographic views for each step of the procedure, especially preferences between 2D and 3D imaging. If needed, pulse wave, continuous wave and color doppler measurements are described. Furthermore, as there are no official recommendations for the quantification of mitral regurgitation during the percutaneous edge-to-edge-repair procedure, advice is also included for echocardiographic quantification after grasping the mitral leaflets and after device deployment. In addition, the article deals with important echocardiographic views to prevent and deal with possible complications during the procedure.
Echocardiographic guidance during transcatheter mitral valve repair is mandatory. A structured approach improves the collaboration between interventionist and imager and is indispensable for a safe and effective procedure.

This protocol presents in detail how to perform real-time echocardiographic guidance during transcatheter mitral valve repair. The fundamental views and the necessary measurements are described for each stage of the procedure.

En forenklet trinnvis tilnærming til ekkoveiledning under perkutan mitralklaffreparasjon

Percutaneous transcatheter edge-to-edge reconstruction of the mitral valve is a safe and well-established therapy for severe symptomatic mitral ...

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Cardiogenic shock is defined as persistent hypotension, accompanied by evidence of end organ hypo-perfusion. Percutaneous ventricular assist devices (PVADs) are used for the treatment of cardiogenic shock in an effort to improve hemodynamics. Impella is currently the most common PVAD and actively pumps blood from the left ventricle into the aorta. PVADs unload the left ventricle, increase cardiac output and improve coronary perfusion. PVADs are typically placed in the cardiac catheterization laboratory under fluoroscopic guidance via the femoral artery when feasible. In cases of severe peripheral arterial disease, PVADs can be implanted through an alternative access. In this article, we summarize the mechanism of action of PVAD and the data supporting their use in the treatment of cardiogenic shock.

Percutaneous ventricular assist devices are increasingly being utilized in patients with acute myocardial infarction and cardiogenic shock. Herein, we discuss the mechanism of action and hemodynamic effects of such devices. We also review algorithms and best practices for the implantation, management and weaning of these complex devices.

Bruk av perkutane ventrikulære hjelpeenheter i akutt hjerteinfarkt komplisert av kardiogent sjokk

Cardiogenic shock is defined as persistent hypotension, accompanied by evidence of end organ hypo-perfusion. Percutaneous ventricular assist devices ...

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the left ventricle by draining blood from the left atrium (LA) and returning it to the systemic arterial circulation via the femoral artery. It can provide flows ranging from 2.5-5 L/min depending on the size of the cannula. Here, we discuss the mechanism of action of LAFAB, available clinical data, indications for its use in cardiogenic shock, steps of implantation, post-procedural care, and complications associated with the use of this device and their management.
We also provide a brief video of the procedural component of device therapy, including the pre-placement preparation, percutaneous placement of the device via transseptal puncture under echocardiographic guidance and the post-operative management of device parameters.

The following article describes the stepwise procedure for placement of a device (e.g., Tandemheart) in cardiogenic shock (CS) that is a percutaneous left ventricular assist device (pLVAD) and a left atrial to femoral artery bypass (LAFAB) system that bypasses and supports the left ventricle (LV) in CS.

Bruk av en perkutan ventrikulær hjelpeenhet / venstre atrium til femoral arterie bypass-system for kardiogent sjokk

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the ...