Name: application of hemostatic devices in laparoscopic hepatectomy
Uploaded: 2022-04-19T13:00:00
Description: Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

Dette arbejde blev støttet af tilskud fra Science and Technology Project of Guangzhou City (202102010090).

Operationen er rutinemæssig og modtaget etisk godkendelse. Godkendelserne er som følger: Godkendelse til hurtig gennemgang af den kliniske forsknings- og applikationsetiske komité på det andet tilknyttede hospital i Guangzhou Medical University: Det videnskabelige forskningsetiske gennemgangsprojekt "Anvendelse af enkle og lette hæmostatiske enheder i laparoskopisk hepatektomi" (accept nr.: 2022-hg-ks-02) blev godkendt af den kliniske forsknings- og applikationsetiske komité på det andet tilknyttede hospital i Gua...

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Hepatektomi er en af de vigtigste behandlingsmetoder for patienter med primær leverkræft og sekundær leverkræft. I 1991 anvendte Reich et al. laparoskopi for at fjerne godartede tumorer i leveren og afsluttede verdens første laparoskopiske hepatektomi4. Efter mange års hurtig udvikling og forfremmelse er laparoskopisk hepatektomi blevet en af de almindelige metoder til behandling af lever maligne tumorer og er blevet bredt udført i de senere år. Med fordelene ved mindre intraoperativ blød...

Hepatocellulært carcinom er en af de mest almindelige maligne tumorer i fordøjelsessystemet. Ifølge de forskellige primære steder kan det opdeles i primær hepatocellulært carcinom og sekundær leverkræft. Celler kan metastasere fra primære tumorer fra organer uden for leveren ind i leveren på forskellige måder, hvilket fører til karcinom i leveren. Det er blevet rapporteret, at mere end 50% af metastatiske celler i leveren kommer fra kolorektal cancer, mens andre er fra bryst-, bugspytkirtel-, lunge- og mavetumorer osv.1. I de senere år er mange behandlinger for sekundær leverkræft tilgængelige, herunder systematisk kemoterapi, interventionel terapi, molekylær målrettet terapi, kirurgi osv.2. Imidlertid er radikal resektion stadig den mest effektive behandling, fordi den helt kan fjerne kræft3.
Med den hurtige udvikling af laparoskopisk teknologi anerkendes laparoskopisk anatomisk hepatektomi gradvist af kirurger, men udføres stadig ikke bredt, især i primære medicinske institutioner. En af grundene er kravet om hæmostatiske enheder af høj kvalitet. Disse er nødvendige for at reducere risikoen for blødning og galdelækage under driftsprocessen. Her præsenterer vi et sæt simpelt og let hæmostatisk udstyr, herunder et enkelt lumen kateter, harmonisk skalpel og monopol elektrokoagulering til udførelse af laparoskopisk hepatektomi. For at gøre dette okkluderes først porta hepatis intermitterende ved hjælp af et enkelt lumenkateter. Leverparenchymavæv resekteres derefter ved hjælp af den harmoniske skalpel. Blødende pletter koaguleres af monopol elektrokoagulering punkt-til-punkt. Dette enkle og lette hæmostatiske udstyr bruger et enkelt lumenkateter til at udføre pringle-manøvren og udnytter hæmostase af den harmoniske skalpel og monopolelektrokoagulering. Udstyret kan let findes på hospitaler, hvilket giver ekstra lethed til udførelse af laparoskopi eller træning. Således er disse enkle og lette hæmostatiske anordninger egnede til at udføre procedurer i primære medicinske institutioner.
I denne undersøgelse var patienten en 67-årig mand diagnosticeret med et moderat differentieret adenocarcinom af sigmoid kolon metastaseret i leveren. Radikal resektion af sigmoid tyktarmskræft blev udført i januar 2021. De patologiske resultater var moderat differentieret adenocarcinom med TNM-stadiet af pT4aN2aM1. FOLFOX kemoterapi blev givet fire gange efter operationen. Herefter blev patientens kropstilstand anset for egnet til at udføre laparoskopisk anatomisk hepatektomi for fuldstændigt at fjerne læsionen af levermetastaser. Child-Pugh-graden af leverfunktion var klasse A. For leverreservefunktionstesten var R15 i ICG-clearancetesten 1,6% (<10%). CT viste en 57 mm x 68 mm x 76 mm tumor over den dorsale del af S5 og den ventrale del af S6 i leveren; den tredimensionelle rekonstruktionsmodel er vist i figur 1.

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	<tbody>
		<tr>
			<td>HARMONIC ACE Ultrasonic Surgical Devices</td>
			<td>Ethicon Endo-Surgery,LLC</td>
			<td>HAR36</td>
			<td></td>
		</tr>
		<tr>
			<td>Hem-o-lock</td>
			<td>Teleflex Medical</td>
			<td>544233</td>
			<td></td>
		</tr>
		<tr>
			<td>Monopole Electrocoagulation</td>
			<td>KANGJI MEDICAL</td>
			<td>/</td>
			<td></td>
		</tr>
		<tr>
			<td>single lumen ureter</td>
			<td>WELL LEAD MEDICAL CO.,LTD.</td>
			<td>12F</td>
			<td></td>
		</tr>
	</tbody>
</table>

application of hemostatic devices in laparoscopic hepatectomy

Laparoskopisk hopatektomi betragtes som en konventionel metode til behandling af godartede og ondartede leversygdomme, fordi det er en minimalt invasiv metode. På trods af dets ikke-invasive aspekt forekommer blødning og galdelækage i leverparenchymavævsresektion under operationen eller i perioden efter operationen, hvilket indikerer kravet om hæmostatiske enheder af høj kvalitet, såsom ultralydkirurgisk aspiration, bipolar elektrokoagulering osv. Manglen på tilgængelighed af disse højkvalitets hæmostatiske anordninger forhindrer laparoskopisk hepatektomi i at blive en generaliseret procedure i grundlæggende medicinske organisationer. I lyset af ovennævnte situation udvikles en række enkle og lette hæmostatiske anordninger i denne protokol, som omfatter en harmonisk skalpel, monopolelektrokoagulering og et enkelt lumenkateter til innovativt at udføre leverparenchymavævsresektion. Først og fremmest okkluderes porta hepatis eller leverpedikel intermitterende af et enkelt lumen kateter efterfulgt af fastspænding i 15 minutter og frigivelse i 5 minutter. Derefter udføres klemning og knusning af leveren ved hjælp af den harmoniske skalpel for at afskære leverparenchymenvævet og for at afsløre de intrahepatiske arterier, vener og galdekanaler. Endelig koaguleres blødningspletterne ved hjælp af monopolelektrokoagulering på hvert sted. Intrahepatiske rørledningsstrukturer er derefter synlige ved hjælp af disse metoder, som let kan stoppe blødning, reducere forekomsten af galdelækage og forbedre sikkerheden og gennemførligheden af laparoskopisk hopatektomi. Derfor er de enkle og lette hæmostatiske enheder, der er vist her, egnede til at udføre procedurer i primære medicinske institutioner.

Operationen blev afsluttet inden for 2,5 timer, og det intraoperative blødningsvolumen var 100 ml uden blodtransfusion. Der var ingen kortvarige komplikationer, og patienten blev udskrevet fra hospitalet den 8. dag efter operationen. Niveauet for carcinoembryonisk antigen (CEA) efter operationen faldt til 110,64 μg/l fra niveauet før operationen på 1058,69 μg/l (figur 12). To måneder efter operationen vendte patienten tilbage til hospitalet for at fortsætte kemoterapibehand...

Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Højkvalitets hæmostatiske enheder er afgørende for laparoskopisk hepatektomi. Disse enheder er imidlertid ikke generaliseret i grundlæggende medicinske organisationer. Derfor vises en række enkle og lette hæmostatiske enheder i denne artikel, som kan gøre den laparoskopiske hepatektomi lettere at udføre.

Anvendelse af hæmostatiske enheder i laparoskopisk hepatektomi

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. ...

Den største fordel ved denne teknik er, at den hæmostatiske enhed er enkel og nem at opnå og kan udføres på grundlæggende hospitaler. Dette sæt hæmostatiske udstyr kan yderligere anvendes på laparoskopisk hepatektomi og andre systemer. Det anbefales stærkt at have et vist grundlag for laparoskopisk kirurgi, især dygtig brug af en harmonisk skalpel til at anvende dette sæt hæmostatiske enheder i laparoskopisk hepatektomi.Begynd med at anvende direkte punktering for at etablere pneumoperitoneum i laparoskopi. Placer en 10 millimeter trocar i hvert observationshul i det subumbiliske område, højre midtklavikulær linje under kystmargenen og den ventrale midterlinje. Placer derefter en fem millimeter trocar i den højre forreste hjælpelinje og den ventrale midterlinje.Saml de hæmostatiske enheder, der starter fra den harmoniske skalpel, monopolelektrokoagulering og enkelt lumen kateter, der innovativt anvendes i leverparenchymavævsresektion. For at udføre en Pringle-manøvre skal du okkludere den første porta hepatis intermitterende ved hjælp af et enkelt lumenkateter. Klem lumenkateteret med et hæmostatisk klip i 15 minutter efterfulgt af at frigive det i fem minutter ved hjælp af den harmoniske skalpel til at afskære klemmen og tage klemmen ud for at genoprette blodtilførslen til de første porta hepatis.Adskil de leverpedikler, der leverer tumoren. Resect og del dem en efter en med en harmonisk skalpel. Overhold iskæmilinjen på leveroverfladen, som bliver synlig efter resektion af leverpediklerne.Brug krogen til at markere den. Resect leverparenchymavævet ved hjælp af den harmoniske skalpel, mens du klemmer og knuser leveren gradvist. Overhold den indre leverarterie, vene og galdegang.Resect og opdele disse rørledningsstrukturer. Når blødningen viser sig, koaguleres blødningspletterne på leverdissektionsoverfladen straks ved hjælp af punkt til punkt monopol elektrokoagulering. Brug den højre bageste leverpedikel som en vejviser til intrahepatisk parenchymavævsresektion.Reserver den vigtigste bageste leverpedikel og disseker grenen af pedicles, der leverer tumoren. For at afslutte operationen skal du vaske leveroverfladen, så man kan se, om der stadig er blødningspletter. Stop blødningen på leverdissektionsoverfladen og fjern tumorprøven fra bukhulen.Operationen blev afsluttet inden for 2,5 timer. Det intraoperative blødningsvolumen var 100 ml uden blodtransfusion, og der blev ikke observeret nogen kortvarige komplikationer. Det carcinoembryoniske antigenniveau efter operationen faldt til 110,64 mikrogram pr. liter fra niveauet før operationen på 1058,69 mikrogram pr. liter.Kemoterapibehandlingen blev genoptaget to måneder efter operationen, ifølge tumorpatologiresultaterne. Den postoperative CT-undersøgelse blev sammenlignet med den præoperative CT, og der blev ikke observeret tegn på tumorgenvækst. Det vigtigste trin i den kirurgiske proces er brugen af den harmoniske skalpel.Der kræves en god mængde færdigheder for at undgå skader på vitale strukturer.

application-of-hemostatic-devices-in-laparoscopic-hepatectomy

Research

JoVE Journal

Cancer Research

Evaporation-reducing Culture Condition Increases the Reproducibility of Multicellular Spheroid Formation in Microtiter Plates

Tumor models that closely imitate in vivo conditions are becoming increasingly popular in drug discovery and development for the screening of potential anti-cancer drugs. Multicellular tumor spheroids (MCTSes) effectively mimic the physiological conditions of solid tumors, making them excellent in vitro models for lead optimization and target validation. Out of the various techniques available for MCTS culture, the liquid-overlay method on agarose is one of the most inexpensive methods for MCTS generation. However, the reliable transfer of MCTS cultures using liquid-overlay for high-throughput screening may be compromised by a number of limitations, including the coating of microtiter plates (MPs) with agarose and the irreproducibility of uniform MCTS formation across wells. MPs are significantly prone to edge effects that result from excessive evaporation of medium from the exterior of the plate, preventing the use of the entire plate for drug tests. This manuscript provides detailed technical improvements to the liquid-overlay technique to increase the scalability and reproducibility of uniform MCTS formation. Additionally, details on a simple, semi-automatic, and universally applicable software tool for the evaluation of MCTS features after drug treatment is presented.

The uneven loss of medium from microtiter plates affects the reproducibility of uniform multicellular tumor spheroid formation. Improving culture conditions to reduce significant medium loss will improve the reproducibility of spheroid formation and the results of spheroid-based assays using the liquid-overlay technique.

Fordampning-reducerende Kultur Betingelse Øger Reproducerbarhed af flercellet Sfæroide Formation i mikrotiterplader

Tumor models that closely imitate in vivo conditions are becoming increasingly popular in drug discovery and development for the screening of potential ...

Application of Laser Micro-irradiation for Examination of Single and Double Strand Break Repair in Mammalian Cells

Highly coordinated DNA repair pathways exist to detect, excise and replace damaged DNA bases, and coordinate repair of DNA strand breaks. While molecular biology techniques have clarified structure, enzymatic functions, and kinetics of repair proteins, there is still a need to understand how repair is coordinated within the nucleus. Laser micro-irradiation offers a powerful tool for inducing DNA damage and monitoring the recruitment of repair proteins. Induction of DNA damage by laser micro-irradiation can occur with a range of wavelengths, and users can reliably induce single strand breaks, base lesions and double strand breaks with a range of doses. Here, laser micro-irradiation is used to examine repair of single and double strand breaks induced by two common confocal laser wavelengths, 355 nm and 405 nm. Further, proper characterization of the applied laser dose for inducing specific damage mixtures is described, so users can reproducibly perform laser micro-irradiation data acquisition and analysis.

Confocal fluorescence microscopy and laser micro-irradiation offer tools for inducing DNA damage and monitoring the response of DNA repair proteins in selected sub-nuclear areas. This technique has significantly advanced our knowledge of damage detection, signaling, and recruitment. This manuscript demonstrates these technologies to examine single and double strand break repair.

Anvendelsen af Laser mikro-bestråling for undersøgelse af enkelt og dobbelt Strand bryde reparation i pattedyrceller

Highly coordinated DNA repair pathways exist to detect, excise and replace damaged DNA bases, and coordinate repair of DNA strand breaks. While molecular ...

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic pancreatoduodenectomy (LPD) has not yet obtained wide acceptance, probably due to technical challenges, especially regarding the pancreatic anastomosis.
The study describes and demonstrates all steps of LPD, including the modified Blumgart pancreaticojejunostomy. Indications for LPD are all pancreatic and peri-ampullary tumors without vascular involvement. Relative contra-indications are body mass index &#62;35 kg/m2, chronic pancreatitis, mid-cholangiocarcinomas and large duodenal cancers.
The patient is in French position, 6 trocars are placed, and dissection is performed using an (articulating) sealing device. A modified Blumgart end-to-side pancreaticojejunostomy is performed with 4 large needles (3/0) barbed trans-pancreatic sutures and 4 to 6 duct-to-mucosa sutures using 5/0 absorbable multifilament combined with a 12 cm, 6 or 8 Fr internal stent using 3D laparoscopy. Two surgical drains are placed alongside the pancreaticojejunostomy.
The described technique for LPD including a modified Blumgart pancreatico-jejunostomy is well standardized, and its merits are currently studied in the randomized controlled multicenter trial. This complex operation should be performed at high-volume centers where surgeons have extensive experience in both open pancreatic surgery and advanced laparoscopic gastro-intestinal surgery.

Laparoscopic pancreatoduodenctomy (LPD) may offer advantages over open pancreatoduodenectomy, including early postoperative mobilization, less delayed gastric emptying and a shorter hospital stay. However, LPD is technically challenging and not well-standardized, especially regarding the pancreatic anastomosis. We describe a standardized technique for the pancreatic anastomosis during LPD: modified Blumgart pancreaticojejunostomy.

Laparoskopisk Pancreatoduodenectomy med modificerede Blumgart Pancreaticojejunostomy

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal ...

The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery (BCS), a separate incision in the lower axilla hairline was made to find the sentinel nodes (SNs). In mastectomy, the SNs were identified through the same mastectomy incision. The SNs were described as blue nodes or nodes with lymphatic blue channels. An anatomical landmark in the axilla was used to facilitate SNs identification. The SNs metastases were evaluated by intraoperative frozen section analysis and histopathology examination as it is a gold standard. Here, we described the MBD as the lone technique in breast cancer sentinel node biopsy (SNB) which could be useful when radioisotope tracer or patent or isosulfan blue dye (PBD) cannot be provided.

In Indonesia, sentinel node biopsy (SNB) is not routinely performed for breast cancer surgery because of the limitation to provide radioisotope tracer and isosulfan or patent blue dye (PBD). To overcome this obstacle, we applied 1% methylene blue dye (MBD) as a single agent to map the sentinel nodes (SNs).

Anvendelsen af 1% methylenblåt farvestof som en enkelt teknik i brystkræft Sentinel node biopsi

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery ...

The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

Glioblastoma is the most common and lethal form of brain cancer, with a median survival of 15 months after diagnosis and a 5 year survival rate of only 5% with current standard of care. Tumors often recur within 9 months following initial surgery, radiation and chemotherapy, at which point treatment options become limited. This highlights the pressing need for the development of better therapeutics to prolong survival and increase the quality of life for these patients.
Tumor Treating Fields (TTFields) therapy was developed to take advantage of the effect of low frequency alternating electrical fields on cells for cancer therapy. TTFields have been demonstrated to disrupt cells during mitosis and slow tumor growth. There is also growing evidence that they act through stimulating immune responses within exposed tumors. The advantages of TTFields therapy include its noninvasive approach and increased quality of life compared to other treatment modalities such as cytotoxic chemotherapies. The Food and Drug Administration approved TTFields therapy for the treatment of recurrent glioblastoma in 2011 and for newly diagnosed glioblastoma in 2015. We report on the effects of TTFields during mitosis, the results of electric fields modeling, and proper transducer array placement. Our protocol outlines the clinical application of TTFields on a patient post-surgery, using the second-generation device.

Glioblastoma is the most common and aggressive primary brain malignancy in adults, with most tumors recurring after initial treatment. Tumor Treating Fields (TTFields) therapy is the newest treatment modality for glioblastoma. Here, we describe the proper application of TTFields-transducer arrays on patients and discuss theory and aspects of treatment.

Den kliniske anvendelse af Tumor behandling af felter terapi i glioblastom

Glioblastoma is the most common and lethal form of brain cancer, with a median survival of 15 months after diagnosis and a 5 year survival rate of only 5% ...

In Vitro Evaluation of Oncogenic Transformation in Human Mammary Epithelial Cells

Tumorigenesis is a multi-step process in which cells acquire capabilities&#160;that allow their growth, survival, and dissemination under hostile conditions. Different tests seek to identify and quantify these hallmarks of cancerous cells; however, they often focus on a single aspect of cellular transformation and, in fact, multiple tests are required for their proper characterization. The purpose of this work is to provide researchers with a set of tools to assess cellular transformation in vitro from a broad perspective, thereby making it possible to draw sound conclusions.
A sustained proliferative signaling activation is the major feature of tumoral tissues and can be easily monitored under in vitro conditions by calculating the number of population doublings achieved over time. Besides, the growth of cells in 3D cultures allows their interaction with surrounding cells, resembling what occurs in vivo. This enables the evaluation of cellular aggregation and, together with immunofluorescent labeling of distinctive cellular markers, to obtain information on another relevant feature of tumoral transformation: the loss of proper organization. Another remarkable characteristic of transformed cells is their capacity to grow without attachment to other cells and to the extracellular matrix, which can be evaluated with the anchorage assay.
Detailed experimental procedures to evaluate cell growth rate, to perform immunofluorescent labeling of cell lineage markers in 3D cultures, and to test anchorage-independent cell growth in soft agar are provided. These methodologies are optimized for Breast Primary Epithelial Cells (BPEC) due to its relevance in breast cancer; however, procedures can be applied to other cell types after some adjustments.

This protocol provides experimental in vitro tools to evaluate the transformation of human mammary cells. Detailed steps to follow-up cell proliferation rate, anchorage-independent growth capacity, and distribution of cell lineages in 3D cultures with basement membrane matrix are described.

In Vitro evaluering af onkogene transformation i humane mammary epitelceller

Tumorigenesis is a multi-step process in which cells acquire capabilities&#160;that allow their growth, survival, and dissemination under hostile ...

Co-culture of Glutamatergic Neurons and Pediatric High-Grade Glioma Cells Into Microfluidic Devices to Assess Electrical Interactions

Pediatric high-grade gliomas (pHGG) represent childhood and adolescent brain cancers that carry a rapid dismal prognosis. Since there is a need to overcome the resistance to current treatments and find a new way of cure, modeling the disease as close as possible in an in vitro setting to test new drugs and therapeutic procedures is highly demanding. Studying their fundamental pathobiological processes, including glutamatergic neuron hyperexcitability, will be a real advance in understanding interactions between the environmental brain and pHGG cells. Therefore, to recreate neurons/pHGG cell interactions, this work shows the development of a functional in vitro model co-culturing human-induced Pluripotent Stem (hiPS)-derived cortical glutamatergic neurons pHGG cells into compartmentalized microfluidic devices and a process to record their electrophysiological modifications. The first step was to differentiate and characterize human glutamatergic neurons. Secondly, the cells were cultured in microfluidic devices with pHGG derived cell lines. Brain microenvironment and neuronal activity were then included in this model to analyze the electrical impact of pHGG cells on these micro-environmental neurons. Electrophysiological recordings are coupled using multielectrode arrays (MEA) to these microfluidic devices to mimic physiological conditions and to record the electrical activity of the entire neural network. A significant increase in neuron excitability was underlined in the presence of tumor cells.

Recent works uncover the neuronal impact on high-grade pediatric glioma (pHGG) cells and their reciprocal interactions. The present work shows the development of an in vitro model co-culturing pHGG cells and glutamatergic neurons and recorded their electrophysiological interactions to mimic those interactivities.

Co-kultur af glutamatergiske neuroner og pædiatriske høj kvalitet Glioma celler i mikrofluidiske enheder til at vurdere elektriske interaktioner

Pediatric high-grade gliomas (pHGG) represent childhood and adolescent brain cancers that carry a rapid dismal prognosis. Since there is a need to ...

Flexible Organic Electronic Devices for Pulsed Electric Field Therapy of Glioblastoma

Glioblastoma is difficult to eradicate with standard oncology therapies due to its high degree of invasiveness. Bioelectric treatments based on pulsed electric fields (PEFs) are promising for the improvement of treatment efficiency. However, they rely on rigid electrodes that cause acute and chronic damage, especially in soft tissues such as the brain. In this work, flexible electronics were used to deliver PEFs to tumors and the biological response was evaluated with fluorescent microscopy. Interdigitated gold electrodes on a thin, transparent parylene-C substrate were coated with the conducting polymer PEDOT:PSS, resulting in a conformable and biocompatible device. The effects of PEFs on tumors and their microenvironment were examined using various biological models. First, monolayers of glioblastoma cells were cultured on top of the electrodes to investigate phenomena in vitro. As an intermediate step, an in ovo model was developed where engineered tumor spheroids were grafted in the embryonic membrane of a quail. Due to the absence of an immune system, this led to highly vascularized tumors. At this early stage of development, embryos have no immune system, and tumors are not recognized as foreign bodies. Thus, they can develop fast while developing their own vessels from the existing embryo vascular system, which represents a valuable 3D cancer model. Finally, flexible electrode delivery of PEFs was evaluated in a complete organism with a functional immune system, using a syngenic, orthograft (intracranial) mouse model. Tumor spheroids were grafted into the brain of transgenic multi-fluorescent mice prior to the implantation of flexible organic electrode devices. A sealed cranial window enabled multiphoton imaging of the tumor and its microenvironment during treatment with PEFs over a period of several weeks.

This work describes the development of flexible interdigitated electrodes for implementation in 3D brain tumor models, namely, in vitro culture, in ovo model, and in vivo murine model. The proposed method can be used to evaluate the effects of pulsed electric fields on tumors at different levels of complexity.

Fleksible organiske elektroniske enheder til pulserende elektrisk feltterapi af glioblastom

Glioblastoma is difficult to eradicate with standard oncology therapies due to its high degree of invasiveness. Bioelectric treatments based on pulsed ...

Generation and Culturing of High-Grade Serous Ovarian Cancer Patient-Derived Organoids

Organoids are 3D dynamic tumor models that can be grown successfully from patient-derived ovarian tumor tissue, ascites, or pleural fluid and aid in the discovery of novel therapeutics and predictive biomarkers for ovarian cancer. These models recapitulate clonal heterogeneity, the tumor microenvironment, and cell-cell and cell-matrix interactions. Additionally, they have been shown to match the primary tumor morphologically, cytologically, immunohistochemically, and genetically. Thus, organoids facilitate research on tumor cells and the tumor microenvironment and are superior to cell lines. The present protocol describes distinct methods to generate patient-derived ovarian cancer organoids from patient tumors, ascites, and pleural fluid samples with a higher than 97% success rate. The patient samples are separated into cellular suspensions by both mechanical and enzymatic digestion. The cells are then plated utilizing a basement membrane extract (BME) and are supported with optimized growth media containing supplements specific to the culturing of high-grade serous ovarian cancer (HGSOC). After forming initial organoids, the PDOs can sustain long-term culture, including passaging for expansion for subsequent experiments.

Patient-derived organoids (PDO) are a three-dimensional (3D) culture that can mimic the tumor environment in vitro. In high-grade serous ovarian cancer, PDOs represent a model to study novel biomarkers and therapeutics.

Generering og dyrkning af højkvalitets serøs ovariecancer patientafledte organoider

Organoids are 3D dynamic tumor models that can be grown successfully from patient-derived ovarian tumor tissue, ascites, or pleural fluid and aid in the ...

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when there are tumors adjacent to the cystic bed, surgeons cannot palpate the surgical margins through the laparoscopic approach, which leads to uncertainty about R0 resection. Conventionally, the gallbladder is resected first, and the hepatic lobes or segments are resected second. However, tumor tissues can be disseminated in the above cases. To address this issue, based on the recognition of the porta hepatis and intrahepatic anatomy, we propose a unique approach to hepatectomy combined with gallbladder resection by en bloc anatomic resection in situ. Firstly, after dissecting the cystic duct, without cutting the gallbladder primarily, the porta hepatis is pre-occluded by the single lumen ureter; secondly, the left hepatic pedicle is made free by the gap of the Laennec membrane and Hilar plate; thirdly, the assistant is asked to drag the fundus of the gallbladder, and the liver parenchyma tissue is resected using a harmonic scalpel along the ischemia line on the liver surface and intraoperative ultrasound. The whole middle hepatic vein (MHV) and its tributaries appear completely; lastly, the left hepatic vein (LHV) is disconnected, and the specimen is taken out from the abdominal cavity. The tumor, gallbladder, and other surrounding tissues are resected en bloc, which meets the tumor-free criterion, and a wide incisal margin and R0 resection are achieved. Therefore, the laparoscopic hepatectomy with the combination of the en bloc concept and anatomic resection is a safe, effective, and radical method with low postoperative recurrence and metastasis.

Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

Anvendelse af En Bloc-konceptet kombineret med anatomisk resektion i laparoskopisk hepatektomi

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when ...