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

Dit werk werd ondersteund door subsidies van het Science and Technology Project van Guangzhou City (202102010090).

De operatie is routine en kreeg ethische goedkeuring. De goedkeuringen zijn als volgt: Goedkeuring voor snelle beoordeling door de Clinical Research and Application Ethics Committee van het Second Affiliated Hospital of Guangzhou Medical University: Het wetenschappelijke onderzoeksethische beoordelingsproject "Application of simple and easy Hemostatic Devices in Laparoscopic Hepatectomy" (acceptatienummer: 2022-hg-ks-02) werd goedgekeurd door de ethische commissie voor klinisch onderzoek en toepassing van het Second Affi...

<ol>
	<li>Hess, K. R., 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=Metastatic+patterns+in+adenocarcinoma.">Metastatic patterns in adenocarcinoma.</a> Cancer. 106 (7), 1624-1633 (2006).</li><li>van de Velde, C. 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=EURECCA+colorectal:+multidisciplinary+management:+European+consensus+conference+colon+&amp;+rectum.">EURECCA colorectal: multidisciplinary management: European consensus conference colon &amp; rectum.</a> European Journal of Cancer. 50 (1), 1-34 (2014).</li><li>Adams, R. B., 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=Selection+for+hepatic+resection+of+colorectal+liver+metastases:+expert+consensus+statement[J].">Selection for hepatic resection of colorectal liver metastases: expert consensus statement[J].</a> HPB. 15 (2), 91-103 (2013).</li><li>Reich, H., McGlynn, F., DeCaprio, J., Budin, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+excision+of+benign+liver+lesions.">Laparoscopic excision of benign liver lesions.</a> Obstetrics and Gynecology. 78 (5), 956-958 (1991).</li><li>Ciria, R., Cherqui, D., Geller, D. A., Briceno, J., Wakabayashi, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+short-term+benefits+of+laparoscopic+liver+resection:+9000+cases+and+climbing.">Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing.</a> Annals of Surgery. 263 (4), 761-777 (2016).</li><li>Makuuchi, M., Hasegawa, H., Yamazaki, S. <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+subsegmentectomy.">Ultrasonically guided subsegmentectomy.</a> Surgery, Gynecology, and Obstetrics. 161 (4), 346-350 (1985).</li><li>Agrawal, S., Belghiti, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oncologic+resection+for+malignant+tumors+of+the+liver.">Oncologic resection for malignant tumors of the liver.</a> Annals of Surgery. 253 (4), 656-665 (2011).</li><li>Wakabayashi, T., 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=Laparoscopic+repeat+liver+resection+after+open+liver+resection:+A+comparative+study+from+a+single-centre.">Laparoscopic repeat liver resection after open liver resection: A comparative study from a single-centre.</a> Journal of Minimal Access Surgery. 16 (1), 59-65 (2020).</li><li>Berardi, G., 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=Parenchymal+sparing+anatomical+liver+resections+with+full+laparoscopic+approach:+description+of+technique+and+short-term+results.">Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results.</a> Annals of Surgery. 273 (4), 785-791 (2021).</li><li>Cho, J. Y., Han, H. S., Yoon, Y. S., Shin, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+laparoscopic+liver+resection+for+tumors+located+in+the+posterosuperior+segments+of+the+liver,+with+a+special+reference+to+overcoming+current+limitations+on+tumor+location.">Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location.</a> Surgery. 144 (1), 32-38 (2008).</li><li>Ome, Y., Honda, G., Doi, M., Muto, J., Seyama, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+anatomic+liver+resection+of+segment+8+using+intrahepatic+Glissonean+approach.">Laparoscopic anatomic liver resection of segment 8 using intrahepatic Glissonean approach.</a> Journal of the American College of Surgeons. 230 (3), 13-20 (2020).</li><li>Ryu, T., 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=Perioperative+and+oncological+outcomes+of+laparoscopic+anatomical+hepatectomy+for+hepatocellular+carcinoma+introduced+gradually+in+a+single+center.">Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center.</a> Surgical Endoscopy. 32 (2), 790-798 (2018).</li><li>Makabe, 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=Efficacy+of+occlusion+of+hepatic+artery+and+risk+of+carbon+dioxide+gas+embolism+during+laparoscopic+hepatectomy+in+a+pig+model.">Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model.</a> Journal of Hepato-Biliary-Pancreatic Sciences. 21 (8), 592-598 (2014).</li><li>Miyagi, 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=Pure+laparoscopic+hepatectomy+combined+with+a+pure+laparoscopic+pringle+maneuver+in+patients+with+severe+cirrhosis.">Pure laparoscopic hepatectomy combined with a pure laparoscopic pringle maneuver in patients with severe cirrhosis.</a> Case Reports in Gastroenterology. 9 (1), 101-105 (2015).</li></ol>

Hepatectomie is een van de belangrijkste behandelingsmethoden voor patiënten met primaire leverkanker en secundaire leverkanker. In 1991 pasten Reich et al. laparoscopie toe om goedaardige tumoren van de lever te verwijderen en voltooiden 's werelds eerste laparoscopische hepatectomie4. Na jaren van snelle ontwikkeling en promotie is laparoscopische hepatectomie een van de reguliere methoden geworden om kwaadaardige tumoren in de lever te behandelen en is het de afgelopen jaren op grote schaal ui...

Hepatocellulair carcinoom is een van de meest voorkomende kwaadaardige tumoren van het spijsverteringsstelsel. Volgens de verschillende primaire sites kan het worden onderverdeeld in primair hepatocellulair carcinoom en secundaire leverkanker. Cellen kunnen op verschillende manieren uitzaaien van primaire tumoren van organen buiten de lever naar de lever, wat leidt tot carcinoom in de lever. Er is gemeld dat meer dan 50% van de gemetastaseerde cellen in de lever afkomstig zijn van colorectale kanker, terwijl anderen afkomstig zijn van borst-, pancreas-, long- en maagtumoren, enz. 1. In de afgelopen jaren zijn veel behandelingen voor secundaire leverkanker beschikbaar, waaronder systematische chemotherapie, interventionele therapie, moleculaire gerichte therapie, chirurgie, enz. 2. Radicale resectie is echter nog steeds de meest effectieve behandeling omdat het de kanker volledig kan verwijderen3.
Met de snelle ontwikkeling van laparoscopische technologie wordt laparoscopische anatomische hepatectomie geleidelijk erkend door chirurgen, maar wordt nog steeds niet op grote schaal uitgevoerd, vooral in primaire medische instellingen. Een van de redenen is de vereiste voor hoogwaardige hemostatische apparaten. Deze zijn nodig om de risico's op bloedingen en gallekkage tijdens het operatieproces te verminderen. Hier presenteren we een reeks eenvoudige en gemakkelijke hemostatische apparatuur, waaronder een katheter met één lumen, harmonisch scalpel en monopole-elektrocoagulatie, voor het uitvoeren van laparoscopische hepatectomie. Om dit te doen, wordt eerst de porta hepatis met tussenpozen afgesloten door een katheter met één lumen te gebruiken. Leverparenchymweefsel wordt vervolgens gereseceerd met behulp van het harmonische scalpel. Bloedingsvlekken worden gecoaguleerd door monopole elektrocoagulatie point-to-point. Deze eenvoudige en gemakkelijke hemostatische apparatuur maakt gebruik van een katheter met één lumen om de pringle-manoeuvre uit te voeren en maakt gebruik van de hemostase van het harmonische scalpel en monopole-elektrocoagulatie. De apparatuur is gemakkelijk te vinden in ziekenhuizen, waardoor het extra gemak biedt voor het uitvoeren van laparoscopie of training. Deze eenvoudige en gemakkelijke hemostatische apparaten zijn dus geschikt voor het uitvoeren van procedures in primaire medische instellingen.
In deze studie was de patiënt een 67-jarige man gediagnosticeerd met een matig gedifferentieerd adenocarcinoom van de sigmoïde colon uitgezaaid in de lever. Radicale resectie van de sigmoïde darmkanker werd uitgevoerd in januari 2021. De pathologische resultaten waren matig gedifferentieerd adenocarcinoom met het TNM-stadium van pT4aN2aM1. FOLFOX chemotherapie werd vier keer na de operatie gegeven. Hierna werd de lichaamsconditie van de patiënt geschikt geacht om laparoscopische anatomische hepatectomie uit te voeren om de laesie van levermetastasen volledig te verwijderen. De Child-Pugh graad van leverfunctie was graad A. Voor de leverreservefunctietest was R15 in de ICG-klaringstest 1,6% (<10%). CT toonde een tumor van 57 mm x 68 mm x 76 mm over het dorsale deel van S5 en het ventrale deel van S6 van de lever; het driedimensionale reconstructiemodel is weergegeven in figuur 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

Laparoscopische hepatectomie wordt beschouwd als een conventionele methode voor de behandeling van goedaardige en kwaadaardige leverziekten omdat het een minimaal invasieve methode is. Ondanks het niet-invasieve aspect treden bloedingen en gallekkage op in leverparenchym weefselresectie tijdens de operatie of in de periode na de operatie, wat wijst op de behoefte aan hoogwaardige hemostatische apparaten, zoals ultrasone chirurgische aspiratie, bipolaire elektrocoagulatie, enz. Het gebrek aan beschikbaarheid van deze hoogwaardige hemostatische apparaten voorkomt dat laparoscopische hepatectomie een gegeneraliseerde procedure wordt in medische basisorganisaties. In het licht van de hierboven genoemde situatie wordt in dit protocol een reeks eenvoudige en gemakkelijke hemostatische apparaten ontwikkeld, waaronder een harmonisch scalpel, monopole-elektrocoagulatie en een katheter met één lumen, om op innovatieve wijze leverparenchymweefselresectie uit te voeren. Allereerst wordt de porta hepatis of leverpedist met tussenpozen afgesloten door een katheter met één lumen, gevolgd door klemmen gedurende 15 minuten en loslaten gedurende 5 minuten. Vervolgens worden met behulp van het harmonische scalpel klemmen en pletten van de lever gedaan om het leverparenchymweefsel af te snijden en de intrahepatische slagaders, aderen en galwegen te onthullen. Ten slotte worden de bloedingsplekken gecoaguleerd door op elke plek monopole elektrocoagulatie te gebruiken. Intrahepatische pijplijnstructuren zijn dan zichtbaar door deze methoden te gebruiken, die het bloeden gemakkelijk kunnen stoppen, de incidentie van gallekkage kunnen verminderen en de veiligheid en haalbaarheid van laparoscopische hepatectomie kunnen verbeteren. Daarom zijn de eenvoudige en gemakkelijke hemostatische apparaten die hier worden getoond geschikt voor het uitvoeren van procedures in primaire medische instellingen.

De operatie werd binnen 2,5 uur voltooid en het intraoperatieve bloedingsvolume was 100 ml zonder de bloedtransfusie. Er waren geen complicaties op korte termijn en patiënt werd op de8e dag na de operatie uit het ziekenhuis ontslagen. Het carcino-embryonaal antigeen (CEA) niveau na de operatie daalde tot 110,64 μg/l ten opzichte van het niveau vóór de operatie van 1058,69 μg/l (figuur 12). Twee maanden na de operatie keerde patiënt terug naar het ziekenhuis om de chemotherap...

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

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Hoogwaardige hemostatische apparaten zijn essentieel voor laparoscopische hepatectomie. Deze apparaten zijn echter niet gegeneraliseerd in medische basisorganisaties. Daarom wordt in dit artikel een reeks eenvoudige en gemakkelijke hemostatische apparaten getoond, die de laparoscopische hepatectomie gemakkelijker uit te voeren kunnen maken.

Toepassing van hemostatische apparaten bij laparoscopische hepatectomie

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

Het belangrijkste voordeel van deze techniek is dat het hemostatische apparaat eenvoudig en gemakkelijk te verkrijgen is en kan worden uitgevoerd in basisziekenhuizen. Deze set hemostatische apparatuur kan verder worden toegepast op laparoscopische hepatectomie en andere systemen. Het wordt ten zeerste aanbevolen om een bepaalde basis van laparoscopische chirurgie te hebben, vooral vakkundig gebruik van een harmonisch scalpel om deze set hemostatische apparaten toe te passen bij laparoscopische hepatectomie.Begin met het toepassen van directe punctie om pneumoperitoneum in laparoscopie vast te stellen. Plaats een trocar van 10 millimeter in elk observatiegat in het subumbilicale gebied, rechter middenclaviculaire lijn onder de kustrand en ventrale middellijn. Plaats vervolgens een vijf millimeter trocar in de rechter voorste hulplijn en de ventrale middellijn.Monteer de hemostatische apparaten vanaf het harmonische scalpel, monopole elektrocoagulatie en katheter met één lumen om innovatief te worden gebruikt bij de resectie van leverparenchymweefsel. Om een Pringle-manoeuvre uit te voeren, sluit u de eerste porta hepatis met tussenpozen af met behulp van een enkele lumenkatheter. Klem de lumenkatheter gedurende 15 minuten vast met een hemostatische clip, gevolgd door deze gedurende vijf minuten los te laten met behulp van het harmonische scalpel om de clip af te snijden en de clip eruit te halen om de bloedtoevoer naar de eerste porta hepatis te herstellen.Scheid de leverpedicilie die de tumor levert. Reseceer en verdeel ze één voor één met een harmonisch scalpel. Observeer de ischemielijn op het leveroppervlak, die zichtbaar wordt na de resectie van de leverpedikels.Gebruik de haak om het te markeren. Reseceer het leverparenchymweefsel met behulp van het harmonische scalpel terwijl u de lever geleidelijk klemt en verplettert. Observeer de interne leverslagader, ader en galwegen.Resecteer en verdeel deze pijplijnstructuren. Zodra de bloeding verschijnt, stolt u de bloedende vlekken op het leverdissectieoppervlak onmiddellijk met behulp van point-to-point monopole elektrocoagulatie. Gebruik de rechter achterste leverpedicle als wegwijzer voor intrahepatische parenchym weefselresectie.Reserveer de belangrijkste posterieure lever pedikel en ontleed de tak van pedikels die de tumor leveren. Om de operatie te voltooien, wast u het leveroppervlak zodat men kan zien of er nog steeds bloedende vlekken zijn. Stop de bloeding op het leverdissectieoppervlak en verwijder het tumormonster uit de buikholte.De operatie werd binnen 2,5 uur afgerond. Het intraoperatieve bloedingsvolume was 100 milliliter zonder de bloedtransfusie en er werden geen complicaties op korte termijn waargenomen. Het carcino-embryonale antigeenniveau na de operatie daalde tot 110,64 microgram per liter ten opzichte van het niveau vóór de operatie van 1058,69 microgram per liter.De chemotherapiebehandeling werd twee maanden na de operatie hervat, volgens de resultaten van de tumorpathologie. Het postoperatieve CT-onderzoek werd vergeleken met de preoperatieve CT en er werden geen tekenen van tumorhergroei waargenomen. De belangrijkste stap in het chirurgische proces is het gebruik van het harmonische scalpel.Een goede hoeveelheid vaardigheid is vereist om schade aan vitale structuren te voorkomen.

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.

Verdamping-reducerende Cultuur Voorwaarde Verhoogt de reproduceerbaarheid van Meercellige Sferoïde Formation in microtiterplaten

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.

Toepassing van Laser-Micro-bestraling voor onderzoek van enkele en dubbele Strand Break Repair in zoogdiercellen

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.

Laparoscopische Pancreatoduodenectomy met gemodificeerde 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).

De toepassing van 1% methyleenblauw kleurstof als een enkele techniek in borstkanker Sentinel knooppunt biopsie

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.

De klinische toepassing van Tumor velden therapie behandelen 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% ...

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 Evaluatie van Oncogene Transformatie 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 ...

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-cultuur van glutamaterge neuronen en pediatrische hoogwaardige glioomcellen in microfluïdische apparaten om elektrische interacties te beoordelen

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.

Flexibele organische elektronische apparaten voor gepulseerde elektrische veldtherapie van glioblastoom

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.

Generatie en kweek van hoogwaardige sereuze eierstokkankerpatiënt-afgeleide organoïden

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.

Toepassing van het En Bloc Concept Gecombineerd met Anatomische Resectie bij Laparoscopische Hepatectomie

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