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

Ce travail a été soutenu par des subventions du projet science et technologie de la ville de Guangzhou (202102010090).

L’opération est routinière et a reçu l’approbation de l’éthique. Les approbations sont les suivantes: Approbation pour examen rapide par le Comité d’éthique de la recherche clinique et de l’application du deuxième hôpital affilié de l’Université médicale de Guangzhou: Le projet d’examen de l’éthique de la recherche scientifique « Application de dispositifs hémostatiques simples et faciles dans l’hépatectomie laparoscopique » (numéro d’acceptation: 2022-hg-ks-02) a été approuvé pa...

<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>

L’hépatectomie est l’une des méthodes de traitement les plus importantes pour les patients atteints d’un cancer primitif du foie et d’un cancer secondaire du foie. En 1991, Reich et al. ont appliqué la laparoscopie pour enlever les tumeurs bénignes du foie et ont terminé la première hépatectomie laparoscopique au monde4. Après des années de développement et de promotion rapides, l’hépatectomie laparoscopique est devenue l’une des méthodes courantes pour traiter les tumeurs ...

Le carcinome hépatocellulaire est l’une des tumeurs malignes les plus courantes du système digestif. Selon les différents sites primaires, il peut être divisé en carcinome hépatocellulaire primaire et cancer du foie secondaire. Les cellules peuvent métastaser à partir de tumeurs primaires d’organes extérieurs au foie dans le foie de diverses manières, conduisant à un carcinome dans le foie. Il a été rapporté que plus de 50% des cellules métastatiques dans le foie proviennent du cancer colorectal, tandis que d’autres proviennent de tumeurs du sein, du pancréas, du poumon et de l’estomac, etc.1. Au cours des dernières années, de nombreux traitements pour le cancer secondaire du foie sont disponibles, y compris la chimiothérapie systématique, la thérapie interventionnelle, la thérapie moléculaire ciblée, la chirurgie, etc.2. Cependant, la résection radicale reste le traitement le plus efficace car elle permet d’enlever complètement le cancer3.
Avec le développement rapide de la technologie laparoscopique, l’hépatectomie anatomique laparoscopique est progressivement reconnue par les chirurgiens, mais n’est pas encore largement pratiquée, en particulier dans les établissements médicaux primaires. L’une des raisons est la nécessité de dispositifs hémostatiques de haute qualité. Ceux-ci sont nécessaires pour réduire les risques de saignement et de fuite de bile pendant le processus d’opération. Nous présentons ici un ensemble d’équipements hémostatiques simples et faciles, y compris un cathéter à lumière unique, un scalpel harmonique et une électrocoagulation monopolaire, pour effectuer une hépatectomie laparoscopique. Pour ce faire, le porta hepatis est d’abord obstrué par intermittence à l’aide d’un cathéter à lumière unique. Le tissu du parenchyme hépatique est ensuite réséqué à l’aide du scalpel harmonique. Les taches saignantes sont coagulées par électrocoagulation monopolistique point à point. Cet équipement hémostatique simple et facile utilise un cathéter à lumière unique pour effectuer la manœuvre de pringle et utilise l’hémostase du scalpel harmonique et de l’électrocoagulation monopolaire. L’équipement peut être trouvé facilement dans les hôpitaux, offrant ainsi une facilité supplémentaire pour effectuer une laparoscopie ou une formation. Ainsi, ces dispositifs hémostatiques simples et faciles conviennent à la réalisation de procédures dans des établissements médicaux primaires.
Dans cette étude, le patient était un homme de 67 ans diagnostiqué avec un adénocarcinome modérément différencié du côlon sigmoïde métastasé dans le foie. La résection radicale du cancer du côlon sigmoïde a été réalisée en janvier 2021. Les résultats pathologiques ont été un adénocarcinome modérément différencié avec le stade TNM de pT4aN2aM1. La chimiothérapie FOLFOX a été administrée quatre fois après l’opération. Suite à cela, l’état corporel du patient a été jugé approprié pour effectuer une hépatectomie anatomique laparoscopique afin d’éliminer complètement la lésion des métastases hépatiques. Le grade child-pugh de la fonction hépatique était le grade A. Pour le test de la fonction de réserve hépatique, le R15 dans le test de clairance ICG était de 1,6% (<10%). La tomodensitométrie a montré une tumeur de 57 mm x 68 mm x 76 mm à travers la partie dorsale de S5 et la partie ventrale de S6 du foie; le modèle de reconstruction tridimensionnelle est illustré à la figure 1.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<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

L’hépatectomie laparoscopique est considérée comme une méthode conventionnelle pour traiter les maladies hépatiques bénignes et malignes, car il s’agit d’une méthode peu invasive. Malgré son aspect non invasif, des saignements et des fuites biliaires se produisent dans la résection du tissu du parenchyme hépatique pendant l’opération ou dans la période post-opératoire, indiquant la nécessité de dispositifs hémostatiques de haut grade, tels que l’aspiration chirurgicale par ultrasons, l’électrocoagulation bipolaire, etc. Le manque de disponibilité de ces dispositifs hémostatiques de haut grade empêche l’hépatectomie laparoscopique de devenir une procédure généralisée dans les organisations médicales de base. Compte tenu de la situation mentionnée ci-dessus, une suite de dispositifs hémostatiques simples et faciles est développée dans ce protocole, qui comprend un scalpel harmonique, une électrocoagulation monopolaire et un cathéter à lumière unique, pour effectuer de manière innovante la résection du tissu du parenchyme hépatique. Tout d’abord, le porta hepatis ou pédicule hépatique est obstrué par intermittence par un cathéter à une seule lumière, suivi d’un serrage pendant 15 min et d’une libération pendant 5 min. Par la suite, en utilisant le scalpel harmonique, le serrage et l’écrasement du foie sont effectués pour couper le tissu du parenchyme hépatique et pour révéler les artères intrahépatiques, les veines et les voies biliaires. Enfin, les taches saignantes sont coagulées en utilisant l’électrocoagulation monopolistique à chaque endroit. Les structures intrahépatiques du pipeline sont alors visibles en utilisant ces méthodes, qui pourraient arrêter facilement les saignements, réduire le taux d’incidence des fuites biliaires et améliorer la sécurité et la faisabilité de l’hépatectomie laparoscopique. Par conséquent, les dispositifs hémostatiques simples et faciles présentés ici conviennent à la réalisation de procédures dans des établissements médicaux primaires.

L’opération a été terminée en 2,5 h et le volume de saignement peropératoire était de 100 mL sans transfusion sanguine. Il n’y a pas eu de complications à court terme et le patient est sorti de l’hôpital le 8e jour après l’opération. Le niveau d’antigène carcinoembryonnaire (ACE) après l’opération a diminué à 110,64 μg/L par rapport au niveau préopératoire de 1058,69 μg/L (figure 12). Deux mois après l’opération, le patient est retourné à l’h...

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

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Les dispositifs hémostatiques de haut grade sont essentiels pour l’hépatectomie laparoscopique. Cependant, ces dispositifs ne sont pas généralisés dans les organisations médicales de base. Par conséquent, une suite de dispositifs hémostatiques simples et faciles est présentée dans cet article, ce qui peut rendre l’hépatectomie laparoscopique plus facile à effectuer.

Application de dispositifs hémostatiques dans l’hépatectomie laparoscopique

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

Le principal avantage de cette technique est que le dispositif hémostatique est simple et facile à obtenir et peut être effectué dans les hôpitaux de base. Cet ensemble d’équipements hémostatiques peut être appliqué à l’hépatectomie laparoscopique et à d’autres systèmes. Il est fortement recommandé d’avoir une certaine base de chirurgie laparoscopique, en particulier l’utilisation habile d’un scalpel harmonique pour appliquer cet ensemble de dispositifs hémostatiques dans l’hépatectomie laparoscopique.Commencez par appliquer une ponction directe pour établir le pneumopéritoine en laparoscopie. Placez un trocart de 10 millimètres dans chaque trou d’observation de la zone subumbilicale, de la ligne médiane droite sous la marge costale et la ligne médiane ventrale. Placez ensuite un trocart de cinq millimètres dans la ligne auxiliaire antérieure droite et la ligne médiane ventrale.Assemblez les dispositifs hémostatiques à partir du scalpel harmonique, de l’électrocoagulation monopolaire et du cathéter à lumière unique pour être utilisés de manière innovante dans la résection tissulaire du parenchyme hépatique. Pour effectuer une manœuvre de Pringle, obstruez le premier porta hepatis par intermittence en utilisant un cathéter à lumière unique. Serrez le cathéter lumineux avec un clip hémostatique pendant 15 minutes, puis relâchez-le pendant cinq minutes à l’aide du scalpel harmonique pour couper le clip et retirez le clip pour rétablir l’apport sanguin au premier porta hepatis.Séparez les pédicules hépatiques alimentant la tumeur. Réséquez-les et divisez-les un par un avec un scalpel harmonique. Observez la ligne d’ischémie à la surface du foie, qui devient visible après la résection des pédicules hépatiques.Utilisez le crochet pour le marquer. Réséquez le tissu du parenchyme hépatique à l’aide du scalpel harmonique tout en serrant et en écrasant progressivement le foie. Observez l’artère hépatique interne, la veine et le canal biliaire.Réséquez et divisez ces structures de pipeline. Une fois que le saignement apparaît, coagulez immédiatement les taches saignantes sur la surface de la dissection hépatique en utilisant l’électrocoagulation monopolistique point à point. Utilisez le pédicule hépatique postérieur droit comme indicateur de la résection intrahépatique du tissu du parenchyme.Réservez le pédicule hépatique postérieur principal et disséquez la branche des pédicules alimentant la tumeur. Pour terminer l’opération, lavez la surface du foie afin de voir s’il y a encore des taches saignantes. Arrêtez le saignement sur la surface de dissection du foie et retirez l’échantillon tumoral de la cavité abdominale.L’opération a été achevée en 2,5 heures. Le volume hémorragique peropératoire était de 100 millilitres sans transfusion sanguine et aucune complication à court terme n’a été observée. Le niveau d’antigène carcinoembryonnaire après l’opération a diminué à 110,64 microgrammes par litre par rapport au niveau pré-opératoire de 1058,69 microgrammes par litre.Le traitement de chimiothérapie a été repris deux mois après l’opération, selon les résultats de la pathologie tumorale. L’examen postopératoire de la tomodensitométrie a été comparé à la tomodensitométrie préopératoire et aucun signe de repousse tumorale n’a été observé. L’étape la plus importante du processus chirurgical est l’utilisation du scalpel harmonique.Une bonne quantité de compétence est nécessaire pour éviter d’endommager les structures vitales.

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.

L&#39;évaporation de réduction Culture Condition Augmente la reproductibilité de la formation multicellulaire Spheroid en plaques de microtitration

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

Recherche

Recherche en cancérologie

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.

Application de Micro-irradiation Laser pour examen du Single et Double brin pause réparation dans les cellules de mammifères

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.

Pancreatoduodenectomy laparoscopique avec mis à jour le 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).

L'application de 1% de méthylène Blue Dye comme une technique unique dans le cancer du sein Sentinel Node 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.

L’Application clinique de la tumeur, traitement de thérapie de champs dans le glioblastome

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.

Évaluation in vitro de la transformation oncogène des cellules épithéliales mammaires humaines

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-culture de neurones glutamatergiques et de cellules de gliome pédiatrique de haut grade dans des dispositifs microfluidiques pour évaluer les interactions électriques

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.

Dispositifs électroniques organiques flexibles pour la thérapie par champs électriques pulsés du glioblastome

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.

Génération et culture d’organoïdes dérivés de patients atteints d’un cancer de l’ovaire séreux de haut grade

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.

Application du concept en bloc combiné à la résection anatomique dans l’hépatectomie laparoscopique

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