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

Diese Arbeit wurde durch Zuschüsse des Science and Technology Project der Stadt Guangzhou (202102010090) unterstützt.

Die Operation ist Routine und erhielt eine ethische Zulassung. Die Zulassungen sind wie folgt: Genehmigung für eine schnelle Überprüfung durch die Ethikkommission für klinische Forschung und Anwendung des Zweiten Angeschlossenen Krankenhauses der Guangzhou Medical University: Das wissenschaftliche Forschungsethik-Review-Projekt "Application of simple and easy Hemostatic Devices in Laparoscopic Hepatectomy" (Akzeptanz-Nr.: 2022-hg-ks-02) wurde von der Ethikkommission für klinische Forschung und Anwendung des Second A...

<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>

Die Hepatektomie ist eine der wichtigsten Behandlungsmethoden für Patienten mit primärem Leberkrebs und sekundärem Leberkrebs. Im Jahr 1991 wandten Reich et al. die Laparoskopie an, um gutartige Tumoren der Leber zu entfernen, und führten die weltweit erste laparoskopische Hepatektomie4 durch. Nach Jahren der schnellen Entwicklung und Förderung ist die laparoskopische Hepatektomie zu einer der gängigen Methoden zur Behandlung von bösartigen Lebertumoren geworden und wurde in den letzten Jah...

Das hepatozelluläre Karzinom ist einer der häufigsten bösartigen Tumoren des Verdauungssystems. Entsprechend den verschiedenen primären Stellen kann es in primäres hepatozelluläres Karzinom und sekundären Leberkrebs unterteilt werden. Zellen können auf verschiedene Weise von Primärtumoren aus Organen außerhalb der Leber in die Leber metastasieren, was zu einem Karzinom in der Leber führt. Es wurde berichtet, dass mehr als 50% der metastasierten Zellen in der Leber von Darmkrebs stammen, während andere von Brust-, Bauchspeicheldrüsen-, Lungen- und Magentumoren usw.stammen 1. In den letzten Jahren stehen viele Behandlungen für sekundären Leberkrebs zur Verfügung, darunter systematische Chemotherapie, interventionelle Therapie, molekulare gezielte Therapie, Operation usw.2. Die radikale Resektion ist jedoch immer noch die effektivste Behandlung, da sie den Krebs vollständig entfernenkann 3.
Mit der rasanten Entwicklung der laparoskopischen Technologie wird die laparoskopische anatomische Hepatektomie allmählich von Chirurgen anerkannt, ist aber immer noch nicht weit verbreitet, insbesondere in primärmedizinischen Einrichtungen. Einer der Gründe ist die Anforderung an hochwertige hämostatische Geräte. Diese sind erforderlich, um das Risiko von Blutungen und Gallenleckagen während des Operationsprozesses zu reduzieren. Hier stellen wir eine Reihe von einfachen und einfachen hämostatischen Geräten vor, darunter einen einzelnen Lumenkatheter, ein harmonisches Skalpell und eine monopole Elektrokoagulation zur Durchführung einer laparoskopischen Hepatektomie. Dazu wird zunächst die Porta hepatis intermittierend mit einem einzigen Lumenkatheter verschlossen. Leberparenchymgewebe wird dann mit dem harmonischen Skalpell reseziert. Blutungsflecken werden durch Monopolelektrokoagulation Punkt zu Punkt koaguliert. Diese einfache und einfache hämostatische Ausrüstung verwendet einen einzigen Lumenkatheter, um das Pringle-Manöver durchzuführen, und nutzt die Hämostase des harmonischen Skalpells und der Monopolelektrokoagulation. Die Geräte können leicht in Krankenhäusern gefunden werden und bieten so zusätzliche Leichtigkeit für die Durchführung von Laparoskopie oder Training. Somit eignen sich diese einfachen und leichten hämostatischen Geräte für die Durchführung von Verfahren in primärmedizinischen Einrichtungen.
In dieser Studie war der Patient ein 67-jähriger Mann, bei dem ein mäßig differenziertes Adenokarzinom des Sigmas diagnostiziert wurde, das in der Leber metastasierte. Eine radikale Resektion des Sigmoiddarmkrebses wurde im Januar 2021 durchgeführt. Die pathologischen Ergebnisse waren ein mäßig differenziertes Adenokarzinom mit dem TNM-Stadium von pT4aN2aM1. Die FOLFOX-Chemotherapie wurde viermal nach der Operation verabreicht. Danach wurde der Körperzustand des Patienten als geeignet erachtet, eine laparoskopische anatomische Hepatektomie durchzuführen, um die Läsion von Lebermetastasen vollständig zu entfernen. Der Child-Pugh-Grad der Leberfunktion war Grad A. Für den Leberreservefunktionstest betrug R15 im ICG-Clearance-Test 1,6% (<10%). CT zeigte einen 57 mm x 68 mm x 76 mm großen Tumor über den dorsalen Teil von S5 und den ventralen Teil von S6 der Leber; Das dreidimensionale Rekonstruktionsmodell ist in Abbildung 1 dargestellt.

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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

Die laparoskopische Hepatektomie gilt als konventionelle Methode zur Behandlung gutartiger und bösartiger Lebererkrankungen, da es sich um eine minimal-invasive Methode handelt. Trotz seines nicht-invasiven Aspekts treten Blutungen und Gallenleckagen in der Leberparenchymgeweberesektion während der Operation oder in der Zeit nach der Operation auf, was auf die Notwendigkeit hochwertiger hämostatischer Geräte wie Ultraschall-Operationsaspiration, bipolare Elektrokoagulation usw. hinweist. Die mangelnde Verfügbarkeit dieser hochwertigen hämostatischen Geräte verhindert, dass die laparoskopische Hepatektomie zu einem generalisierten Verfahren in medizinischen Grundorganisationen wird. Angesichts der oben genannten Situation wird in diesem Protokoll eine Reihe einfacher und einfacher hämostatischer Geräte entwickelt, die ein harmonisches Skalpell, eine Monopolelektrokoagulation und einen Einzellumenkatheter umfassen, um eine innovative Leberparenchymgeweberesektion durchzuführen. Zunächst wird der Porta hepatis oder Leberstiel intermittierend durch einen einzelnen Lumenkatheter verschlossen, gefolgt von einer Klemmung für 15 min und einer Freisetzung für 5 min. Anschließend werden mit dem harmonischen Skalpell Klemmen und Zerkleinern der Leber durchgeführt, um das Leberparenchymgewebe abzuschneiden und die intrahepatischen Arterien, Venen und Gallengänge freizulegen. Schließlich werden die Blutungsflecken durch die Verwendung von Monopolelektrokoagulation an jeder Stelle koaguliert. Intrahepatische Pipelinestrukturen sind dann mit diesen Methoden sichtbar, die Blutungen leicht stoppen, die Inzidenzrate von Gallenleckagen reduzieren und die Sicherheit und Machbarkeit der laparoskopischen Hepatektomie verbessern könnten. Daher eignen sich die hier gezeigten einfachen und leichten hämostatischen Geräte für die Durchführung von Verfahren in primärmedizinischen Einrichtungen.

Die Operation wurde innerhalb von 2,5 h abgeschlossen und das intraoperative Blutungsvolumen betrug 100 ml ohne die Bluttransfusion. Es gab keine kurzfristigen Komplikationen, und der Patient wurde am 8. Tag nach der Operation aus dem Krankenhausentlassen. Das Niveau des karzinomenalen Antigens (CEA) nach der Operation sank von 1058,69 μg/L vor der Operation auf 110,64 μg/L (Abbildung 12). Zwei Monate nach der Operation kehrte der Patient ins Krankenhaus zurück, um die Chemothe...

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

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Hochwertige hämostatische Geräte sind für die laparoskopische Hepatektomie unerlässlich. Diese Geräte sind jedoch in grundlegenden medizinischen Organisationen nicht verallgemeinert. Daher wird in diesem Artikel eine Reihe von einfachen und einfachen hämostatischen Geräten gezeigt, die die Durchführung der laparoskopischen Hepatektomie erleichtern können.

Anwendung hämostatischer Geräte in der laparoskopischen Hepatektomie

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

Der Hauptvorteil dieser Technik besteht darin, dass das hämostatische Gerät einfach und leicht zu beschaffen ist und in einfachen Krankenhäusern durchgeführt werden kann. Diese hämostatischen Geräte können weiter auf die laparoskopische Hepatektomie und andere Systeme angewendet werden. Es wird dringend empfohlen, eine bestimmte Grundlage der laparoskopischen Chirurgie zu haben, insbesondere die geschickte Verwendung eines harmonischen Skalpells, um diese Reihe von hämostatischen Geräten in der laparoskopischen Hepatektomie anzuwenden.Beginnen Sie mit der Anwendung einer direkten Punktion, um das Pneumoperitoneum in der Laparoskopie zu etablieren. Platzieren Sie einen 10-Millimeter-Trokar in jedem Beobachtungsloch im subumbilischen Bereich, rechts in der Mitte der Schlüsselbeinlinie unter dem Rippenrand und der ventralen Mittellinie. Legen Sie dann einen Fünf-Millimeter-Trokar in die rechte vordere Hilfslinie und die ventrale Mittellinie.Montieren Sie die hämostatischen Geräte, beginnend mit dem harmonischen Skalpell, der Monopolelektrokoagulation und dem Einzellumenkatheter, um sie innovativ bei der Resektion von Leberparenchymgewebe einzusetzen. Um ein Pringle-Manöver durchzuführen, schließen Sie die erste Porta hepatis intermittierend mit einem einzelnen Lumenkatheter aus. Klemmen Sie den Lumenkatheter mit einem hämostatischen Clip für 15 Minuten ein, gefolgt von fünf Minuten mit dem harmonischen Skalpell, um den Clip abzuschneiden und den Clip herauszunehmen, um die Blutversorgung der ersten Porta hepatis wiederherzustellen.Trennen Sie die Leberstiele, die den Tumor versorgen. Sezieren und teilen Sie sie nacheinander mit einem harmonischen Skalpell. Beobachten Sie die Ischämielinie auf der Leberoberfläche, die nach der Resektion der Leberstiele sichtbar wird.Verwenden Sie den Haken, um ihn zu markieren. Resektieren Sie das Leberparenchymgewebe mit dem harmonischen Skalpell, während Sie die Leber allmählich klemmen und zerquetschen. Beobachten Sie die innere Leberarterie, die Vene und den Gallengang.Sezieren und teilen Sie diese Pipeline-Strukturen. Sobald Blutungen auftreten, koagulieren Sie die Blutungsflecken auf der Leberdissektionsoberfläche sofort mit Punkt-zu-Punkt-Monopol-Elektrokoagulation. Verwenden Sie den rechten hinteren Leberstiel als Wegweiser für die intrahepatische Parenchymgeweberesektion.Reservieren Sie den hinteren Leberstiel und sezieren Sie den Zweig der Stiele, die den Tumor versorgen. Um die Operation abzuschließen, waschen Sie die Leberoberfläche, damit Sie sehen können, ob noch Blutungsflecken vorhanden sind. Stoppen Sie die Blutung auf der Leberdissektionsoberfläche und entfernen Sie die Tumorprobe aus der Bauchhöhle.Der Vorgang wurde innerhalb von 2,5 Stunden abgeschlossen. Das intraoperative Blutungsvolumen betrug ohne die Bluttransfusion 100 Milliliter und es wurden keine kurzfristigen Komplikationen beobachtet. Der karzinoembryonale Antigenspiegel nach der Operation sank von 1058,69 Mikrogramm pro Liter auf 110,64 Mikrogramm pro Liter.Die Chemotherapie wurde zwei Monate nach der Operation wieder aufgenommen, so die Ergebnisse der Tumorpathologie. Die postoperative CT-Untersuchung wurde mit der präoperativen CT verglichen und es wurden keine Anzeichen eines Tumornachwachsens beobachtet. Der wichtigste Schritt im chirurgischen Prozess ist die Verwendung des harmonischen Skalpells.Ein gutes Maß an Geschick ist erforderlich, um Schäden an lebenswichtigen Strukturen zu vermeiden.

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.

Verdunstungsmindernde Kultur Zustand Erhöht die Reproduzierbarkeit von mehrzelligen Sphäroidformation in Mikrotiterplatten

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

Forschung

Krebsforschung

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.

Anwendung von Mikro-Laserbestrahlung zur Prüfung von einzelnen und doppelt Strand Break Repair in Säugerzellen

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.

Laparoskopische Pankreatoduodenektomie mit modifizierten 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).

Die Anwendung von 1% Methylen blauer Farbstoff als eine einzige Technik in Brustkrebs 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.

Die klinische Anwendung des Tumors, die Behandlung von Feldern Therapie bei 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-Bewertung der onkogenen Transformation in menschlichen Mammaepithelzellen

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.

Kokultur von glutamatergen Neuronen und pädiatrischen hochgradigen Gliomzellen in mikrofluidische Geräte zur Beurteilung elektrischer Wechselwirkungen

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.

Flexible organische elektronische Bauelemente für die gepulste elektrische Feldtherapie des Glioblastoms

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.

Erzeugung und Kultivierung von hochgradigen serösen Ovarialkarzinom-Organoiden, die von Patientinnen stammen

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.

Anwendung des En-Bloc-Konzepts in Kombination mit anatomischer Resektion in der laparoskopischen Hepatektomie

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