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

この研究は、広州市の科学技術プロジェクト(202102010090)からの助成金によって支援されました。

操作は日常的であり、倫理的な承認を受けています。承認は以下の通りです:広州医科大学第二附属病院の臨床研究・応用倫理委員会による迅速な審査承認:科学研究倫理審査プロジェクト「腹腔鏡下肝切除術におけるシンプルで簡単な止血装置の適用」(受理番号:2022-hg-ks-02)は、広州医科大学第二附属病院の臨床研究・応用倫理委員会によって承認されました。その研究内容と方法は、医療倫?...

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肝切除術は、原発性肝癌および二次肝癌の患者にとって最も重要な治療法の1つである。1991年、Reichらは腹腔鏡検査を適用して肝臓の良性腫瘍を除去し、世界初の腹腔鏡下肝切除術を完了しました4。急速な開発と促進の年後、腹腔鏡下肝切除術は、肝臓悪性腫瘍を治療するための主流の方法の一つとなっており、近年広く行われています。術中出血が少ない、術後の痛みが?...

肝細胞癌は、消化器系の最も一般的な悪性腫瘍の1つです。異なる原発部位によれば、原発性肝細胞癌と続発性肝癌とに分けることができる。細胞は、原発性腫瘍から肝臓外の器官から肝臓に様々な方法で転移し、肝臓の癌腫につながる可能性がある。肝臓の転移細胞の50%以上が結腸直腸がんから来ているのに対し、乳がん、膵臓がん、肺がん、胃がんなどに由来するものもあると報告されています1。近年、二次肝癌の多くの治療法が利用可能であり、体系的な化学療法、介入療法、分子標的療法、手術など、2.しかし、根治的切除は癌を完全に除去することができるため、依然として最も効果的な治療法である3。
腹腔鏡技術の急速な発展に伴い、腹腔鏡下解剖学的肝切除術は外科医によって徐々に認識されるが、特に一次医療機関においてはまだ広く行われていない。その理由の1つは、高品位止血装置の要件です。これらは、操作プロセス中の出血や胆汁漏れのリスクを軽減するために必要です。ここでは、腹腔鏡下肝切除術を行うための、単一のルーメンカテーテル、ハーモニックメス、モノポール電気凝固を含む、シンプルで簡単な止血装置のセットを紹介します。これを行うには、まず、単一の内腔カテーテルを使用して、ポルタ肝炎を断続的に閉塞する。肝臓実質組織は、次いで、高調波メスを用いて切除される。出血斑点は、モノポール電気凝固によってポイントツーポイントで凝固される。このシンプルで簡単な止血装置は、単一のルーメンカテーテルを使用してプリングル操作を実行し、高調波メスとモノポール電気凝固の止血を利用します。この装置は病院で簡単に見つけることができ、腹腔鏡検査やトレーニングを行うためのさらなる容易さを提供します。したがって、これらのシンプルで容易な止血装置は、一次医療機関における処置の実施に適している。
この研究では、患者は肝臓に転移したS状結腸の中等度分化腺癌と診断された67歳の男性であった。S状結腸癌の根治的切除は2021年1月に行われた。病理学的結果は、pT4aN2aM1のTNMステージを有する中等度に分化した腺癌であった。FOLFOX化学療法は手術後に4回投与された。これに続いて、患者の身体状態は、肝転移の病変を完全に除去するために腹腔鏡下解剖学的肝切除術を行うのに適していると考えられた。肝機能のチャイルドピューグレードはグレードAでした。肝予備機能試験の場合、ICGクリアランス試験におけるR15は1.6%(<10%)であった。CTは、肝臓のS5の背部およびS6の腹側部分にわたって57mm×68mm×76mmの腫瘍を示した。その3次元再構成モデルを 図1に示す。

<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

腹腔鏡下肝切除術は、低侵襲法であるため、良性および悪性肝疾患を治療するための従来の方法と考えられている。その非侵襲的な側面にもかかわらず、出血および胆汁漏出は、手術中または手術後の期間に肝実質組織切除において起こり、超音波外科的吸引、双極性電気凝固などの高品位止血装置の必要性を示す。これらの高品位止血装置の可用性の欠如は、腹腔鏡下肝切除術が基本的な医療機関における一般的な手順になるのを妨げる。上記の状況に鑑み、肝臓実質組織切除を革新的に行うために、高調波メス、モノポール電気凝固、および単一の管腔カテーテルを含む、シンプルで簡単な止血装置のスイートがこのプロトコルで開発される。まず第一に、ポルタ肝または肝椎弓根は、単一の内腔カテーテルによって断続的に閉塞され、続いて15分間クランプされ、5分間放出される。続いて、ハーモニックメスを使用して、肝臓実質組織を切断し、肝内動脈、静脈、胆管を明らかにするために、肝臓のクランプおよび破砕が行われる。最後に、出血スポットは、各スポットでモノポール電気凝固を用いて凝固される。これらの方法を使用することにより、肝内パイプライン構造が可視化され、出血を容易に停止させ、胆汁漏出の発生率を低下させ、腹腔鏡下肝切除術の安全性および実現可能性を改善することができる。したがって、ここに示したシンプルで簡単な止血装置は、一次医療機関での処置に適している。

手術は2.5時間以内に完了し、術中の出血量は輸血なしで100mLであった。短期的な合併症はなく、患者は手術後8日目に 退院した。手術後のがん胚性抗原(CEA)レベルは、手術前の1058.69 μg/Lから110.64 μg/Lに低下した(図12)。手術の2ヶ月後、患者は化学療法治療を継続するために病院に戻った(化学療法レジメンはmFOLFOX6であった)。化学療法レジメンを、 ...

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

Application of Hemostatic Devices in Laparoscopic Hepatectomy

高品位止血装置は、腹腔鏡下肝切除術に不可欠です.しかし、これらの機器は、基本的な医療機関では一般化されていません。したがって、シンプルで簡単な止血装置のスイートがこの記事に示されており、腹腔鏡下肝切除術の実行が容易になります。

腹腔鏡下肝切除術における止血装置の適用

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

この技術の主な利点は、止血装置がシンプルで入手が容易であり、基本的な病院で行うことができることである。止血装置のこのセットは、腹腔鏡下肝切除術および他のシステムにさらに適用することができる。腹腔鏡下肝切除術で止血装置のこのセットを適用するために、腹腔鏡手術、特に高調波メスの熟練した使用の特定の基礎を有することを強くお勧めします。腹腔鏡検査で気腹膜を確立するために直接穿刺を適用することから始めます。臍帯領域の各観察穴に10ミリメートルのトロカールを置き、肋骨縁の下の右鎖骨中線および腹側正中線。次に、5ミリメートルのトロカールを右前補助線と腹側正中線に配置します。肝実質組織切除に革新的に使用される高調波メス、モノポール電気凝固、および単一管腔カテーテルから始まる止血装置を組み立てる。プリングル操作を行うには、単一の内腔カテーテルを使用して最初のポルタ肝を断続的に閉塞する。内腔カテーテルを止血クリップで15分間クランプした後、ハーモニックメスを使用して5分間離してクリップを切り取り、クリップを取り出して最初のポルタ肝への血液供給を回復させます。腫瘍を供給する肝椎弓根を分離する。それらを切除し、調和メスで1つずつ分割します。肝椎弓根の切除後に見えるようになる肝表面の虚血線を観察します。フックを使用してマークします。ハーモニックメスを使用して肝実質組織を切除し、肝臓を徐々に締め付けて粉砕します。内肝動脈、静脈、胆管を観察します。これらのパイプライン構造を切除して分割します。出血が現れたら、ポイントツーポイントモノポール電気凝固を使用して、すぐに肝臓郭清表面上の出血スポットを凝固させる。右後部肝椎弓根を肝内実質組織切除の道しるべとして使用してください。主後部肝椎弓根を予約し、腫瘍を供給する椎弓根の枝を解剖する。手術を完了するには、肝臓の表面を洗って、出血の斑点がまだあるかどうかを確認してください。肝臓郭清表面の出血を止め、腹腔から腫瘍標本を除去する。操作は2.5時間以内に完了した。術中の出血量は輸血なしで100ミリリットルであり、短期的な合併症は観察されなかった。手術後の癌胚性抗原レベルは、手術前レベル1058.69マイクログラム/リットルから1リットル当たり110.64マイクログラムに減少した。腫瘍病理学的結果によると、化学療法治療は手術の2ヶ月後に再開された。術後CT検査を術前CTと比較し、腫瘍再増殖の徴候は認められなかった。外科的プロセスにおける最も重要なステップは、高調波メスの使用である。重要な構造物の損傷を避けるためには、かなりのスキルが必要です。

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.

蒸発低減文化条件は、マイクロタイタープレートに多細胞スフェロイド形成の再現性を高め

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

がん研究

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.

マイクロ レーザーの単一の試験と哺乳類細胞における二重鎖切断修復のためのアプリケーション

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.

変更された Blumgart 膵炎と腹腔鏡下膵頭十二指腸切除

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).

乳癌センチネルノード生検における単一の技術としての1%メチレン色素の応用

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.

腫瘍神経膠芽腫でフィールド療法を治療の臨床応用

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.

ヒト乳腺上皮細胞における発癌性転換のインビトロ評価

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.

グルタミン酸ニューロンと小児の高品位グリオーマ細胞の微小流体デバイスへの共培養による電気的相互作用の評価

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.

膠芽腫のパルス電界治療のための柔軟な有機電子デバイス

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.

高悪性度漿液性卵巣癌患者由来オルガノイドの作製と培養

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.

腹腔鏡下肝切除術における解剖学的切除と組み合わせたEnBloc概念の適用

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