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

이 사업은 광저우시 과학 기술 프로젝트 (202102010090)의 보조금으로 지원되었습니다.

운영은 일상적이며 윤리 승인을 받았습니다. 승인은 다음과 같습니다 : 광저우 의과 대학 제 2 부속 병원 임상 연구 및 응용 윤리위원회의 신속한 검토 승인 : 과학 연구 윤리 검토 프로젝트 "복강경 간절제술에서 간단하고 쉬운 지혈 장치의 적용"(수락 번호 : 2022-hg-ks-02)은 광저우 의과 대학 제 2 부속 병원의 임상 연구 및 응용 윤리위원회의 승인을 받았습니다. 연구 내용과 방법은 의료 윤리 규범?...

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	<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>

간절제술은 원발성 간암 및 이차 간암 환자에게 가장 중요한 치료 방법 중 하나입니다. 1991 년 Reich 등은 복강경 검사를 적용하여 간장의 양성 종양을 제거하고 세계 최초의 복강경 간 절제술4을 완료했습니다. 수년간의 급속한 발전과 촉진 끝에 복강경 간 절제술은 간 악성 종양을 치료하는 주류 방법 중 하나가되었으며 최근 몇 년 동안 널리 수행되었습니다. 수술 중 출혈이 적?...

간세포 암종은 소화 시스템의 가장 흔한 악성 종양 중 하나입니다. 다른 주요 부위에 따르면, 원발성 간세포암과 이차성 간암으로 나눌 수 있다. 세포는 원발성 종양에서 간 외부의 장기에서 간으로 다양한 방법으로 전이되어 간에서 암종으로 이어질 수 있습니다. 간에서 전이성 세포의 50 % 이상이 대장암에서 오는 반면, 다른 것들은 유방, 췌장, 폐 및 위 종양 등에서 온 것으로보고되었습니다1. 최근에는 체계적인 화학요법, 중재치료, 분자표적치료, 수술 등2차 간암에 대한 많은 치료법이 이용가능하다. 그러나, 라디칼 절제술은 암을 완전히 제거할 수 있기 때문에 여전히 가장 효과적인 치료법이다3.
복강경 기술의 급속한 발전으로 복강경 해부학 적 간 절제술은 외과 의사에 의해 점차 인식되지만 특히 주요 의료기관에서는 여전히 널리 수행되지 않습니다. 그 이유 중 하나는 고급 지혈 장치에 대한 요구 사항입니다. 이들은 수술 과정에서 출혈과 담즙 누출의 위험을 줄이기 위해 필요합니다. 여기에서는 복강경 간 절제술을 수행하기 위해 단일 루멘 카테터, 고조파 메스 및 단극 전기 응고를 포함한 간단하고 쉬운 지혈 장비 세트를 제시합니다. 이렇게하기 위해, 먼저 포르타 간장은 단일 루멘 카테터를 사용하여 간헐적으로 폐색됩니다. 간 실질 조직은 고조파 메스를 사용하여 절제됩니다. 출혈 반점은 단극 전기 응고에 의해 점대점으로 응고된다. 이 간단하고 쉬운 지혈 장비는 단일 루멘 카테터를 사용하여 프링글 기동을 수행하고 고조파 메스의 지혈과 단극 전기 응고를 활용합니다. 이 장비는 병원에서 쉽게 찾을 수 있으므로 복강경 검사 또는 훈련을 쉽게 수행 할 수 있습니다. 따라서, 이러한 간단하고 쉬운 지혈 장치는 일차 의료기관에서 절차를 수행하는 데 적합합니다.
본 연구에서, 환자는 간에서 전이된 시그모이드 결장의 적당히 분화된 선암종으로 진단된 67세 남성이었다. 시그모이드 결장암의 라디칼 절제술은 2021년 1월에 수행되었다. 병리학적 결과는 pT4aN2aM1의 TNM 단계와 함께 적당히 분화된 선암종이었다. FOLFOX 화학요법은 수술 후 네 번 투여되었다. 그 후, 환자의 신체 상태는 간 전이의 병변을 완전히 제거하기 위해 복강경 해부학 적 간 절제술을 수행하는 데 적합한 것으로 간주되었습니다. 간 기능의 Child-Pugh 등급은 A 등급이었습니다. 간 예비 기능 검사의 경우, ICG 클리어런스 테스트에서 R15는 1.6 % (<10 %)였습니다. CT는 S5의 등쪽 부분 및 S6의 복부 부분을 가로질러 57 mm x 68 mm x 76 mm 종양을 보였다; 입체 재구성 모델은 그림 1에 나와 있습니다.

<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

복강경 간절제술은 최소 침습적 방법이기 때문에 양성 및 악성 간 질환을 치료하는 전통적인 방법으로 간주됩니다. 비침습적 측면에도 불구하고, 출혈 및 담즙 누출은 수술 중 또는 수술 후 기간 동안 간 실질 조직 절제술에서 발생하며, 이는 초음파 수술 흡인, 양극성 전기 응고 등과 같은 고급 지혈 장치에 대한 요구 사항을 나타냅니다. 이러한 고급 지혈 장치의 가용성이 부족하여 복강경 간 절제술이 기본 의료 기관에서 일반화 된 절차가되는 것을 방지합니다. 위에서 언급 한 상황을 고려하여 고조파 메스, 단극 전기 응고 및 단일 루멘 카테터를 포함하는이 프로토콜에서 간단하고 쉬운 지혈 장치 제품군이 개발되어 간 실질 조직 절제술을 혁신적으로 수행합니다. 우선, 포르타 간염 또는 간 페디클은 단일 루멘 카테터에 의해 간헐적으로 가려지고, 15 분 동안 클램핑하고 5 분 동안 방출됩니다. 그 후, 고조파 메스를 사용하여 간 실질 조직을 차단하고 간내 동맥, 정맥 및 담관을 밝히기 위해 간을 클램핑 및 분쇄합니다. 마지막으로, 출혈 반점은 각 지점에서 단극 전기 응고를 사용하여 응고됩니다. 간내 파이프 라인 구조는 출혈을 쉽게 멈추고 담즙 누출의 발생률을 줄이며 복강경 간 절제술의 안전성과 실현 가능성을 향상시킬 수있는 이러한 방법을 사용하여 볼 수 있습니다. 따라서 여기에 표시된 간단하고 쉬운 지혈 장치는 일차 의료기관에서 절차를 수행하는 데 적합합니다.

수술은 2.5 시간 이내에 완료되었으며 수술 중 출혈 부피는 수혈없이 100 mL였습니다. 단기 합병증은 없었으며 환자는 수술 후 8 일째 에 병원에서 퇴원했습니다. 수술 후 발암 배아 항원 (CEA) 수준은 수술 전 수준 인 1058.69 μg / L에서 110.64 μg / L로 감소했습니다 (그림 12). 수술 후 두 달 후, 환자는 화학 요법 치료를 계속하기 위해 병원으로 돌아 왔습니다 (화학 요법 요법...

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

Application of Hemostatic Devices in Laparoscopic Hepatectomy

고급 지혈 장치는 복강경 간 절제술에 필수적입니다. 그러나 이러한 장치는 기본 의료 기관에서 일반화되지 않습니다. 따라서이 기사에는 간단하고 쉬운 지혈 장치 제품군이 표시되어있어 복강경 간 절제술을 더 쉽게 수행 할 수 있습니다.

복강경 간절제술에서 지혈 장치의 적용

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

이 기술의 가장 큰 장점은 지혈 장치가 간단하고 쉽게 얻을 수 있으며 기본 병원에서 수행 할 수 있다는 것입니다. 이 지혈 장비 세트는 복강경 간 절제술 및 기타 시스템에 추가로 적용될 수 있습니다. 복강경 수술의 특정 기초, 특히 복강경 간절제술에서이 지혈 장치 세트를 적용하기 위해 고조파 메스의 숙련 된 사용을 갖는 것이 좋습니다.복강경 검사에서 폐렴 복막을 확립하기 위해 직접 구멍을 뚫는 것으로 시작하십시오. 10 밀리미터 트로카를 하부 영역의 각 관측 구멍에 놓고, 늑골 마진과 복부 미드 라인 아래의 오른쪽 중간 쇄골 라인을 배치하십시오. 그런 다음 오른쪽 전방 보조 라인과 복부 미드 라인에 다섯 밀리미터 트로카를 놓습니다.고조파 메스, 단극 전기 응고 및 단일 루멘 카테터에서 시작하여 간 실질 조직 절제술에 혁신적으로 사용되는 지혈 장치를 조립하십시오. 프링글 기동을 수행하기 위해, 단일 루멘 카테터를 사용하여 간헐적으로 첫 번째 포르타 간장을 폐색시킨다. 루멘 카테터를 지혈 클립으로 15 분 동안 클램프 한 다음 고조파 메스를 사용하여 5 분 동안 풀어 클립을 자르고 클립을 꺼내 첫 번째 포르타 간장에 혈액 공급을 복원하십시오.종양을 공급하는 간 페디클을 분리하십시오. 고조파 메스로 하나씩 절제하고 나눕니다. 간 페디클의 절제 후에 보이게되는 간 표면의 허혈 라인을 관찰하십시오.후크를 사용하여 표시하십시오. 고조파 메스를 사용하여 간 실질 조직을 절제하면서 간을 점차적으로 클램핑하고 분쇄하십시오. 내부 간 동맥, 정맥 및 담관을 관찰하십시오.이러한 파이프라인 구조를 절제하고 나눕니다. 출혈이 나타나면 점 대 점 단극 전기 응고를 사용하여 간 해부 표면의 출혈 반점을 즉시 응고시킵니다. 오른쪽 후부 간 페디클을 간내 실질 조직 절제술의 푯말로 사용하십시오.주요 후부 간 페디클을 예약하고 종양을 공급하는 페디클의 가지를 해부하십시오. 수술을 완료하려면 간 표면을 씻어서 여전히 출혈 반점이 있는지 확인할 수 있습니다. 간 해부 표면의 출혈을 멈추고 복강에서 종양 표본을 제거하십시오.작업은 2.5 시간 이내에 완료되었습니다. 수술 중 출혈량은 수혈없이 100 밀리리터였으며 단기간의 합병증은 관찰되지 않았습니다. 수술 후 발암 배아 항원 수준은 리터 당 1058.69 마이크로 그램의 수술 전 수준에서 리터 당 110.64 마이크로 그램으로 감소했습니다.화학 요법 치료는 종양 병리학 결과에 따라 수술 후 두 달 후에 재개되었습니다. 수술 후 CT 검사는 수술 전 CT와 비교되었으며 종양 재성장의 징후는 관찰되지 않았습니다. 수술 과정에서 가장 중요한 단계는 고조파 메스의 사용입니다.중요한 구조물의 손상을 피하기 위해서는 많은 양의 기술이 필요합니다.

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.

증발 감소 문화 조건은 미세 적정 플레이트에서 다세포 회전 타원체 형성의 재현성을 증가

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

연구

암 연구학

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.

단일의 검사 및 포유류 세포에서 이중 가닥 브레이크 수리에 대 한 레이저 마이크로-방사선의 응용

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.

수정 된 Blumgart Pancreaticojejunostomy와 복 강경 Pancreatoduodenectomy

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).

유방암 센티넬 노드 생검에 있는 단 하나 기술로 1% 메틸렌 청색염의 응용

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.

종양 세포종 필드 치료 치료의 임상 적용

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.

인간 유방 상피 세포에 있는 종양원성 변환의 시험관 내 평가

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.

글루타미터기뉴런과 소아 고학년 신경교세포의 공동 배양을 미세유체 장치로 결합하여 전기 적 상호 작용을 평가합니다.

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.

교모세포종의 펄스 전기장 치료를 위한 유연한 유기 전자 장치

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.

고급 장액성 난소암 환자 유래 오가노이드의 생성 및 배양

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.

복강경 간 절제술에서 해부학적 절제술과 결합된 En Bloc 개념의 적용

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