S. A. Lang, J. Bednarsch, S. Schmitz, Marius J Helmedag, I. Amygdalos, Daniel Heise, Maxim Dewulf, T. Ulmer, Ulf P. Neumann
Exact knowledge of the portal vein (PV) anatomy is essential for any hepatobiliary procedure. Absence of the portal bifurcation with the complete blood flow to the left lobe coming from the right portal vein (RPV) is an extremely rare anatomical variation. In this situation, a solitary metachronous colorectal liver metastasis with suspected infiltration of the RPV and the right bile duct was detected in a 51-year-old male patient. Neither percutaneous ablation nor stereotactic radiotherapy were considered indicated due to the close proximity to the central structures. Hence, a surgical two-step procedure was scheduled. First, a porto-rex shunt with an 8 mm PTFE graft to maintain the portal blood flow to the left lobe was performed. In addition, the RPV was ligated during the same procedure. After recovery, the procedure was completed with a right hepatectomy. The final pathological report confirmed invasion of the right bile duct and the RPV and resection margins were tumor-free. This case shows that careful preoperative assessment of vascular anatomy is critical. The use of the porto-rex shunt allowed a potentially curative resection in an otherwise irresectable situation.
{"title":"Right hepatectomy in absence of the left portal vein using the porto-rex shunt procedure","authors":"S. A. Lang, J. Bednarsch, S. Schmitz, Marius J Helmedag, I. Amygdalos, Daniel Heise, Maxim Dewulf, T. Ulmer, Ulf P. Neumann","doi":"10.1515/iss-2024-0008","DOIUrl":"https://doi.org/10.1515/iss-2024-0008","url":null,"abstract":"\u0000 \u0000 \u0000 Exact knowledge of the portal vein (PV) anatomy is essential for any hepatobiliary procedure. Absence of the portal bifurcation with the complete blood flow to the left lobe coming from the right portal vein (RPV) is an extremely rare anatomical variation.\u0000 \u0000 \u0000 \u0000 In this situation, a solitary metachronous colorectal liver metastasis with suspected infiltration of the RPV and the right bile duct was detected in a 51-year-old male patient. Neither percutaneous ablation nor stereotactic radiotherapy were considered indicated due to the close proximity to the central structures. Hence, a surgical two-step procedure was scheduled. First, a porto-rex shunt with an 8 mm PTFE graft to maintain the portal blood flow to the left lobe was performed. In addition, the RPV was ligated during the same procedure. After recovery, the procedure was completed with a right hepatectomy. The final pathological report confirmed invasion of the right bile duct and the RPV and resection margins were tumor-free.\u0000 \u0000 \u0000 \u0000 This case shows that careful preoperative assessment of vascular anatomy is critical. The use of the porto-rex shunt allowed a potentially curative resection in an otherwise irresectable situation.\u0000","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robotic surgery has become increasingly prevalent in UGI surgery over the last decade, particularly for treating hiatal hernias. Voluminous hiatal hernias, defined as the herniation of 30–50 % of the stomach into the thorax, often require surgical intervention due to associated dysphagia and potential severe complications. Given the challenges of repairing voluminous hiatal hernias, especially in elderly and fragile patients, the surgical technique should be optimal. Robotic surgery affords excellent visualization, allowing high mediastinal dissection and precise hiatus reconstruction. Despite the clear technical advantages, it remains to be demonstrated if the robotic approach matches the outcomes of conventional laparoscopic techniques. We review here the fundamentals of hiatal hernia surgery and describe our surgical technique using the da Vinci Xi robot to operate voluminous hiatal hernias. Additionally, we performed a systematic research analysis and selected recent publications focusing on robotic surgery for voluminous hiatal hernias. Recent studies report comparable complication rates, recurrence, and hospital stay lengths between robotic and laparoscopy surgery. Initial robotic procedures had longer operative times, which decreased with surgeon experience. Most of the studies were observational and retrospective, reporting the experience of a single center. Robotic surgery appears to be a viable option with similar complications rates to laparoscopic surgery under optimized conditions. Current literature supports the broader adoption of robotic surgery for voluminous hiatal hernias. However, prospective randomized studies are needed to further validate its use.
{"title":"Voluminous hiatal hernias – the role of robotic surgery","authors":"M. Dosch, M. Chevallay, M. Jung, S. Mönig","doi":"10.1515/iss-2023-0033","DOIUrl":"https://doi.org/10.1515/iss-2023-0033","url":null,"abstract":"\u0000 Robotic surgery has become increasingly prevalent in UGI surgery over the last decade, particularly for treating hiatal hernias. Voluminous hiatal hernias, defined as the herniation of 30–50 % of the stomach into the thorax, often require surgical intervention due to associated dysphagia and potential severe complications. Given the challenges of repairing voluminous hiatal hernias, especially in elderly and fragile patients, the surgical technique should be optimal. Robotic surgery affords excellent visualization, allowing high mediastinal dissection and precise hiatus reconstruction. Despite the clear technical advantages, it remains to be demonstrated if the robotic approach matches the outcomes of conventional laparoscopic techniques. We review here the fundamentals of hiatal hernia surgery and describe our surgical technique using the da Vinci Xi robot to operate voluminous hiatal hernias. Additionally, we performed a systematic research analysis and selected recent publications focusing on robotic surgery for voluminous hiatal hernias. Recent studies report comparable complication rates, recurrence, and hospital stay lengths between robotic and laparoscopy surgery. Initial robotic procedures had longer operative times, which decreased with surgeon experience. Most of the studies were observational and retrospective, reporting the experience of a single center. Robotic surgery appears to be a viable option with similar complications rates to laparoscopic surgery under optimized conditions. Current literature supports the broader adoption of robotic surgery for voluminous hiatal hernias. However, prospective randomized studies are needed to further validate its use.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast sensation following autologous breast reconstruction impacts patients’ quality of life. Although spontaneous reinnervation in free flaps was documented by many authors, there are efforts to further improve restoration of breast sensation. Interestingly, animal studies indicated that trastuzumab has several beneficial effects on transected peripheral nerves. Our aim was to compare spontaneous sensory recovery after free TRAM flap breast reconstruction between patients who were and were not treated with trastuzumab. The study included 14 subjects who underwent tactile sensation examination in 5-year period after noninnervated free muscle-sparing TRAM flap breast reconstruction at the University Hospital Centre Zagreb, Croatia. Small and large flap skin islands and contralateral healthy breasts were tested with Semmes-Weinstein type monofilaments. Three sensory scores were created to more accurately compare breast sensation. In subjects receiving trastuzumab, sensory recovery earlier extended to at least four of five large skin island regions and was always present in the central flap area in comparison with subjects who were not administered trastuzumab (p=0.0476). As indicated by total sensory scores, trastuzumab-treated subjects restored sensation better resembling healthy control breasts (54 vs. 39 % in large skin islands; 95 vs. 71 % in small skin islands). To the authors’ knowledge, the current study for the first time demonstrated trastuzumab’s potential to improve sensory outcomes in human. Our results support the strategy that accelerated nerve regeneration is a key to more successful reinnervation. HER2 and EGFR inhibitors emerge as new candidates for pharmacological interventions in peripheral nerve injury treatment.
{"title":"Trastuzumab holds potential to accelerate spontaneous sensory reinnervation after free flap breast reconstruction: a proof of concept","authors":"Jana Leskovar, Marko Petrovečki, K. Bulić","doi":"10.1515/iss-2023-0070","DOIUrl":"https://doi.org/10.1515/iss-2023-0070","url":null,"abstract":"\u0000 \u0000 \u0000 Breast sensation following autologous breast reconstruction impacts patients’ quality of life. Although spontaneous reinnervation in free flaps was documented by many authors, there are efforts to further improve restoration of breast sensation. Interestingly, animal studies indicated that trastuzumab has several beneficial effects on transected peripheral nerves. Our aim was to compare spontaneous sensory recovery after free TRAM flap breast reconstruction between patients who were and were not treated with trastuzumab.\u0000 \u0000 \u0000 \u0000 The study included 14 subjects who underwent tactile sensation examination in 5-year period after noninnervated free muscle-sparing TRAM flap breast reconstruction at the University Hospital Centre Zagreb, Croatia. Small and large flap skin islands and contralateral healthy breasts were tested with Semmes-Weinstein type monofilaments. Three sensory scores were created to more accurately compare breast sensation.\u0000 \u0000 \u0000 \u0000 In subjects receiving trastuzumab, sensory recovery earlier extended to at least four of five large skin island regions and was always present in the central flap area in comparison with subjects who were not administered trastuzumab (p=0.0476). As indicated by total sensory scores, trastuzumab-treated subjects restored sensation better resembling healthy control breasts (54 vs. 39 % in large skin islands; 95 vs. 71 % in small skin islands).\u0000 \u0000 \u0000 \u0000 To the authors’ knowledge, the current study for the first time demonstrated trastuzumab’s potential to improve sensory outcomes in human. Our results support the strategy that accelerated nerve regeneration is a key to more successful reinnervation. HER2 and EGFR inhibitors emerge as new candidates for pharmacological interventions in peripheral nerve injury treatment.\u0000","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Agil, Tjahjodjati Romdam, Nur Atik, Dedi Rachmadi, A. Yantisetiasti, A. Zumrutbas
Kidney trauma is the most common urological trauma. Technological advances have made conservative management possible for almost all kidney trauma. However, grade five kidney trauma needs to be carefully examined due to its various complications, especially late complications that often delayed in recognition thus forming irreversible morbidity, with the most common late complication is kidney damage due to ischemic and fibrotic process. This study aims to confirm the effect of Adipose-Derived Stem Cells (ADSC) on the prevention of fibrosis in grade five kidney trauma using Wistar rat models, where the fibrosis process will be measured with histopathological examination which had features of glomerular sclerosis, tubular atrophy, and interstitial fibrosis in kidney tissue, then followed by histopathological scoring and total renal score. A total of 22 adult rats were divided into five groups: one healthy control group, two trauma groups without ADSC, and two others trauma groups with ADSC. Two different treatment times were set: two weeks and four weeks after treatment. The data were tested for normality (Shapiro-Wilk test), while differences between groups were assessed using one-way ANOVA or Kruskal-Wallis test if the distribution was not normal. For the result of total renal score, statistical analysis reveal a significant difference in the total renal score in the kidney trauma with ADSC group compared with kidney trauma without ADSC group in fourth week of observation (p=0.001). These findings highlighted ADSC capability to prevent fibrosis caused by grade five kidney trauma on the Wistar rat models, as proven by significantly reduced histopathological grading on fibrosis.
{"title":"The effect of adipose-derived stem cells (ADSC) treatment on kidney histopathological appearance on the Wistar rat models with grade five kidney trauma","authors":"Ahmad Agil, Tjahjodjati Romdam, Nur Atik, Dedi Rachmadi, A. Yantisetiasti, A. Zumrutbas","doi":"10.1515/iss-2023-0065","DOIUrl":"https://doi.org/10.1515/iss-2023-0065","url":null,"abstract":"\u0000 \u0000 \u0000 Kidney trauma is the most common urological trauma. Technological advances have made conservative management possible for almost all kidney trauma. However, grade five kidney trauma needs to be carefully examined due to its various complications, especially late complications that often delayed in recognition thus forming irreversible morbidity, with the most common late complication is kidney damage due to ischemic and fibrotic process. This study aims to confirm the effect of Adipose-Derived Stem Cells (ADSC) on the prevention of fibrosis in grade five kidney trauma using Wistar rat models, where the fibrosis process will be measured with histopathological examination which had features of glomerular sclerosis, tubular atrophy, and interstitial fibrosis in kidney tissue, then followed by histopathological scoring and total renal score.\u0000 \u0000 \u0000 \u0000 A total of 22 adult rats were divided into five groups: one healthy control group, two trauma groups without ADSC, and two others trauma groups with ADSC. Two different treatment times were set: two weeks and four weeks after treatment. The data were tested for normality (Shapiro-Wilk test), while differences between groups were assessed using one-way ANOVA or Kruskal-Wallis test if the distribution was not normal.\u0000 \u0000 \u0000 \u0000 For the result of total renal score, statistical analysis reveal a significant difference in the total renal score in the kidney trauma with ADSC group compared with kidney trauma without ADSC group in fourth week of observation (p=0.001).\u0000 \u0000 \u0000 \u0000 These findings highlighted ADSC capability to prevent fibrosis caused by grade five kidney trauma on the Wistar rat models, as proven by significantly reduced histopathological grading on fibrosis.\u0000","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luis Fernando Tintinago-Londoño, E. Candelo, Tania Guzmán, William Victoria-Morales
Reconstructing the hypopharynx while preserving the larynx poses a complex surgical challenge due to the limited space and the high position of the hypopharynx in the neck. We present our experience with hypopharyngeal reconstruction and larynx preservation using an ileal free flap. Six consecutive cases were reported (age range 17–75; 2 females). Indications for surgery were tumor excision, postexcision flap failure, postradiation stenosis, caustic ingestion injury, and cervical esophageal perforation. The larynx was preserved in four cases. Graft survival rate was 100 %. Videofluoroscopic swallowing studies conducted at postoperative day 20–80 were normal in three cases. Two cases presented with stenosis but responded well to endoscopic dilations. Unfortunately, the third case expired due to tumor recurrence. The ileal free flap is a surgical alternative for the reconstruction of the hypopharynx, especially in cases where the larynx is preserved.
{"title":"Ileal free flap for hypopharynx reconstruction – case series","authors":"Luis Fernando Tintinago-Londoño, E. Candelo, Tania Guzmán, William Victoria-Morales","doi":"10.1515/iss-2024-0005","DOIUrl":"https://doi.org/10.1515/iss-2024-0005","url":null,"abstract":"\u0000 \u0000 \u0000 Reconstructing the hypopharynx while preserving the larynx poses a complex surgical challenge due to the limited space and the high position of the hypopharynx in the neck. We present our experience with hypopharyngeal reconstruction and larynx preservation using an ileal free flap.\u0000 \u0000 \u0000 \u0000 Six consecutive cases were reported (age range 17–75; 2 females). Indications for surgery were tumor excision, postexcision flap failure, postradiation stenosis, caustic ingestion injury, and cervical esophageal perforation. The larynx was preserved in four cases. Graft survival rate was 100 %. Videofluoroscopic swallowing studies conducted at postoperative day 20–80 were normal in three cases. Two cases presented with stenosis but responded well to endoscopic dilations. Unfortunately, the third case expired due to tumor recurrence.\u0000 \u0000 \u0000 \u0000 The ileal free flap is a surgical alternative for the reconstruction of the hypopharynx, especially in cases where the larynx is preserved.\u0000","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter M. Vogt, Christine Radtke, Nicco Krezdorn, Katja Kollewe, C. Liebsch, K. Dastagir, Sarah Strauß
The availability of appropriate conduits remains an obstacle for successful reconstruction of long-distance nerve defects. In previous sheep trials, we were able to bridge 6 cm nerve gaps with nerve conduits based on spider silk fibers with full functional outcomes. Here, we describe the first application of spider silk for nerve repair in humans. Four patients with extended nerve defects (>20 cm) underwent nerve reconstruction by interposition of conduits that were composed of spider silk fibers contained in autologous veins. The longitudinal luminal fibers (approx. 2500 fibers per graft) consisted of drag line silk from Trichonephila spiders. All patients were evaluated between 2 and 10 years postreconstruction, clinically, and by neurography. In all patients, primary wound healing and no adverse reactions to the implanted spider silk material were observed. Patients regained the following relevant functions: protective sensibility, full flexor function with near-normal grasp and powerful function after microvascular gracilis muscle transfer, and key grip function and gross finger flexion after additional tenodesis. One patient with sciatic nerve reconstruction developed protective sensibility of the lower leg, foot, and gait, enabling normal walking and jogging. No neuroma formation or neuropathic or chronic pain occurred in any of the patients. For patients with extended peripheral nerve defects in the extremities, use of conduits based on spider silk fibers offers the possibility of restoring sensory function and protection from neuroma. This kind of nerve bridges provides new perspectives for the reconstruction of complex and long-distance nerve defects.
{"title":"Biological conduits based on spider silk for reconstruction of extended nerve defects","authors":"Peter M. Vogt, Christine Radtke, Nicco Krezdorn, Katja Kollewe, C. Liebsch, K. Dastagir, Sarah Strauß","doi":"10.1515/iss-2023-0050","DOIUrl":"https://doi.org/10.1515/iss-2023-0050","url":null,"abstract":"\u0000 \u0000 \u0000 The availability of appropriate conduits remains an obstacle for successful reconstruction of long-distance nerve defects. In previous sheep trials, we were able to bridge 6 cm nerve gaps with nerve conduits based on spider silk fibers with full functional outcomes. Here, we describe the first application of spider silk for nerve repair in humans.\u0000 \u0000 \u0000 \u0000 Four patients with extended nerve defects (>20 cm) underwent nerve reconstruction by interposition of conduits that were composed of spider silk fibers contained in autologous veins. The longitudinal luminal fibers (approx. 2500 fibers per graft) consisted of drag line silk from Trichonephila spiders. All patients were evaluated between 2 and 10 years postreconstruction, clinically, and by neurography.\u0000 \u0000 \u0000 \u0000 In all patients, primary wound healing and no adverse reactions to the implanted spider silk material were observed. Patients regained the following relevant functions: protective sensibility, full flexor function with near-normal grasp and powerful function after microvascular gracilis muscle transfer, and key grip function and gross finger flexion after additional tenodesis. One patient with sciatic nerve reconstruction developed protective sensibility of the lower leg, foot, and gait, enabling normal walking and jogging. No neuroma formation or neuropathic or chronic pain occurred in any of the patients.\u0000 \u0000 \u0000 \u0000 For patients with extended peripheral nerve defects in the extremities, use of conduits based on spider silk fibers offers the possibility of restoring sensory function and protection from neuroma. This kind of nerve bridges provides new perspectives for the reconstruction of complex and long-distance nerve defects.\u0000","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141821238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence-based medicine demands treatment options for patients to be based on the current best available evidence. Systematic reviews (SRs) with meta-analyses allow surgeons to make therapeutical decisions in accordance with the highest level of evidence. Also, high-quality SRs support physicians to challenge the colossal amount of new research data created daily. The systematic review working group of the Study Center of the German Society of Surgery (SDGC) has created specific methodological literature regarding surgical SRs, giving recommendations to assess critical risk of bias and to prevent the creation of SRs that do not provide any new insights to the field. SRs should only be considered if there is new clinically relevant data available that allows the SR to create novel evidence. To address the dilemma of new SRs generated without adding new evidence, living systematic reviews and evidence mapping represent an innovative approach, in which SRs are regularly updated with new research data.
{"title":"Surgical systematic reviews: best available evidence or disposable waste?","authors":"R. Klotz, S. Tenckhoff, Pascal Probst","doi":"10.1515/iss-2022-0029","DOIUrl":"https://doi.org/10.1515/iss-2022-0029","url":null,"abstract":"\u0000 Evidence-based medicine demands treatment options for patients to be based on the current best available evidence. Systematic reviews (SRs) with meta-analyses allow surgeons to make therapeutical decisions in accordance with the highest level of evidence. Also, high-quality SRs support physicians to challenge the colossal amount of new research data created daily. The systematic review working group of the Study Center of the German Society of Surgery (SDGC) has created specific methodological literature regarding surgical SRs, giving recommendations to assess critical risk of bias and to prevent the creation of SRs that do not provide any new insights to the field. SRs should only be considered if there is new clinically relevant data available that allows the SR to create novel evidence. To address the dilemma of new SRs generated without adding new evidence, living systematic reviews and evidence mapping represent an innovative approach, in which SRs are regularly updated with new research data.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141641420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessing bowel perfusion in emergency intestinal surgery can prove challenging even for experienced surgeons. The necessity of a technological tool assisting clinicians is undisputed. Near-infrared indocyanine green (NIR-ICG) angiography has been increasingly used in elective colorectal surgery to evaluate intestinal perfusion with promising results. This review aims to answer whether a similar outcome can be observed in acute cases of bowel ischemia. We conducted online research of the literature using keywords such as “indocyanine green”, “bowel”, “emergency” and “ischemia”, to identify articles concerning the use of ICG-angiography in evaluating bowel perfusion during emergency operations. PubMed was the primary database. 11 articles were included in this systematic review with a total of 358 patients. Most papers showed a positive effect after using NIR-ICG-angiography, whereas one study indicated the limitations of the method by exhibiting increased reoperation and mortality rates. Moreover, a significant variation in indocyanine green (ICG) dose and fluorescence identification systems was observed. NIR-ICG-angiography has the potential to become a fundamental tool in emergency intestinal operations. Nevertheless, additional research, especially high-quality, randomized studies, as well as quantification techniques are still needed to support these preliminary observations.
{"title":"Near-infrared indocyanine green angiography in recognizing bowel ischemia in emergency surgery: game changer or overrated?","authors":"Anastasia Christofi, Thilo Traska, Dimitrios Dimitroulis","doi":"10.1515/iss-2024-0013","DOIUrl":"https://doi.org/10.1515/iss-2024-0013","url":null,"abstract":"\u0000 Assessing bowel perfusion in emergency intestinal surgery can prove challenging even for experienced surgeons. The necessity of a technological tool assisting clinicians is undisputed. Near-infrared indocyanine green (NIR-ICG) angiography has been increasingly used in elective colorectal surgery to evaluate intestinal perfusion with promising results. This review aims to answer whether a similar outcome can be observed in acute cases of bowel ischemia. We conducted online research of the literature using keywords such as “indocyanine green”, “bowel”, “emergency” and “ischemia”, to identify articles concerning the use of ICG-angiography in evaluating bowel perfusion during emergency operations. PubMed was the primary database. 11 articles were included in this systematic review with a total of 358 patients. Most papers showed a positive effect after using NIR-ICG-angiography, whereas one study indicated the limitations of the method by exhibiting increased reoperation and mortality rates. Moreover, a significant variation in indocyanine green (ICG) dose and fluorescence identification systems was observed. NIR-ICG-angiography has the potential to become a fundamental tool in emergency intestinal operations. Nevertheless, additional research, especially high-quality, randomized studies, as well as quantification techniques are still needed to support these preliminary observations.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141643987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bikal Ghimire, Göran Kurlberg, Peter Falk, Yogendra Singh, Y. Wettergren
Abstract Objectives Colorectal cancer (CRC) is one of the most prevalent cancer types worldwide, exhibiting significant variance in incidence rates across different ethnicities and geographical regions. Notably, there is a rising incidence of CRC among younger adults, particularly evident in advanced stages, with a more pronounced trend observed in developing nations. Epigenetic alterations potentially play a role in the early onset of CRC and could elucidate interpopulation disparities. This study aimed to examine DNA methylation levels in the tumor suppressor genes MLH1 and p16INK4a, comparing Nepalese and Swedish patients with CRC. Methods Patients who underwent CRC surgery at Tribhuvan University Teaching Hospital, Nepal (n=39), and Sahlgrenska University Hospital, Sweden (n=39) were included. Demographic and clinicopathological data were analyzed, and pyrosequencing was employed to determine methylation levels in the MLH1 promoter region and the first exon of p16INK4a in tumor tissues and adjacent mucosa located 10 cm from the tumor site. Subsequently, methylation status was compared between Nepalese and Swedish patients and correlated with clinicopathological parameters. Results Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors, but Nepalese patients exhibited a significantly higher level of MLH1 methylation in mucosa compared to Swedish patients (p=0.0008). Moreover, a greater proportion of Nepalese patients showed MLH1 methylation in mucosa compared to Swedish patients (31 vs. 2.6 %). Aberrant methylation of p16INK4a was also observed in the mucosa of Nepalese patients, characterized by high methylation at specific sites rather than uniform methylation across CpG sites. There were no significant differences in methylation levels based on tumor location among Nepalese patients, whereas Swedish patients exhibited higher methylation in right- compared to left-sided colon tumors. Swedish patients showed an increase in p16INK4a methylation in tumors with advancing age. Conclusions Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors. In contrast, Nepalese patients had a higher level of MLH1 methylation as well as aberrant methylation of p16INK4a in mucosa compared to Swedish patients. These epigenetic differences may be linked to environmental and lifestyle factors. Ongoing research will further explore whether hypermethylation in the mucosa of Nepalese patients is associated with tumorigenesis and its potential utility in screening high-risk patients or predicting recurrence.
{"title":"Epigenetic differences in the tumor suppressor genes MLH1 and p16INK4a between Nepalese and Swedish patients with colorectal cancer","authors":"Bikal Ghimire, Göran Kurlberg, Peter Falk, Yogendra Singh, Y. Wettergren","doi":"10.1515/iss-2023-0039","DOIUrl":"https://doi.org/10.1515/iss-2023-0039","url":null,"abstract":"Abstract Objectives Colorectal cancer (CRC) is one of the most prevalent cancer types worldwide, exhibiting significant variance in incidence rates across different ethnicities and geographical regions. Notably, there is a rising incidence of CRC among younger adults, particularly evident in advanced stages, with a more pronounced trend observed in developing nations. Epigenetic alterations potentially play a role in the early onset of CRC and could elucidate interpopulation disparities. This study aimed to examine DNA methylation levels in the tumor suppressor genes MLH1 and p16INK4a, comparing Nepalese and Swedish patients with CRC. Methods Patients who underwent CRC surgery at Tribhuvan University Teaching Hospital, Nepal (n=39), and Sahlgrenska University Hospital, Sweden (n=39) were included. Demographic and clinicopathological data were analyzed, and pyrosequencing was employed to determine methylation levels in the MLH1 promoter region and the first exon of p16INK4a in tumor tissues and adjacent mucosa located 10 cm from the tumor site. Subsequently, methylation status was compared between Nepalese and Swedish patients and correlated with clinicopathological parameters. Results Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors, but Nepalese patients exhibited a significantly higher level of MLH1 methylation in mucosa compared to Swedish patients (p=0.0008). Moreover, a greater proportion of Nepalese patients showed MLH1 methylation in mucosa compared to Swedish patients (31 vs. 2.6 %). Aberrant methylation of p16INK4a was also observed in the mucosa of Nepalese patients, characterized by high methylation at specific sites rather than uniform methylation across CpG sites. There were no significant differences in methylation levels based on tumor location among Nepalese patients, whereas Swedish patients exhibited higher methylation in right- compared to left-sided colon tumors. Swedish patients showed an increase in p16INK4a methylation in tumors with advancing age. Conclusions Nepalese and Swedish patients displayed equal levels of MLH1 and p16INK4a methylation in tumors. In contrast, Nepalese patients had a higher level of MLH1 methylation as well as aberrant methylation of p16INK4a in mucosa compared to Swedish patients. These epigenetic differences may be linked to environmental and lifestyle factors. Ongoing research will further explore whether hypermethylation in the mucosa of Nepalese patients is associated with tumorigenesis and its potential utility in screening high-risk patients or predicting recurrence.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Davide Stimolo, Filippo Leggieri, F. Matassi, Angelo Barra, R. Civinini, M. Innocenti
Abstract Objectives Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p<0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.
{"title":"Learning curves for high tibial osteotomy using patient-specific instrumentation: a case control study","authors":"Davide Stimolo, Filippo Leggieri, F. Matassi, Angelo Barra, R. Civinini, M. Innocenti","doi":"10.1515/iss-2024-0007","DOIUrl":"https://doi.org/10.1515/iss-2024-0007","url":null,"abstract":"Abstract Objectives Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p<0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141681326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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