1
|
D’Amore A, Anoldo P, Manigrasso M, Aprea G, De Palma GD, Milone M. Cyanoacrylate in Colorectal Surgery: Is It Safe? J Clin Med 2023; 12:5152. [PMID: 37568554 PMCID: PMC10419358 DOI: 10.3390/jcm12155152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Anastomotic leakage (AL) of a gastrointestinal (GI) anastomosis continues to be an important complication in GI surgery. Since its introduction more than 60 years ago, Cyanoacrylate (CA) has gained popularity in colorectal surgery to provide "prophylaxis" against AL. However, although in surgical practice it is increasingly used, evidence on humans is still lacking. The aim of this study is to analyze in humans the safety of CA to seal colorectal anastomosis. All consecutive patients from Jannuary 2022 through December 2022 who underwent minimally invasive colorectal surgery were retrospectively analyzed from a prospectively maintained database. Inclusion criteria were a histological diagnosis of cancer, a totally minimally invasive procedure, and the absence of intraoperative complications. 103 patients were included in the study; N-butyl cyanoacrylate with metacryloxisulfolane (Glubran 2®) was used to seal colorectal anastomosis, no adverse reactions to CA or postoperative complications related to inflammation and adhesions occurred; and only one case of AL (0.9%) was recorded. We can consider this study an important proof of concept on the safety of CA to seal colorectal anastomosis. It opens the possibility of starting prospective and comparative studies in humans to evaluate the effectiveness of CA in preventing colorectal AL.
Collapse
Affiliation(s)
- Anna D’Amore
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (M.M.); (G.A.); (G.D.D.P.); (M.M.)
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy;
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (M.M.); (G.A.); (G.D.D.P.); (M.M.)
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (M.M.); (G.A.); (G.D.D.P.); (M.M.)
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (M.M.); (G.A.); (G.D.D.P.); (M.M.)
| | - Marco Milone
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (M.M.); (G.A.); (G.D.D.P.); (M.M.)
| |
Collapse
|
2
|
Calborean A, Macavei S, Mocan M, Ciuce C, Bintintan A, Cordos A, Pestean C, Chira R, Zarbo L, Barbu-Tudoran L, Dindelegan G, Nickel F, Mocan B, Surlin V, Bintintan V. Non-invasive laparoscopic detection of small tumors of the digestive tract using inductive sensors of proximity. Sci Rep 2022; 12:760. [PMID: 35031673 PMCID: PMC8760327 DOI: 10.1038/s41598-022-04822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on the normal bowel mucosa, adjacent to the tumor. In the current in-vivo experiments performed on large animals, the modified clips were transported without difficulties to the point of interest and attached to the mucosa of the bowel. Using a laparoscopic approach, the detection rate of this system reached 65% when the sensor scanned the bowel at a speed of 0.3 cm/s, and applying slight pressure on the serosa. This value increased to 95% when the sensor was guided directly on the point of clip attachment. The detection rate dropped sharply when the scanning speed exceeded 1 cm/s and when the sensor-clip distance exceeded the cut-off value of 3 mm. In conclusion, the proposed detection system demonstrated its potential to offer a swift and convenient solution for the digestive laparoscopic surgeons, however its detection range still needs to be improved to render it useful for the clinical setting.
Collapse
Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Catalin Ciuce
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Manastur Street No. 3-5, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Liviu Zarbo
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Felix Nickel
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, INF 110, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj-Napoca, Memorandumului, Street No.28, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rares Street No. 2, 700115, Craiova, Romania
| | - Vasile Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| |
Collapse
|
3
|
Calborean A, Macavei S, Mocan M, Ciuce C, Cordos A, Bintintan A, Chira R, Pestean C, Pop O, Barbu-Tudoran L, Dindelegan G, Surlin V, Nickel F, Mocan B, Bintintan V. Laparoscopic compatible device incorporating inductive proximity sensors for precise detection of gastric and colorectal small tumors. Surg Oncol 2020; 35:504-514. [PMID: 33137657 DOI: 10.1016/j.suronc.2020.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
The accurate localization of small tumors of the digestive tract is of paramount importance in surgical oncology because it dictates the limits of resection and the extent of lymph node dissection. In this view, we have designed and fabricated a highly efficient sensing laparoscopic instrument focused on precise non-invasive extralumenal intraoperative detection of small colorectal or gastric tumors. The equipment is fully adapted for laparoscopic surgery and consists of an inductive proximity sensor encapsulated into a watertight stainless-steel case that is connected to an electronic functional block dimensionally scaled-down by the desired form and size for optimal surgical manipulation. The sensor-case unit and the electronic block are coupled together using a modular system which allows disconnection of the latter and sterilization by autoclavation of the former, followed by swift plugging of the electronic block just before surgery in a sterile-controlled environment. The instrument works in tandem with a modified endoscopic hemostatic clip which is attached endoscopically, before surgery, in the mucosa proximal and distal to the tumor. By scanning the serosal side of the digestive organ during the laparoscopic surgical procedure, the detector senses the modified clip and thus pinpoints to the location of the tumor. Additional engineering of the standard endoscopic hemostatic clips by coating them with various combinations of metallic alloys of Cu and Zn was necessary to improve the detection range and sensitivity without compromising on their functionality. The clips were also covered with nanometric layers of Au to ensure their biocompatibility. The ex-vivo dry-lab experiments showed a satisfactory detection distance which was later confirmed in ex-vivo wet-lab experiments on animal organs and human surgical specimens.
Collapse
Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cătalin Ciuce
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăştur Street No. 3-5, 400372, Cluj-Napoca, Romania
| | - Oana Pop
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăştur Street No. 3-5, 400372, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, 400293, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rare Street No.2, 200394, Craiova, Romania
| | - Felix Nickel
- University of Heidelberg, Clinic for General, Visceral and Transplantation Surgery, INF 110, 69120, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj Napoca, Memorandumului Street No. 28, 400114, Cluj Napoca, Romania
| | - Vasile Bintintan
- Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| |
Collapse
|
4
|
Kazama K, Aoyama T, Hayashi T, Yamada T, Numata M, Amano S, Kamiya M, Sato T, Yoshikawa T, Shiozawa M, Oshima T, Yukawa N, Rino Y, Masuda M. Evaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401). BMC Surg 2017; 17:29. [PMID: 28327119 PMCID: PMC5361779 DOI: 10.1186/s12893-017-0229-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The short-term outcomes of laparoscopic-assisted surgery for colorectal cancer (LAC) have not been fully evaluated in elderly patients. The aim of this study was to compare the short term surgical outcomes of LAC between the patients older than 75 years and those with non-elderly patients. METHODS This retrospective multi-institutional study selected patients who underwent LAC between April 2013 and March 2014 at Yokohama City University Hospital and its related general hospitals. The patients were categorized into two groups: elderly patients (>75 years of age: group A) and non-elderly patients (<75 years of age: group B). Surgical outcomes and post operative complications were compared between the two groups. RESULTS A total of 237 patients were evaluated in the present study. Eighty-four patients were classified into group A, and 153 into group B. Preoperative clinicopathological outcomes demonstrated no significant differences except for the ASA score. When comparing the surgical outcomes between group A and group B, the rate of conversion to open procedure (3.6% vs 5.2%, P = 0.750), median operation time (232 min vs 232 min, P = 0.320), median blood loss (20 ml vs 12 ml, P = 0.350). The differences were not significantly different in the surgical outcomes. The incidences of > grade 2 post operative surgical complications were similar between two groups ((19.0% vs 15.7%, p = 0.587). No mortality was observed in this study. The length of postoperative hospital stay was also similar (10 days vs 10 days, p = 0.350). CONCLUSIONS The present study suggested that LAC is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for colon cancer surgery.
Collapse
Affiliation(s)
- Keisuke Kazama
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Tsutomu Hayashi
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takanobu Yamada
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shinya Amano
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mariko Kamiya
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takaki Yoshikawa
- The Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, 241-8515, Japan
| | - Manabu Shiozawa
- The Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, 241-8515, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| |
Collapse
|