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Arndt S, Wex C, Häusler-Pliske I, Jechorek D, Krause H, Halloul Z, Meyer F. Laparoscopic cholecystectomy for symptomatic cholecystolithiasis (CCL) in "Kasabach-Merritt syndrome" (KMS) (Kaposi-tumor like hemangioendothelioma with case-specific perioperative management). Innov Surg Sci 2023; 8:113-117. [PMID: 38058777 PMCID: PMC10696942 DOI: 10.1515/iss-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/28/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The Kasabach-Merritt syndrome (KMS) is characterized by the occurrence of hemangioendothelioma (giant hemangioma with thrombosis leading to thrombocytopenia), which can be associated with disseminated intravasal coagulation. Specific aim: Based on (i) selective references from the current scientific literature and derived recommendations as well as (ii) own experiences obtained in the diagnostic and perioperative management of a representative case from daily practice in abdominal surgery, the specific case undergoing elective cholecystectomy (CCE) in KMS is to be described by means of scientific case report. Case presentation (Patient-, finding- and treatment-specific characteristics): - Medical history: 72-years old female patient with a known KMS of the left arm and upper thorax, recurrent thrombophlebitis of the left arm and thoracic veins, previous upper GI bleeding (Mallory-Weiss syndrome in 2006, chronic anemia in lack of vitamin B12, type-A gastritis, former bleeding complications after teeth extraction/open appendectomy 1962/Caesarean section 1968 with need of transfusion [60 red blood cell packages]), intraabdominal adhesions, hypothyreosis, initial liver cirrhosis. - Symptomatology: Characteristic for cholecystolithiasis (CCL). - Diagnostic: Abdominal ultrasound shows CCL, fibroscan does not confirm suspicious cirrhosis. Laboratory parameters showed: Activation of intravasal coagulation with elevated prothrombin fragments, D-dimers and reduced antiplasmin concentration. Accelerated fibrinolysis capacity; currently, no secondary thrombocytopenia or factor-13 decrease. In addition, fibrinogen concentration within normal range, no hint onto the manifestation of an aquired von-Willebrand's syndrome. - Diagnosis: Chronic fibrosing cholecystitis in CCL after former acute cholecystitis (3 months ago) with indication for surgical intervention. - Therapy: Laparoscopic CCE including careful exploration of upper abdominal cavity for KMS manifestation (with no revision of bile duct) and peritoneal adhesiolysis (histological finding, chronic fibrosing cholecystitis with thickening of the wall of the gall bladder but no hint of malignancy) under perioperative prophylaxis with antibiotics and temporary cessation of platelet medication for 7 d preoperatively, "bridging" with low molecular weight heparin (Clexane, 1 × 40 mg s.c.; Sanofi-Aventis, Frankfurt/Main, Germany); 1 h preoperatively, 15-20 mg/kg body weight Cyclocapron i.v. (once again 6-8 h postoperatively; thereafter, 500 mg of Cyclocapron 4×/d until the 3rd postoperative day). - Intraoperatively: Congestion of veins but not at the immediate surgical field (gall bladder, hepatic bed of the gall bladder, Calot's triangle). - Outcome: Uneventful, in particular, no (bleeding) complications. Conclusions If surgical approach is indicated, the intervention should be thoroughly planned (in particular, under elective circumstances) with regard to hemangioma site and extension as well as distance to the surgical field and possible surgical alternative options (surgical access site, open/laparoscopic approach etc.) to prevent - at the best possible rate - bleeding complications intra-/postoperatively and, thus, to provide adequate patient safety.
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Affiliation(s)
- Stephan Arndt
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Cora Wex
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Inken Häusler-Pliske
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Dörthe Jechorek
- Institute of Pathology, University Hospital, Magdeburg, Germany
| | - Hardy Krause
- Division of Pediatric Surgery, Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Zuhir Halloul
- Division of Vascular Surgery, Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
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Boese A, Croner R, Wex C. Concept for a retractor with force indicator for reduction of tissue trauma in abdominal surgery. Current Directions in Biomedical Engineering 2022. [DOI: 10.1515/cdbme-2022-1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Retractors are used in surgery for the displacement of tissue and organs and to keep the surgical area open. The retraction can lead to a tissue compression that can cause irritation on nerves, perfusion deficits, hematoma or late sequelae like wound healing disorders, pain and numbness. The retraction force and thus the load on the tissue can not be measured with retraction systems today. We present a new concept for a retractor with an integrated spring element and an indicator to visualize retraction force and allow an adjustment of the organ compression. The new retractor was designed considering organ compression limits, requirements on sterility and easy manufacturing. Two retractors were built up as a prototype by 3D printing and tested in a distinguished test setup. The first test of the retractors was performed on a force measurement test bench using a fixed retractor, and in a second test, a liver specimen in a bowl. Tests were repeated for both retractor variants. The tests showed how different spring characteristics could be realized with the new retractor design. Depending on the spring characteristics, the compression could be limited to a certain level and flexibility that can compensate for unwanted patient motion. An indicator is integrated into the design showing the applied load on the retraction system. The presented concept can help to increase patient safety and reduce tissue trauma and late sequelae. The indicator is an easy way to visualize applied forces and allow adaption of the setup to the surgeon's needs.
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Affiliation(s)
- Axel Boese
- Otto-von-Guericke University Magdeburg, Medical Faculty, INKA - Application driven Research, Leipziger Str. 44, Magdeburg , Germany
| | - Roland Croner
- Otto-von-Guericke University Magdeburg, Medical Faculty, Clinics of Surgery, Magdeburg , Germany
| | - Cora Wex
- Otto-von-Guericke University Magdeburg, Medical Faculty, Clinics of Surgery, Magdeburg , Germany
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Amini A, Zeller Y, Stein KP, Hartmann K, Wartmann T, Wex C, Mirzaee E, Swiatek VM, Saalfeld S, Haghikia A, Dumitru CA, Sandalcioglu IE, Neyazi B. Overcoming Barriers in Neurosurgical Education: A Novel Approach to Practical Ventriculostomy Simulation. Oper Neurosurg (Hagerstown) 2022; 23:225-234. [PMID: 35972086 DOI: 10.1227/ons.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In the high-risk, high-stakes specialty of neurosurgery, traditional teaching methods often fail to provide young residents with the proficiency needed to perform complex procedures in stressful situations, with direct effects on patient outcomes. Physical simulators provide the freedom of focused, hands-on training in a more controlled environment. However, the adoption of simulators in neurosurgical training remains a challenge because of high acquisition costs, complex production processes, and lack of realism. OBJECTIVE To introduce an easily reproducible, cost-effective simulator for external ventricular drain placements through various ventriculostomy approaches with life-like tactile brain characteristics based on real patients' data. METHODS Whole brain and skull reconstruction from patient's computed tomography and MRI data were achieved using freeware and a desktop 3-dimensional printer. Subsequently, a negative brain silicone mold was created. Based on neurosurgical expertise and rheological measurements of brain tissue, gelatin in various concentrations was tested to cast tactilely realistic brain simulants. A sample group of 16 neurosurgeons and medical students tested and evaluated the simulator in respect to realism, haptics, and general usage, scored on a 5-point Likert scale. RESULTS We saw a rapid and significant improvement of accuracy among novice medical students. All participants deemed the simulator as highly realistic, effective, and superior to conventional training methods. CONCLUSION We were able to demonstrate that building and implementing a high-fidelity simulator for one of the most important neurosurgical procedures as an effective educational and training tool is achievable in a timely manner and without extensive investments.
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Affiliation(s)
- Amir Amini
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Yannic Zeller
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Karl Hartmann
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Wartmann
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Cora Wex
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Elyas Mirzaee
- Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany.,Research Campus STIMULATE , Magdeburg, Germany
| | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Claudia A Dumitru
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
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Rahimli M, Wex C, Wiesmueller F, Weber F, Dölling M, Rose A, Al-Madhi S, Andric M, Croner R, Perrakis A. Laparoscopic cholecystectomy during the COVID-19 pandemic in a tertiary care hospital in Germany: higher rates of acute and gangrenous cholecystitis in elderly patients. BMC Surg 2022; 22:168. [PMID: 35538571 PMCID: PMC9087165 DOI: 10.1186/s12893-022-01621-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany. Patients and methods We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year. Results A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the “pandemic subgroup”. Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality. Conclusion Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.
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Affiliation(s)
- Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Cora Wex
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Felix Wiesmueller
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Frederike Weber
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maximilian Dölling
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Alexander Rose
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Georgieva E, Leber SL, Wex C, Garbers C. Perturbation of the Actin Cytoskeleton in Human Hepatoma Cells Influences Interleukin-6 (IL-6) Signaling, but Not Soluble IL-6 Receptor Generation or NF-κB Activation. Int J Mol Sci 2021; 22:ijms22137171. [PMID: 34281231 PMCID: PMC8268250 DOI: 10.3390/ijms22137171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
The transcription factor nuclear factor-kappa B (NF-κB) is critically involved in inflammation and cancer development. Activation of NF-κB induces the expression and release of several pro-inflammatory proteins, which include the cytokine interleukin-6 (IL-6). Perturbation of the actin cytoskeleton has been previously shown to activate NF-κB signaling. In this study, we analyze the influence of different compounds that modulate the actin cytoskeleton on NF-κB activation, IL-6 signaling and the proteolytic generation of the soluble IL-6 receptor (sIL-6R) in human hepatoma cells. We show that perturbation of the actin cytoskeleton is not sufficient to induce NF-κB activation and IL-6 secretion. However, perturbation of the actin cytoskeleton reduces IL-6-induced activation of the transcription factor STAT3 in Hep3B cells. In contrast, IL-6R proteolysis by the metalloprotease ADAM10 did not depend upon the integrity of the actin cytoskeleton. In summary, we uncover a previously unknown function of the actin cytoskeleton in IL-6-mediated signal transduction in Hep3B cells.
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Affiliation(s)
- Elizabeta Georgieva
- Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
| | - Stefan L. Leber
- Division of Neuroradiology, Vascular & Interventional Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria;
| | - Cora Wex
- Department of General, Visceral, Vascular and Transplantation Surgery, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
| | - Christoph Garbers
- Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
- Correspondence:
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Croner R, Franz M, Arend J, Rahimli M, Stockheim J, Negrini VR, Lorenz E, Andric M, Perrakis A, Wex C. [Indocyanine-Green-Guided, Robot-Assisted Left Hemihepatectomy]. Zentralbl Chir 2020; 146:377-380. [PMID: 32599636 DOI: 10.1055/a-1157-9754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Roland Croner
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mareike Franz
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jörg Arend
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mirhasan Rahimli
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Jessica Stockheim
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Victor Radu Negrini
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Eric Lorenz
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Mihalo Andric
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Aristotelis Perrakis
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Cora Wex
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Deutschland
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Chen CH, Sühn T, Kalmar M, Maldonado I, Wex C, Croner R, Boese A, Friebe M, Illanes A. Texture differentiation using audio signal analysis with robotic interventional instruments. Comput Biol Med 2019; 112:103370. [PMID: 31374348 DOI: 10.1016/j.compbiomed.2019.103370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022]
Abstract
Robotic minimally invasive surgery (RMIS) has played an important role in the last decades. In traditional surgery, surgeons rely on palpation using their hands. However, during RMIS, surgeons use the visual-haptics technique to compensate the missing sense of touch. Various sensors have been widely used to retrieve this natural sense, but there are still issues like integration, costs, sterilization and the small sensing area that prevent such approaches from being applied. A new method based on acoustic emission has been recently proposed for acquiring audio information from tool-tissue interaction during minimally invasive procedures that provide user guidance feedback. In this work the concept was adapted for acquiring audio information from a RMIS grasper and a first proof of concept is presented. Interactions of the grasper with various artificial and biological texture samples were recorded and analyzed using advanced signal processing and a clear correlation between audio spectral components and the tested texture were identified.
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Affiliation(s)
- C H Chen
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany.
| | - T Sühn
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
| | - M Kalmar
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
| | - I Maldonado
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
| | - C Wex
- Clinic for General, Visceral, Vascular and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - R Croner
- Clinic for General, Visceral, Vascular and Transplant Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - A Boese
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
| | - M Friebe
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
| | - A Illanes
- INKA Intelligente Katheter, Otto-von-Guericke University, Magdeburg, Germany
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Chen CH, Sühn T, Illanes A, Maldonado I, Ahmad H, Wex C, Croner R, Boese A, Friebe M. Proximally placed signal acquisition sensoric for robotic tissue tool interactions. Current Directions in Biomedical Engineering 2018. [DOI: 10.1515/cdbme-2018-0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractRobotic surgeries are still limited with respect to the surgeon’s natural senses. The tactile sense is exceptional important in conventional clinical procedures. To identify critical structures inside the tissue, palpation is a commonly used technique in conventional open surgeries. The underlying organ or pathological structures conditions (healthy, abnormally hard or soft) can for example be localized and assessed through this process. Palpation needs a tactile sense; however, that is commonly not available or limited in robotic surgeries. The palpation need was already addressed by several research groups that integrated complex sensor-feedback-systems into prototype surgical instruments for robotic systems. We propose a new technique to acquire data of the tissue tool interaction of the surgical instruments. The structure borne transmission path is used to measure acoustic emission (AE) at the outpatient (proximal) end of the instruments with the help of different sensors attached to the surface of the surgical tool. Initial tests were performed using a microphone in combination with a stethoscope. This setup showed promising results and a more integrated prototype was subsequently designed. A piezoelectric charge accelerometer was used as vibration sensor and compared to a MEMS microphone. A signal acquisition system was developed to acquire signals from both sensors in parallel. The sensors were then attached onto the shaft of a daVinci Prograsp Forceps instrument. According to the surgery observation, a series of simulated experiments was conducted. The tip of the grasper was swiped manually over a human subject’s dorsal and palmar hand side, lateral side of neck and over the carotid artery. Additionally, contact with soft tissue and other instruments were evaluated since these are events of interest during surgery. Advanced signal processing techniques allowed the identification and characterization of significant events such as palpation dynamics, contact and pulsation. Signals acquired by the MEMS microphone showed the most promising results. This approach will now be used to build a prototype for further evaluation in a clinical setup. The paper presents the first results that show that this novel technique can provide valuable information about the tool-tissue interaction in robotic surgery that typically can only be obtained through advanced distal sensor systems or actual human touch.
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Affiliation(s)
- Chien-Hsi Chen
- 1Institute of medical technology, INKA, Otto-von-Guericke University, Rötgerstraße 9,Magdeburg, Germany
| | - Thomas Sühn
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
| | - Alfredo Illanes
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
| | - Ivan Maldonado
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
| | - Hesham Ahmad
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
| | - Cora Wex
- 3Clinic for general, visceral, vascular and transplant surgery, Otto-von-Guericke University,Magdeburg, Germany
| | - Roland Croner
- 3Clinic for general, visceral, vascular and transplant surgery, Otto-von-Guericke University,Magdeburg, Germany
| | - Axel Boese
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
| | - Michael Friebe
- 2Institute of medical technology, INKA, Otto-von-Guericke University,Magdeburg, Germany
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Schadow C, Wex C, Wybranski C, Kalinski T, Schulz C, Meyer F. Angioneurotisches Ödem als Differenzialdiagnose rezidivierender Bauchschmerzen. Dtsch Med Wochenschr 2017; 142:341-345. [DOI: 10.1055/s-0042-100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Claudia Schadow
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R
| | - Cora Wex
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R
| | - Christian Wybranski
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R
| | - Thomas Kalinski
- Institut für Pathologie, Universitätsklinikum Magdeburg A.ö.R
| | - Christian Schulz
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg A.ö.R
| | - Frank Meyer
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R
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Arndt S, Russell A, Tomas J, Müller P, Shekhar S, Brandstädter K, Bruns C, Wex C. Rupture probability of porcine liver under planar and point loading. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/5/055018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wex C, Arndt S, Stoll A, Bruns C, Kupriyanova Y. Isotropic incompressible hyperelastic models for modelling the mechanical behaviour of biological tissues: a review. ACTA ACUST UNITED AC 2015; 60:577-92. [DOI: 10.1515/bmt-2014-0146] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/07/2015] [Indexed: 11/15/2022]
Abstract
AbstractModelling the mechanical behaviour of biological tissues is of vital importance for clinical applications. It is necessary for surgery simulation, tissue engineering, finite element modelling of soft tissues, etc. The theory of linear elasticity is frequently used to characterise biological tissues; however, the theory of nonlinear elasticity using hyperelastic models, describes accurately the nonlinear tissue response under large strains. The aim of this study is to provide a review of constitutive equations based on the continuum mechanics approach for modelling the rate-independent mechanical behaviour of homogeneous, isotropic and incompressible biological materials. The hyperelastic approach postulates an existence of the strain energy function – a scalar function per unit reference volume, which relates the displacement of the tissue to their corresponding stress values. The most popular form of the strain energy functions as Neo-Hookean, Mooney-Rivlin, Ogden, Yeoh, Fung-Demiray, Veronda-Westmann, Arruda-Boyce, Gent and their modifications are described and discussed considering their ability to analytically characterise the mechanical behaviour of biological tissues. The review provides a complete and detailed analysis of the strain energy functions used for modelling the rate-independent mechanical behaviour of soft biological tissues such as liver, kidney, spleen, brain, breast, etc.
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Wex C, Fröhlich M, Brandstädter K, Bruns C, Stoll A. Experimental analysis of the mechanical behavior of the viscoelastic porcine pancreas and preliminary case study on the human pancreas. J Mech Behav Biomed Mater 2014; 41:199-207. [PMID: 25460416 DOI: 10.1016/j.jmbbm.2014.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023]
Abstract
The aim of this article is to study the mechanical properties of the pancreas. Up to now, the mechanical properties of the pancreas are not sufficiently characterized. The possibility of intraoperative mechanical testing of pathological pancreata will allow the classification of pancreatic diseases in the future. The application of mechanical parameters instead of the intraoperative frozen section analysis shortens waiting times in the operating room. This study proves the general applicability of shear rheology for the determination of the mechanical properties of pancreas and the assessment of graft quality for transplantation. Porcine and human pancreas samples were examined ex vivo and a nonlinear viscoelastic behavior was observed. Pancreas was found to be more viscous than liver but both abdominal organs showed a similar flow behavior. The shear deformation dependence of healthy human pancreas was similar to porcine pancreas. An increase in the post-mortem time led to an increase in the complex modulus for a post-mortem time up to 8.5 days. Histological investigations showed that an increased amount of collagen coincides with the stiffening of the pancreatic tissue.
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Affiliation(s)
- C Wex
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Germany
| | - M Fröhlich
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Germany
| | - K Brandstädter
- Center for Pathology and Forensic Medicine, University Clinic Magdeburg, Germany
| | - C Bruns
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Germany
| | - A Stoll
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Germany.
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Wex C, Stoll A, Fröhlich M, Arndt S, Lippert H. Mechanics of fresh, frozen-thawed and heated porcine liver tissue. Int J Hyperthermia 2014; 30:271-83. [DOI: 10.3109/02656736.2014.924161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Ussat S, Lodes U, Wex C, Rapp L, Schulz HU, Meyer F. [Successful closure of a postoperative esophagobronchial fistula following esophageal resection using fibrin glue]. Dtsch Med Wochenschr 2013; 138:1406-9. [PMID: 23801262 DOI: 10.1055/s-0033-1343238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED HISTORY AND INTERVENTION: A 52-year-old female patient underwent open abdominothoracic cardia and esophageal resection with gastric transposition because of histologically diagnosed Barrett metaplasia with "high-grade" intraepithelial neoplasia (HGIEN) and parts of an invasive adenocarcinoma. The anastomotic insufficiency on the 10th postoperative day including an esophagobronchial fistula prompted to a subsequent surgical re-intervention with suture of the fistula, lavage and additional drainage, an endoscopic stenting of the fistula from esophageal site, as well as repeated (n = 22) bronchoscopic applications of fibrin glue (1-3 ml each) into the lumen of the fistula after each bronchoscopic lavage of the fistula until the complete closure was achieved. The changeful clinical course of 77 days on the surgical ICU was characterized by secondary complications such as pneumonia, mediastinitis and respiratory insufficiency with long-term artificial respiration and creation of a percutaneous dilatation tracheotomy. CONCLUSION The application of fibrin glue can be considered a promising, minimally invasive therapeutic option in the management of postoperative fistula after esophageal resection, which requires expertise in decision-making and the finding-specific approach, in particular, if indicated inital steps of the sequential complication management such as surgical re-intervention and conventional endoscopic measures (stenting, Endo-VAC[-sponge]) do not provide great therapeutic potential any more due to the prolonged postoperative time course and the unfavorable local findings. In the presented case, modes of an assisted artificial respiration with low pressure and short phases of apnoe after fibrin glue application were the crucial predictions for an initial and favorable adhesion of this glue and finally for a successful sealing resulting in a sufficient closure of the fistula.
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Affiliation(s)
- S Ussat
- Chirurgischen Intensivstation, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland.
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Wex C, Stoll A, Fröhlich M, Arndt S, Lippert H. How preservation time changes the linear viscoelastic properties of porcine liver. Biorheology 2013; 50:115-31. [DOI: 10.3233/bir-130632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C. Wex
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Magdeburg, Germany
| | - A. Stoll
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Magdeburg, Germany
| | - M. Fröhlich
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Magdeburg, Germany
| | - S. Arndt
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Magdeburg, Germany
| | - H. Lippert
- Clinic for General, Visceral and Vascular Surgery, University Clinic Magdeburg, Magdeburg, Germany
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Balgon S, Wex C, Rapp L, Lippert H, Meyer F. [Volvulus of the small intestine - diagnostic and therapeutic management of a rare surgical finding in adults demonstrated with an entity-specific modern imaging using impressive CT scan-based video sequence]. Zentralbl Chir 2011; 138:313-6. [PMID: 21598204 DOI: 10.1055/s-0031-1271396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Balgon
- Universitätsklinikum Magdeburg A. ö. R., Klinik für Allgemein-, Viszeral- und Gefäß-chirurgie, -Magdeburg, Deutschland.
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Wex C, Jacob S, Meyer F, Stübs P, Lippert H. [Innovation forum - application of haptics in robot-assisted surgery]. Zentralbl Chir 2011; 136:181-4. [PMID: 21400405 DOI: 10.1055/s-0030-1262680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Wex
- Universitätsklinikum Magdeburg A. ö. R., Universitätsklinik für Allgemein-, Viszeral- und Gefässchirurgie, Magdeburg, Deutschland.
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Mueller A, Platz KP, Krause P, Kahl A, Rayes N, Glanemann M, Lang M, Wex C, Bechstein WO, Neuhaus P. Perioperative factors influencing patient outcome after liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02010.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stübs P, Habermann P, Wex C, Mohren M, Zierau K, Lippert H, Fahlke J. [Palliative chemotherapy for colorectal cancer--current state, significance, trends]. Zentralbl Chir 2010; 135:535-40. [PMID: 21154211 DOI: 10.1055/s-0030-1262701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are a number of effective substances available for palliative treatment of colorectal cancer, contributing to a considerable extension of the median survival time either purely medically or by increasing the chance of secondary resectability through improved effectiveness of the administered drugs. PATIENTS / MATERIAL: Defining treatment depending on predominant patient characteristics remains crucial for any therapeutic success. This requires interdisciplinary co-ordination within tumour boards. METHODS In aggressive tumours a therapeutic approach inducing high response rates is favoured, usually including a triple or quadruple combination incl. antibodies. In cases of slow tumour progress and limited patient profile, a sequence of chemotherapy is chosen. Implementing and integrating locally ablative modes of therapy into the treatment strategy can increase the effectiveness additionally. In a best case scenario additional systemic side effects can be avoided resulting in a not insignificant benefit in quality of life. RESULTS Further genotyping beyond the K-RAS state is necessary to make predictive and prognostic statements concerning the drugs applied and to avoid ineffectiveness. CONCLUSION Considerable progress has been achieved in the medical therapy for metastasised colorectal cancer. The targeted application of already available as well as recently developed substances requires further evaluation by appropriate studies.
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Affiliation(s)
- P Stübs
- Otto-von-Guericke-Universität, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Magdeburg, Deutschland.
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Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005; 61:891-6. [PMID: 15933696 DOI: 10.1016/s0016-5107(05)00325-1] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Surgery, as well as conservative treatment, in patients with clinically apparent intrathoracic esophageal anastomotic leaks often is associated with poor results and carries a high morbidity and mortality. The successful treatment of esophageal anastomotic insufficiencies and perforations when using covered, self-expanding metallic stents is described. METHODS The feasibility and the outcome of endoscopic treatment of intrathoracic anastomotic leakages when using silicone-covered self-expanding polyester stents were investigated. Twelve consecutive patients presented with clinically apparent intrathoracic esophageal anastomotic leak caused by resection of an epiphrenic diverticulum (n = 1), esophagectomy for esophageal cancer (n = 9), or gastrectomy for gastric cancer (n = 2), were endoscopically treated in our department. The extent of the dehiscences ranged from about 20% to 70% of the anastomotic circumference. After endoscopic lavage and debridement of the leakage at 2-day intervals (mean duration, 8.6 days), a large-diameter polyester stent (Polyflex; proximal/distal diameters 25/21 mm) was placed to seal the leakage. Simultaneously, the periesophageal mediastinum was drained by chest drains. OBSERVATIONS All 12 patients were successfully treated endoscopically without the need for reoperation. A complete closure of the leakage was obtained in 11 of 12 patients after stent removal (median time to stent retrieval, 4 weeks, range 2-8 weeks). In one patient, a persistent leak was sealed endoscopically after stent removal by using 3 clips. Distal stent migration was obtained in two patients. CONCLUSIONS The placement of silicone-covered self-expanding polyester stents seems to be a successful minimally invasive treatment option for clinically apparent intrathoracic esophageal anastomotic leaks.
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Affiliation(s)
- Daniel Schubert
- Department of General, Visceral and Vascular Surgery, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Mueller AR, Platz KP, Krause P, Kahl A, Rayes N, Glanemann M, Lang M, Wex C, Bechstein WO, Neuhaus P. Perioperative factors influencing patient outcome after liver transplantation. Transpl Int 2001; 13 Suppl 1:S158-61. [PMID: 11111987 DOI: 10.1007/s001470050311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We have previously shown that the development of multiple organ dysfunction syndrome (MODS) after liver transplantation significantly reduced patient survival. Therefore, the question arises of which are the most prominent perioperative donor and recipient factors leading to MODS after transplantation. In total, 634 patients with 700 liver transplants were analyzed. Donor factors included age, increase in transaminases, sex mismatch, requirement for catecholamines, intensive care time, histology, and macroscopic graft appearance. Recipient factors included Child classification, preoperative gastrointestinal (GI) bleeding, mechanical ventilation, hemodialysis, and requirement for catecholamines. MODS was defined by more than two severe organ dysfunctions. The cumulative 2 to 9-year patient survival was 90.9% in patients developing less than 3 severe organ dysfunctions following transplantation. Survival decreased to 60.3% in patients with MODS. Neither any of the donor factors nor the duration of cold ischemia (CIT) was associated with an increase in MODS or decrease in survival. On the other hand, duration of warm ischemia, amount of blood loss, requirement for red packed blood cells, and reoperation had an influence on the development of MODS (40%-56%) and decreased patient survival to 58%-69%. Preoperative therapy with catecholamines, GI bleeding, mechanical ventilation, and hemodialysis were associated with the development of MODS in 54%-88%. Patient survival following MODS decreased to 50%-74%. Initial graft function had a slight influence on the development of MODS, but no influence on the long-term patient survival. In conclusion, patient survival was significantly influenced by the development of postoperative MODS. The most prominent factors in this were recipient and intraoperative ones. No major influence was observed for donor factors, CIT, and initial graft function. Prevention of MODS will further improve the outcome after liver transplantation.
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Affiliation(s)
- A R Mueller
- Department of Surgery, Humboldt University of Berlin, Germany
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Hidajat N, Vogl T, Stobbe H, Schmidt J, Wex C, Lenzen R, Berg T, Neuhaus P, Felix R. Transjugular intrahepatic portosystemic shunt. Experiences at a liver transplantation center. Acta Radiol 2000; 41:474-8. [PMID: 11016769 DOI: 10.1080/028418500127345712] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center. MATERIAL AND METHODS One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision. RESULTS TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient. CONCLUSION In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.
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Affiliation(s)
- N Hidajat
- Department of Radiology, Charité Campus Virchow-Clinic, Medical Faculty, Humboldt-University, Berlin, Germany
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Abstract
OBJECTIVE To evaluate different strategies for extended resections of hilar cholangiocarcinomas on radicality and survival. SUMMARY BACKGROUND DATA Surgical resection of hilar cholangiocarcinoma is the only potentially curative treatment. Resection of central bile duct carcinomas, however, cannot always comply with the general principles of surgical oncology to achieve wide tumor-free margins with no-touch techniques. METHODS From 1988 to 1998, 95 patients underwent resection of hilar cholangiocarcinoma. Eighty patients had hilar and hepatic resections and 15 had liver transplantation and partial pancreatoduodenectomy (LTPP; i.e., eradication of the entire biliary tract using a no-touch technique). RESULTS The 60-day death rate was 8%. The overall 1- and 5-year survival rates were 67% and 22%, respectively. Five-year survival rates after R0, R1, and R2 resections were 37%, 9%, and 0%. In a multivariate analysis, surgical radicality was the strongest determinant of survival (p < 0.001). The rate of formally curative resection (R0 resection) was significantly lower in hilar resections (29%) than in liver resections (left hemihepatectomy 59%, right hemihepatectomy 55%, right trisegmentectomy 65%; p < 0.05). The highest rate of R0 resection was observed after LTPP (93%; p < 0.05). Right trisegmentectomies achieved the highest rate of 5-year survival after R0 resection (57%). In a multivariate analysis of patient survival after R0 resection, additional portal vein resection was the only significant factor. The 5-year survival rate after formally curative liver resection with portal vein resection was 65% versus 28% without. CONCLUSION Extended resections, especially right trisegmentectomies and LTPP, resulted in the highest rate of R0 resection. Right trisegmentectomy together with portal vein resection best represents the principles of surgical oncology and may be regarded as the surgical procedure of choice. Immunosuppression limits the applicability of LTPP.
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Affiliation(s)
- P Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité-Virchow Klinikum, Humboldt University, Berlin, Germany
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Affiliation(s)
- P Neuhaus
- Clinic of General, Visceral and Transplantation Surgery, Charité, Medical Faculty of the Humboldt-University Berlin, Campus Virchow-Clinic, Germany
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