779 USE OF INDOCYANINE GREEN TO ASSESS THE CORRECT VASCULARIZATION OF GASTROPLASTY IN MCKWEON ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Lourdes Avelino González ◽  
Mireia Navasquillo Tamarit ◽  
David Abelló Audí ◽  
Hanna Cholewa ◽  
Marcos Bruna Esteban ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Esophageal Surgery ◽  
Hepatobiliary Surgery ◽  
Purse String Suture ◽  
Purse String ◽  
Green Is ◽  
Proximal Esophagus ◽  
Optimal Site ◽  
Retrosternal Space

Abstract   Cervical anastomostic leakage in esophageal surgery is one of the most serious complications and its incidence is 10–30% according to series. ndocyanine green is being used in multitude of surgical procedures in colorectal and hepatobiliary surgery. In this video we try to prove its usefulness to assess the adequate vascularization of the gastroplasty with the aim of reducing anastomotic leak due to not-well perfusion. Methods A left lateral cervicotomy was performed and proximal esophagus was divided. Then a handsewn purse-string suture was performed and the anvil of CEA 25 stapler was introduced into the esophagus. Gastroplasty was performed with endoGIA section by minilaparotomy. An intravenous infussion of Indocyanine green was used to assess the vascularization "in situ" of the gastroplasty. The gastroplasty was pull up through the retrosternal space and when the plasty was positioned in a correct way, the optimal site for the anastomosis was chosen. Mechanical T-L anastomosis with CEA 25 stapler was performed and it was covered with an omental flap. Video https://drive.google.com/file/d/1kqmNzJCdlJFOcxKBYRp0jamoHz6Gwgt7/view?usp=sharing.

P155 REAL-TIME EVALUATION OF THE GASTRIC CONDUIT BASED ON THE REGIONAL O2 SATURATION (%) AND TOTAL HEMOGLOBIN INDEX IN THORACIC ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Fujita Takeo ◽  
Sato Kazuma ◽  
Hirano Yuki ◽  
Fujiwara Hisashi ◽  
Daiko Hiroyuki
Keyword(s):  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Evaluation Method ◽  
Mean Value ◽  
Gastric Conduit ◽  
Green Is ◽  
Mean Values ◽  
Total Hemoglobin ◽  
Distal Side ◽  
Optimal Site

Abstract Aim Evaluation of blood supply of gastric conduit is one of the most importance parameter in thoracic esophagectomy. Evaluation with indocyanine green is the most popular evaluation method. However, indocyanine green does not objecctive values with Herein we introduce the new evaluation method based on the regional SO2(%) and Total hemoglobin index in thoracic esophagectomy. Background and methods: Between February to July 2018, we evaluated 56 patients underwent thoracic esophagectomy for esophageal cancer. Regional O2 saturation level (rSO%) and total hemoglobin indexes (T-HbI) of gastric conduit was evaluated using the ToccareTM (ASTEM Co. Ltd Tokyo, Japan) to determine the optimal site of anastomosis on gastric conduit. Results Fifty-two patients were eligible in this study. Mean value of the rSO2(%)/T-HbI were 57.6%/0.22 at the anal side of the gastric conduit where sufficient feeding arteries were existed from right gastroepiploic artery and vein. On the other hand, mean values of the rSO2(%)/T-HbI were 59.4%/0.28 (p<0.05) at the distal side of the gastric conduit where direct feeding artery from right gastroepiploic vessel was terminated. Then, mean values of rSO2(%)/T-HbI were 46.3%/0.34 (p<0.05) at the tip of the gastric conduit, which consisted to the gradual congestion was happened prior to the tissue oxygenation in the gastric conduit. There were 1 patient which found anastomotic leakage (1.9%) among 56 patients. Conclusion Evaluation of the regional SO2(%) and total hemoglobin index of the gastric conduit was non-invasiveness procedure and useful to easily determine the optimal site of anastomotic level to minimize the incidence of anastomotic leakage in thoracic esophagectomy.

scholarly journals Distal purse-string suture technique for TaTME

2018 ◽  
Vol 23 (1) ◽  
pp. 67-68 ◽  
Author(s):  
R. Wu ◽  
R. Benedict ◽  
A. Caycedo-Marulanda
Keyword(s):  
Suture Technique ◽  
Purse String Suture ◽  
Purse String

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

scholarly journals Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma

2021 ◽  
Author(s):  
Charissa M. Lake ◽  
Alexander J. Bondoc ◽  
Anasua Roshni Dasgupta ◽  
Todd M. Jenkins ◽  
Alexander J. Towbin ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Surgical Management ◽  
Green Is

scholarly journals Reconstruction of Areolar Projection Using a Purse-String Suture Technique

2015 ◽  
Vol 3 (7) ◽  
pp. e453 ◽  
Author(s):  
Stephanie A. Caterson ◽  
Mansher Singh ◽  
Simon G. Talbot ◽  
Elof Eriksson
Keyword(s):  
Suture Technique ◽  
Purse String Suture ◽  
Purse String

scholarly journals Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeffrey Dalli ◽  
Eamon Loughman ◽  
Niall Hardy ◽  
Anwesha Sarkar ◽  
Mohammad Faraz Khan ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Real Time ◽  
Normal Tissue ◽  
Near Infrared ◽  
Malignant Lesion ◽  
Fluorescence Analysis ◽  
Video Tracking ◽  
Continuous Stream ◽  
Rich Data

AbstractAs indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis. Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 min. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame/second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Early kinetic FI signal measurement delineated discriminative temporal signatures from tumours (n = 20, 9 cancers) offering rich data for analysis versus delayed spot measurement (n = 10 cancers). Malignant lesion dynamic curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Photobleaching appeared clinically irrelevant. Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

Comparison of three purse-string suture techniques for prevention of anal leakage during surgery

2021 ◽  
pp. 1-5
Author(s):  
Jo Anne Au Yong ◽  
Daniel D. Smeak
Keyword(s):  
Clinical Relevance ◽  
Suture Technique ◽  
Suture Techniques ◽  
Leak Pressure ◽  
Purse String Suture ◽  
Purse String ◽  
Pressure Testing ◽  
Nylon Suture ◽  
Cutaneous Tissue ◽  
Suture Placement

Abstract OBJECTIVE To compare 3 anal purse-string suture techniques for resistance to leakage and to identify the suture technique requiring the fewest tissue bites to create a consistent leak-proof orifice closure. ANIMALS 18 large-breed canine cadavers. PROCEDURES 3 purse-string suture techniques (3 bites with 0.5 cm between bites [technique A], 5 bites with 0.5 cm between bites [technique B], and 3 bites with 1.0 cm between bites [technique C]) were evaluated. Each technique involved 2-0 monofilament nylon suture that was placed in the cutaneous tissue around the anus and knotted with 6 square throws. Standardized 2.0-cm-diameter circular templates with the designated bite number and spacing indicated were used for suture placement. Leak-pressure testing was performed, and the pressure at which saline was first observed leaking from the anus was recorded. The median and interquartile (25th to 75th percentile) range (IQR) were compared among 3 techniques. RESULTS Median leak pressure for technique A (101 mm Hg; IQR, 35 to 131.3 mm Hg) was significantly greater than that for technique C (19 mm Hg; IQR, 14.3 to 25.3 mm Hg). Median pressure did not differ between techniques A and B (50 mm Hg; IQR, 32.5 to 65 mm Hg) or between techniques B and C. CLINICAL RELEVANCE Placement of an anal purse-string suture prevented leakage at physiologic colonic and rectal pressures, regardless of technique. Placement of 3 bites 0.5 cm apart (technique A) is recommended because it used the fewest number of bites and had the highest resistance to leakage.

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Purse String Suture ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

scholarly journals Indocyanine Green Loaded PLGA Film Coated Coronary Stents for Photo-Triggered in situ Biofilm Eradication

2018 ◽  
Vol 27 ◽  
pp. 35-39 ◽  
Author(s):  
Hendrik Vögeling ◽  
Shashank Reddy Pinnapireddy ◽  
Benjamin Seitz ◽  
Udo Bakowsky
Keyword(s):  
Indocyanine Green ◽  
Coronary Stents ◽  
Plga Film
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