scholarly journals FOUR-LEVEL EN BLOC VERTEBRECTOMY: A NOVEL TECHNIQUE AND LITERATURE REVIEW

2018 ◽  
Vol 26 (6) ◽  
pp. 406-410
Author(s):  
Douglas Kenji Narazaki ◽  
Lucas P. Higino ◽  
William Gemio Jacobsen Teixeira ◽  
Ivan Dias da Rocha ◽  
Alexandre Fogaça Cristante ◽  
...  
Keyword(s):  
Literature Review ◽  
Mechanical Stability ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
University Hospital ◽  
Surgical Morbidity ◽  
En Bloc ◽  
Level Of Evidence ◽  
Novel Technique ◽  
Reconstruction Methods

ABSTRACT Objective: To demonstrate a novel technique for multilevel en bloc post-vertebrectomy reconstruction. Methods: A novel technique for en bloc multiple post-vertebrectomy reconstruction was used in a patient presenting for curative resection of Ewing's Sarcoma at the oncology center of a public university hospital. Results: The procedure described was feasible for en bloc resection of the four vertebrae. The reconstruction was acceptable and satisfactory in terms of mechanical stability and was without any neurological sequelae in the patient. Conclusion: The use of an allograft with a locked intramedullary nail was an adequate solution for reconstructing the anterior and medial spines after multilevel vertebrectomy. In addition, the association of four intramedullary nails provided stability to the reconstruction. Immediate benefits of the technique compared to other commonly used techniques were shorter hospitalization times and reduced surgical morbidity. Level of Evidence V, Clinical study of a new surgical technique and a literature review.

scholarly journals Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy

2020 ◽  
Vol 08 (02) ◽  
pp. E99-E104 ◽  
Author(s):  
Richard F. Knoop ◽  
Edris Wedi ◽  
Golo Petzold ◽  
Sebastian C.B. Bremer ◽  
Ahmad Amanzada ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Ex Vivo Model ◽  
En Bloc ◽  
Novel Technique ◽  
Mucosal Resection ◽  
Flat Lesions

Abstract Background and study aims Recently, a new external additional working channel (AWC) was introduced by which conventional endoscopic mucosal resection (EMR) can be improved to a technique termed “EMR+”. We first evaluated this novel technique in comparison to classical EMR in flat lesions. Methods The trial was prospectively conducted in an ex vivo animal model with porcine stomachs placed into the EASIE-R simulator. Prior to intervention, standardized lesions were set by coagulation dots, measuring 1, 2, 3 or 4 cm. Results Overall, 152 procedures were performed. EMR and EMR+ were both very reliable in 1-cm lesions, each showing en bloc resection rates of 100 %. EMR+ en bloc resection rate was significantly higher in 2-cm lesions (95.44 % vs. 54.55 %, P = 0.02), in 3-cm lesions (86.36 % vs. 18.18 %, P < 0.01) and also in 4-cm lesions (60.00 % vs. 0 %, P < 0.01). Perforations occurred only in EMR+ procedures in 4-cm lesions (3 of 20; 15 %). Conclusions With its grasp-and-snare technique, EMR+ facilitates en bloc resection of larger lesions compared to conventional EMR. In lesions 2 cm and larger, EMR+ has demonstrated advantages, especially concerning en bloc resection rate. At 3 cm, EMR+ reaches its best discriminatory power whereas EMR+ has inherent limits at 4 cm and in lesions of that size, other techniques such as ESD or surgery should be considered.

scholarly journals High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

2019 ◽  
Vol 07 (09) ◽  
pp. E1166-E1174 ◽  
Author(s):  
Jérémie Jacques ◽  
Aurélie Charissoux ◽  
Pierre Bordillon ◽  
Romain Legros ◽  
Jérôme Rivory ◽  
...  
Keyword(s):  
Case Series ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Point Of View ◽  
University Hospital ◽  
Control Group ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

scholarly journals The utility of a novel colonoscope with retroflexion for colorectal endoscopic submucosal dissection

2019 ◽  
Vol 07 (02) ◽  
pp. E130-E137 ◽  
Author(s):  
Hidenori Tanaka ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Katsuaki Inagaki ◽  
Yuki Okamoto ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Tumor Location ◽  
Bloc Resection ◽  
University Hospital ◽  
Outcome Analysis ◽  
The Novel ◽  
Retrograde Approach ◽  
Resection Rate ◽  
En Bloc ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The PCF-H290TI/L produced by Olympus is a novel colonoscope equipped with some advantageous features for endoscopic treatment. It is expected to improve the potential for retroflexion and overall endoscope operability, which can reduce the difficulty of performing colorectal ESD. The aim of this study was to evaluate the utility of the novel colonoscope in colorectal ESD. Methods Three hundred and forty-eight consecutive colorectal lesions resected via ESD between June 2014 and January 2017 at Hiroshima University Hospital were included in the retroflexion ability analysis. We compared the retroflexion potential of PCF-H290TI to that of a conventional endoscope. Two hundred and twenty-seven colorectal lesions located in the left-sided colon and resected with ESD between April 2009 and February 2018 were enrolled in the treatment outcome analysis. Treatment outcomes using PCF-H290TI compared to those of the conventional colonoscope, and outcomes of the PCF-H290TI with retroflexion compared to those of the conventional colonoscope without retroflexion were evaluated by propensity score matching. Results The retroflexion rate with the PCF-H290TI was 76 %, which was significantly higher than the 44 % rate with the conventional scope. Endoscope operability was better and dissection speed was faster when using the PCF-H290TI with retroflexion compared to the conventional colonoscope without retroflexion. There were no significant differences between the groups in en bloc resection rate and adverse events. Conclusion Compared to the conventional colonoscope, the PCF-H290TI/L made it easier to perform ESD via a retrograde approach regardless of tumor location, and thus may be useful for performing colorectal ESD.

scholarly journals Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

2021 ◽  
Author(s):  
Amanda N Sacino ◽  
Sutipat Pairojboriboon ◽  
Ian Suk ◽  
Daniel Lubelski ◽  
Robin Yang ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Pelvic Ring ◽  
Surgical Techniques ◽  
Extent Of Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mobile Spine ◽  
Sacral Tumors ◽  
Fibrous Tumor

Abstract BACKGROUND AND IMPORTANCE En bloc resection of sacral tumors is the most effective treatment to help prevent recurrence. Sacrectomy, however, can be destabilizing, depending on the extent of resection. Various surgical techniques for improving stability and enabling early ambulation have been proposed. CLINICAL PRESENTATION Here, we report a case in which we use PMMA (poly[methyl methacrylate]) to augment pelvic instrumentation to improve mechanical stability after sacrectomy for en bloc resection of a solitary fibrous tumor. CONCLUSION We highlight the use of sacroplasty augmentation of pelvic ring reconstruction to provide biomechanical stability without the need for fusion of any mobile spine segments, which allowed for early patient ambulation and no appreciable loss of range of motion or mobility.

Longitudinal quality of life (QOL) and sexual functioning in women undergoing pelvic exenteration for gynecologic malignancies.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5608-5608 ◽  
Author(s):  
Pamela T. Soliman ◽  
Charlotte C. Sun ◽  
Shannon Neville Westin ◽  
Lois M. Ramondetta ◽  
Diane C. Bodurka ◽  
...  
Keyword(s):  
Social Support ◽  
Body Image ◽  
Functional Status ◽  
Sexual Functioning ◽  
Pelvic Exenteration ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Morbidity ◽  
En Bloc ◽  
Reconstruction Methods

5608 Background: Pelvic exenteration (PE) is en bloc resection of the pelvic organs including bladder, vagina, and rectum to treat central recurrence of a gynecologic malignancy. While this procedure has high morbidity, it is the only option for cure in some patients. The goal of this study was to assess QOL and sexual functioning in women who underwent PE with vaginal and/or bladder reconstruction. Methods: All patients were enrolled prior to PE. Surveys included the SF-12 (functional status), BIS (body image), SAQ (sexual functioning), SWD (satisfaction with decision), CES-D (depression), Stoma QOL, and DUFSS completed preoperatively (preop) and post-operatively at 4-6 wks, 6 mo, 1 yr, and 2 yrs. Descriptive statistics, chi-square, Mann-Whitney, and Kruskal Wallis tests were used to evaluate the data. Results: Between 2008 and 2012, 39 women participated. Median age was 56.7 yrs. Mean physical functional status scores (SF-12) declined through 6 mo postop, with improvements at 1 and 2 yrs (p=.002) but did not reach preop levels. SF-12 mental functioning scores declined immediately postop but returned to baseline by 6 mo. BIS was significantly worse at 1ys (p=0.02) and 2 yrs (p=0.025). Mean depression (CES-D) scores decrease but remained above the clinical cutoff of 17 at 6 mo. Poor sexual function was noted preop and did not improve. High scores for social support (DUFSS) remained constant. Stoma QOL improved in the first 2 yrs but not significantly. Pts reported high satisfaction with the decision to undergo PE, which did not change over time. Conclusions: While a majority of women remained satisfied with their decision to undergo PE, the procedure was associated with depression, worsening physical functioning and poor body image despite stable social support. Interventions are currently under development to improve QOL in this patient population. [Table: see text]

Closed-loop audit of muscle sampling in Trans-Urethral Resection of Bladder Tumour

2021 ◽  
pp. 205141582110499
Author(s):  
Raghav Varma ◽  
Abdalla Deb ◽  
Dorina Roy ◽  
Ali Ahmed
Keyword(s):  
Bladder Cancer ◽  
Closed Loop ◽  
Bladder Tumour ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Detrusor Muscle ◽  
En Bloc ◽  
Level Of Evidence ◽  
Muscle Invasive

Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3

scholarly journals Primary Leiomyosarcoma of the Lumbar Spine: A Case Report and Literature Review

2021 ◽  
pp. 1-6
Author(s):  
Eric Luis ◽  
Eric Luis ◽  
Vasanthie Balakrishnan ◽  
Zainur Anuar bin Kamarul Bahrin ◽  
Han Sim Lim ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Literature Review ◽  
Immunohistochemical Staining ◽  
Tumor Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
First Case ◽  
Staining Techniques

Primary vertebral leiomyosarcoma of the spine is extremely rare. Due to its rarity, the number of studies on pathology, treatment and prognosis is limited. Tissue Biopsy and Immunohistochemical staining techniques provide unequivocal diagnosis of leiomyosarcoma. The mainstay of treatment of spinal leiomyosarcoma is surgery, with or without radiotherapy and embolization. The principles of surgery comprise resection of tumor, decompression and stabilisation of the spinal cord and prevention of tumor recurrence. The Tomita total en-bloc resection is the preferred surgical technique. We hereby present a literature review of spinal leiomyosarcoma and a case report of the first case of a 56-year-old lady in Malaysia who was diagnosed with L3 vertebral leiomyosarcoma and lung metastasis.

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