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Endoscopy ◽  
2021 ◽  
Author(s):  
Jenny Krause ◽  
Thomas Rösch ◽  
Stefan Steurer ◽  
Till Clauditz ◽  
Susanne Sehner ◽  
...  

Background Following endoscopic resection of early-stage Barrett’s esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens. Methods In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated. Results No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections. Conclusion The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.


2021 ◽  
Vol 12 ◽  
Author(s):  
Yurika Numata-Uematsu ◽  
Mitsugu Uematsu ◽  
Rie Sakuraba ◽  
Masaki Iwasaki ◽  
Shinichiro Osawa ◽  
...  

Objective: Accurate estimation of the epileptogenic zone (EZ) is essential for favorable outcomes in epilepsy surgery. Conventional ictal electrocorticography (ECoG) onset is generally used to detect the EZ but is insufficient in achieving seizure-free outcomes. By contrast, high-frequency oscillations (HFOs) could be useful markers of the EZ. Hence, we aimed to detect the EZ using interictal spikes and investigated whether the onset area of interictal spike-related HFOs was within the EZ.Methods: The EZ is considered to be included in the resection area among patients with seizure-free outcomes after surgery. Using a complex demodulation technique, we developed a method to determine the onset channels of interictal spike-related ripples (HFOs of 80–200 Hz) and investigated whether they are within the resection area.Results: We retrospectively examined 12 serial patients who achieved seizure-free status after focal resection surgery. Using the method that we developed, we determined the onset channels of interictal spike-related ripples and found that for all 12 patients, they were among the resection channels. The onset frequencies of ripples were in the range of 80–150 Hz. However, the ictal onset channels (evaluated based on ictal ECoG patterns) and ripple onset channels coincided in only 3 of 12 patients.Conclusions: Determining the onset area of interictal spike-related ripples could facilitate EZ estimation. This simple method that utilizes interictal ECoG may aid in preoperative evaluation and improve epilepsy surgery outcomes.


2021 ◽  
Author(s):  
Ana P Millan ◽  
Elisabeth CW van Straaten ◽  
Cornelis J Stam ◽  
Ida A Nissen ◽  
Sander Idema ◽  
...  

Background Epilepsy surgery is the treatment of choice for drug-resistant epilepsy patients. However, seizure-freedom is currently achieved in only 2/3 of the patients after surgery. In this study we have developed an individualized computational model based on functional brain networks to explore seizure propagation and the efficacy of different virtual resections. Eventually, the goal is to obtain individualized models to optimize resection strategy and outcome. Methods We have modelled seizure propagation as an epidemic process using the susceptible-infected (SI) model on individual functional networks derived from presurgical MEG. We included 10 patients who had received epilepsy surgery and for whom the surgery outcome at least one year after surgery was known. The model parameters were tuned in order to reproduce the patient-specific seizure propagation patterns as recorded with invasive EEG. We defined a personalized search algorithm that combined structural and dynamical information to find resections that maximally decreased seizure propagation for a given resection size. The optimal resection for each patient was defined as the smallest resection leading to at least a $90\%$ reduction in seizure propagation. Results The individualized model reproduced the basic aspects of seizure propagation for 9 out of 10 patients when using the resection area as the origin of epidemic spreading, and for 10 out of 10 patients with an alternative definition of the seed region. We found that, for 7 patients, the optimal resection was smaller than the resection area, and for 4 patients we also found that a resection smaller than the resection area could lead to a 100% decrease in propagation. Moreover, for two cases these alternative resections included nodes outside the resection area. Conclusion Epidemic spreading models fitted with patient specific data can capture the fundamental aspects of clinically observed seizure propagation, and can be used to test virtual resections in silico. Combined with optimization algorithms, smaller or alternative resection strategies, that are individually targeted for each patient, can be determined with the ultimate goal to improve surgery outcome.


Author(s):  
Yasuo Sekine ◽  
Eitetsu Koh ◽  
Hidehisa Hoshino

Abstract Central image: Virtual wedge resection of right S2aiiα+S2aiiβ and the same intraoperative fluorescent image. OBJECTIVES The purpose of this study was to investigate the feasibility of lung wedge resection by combining 3-dimensional (3D) image analysis with transbronchial indocyanine green (ICG) instillation, in order to delineate the intended area for resection. METHODS From December 2017 to July 2020, 28 patients undergoing wedge resection (17 primary lung cancers, 11 metastatic lung tumours) were enrolled, and fluorescence-guided wedge resection was attempted. Virtual sublobar resections were created preoperatively for each patient using a 3D Image Analyzer. Surgical margins were measured in each sublobar resection simulation in order to select the most optimal surgical resection area. After transbronchial instillation of ICG, near-infrared thoracoscopic visualization allowed matching of the intended area for resection to the virtual sublobar resection area. To investigate the effectiveness of ICG instillation, the clarity of the ICG-florescent border was evaluated, and the distance from the true tumour to the surgical margins was compared to that of simulation. RESULTS Mean tumour diameter was 12.4 ± 4.3 mm. The entire targeted tumour was included in resected specimens of all patients (100% success rate). The shortest distances to the surgical margin via 3D simulation and by actual measurement of the specimen were11.4 ± 5.4 and 12.2 ± 4.1 mm, respectively (P = 0.285) and were well correlated (R2 = 0.437). While all specimens had negative malignant cells at the surgical margins, one loco-regional recurrence was observed secondary to the dissemination of neuroendocrine carcinoma. CONCLUSIONS ICG-guided lung wedge resection after transbronchial ICG instillation and preoperative 3D image analysis allow for adequate negative surgical margins, providing decreased risk of local recurrence.


2021 ◽  
pp. 85-91
Author(s):  
E.S. Drozdov ◽  
◽  
A.I. Baranov ◽  
D.A. Shkatov ◽  
S.S. Klokov ◽  
...  

Aim of study. Investigation of risk factors in development of postoperative pancreatic fi stula (POPF) in patients aft er distal pancreatectomy (DP) involving application of a cutting stapler device (CS) as well as determination of the criteria for selection of the optimal cassette type for such devices making it possible to reduce the POPF development frequency. Material and methods. A two-centre retrospective/prospective controlled study was performed. A total of 46 patients (19 (41.3 %) male and 27 (58.7 %) female) were enrolled. All patients included in the study underwent DP surgery using CS for excision of the pancreas with closure of its stump. In all cases, measurement of the pancreas thickness in the resection area based on the data of preoperative computed tomography and calculation of the difference between the pancreatic parenchymal thickness in the resection area and the staple closure height (SCH). Th e patients were distributed between two groups: 1) without POPF of with biochemical leakage (BL); 2) with clinically relevant POPF (CR-POPF). Results. CR-POPF developed in 15 (32.6 %) cases (type-B POPF: 14 (93.3 %) cases, type-С: 1 (6.7 %) case). Statistically signifi cant diff erence in mean pancreatic parenchymal thickness in the resection area as well as mean SCH between the group without POPF or with BL and the group with CR-POPF (15.4±4.3mm versus 12.3±3.5mm, р=0.01 and 12.8±2.3mm versus 16.4±3.1mm, р<0.01, respectively). Th e frequency of CR-POPF development was reliably lower at the SCH varying from 8 to 14mm (9.5 %) as compared to cases with SCH below 8mm (55.6 %, p<0.01) and above 14mm (50.0 %, p<0.01). Conclusion. Upon analysis of risk factors in POPF development aft er DP, it has been established that a greater pancreatic parenchymal thickness in the resection area as well as SCH are statistically significant risk factors for this complication. Th e optimal SCH making it possible to achieve the minimal frequency of POPF aft er pancreatic stump closure using a CS is within the range of 8-14mm.


2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.


2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  

Abstract Background When surgeons perform TKA, popliteus tendon (PT) and lateral collateral ligament (LCL) iatrogenic injuries are a risk because the femoral attachments are relatively close to the bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model. Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used. All the surrounding soft tissue except the PT, ligaments and meniscus were removed from the knee. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a K-wire. CT scanning was then performed. The data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image, the shortest length between each footprint and the osteotomy area were calculated. Results The area of the PT and LCL footprints was 38.7±17.7mm 2 and 58.0±24.6mm 2 . The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm. The length between these same points and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm. Under TKA simulation, for the Journey II BCS and the Persona PS, the shortest length between the PT footprint and the osteotomy area was 4.3±2.5mm and 3.2±2.9mm, and the shortest length between the LCL footprint and the osteotomy area was 7.2±2.3mm and 5.6±2.1mm. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knee. Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. Careful attention is needed to avoid damage to the PT and LCL during surgical procedures.


2020 ◽  
Vol 4 (1) ◽  
pp. 019-023
Author(s):  
Panico Vinicius JA ◽  
Simardi Lucila H ◽  
Faria Eliney F ◽  
Sotelo Rene ◽  
Suarez Ruben ◽  
...  

Methods: Experimental phase: Performed a partial nephrectomy off clamp in pig model followed by cauterization of lidocaine gel 2% with different power (control, 30W, 50W and 100W) in the kidney resection bed to evaluate efficacy and deep injury extension. Clinical phase: 20 patients submitted to laparoscopic or partial nephrectomy for low risk RENAL score were utilized greased lidocaine gel 2% with 50W in cautery scalpel to hemostasis of renal parenchima to validate efficacy and safety. Results: Experimental study shows that this technique is effective and promote better hemostasis with 50W and 100W, with deep injury of less than 3 mm. Clinical study confirm efficacy, good control of hemorrage, few complications and no transfusion. Minimal changes in hematocrit, haemoglobin and creatinine were observed. Conclusion: In this preliminary experience the use of this new alternative to hemostasis for low risk partial nephrectomy was satisfactory and with good intra and postoperative results. The best advantages were safety in terms of the depth thermal injury, low cost and absence of artifacts over the resection area observed at CT scan postoperatively.


2020 ◽  
pp. 1-10 ◽  
Author(s):  
Yuji Ito ◽  
Satoshi Maesawa ◽  
Epifanio Bagarinao ◽  
Yu Okai ◽  
Daisuke Nakatsubo ◽  
...  

OBJECTIVEThe authors recently reported a novel subsecond analysis method of analyzing EEG–functional MRI (fMRI) to improve the detection rate of epileptic focus. This study aims to validate the utility of this method for presurgical evaluation in pharmacoresistant focal epilepsy.METHODSAmong 13 patients with focal epilepsy undergoing presurgical examinations including simultaneous EEG-fMRI at 3T, 11 patients had interictal epileptiform discharges (IEDs) during fMRI. The authors used the sequence of topographic maps during the IEDs as a reference to obtain subsecond fMRI activation maps with the same temporal resolution as the EEG data, and constructed “spike-and-slow-wave-activation-summary” (SSWAS) maps that showed the activation frequency of voxels during IEDs. Clusters were defined by thresholding the SSWAS maps (voxel value > 10), and those containing voxels with the top 3 highest activation frequencies were considered significant. Significant hemodynamic responses using conventional event-related (ER) analysis and SSWAS maps were compared with the resection areas and surgical outcomes at 1 year after surgery.RESULTSUsing ER analysis, 4 (36%) of 11 patients had significant hemodynamic responses. One of 4 patients had significant hemodynamic responses in the resection area and good surgical outcome. Using SSWAS maps, 10 (91%) of 11 patients had significant hemodynamic responses. Six of 10 patients had significant hemodynamic responses in the resection area, and 5 of the 6 patients achieved good surgical outcomes. The remaining 4 patients had significant hemodynamic responses distant from the resection area, and only 1 of the 4 patients achieved good surgical outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value of SSWAS maps were 83.3%, 75.0%, 83.3%, and 75.0%, respectively.CONCLUSIONSThis study demonstrated the clinical utility of SSWAS maps for presurgical evaluation of pharmacoresistant focal epilepsy. The findings indicated that subsecond EEG-fMRI analysis may help surgeons choose the resection areas that could lead to good surgical outcomes.


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