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Effect of an Airbag-selective Portal Vein Blood Arrester on the Liver after Hepatectomy:A New Technique for selective clamping of the Portal Vein

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Current Medical Science 2024年第2期44卷 380-390页

作者： Ce-xiong FU Xiao-ri QIN Jin-song CHEN Jie ZHONG Yu-xu XIE Bi-dan LI Qing-qing FU Fang LI Jin-fang ZHENG Department of Hepatobiliary and Pancreatic Surgery Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China University of South China Hengyang 421001China Department of Gastroenterology Gastroenterology Endoscopy CenterHainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 57031lChina Center of Clinical Laboratory Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China Department of Radiology Hainan General HospitalHainan Affiliated Hospital of Hainan Medical UniversityHaikou 570311China

Objective:A novel technique was explored using an airbag-selective portal vein blood arrester that circumvents the need for an intraoperative assessment of anatomical variations in patients with complex intrahepatic space-occupying ***:Rabbits undergoing hepatectomy were randomly assigned to 4 groups:intermittent portal triad clamping(PTC),intermittent portal vein clamping(PVC),intermittent portal vein blocker with an airbag-selective portal vein blood arrester(APC),and without portal blood occlusion(control).Hepatic ischemia and reperfusion injury were assessed by measuring the 7-day survival rate,blood loss,liver function,hepatic pathology,hepatic inflammatory cytokine infiltration,hepatic malondialdehyde levels,and proliferating cell nuclear antigen ***:Liver damage was substantially reduced in the APC and PVC *** APC animals exhibited transaminase levels similar to or less oxidative stress damage and inflammatory hepatocellular injury compared to those exhibited by the PVC *** was significantly higher in the control group than in the other *** APC group had less bleeding than the PVC group because of the avoidance of portal vein skeletonization during ***,more operative time was saved in the APC group than in the PVC ***,the total 7-day survival rate in the APC group was higher than that in the PTC ***:Airbag-selective portal vein blood arresters may help protect against hepatic ischemia and reperfusion injury in rabbits undergoing partial *** technique may also help prevent liver damage in patients requiring hepatectomy.

关键词： hepatectomy portal vein hepatic damage selective clamping

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Hyper accuracy three-dimensional virtual anatomical rainbow model facilitates surgical planning and safe selective clamping during robot-assisted partial nephrectomy

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Asian Journal of Urology 2024年第4期11卷 660-665页

作者： Francesco Ditonno Antonio Franco Celeste Manfredi Daniele Amparore Enrico Checcucci Marco De Sio Alessandro Antonelli Cosimo De Nunzio Cristian Fiori Francesco Porpiglia Riccardo Autorino Department of Urology Rush UniversityChicagoILUSA Department of Urology Azienda Ospedaliera Universitaria Integrata VeronaUniversity of VeronaVeronaItaly Department of Urology Sant'Andrea HospitalSapienza UniversityRomeItaly Unit of Urology Department of WomanChild and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”NaplesItaly Division of Urology Department of OncologyUniversity of TurinSan Luigi Gonzaga HospitalOrbassanoTurinItaly

ObjectiveTo highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).MethodsA transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass(R.E.N.A.L nephrometry score 7A).An abnormal vasculature was observed,with a single renal vein and two right renal arteries originating superiorly to the vein and anterior,when dividing in their segmental *** to the hyper accuracy 3D(HA3D^(®))rainbow model(MEDICS Srl,Turin,Italy),one branch belonging to one of the segmental arteries was feeding the *** allowed for an accurate prediction of the area vascularized by each arterial *** 3D model was included in the intraoperative console view during the whole procedure,using the TilePro feature.A step-by-step explanation of the procedure is provided in the video attached to the present *** operative time was 90 min with a warm ischemia time on selective clamping of 13 *** blood loss was 180 *** intraoperative complication was encountered and no drain was placed at the end of the *** patient was discharged on postoperative Day 2,without any early postoperative *** final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical *** present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective *** shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps,and to safely adopt a“selective”clamping strategy that can translate in minimal functional impact.

关键词： Hyper accuracy three-dimensional rainbow model Augmented reality Clear cell renal cell carcinoma Robot-assisted partial nephrectomy selective clamping

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