Experimental laparoscopic liver resection with a multimodal water jet dissector.
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Biomedical subjects
Publications and source records attributed to C Rausis.
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UNLABELLED: In order to avoid laparotomy in patients with superficially and/or anatomically favourably located liver lesions, the feasibility of laparoscopic liver resection using an aqua jet was evaluated in 6 pigs. For this purpose a commercially available water jet dissector was adapted for laparoscopic use and modified to a multifunctional device providing aqua jet, suction and cautery. To improve laparoscopic vision during jet activity a hydrolaparoscope was used. The left lateral lobe was resected using clips for haemostasis only. RESULTS: All animals (34-55 kg, average 41 kg) survived the procedure. The blood loss at operation consisted of 225 ml (50-600 ml), the haematocrit 3.3% (1-8%). No bleeding or other complications were encountered postoperatively. The average weight of the specimens was 201 g (120-289 g). CONCLUSIONS: Laparoscopic liver resection using an aqua jet is feasible. Safe haemostasis can be achieved with clips if the vessels are entirely freed with the jet before clipping.
Like the CO2-laser, a H2O-jet stream may produce a selective cutting effect by working at distance. Because of the innovative possibility to add any kind of pharmacological agents to the ejected operating liquid, the new surgical equipment: Aquatom NTS-1000 allows a deep penetration of efficient medicaments directly into pathological areas, such as met in septic cutaneous diseases.
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Intraluminal spiral support of bovine heterografts (Solcograft-P) offers promising mechanical characteristics for av-shunts. Using a tunneling technique the spiral prevents twisting and kinking during subcutaneous placement and allows prolonged and vigorous post-puncture compression for hemostasis without compromising shunt flow. Canine experiments (femoro-femoral loop) suggest that additional insertion of the spiral into the efferent vein for some centimeters can prevent or delay the development of outflow-tract stenosis, the main cause of late shunt failure (0% (0/5) vs. 75% (3/4) significant stenosis; total patency rate 90% (9/10); follow-up 3 months). Preliminary clinical results with brachio-cephalic/basilic av-shunts in the forearm (loop) support our experimental investigations. In all eight patients the shunt is functioning perfectly without reinterventions being necessary (mean follow-up 8.8 months, totally 55 dialysis months). In five patients the shunt was used early for hemodialysis (days 1-10 post operation). Angiographically, stenoses developed in the outflow-tract in five of six shunts, but only one stenosis was observed in the spiral-supported venous segment where it usually occurs. In some cases shunt function was preserved by collaterals from the nonstenotic spiral-supported venous segment despite occlusion of the main efferent vein. Thus, it appears that a spiral placed into the graft and efferent vein is suitable to prolong the functional life of av-shunts.
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The treatment of hemorrhoids by cryosurgery is fairly new. Cryogenic hemorrhoidectomy, a painless technique, can be performed on an ambulatory basis without anesthesia or hospitalisation. Using a nitrous oxide cryoprobe operating at -90 degrees C 65 cases (34 women and 31 men) are subjected to the minor treatment of hemorrhoids by cryotherapy. Although the maximum follow-up is only 14 months, so far the first results have been encouraging. Of the 10 bad results (15%), 4 have been cured by a repeated cryosurgery.
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A simple technique is described for the autoimplantation of splenic tissue in the peritoneal cavity of rats. The effect of splenic implants on irradiated splenectomised rats was investigated, by following the evolution of the implants both microscopically and macroscopically. The effect on haemopoiesis was also observed. The dose of irradiation given was sublethal, do not think it necessary to put in, and non lethal.
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In 15 mongrel dogs, a mixture of exocrine and endocrine pancreatic tissue obtained by a simple procedure was implanted into the liver of the same animal through a branch of the portal vein. Five animals with partial pancreatectomy were used for a morphological study. In a second group of ten dogs, 5 delayed and 5 immediate pancreatectomies were performed. No diabetes appeared after the pancreatectomy. The subsequent blood glucose and insulin levels remained within or close to the normal range for several weeks in 9 animals and up to 10 months in a last one, still alive. In 9 out of 10 animals, the long term study was limited between 6 and 17 weeks by the development of a malnutrition syndrome with hepatic steatosis due to the lack of exocrine secretory function because of the pancreatectomy. The last animal still alive developed the malnutrition syndrome after a second complementary resection of a small pancreatic fragment left along the duodenum. This last animal without diabetes at the 45th week suggests that the endocrine function of the autotransplanted pancreatic tissue could be maintained over a long period of time.
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