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  • 1
    Electronic Resource
    Electronic Resource
    Kryochirurgie – Renaissance oder echter Fortschritt? (1999)
    Springer
    Der Chirurg 70 (1999), S. 154-159 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Cryosurgery ; Colorectal metastases ; Liver neoplasia ; Intraoperative ultrasound ; Complications. ; Schlüsselwörter: Kryochirurgie ; colorectale Metastasen ; Lebertumoren ; intraoperative Sonographie ; Komplikationen.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Durch die Entwicklung einer verbesserten Kryotechnik in Verbindung mit der intraoperativen Sonographie ist inzwischen bei Einhaltung bewährter Regeln der kryochirurgischen Forschung eine zuverlässige, wenn auch nicht komplikationsfreie Destruktion von Lebertumoren möglich geworden. Insofern kann von einem echten Fortschritt gesprochen werden. Auf der Basis einer dreijährigen Testphase mit dem CRYO6-Gerät von ERBE wird ein Arbeitsprotokoll für die Kryotechnik bei Lebertumoren vorgestellt. Der Indikationsbereich der Kryochirurgie umfaßt nichtresektable Metastasen bzw Tumoren in kurativer Absicht und die Vereisung knapper oder unvollständiger Resektionsränder. Die vorläufigen Ergebnisse der Methode sind ermutigend. Nachwievor besteht jedoch ein großer Bedarf an klinischer Forschung, um die Kryochirurgie definitiv werten zu können.
    Notes: Summary. The developement and improvement of the cryosurgical technique in combination with intraoperative ultrasonographic imaging enables reliable destruction of liver tumors – although not free of complications – given that tried and tested rules of cryosurgical research are obeyed. In this respect, we can speak of real progress. On the basis of a 3-year testing phase with the CRYO6 cryosurgical apparatus from ERBE, a protocol for the cryosurgical technique for liver tumors is introduced. The spectrum of indications for cryosurgery includes the destruction of irresectable hepatic secondaries or primary tumors with curative intention and the freezing of insufficient or incomplete resection margins. The preliminary results of this treatment modality are encouraging. However, there remains a need for further clinical research to allow final judgement of the cryosurgical method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050025
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  • 2
    Electronic Resource
    Electronic Resource
    Effectiveness of a hands-on training course for laparoscopic spine surgery in a porcine model (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 118-122 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Hands-on training course — Minimal invasive surgery — Laparoscopic anterior interbody spine fusion — Porcine model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Although it is widely proposed that surgeons, before introducing a novel laparoscopic technique in man, should practice in an appropriate animal model for acquisition of the necessary technical skills, the effectiveness of those hands-on training courses are rarely documented. Methods: In 1995 we have organized eight hands-on training courses for laparoscopic anterior interbody spine fusion in an in vivo porcine model. A total of 72 colleagues from 50 different centers of 12 countries participated, including orthopedic, trauma, visceral, neuro-, and vascular surgeons. Quality and effectiveness of the course were evaluated by a questionnaire after a 1.5- to 2.5-year period. Results: During this time, 42.2% of the participating centers had applied the new technique successfully in man. Centers which participated in the course with a team that included a skilled laparoscopic surgeon and an orthopedic or trauma surgeon introduced the technique more frequently to clinical practice (57.9%) than those represented by only one participant (30.8%). Moreover, there was a tendency toward a more frequent introduction of the technique to clinical practice in centers associated with university hospitals (57.1% vs. 29.2%), indicating the requirement of a particular infrastructure for this complex interdisciplinary procedure. Almost all participants (98.3%) agreed that for novel surgical techniques requiring advanced technical skills, there should first be training in a large animal model before the technique is applied in man. Conclusions: Complex laparoscopic procedures (i.e., laparoscopic spine surgery) can be successfully learned by in vivo hands-on training courses. We propose that for refinements and modifications of the technique (e.g., the lumboscopic approach), there should also first be training in a large animal model before these are applied in man.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900918
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  • 3
    Electronic Resource
    Electronic Resource
    First experience with laparoscopic spine fusion in an experimental model in the pig (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 143-146 
    Details
    ISSN: 1432-2218
    Keywords: Anterior lumbar interbody spine fusion ; Laparoscopic surgery ; Minimal invasive surgery ; Pig model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: We elucidated whether anterior lumbar spine fusion with interbody implants (BAK) can be performed in an experimental model in the pig using a transperitoneal laporoscopic approach. Methods: In seven animals, a pneumoperitoneum with an intraabdominal pressure of 12 mmHg was induced, and five trocars were placed in the middle, as well as in the left and right lateral aspect of the abdomen. With the use of specially designed instruments, the bifurcations of the aorta and vena cava were prepared. The sacral artery, overlying the anterior aspect of the L5/S1 disc space, was retracted, allowing the exposure of the disc space. A working trocar was then fixed to the spine bodies above (L6) and below (S1) the disc, and instrumentation was completed by destruction of the disc, insertion of distraction plug, and implantation of the BAK cage. X-ray control allowed exact positioning of the cage. Results: There were no major complications during the operative procedure, in particular no bleeding from major blood vessels and no injury to intraperitoneal organs. Cages were implanted in all animals in correct position, as indicated by postoperative X-ray control. Conclusions: We conclude from our experiments that in the pig model implants for anterior interbody lumbar spine fusion can be inserted successfully using the laparoscopic approach. We propose that the pig model represents an ideal tool for training before applying this operative procedure in men.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188360
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  • 4
    Electronic Resource
    Electronic Resource
    Pancreatic autotransplantation in the pig: variations in epigastric arterial blood supply (1989)
    Springer
    Transplant international 2 (1989), S. 193-198 
    Details
    ISSN: 1432-2277
    Keywords: Pancreas transplantation, in the pig ; Experimental pancreas transplantation, pig, anatomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A major problem in pancreatic autotransplantation is the vascular supply of the left segment, which serves as the graft. We therefore examined the arterial blood supply of the epigastric organs in 36 German landrace pigs. In 19 pigs (anatomical variation 1) there was a pancreatic branch of the splenic artery supplying the left segment. After splenectomy the splenic artery could be used as the graft-supplying vessel. In 14 pigs (anatomical variation 2) the arterial branch for the left segment was the first branch out of the hepatic artery distal to the coeliac trunk. In these cases a splenohepatic bypass was performed to ensure delivery of the blood to the epigastric organs. Thereafter, the proximal part of the hepatic artery could be used as the vessel supplying the graft. The left segment could not be used for autotransplantation in 3 pigs (anatomical variation 3) because of the atypical vascular supply. During the 6-month observation period, no malfunction of the epigastric organs was evident.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02414533
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  • 5
    Electronic Resource
    Electronic Resource
    334. Temporäre occlusion des pankreasganges mit einem modifizierten fibrinkleber (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 944-945 
    Details
    ISSN: 1435-2451
    Keywords: Pancreatic autotransplantation ; Temporary duct occlusion ; Fibrin sealant ; Aprotinin ; Pankreasautotransplantation ; Temporäre Gangblockade ; Fibrinocclusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nach Pankreaskopfresektionen bzw. nach Pankreasautotransplantationen am Schwein wurde der Pankreasgang mit einem modifizierten Fibrinkleber verschlossen. Die Fibrinocclusion erzeugt keine Pankreatitis. Die exokrine Akivität des Organs kann bis zu drei Tagen unterbrochen werden. Diese Zeitspanne genügt für ein ungestörtes Einheilen von Pankreasanastomosen. Langzeitbeobachtungen zeigen eine ungestörte Funktionstüchtigkeit des endokrinen und des exokrinen Pankreas. Diese neue Technik verbindet die Vorteile der Gangocclusion mit denen der Gangdrainage.
    Notes: Summary The pancreatic duct of pigs was occluded with a modified fibrin glue following resection of the head of the pancreas or autotransplantation of the left pancreatic segment. Occlusion with liquid fibrin glue did not induce pancreatitis. Following the injection, the exocrine activity was interrupted for 3 days. This allowed time for healing of the pancreas anastomoses to the gut to occur. Three months later, all animals had normal exocrine and endocrine activities. This new technique combines the advantages of permanent duct occlusion with those of duct drainage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298119
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  • 6
    Electronic Resource
    Electronic Resource
    Aneurysma spurium der A. hepatica (1994)
    Springer
    Langenbeck's archives of surgery 379 (1994), S. 291-293 
    Details
    ISSN: 1435-2451
    Keywords: Hepatic artery aneurysm ; Minimally invasive surgery ; Complications of cholecystectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Rahmen der Verbreitung der laparoskopischen Cholezystektomie werden zunehmend postoperative Komplikationen beobachtet. Es wird erstmalig ein Aneurysma spurium der A. hepatic dextra nach laparoskopischer Cholezystektomie bei einer 55jährigen Patientin sowie dessen Therapie beschrieben. Im Rahmen des radiologischen Embolisationsversuches trat eine Aneurysmaruptur auf, so daß eine Notlaparotomie mit Ligatur der A. hepatica dextra erforderlich wurde. Der postoperative Verlauf über 6 Monate gestaltete sich komplikationslos.
    Notes: Abstract With the spread of laparoscopic cholecystectomy more and more complications are being reported. For the first time in this paper a pseudoaneurysm of the right hepatic artery as a complication of laparoscopic cholecystectomy in a 55 year old patient is described. During embolization the aneurysm ruptured and an emergency laparotomy was performed. The right hepatic artery was ligated. The postoperative course up to follow-up at 6 months was uncomplicated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00186395
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  • 7
    Electronic Resource
    Electronic Resource
    Ein intestinaler Neosphinkter (INS) durch umschriebene Muskelvermehrung Technische entwicklung und funktionelle evaluierung beim hund (1994)
    Springer
    Langenbeck's archives of surgery 379 (1994), S. 361-367 
    Details
    ISSN: 1435-2451
    Keywords: Intestinal ecology ; Muscular sphincter-replacement ; Ultrasonic tissue fragmentation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Experimentell wurde em intestinaler Neosphinkter (INS) aus 3 Muskelschichten konstruiert. Dazu wurde das Prinzip der ileokolischen Nippel-Valve-Anastomose dahingehend abgewandelt. daß die kontaktierende Serosa des Ileums und die korrespondierende Mukosa von Ileum und Kolon durch Ultraschallfragmentation entfernt werden. Die dadurch beabsichtigte kompakte Verheilung der Muskelschichten wurde histomorphologisch kontrolliert. Die Funktion des intestinalen Neosphinkters als Ileozäkalklappenersatz wurde im intraindividuellen Vergleich bei 6 Hunden überprüft. Morphologisch waren die Neosphinkteren nach 3 Monaten ohne verstärkte Fibrosebildung stabil verheilt. Die Referenzwerte der Keimbesiedlung im terminalen Ileum lagen bei der physiologischen Ileozäkalklappe für aerobe und anaerobe Keime im Median deutlich um mehr als 2 Zehnerpotenzen niedriger als im Kolon, wobei dieser Unterschied nur bei den anaeroben Keimzahlen statistisch signifikant war (p〈0,05). Während nach Resektion der Ileozäkalklappe und Anlage einer End-zu-End-Anastomose qualitativ und quantitativ die bakterielle Kolonisation des Ileums nachgewiesen wurde, führte die danach erfolgte Interposition des Neosphinkters wieder zur mikrobiellen Clearance des terminalen Ileums. Die medianen aeroben Keimzahlen sanken um 6 Zehnerpotenzen gegenüber dem Kolon, die anaeroben um 3 Zehnerpotenzen. Obwohl die mediane Keimreduzierung im terminalen Ileum beim Neosphinkter damit besser war als bei der physiologischen Ileozäkalklappe, konnte eine statistische Signifikanz wegen großer Streubreiten der Einzelwerte nicht gesichert werden. Die trotzdem nachweisbare Clearance des terminalen Ileums wird durch die absolut stagnationsfreie orthograde Durchgängigkeit und die relative (his 100 cm Bariumsäule) retrograde Druckkompetenz des Neosphinkters erklärt. Mit Hilfe der Ultraschallfragmentation von Serosa und Mukosa des Darmes läßt sich ein mehrschichtiger muskulärer intestinaler Neosphinkter herstellen, der eine bakterielle Milieutrennung zwischen verschiedenen Darmabschnitten erzeugt. Vor klinischer Einführung als Ileozäkalklappenersatz bei Kurzdarmsyndrom sollte die Integration in die intestinale Motilität durch weitere experimentelle Studien erhärtet werden.
    Notes: Abstract In an experimental study an intestinal neosphincter (INS) was constructed by modifying the principle of the ileocolic nipple-valve anastomosis by means of ultrasonic tissue fragmentation of the contacting serosa of the ileum and the corresponding mucosa of the ileum and colon. The healing of the muscle layers was studied histologically. The function of the INS was investigated in six dogs and compared intraindividually with that of the ileocecal valve and conventional end-to-end anastomosis. Morphologically the neospincters healed within 3 months without major fibrosis. The reference values of the aerobic and anaerobic bacterial counts in the terminal ileum were more than 2 logs lower than in the colon with the normal ileocecal valve, and after ileo-colonic end-to-end anastomosis bacterial colonization of the terminal ileum was found both qualitatively and quantitatively. Subsequent interposition of the INS led to bacterial clearance of the terminal ileum. The median aerobic bacterial counts were lower by six logs and the an aerobic bacterial counts by 3 logs than in the colon. However, differences were not statistically significant owing to the wide variation in the individual values. Nevertheless, the demonstrable clearance of the terminal ileum could be explained by the orthograde passage with absolutely no stagnation and the relative competence of the INS in resisting retrograde pressure competence. In conclusion, ultrasonic fragmentation of the serosa and mucosa of the bowel allows construction of an INS from three muscle layers, which acts as a bacteriological barrier. Before it is introduced into the clinical setting its integration into the intestinal motility should be evaluated by further studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00191584
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  • 8
    Electronic Resource
    Electronic Resource
    362. Ein neues Modell der autologen Pankreastransplantation am Schwein. Induktion des Diabetes durch regionale Streptozotocinapplikation (1986)
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 865-866 
    Details
    ISSN: 1435-2451
    Keywords: Segmental pancreatic autotransplantation ; Regional streptozotocin application ; Pankreasautotransplantation ; Regionale Streptozotocinapplikation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Wir entwickelten ein neues Modell der autologen Pankreastransplantation am Schwein. Das linke Pankreassegment wird als Transplantat entnommen, während der Pankreaskopf verbleibt und die exokrine Funktion aufrechterhält. Sein endokriner Anteil wird über eine regionale Streptozotocinapplikation ausgeschaltet. Das Autotransplantat wird an die Iliacagefäße angeschlossen und je nach Protokoll mit einer Jejunostomie bzw. mit Ethibloc® versorgt. In diesem neuen Modell können alle technischen Fragen der Pankreastransplantation am diabetischen Tier unter Ausschluß von Abstoßungsvorgängen untersucht werden.
    Notes: Summary A new model of pancreatic autotransplantation was developed in pigs. The left pancreatic segment was removed and used as an autograft. The head of the pancreas was left in place in order to maintain normal exocrine function. Its endocrine part, however, was ablated by regional streptozotocin infusion into the pancreaticoduodenal artery. The autograft was transplanted onto the right iliac vessels and its exocrine part either occluded using Ethibloc® or anastomosed with a jejunal Roux-en-y-loop. In this new model, all technical problems of pancreatic transplantation can be investigated in a diabetic animal without interference as a result of rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01274682
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  • 9
    Electronic Resource
    Electronic Resource
    Granulocyte elastase and systemic cytokine response after laparoscopic-assisted and open resections in Crohn's disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1480-1486 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopic surgery ; Surgical trauma ; Inflammatory response ; Crohn's disease ; Granulocyte elastase ; Cytokines ; C-reactive protein
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to assess whether systemic proinflammatory cytokines (IL-6), anti-inflammatory cytokines (IL-4, IL-10), acute phase proteins (C-reactive protein), or granulocyte elastase are valuable indicators for determining the degree of surgical trauma after openvs. laparoscopic-assisted resections in Crohn's disease. METHOD: Eleven patients in each group (open and laparoscopic-assisted surgery) were matched for indication, surgical procedure, and Crohn's disease activity index. Serum IL-4, IL-6, and IL-10 were measured using enzyme-linked immunosorbent assay. Serum C-reactive protein was determined by immunoturbidimetric assay. Plasma granulocyte elastase was determined by immunoactivation immunoassay. Blood was sampled preoperatively, six hours after the operation, and at postoperative Days 1 to 5. RESULTS: IL-4 was not detectable in any sample analyzed. Serum IL-6 and IL-10 levels peaked postoperatively in both groups without significant differences between laparoscopic-assisted (185.6±54.1 pg/ml and 112.1±19.4 pg/ml, respectively; mean ± standard error of the mean) and open surgery (431.1±240.4 pg/ml and 196.7±56.5pg/ml, respectively). Serum C-reactive protein levels also rose postoperatively, with a peak on the second day, but showed similar values after laparoscopic-assisted (107.1±12.1 mg/l) and open (128.3±17.5 mg/l) surgery. Plasma granulocyte elastase levels peaked on the first and second postoperative day and were found elevated almost throughout the five-day observation period. Comparison between the groups revealed significantly (P〈0.02) lower values after laparoscopic-assisted (Day 1, 46.5±8.9 µg/l; Day 2, 41.9±5.9 µg/l) when compared with open surgery (Day 1, 89.7±13.8 µg/l; Day 2, 91.4±14). CONCLUSIONS: Serum IL-6 and IL-10 may not be ideal measures for evaluation of the degree of tissue trauma in laparoscopic-assisted and open resections in Crohn's disease, probably because of interference with disease-specific cytokine interactions. In contrast, granulocyte elastase has to be considered a strong marker discriminating the different severity of surgical trauma induced by laparoscopic-assistedvs. open resection in Crohn's disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02235052
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