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ABSTRACT: Background. Pancreatic fistula is still the major postoperative morbidity after distal pancreatectomy (DP). An inductive heat technology via needle arrays in a system of alternating magnetic fields (AMFs) was designed to seal off the pancreatic end. Methods. Twenty Lanyu pigs were divided into 2 groups for DP: the conventional group had hand-sewn closure of the pancreatic end (n = 10), and the AMF group received thermal DP by AMF (n = 10). Pathological examinations of the resected and remnant pancreas were studied immediately after resection and on the 14th postoperative day (POD), respectively. The severity and the incidence of pancreatic abscess were compared. Results. The incidence and severity of pancreatic abscess were significantly decreased in the AMF group than those in the conventional group (P = .009). In the immediate postoperative period, microscopic examination of the pancreatic resected end showed prominent coagulative necrosis, loss of NADPH-diaphorase activity, and significant apoptosis at the resected pancreas in the AMF group compared with the control group. Fourteen days after AMF ablation, the pancreatic stump end was covered with thick fibrosis, and histological study of the remnant pancreas showed that the parenchyma had well recovered with positive NADPH-diaphorase activity, and the pancreatic duct was sealed off successfully by prominent periductal fibrosis and intraductal plug. The body weight gain on the 14th POD was significantly increased in the AMF group (from 23.8 ± 1.8 kg to 25.4 ± 5.5 kg) compared with the conventional group (from 25.3 ± 2.1 to 25.4 ± 6.0 kg; P = .003). Conclusions. Inductive heats by the AMF system via needle array can be performed easily and can seal the pancreatic cut surface well during DP.
Surgical Innovation 05/2012; · 2.13 Impact Factor
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ABSTRACT: The aim of this study is to design a simple, secure, and safe technique of intracorporeal Pringle's maneuver to facilitate safer laparoscopic liver resection.
A self-designed six-loop catheter was made using 20-French T-tube and 10-French nelaton urethral catheter. The cross head and stem of the T-tube were trimmed to 1 cm, respectively. The nelaton was shortened to 12-cm-long tube from the round tip, and the cut end was inserted and sutured to the stem of the T-tube. After establishment of pneumoperitoneum, the T-tube with nelaton was placed into the abdomen. The round end of the nelaton was inserted into the lesser sac and pulled through the foramen of Winslow, and the end of nelaton was then inserted into one end of the T-tube and pulled through the other end, forming a six-loop. The nelaton was pulled to occlude the hepatic inflow and temporarily fixed with 1-0 Vicryl on a curved round needle on the other end of the T-tube. The protocol of Pringle's maneuver was 15-min clamp and 5-min release periods. The liver parenchymal transection was performed using Harmonic scalpel.
From November 2009 to August 2011, 20 patients received laparoscopic liver resection using the six-loop Pringle's maneuver. During operation, 17 patients were positioned supine, 2 patients in left decubitus, and 1 patient in supine followed by left decubitus position. There were 9 anatomical resections and 11 nonanatomical resections (18 patients for single lesion, 1 for two lesions, and 1 for three lesions). The average times of liver resection and Pringle's maneuver were 33.1 and 36.2 min, respectively. Mean blood loss was 102.5 ml. The postoperative course was uneventful, and average hospital stay was 4.4 days.
Our self-designed six-loop intracorporeal Pringle's maneuver can facilitate safer laparoscopic liver resection.
Surgical Endoscopy 03/2012; 26(9):2681-6. · 4.01 Impact Factor
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IEEE Trans. Biomed. Engineering. 01/2012; 59:824-831.
