Jessica Lange

Single-port live donor nephrectomy using a novel Curved Radius r2 Surgical System in an in vivo model.

Abstract Objective: Single-port laparoscopic donor nephrectomy provides low morbidity and satisfactory cosmetic results for patients. The aim of this animal study was to establish a surgical technique of single-site (LESS) living donor nephrectomy using novel curved r2 CURVE manipulators specially designed for single-port access. Material and methods: A total of six LESS nephrectomies were performed in three female pigs. r2 CURVE-instruments (Tuebingen Scientific Medical GmbH) were used providing a curved rotatable shaft, endless tip rotation, as well as 90° tip deflection. A 10 mm 30° extra long laparoscope, r2-curved Grasper, Maryland dissector and bipolar scissors were used for mobilization and dissection. Results: All LESS nephrectomies were performed successfully. Average operative time was 80 min (range, 42–149 min). No technical problems were observed. Insertion and extraction of the instruments through the single-port were easy to conduct. The diameter of the used single-port was sufficient for safe manual organ harvesting. Potential conflict between the laparoscope and the instrument handles was avoided by using an extra long laparoscope. Conclusions: The new curved and deflectable instruments showed that single-port nephrectomy using the R2 manipulators is feasible. Single-port laparoscopic nephrectomy might be more patient-friendly and improve the willingness of potential donors to donate live organs.

Incidence of heparin-induced thrombocytopenia type II and postoperative recovery of platelet count in liver graft recipients: a retrospective cohort analysis

BACKGROUND Thrombocytopenia in patients with end-stage liver disease is a common disorder caused mainly by portal hypertension, low levels of thrombopoetin, and endotoxemia. The impact of immune-mediated heparin-induced thrombocytopenia type II (HIT type II) as a cause of thrombocytopenia after liver transplantation is not yet understood, with few literature citations reporting contradictory results. The aim of our study was to demonstrate the perioperative course of thrombocytopenia after liver transplantation and determine the occurrence of clinical HIT type II. METHOD We retrospectively evaluated the medical records of 205 consecutive adult patients who underwent full-size liver transplantation between January 2006 and December 2010 due to end-stage or malignant liver disease. Preoperative platelet count, postoperative course of platelets, and clinical signs of HIT type II were analyzed. RESULTS A total of 155 (75.6%) of 205 patients had thrombocytopenia before transplantation, significantly influenced by Model of End-Stage Liver Disease score and liver cirrhosis. The platelet count exceeded 100,000/μL in most of the patients (n = 193) at a medium of 7 d. Regarding HIT II, there were four (1.95%) patients with a background of HIT type II. CONCLUSIONS The incidence of HIT in patients with end-stage hepatic failure is, with about 1.95%, rare. For further reduction of HIT type II, the use of intravenous heparin should be avoided and the prophylactic anticoagulation should be performed with low-molecular-weight heparin after normalization of platelet count.

Surgical Technique of a Vertical Sleeve Gastrectomy in Mice

ABSTRACT Background/Aims: The prevalence of morbid obesity is increasing. In failing of conservative methods to weight reduction, one effective surgical option is the sleeve gastrectomy. Aim of this study was to show the feasibility of simplified surgical techniques of sleeve gastrectomy in normal weight mice as base model for surgery in super-obese mice. Methods: In an animal study, 15 male C57/Bl6 mice were randomized into two groups of 5 (1) and 10 animals (2) to undergo sleeve gastrectomy with antidromic suture course. The sutures of the tubular stomach were performed from aborally to orally in group 1 and from orally to aborally in group 2. Mean body weight was 20.8 ± 0.6 g. Body weight was recorded daily for 14 days after surgery and weekly for further 10 weeks. Results: In our study, 12 of 15 animals survived the procedure and follow-up period. Out of group 1, two mice died because of leakage of the gastric sleeve with diffuse peritonitis. Out of group 2, one animal died seven weeks after surgery due to an abscess in the abdominal wall. Regarding the weight charts, there was a decrease until the third postoperative day with continuous increase thereafter. Conclusion: The presented model of sleeve gastrectomy is feasible in mice with low mortality and tolerable morbidity. The simplified model enables short operation times, which is decisive especially in obese mice.