Search

Highlights • Hyperspectral Imaging (HSI) is non-contact, non-ionizing and non-invasive. • HSI detects tissue pathology based on spectral characteristics of different tissues. • HSI is well suited for counter perfusion staining in anatomic liver resection. • HSI can be used for future image guided liver surgery., Introduction Anatomic liver resection is based on the description of functional segments, which rely on the organs arterial and portal venous blood supply. Vascular inflow control of the left liver is performed by occlusion of the left hepatic artery (LHA) and left portal vein (LPV). Depending on the quality of the parenchyma a sharp demarcation line (Cantlie Line) between segments IV and V/VIII can hence be detected. Material and Methods TIVITA® is a novel contact free tool which facilitates non-invasive hyperspectral imaging (HSI) and near infrared spectroscopy (NIRS) for the assessment of tissue- oxygenation (StO2) and perfusion (NIR Perfusion). We hypothesized that this imaging modality might be practicable to identify the future resection plane after left vascular inflow occlusion in anatomic liver resection. Presentation of Case TIVITA ® is a viable tool for the identification of segments with reduced StO2 (inflow occlusion: 0.23 ± 0.03 vs normal: 0.50 ± 0.06) and NIR Perfusion (inflow occlusion: 0.02 ± 0.04 vs normal: 0.47 ± 0.06) and allows for a visual differentiation of well oxygenated, perfused (green) and low oxygenated, poorly perfused (blue) liver tissue in a patient undergoing left hemihepatectomy for hepatocellular carcinoma. Conclusion Hyperspectral Imaging is an emerging optical technique with the potential to identify exact resection planes for anatomic liver resection based on the optically determined perfusion and oxygenation status of liver segments lined up for resection. This novel Hyperspectral Demarcation Technique (HSI DT) is non- contact, non-ionizing and non-invasive.

BACKGROUND: Robotic assisted nephrectomy for living donation (RANLD) is a rapid emerging surgical technique competing for supremacy with totally laparoscopic and laparoscopic hand assisted techniques. Opinions about the safety of specific techniques of vascular closure in minimally invasive living kidney donation are heterogeneous and may be different for laparoscopic and robotic assisted surgical techniques. METHODS: We retrospectively analyzed perioperative and short-term outcomes of our first (n=40) RANLD performed with the da Vinci Si surgical platform. Vascular closure of renal vessels was performed by either double clipping or a combination of clips and non-transfixing suture ligatures. RESULTS: RANLD almost quintupled in our center for the observed time period. A total of n=21 (52.5%) left and n=19 (47.5%) right kidneys were procured. Renal vessel sealing with two locking clips was performed in 18 cases (45%) Both, clips and non-transfixing ligatures were used in 22 cases (55%). Mean donor age was 53.075±11.68 years (range, 28–70). The average total operative time was 150.75±27.30 min. Right donor nephrectomy (139±22 min) was performed significantly faster than left (160.95±27.93 min, P=0.01). Warm ischemia time was similar for both vascular sealing techniques and did not differ between left and right nephrectomies. No conversion was necessary. Clavien-Dindo Grade ≤IIIb complications occurred in (n=5) 12.5%. Grade IV and V complications did not develop. In particular no hemorrhage occurred using multiple locking clips or suture ligatures for renal vascular closure. Mortality was 0%. Thirteen kidneys (32.5%) were transplanted across the AB0 barrier. CONCLUSIONS: RANLD is an emerging minimally invasive surgical technique which facilitates excellent perioperative and short-term outcomes also when using multiple locking clips or suture ligatures for renal vascular closure.

Fragestellung: Prothesenassoziierte Knocheninfektionen durch Methicillin-resistente Staphylokokkus Aureus (MRSA) Erreger stellen eine große Herausforderung dar. Zur Erprobung und Verbesserung neuer Therapiestrategien sind klinisch relevante Infektionsmodelle von großer Bedeutung. Diese existieren[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)