Videos

Source URL: https://www.testbiotech.org/en/limits-to-biotech/videos Links [1] https://www.testbiotech.org/gentechnik-grenzen/videos/was-ist-gentechnik-1 [2] https://www.testbiotech.org/gentechnik-grenzen/videos/was-ist-gentechnik-2 [3] https://www.testbiotech.org/gentechnik-grenzen/videos/was-ist-gentechnik-3 [4] https://www.testbiotech.org/gentechnik-grenzen/videos/gene-drives [5] https://www.testbiotech.org/gentechnik-grenzen/videos/crispr-pilze [6] https://www.testbiotech.org/gentechnik-grenzen/videos/gentechnik-soja-importe

A 30 years old man underwent a left lateral segmentectomy as a graft-harvesting for transplantation in his 3 years old daughter with biliary atresia.
Donor liver volumetry using CT scan showed a left lobe of 300 cc.
Anatomic analysis of the hepatic artery using arteriography demonstrated a common branche of segments II, III and IV. Anatomic analysis of hepatic veins was obtained by ultrasonography. Donor operation: intraoperative US scan confirmed the presence of a common trunk of the middle and left hepatic veins. The left hepatic artery was exposed near its origin from the proper hepatic artery and the left portal vein was exposed posteriorly near the caudate lobe. The left triangular and hepatogastric ligaments were dissected from the liver and the common trunk of the middle and left hepatic veins was isolated.The hepatic parenchyma was transected using ultrasonic dissector without blood vessel clamping. After parenchymal transection from the right lobe and from the anterior part of the caudate lobe, the left bile duct was transected. When the liver was free on its hepatic artery, portal vein and hepatic vein which were then transected, the graft was flushed in situ through the left portal vein first with 200 mL of Ringer's solution. On the back table the liver was perfused with 1000 mL UW solution during hepatic veins reconstruction. Fibrin glue ((R)Tissucol, Immunotransfusion) was applied on the cut surface of the liver for secure hemostasis. Blood loss was estimated to 800 mL for which autotransfusion was performed. Postoperative course of both donor and recipient were uneventful and they were discharged from the hospital respectively on the 7 and 21 postoperative days. A new technique, which has simplified segmental liver resection, is described. The individual Glissonian sheaths supplying the segments of the right liver are approached by posterior intrahepatic dissection from the porta hepatis. The segment to be removed is clearly delineated by clamping individual sheaths which produces a colour change. This permits accurate resection of a single liver segment. In the last decade liver resection has become an established treatment for benign and malignant diseases.Currently the operative mortality for non cirrhotic livers is 5% and for cirrhotic livers 15 %.From October 1990 to November 1994 lO0 hepatic resections were performed consecutevely.58 patients were operated for liver metastases (with lO rehepatectomy for recurrent disease).In this group of patients 52 had metastases from colorectal carcinoma, 2 from gastric cancer ,2 from breast tumor;l patient from pulmonary carcinoid and from a caval leyomiosarcoma. 22 liver resections were realized for hepatocellular carcinoma (16 on cirrhotic liver);8 patients were resected for gallbladder carcinoma,l for choledocal carcinoma and for cholangiocarcinoma.2 hepatectomies have been performed for intrahepatic lithiasis,2 adenomas,2 focal nodular hyperplasia,l hydatic cyst and 3 hemangiomas.Tl minor and 29 major hepatectomies were realised.There were no deaths on 84 resections in non-cirrhotic patients, while cirrhotic patient died from hepatic postoperative insufficiency.The mean hospital stay was 8 days for non cirrhotic livers and lO days for cirrhotic patients.Morbidity was respectively 13 and 33%.In conclusion improvements in operative and anesthetique techniques,a better anatomic understanding and an earlier detection of hepatic neoplasm have improved the safety of hepatectomies. The longitudinal pancreatojejunostomy as described by Partington and Rochelle is acepted as the standard procedure in patients with chronic pancreatitis associated with ductal dilatation. However in the group presenting with severe pancreatic head complications the pylorus preserving Whipple represents a more widespread procedure. The pancreatic head partial ressection associated to pancreatojejunostomy as proposed by Frey in 1987 represents an alternative to ressective procedures. From 1990 to 1994 30 patients were submited to pancreatic head partial ressection associated to pancreatojejunostomy.

158
All patients were men. The mean age was 39,8 years (range 26-56 years). The indications to operate were severe pain (100%), biliary obstruction (76,6%), Pancreatic cysts (59,9%) duodenal obstruction (13,3%) wirsunghorragia (6,6%) and persistente of pain after longitudinal pancreatojejunostomy (3,3%). Intrapancreatic biliary decompression was performed in 23 patients (76,6%). The pre and post-operative investigations included: pain, body weight, bioquemical tests (alkaline phosphatasis, glucose, fecal fat) CT, ultrassonography, ERCP, hospital readmissions. The follow-up average was 36 months. There was no operative mortality. All but one patient were free of pain, the mean weight gain 9 kg (range 2-34 kg). Two patients with elevated alkaline phosphatasis and were submited to endoscopic sphincterotomy, one patient with acute cholecystitis, and one patient with moderate residual pain. The pancreatic head partial ressection associated to longidutinal pancreatojejunostomy is a safe procedure, with excelent postoperative outcome in regard to clinical as well as metabolic data, in patients with severe pancreatic head comolications in chronic oancreatitis. A step wise description of pyloric preserving pancreaticoduodenectomy is presented using colored art work and video.
Technical highlights include preservation of the blood supply to the oyloris, dissection of the neck of the oancreas in the presence of inflammation, and techniques for vascular control.
Our experience with over 45 PPPDs for pancreatitis is summarized. Potential benefits include improved gastric emptying, better postoperative weight gain, and better pain control. This video shows the technical aspects of the pancreaticoduodenectomy in an ampul lary carcinoma regarding the limphadenectomy (R2), apropriate anatomic vascular identification and meticulous performance of pancreatojejunostomy with duct-to-mucosa anastomosis. In this particular case a lost catether was used through the anastomosis. There was no blood transfusion and the procedure lenght was 5 hours. The authors put emphasis in the safety of the procedure in cerms of morbidity and mortal ty.
Benign tumors of the extrahepatic bile ducts are rare and adenomyoma of the ampulla of Vater is extremely rare. We present a video tape of a 56-year old man who came to the hospital for jaundice, (TBL=26 mg/dl, DBL=20 mg/dl), weight loss, anorexia, dark urine, light stools and palpable gallbladder. CT scan detected tumor of the head of pancreas 3 cm in diameter. ERCP and preoperative bi|iary decompression were unsuccessful. The preoperative diagnosis was tumor of the head of the pancreas probably carcinoma. On the operative table resectable mass of the head of the pancreas was found. The tru-cut needle biopsy showed chronic pancreatitis. To correct the jaundice, liver function and nutritional deficiency the first step of operation was cholecystojejunostomy. Twenty days later the improvement of general conditionof the patient was evident and Whipple pancreaticoduodenectomy was performed.
Examination of the excised specimen revealed mass in the head of the pancreas and complete obstruction of common bile and pancreatic ducts at the level of the ampulla. Histological examination revealed adenomyoma of the ampulla of Vater, complete obstruction of the ducts and chronic pancreatitis of the head of the pancreas. The patient discharge was on the 9m postoperative day in excellent The video shows the technique of orthotopic liver transplantation with the preservation of the recipient retrohepatic vena cava. This technique allows the maintenance of the caval flow during the anhepatic phase and the avoidance of the veno-venous by-pass. The liver is detached completely from the retrohepatic vena cava with the legation of accessory veins. The main hepatic veins are clamped and the liver removed. In the case shown, an end to side porto-caval shunt has been performed to avoid splancnic congestion during the anhepatic phase. This temporary porto-caval shunt has not been performed in 77% of the cases, without any hemodynamic drawnback. The upper vena cava of the graft is anastomized end to side with the recipient vena cava or preferably end to end with the stump of the middle-left hepatic vein. The lower vena cava of the graft is stapled and the portal vein anastomosis is performed. The piggy back technique has been performed in 7% of our liver transplantations: it is advisable in the case of small grafts, such as reduced size liver grafts, in the presence of previously operations to reduce bleeding of retrohepatic space and when the patient has a prior porto-caval or a meso-caval shunt. A particular indication is fulminant hepatitis, when it can be employed as a bridge procedure before the implant of the graft. A further advantage is economical, since the veno-venous by-pass is not necessary. Hepatic hydatic cyst are located more frecuently in the fight lobe, being in more than 60% of the cases in posterosuperior segments. Radical surgery is the most effec'five. We proposed the thoracophrenolaparotomy for superior edge of l0 fib (TPLI0)  The purpose is to report on the iaparoscopic treatment of an asymptomatic benign cystic neoplasm of the body and tail of the pancreas occurring in a 20 years old, professional athletic, female patient who was treated by iaparoscopic corpo-caudal resection of the pancreas with preservation of the spleen.
The cystic neoplasm, measuring at CT scan 10 x 10 cm. in size, extended from the level of the celiac trunk to the level of the inferior pole of the left kidney. Serum CEA and Ca 19-9 were negative. 3 trocars were used, one at the umbilicus and two in the left and right hypochondria, respectively. The gastro-colic ligament was opened, and the body and tail of the pancreas including the lesion were carefully dissected from the splenic vein and artery. A plane behind the body of the pancreas was bluntly dissected free to apply a 65 mm. linear stapler (3.85 mm staples) for stapling and resection at this level with adequate margins of apparently normal tissue. Two 35 mm linear staplers (2.5 mm staples) were applied to divide the tail of the pancreas from the spleen. The specimen was introduced inside a specimenretrieval bag and the cyst was puncture-drained avoiding to spill material outside the bag. After specimen removal, intraoperative cytological fluid analysis and frozen section of the cyst allowed to reasonably exclude the malignant nature of the tumor. Fibrin glue was applied to seal the pancreatic suture line and two drains were employed.
No complications were observed in the postoperative course. Drains were removed after 3 and 6 days, respectively. The patient was dismissed after 9 days to resume her athletic activity. Histology confirmed a benign mucinous cystadenoma. Recently, laparoscopic intraluminal cystogastrostomy has been described, and a window is created between the cyst and the stomach wall, but morbidity after cystogastrostomy arises in bleeding of the cut surface. We present the technique for stapled intraluminal cysto-gastrostomy, that offers a similar treatment to the open way with a laparoscopic approach. Case reort: A 29 y. old man developed a 6 cm pseudocyst located in the body of the pancreas after a biliary acute pancreatitis. Laparoscopic cholecystectomy with intraoperative cholangiography was performed. 4 months later, a control CT scan showed the persistence of the image and surgical treatment was proposed. SuralcalTechnlaue: After creation of the pneumoperitoneum, the abdominal exploration showed a mass that displaced the gastric body. Two 12 mm trocars with a balloon were inserted into the gastric cavity through the fundus and antrum an the balloon were inflated. The gastric wall was pulled out to the abdominal wall and the stomach was distended with air. Another camera was inserted into de gastric cavity and a flexible tip ecoendosonography probe permitted to choose the more adequate place for the cystogastrostomy. The cyst was punctured and the orifice was enlarged. Then, an endostapler device was inserted through the hole and fired and a wide cystogastrostomy was created. After the retrieval of the trocars, both gastric holes were closed with an endo-stapler The patient returned to oral feeding at 48 h. and was discharged at 7  From 1991 to November 1994 18 patients underwent a laparoscopic resection of the cystic roof. To avoid recurrence the greater omentum was seperated from the transverse colon and placed into the cystic cavity in the last 13 patients. Follow-up data were required from all patients by repeat ultrasound.
All patients were female and had an average age of 54 (39-73) years. Fifteen were symptomatic and 3 required surgery because of rapid growth. Cysts had a diameter of 10 to 17 cm, volume varied from 800 to 3000 ml. Mean operation time was 100 (50-145) min. Postoperatively bile leakage in patient stopped under drainage with a Sonnenberg-catheter. Hospitalisation time was 2-14 (mean 4) days. Among our first patients without omental transposition there were 2 early relapses (one operated on conventionally, one asymptomatic). After a median follow-up of 19 (1-43) months all other patients are free of recurrence.
According to our experiences the laparoscopic treatment of non parasytic liver cysts is as safe and effective as the conventional one but has the advantages of the minimal invasive approach. 2) a laparoscopic cysto-gastrostomy for a huge pancreatic pseudocyst developped 8 months after a Whipple procedure; 3) a |aparoscopic resection of a 5 cm cyst located in the head of the pancreas (uncinate process). The postoperative course was uneventful in every case with an hospital stay of 4,6 and 3 days respectevly. We believe that,in the management of pancreatic cystic lesions,the laparoscopic approach is an attractive alternative either to open surgery,or to endoscopic and radiological treatments, provided that any potential malignancy has been fully explored and excluded. This ten minute video shows the laparoscopic resection of a large recurrent benign liver cyst.
The patient is a 73 year old female who first presented with an epigastric mass in 1991 to the department of surgery. Subsequent investigations including ultrasound and CT confirmed a 15cm benign left lobe liver cyst and percutaneous aspiration under ultrasound was successfully performed. This patient returned with a recurrent epigastric mass in 1994 and ultrasound confirmed a 15cm recurrent cyst. Laparoscopic guided drainage with marsupilisation was performed. This was followed by a recurrence within 2 months and the cyst measured 18 cm in size.
The recurrent cyst was approached laparoscopically again.
The patient was placed in a supine position and 4 trocars were used for the procedure. The largest trocar was 12mm allowing the use of an Endo-GIA. Omental adhesions were taken down and the cyst was opened and clear fluids were drained. The cyst wall was divided with Endo -GIA up to the edge of liver tissues resulting in two thirds of the cyst resected. Omentalplasty was done to the remnant with an Endo stapler. A silicone drain was inserted for drainage which was removed on day 3 postop. Her postoperative recovery was complicated by a minor chest infection which responded to antibiotics therapy. She was discharged home on day 10.
The successful outcome of resecting the cyst laparoscopically has encouraged the application of this technique to further cases. Better cosmetic results are obtained by single trocar LC, which appears from this limited experience to be feasible and safe in highly selected patients. Since the first performed laparoscopic assisted cholecystectoniy procedure by Mouret, laparoscopic surgery has moved at an accelerating pace which has no limit. One of the known contra indications of laparoscopic cholecystectomy is bilio-enteric fistulae.
With individual cases, trials with new techniques and procedures are constantly attempted in such situations. This is a report of such a case, 53 years old morbidly obese female was diagnosed with cholelithiasis. Further laparoscopic diagnosis revealed a fistulae in the area between fundus of the gallbladder and hepatic flexura of the colon The procedure was connnued laparoscopically and the gallbladder and fistulae were freed by dissection. Gallbladder and fistulae together with the colon was taken out of the abdomen through a small incision. Fistulae was resected and the defect in the colon was repaired using interrupted sutures. The total duration of the procedure lasted two hours and fifteen minutes.
The panent was discharged on the fifth postoperative day wthout any complication.
Safe and successful laparoscopic treatment of b!ho-entenc fistulae is stdl a controversy though margins of contra-ndications need to be constantly forced.

163
LAPAROSCOPIC SUBTOTAL CHOLECYSTECTOMY FOR THE "DIFFICULT" GALLBLADDER PC B0rnmmL PJ Gallagher, JKI Krige, J Terblanche. Department of Surgery, University of Cape Town, South Africa.
Dissection of Calot's triangle followed by a standard cholecystectomy can be hazardous in the presence of severe inflammation of the gallbladder (GB) or the presence of cirrhosis with portal hypertension. In this setting open subtotal cholecystectomy has been proven to be a safe, simple and definitive procedure (1). This study and the video demonstrate application of this technique to laparoscopfc subtotal cholecystectomy (LSC). Over a 9 month period from January September 1994 227 patients presented for laparoscopic cholecystectomy. Ninety-eight were for acute cholecystitis and 10 of this group had conversion to open cholecystectomy. In 11 patients (7 males, 4 females; median e 56 years (range:33-81)) LSC was performed for acute cholecystitis/empyema (8),severe fibrosis (2) and cirrhosi with portal hypertension (1). Ten of the 11 had significant comorbidity. The cystic duct and artery were isolated by blunt dissection and when possible clipped before division. When this was not feasible (eg:a thickened inflamed cystic duct) the GB was divided at the junction of the cystic duct with Hartmann's pouch and then tied with an Endoloop(Ethicon). An initial standard dissection of the GB was commenced but when difficulty was encountered the subtotal modification was used. In this situation the GB was entered and the wall was divided along the junction with the liver using diathermy and clips. Thus, a disc of posterior GB wall was left in situ. Gallstone recovery and irrigation was thorough. A portovac drain was inserted in the 8 cases with empyema. Median operation time was 70 minutes (range:45-120). There were no significant intra-or post-operative complications related to the surgery. Five patients were febrile due to a respiratory cause. Pulmonary embolism occurring weeks after surgery the only major complication in this series. Hospital stay brief, and the postoperative recovery swift in all but To date, follow-up reveals relief of symptoms in all of the patients who were symptomatic preoperatively.
Paraesophageal hernias quite rare. Even though they represent approximately 2% of all hiatal hernias discovered radiographically, they prone to major complications including visceral infarction, perforation, and bleeding, as well as respiratory problems. The symptomatic control of patients with metastatic hepatic carcinoid often poses a difficult management problem. Although many patients benefit from somatostatin analogue therapy, a significant number of patients fail to respond to medical management and may benefit from liver surgery.
The video will demonstrate the combination of surgical resection of a large carcinoid metastasis in the quadrate lobe of the liver with hepatic cryotherapy to a number of other smaller metastases elsewhere in both lobes. The patient originally underwent pneumonectomy for primary bronchogenic carcinoid and subsequently failed to respond to somatostatin therapy. Following resection, she was clinically and biochemically restored to normality. The video will place great emphasis on the techniques of hepatic cryotherapy.
In conclusion, we recommend this approach for the symptomatic control of patients who fail to respond to medical management. Hepatocyte growth factor scatter factor (HGF/SF) is a promoter ofturnout cell motility and invasion. This study determined the effects ofHGF/SF on tumour cell membrane ruffling, an early event in tumour cell motility and invasion.
Membrane ruffling of human cancer cells, HT115 and HRT18, was monitored with a time lapse video recorder which revealed a rapid membrane ruffling and formation ofmicrospikes after HGF/SF stimulation. Onset of membrane ruffling occurred as early as 5 minutes and reached maximum in approximately 30 minutes. HGF/SF exerted the biological effects at a wide range of concentrations (2-100ng/ml). These events were also confirmed by scanning electron microscopy. The ruffling indices were 0.23-0.03 in control and 1.1+/-0.08 with HGF (10ng/ml). This increased ruffling was related to a increased cell motility as visualised by time lapse video and also confirmed by both an increased phagokinetics in a colloidal gold phagokinetic assay and an increased dissociation from carder beads in a Cytodex-2 dissociation assays (dissociation indices 1.04.0.1 in control and 6.14-0.3 with HGF/SF).
It is concluded that HGF/SF promotes tumour cell membrane ruffling which is related to a increased motility. In the video we present the case of a 66 y/o white woman who, during a routine analysis,was discover to have a raised serum alkaline phosphatase. US and CT examination showed dilatation of bile ducts filled with stones, in the left liver. ERCP failed to outline the intrahepatic ducts. PTC confirmedthe involvement of the left lateral segment.We decide to perform left lateral segmentectomy(Couinaud:left lobectomy).In the film we show the surgical technique, with special emphasis in the left bile duct disection,and caudate lobe removal(to achieve a better approach to distal parts of this conduct) in order to ease the emptiying of calculi, prior the resection.
Two years after the operation the patient is asymptomatic.
We consider the resection as the treatment of choice in the management of locali- The case is reported of a young man (age 28 years) with an atypical chronic myeloproliferative disorder characterized by a high thrombotic risk and a slow disease progression. The haematologic disease was associated with a complete hepatic venous thrombosis (BCS). The patient had hepatomegaly, ascites and abnormal liver function (PT 30). Encephalopathy was absent. Antithrombin III, protein C and protein S were normal. A biopsy specimen showed intense hepatic congestion and necrosis. Doppler ultrasonography, angiography, CT scan and NMR of the abdomen demonstrated a patent portal vein. The hepatic venous thrombosis involved the suprahepatic inferior vena cava incompletely. Based on the absence of encephalopathy, the myeloproliferative aetiology of the disease, and the refractory ascites a double prosthetic side-to-side portal-caval and caval-atrial by-pass was devised to decompress the hypertensive IVC and shunt the entire portal venous flow.
The operation was performed through a bilateral subcostal laparotomy and a median sternotomy. With a 10-mm ringreinforced polytetrafluoroethylene (Gore-Tex) graft a side-to-side portal-caval (suprarenal) shunt was performed.
With a 16-mm ring-reinforced Gore-Tex graft a side-to-side caval (infrarenal)-atrial shunt was performed.
Before shunting the IVC pressure was 22 cm of saline and the portal pressure was 33 cm. After shunting the IC pressure was cm of saline and the portal pressure was 15 cm. The patient survived the operation and the postoperative course was uneventful. Repeated Doppler ultrasonographies demonstrated patency and good function of both the grafts.
Permanent anticoagulation therapy with lowdose acetylsalicylic acid is used in the patient who is alive to date and free of ascites and encephalopathy.
A dilatation of intrahepatic biliary duct is necessary. Before the anastomosis must find the biliary duct of third segment.
We use often this operative technique in steao to internal or external drainage. We reserve this traitment for patients A consecutive series of 16 patients with difficult common bile duct stones underwent intracorporeal laser lithotripsy with an automatic stone recognition system during a 3 month period. A pulsed rhodamine 6G laser with a wavelength of 594 nm was used.The integrated stone recognition system shuts off fully energy deliverance when the laser fibre does not reach contact with the stone surface. 15 patients were treated via the peroral route, one patient via the transhepatic route with an ultrathin cholangioscope. All patients aged 49 89 years, 70 years had concrements in the extra or intrahepatic bile ducts with a mean number of 4 10 and a mean diameter of 22 mm II 32 mm). One patient had an inaccessible papilla after gastroduodenal surgery and a CBD stone in front of the strictured pancreatic part of the duct.
Stone disintegration could be achieved in all cases with a mean discharge number of 6800 120-25000) and a power setting of OOmJ and within I, 7 4 sessions on average. The mean session time was 53 min 8 126 min ). Complete stone clearance could be reached in 14 cases, in two patients small fragments remained in the duct, able to pass spontaneously. In one patient slight hemobilia was seen as a procedure related side effect wich required no special treatment. In conclusion laser lithotripsy with the stone recognition system is as effective as save in patients with biliary concrements not amenable for conventional endoscopic procedures.