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Kempten (Allgäu), Germany

De Deken J.,Visceral | De Deken J.,Catholic University of Leuven | Kocabayoglu P.,University of Duisburg - Essen | Moers C.,University of Groningen
Current Opinion in Organ Transplantation

Purpose of review: This article summarizes novel developments in hypothermic machine perfusion (HMP) as an organ preservation modality for kidneys recovered from deceased donors. Recent findings: HMP has undergone a renaissance in recent years. This renewed interest has arisen parallel to a shift in paradigms; not only optimal preservation of an often marginal quality graft is required, but also improved graft function and tools to predict the latter are expected from HMP. The focus of attention in this field is currently drawn to the protection of endothelial integrity by means of additives to the perfusion solution, improvement of the HMP solution, choice of temperature, duration of perfusion, and machine settings. HMP may offer the opportunity to assess aspects of graft viability before transplantation, which can potentially aid preselection of grafts based on characteristics such as perfusate biomarkers, as well as measurement of machine perfusion dynamics parameters. Summary: HMP has proven to be beneficial as a kidney preservation method for all types of renal grafts, most notably those retrieved from extended criteria donors. Large numbers of variables during HMP, such as duration, machine settings and additives to the perfusion solution are currently being investigated to improve renal function and graft survival. In addition, the search for biomarkers has become a focus of attention to predict graft function posttransplant. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source

Bauer K.,Visceral | Porzsolt F.,University of Ulm | Henne-Bruns D.,University of Ulm
Journal of Gastric Cancer

Purpose: According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric cancer can be recommended on the basis of their findings. Materials and Methods: We analyzed the validity of the three most important studies (MAGIC, ACCORD, and EORTC) using a standardized questionnaire. Each study was evaluated for the study design, patient selection, randomization, changes in protocol, participating clinics, preoperative staging, chemotherapy, homogeneity of subjects, surgical quality, analysis of the results, and recruitment period. Results: All three studies had serious shortcomings with respect to patient selection, homogeneity of subjects, changes in protocol, surgical quality, and analysis of the results. The protocols of the MAGIC and ACCORD-studies were changed during the study period because of insufficient recruitment, such that carcinomas of the lower esophagus and the stomach were examined collectively. In neither the MAGIC study nor the ACCORD study did patients undergo adequate lymphadenectomy, and only about half of the patients in the chemotherapy group could undergo the treatment specified in the protocol. The EORTC study had insufficient statistical power. Conclusions: We concluded that none of the three studies was sufficiently robust to justify an unrestrained recommendation for perioperative chemotherapy in cases of advanced gastric cancer. © 2014 by The Korean Gastric Cancer Association. Source

Ronellenfitsch U.,University of Mannheim | Schwarzbach M.,Visceral | Kring A.,University of Mannheim | Kienle P.,University of Mannheim | And 2 more authors.
Obesity Surgery

Background: Bariatric surgery demands a multidisciplinary approach and enhanced recovery schemes. Such schemes are complex and cumbersome to introduce into practice. This study evaluates if a clinical pathway (CP) facilitates implementation of an enhanced recovery scheme in bariatric surgery with the goal of improving perioperative quality of care. Methods: We compared 65 consecutive patients who underwent bariatric surgery in 2009 and were treated with a CP (CP group) with 64 consecutive patients treated without CP in 2007/2008 (pre-CP group). Process quality indicators were catheter management, postoperative mobilization, spirometer training, vitamin B supplementation, diet resumption, intake of supplement drinks, and length of stay. Outcome quality was measured through morbidity, mortality, re-operations, and re-admissions. Results: In the CP group, foley catheters were removed earlier (p<0.0001), patients were mobilized more often on the surgery day (CP group 92.3% vs. pre-CP group 78.1%, p=0.03), used spirometers more often (56.9% vs. 28.1%, p=0.002), were more often supplemented with vitamin B (100% vs. 31.3%, p<0.0001), and received oral supplement nutrition more often (100% vs. 59.4%, p<0.0001). Median length of stay was shorter in the CP group (6 vs. 7 days, p=0.007). There was no significant difference in mortality, morbidity, re-operations, and re-admissions. Conclusions: Following implementation of an enhanced recovery CP for bariatric surgery, several indicators of process quality improved while outcome quality remained unchanged. A CP seems useful for optimizing treatment of bariatric surgery patients according to enhanced recovery principles. However, future studies are required to better determine which elements of care can be improved most. © Springer Science+Business Media LLC 2012. Source

Background: The transoral endoscopic approach for thyroid surgery was based on a previous attempt to reach the thyroid gland by an axilloscope. In contrast to this single-port access, endoscopic minimally invasive thyroidectomy (eMIT) uses three access points (sublingual and bivestibular). This results in a sufficient triangulation of instruments, making surgical procedures in the anterior neck region possible. Methods: The idea and development of the eMIT technique are described in detail. Anatomic studies, the development of the surgical access in a cadaver study, and the animal study for safety and feasibility of this transoral endoscopic approach for surgery of the anterior neck are outlined. Also, the foundations and ethical aspects are addressed in the context of developing a surgical innovation, which resulted in the first clinical application of this technique in humans. Results: The preclinical studies regarding endoscopic minimally invasive thyroidectomy proofed feasibility in a human cadaver studies as well as safety in a short-time survival animal study. The first clinical application in a 53-year old patient was successful without any significant complications; expected benefits (no postoperative pain or dysphagia, no visible scar) could be demonstrated. Conclusions: The eMIT technique represents a promising new surgical approach for endoscopic surgery in the anterior neck region. The whole development was based on principles for surgical innovation published after the authors' preclinical studies. At this writing, after an initial clinical study with humans, the time has come to compare this new technique with other endoscopic and minimally invasive approaches in a prospective randomized multicenter trial. © 2010 Springer Science+Business Media, LLC. Source

Wilhelm T.,Head Neck and Facial Plastic Surgery | Metzig A.,Visceral
World Journal of Surgery

Background: We have developed a new approach for endoscopic minimally invasive thyroidectomy (eMIT) in anatomical studies. Safety and feasibility were demonstrated in an animal study and then the eMIT technique was applied for the first time successfully in humans on the 18 March 2009. Methods: In a prospective study, we performed this eMIT technique on eight patients suffering from nodular change of the thyroid gland. All patients were evaluated regarding recurrent laryngeal nerve function, intra- and postoperative complications, and postoperative outcome, particularly with respect to swallowing disorders. Results: A total thyroidectomy and a partial resection were performed in four cases each. In three cases, a conversion to open surgery was necessary due to specimen size. No local infection at the incision site or within the cervical spaces occurred within the direct postoperative course. No intraoperative bleeding necessitating conversion to open surgery was observed. In one case, a permanent palsy of the right recurrent laryngeal nerve was noted. Voice function and breathing were not affected. Paresthesia of the mental nerve did not occur in all patients and in those in which it did occur, it resolved within 3 weeks. Mean follow-up time was 10.9 months. Conclusions: The experimental development of the eMIT technique has led to its first clinical application in humans. In this prospective proof-of-concept study in humans, the thyroid gland was reached via the transoral endoscopic approach in an anatomically defined layer without any relevant damage to vessels. Limitations to this technique are determined by specimen volume (up to 30 ml) and nodule size (up to 20 mm). © 2010 Société Internationale de Chirurgie. Source

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