Author: fidelmac

Background: Ultrasonography (US) is widely used for pre-operative detection of liver tumors. However, US does not have high resolution and very small tumors, tumors located near the liver surface, or those in cirrhotic livers are often not detected. Case Report: A 47-year-old woman with a previous surgery for sigmoid colon cancer (T3N1bM0 Stage3b) showed a liver tumor on the surface of segment 2 by contrast-enhanced computed tomography (CT) and gadoliniumethoxybenzyldiethlenetriaminepen-taacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI). Laparoscopic liver resection was performed under fluorescence guidance (using Indocyanine Green, ICG). Pathological examination showed a pseudotumor with negative margins. The present study showed that ICG can allow the detection of tumors in the liver that are invisible with IOUS. Furthermore ICG fluorescence has a higher detection rate for small tumors or tumors near the surface of the liver than IOUS.

Conclusion: ICG fluorescence imaging can allow visualization of liver tumors that are undetectable on US.

https://pubmed.ncbi.nlm.nih.gov/34281847/

Background: With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion.

Methods: Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis.

Results: PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001).

Conclusions: The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.

https://pubmed.ncbi.nlm.nih.gov/34448934/

A study led by experts University of Birmingham has been awarded the Guinness World Records title for the world’s largest scientific collaboration – involving over 140,000 patients in 116 countries. The record for ‘Most authors on a single peer-reviewed academic paper’ is now held by the Universities of Birmingham and Edinburgh after 15,025 scientists around the globe contributed to major research into the impact of COVID-19 on surgical patients.

Launched in March 2020, the COVIDSurg Collaborative has provided data needed to support changes to surgical delivery in the fastest time frame ever seen by a surgical research group. Research from this huge study group has also explored the timing of surgery after COVID infection, preoperative isolation, and risks of blood clots, all published in the field-leading journal Anaesthesia.

During the first wave of the pandemic, up to 70% of elective surgeries were postponed, resulting in an estimated 28 million procedures being delayed or cancelled. Whilst surgery volumes have started to recover in many countries, ongoing disruption is likely to continue throughout 2021, particularly in the event of countries experiencing further waves of COVID-19. Vaccination is also likely to decrease post-operative pulmonary complications – reducing intensive care use and overall healthcare costs.

https://www.birminghamhealthpartners.co.uk/global-covid-19-surgery-study-scoops-scientific-world-record/

Hospitals nationwide are postponing elective procedures as COVID-19 surges are reaching record highs.  Here are states where elective procedures are being postponed: 

https://www.beckersasc.com/asc-news/here-s-where-elective-procedures-are-being-postponed.html

Central serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

https://pubmed.ncbi.nlm.nih.gov/34416788/

Background: Prediction of post-hepatectomy liver failure (PHLF) based on remnant liver function reserve is important for successful hepatectomy. The aim of this study was to investigate whether intraoperative indocyanine green (ICG) clearance in a future remnant liver was a predictor of PHLF.

Methods: This prospective study enrolled 31 consecutive patients who underwent anatomical hepatectomy between June 2016 and August 2019. Intraoperative ICG plasma disappearance rate (ICG-PDR) and ICG retention rate at 15 min (ICG-R15) were measured.

Results: Of the operations performed, 87.1% were major hepatectomy. PHLF Grade B/C was observed in eight patients (25.8%) with no mortality. The concordance indices of intraoperative ICG-PDR and ICG-PDR for predicting PHLF were 0.834 (95% CI, 0.69-0.98) and 0.834 (95% CI, 0.69-0.98), respectively. A subgroup analysis of patients with preoperative biliary drainage (BD) (n = 17) showed that the concordance indices of intraoperative ICG-PDR increased to 0.923 (95% CI, 0.79-1.00).

Conclusions: Intraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD (biliary drainage).

https://pubmed.ncbi.nlm.nih.gov/34392399/

Abstract

The injury of common bile duct (CBD) is one of the most common complications during laparoscopic cholecystectomy. Consequences of CBD injury are grave since CBD is the only pathway of bile from biliary tracts to duodenum. When CBD injury occurs, extra surgical procedures repairing CBD or reconstructing biliary tracts have to be performed on patients, which increase expenses of patients and physical trauma. A total of 238 patients undergoing laparoscopic cholecystectomy (LC) in Zhuhai People’s Hospital from July 2020 to April 2021 were enrolled in this observational study, including 126 patients undergoing conventional LC and 112 patients undergoing ICG angiography-guided LC. Method of propensity score matching was used to balance the preoperative data of patients in the two groups. For both groups, the “Critical View of Safety” (CVS) was introduced. For the ICG group, the CBD, cystic duct (CD), and gallbladder were identified using near-infrared (NIR) ray. Intraoperative blood loss, operation time, postoperative hospitalization time, and the incidence rate of intraoperative complications were compared between the two groups. ICG angiography in LC shows safe and effective outcomes. The intraoperative blood loss, operation duration, postoperative hospitalization time, and complication incidence rate of the ICG group are significantly lower than those of the conventional group. ICG angiography in LC was a useful and effective method to identify the CBD and prevent intraoperative complications.

https://pubmed.ncbi.nlm.nih.gov/34398384/

Background: Ultrasonography (US) is widely used for pre-operative detection of liver tumors. However, US does not have high resolution and very small tumors, tumors located near the liver surface, or those in cirrhotic livers are often not detected. Case Report: A 47-year-old woman with a previous surgery for sigmoid colon cancer (T3N1bM0 Stage3b) showed a liver tumor on the surface of segment 2 by contrast-enhanced computed tomography (CT) and gadoliniumethoxybenzyldiethlenetriaminepen-taacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI). However, preoperative US could not identify a tumor lesion at the same site. The most likely preoperative diagnosis was metastasis from her sigmoid colon cancer and laparoscopic liver resection was performed. Intraoperative ultrasonography (IOUS) did not identify the tumor, but it was visualized with indocyanine green (ICG) fluorescence at the surface of segment 2. Laparoscopic liver resection was performed under fluorescence guidance. Pathological examination showed a pseudotumor with negative margins.

Conclusion: ICG fluorescence imaging can allow visualization of liver tumors that are undetectable on Ultrasonography.

https://ar.iiarjournals.org/content/41/8/3867