Introduction: Surgical treatment in oncology is one of the main part concerning the surveillance rate of the patient in case of tumor recurrence. Metastatic suspected lesions are mostly located in the abdomen or pelvis and are diagnosed by PET, MRI, or CT scan. Especially surgery of small lesions in recurrent disease for diagnostic or therapeutic purpose is often challenging.Material and Methods: We report a case series of 3 patients who were treated in our department due to a metastatic suspected lesion in PET-CT in follow up. For histological confirmation we performed a laparoscopy using a near infrared camera (NIR) for an improved visualization of the metastatic suspected lesion during surgical treatment. Previously the lesion was marked with an amount of Indocyanine Green (ICG) via computer tomography-guided percutaneous injection. The lesion was identified via NIR camera. While changing the camera in NIR mode, it show up as a blue spot due to the fluorescent signal. After correct identification it was removed and send to pathology.Results: In all 3 cases they confirmed the diagnosis of a metastatic lesion. Complication occur in just one case, where the metastatic lymph node infiltrated the external iliac vein, which led to a high blood loss. In this case a vascular interposition had to be done.Conclusions: Because of separate wavelengths, which are used for illumination and recording, only the marked area is visible, not the background.Due to correct identification, resection of the lesion was improved and healthy surrounding tissue could have been spared.
IntroductionBiliodigestive leaks are typically caused by an insufficiency at the surgical anastomosis. Biliodigestive anastomosis (BDA) insufficiencies can lead to bilomas, abscesses and vascular erosion in chronic conditions.Material and methodsWe performed a retrospective analysis of the medical and radiological records of all patients with biliodigestive insufficiency who received interventional treatment between July 2015 and February 2021. Nine patients (three with unilateral drainage and six with bilateral drainage) were treated with a modified percutaneous transhepatic cholangiodrainage (PTCD). Clinical success was considered after complete resolution of the peribiliary collections, absence of bile within the surgical drains, radiological patency of the BDA (contrast medium flowing properly through the BDA and no signs of leakage) and haemodynamic stability of the patient without signs of sepsis.ResultsClinical success was achieved in all nine patients. No patients required revision surgery to repair their BDA. The mean indwelling drainage time was 34.8±16.5 days. The mean number of interventional procedures performed per patient was 6.6±2.0.ConclusionPatients who present with BDA insufficiency may benefit from interventional radiological techniques. Our modified PTCD resolved the BDA leak in all nine cases and should be considered as a valuable option for the treatment of patients with this complication. Our technique demonstrated to be feasible and effective.
Background The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration Retrospectively registered
Background The present study attempted to demonstrate how the configuration of hydrogel-coated coils is influenced by different temperature exposures. Thirty detachable hydrogel-coated coils were evaluated in an in vitro water immersion test under five different temperature ranges (22.6 °C, 37 °C, 40–50 °C, 50–60 °C, and 60–70 °C). The configuration changes were classified (configuration I, configuration II, and configuration III) according to the curling that occurred during 30 min of immersion. Configuration stability of five Hydrogel-coated coils was also evaluated in a two-step temperature immersion test. Results All hydrogel-coated coils showed some configuration changes during water immersion. However, a logarithmic transformation of the time and temperature data showed a significant (p < 0.05) negative linear correlation between time and temperature for all coil configurations (configuration I: R = 0.97, configuration II: R = 0.98, configuration III: R = 0.97). The time needed to reach configuration III (complete coiling) was 160.4 ± 41.9 s at 37.5 °C (range: 100–205 s), 45.7 ± 22.2 s at 47.5 °C (range: 23–70 s), 20.2 ± 7.2 s at 57.5 °C (range: 14–32 s), and 10.3 ± 2.4 s at 67.5 °C (range: 7–13 s). Conclusions Temperatures above 55 °C induced immediate configurational changes in the hydro-coated coils, achieving complete curling within less than 30 s. Temperatures near 36 °C (normal body temperature) require more time to reach optimal coil curling (configuration III). The optimization of HydroCoil preparation can reduce interventional procedural time and improve clinical results.
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