Water-jet dissector for endoscopic submucosal dissection in an animal study: outcomes of the continuous and pulsed modes.

BACKGROUND: Endoscopic submucosal dissection (ESD) allows en bloc resection of early neoplastic lesions of gastrointestinal tract. Lesions are lifted by submucosal fluid injection before circumferential incision and dissection. High-pressure fluid injection using water jet (WJ) technology is already used for lifting and dissection in surgery. The study was designed to assess WJ for ESD submucosal lifting and dissection. METHODS: An experimental, randomized comparative, "in vivo" nonsurvival animal study on 12 pigs was designed. Stomach mucosal areas were delineated and resected using three ESD techniques: technique A-syringe injection and IT knife dissection; technique B-WJ continuous injection and IT knife dissection; technique C-WJ injection and WJ pulsed dissection. Injection and dissection speeds and complications rates were assessed. RESULTS: Water jet continuous injection is faster than syringe injection (B faster than A, p = 0.001 and B nonsignificantly faster than C, p = 0.06). IT knife dissection is significantly faster after WJ continuous injection (B faster than A, p = 0.003). WJ pulsed dissection is significantly slower than IT knife dissection (C slower than A and B, both p < 0.001). The overall procedure speed was significantly higher and the immediate bleedings rate was significantly lower for technique B than A and C (overall procedure speed p = 0.001, immediate bleedings p = 0.032 and 0.038 respectively). There were no perforations with any technique. CONCLUSIONS: Water jet fluid continuous injection speeds up ESD, whereas pulsed WJ dissection does not.

Thermal Ablation of the Pancreas With Intraoperative High-Intensity Focused Ultrasound: Safety and Efficacy in a Porcine Model.

OBJECTIVE: New focal destruction technologies such as high-intensity focused ultrasound (HIFU) may improve the prognosis of pancreatic ductal adenocarcinoma. Our objectives were to demonstrate the safety and efficacy of intraoperative pancreatic HIFU ablation in a porcine model. METHODS: In a porcine model (N = 12), a single HIFU ablation was performed in either the body or tail of the pancreas, distant to superior mesenteric vessels. All animals were sacrificed on the eighth day. The primary objective was to obtain an HIFU ablation measuring at least 1 cm without premature death. RESULTS: In total, 12 HIFU ablations were carried out. These ablations were performed within 160 seconds and on average measured 20 (15-27) × 16 (8-26) mm. The primary objective was fulfilled in all but 1 pig. There were no premature deaths or severe complications. High-intensity focused ultrasound treatment was associated with a transitory increase in amylase and lipase levels, and pseudocysts were observed in half of the pigs without being clinically apparent. All ablations were well delimited at both gross and histological examinations. CONCLUSIONS: Intraoperative thermal destruction of porcine pancreas with HIFU is feasible. Reproducibility and safety have to be confirmed when applied close to mesenteric vessels and in long-term preclinical studies.

A model of mandibular irradiation in the rabbit: preliminary results.

Radiotherapy is widely used in the treatment of head and neck cancers. Its major adverse effect is osteoradionecrosis, which can occur during the whole life of the patient, involving the vital prognosis. The aim of the study was to develop a model for irradiation of the rabbit mandible in order to have a better knowledge of radiotherapy-induced bone alterations and thus a better prevention and treatment of osteoradionecrosis. The control group consisted in 7 rabbits and was used to assess anatomical and histological parameters of the rabbit's mandible. A first group of 14 rabbits was weekly irradiated at doses of 5.5 Gy during 5 weeks, at a total dose of 46.8Gy. Sacrifices were done at 1 week, 4 weeks, 12 weeks and 24 weeks. As histological analysis did not reveal statistical differences with the control group, a second group (3 rabbits) was weekly irradiated at 8.0, 8.5 and 9 Gy during 5 weeks. The first histological results seem to show vascular alterations, bone cells decrease and alterations of bone architecture. The role of intra alveolar collagen sponges, PRF®, ultrasounds and stem cells in bone regeneration after radiotherapy will be further studied.

Bevacizumab impairs hepatocyte proliferation after partial hepatectomy in a rabbit model.

BACKGROUND: Bevacizumab is used to treat patients with metastatic colorectal cancer, including those who will undergo liver surgery. The effects of this agent on the regenerative capacity of the liver are unclear. We used a rabbit model of partial hepatectomy to assess the effects of bevacizumab on hepatocyte replication and the expression of genes relevant to angiogenesis and proliferation. MATERIALS AND METHODS: Thirty rabbits underwent 28% hepatectomy. At the end of the procedure, animals were blindly randomized into two groups. A control group was injected i.v. with saline and the other group with bevacizumab at 50 mg/kg. Three rabbits from each group were sacrificed at days 2, 3, 5, 7 and 14 after hepatectomy. Livers were collected and processed. Hepatocyte proliferation was evaluated by Ki-67 immunostaining and apoptosis by caspase-3 activity. Gene expression of Vascular endothelial growth factor (VEGF), Hepatocyte growth factor (HGF) and Inhibitor α of nuclear factor-κB (IκBα) was determined by quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR). RESULTS: Compared with controls, hepatocyte proliferation in bevacizumab-treated animals was decreased 1.8-fold at day 3, 1.6-fold at day 5 and 2.1-fold at day 14. Neoangiogenesis began after day 5, with a peak of VEGF mRNA evident at day 7 in both groups. Expression of IκBα, a transcriptional target of Nuclear Factor-κB, increased significantly from baseline only in the control group: at day 2, expression was 179% of the day 0 value in controls versus 112% in the bevacizumab group. Expression of HGF and caspase-3 was similar in the two groups and remained stable over time. CONCLUSION: A single i.v. injection of bevacizumab impaired hepatocyte proliferation in a rabbit model of partial hepatectomy.