Başkent Üniversitesi Makaleler

Permanent URI for this collectionhttps://hdl.handle.net/11727/13096

Browse

Filters

2004 - 20103

Settings

Author: search.filters.author.Papalois, VassiliosHas files: Yes

Search Results

Now showing 1 - 3 of 3
  • No Thumbnail Available
    Item
    An Ex-Vivo Model for Hypothermic Pulsatile Perfusion of Porcine Pancreata: Hemodynamic and Morphologic Characteristics
    (Başkent Üniversitesi, 2010-03) Karcz, Marcin; Papalois, Vassilios; Dorling, Anthony; Gray, Cathy; Sibbons, Paul; Cook, H. Terence
    Objectives: Hypothermic machine perfusion is a well-established preservation method for kidneys that allows for better preservation over longer periods and pretransplant assessment of graft viability. This technique has only sporadically been used for pancreatic grafts. The aim of this study was to establish a hypothermic machine perfusion model for porcine pancreas perfusion. Materials and Methods: Fifteen porcine pancreata were subjected to 25 minutes of warm ischemia and 149 minutes of cold ischemia before undergoing meticulous bench work preparation and perfusion, via an aortic segment, on the RM3 perfusion machine with University of Wisconsin (Barr Laboratories Inc., Pomona, NY, USA) solution. Perfusion variables (°C, temperature; mm Hg, systolic perfusion pressure; mL/min, flow volume; mm Hg/mL/min, resistance) were recorded every 30 minutes. Tissue samples were assessed for each pancreas preperfusion and postperfusion using a semiquantitative scoring scale to grade histopathologic changes: acinar cell damage (0-4), islet cell damage (0-3), inflammation (0-3), and edema (0-3). Results: Hypothermic machine perfusion time was set at 315 minutes, and all grafts were maintained between 4-10°C. The results were as follows (range, mean ± SD): systolic perfusion pressures were 5-13 mm Hg (9.61 ± 3.25 mm Hg) during the first 60 minutes (priming), and 15-23 mm Hg (21.07 ± 4.26 mm Hg) during the maintenance period. Target flow volumes reached 141-152 mL/min (147.6 ± 8.969 mL/min) at 60 pulses per minute. Intrapancreatic resistance decreased throughout priming to 0.03-0.09 mm Hg/mL/min (0.083 ± 0.042 mm Hg/mL/min), and remained unchanged until completion of perfusion. Pancreatic weight increase varied from 3.2% to 18.3% (13.36% ± 4.961%). There was significant postperfusion reduction in islet and acinar cell damage (P = .001 and P = .01 respectively). Conclusions: We have developed a model of machine perfusion for porcine pancreata which is simple, reliable, and protects graft histopathologic integrity. The model can be used in further studies to improve the quality of pancreas preservation, and assess and improve the viability of the condition of borderline pancreatic grafts.
  • No Thumbnail Available
    Item
    A Fast and Safe Living-Donor "Finger-Assisted" Nephrectomy Technique: Results of 225 Cases
    (Başkent Üniversitesi, 2008-12) Hakim, Nadey S.; Canelo, Ruben; Papalois, Vassilios
    Renal transplant remains the treatment of choice for end-stage renal disease. It improves both the quality of life and the quantity of life in recipients. We present a living-donor nephrectomy technique that is less invasive than the conventional open flank incision. This technique involves only 1 incision and is smaller than the one used in the laparoscopic technique. We have successfully introduced this new technique at our center. The procedure may be done safely and is applicable in all potential donors regardless of the body mass index of the donor or the size of the surgeon’s hands. It provides excellent grafts and has allowed us to expand our living-donor program.
  • No Thumbnail Available
    Item
    Use of ETS-FLEX Endoscopic Linear Vascular Cutter in Donor Nephrectomy and Transplantation Surgery: A Single Institution’s Experience
    (Başkent Üniversitesi, 2004-12) Hakim, Nadey S.; Dosani, Muhammad Tariq; Papalois, Vassilios
    Objectives: We describe our experience with the use of ETS-FLEX endoscopic linear vascular cutter from January 2000 to October 2004 in live-donor nephrectomy and pancreatic bench work. Materials and Methods: In live-donor nephrectomy, ETS-FLEX endoscopic linear vascular cutter (ELVC) is used for the stapling and division of renal vessels and ureter. When positioned on a vessel, the vascular cutter applies 3 staple lines proximally and 3 distally, and the vessel in between them is divided. In pancreatic graft bench work, ELVC is applied in 3 steps: the splenectomy, ligation of the mesenteric root, and the ligation of any peripancreatic lymphatic tissue or small vessels. Results: From October 2000 to October 2004, we performed 80 living-donor nephrectomies in 56 men and 24 women (mean age, 39 years; range, 24-63 years). Thirty-one grafts were with multiple vessels. Mean warm ischemia time was 60 ± 5 seconds. Mean operative time was 60 ± 10 minutes. In all cases, there was no need for further hemostasis after removal of the kidney. There were no operative complications. All grafts were successfully revascularized with 100% graft survival (range of follow-up, 1-48 months). Patients’ length of stay in hospital was 3 ± 1 days. We have used the ETS-FLEX ELVC in 30 pancreatic graft preparations since January 2000. Mean time taken for the bench work preparation including Y-graft anastomosis was 45 ± 10 minutes. Following revascularization, there was excellent perfusion with minimal and easily controllable bleeding that did not require blood transfusion. Conclusions: We believe that our use of the laparoscopic instrument, ETS-FLEX ELVC, with a mini-incision technique in live-donor nephrectomy and pancreatic graft preparation makes these complex and time-consuming procedures simple and fast, minimizing the chances of postoperative complications and resulting in excellent patient and graft survival.