Organ Bag Research Articles

BIO1: Ice Is Not 4°C: Thermodynamic Characterization of Livers Preserved on Ice Vs Advanced Hypothermic Preservation Technology

Background: Clinical literature and conventional knowledge assumes that the temperature of donor livers stored on ice is 4°C. However, this assumption is not backed by empirical data as the typical environment of organ storage in solution is not measured or controlled, increasing risk of freezing injury. In an era where programs are evaluating the clinical and logistical tradeoffs of various perfusion strategies, it is important to quantify the actual temperature of livers stored on ice. Methods: Porcine livers were packaged in a traditional manner within 3 bags (3M) and placed on ice in a cooler (n=3) or using an advanced hypothermic technology (LIVERguard) (n=3). 2L preservation solution was in the organ bag, 2L saline in the second bag. Temperature probes were inside the liver tissue, liver surface, and in the saline bag. Temperatures were captured every 30 seconds, for up to 15 hours. Results: A total of 10,800 temperature measurements were analyzed between the two groups. Average liver surface temperatures evolved from an initial 5.9°C to 0.8°C (1 hr) to -0.1°C (4 hrs) in the ice group and from an initial 7.3°C to 7.3°C (1 hr), to 6.9°C (4 hrs) in LIVERguard group. Saline temperatures were like the surface temperatures. The starting temperature for ice was (-)6°C and approached 0°C at 8 hours. Average liver tissue temperature evolved from 5.7°C to 1.2°C (4 hrs), 0.2°C (8 hrs) and 0.1°C (12 hrs) in the ice group and from an initial 7.5°C to 6.8°C (4 hrs), 6.2°C (8 hrs), and 5.8°C (12 hrs) in LIVERguard group. Conclusions: Donor livers packaged and preserved on ice undergo rapid drop in temperature, approaching freezing in an uncontrolled manner. Actual temperatures are lower than the historically assumed 4°C. In contrast, donor livers packaged using LIVERguard remained between 4°C and 8°C. Centers may benefit from adopting controlled hypothermic strategies to prevent cold injury to donor livers.

Performance test of organic planting bags for woody plant seedlings

Organic planting bag has been developed to overcome both weaknesses of plastic polybags, contaminating the soil and damaging the plant’s root when transplanting. The improvement in this stage was achieved by inserting coconut fiber to strengthen a bag. The main purpose of this study was to investigate the effectiveness of seedling and transplanting by using organic planting bags, employed, three woody plants, i.e., Albizia (Albizia julibrissin), Cadam (Neolamarckia cadamba) and Gmelina (Gmelina arborea). Performance testing of organic plant bags was conducted on three compositions of coconut fiber and water hyacinth. Two stages of experiments were conducted to know bag performance. First, the testing of organic plant bags during the nursery was conducted for 50 d from day 0 to day 50. Second, the testing of organic plant bags after transplanting and observed on days 60, 70, and 80, after transplanted on the field. The parameters in this study were plant height, a total of roots that penetrate the organic plant bags and a total of leaves and stem diameters of plant grown in the organic bag and transplanting on land. The results showed that organic planting bag with the composition 155 g of coconut fiber and 505 g of water hyacinth (A3B3) has 0.020 kg/cm2 compressive strength and provides the best plant growth rates. Compressive strength affects the number of roots which penetrate the organic bag. Generally, the growth of seed in organic bags is faster than that in polybags. Albizia shows a higher growth rate (0.379 cm/d) compared to Cadam and Gmelina. Keywords: seedling effectiveness, organic planting bag, nursery, transplanting, woody plant DOI: 10.25165/j.ijabe.20201305.4975 Citation: Lutfi M, Agung N W, Vo T H, Djoyowasito G, Ahmad A M, Sandra S. Performance test of organic planting bags for woody plant seedlings. Int J Agric & Biol Eng, 2020; 13(5): 93–98.

Performance test of organic planting bags for woody plant seedlings

Organic planting bag has been developed to overcome both weaknesses of plastic polybags, contaminating the soil and damaging the plant’s root when transplanting. The improvement in this stage was achieved by inserting coconut fiber to strengthen a bag. The main purpose of this study was to investigate the effectiveness of seedling and transplanting by using organic planting bags, employed, three woody plants, i.e., Albizia (Albizia julibrissin), Cadam (Neolamarckia cadamba) and Gmelina (Gmelina arborea). Performance testing of organic plant bags was conducted on three compositions of coconut fiber and water hyacinth. Two stages of experiments were conducted to know bag performance. First, the testing of organic plant bags during the nursery was conducted for 50 d from day 0 to day 50. Second, the testing of organic plant bags after transplanting and observed on days 60, 70, and 80, after transplanted on the field. The parameters in this study were plant height, a total of roots that penetrate the organic plant bags and a total of leaves and stem diameters of plant grown in the organic bag and transplanting on land. The results showed that organic planting bag with the composition 155 g of coconut fiber and 505 g of water hyacinth (A3B3) has 0.020 kg/cm2 compressive strength and provides the best plant growth rates. Compressive strength affects the number of roots which penetrate the organic bag. Generally, the growth of seed in organic bags is faster than that in polybags. Albizia shows a higher growth rate (0.379 cm/d) compared to Cadam and Gmelina. Keywords: seedling effectiveness, organic planting bag, nursery, transplanting, woody plant DOI: 10.25165/j.ijabe.20201305.4975 Citation: Lutfi M, Agung N W, Vo T H, Djoyowasito G, Ahmad A M, Sandra S. Performance test of organic planting bags for woody plant seedlings. Int J Agric & Biol Eng, 2020; 13(5): 93–98.

Recognition of Skeletal Fractures in Infants: An Autopsy Technique

Complete recognition and documentation of injury pattern is crucial in the diagnosis of child abuse. Skeletal fractures regarded as highly specific to nonaccidental injury in infants include posterior rib, scapular, metaphyseal, and spinous process fractures. These injuries are often occult, especially when acute, to standard radiologic and autopsy procedures. The presented autopsy technique requires incising and reflecting skeletal muscles to expose the bones and costal osseous joints in situ, increasing the opportunity to recognize skeletal injury. Fractured or atypical appearing bones are removed and processed for complete evaluation. The bones are processed by macerating the soft tissue in a water soap bath at an elevated temperature. To aid in reconstruction of the decedent, long bones are replaced with wooden dowels and the chest cavity is packed with the organ bag. The technique is invasive and recommended for cases in which the pathologist has reasonable suspicion of acute or remote trauma.

Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: Results of a Belgian Retrospective Multicentre Survey

ObjectivesTo evaluate the technical and oncologic feasibility of laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. MethodsA retrospective survey of 100 patients, treated with laparoscopic nephroureterectomy in 10 Belgian centres, was performed. Most procedures were performed transperitoneally. The distal ureter was managed by open surgery in 55 patients and laparoscopically in 45 patients. The mean follow-up was 20 mo. ResultsMean operation time was 192min and mean blood loss 234ml. The conversion rate was 7%. Important postoperative complications were seen in 9%. Pathologic staging was pTa in 31 patients, pT1 in 23, pT2 in 12, pT3 in 33, and pT4 in 1, concomittant pTis in 3. Pathologic grade was G1 in 24 patients, G2 in 28, and G3 in 48. Negative surgical margins were obtained in all but one patient. Twenty-five patients developed progressive disease (24%) at a mean postoperative time of 9 mo (local recurrence in 8%, metastases in 11%, both in 5%). Progression was 0% for pTa, 17% for pT1, 17% for pT2, 51% for pT3, and 100% for pT4. Cancer-specific survival was 100% for pTa, 86% for pT1, 100% for pT2, 77% for pT3, and 0% for pT4. ConclusionLaparoscopic nephroureterectomy appears to be a technically and oncologically feasible operation. To prevent tumour seeding, one should avoid opening the urinary tract and should extract the specimen with an intact organ bag. The high local recurrence rate in this study probably reflects the high percentage of high-grade and high-stage tumours in this study.

Laparoscopic tumor nephrectomy

Initially, laparoscopic surgery in urology was restricted to the treatment of benign diseases, whereas its role in the management of malignant disease was restricted to purely diagnostic procedures. Only recently has laparoscopy been introduced for the treatment of low stage renal cell carcinoma (RCC), and the data on both surgical efficiency and oncologic efficacy are very promising. Therefore, we present our experience with laparoscopic radical nephrectomy and data from literature. The technique of the transperitoneal approach is described in detail. Retroperitoneoscopy is a good alternative, however. Intact removal of the specimen within an organ bag to avoid tumor spillage is an important detail of our technique. Our experience amounts to radical nephrectomy in 121 patients. The indication was clinical stage T1-T2. Mean operative time and blood loss was 2.4 h and 154 ml, respectively. The rate of minor or major complications was 5% and 4%, respectively. There was no conversion to open surgery in any patient. Mean postoperative hospital stay was 6.1 days. Data on tumor control are available for 73 patients with a mean follow-up of 13.3 months. There was no recurrence within this period. Radical nephrectomy for low-stage RCC is associated with low morbidity and great surgical efficiency. The rates for local recurrences and metastases are low, tumor-specific survival is high. However, there is still a lack of long-term data on large series of patients. Despite this fact, laparoscopy is already widely accepted for this indication, and it is quite likely that it will become the standard treatment.

Laparoscopic Surgery for Stage T1 Renal Cell Carcinoma: Radical Nephrectomy and Wedge Resection

Objectives: Renal cell carcinoma (RCC) is likely to become one of the most important indications for laparoscopic surgery. We herein report our experience.Methods: From April 1994 until April 1999, 98 patients presenting with RCC were treated laparoscopically by either radical nephrectomy (RN; n = 73) or wedge resection (WR; n = 25). The mean age was 62.3 years. The mean tumour diameters were 3.8 cm (RN) and 1.9 cm (WR). All tumours were clinical stage T1 lesions. The transperitoneal approach was used for RN in all patients. For WR either the transperitoneal or the retroperitoneal approach was used. In 15 patients, the adrenal gland was removed simultaneously. The specimen was entrapped in an organ bag and removed intact through a small muscle–splitting incision in the lower abdominal wall.Results: RN: The mean operating time was 142 (range 86–230) min, the mean blood loss was 170 (range 0–1,500) ml, and the mean postoperative hospital stay was 7.4 (range 3–32) days. Minor complications occurred in 4.0% of the patients, while major complications were seen in 8.0% of them. WR: The mean operating time was 163.5 (range 90–300) min, the mean blood loss was 287 (range 20–800) ml, and the postoperative hospital stay was 8.0 (range 3–8) days. Minor complications: 4%, major complications: 8%. Histology revealed RCC stage T1 in 77 patients, stage T3a in 7, and stage T3b in 3 patients, oncocytoma in 2 patients, angiomyolipoma in 2, renal adenoma in 1, renal metastasis in 1, multilocular cysts in 4, and renal abscess in 1 patient. Over mean follow–up periods of 13.3 and 22.2 months for RN and WR, respectively, neither local recurrences nor metastases have been observed among patients with histologically confirmed RCC.Conclusions: Laparoscopic surgery for clinical stage T1 RCC is safe and efficient. Excellent tumour control can be achieved. However, longer follow–up periods will be necessary to confirm these results.

Long–Term Experience with Laparoscopic Retroperitoneal Lymph Node Dissection in the Management of Low–Stage Testis Cancer

Objectives: We describe our experience with laparoscopic retroperitoneal lymphadenectomy (LRLA) in 34 patients with low–stage germ cell tumors treated from 1992 to 1998. All patients had clinical stage–I disease with no clinical evidence (CT scan, ultrasound, tumor markers) of metastases. A laparoscopic dissection was used to assess the pathologic status of the relevant retroperitoneal lymph nodes. Material and Methods: 17 patients were treated by a transperitoneal laparoscopic approach, whereas in the last 17 patients retroperitoneoscopic retroperitoneal lymph node dissection was performed. The lymph node dissection was performed identically to open surgery with the modified template according to Weissbach including the paracaval, interaortocaval, upper pre–aortic, and right common iliac zonal nodes for right–sided tumors, and para–aortic, upper pre–aortic zones for left–sided tumors. Retrieval of the lymph node chains was accomplished using a small organ bag. Results: The procedure could be completed successfully in 30 of 34 patients with stage–I disease. In these cases the mean duration of the procedure was 248 min. In 3 patients the lymphadenectomy was abandoned, because frozen section showed metastasis. In 1 case conversion to open surgery was necessary because of bleeding from the aorta. One patient developed a delayed ureteral stenosis which required operative repair. Three patients required temporary insertion of an indwelling ureteral stent, and another patient had a pulmonary embolism with an uneventful outcome. One patient with a LRLA on the right side later developed retrograde ejaculation. In 6 of the 33 patients (18%) embryonal carcinoma or mixed carcinoma was found. The postoperative hospital stay averaged 5.3 (3–9) days for the patients without complications or conversion to open surgery. After a median follow–up of 40 months no regional relapse occurred, but 2 patients developed pulmonary metastases which were treated successfully by three cycles of platinum–based chemotherapy. All patients have no evidence of disease. Conclusions: Our experience suggests that LRLA is a safe and accurate method for low–stage germ cell tumors with minimal invasiveness, but because of its technical difficulty it should be restricted to experienced centers.

Laparoscopic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Tumors: Indications and Limitations

Purpose We describe our experience with laparoscopic retroperitoneal lymph node dissection in 26 patients with nonseminomatous germ cell tumors: 17 had stage I disease with no clinical (computerized tomography, ultrasound or tumor markers) evidence of metastases and 9 (2 with stage IIb and 7 with stage IIc disease) had residual tumor after chemotherapy but with negative tumor markers. Laparoscopic dissection was performed to assess more fully pathological status of the relevant retroperitoneal lymph nodes in both groups. Materials and Methods The patient was positioned and trocars were introduced at sites similar to that used for transperitoneal laparoscopic nephrectomy (flank position with 3, 10 mm. and 2, 5 mm. ports). After the white line of Toldt was incised and the colon was reflected anteromedially, the retroperitoneal space was exposed. The landmarks of lymph node dissection were then isolated, including the ureter, aorta, inferior vena cava and both renal veins. Lymph node dissection was performed identical to that for open surgery, with a modified template including the paracaval, interaortocaval, upper preaortic and right common iliac nodes for right tumors, and para-aortic and upper preaortic nodes for left tumors. Lymph node chains were retrieved with a small organ bag. Results The procedure was completed successfully in 16 of 17 patients with stage I disease (mean duration 268 minutes for the left and 312 minutes for the right sides). No intraoperative complications were encountered. One patient had delayed ureteral stenosis requiring operative repair, 1 had a pulmonary embolism with an uneventful outcome and 1 who underwent laparoscopic retroperitoneal lymph node dissection on the right side later had retrograde ejaculation. Embryonal carcinoma was found in 1 of the 17 patients. Average postoperative hospital stay was 4.5 days for patients without complications or conversion to an open procedure. After a median followup of 27 months no patient had regional relapse but 2 had pulmonary metastases that were treated successfully with 3 cycles of platinum based chemotherapy. Laparoscopic dissection was significantly more difficult in patients with stage II tumors after chemotherapy. Only in 2 patients with stage IIb disease was laparoscopic lymphadenectomy successful. In 5 of the 7 patients with stage IIc cancer portions of the dissection had to be done after conversion to an open (conventional) operation via a small incision (suprainguinal or pararectal). In 1 patient the laparoscopic approach was completely abandoned and converted to an open operation via a standard midline incision. In all 9 cases histopathological examination revealed complete necrosis. No patient has evidence of disease. Conclusions Our preliminary experience suggests that a modified laparoscopic retroperitoneal lymph node dissection is feasible for stage I tumors. However, it cannot be recommended after previous chemotherapy (stages IIb and IIc disease).

Kidney retrieval after endoscopic nephrectomy

Laparoscopic or retroperitoneoscopic interventions such as nephrectomy or tumour nephrectomy call for the removal of large quantities of tissue which can no longer be extracted via the relatively confined lumen of a cannula. For this purpose, a variety of organ retrieval systems have been designed and are commercially available with the aim of safe tissue retrieval. This paper summarizes the results of an experimental and clinical comparison of the most important organ entrapment systems suitable for endoscopic nephrectomy. The LapSacR was the first organ bag especially designed for laparoscopic nephrectomy. Despite various new modifications of this entrapment system, it still represents one of the best alternatives and has been used worldwide with success. However, due to its simplicity it requires laparoscopic expertise. Newly developed retrieval systems (i.e. LapBagR, Extraction BagR) offer some advantages regarding the handling of the bag which may be particularly usetul during retroperitoneoscopic ne...