Double-stapling technique for transhiatal distal esophageal resection: feasibility test in a cadaver model

OBJECTIVES

To assess the feasibility of a new surgical technique for the resection of the distal third of the esophagus and/or cardias for neoplasm.

METHODS

This surgical technique consists of two steps: For this purpose we built a stainless steel support bar for the anvil that is thinner than the freespace of a standard linear suturing stapler (TATM). The support bar holds up a push rod that can be adapted to the hooking-unhooking of the anvil.

RESULTS

We performed our new technique on five cadavers. We did not encounter any difficulty during the procedures. We tested the anastomosis with hydropneumatic assessment without recording any leaks. The esophago-enteric anastomosis was then opened without finding any mechanical defects related to the procedure.

CONCLUSION

It can often be very difficult to fashion a safe hand-sewn pouch or a purse string around the anvil of an EEATM during the resection of the distal third of the esophagus or the cardias by a trans-hiatal approach. Moreover, there is no standardized procedure to minimize anastomotic leak. To avoid these mechanical problems we designed this innovative procedure, which is considered to be reproducible without significant training.

Use of coagulant spray glue (Glubran 2) for aerostatic purposes in pulmonary parenchyma resections in pigs: a preliminary study

BACKGROUND

The aim of our study was to test the aerostatic validity of a cyan-acrylic glue (Glubran 2), applied by means of a spray catheter, on an experimental pig model.

MATERIALS AND METHODS

15 young pigs were divided into three study groups of 5 based on surgical techniques: (1) atypical pulmonary resection with mechanical suturing and reinforcement with continuous suturing; (2) resection of the pulmonary parenchyma with a cold scalpel, followed by local application of Glubran 2; (3) atypical pulmonary resection with mechanical suturing followed by application of Glubran 2.

RESULTS

The mean aerostasis time was calculated at 3.5 +/- 1.26 s. The histopathological analysis did not show any particular differences when comparing the effects of the treatments carried out with Glubran 2 spray glue and the standard treatments. No statistically significant differences were recorded in the short- and medium-term survival of pigs treated with Glubran 2 compared with the respective control groups.

CONCLUSIONS

The application of Glubran 2 spray on wounds caused by pulmonary resections in pigs proved to have a rapid and effective influence for the purposes of aerostasis without significant differences in air losses and survivals.

An adaptive neural network admission controller for dynamic bandwidth allocation

In an access node to a hybrid-switching network (e.g., a base station handling the downlink in a cellular wireless network), the output link bandwidth is dynamically shared between isochronous (guaranteed bandwidth) and asynchronous traffic types. The bandwidth allocation is effected by an admission controller, whose goal is to minimize the refusal rate of connection requests as well as the loss probability of packets queued in a finite buffer. Optimal admission control strategies are approximated by means of backpropagation feedforward neural networks, acting on the embedded Markov chain of the connection dynamics. The case of unknown, slowly varying, input rates is explicitly considered. Numerical results are presented, comparing the approximation with the optimal solution obtained by dynamic programming.