• Publication type
• Overall MeSH

Aim: To present on video our current most used technique of robot-assisted resection of renal tumour (RR). Material: We performed 274 RRs between June 2020 and November 2024. Our technique is based on a modification of conventional laparoscopic renal resection, of which we performed 599 between August 2004 and May 2020. RRs currently account for over one third of the surgical procedures for kidney cancer at our institution. Laparoscopic (rarely robotic assisted) nephrectomy is almost as frequent. Open resection accounts for about 17% and open nephrectomy for slightly less. Open resections are mainly indicated for more complex tumours, for tumors with significant \"toxic\" fat capsule, and when combined with other procedures, mostly for intestinal malignancies. RR is routinely performed by two console surgeons, occasionally by two additional ones. Operation technique: General anaesthesia. Optional urinary catheter inserted. Lateral position 60-70°. Upper limbs extended in front, close together. Operative field prepared for eventual lumbotomy. Transperitoneal approach. The capnoperitoneum is created with a Veres needle, CO2 pressure 12 mmHg. Assist port 12 mm slightly lateral to the umbilicus. Four 8-mm robotic ports are inserted pararectally under visual control. Four-arm daVinci Xi robotic system is inserted. Ports craniocaudally: 1. ProGrasp, 2. bipolar grasper (bipolar forceps Maryland or more often fenestrated) or monopolar curved scissors (Hot shears) according to the operated side and the dominant hand of the operator, 3. camera 30°, 4. the second of the mentioned instruments from port 2. The scissors are alternated with a needle driver, usually the Large SutureCut needle driver. In the Toldt line, the peritoneum is opened, the colon is retracted medially, and the Gerota fascia is opened medially from the kidney. The necessary part of the kidney is dissected from the fat capsule for good access to the tumour. The tumour is verified sonographically with a drop-in probe inserted through the assistant port. Scissors can be used to mark the line of resection on the kidney. The ureter is verified and the hilar vessels are released. The artery(s) or necessary branch is bypassed with tubing and clamped with the SCANLAN® robotic endo-bulldog. Only in central tumours is the vein also clamped. Knowledge of the topographic anatomy of the vessels from two-phase CT angiography is very helpful at this stage. The effectiveness of ischemia is verified by Doppler; exceptionally (especially in selective clamping of the artery branches) by NIR imaging with FireFly® with administration of indocyanine green - Verdye® 1.25-2.5 mg. The tumour is resected with cold scissors with a rim of healthy tissue. Suturing of the base is performed with an absorbable self-anchoring barbed suture (V-Loc® 90, size 3-0, 1/2 needle 26 mm). The edges of the kidney are mattress sutured with another suture, tightened with Absolok® AP300 absorbable clips (polydioxanone PDS, size ML) - \"sliding clips\" technique. The second layer of the parenchyma is sewn with simple continuation stitches, mostly without continuous anchoring. For more superficial tumours, a straight suture of the parenchyma is

• MeSH
• Laparoscopy MeSH
• Humans MeSH
• Kidney Neoplasms * surgery   MeSH
• Nephrectomy MeSH
• Robotic Surgical Procedures methods   MeSH
• Check Tag
• Humans MeSH

Ramanovu spektroskopii lze v chemii použít nejen k určování chemického složení, ale také pro získávání dalších informací o struktuře materiálu. Ve spektrech semikrystalických polymerů lze nalézt vzájemně odlišné pásy charakteristické pro krystalickou nebo amorfní fázi, stanovit z nich krystalinitu a z ní odhadnout míru degradace polymeru. V předložené studii byly vyhodnoceny změny raménka pásu na vlnočtu 1733 cm−1 v Ramanových spektrech vlákna z poly(p-dioxanonu) podrobeného hydrolytické degradaci. Pro různě dlouhé doby degradace byly vypočteny obsahy ploch pod raménkem tohoto pásu a též byl proveden jeho modelový rozklad na předpokládané píky krystalické a amorfní fáze. Obsahy ploch pod raménkem i parametry modelových píků byly porovnány s hodnotami krystalinity získanými pomocí diferenční skenovací kalorimetrie, přičemž bylo dosaženo dobré shody. Tato práce ukazuje příklad využití Ramanovy spektroskopie při studiu hydrolytické degradace polymerů.

Raman spectroscopy can be used in chemistry not just to determine chemical composition, but also to obtain further information on the material structure. In the spectra of semi-crystalline polymers, distinct bands characteristic of the crystalline or the amorphous phase can be found, the degree of crystallinity determined from them, and the degree of polymer degradation estimated from the crystallinity. In the present study, changes in the 1733 cm−1 band shoulder in Raman spectra of poly(p-di­oxanone) fibres subjected to hydrolytic degradation were evaluated. For different degradation periods, the areas under the shoulder of this band were calculated and a model deconvolution of this band into assumed crystalline and amorphous peaks was also performed. The areas under the shoulder, as well as the model peaks' parameters, were compared with the crystallinity values obtained by differential scanning calorimetry, achieving a good agreement. This work shows an example of using Raman spectroscopy when studying the hydrolytic degradation of polymers.

• MeSH
• Humans MeSH
• Polydioxanone chemistry   MeSH
• Polymers chemistry   MeSH
• Spectrum Analysis, Raman * methods   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between September 2013 and December 2022 at the Department of Respiratory Medicine of the 1st Faculty of Medicine in Prague and Thomayer University Hospital. The indications included functionally significant nonmalignant tracheal stenosis and tracheomalacia. Self-expandable, biodegradable, polydioxanone tracheal stents manufactured by ELLA-CS Ltd. (Hradec Kralove, Czech Republic) were implanted during rigid bronchoscopy under general anaesthesia. All patients were followed up in the department and were provided with the necessary care. The main efficacy and safety parameters and relationships were analysed using descriptive statistics and Fisher ́s exact, Wilcoxon and Kruskal‒Wallis tests. RESULTS: A total of 65 stents were implanted in 47 adult patients. During the first two months after implantation, when adequate function was expected, the stent was found to be effective in 26 out of 39 patients who completed this period (66.7%). The clinical effectiveness reached 89.7%, as early restenoses were mostly mild and necessitated treatment in only 4 patients. The frequencies of significant mucostasis, migration and granulation tissue growth were 2.6%, 7.5% and 23.1%, respectively, during this period. Thirty-four participants completed the half-year follow-up period after the first or second stent insertion, and some were followed up beyond this period. Poor control of symptoms, the development of restenosis and the need for interventions were characteristic of this period as the stents degraded. Twenty-two patients who experienced remodelling or stabilization of the tracheal lumen achieved a stent-free state. Seven patients underwent subsequent surgical treatment. CONCLUSIONS: BD stents are safe and provide adequate tracheal support until they begin to degrade. The use of BD stents necessitates close monitoring of patients and accurate treatment of possible restenosis. TRIAL REGISTRATION: Based on project NT14146 - Biodegradable stents in the management of the large airways (2013-2015, MZ0/NT), registered on May 1, 2013, in the Research and Development and Innovation Information System of the Czech Republic and at ClinicalTrials.gov (reg. no. NCT02620319, December 2, 2015).

• MeSH
• Bronchoscopy * MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Polydioxanone MeSH
• Prosthesis Design MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Tracheal Stenosis * surgery   MeSH
• Stents * MeSH
• Trachea surgery   MeSH
• Tracheomalacia surgery   MeSH
• Absorbable Implants * MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Biodegradable stents are promising treatments for many diseases, e.g., coronary artery disease, urethral diseases, tracheal diseases, and esophageal strictures. The mechanical properties of biodegradable stent materials play a key role in the safety and efficacy of treatment. In particular, insufficient creep resistance of the stent material could result in premature stent collapse or narrowing. Commercially available biodegradable self-expandable SX-ELLA stents made of polydioxanone monofilament were tested. A new, simple, and affordable method to measure the shear modulus of tiny viscoelastic wires is presented. The important mechanical parameters of the polydioxanone filament were obtained: the median Young's modulus was [Formula: see text] = 958 (922, 974) MPa and the shear modulus was [Formula: see text] = 357 (185, 387) MPa, resulting in a Poisson's ratio of ν = 0.34. The SX-ELLA stents exhibited significant force relaxation due to the stress relaxation of the polydioxanone monofilament, approximately 19% and 36% 10 min and 48 h after stent application, respectively. However, these results were expected, and the manufacturer and implanting clinician should be aware of the known behavior of these biodegradable materials. If possible, a biodegradable stent should be designed considering therapeutic force rather than initial force. Additionally, new and more advanced biodegradable shape-memory polymers should be considered for future study and use.

• MeSH
• Biocompatible Materials chemistry   MeSH
• Humans MeSH
• Mechanical Phenomena MeSH
• Elastic Modulus MeSH
• Polydioxanone chemistry   MeSH
• Prosthesis Design MeSH
• Stents * MeSH
• Materials Testing MeSH
• Absorbable Implants * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Aplikace kyseliny hyaluronové (HA) patří v dnešní době mezi nejčastější a řadí se mezi bezpečné zákroky estetické medicíny. Hydratuje pokožku, podporuje přirozené hojivé procesy, regene-ruje, je přirozeným antioxidantem, reguluje mazotok, vyrovnává nerovnosti kožního povrchu, vyplňuje vrásky. I když se jedná o látku bezpečnou, je nutné myslet i na nežádoucí účinky. Každý pacient je individuální a může reagovat různě. Další, stále častěji používanou metodou pro zlepšení vzhledu, nejen obličeje, je aplikace polydioxa-nonových (PDO) nití. Ve sdělení jsou popsány 2 případy komplikací u pacientek po podání kyseliny hyaluronové a po aplikací nití. Článek není věnován popisu látek a dělení materiálů.

The application of hyaluronic acid (HA) is one of the most frequent treatment of aesthetic medicine nowadays and is considered as safe procedure. It hydrates the skin, promotes natural healing processes, regenerates, is a natural antioxidant, regulates sebum, compensates for uneven skin surface, fills wrinkles. Even if it is safe filler, it is necessary to think about adverse drug effects. Each patient is individual and can respond differently.Another, increasingly used method to skin rejuvention, not only the face, is the application of polydioxano-ne (PDO) threads. There are two cases of pacients complications after application of hyaluronic acid and after application of PDO threads. The article is not devoted to the description of substances and materials.

• Keywords
• nosoretní rýhy, polydioxanové nitě,
• MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Gels administration & dosage   adverse effects   MeSH
• Granuloma chemically induced   surgery   MeSH
• Histological Techniques MeSH
• Adrenal Cortex Hormones administration & dosage   MeSH
• Skin pathology   MeSH
• Hyaluronic Acid administration & dosage   history   pharmacology   adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Drug-Related Side Effects and Adverse Reactions drug therapy   pathology   prevention & control   therapy   MeSH
• Face * pathology   MeSH
• Surgery, Plastic * adverse effects   MeSH
• Polydioxanone administration & dosage   MeSH
• Recurrence MeSH
• Rhytidoplasty methods   adverse effects   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Kniha vás fotografiemi a k nim vytvořenými obrazovými schématy provede současným spektrem nejužívanějších terapeutických a estetických postupů v periokulární oblasti. Nakladatelská anotace. Kráceno; Jedná se o první okuloplastickou monografii v českém jazyce. Je učena především oftalmologům a plastickým chirurgům, ale také lékařům dalších specializací, které zajímá daná problematika. Kniha vás fotografiemi a k nim vytvořenými obrazovými schématy provede současným spektrem nejužívanějších terapeutických a estetických postupů v periokulární oblasti. V první části probírá anatomii a topografii očních adnex, základní techniky šití a šicí materiály, chirurgické nástroje, anestezii, a možnosti chirurgického řešení j nejběžnějších afekcí. Dále je zaměřena „step by step“ na operační postupy, které řeší základní malpozice víček a rekonstrukci dané oblasti, s ohledem na výsledný kosmetický a funkční efekt. Samostatná část je věnována stávajícím trendům estetické chirurgie víček a obočí, ale i výhodám jejich miniinvazivních variant. V neposlední řadě seznámí čtenáře s využitím výplňových materiálů a toxinů a s technikami a schématy jejich aplikace v rámci postupů korektivní dermatologie.

• MeSH
• Eyelids surgery   MeSH
• Ophthalmologic Surgical Procedures MeSH
• Surgery, Plastic MeSH
• Publication type
• Handbook MeSH

• Conspectus
• Ortopedie. Chirurgie. Oftalmologie
• NML Fields
• plastická chirurgie

BACKGROUND: The most common biliary complications after orthotopic liver transplantation are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dysfunction. These complications can occur in up to 10% to 30% of liver transplant recipients. Leaks occur early in the posttransplant period; the stricture formation typically graduates over time. METHODS: Ten patients underwent transplantation in our preliminary study: 5 were randomized to the group with stent placement and 5 to the control group. We investigated the role of an absorbable biliary stent with the goal of proving patency of duct-to-duct biliary anastomosis. The stents are made of machine-knitted polydioxanone monofilaments. RESULTS: Our initial results show that duct-to-duct biliary reconstruction using an absorbable internal stent had good patency in all 5 patients. There were no signs of biliary leakage accompanying the anastomoses in any of the cases, and there was no stone formation observed after liver transplantation. The biliary stent was completely absorbed, with no adverse effects. CONCLUSIONS: Based on our initial experience and data, we concluded that biodegradable stents can be successfully and safely used in clinical practice. Further large prospective randomized studies are needed to estimate the efficacy of the bioabsorbable stents.

• MeSH
• Anastomosis, Surgical instrumentation   methods   MeSH
• Biliary Tract Surgical Procedures instrumentation   methods   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Aged MeSH
• Stents * MeSH
• Liver Transplantation methods   MeSH
• Absorbable Implants * MeSH
• Treatment Outcome MeSH
• Bile Ducts surgery   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Nerandomizovaná prospektivní intervenční studie šetřící použitelnost a efektivitu biodegradabilních polydioxanonových stentů v léčbě stenóz trachey a hlavních bronchů. Navazuje na výsledky s polydioxanonovými stenty užitými v minulosti k mechanické podpoře různých dutých orgánů včetně dýchacích cest. Indikační kritéria k použití biodegradabilních stentů v trachee a hlavních bronších jsou na rozdíl od předchozích studií širší – jde o funkčně významnou stenózu benigní i maligní etiologie při existenci indikace léčby stentem. Plánováno zařazení 30 – 50 pacientů. Studie zahrnuje pravidelné sledování nemocných se zavedeným stentem v participujících centrech, analýzu klinického a funkčního efektu, analýzu vývoje endoskopického obrazu, analýzu případných nežádoucích účinků, statistické zhodnocení výsledků a jejich publikaci v českých a zahraničních odborných periodicích. Předpokládá potvrzení efektivity stentů a výhledově zavedení metody do klinické praxe.; Non-randomized prospective interventional study will investigate the efficacy of biodegradable polydioxanone stents in the treatment of tracheobronchial stenoses. It is based on previous experience with polydioxanone stents used as the mechanical support of various hollow organs including the airways. In contrast to previous studies the indication criteria are wide – serious tracheobronchial stenoses of any origin when the stent placement is found to be the primary therapeutic option. We intend to enroll 30 – 50 patients. Study comprises analysis of clinical data in participating centers, analysis of functional, radiological and endoscopic parameters, investigation of possible side-effects, statistical analysis of results and their publishing in the Czech and foreign scientific press. We assume proving of efficacy and introduction of the method into the general practice

• MeSH
• Biocompatible Materials MeSH
• Bronchoscopy MeSH
• Endoscopy MeSH
• Polydioxanone MeSH
• Tracheal Stenosis MeSH
• Stents MeSH
• Materials Testing MeSH
• Absorbable Implants MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• pneumologie a ftizeologie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

BACKGROUND: Biodegradable stents that disintegrate after a period of time are expected to be well tolerated and have advantages over other stents that are more commonly used in practice today. Polydioxanone is a biodegradable polymer that is widely used during surgery with absorbable sutures. METHODS: We present cases from the first four patients to undergo a tracheal polydioxanone stent insertion. Indications included significant non-malignant tracheal stenosis in cases where primary surgical treatment was not possible. The stents were implanted using rigid bronchoscopy and patients received regular follow-ups as needed. This use of biodegradable stents in adult patients was a novel, previously untested approach. The study was approved by the Institutional Ethics Committee and was based on a project entitled; "Biodegradable stents in the management of stenoses of large airways" (project NT 14146-3/2013). RESULTS: Six biodegradable stents were implanted in four patients with benign stenoses. No technical difficulties occurred and no serious or life-threatening events were recorded. All patients reported some benefit from treatment. CONCLUSION: Polydioxanone tracheal stents can be considered when a need for temporary support is expected, and as an alternative to other stents if the latter could compromise the patient. Owing to limited experience and observed disadvantages, further research is needed to fully assess this treatment. TRIAL REGISTRATION: This work is based on project NT14146 - Biodegradable stents in the management of stenoses of the large airways (2013-2015, MZ0/NT), registered from May 1, 2013 in The Research and Development and Innovation Information System of the Czech Republic and in ClinicalTrials.gov, reg. no. NCT02620319, December 2, 2015.

• MeSH
• Biocompatible Materials chemistry   MeSH
• Bronchoscopy MeSH
• Middle Aged MeSH
• Humans MeSH
• Polydioxanone chemistry   MeSH
• Aged MeSH
• Tracheal Stenosis surgery   MeSH
• Stents classification   MeSH
• Trachea surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH