Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Uterine Cervical Neoplasms

Uterine Neoplasms

Genital Neoplasms, Female

Urogenital Neoplasms

Uterine Cervical Diseases

Uterine Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

All patients in the postoperative group will undergo computed tomography angiography (CTA) to evaluate the status of the preserved ascending branch and the residual uterine blood supply pattern after surgery.

Patients in the preoperative group will undergo CTA before RT to determine the uterine blood supply pattern in healthy individuals.

Huaiwu Lu

Purpose: To evaluate the clinical value of preserving the ascending branch of the uterine artery in improving the uterine blood supply after radical trachelectomy (RT). Method: This study will include 100 patients with early-stage cervical cancer, who undergo RT with the preservation of the ascending branch of the uterine artery. A new skill called the "cuff-sleeve" suture method is introduced to wrap the vagina around the stump cervix, wherein they are sutured using a 2-0 absorbable suture by placing two cross-stitches in the anterior and posterior wall, respectively, without piercing the cervical mucosa layer or damaging the uterine arteries. Study groups: The patients will be categorized into two groups. Patients in the postoperative group will undergo computed tomography angiography (CTA) after surgery and patients in the preoperative group will undergo CTA before RT. Data collection: Data regarding individual patient characteristics, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic subtype, lymphovascular space involvement (LVSI) status, recurrence, CTA data, fertility results, and obstetric outcomes will be collected for the patients in the postoperative group. The CTA findings of the preoperative group will be obtained. Statistical methods: Statistical analyses were performed using IBM SPSS Statistics, version 26. The t-test is used for analyzing the continuous variables and the chi-squared test for categorical variables.

Purpose: To evaluate the clinical value of preserving the ascending branch of the uterine artery in improving the uterine blood supply after radical trachelectomy (RT). Method: This study will include 100 patients with early-stage cervical cancer, who undergo RT with the preservation of the ascending branch of the uterine artery, at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The investigators attribute the uterine artery occlusion to the inevitable injury of the remaining uterine arteries during the ligation of the descending branch of the uterine artery and continuous or intermittent suturing. Hence, the investigators will carefully skeletonize the three branches of the uterine artery, ligates the vaginal and cervical branches, and preserves the ascending branch of the uterine artery under direct vision. Furthermore, a new skill called the "cuff-sleeve" suture method is introduced to wrap the vagina around the stump cervix, wherein they are sutured using a 2-0 absorbable suture by placing two cross-stitches in the anterior and posterior wall, respectively, without piercing the cervical mucosa layer or damaging the uterine arteries. Study groups: The patients will be categorized into two groups. All patients in the postoperative group will undergo computed tomography angiography (CTA) to evaluate the status of the preserved ascending branch and the residual uterine blood supply pattern after surgery. Patients in the preoperative group will undergo CTA before RT to determine the uterine blood supply pattern in healthy individuals. Data collection: Data regarding individual patient characteristics, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic subtype, lymphovascular space involvement (LVSI) status, recurrence, CTA data, fertility results, and obstetric outcomes will be collected for the patients in the postoperative group. The CTA findings of the preoperative group will be obtained. The CTA data are mainly analyzed to determine the arteries supplying the uterus. The investigators consider a vessel as a supplying artery only when it is continuous from its origin up to the entry into the uterus and then branches. The uterine blood supply in patients is divided into three patterns based on the supplying vessels. The first is the ovarian artery-supplying pattern, wherein the residual uterus is supplied only by the ovarian arteries. The second is the hybrid-supplying pattern, in which an ovarian artery or a newly formed artery supplied the residual uterus along with the contralateral uterine artery. The third is the uterine artery-supplying pattern, wherein the residual uterus is supplied only by the uterine arteries. Furthermore, the diameter of the visualized supplying vessels is recorded. The diameters of the uterine and newly formed arteries are measured 2 cm before they enter the corpus uteri. However, the ovarian artery diameter is measured at its origin from the aorta ventralis, beside the external iliac artery, and 2 cm before it enters the corpus uteri since the ovarian arteries are convoluted. Statistical methods: Statistical analyses were performed using IBM SPSS Statistics, version 26. The t-test is used for analyzing the continuous variables and the chi-squared test for categorical variables.

Clinical Value of the Fertility-preserving Surgery in Cervical Cancer

Clinical Value of the Fertility-preserving Surgery in Cervical Cancer -- the Feasibility of the 'Cuff-sleeve' Suture Method in the Ascending Branch of Uterine Artery Preserved Radical Trachelectomy

The first is the ovarian artery-supplying pattern, wherein the residual uterus is supplied only by the ovarian arteries. The second is the hybrid-supplying pattern, in which an ovarian artery or a newly formed artery supplied the residual uterus along with the contralateral uterine artery. The third is the uterine artery-supplying pattern, wherein the residual uterus is supplied only by the uterine arteries.

Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

Professor

Skin and Connective Tissue Diseases

Breast Neoplasms

Micronutrients

Anti-Infective Agents

All Drugs and Chemicals

Anti-Inflammatory Agents

Antirheumatic Agents

Analgesics

Iodine

Cadexomer iodine

Diclofenac

Diclofenac hydroxyethylpyrrolidine

Anti-Inflammatory Agents, Non-Steroidal

Analgesics, Non-Narcotic

Participants in this group underwent preoperative planning with a contrast-free magnetic resonance angiography (MRA) using an enhanced protocol that eliminates the use of potentially hazardous contrast agent and radiation exposure while providing high accuracy of visualization.

Control group. Participants in this group underwent preoperative planning using the standard commonly used method - computed tomography angiography (CTA) with IV (intravenous) iodine-containing contrast injection.

Device: MRA scan Philips Ingenia 1.5 T (Royal Philips, Netherlands)

Preprocedural patient's preparation: the study was performed on an empty stomach (at least 8 hours of fasting).

Type of patient positioning. MRA scanning was performed in the prone position.

Additional devices. The investigators placed the patient on her abdomen on a special coordinate system mesh, for the most precise and convenient way of marking.

Scanning protocol. The investigators added T2 pulse sequence to increase the accuracy of muscle localization assessment and the point of vessel immersion into the muscle at TR and TE using a fat suppression program, wich allows receiving information from moving objects (including blood within the vascular lumen).

Scan viewer program. OsiriX 10.0 Release

Non-contrast MRA in preoperative perforator vessels mapping for deep inferior epigastric perforator (DIEP) flap breast reconstruction planning.

Device: Device: Toshiba Aquilion 64 CTA scan machine (Toshiba Medical Systems, Tokyo, Japan).

Preprocedural patient's preparation: A catheter was placed in the antecubital vein of one arm, and a bolus injection of 80 ml contrast medium (Omnipaque 300 mg/ml, GE Healthcare, Oslo, Norway, registration number P N015799/01 from July 31, 2003, international nonproprietary name is a Iohexol) was administered through a power injector (M. Schilling GmbH Medical Products, Germany) at 4 ml/s.

Type of patient positioning. CTA scanning was performed in the supine position.

Scan viewer program. OsiriX 10.0 Release

CTA with iodine contrast in preoperative perforator vessels mapping for deep inferior epigastric perforator (DIEP) flap breast reconstruction planning.

Elina I. Abdeeva, MD

Elina I. Abdeeva, MD, PhD

Dmitry V. Melnikov

Elina I Abdeeva, MD

Dmitry V. Melnikov, MD, PhD

Semyon I. Ivanov, MD

Victor A. Gombolevskiy, MD, PhD

The aim of this study is to evaluate the efficacy and safety of contrast-free magnetic resonance angiography (MRA) for deep inferior epigastric perforator flap planning. The investigators propose to perform a non-contrast MRA to achieve the following extremely important objectives: to avoid radiation exposure, minimize the risk of potentially harmful effects of contrast agents, and reduce the cost of the study.The investigators assume that the use of non-contrast MRA following our protocol including certain patient's positioning, a special pulse scanning sequence and perforators' projection method is effective and allows mapping of perforators without injecting a potential harmful contrast agent.

Rationale. Contrast-free MRA is a new concept for preoperative planning in breast reconstruction that combines the advantages of magnetic resonance imaging (no ionising radiation exposure), requires no potentially harmful contrast agent, and at the same time is highly accurate.

Aim. The aim of the study is to evaluate the efficacy and safety of the contrast-free magnetic resonance angiography (MRA) for perforators mapping in deep inferior epigastric perforator flap planning.

Study design. A retro- and prospective non-randomised non-blinded cohort multicenter study is conducted at the at the Department of Plastic Surgery (Sechenov University, Moscow), and at the Department of Reconstructive and Plastic Surgery (Lancet Clinic, Moscow), with all patients recruited through a single surgical team and all imaging performed at a single institution.

Study population. The investigators plan to conduct a pilot phase of this study using non-contrast MRA in 100 patients and to compare imaging modalities used in deep inferior epigastric perforator flap breast reconstruction (computed tomography angiography with contrast, n=35 and non-contrast magnetic resonance angiography, n=100). Power analysis determine that no less than 35 patients in control group in this study considering 80 % power with 95 % significance. The first group (experimental, MRA "-" group) will be included patients who refused computed tomography angiography (CTA) with contrast due to a number of reasons such as fear of contrast agent administration, history of iodine allergy, fear of radiation exposure, etc was underwent MRA without contrast, and the second group (control, CTA "+" group) will be involved iodine-tolerance patients with healthy kidneys who underwent preoperative planning with a standard technique - CTA with IV iodine-containing contrast injection.

Interventions. Participants in first group (experimental, MRA "-" group) underwent preoperative planning with a contrast-free magnetic resonance angiography (MRA) using an improved contrast-free MRA protocol. MRA was performed on a magnetic resonance machine Philips Ingenia 1.5 T (Royal Philips, Netherlands). High accuracy is achieved by the following actions: certain preprocedural patient's preparation and positioning, special pulse scanning sequence and perforators projection method.

Preprocedural patient's preparation. The investigators added to the MRA protocol a requirement of performing the study on an empty stomach (at least 8 hours of fasting) in order to reduce gastrointestinal activity.

Modified type of patient positioning. The investigators suggest performing MRA scanning in the prone position in order to both limit abdominal wall movement (related to breathing, peristalsis, and aortic pulsation) and to provide the closest location of the target area (vessels) to the coil.

Furthermore, this move allowed to introduce a further trick that facilitated the surgeons' work at the marking stage: the investigators placed the patient on her abdomen on a 3D printed special mesh made of ABS (Acrylonitrile Butadiene Styrene) (the patent for invention № RU 2023118155). The mesh served as a coordinate system, crosshairs of which accommodate capsules with liquid (A), which allows obtaining on the image not only vessels but also all points of capsules to form a basic standardized mesh, coinciding on the image and on the patient's body that is necessary for the most precise and convenient way of marking.

Due to the image directly used for preoperative marking, the protocol of the MRA scans description was not used.

Special pulse sequence and additional series of MRA scans. MRA is performed on a magnetic resonance machine Philips Ingenia 1.5 T in the T2 pulse sequence (to increase the accuracy of muscle localization assessment and the point of vessel immersion into the muscle) at TR and TE using a fat-suppression program with no IV contrast injection, which allows receiving information from moving objects (including blood within the vascular lumen). The investigators have incorporated an additional series of T2 scans without fat suppression with high resolution (thickness of slices from 0.8 to 1.2 mm) and visualization of the muscle fibers, which allows us to determine the site where the vessels pierce the muscle, intramuscular course of the perforating vessels, and the topography of the area of interest with accurate determination of the perforating vessel relative to the anatomical landmarks.

Following scanning, the images were analysed by a plastic surgeon in the OsiriX 10.0 program. The main benefit of the images was extracted by creating multiplanar reconstructions (MPR) in Maximum Intensity Processing (MIP) mode. This mode allows the evaluation of the vessels in length, their lumen diameters and the study of their correlations and distances from each other for the purpose of target vessel selection.The MRA images required simultaneous evaluation in two planes: frontal and sagittal or frontal and axial. This allowed to the investigators to evaluate the localize the point of vessel immersion into the muscle, the extent and direction of the vessel in the muscle thickness and to localize the point of vessel penetration over the muscle with further direction of the vessel course and the point of communications between superficial and deep systems.

The second group participants (control, CTA "+"group) underwent the standard commonly used computed tomography angiography (CTA) IV (intravenous) iodine-containing contrast injection, and in the supine position. CTA was performed on a Toshiba Aquilion 64 CTA scan machine (Toshiba Medical Systems, Tokyo, Japan) according to the Research and Practical Center of Medical Radiology guidelines №12 from March 22, 2017.

Informed consent is obtained from each participant.

Main study parameters. The investigators plan to evaluate the results according to the following criteria: the concordance ratio, the overall operation time, the time of the pedicle cut, the length of the fascia incision, the intraoperative flap perfusion, the presence of early postoperative complications and their nature, the presence of emergent vascular revision surgery. In addition, the investigators plan to evaluate the following parameters: the flap ischemia time, the number of perforators included in the flap, the fact of superficial vein(s) inclusion in the flap, the length of the vascular pedicle.

All patients in both groups will be female.

Non-contrast Magnetic Resonance Angiography in Deep Inferior Epigastric Perforator Flap Breast Reconstruction Planning

Non-contrast Magnetic Resonance Angiography Efficacy and Safety Assessment for Perforators Mapping in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Due to the local ethics committee the investigators are unable to provide this data.

The investigators are use the information about each perforators' deviation (P1, P2, etc.) based on intraoperative finding (confirmation) and MRA or CTA data by more/less than 1 cm.

Intraoperatively, the surgeon determined the distance from the umbilicus to the perforator vessel (by dropping a perpendicular line from umbilicus) and the distance from the point marked on the marking according to the MRA or CTA data to the found perforator vessel. Measurements performed using a 200 mm surgical ruler (Devemed, Germany).

The total operating time including downtime.

The investigators plan to evaluate the time of the pedicle cut from the beginning of surgery and from flap harvest, for the right and left vascular pedicle individually.

Intraoperatively, the surgeon measured the fascia incision length using a 200 mm surgical ruler (Devemed, Germany).

The flap perfusion was assessed for capillary refill after the vascular pedicle clipping, after the vascular pedicle cutting, and at the end of the flap ischemia time (after the microvascular anastomosis formation) by applying mild pressure, using a hemostat handle. Pressure was then released and the flap observed for capillary refill. Refill was deemed positive if it occurred within 3 s.

The presence of flap necrosis was assessed during the first five days after surgery by evaluating capillary refill in thee flap and visually assessed the presence of the flap ischemia or necrosis as a percentage of the total flap.

Flap ischemia time was assessed from the time of vascular pedicle cutoff to completion of microvascular anastomosis formation ( up to the beginning of blood flow).

After flap harvesting, the surgeon measured the vascular pedicle length using a 200 mm surgical ruler (Devemed, Germany).

The investigators recorded the number of perforators included in the flap on each side of the flap.

The investigators recorded the fact of the superficial vein(s) inclusion in the flap, their number and localization (side of the flap).

I.M. Sechenov First Moscow State Medical University

Digestive System Diseases

Rare Diseases

Stomach Neoplasms

Stomach Cancer

The CTA group was peformed upper abdomen enhenced and CT Angiography before surgery

The CTA group was routinely peformed upper abdomen enhenced without CT Angiography before surgery

CT angiography（CTA）

Zhou Yanbing, MD

Meng Cheng, MD

Zhou Yanbing

Gastric cancer is one of the most common malignace worldwide, which caused a dramatically death rate, especially in east Asian, such as Japan , South Korea and China. Although the treatment of gastric cancer has a large improvement, such as radiotherapy, chemotherapy and immunotherapy, surgery is yet the mainstream method for the curable malignace without distant metastasis. As the innovation of treatment in gastric caner, laprascopic has gain its popularity owing to its equivalent oncologic outcomes, earlier oral feeding, shorten postopertative of hospital length,compared with open surgery. Depite it has several advantages, the defect of laparascopic surgery is still obvious, such as 2D surgical field, lack of inverse haptic feedback, Inflexible equipment.

D2 Lymph node dissection associated with laparascopic gastronomy is still regard as standard surgical procedure for the gastric cancer patient whose tumor stage was evaluated in advance stage. As we known that the distribution of lymph nod is accompanied with blood vessels, even for well-trained surgeon, the procedure lymph node dissection is a challenging and tough work. Computed Tomography Angiography(3D-CTA), as a emerging technology, is gradually receive the surgeon's attention for its remedy characteristic to the defect of laparascopic surgery, which can visually display the distribution and type of perigastric artery, resulting in decresing the difficulty and risk of surgery.

The aim of the study is to investigate the clinincal outcomes for the patient with BMI ≥25 kg/㎡who underwent laparascopic or robotic gastronomy using CTA to evaluate the type of perigastric artery.

Gastrointestinal Surgery Study Group 2001

Preoperative CTA to Evaluate the Influence of Gastric Artery Type on the Clinical Outcome of Gastric Cancer Patients With BMI≥25.0 kg/m2：A Multicenter Randomized Controlled Study

the harvest of lymph node during the gastronomy

the postoperative complications was defined as the complications related to the surgery or systematic,such as pneumonia,urinary tract infection

Time to first ambulation, flatus, liquid diet and so on

the 30-day mortality was defined as the death occurs related to the surgery or other occasions within 30 days

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Clinical Value of the Fertility-preserving Surgery in Cervical Cancer	NCT05806125	Cervical Cancer		20 Years - 45 Years	Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Non-contrast Magnetic Resonance Angiography in Deep Inferior Epigastric Perforator Flap Breast Reconstruction Planning	NCT06061835	Breast Cancer Postsurgical Ac...	Non-contrast MR... CTA with iodine...	18 Years - 70 Years	I.M. Sechenov First Moscow State Medical University
Gastrointestinal Surgery Study Group 2001	NCT04636099	Gastrostomy Computed Tomogr... Clinical Outcom...	CT angiography（...	18 Years - 75 Years	The Affiliated Hospital of Qingdao University
Clinical Value of the Fertility-preserving Surgery in Cervical Cancer	NCT05806125	Cervical Cancer		20 Years - 45 Years	Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

Spots Global Cancer Trial Database for computed tomography angiography