The experimental replacement of a cervical esophageal segment with an artificial prosthesis with the use of collagen matrix and a silicone stent Yukinobu.

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Presentation transcript:

The experimental replacement of a cervical esophageal segment with an artificial prosthesis with the use of collagen matrix and a silicone stent Yukinobu Takimoto, MD, Tatsuo Nakamura, MD, Yasumichi Yamamoto, MD, Tetsuya Kiyotani, MD, Masayoshi Teramachi, MD, Yasuhiko Shimizu, MD The Journal of Thoracic and Cardiovascular Surgery Volume 116, Issue 1, Pages 98-106 (July 1998) DOI: 10.1016/S0022-5223(98)70247-8 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Bilayered artificial esophagus consisting of collagen sponge and silicone. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 The operative procedures. A 5 cm long piece of esophagus was excised between the clamps and the artificial esophagus was anastomosed to the distal and proximal stumps. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 A, Regenerated esophagus 14 days after artificial esophagus implantation. Note the connective tissue. (Masson's trichrome stain, original magnification ×200.) B, The stent was removed 21 days after the operation, oral feeding was resumed, and the dog was put to death 3 days later. Note the regenerated esophageal glands. (Elastic van Gieson stain, original magnification ×100.) C, The stent was removed 21 days after the operation, oral feeding was resumed, and the dog was put to death 6 months later. Note the internal surface of the neoesophageal lumen. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 A, Regenerated esophagus 28 days after artificial esophagus implantation. Note the regenerated muscle tissue and inner circular and outer longitudinal muscle layers. (Masson's trichrome stain, original magnification ×100.) B, Regenerated esophagus 28 days after artificial esophagus implantation. The regenerated muscle tissue was immunostained by the antidesmin antibody, which specifically stains striated muscle fibers. (Original magnification ×400.) The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 A, Radiographs taken 12 months after implantation, showing no stenosis or shortening of the neoesophagus. Two arrowheads show the interposed area. B, Regenerated esophagus 3 months after artificial esophagus implantation. Note the regenerated esophagus (R) and the native esophagus (N). Two arrowheads show the distal and proximal stumps. (Masson's trichrome stain, original magnification ×1.) The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Cont'd. C, Regenerated esophagus 3 months after the operation. The mature striated muscle tissue has regenerated. D, Regenerated esophagus 12 months after artificial esophagus implantation. The regenerated esophagus is indistinguishable from the native esophagus. Two arrows show the distal and proximal stumps. The Journal of Thoracic and Cardiovascular Surgery 1998 116, 98-106DOI: (10.1016/S0022-5223(98)70247-8) Copyright © 1998 Mosby, Inc. Terms and Conditions