1. Non-invasive and continuous intra-abdominal pressure assessment using MC sensorsBoštjan Plešnik, Mihajlo Djokić, Srdjan Djordjević, Simon Krašna, Jan Žumer, Blaž Trotovšek, 2025, original scientific article Abstract: Monitoring intra-abdominal pressure (IAP) in critical care patients is crucial for preventing intra- abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), with their severe consequences. The muscle contraction sensor (MC) introduced in this study offers a novel, non-invasive method with promising accuracy based on previous findings. This study further evaluates the MC accuracy and reproducibility and examines its correlation with objective IAP measurements obtained through a ▫$CO_2$▫ insufflator. We enrolled 41 patients undergoing elective laparoscopic gallbladder removal under general anesthesia with complete muscle relaxation. Two MC sensors were placed on the right and left sides of the abdomen, and elevated IAP was induced by insufflating ▫$CO_2$▫ into the peritoneal cavity. IAP measurements from the MC sensors were compared to the randomized IAP values set on the ▫$CO_2$▫ insufflator. Data from both methods were analyzed to assess the accuracy and agreement with the insufflator measurements. The MC sensor provided continuous and accurate detection of IAP changes. A Pearson correlation coefficient of 0.963 indicated a strong positive linear correlation between the MC sensor readings and the IAP values set on the insufflator. The coefficient of determination (▫$R^2$▫) was 0.927, showing that the model explains 92.7% of the variation in IAP values based on the MC sensor signals. Receiver operating characteristic analysis demonstrated that the MC sensor system performed exceptionally well in identifying both IAH and ACS cases, with an area under the curve of 0.996 for IAH and 0.981 for ACS. The study introduces a transcutaneous pressure measuring device as an innovative, non-invasive method for assessing IAP. The system strongly correlates with IAP values measured by ▫$CO_2$▫ insufflation, indicating its accuracy. It thus could present an alternative to conventional IAP measurement in the future. The MC capability to deliver real-time, continuous data holds substantial potential for proactive patient care. By incorporating advanced analytics like machine learning, the system could detect trends and provide early warnings of dangerous IAP changes, enabling timely, targeted interventions to enhance outcomes for critically ill patients.
Keywords: intra-abdominal pressure, transcutaneous sensor, non-invasive measurement, abdominal compartment syndrome
Published in DiRROS: 20.04.2026; Views: 121; Downloads: 81
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2. Primary hepatic mucosa-associated B-cell lymphoma in a patient with primary sclerosing cholangitis : a case ultimately requiring liver transplantationJerica Novak, Mihajlo Djokić, Miha Petrič, Diana Vozlič, Milanka Živanović, Branislava Ranković, Blaž Trotovšek, 2025, original scientific article Abstract: Background: Primary hepatic extranodal marginal zone lymphoma of mucosa-associated type (MALT) is an extremely rare liver neoplasm. The lesions are often misdiagnosed for the most common primary hepatic malignancy, such as hepatocellular carcinoma and cholangiocarcinoma. As the diagnosis is most often made after the resection, there are still no clear guidelines for the optimal treatment of these patients. Case Presentation: A 30-year-old male patient with known primary sclerosing cholangitis (PSC) was treated at the Department of Abdominal Surgery Ljubljana due to a mass in the right liver, believed to be an intrahepatic cholangiocarcinoma. Due to the extent of the disease, extended right hepatectomy with the resection of the hepatocholedochus, lymphadenectomy, and hepaticojejunal anastomosis were performed. After the surgery, the patient developed a small-for-size syndrome and therefore necessitated a liver transplantation (LT) that was afterwards successfully performed. Discussion: This case highlights the diagnostic challenges of differentiating primary hepatic MALT lymphoma from cholangiocarcinoma on imaging, especially in patients with underlying liver disease. Preoperative confirmation of the malignant disease could potentially change treatment course in our patient. Therefore, a serious surgical complication with development of small-for-size syndrome after major hepatectomy could potentially be prevented. Regarding the underlying liver disease, the patient could probably be a candidate for LT with the bridging chemotherapy. Conclusions: Primary hepatic MALT lymphoma is an extremely rare liver lesion but remains a valid option in a differential diagnosis of liver lesions in patients with chronic viral infection or autoimmune disease, especially in settings of cirrhosis. Moreover, a high level of suspicion must be raised in young patients with solitary liver mass and autoimmune liver disease. Surgical resection is the best way to achieve elimination of the disease.
Keywords: primary MALT lymphoma, liver, primary sclerosing cholangitis, small-for-size syndrome, liver transplantation
Published in DiRROS: 10.04.2026; Views: 183; Downloads: 59
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3. Single-port laparoscopic hepatectomy : Slovenian single-center experienceJerica Novak, Miha Petrič, Blaž Trotovšek, Mihajlo Djokić, 2025, original scientific article Abstract: Abstract Background: Single-port laparoscopic hepatectomy is a minimally invasive modality for the treatment of benign and malignant liver lesions. Due to the method’s technical challenges, it is suitable for experienced hepatobiliary surgeons and selected groups of patients. The aim of this study was to evaluate the results of a single Slovenian center performing single-port laparoscopic hepatectomy with a literature overview. Methods: A single-center retrospective consecutive case series of the twenty-six patients with liver disease operated with the single-port technique from January 2018 to July 2024 at the Department of Abdominal Surgery at the University Medical Centre, Ljubljana, was performed. Lesions were located in easy-to-treat segments. Operative time, conversion rate, length of hospital stay, and surgical complications were recorded and evaluated. Results: We performed twenty-six single-port laparoscopic liver resections (median age 63.5, range 31 to 79 years). The mean operative time was 92 ± 31 min. None of the cases were converted to multi-port laparoscopic or open surgery. Safe resection margins were obtained in cases of malignant disease. The mean hospital stay was 4 days. The post-operative complication rate involving intervention was 7% (2/26). The incisional hernia rate was 11.5% (3/26). No life-threatening surgical complications or morbidity were noted. Conclusions: Single-port laparoscopic hepatectomy is a safe and feasible technique for the resection of benign and malignant liver lesions in the hands of skilled and well-trained hepatobiliary surgeons.
Keywords: hepatectomy, minimally invasive hepatobiliary surgery, single-port laparoscopy
Published in DiRROS: 10.03.2026; Views: 279; Downloads: 175
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4. Krožne RNA in hepatocelularni karcinomHana Trček, Benjamin Bajželj, Rok Razpotnik, Blaž Trotovšek, Arpad Ivanecz, Miha Petrič, Mihajlo Djokić, Boštjan Plešnik, Irena Plahuta, Martin Zaplotnik, Linda Cellner, Rado Janša, Robert Vidmar, Marko Fonović, Uršula Prosenc Zmrzljak, Petra Hudler, Damjana Rozman, Tadeja Režen, 2024, published scientific conference contribution abstract Keywords: krožne RNA, hepatocelularni karcinom, onkologija
Published in DiRROS: 25.02.2026; Views: 384; Downloads: 110
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5. L-FABP as a potential biomolecular marker of liver graft injuryAna Kalamutova, Danaja Plevel, Mihajlo Djokić, Aleš Jerin, Blaž Trotovšek, Miha Petrič, 2025, original scientific article Abstract: Background: In recent years, indications for liver transplantation have expanded, while the age of transplant recipients has significantly increased due to improvements in perioperative management. As clinical manifestations of posttransplant complications vary and are often nonspecific, the identification of appropriate biomarkers is important for the assessment of graft quality and early recognition of potential complications following liver transplantation. Liver-type FABP (L-FABP) is a small cytoplasmic protein found abundantly in hepatocytes and is involved in the intracellular transport of long-chain fatty acids. Elevated serum levels have been detected in acute and chronic liver failure, kidney failure, and some malignancies. Materials and Methods: We conducted a prospective, single-center study from July 2023 to January 2025, including 29 adult patients who underwent deceased-donor transplantation. Three patients were excluded due to inadequate sample withdrawals. Serum L-FABP was measured preoperatively and on postoperative days 1, 3, 5, 7, and 14. Clinical, surgical, and biochemical data were collected and analyzed using non-parametric statistical tests. Results: L-FABP levels were significantly higher on POD 7 in recipients of grafts from donors ≥ 65 years (p = 0.035), with no corresponding changes in standard liver function markers. While no significant differences in L-FABP levels were found between patients with and without infectious biliary or vascular complications (all p > 0.05), we proved a strong negative correlation between intraoperative blood transfusion volume and L-FABP levels on POD 5 (ρ = −0.677, p < 0.001) and POD 7 (ρ = −0.455, p = 0.025). Conclusions: Our findings suggest that L-FABP holds promise as a biomarker for the early detection of subclinical hepatic graft cellular injury, which is not detected by means of conventional biomarkers for liver function.
Keywords: liver transplantation, biomarker, L-FABP, hepatic graft injury, marginal liver graft
Published in DiRROS: 11.12.2025; Views: 449; Downloads: 306
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6. Evaluation of methylene blue solution distribution in the four-point transversus abdominis plane block technique in pigs : a pilot anatomical studyJerneja Sredenšek, Jana Brankovič, Urša Lampreht Tratar, Maja Čemažar, Mihajlo Djokić, Alenka Seliškar, 2025, original scientific article Abstract: Aim: This prospective pilot anatomical study aimed to develop an ultrasoundguided transversus abdominis plane (TAP) block technique that desensitises cranial and mid-abdominal wall in grower pigs. We hypothesised that a fourpoint TAP approach would be more efficient than a three-point TAP in staining relevant nerves of the cranial and mid-abdominal wall. Methods: In phase I, the ultrasound anatomy of the abdominal wall musculature was examined on three pig cadavers (two piglets and one fattening pig) and the ultrasound localization of the needle in the corresponding interfascial plane was practised. In phase II, a three-point TAP injection was performed in three freshly euthanized cadavers of grower pigs. A 1% methylene blue solution (0.3 mL/ kg per injection point) was injected between the transversus abdominis and internal oblique muscle. In phase III, methylene blue solution was injected at four points (0.2 mL/kg per injection point) in four anaesthetized grower pigs prior to euthanasia. Positive nerve staining was defined as continuous staining of at least 1 cm of the nerve length. Binary variables (positive/negative) were used for nerve staining assessment. Results: The four-point TAP technique with a lower injection volume stained more nerves than the three-point technique with a higher injection volume, i.e., 69% of the observed nerves from the eighth-last thoracic to the third lumbar nerve were stained with the four-point TAP technique. The nerves in the centre were stained with a higher success rate, while the eighth-last thoracic and the second lumbar nerve were stained with less success (1/8 and 3/8, respectively). The third lumbar nerve was not stained. Conclusion: The four-point TAP technique could be used as part of a multimodal analgesia approach for cranial and mid-abdominal surgery in pigs, but live animal studies are needed to evaluate the clinical applicability and efficacy of desensitisation.
Keywords: abdominal surgery, cadaveric anatomical study, pig, regional anaesthesia, transversus abdominis plane block, methylene blue
Published in DiRROS: 09.12.2025; Views: 934; Downloads: 235
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7. Influence of pancreas transection with cavitron ultrasonic surgical aspirator (CUSA) on incidence of postoperative pancreatic fistula after pancreatoduodenectomy (PANCUT) : study protocol for a randomised controlled trialBenjamin Hadžialjević, Hana Zavrtanik Čarni, Miha Petrič, Mihajlo Djokić, Blaž Trotovšek, Aleš Tomažič, David Badovinac, 2025, original scientific article Abstract: Background: Complications after pancreatoduodenectomy occur in up to 40% of patients. Postoperative pancreatic fistula (POPF) remains the most common complication after pancreatoduodenectomy and is associated with increased postoperative mortality. The cavitron ultrasonic surgical aspirator (CUSA) is a surgical instrument commonly used in liver and neurosurgery. The CUSA selectively dissects tissue parenchyma, leaving blood vessels and bile ducts undamaged, which are then selectively ligated or clipped. Only a few studies have investigated the relationship between the transection of pancreatic tissue with CUSA and the formation of POPF. The results were inconsistent and were published before the updated ISGPS consensus on the definition of POPF. Methods: The PANCUT study is a randomised controlled trial initiated at the Department of Abdominal Surgery, University Medical Centre Ljubljana. The aim of the study is to determine whether precise dissection of the pancreatic tissue with CUSA reduces the incidence of POPF. Patients scheduled for pancreatoduodenectomy will be randomly assigned to either the experimental group, in which the pancreatic tissue will be dissected with CUSA, or the control group, in which pancreas will be conventionally transected with scalpel. A total of 180 patients will be included in the study. The primary endpoint is the formation of POPF. Secondary endpoints include operation time, amount of intraoperative blood loss, postoperative infectious complications, postoperative bleeding, length of hospital stay and mortality. Discussion: To our knowledge, the PANCUT study is the first randomized controlled trial to investigate the role of CUSA in the transection of pancreatic tissue during pancreatoduodenectomy. Trial registration: ClinicalTrials.gov NCT06135012. Registered on 18 November 2023.
Keywords: pancreatic fistula, postoperative complications, pancreas resection, cusa, pancreatoduodenectomy, pancreatic ducts
Published in DiRROS: 26.11.2025; Views: 976; Downloads: 311
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9. Percutaneous image guided electrochemotherapy of hepatocellular carcinoma : technological advancementMihajlo Djokić, Rok Dežman, Maja Čemažar, Miha Štabuc, Miha Petrič, Lojze Šmid, Rado Janša, Boštjan Plešnik, Maša Omerzel, Urša Lampreht Tratar, Blaž Trotovšek, Bor Kos, Damijan Miklavčič, Gregor Serša, Peter Popović, 2020, original scientific article Abstract: Background. Electrochemotherapy is an effective treatment of colorectal liver metastases and hepatocellular carcinoma (HCC) during open surgery. The minimally invasive percutaneous approach of electrochemotherapy has already been performed but not on HCC. The aim of this study was to demonstrate the feasibility, safety and effectiveness of electrochemotherapy with percutaneous approach on HCC. Patient and methods. The patient had undergone the transarterial chemoembolization and microwave ablation of multifocal HCC in segments III, V and VI. In follow-up a new lesion was identified in segment III, and recognized by multidisciplinary team to be suitable for minimally invasive percutaneous electrochemotherapy. The treatment was performed with long needle electrodes inserted by the aid of image guidance. Results. The insertion of electrodes was feasible, and the treatment proved safe and effective, as demonstrated by control magnetic resonance imaging. Conclusions. Minimally invasive, image guided percutaneous electrochemotherapy is feasible, safe and effective in treatment of HCC.
Keywords: electrochemotherapy, hepatocellular carcinoma, percutaneous, minimally invasive
Published in DiRROS: 12.07.2024; Views: 1266; Downloads: 526
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10. Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapyNina Boc, Ibrahim Edhemović, Bor Kos, Maja Marolt-Mušič, Erik Brecelj, Blaž Trotovšek, Maša Omerzel, Mihajlo Djokić, Damijan Miklavčič, Maja Čemažar, Gregor Serša, 2018, original scientific article Abstract: The aim of the study was to characterize ultrasonographic (US) findings during and after electrochemotherapy of liver tumors to determine the actual ablation zone and to verify the coverage of the treated tumor with a sufficiently strong electric field for effective electrochemotherapy. Patients and methods. US findings from two representative patients that describe immediate and delayed tumor changes after electrochemotherapy of colorectal liver metastases are presented. Results. The US findings were interrelated with magnetic resonance imaging (MRI). Electrochemotherapy-treated tumors were exposed to electric pulses based on computational treatment planning. The US findings indicate immediate appearance of hyperechogenic microbubbles along the electrode tracks. Within minutes, the tumors became evenly hyperechogenic, and simultaneously, an oedematous rim was formed presenting as a hypoechogenic formation which persisted for several hours after treatment. The US findings overlapped with computed electric field distribution in the treated tissue, indicating adequate coverage of tumors with sufficiently strong electric field, which may predict an effective treatment outcome. Conclusions. US provides a tool for assessment of appropriate electrode insertion for intraoperative electrochemotherapy of liver tumors and assessment of the appropriate coverage of a tumor with a sufficiently strong electric field and can serve as predictor of the response of tumors.
Keywords: elctrochemotherapy, ultrasound, treatment plan, liver
Published in DiRROS: 11.06.2024; Views: 1400; Downloads: 460
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