in the protocol for clinical tests

RNDr. Vratislav HorŠk, CSc

Attachment # 1 to the "Request for starting clinical tests of devitalization technique in healing malign tumors" handed over to the Czech Ministry of Health by Drs. Fortżn and HorŠk  on October 30, 2000
Translation from the Czech original by Martin Tlusty.

Devitalization is: such a surgical procedure, which influences  s p e c i f i c a l l y  the vascular system of certain organ or tissue, and results in closing of both arterial and venous circulation. This way the tissue circulation is cut out together with its supply by nutrition and oxygen. Devitalization displays at the same time an analgesic effect, because the nerve endings are loosing conductivity for the painful stimulus from the devitalized territory, due to its ischemia.

Concerning performance of the Devitalization technique, it is necessary to stress necessity of a concurrent obstruction of both, artery and vein (or at least obstruction of one after another within the short time period). By Devitalization it should never be meant: obstruction of the artery only via its embolization, performed sometimes. This procedure causes an arterial spastic contracture accompanied with the strong pain, in the influenced area. The full obstruction of the blood circulation is not reached anyway, because the venous reflux is sufficient for transport of a certain amount of oxygenated blood, what leads to the partial survival of the tissue. Confusion of embolization with Devitalization, which is sometimes indicated, combines thus two, in fact different patho-anatomical and patho-physiological phenomena, which have profoundly different effect on organism !

From the point of view of indications for use of the Devitalization operation technique, it is necessary to emphasize that the optimal situation is when Devitalization is performed r i g h t away during the first operation (i.e. when the Devitalization treatment is not postponed to the later time and to the relaparotomy).
The physical and psychic condition of the patient is also important.
The condition, when the tumor considerably expanded and multiple metastases occurred, are somewhat reducing the hope for curative impact of Devitalization.
The situation, where there is generalization of the tumorous process and creation of ascitus (at carcinosis of peritoneum), is insolvable by Devitalization technique (as well as by other curative methods used in the clinical practice).
The Devitalization technique will not be usable also at patients, who went through the previous unsuccessful actino-therapy or chemotherapy. These treatments damage (besides the tumor cells) also cells of the immune system, whose sufficiently high functionality is essential for triggering the curative impact after application of the Devitalization treatment.

Notes to the technique for performance of Devitalization:

The operator must have a detailed anatomical knowledge of the organ or tissue to be Devitalized. For accomplishment of devitalization, the l i g a t u r e of blood vessels (both of arteries and of veins) may be used. Also the devitalizating sutures (mattress sutures inserted specifically to the exact place) obstructing reliably the nutritive vessels at the tumor base (e.g. of melanoma).
In the case of hardly accessible, or extra large primary tumor, the Devitalization treatment can be performed on the lymphatic nodes with metastases (melanoma, carcinoma).
The insertable ligature is inserted at one edge of the node. Then the node is circled by one thread, which is then knotted after its firm tightening.
In the cases of metastases in the liver (e.g. carcinoma) the Devitalization can be performed also by the mattress sutures, which should involve the whole area of metastasis.

For performance of the Devitalization treatment, only the non-absorbable suture material (silon, oxsilon, or silk) should be used.