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Anastomosis using complete continuous suture in uniportal video-assisted thoraco

Authors: Minim Invasive Surg Oncol

Anastomosis using complete continuous suture in uniportal video-assisted thoraco

Zhengcheng Liu, Rusong Yang, Feng Shao
Department of Thoracic Surgery, Nanjing Chest Hospital Affilated to Southeast University School of Medicine, Nanjing, 210029, People’s Republic of China
Correspondence to:  Yang Rusong, MD, Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, Jiangsu Province, 210029, People’s Republic of China, Tel: +86-13951677109, Fax: +86-025-83728558, E-mail:
Objective: To describe complete continuous suture used in bronchial anastomosis in uniportal video-assisted thoracoscopic (VATS) bronchial sleeve lobectomy.
Methods: Seven uniportal VATS bronchial sleeve lobectomy were performed from November 2014 to April 2016 and successfully completed. 3-0 prolene continuous sutures were used to close the bronchial membrane and cartilage. Traction sutures were used to help anastomosis.
Results: The mean surgical time was 201.7 minute, and mean blood loss was 120.0ml. Patient underwent operation successfully. Postoperative bronchoscopy and virtual bronchoscope confirmed no stenosis.
Conclusion: Complete continuous suture was suitable for bronchial anastomosis in uniportal video-assisted thoracoscopic bronchial sleeve lobectomy.
Keywords: uniportal video-assisted thoracoscopic surgery, sleeve lobectomy, continuous suture
Cite this article as: Liu Z, Yang R, Shao F. Anastomosis using complete continuous suture in uniportal video-assisted thoracoscopic bronchial sleeve lobectomy. Minim Invasive Surg Oncol, 2017; 1(1): 31-42.

Thoracotomy is the traditional way to perform a bronchial sleeve lobectomy, but it also can be performed by video-assisted thoracic surgery (VATS). The worldwide experience with VATS lobectomy is now suffciently large enough to compare this procedure with open thoracotomy. Multiple interrupted sutures or mixed with continuous sutures are preferred in bronchial anastomosis, but it can be done using complete continuous suture [1-3]. Most of the complex resections use 2 to 4 incisions, it could also be done using only 1 incision [4, 5]. We report on uniportal VATS bronchial sleeve lobectomy using continuous suture in bronchial anastomosis.
Patients and Methods
Patient Selection
This retrospective study was approved by the institutional review board, and all patients provided written informed consent before operation. Seven uniportal VATS bronchial sleeve lobectomy were attempted from November 2014 to April 2016 and successfully completed, including four cases of right upper lobe (RUL) bronchial sleeve lobectomy, two cases of left upper lobe (LUL) sleeve lobectomy, one case of left lower lobe (LLL) sleeve lobectomy. During that time, 1056 patients were treated surgically for NSCLC, with 827 treated by VATS-approach, 34 sleeve resections underwent thoracotomy, 5 sleeve resections underwent three-port VATS with one conversion to thoracotomy for pulmonary artery bleeding.
Preoperative evaluation included a computed tomographic scan of the chest, cranial magnetic resonance, fiberoptic bronchoscopy, and pulmonary function tests with diffusion capacity. Preoperative clinical tumor stage and other clinical characters were listed in table1. The sleeve resections were planned prior to surgery.
Incision Placement
Surgery was performed under general anesthesia in the lateral decubitus position with single-lung ventilation. Both the surgeon and the assistant who maneuvered the thoracoscope stood anteriorly facing the patient, and a second assistant stood posteriorly. A single incision of approximately 3cm was made in an intercostal space along the anterior axillary line through the fifth intercostal space. Plastic wound protector (Johnson & Johnson, New Brunswick, NJ) was used to stretch open the incision.
Standard minimally invasive instruments for VATS were used. A 10-mm 30-degree thoracoscope (Karl Storz) was inserted. The thoracoscope and several thoracoscopic instruments were simultaneously fitted into the uniport. No additional skin incisions or counter-incisions were made for any purpose such as placement of thoracoscope, graspers, or drains. Ribs were not spread, resected, or fractured during the operation, and there was strict avoidance of metallic retraction. It is very important to keep the camera in the posterior part of the incision, a gauze sling around the thoracoscope was used to maintain the position. Other instrument should be operated below the camera (Figure 1).
Operative Technique
RUL sleeve lobectomy
Staple was perfered for pulmonary arterial branches ligation. After division of the vessels and opening the fissure, the bronchial sleeve resection may begin. The bronchus intermedius and right mainstem bronchi were circumferentially dissected 1.0cm away from right upper bronchi using a long scalpel and scissors, then mobilization of right upper lobe, with care not to devascularize the airway. Fast frozen pathology confirmed no residual tumor.
Dividing the inferior pulmonary ligament was performed to release the tension of airway. Then end-to-end anastomosis begun by placing traction sutures at posterior cartilaginous-membranous junction using 3-0 prolene(Ethicon, Somerville, NJ), knot was tied outside with a thoracoscopic knot pusher. Continuous sutures were used to close the bronchial membrane (from posterior to anterior) and cartilage (from posterior to anterior). Care was taken not to get sutures twisted (Figure 2).
Traction sutures were helpful for anastomosis. Sutures were applied at both bronchus intermedius and right mainstem bronchi and tracted outside incision. When pulled up, the posterior bronchus margines would get closer and have a longer distance from vessels, making anastomosis of posterior wall much easier. When anastomosis of posterior wall was completed, traction sutures were cut and removed in order to avoid tangling with other sutures. We designed a novel long seperating forcep with a greater arc to retract the vessels or push vessles away from bronchus, also benefitting bronchial anastomosis.
Anastomosis air leak was tested by dragging tight sutures and submerging bronchus under saline and inflating the lung with a pressure of 20 cm of water. Then the sutures were finally knotted at anterior cartilaginous-membranous junction with confirmation of no air leak existance without using any tissue flap (Figure 3).
LUL sleeve lobectomy
The main bronchus and lower lobe bronchus proximal and distal to the base of the LUL were incised. A running suture is started at the anterior cartilaginous-membranous junction, after tying knot, posterior wall anastomosis was completed first and another running suture is used to complete the anterior half of the anastomosis. Final knot was tied at posterior cartilaginous-membranous junction.
LLL sleeve lobectomy
The left lower sleeve lobectomy is technically more complex for the presence of the pulmonary artery and upper lobe vein. Left main bronchus was dissected first, and then the upper lobe bronchi was cut circumferentially. The first suture was palced at anterior cartilaginous-membranous junction to help appose the upper lobe bronchi and mainstem bronchi, and then proceeded with a continuous suture in the posterior wall of airway (the most difficult part of anastomosis). Another running anterior suture was performed and both sutures are tied with the help of a thoracoscopic knot-pusher.
Systematic lymph nodes desection was permformed in all patients. A single chest tube through the incision was placed.

Seven patients (five males and two females) with a median age of 61.4 years (range: 48-73 years) underwent uniportal VATS bronchial sleeve lobectomy. The mean surgical time was 201.7±18.9 minutes (range: 166-258). Mean blood loss was 120.0±65.3ml (range: 50-250). Pathological examination showed squamous cell carcinoma (SCC) in all patients, N1

Figure 1 A single incision of approximately 3cm was made
lymph nodes were positive in two patients, negative in four patients. N2 lymph nodes were all negative (Table 2).
Five patients extubated after surgery, two patients were mechanically ventilated after the surgery for 1.0 and 1.5 hours respectively for high partial pressure of carbon dioxide in blood gas and successfully extubated. No patient required continuous positive airway pressure or suffered acute life-threatening events. Mucous impaction at anastomosis site was developed in two patients and treated successfully by sputum suctioning with bronchoscopy.
All patients survived and were discharged with median total length of stay of 12.6± days (range: 9-17), and discharged post-surgery of 7.5±2.6 days (range: 5-13). Mean chest tube duration was 5.5±1.8 days (range: 4-11) without chest tube re-insertions. The patients recovered without complications (bronchial stenosis, fistula) or other notable events, signs of tumor recurrence or metastasis during follow-up time. Postoperative bronchoscopy and virtual bronchoscope confirmed no stenosis. Pulmonary function tests were performed six months after the surgery, the mean FEV1/FVC was 70.5±12.6% (range: 55.1-95.2%), and the mean MVV was 77.4±18.8 L/min (range: 49.5-88.9 L/min).
Since the first VATS lobectomy performed in the early 1990s, many authors worldwide have published reports confirming its safety and advantages, including smaller incisions, decreased postoperative pain, shorter length of stay, decreased chest tube output and duration, decreased blood loss, better preservation of pulmonary function, and earlier return to normal activities. VATS lobectomy may even offer reduced rates of complications and better survival without sacrificing the oncologic principles [6-10]. 
The first reports of VATS sleeve resection only appeared 15 years ago. There are few reports of VATS sleeve resection performed with no direct visualization and no rib retractor (11-13). Most of the authors describe the VATS approach to lobectomy with 3 to 4 incisions, but the surgery can be performed by only 1 incision with similar outcomes [14-16]. Since 2013, we have used the uniportal approach for VATS lobectomy and performed more than two hundred uniportal VATS lobectomy till now. More complex cases could be performed with uniportal VATS including bronchial sleeve lobectomy as

Table 1 Clinical characteristic of patients
Patient number Age(years) Sex Smoking history FEV1 (L) FEV1/FVC (%) Body mass index ASA score Clinical TNM stage
1 59 Male yes 2.01 75.3 22.1 1 cT2aN0M0
2 67 Male Yes 1.77 68.2 24.5 1 cT2aN0M0
3 48 Female Yes 1.85 82.6 23.6 1 cT1b N1M0
4 64 Male Yes 2.34 78.5 25.0 1 cT2aN1M0
5 68 Male Yes 1.69 59.7 28.7 1 cT1bN1M0
6 73 Male Yes 1.98 66.5 23.3 1 cT2aN1M0
7 51 male Yes 2.71 97.5 21.9 1 cT2aN1M0
FEV1: forced expiratory volume in one second
FVC: forced vital capacity
ASA: American Society of Anesthesiologists

Table 2 Postoperative data of patients who underwent uniportal video-assisted thoracoscopic surgery sleeve lobectomy
Patient number Tumor diameter (cm) Histology Tumor location Operation duration (min) Blood loss
Postoperative stay (days) FEV1(L) FEV1/FVC (%)
1 2.0 SCC RUL 189 150 13 1.89 73.4
2 1.6 SCC RUL 175 90 8 1.72 62.8
3 2.2 SCC LUL 211 250 7 1.48 73.5
4 3.5 SCC LUL 258 120 8 1.96 70.6
5 1.2 SCC RUL 166 50 6 1.15 56.7
6 1.9 SCC LLL 232 100 6 1.75 61.5
7 2.5 SCC RUL 181 80 5 2.65 95.2
SCC: squamous cell carcinoma, RUL: right upper lobe, LUL: left upper lobe, LLL: left lower lobe, FEV1: forced expiratory volume in one second, FVC: forced vital capacity

Figure 2 Continuous sutures was used to close the bronchial membrane and cartilage


experience accumulated.
Traction sutures were greatly helpful for anastomosis [17]. The bronchus were divided at a right angle to its long axis and between cartilages [18]. Anastomosis of posterior bronchus would be much easier because margines were closer and away from surrounding tissue. Gonzalez-Rivas has reported the first case of bronchial sleeve lobectomy by uniportal VATS, however, bronchial anastomosis was completed by continuous membranous suture with a posterior stitch in the cartilaginous-membranous junction and interrupted sutures for the anterior cartilaginous portion [19-24]. In our experience, it was hard to avoid tangling the ends of the untied ends during interrupted sutures. In contrast, holding traction sutures at the direction of anastomosis, sutures would be completed much easier with clear visualiztion. More clinical trail should be applied to compare continuous sutures and other way to complete bronchial anastomosis.
Most of reports describe the VATS approach using interrupted sutures in
anastomosis, or combine interrupted with continuous sutures, especially in bronchus cartilage reconstruction [25-31]. The end-to-end anastomosis could also be performed by complete continuous suture, either through VATS or uniportal VATS [32-36]. Continuous suture was used to complete both membranous bronchus and cartilage anastomosis at one time through thoractomy in our institute since 2003

Figure 3 The sutures were knotted at one time with confirmation of no air leak existence

and applied with three-port VATS since 2013. Now we were able to perform sleeve lobectomy with uniportal VATS. Usually, the first step is to suture the posterior bronchus wall and then the second step is to suture the anterior bronchus wall, both edges were tied at the front. In follow-up time, no sign of stenosis was observed. Continuous suture facilitates both smooth stitch placement and sliding of the knots, leading to low incidence of stenosis.
We dragged tight and knot sutures after anastomosis air leak was tested, which could enable additional sutures when small air leak was found. Continous sutures was also an ideal way to avoid tangling the ends of the untied ends [37]. It was quite clear to adjust sutures for any size discrepancy between the proximal and distal airways with precise suture placement along the circumference of the anastomosis. Besides, tension could be carefully and easily adjusted with a sliding knot-pushing instrument.
There were also disadvantages of continuous sutures [38-40]. Once tangling or intersects happened, suture should run backward to have these problems overcome to continue suture. It was also technically hard to complete continuous suture with only one port. The angle of needle insertion were different at every suture, the position of needle holder were changing accordingly, calling for great care.
The left lower or upper sleeve lobectomy is more complex than RUL because of the interference with aortic arch and main PA and the short length of upper lobe bronchus, the absence of intermediate bronchus [41]. Subcarinal lymph node dissection should be performed before the bronchial division, facilatates bronchus anastomosis [42]. The continuous suture technique should be performed in two steps, bronchial membrane at first from anterior to posterior and then cartilage from anterior to posterior, every 180 degree of the bronchus circumference [43].
Complete continuous suture used for bronchial anastomosis in uniportal video-assisted thoracoscopic bronchial sleeve lobectomy was described, however, small sample size and short follow-up time was the main limitation of this study, more cases should be reviewed with longer follow-up time for further research.
As experience has grown, the list of contraindications to VATS has shrunk. Uniportal VATS would become more popular with acceptable morbidity and mortality as well as fast recovery.
Conflict of interest
The authors have no potential conflicts of interest to disclose
We sincerely thank our hospital colleagues who participated in this research.
1. Shao F, Yang R, Xu D, Zou W, Ma G, Cao H, Pan Y. Bronchial sleeve lobectomy and carinal resection in the treatment of central lung cancer: a report of 92 cases. Zhongguo Fei Ai Za Zhi 2010; 13: 1056-1058.
2. Berthet JP, Boada M, Paradela M, Molins L, Matecki S, Marty-Ané CH, Gómez-Caro A. Pulmonary sleeve resection in locally advanced lung cancer using cryopreserved allograft for pulmonary artery replacement. J Thorac Cardiovasc Surg 2013; 146: 1191-1197.
3. Gonzalez M, Litzistorf Y, Krueger T, Popeskou SG, Matzinger O, Ris HB, Gronchi F, Lovis A, Peters S. Impact of induction therapy on airway complications after sleeve lobectomy for lung cancer. Ann Thorac Surg 2013; 96: 247-252.
4. Jiao W, Zhao Y, Huang T, Shen Y. Two-port approach for fully thoracoscopic right upper lobe sleeve lobectomy. J Cardiothorac Surg 2013; 8: 99.
5. Maurizi G, D'Andrilli A, Anile M, Ciccone AM, Ibrahim M, Venuta F, Rendina EA. Sleeve lobectomy compared with pneumonectomy after induction therapy for non-small-cell lung cancer. J Thorac Oncol 2013; 8: 637-643.
6. Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty. World J Surg 2013; 37: 1661-1665.
7. Zhang X, Peng GL, Liang LX, He JX. Right, middle, and lower bronchial sleeve lobectomy by video-assisted thoracic surgery. J Thorac Dis 2013; 5: S277-S279.
8. Han Y, Zhou S, Yu D, Song X, Liu Z. Video-assisted thoracic surgery (VATS) left upper sleeve lobectomy with partial pulmonary artery resection. J Thorac Dis 2013; 5: S301-S303.
9. Xu X, Chen H, Yin W, Shao W, Xiong X, Huang J, He J. Thoracoscopic half carina resection and bronchial sleeve resection for central lung cancer. Surg Innov 2014; 21: 481-486.
10. Han Y, Yu DP, Zhou SJ, Song XY, Xiao N, Li YS, Liu ZD. Video-assisted thoracoscopic surgery bronchial sleeve lobectomy for lung cancer. Zhonghua Yi Xue Za Zhi 2013; 18: 1836-1837.
11. Yang R, Shao F, Cao H, Liu Z. Bronchial anastomosis using complete continuous suture in video-assisted thoracic surgery sleeve lobectomy. J Thorac Dis 2013; 5:S321-S322.
12. Han Y, Zhou S, Yu D, Song X, Liu Z. Video-assisted left upper bronchial sleeve lobectomy. J Thorac Dis 2013; 5: S304-S306.
13. Yu D, Han Y, Zhou S, Song X, Li Y, Xiao N, Liu Z. Video-assisted thoracic bronchial sleeve lobectomy with bronchoplasty for treatment of lung cancer confined to a single lung lobe: a case series of Chinese patients. J Cardiothorac Surg 2014; 9: 67.
14. Andersson SE, Rauma VH, Sihvo EI, Räsänen JV, Ilonen IK, Salo JA. Bronchial sleeve resection or pneumonectomy for non-small cell lung cancer: a propensity-matched analysis of long-term results, survival and quality of life. J Thorac Dis 2015; 7: 1742-1748.
15. Gonzalez-Rivas D, Yang Y, Stupnik T, Sekhniaidze D, Fernandez R, Velasco C, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections. Eur J Cardiothorac Surg 2016; 49: i6-16.
16. Wang X, Jiao W, Zhao Y, Xuan Y, Wang Z. Two-incision approach for video-assisted thoracoscopic sleeve lobectomy treating the central lung cancer. Indian J Cancer 2015; 51: e18-20.
17. Jiao W, Zhao Y, Wang X, Zhao J. Video-assisted thoracoscopic left upper lobe sleeve lobectomy combined with pulmonary arterioplasty via two-port approach. J Thorac Dis 2014; 6: 1813-1815.
18. Nakagawa T, Chiba N, Ueda Y, Saito M, Sakaguchi Y, Ishikawa S. Clinical experience of sleeve lobectomy with bronchoplasty using a continuous absorbable barbed suture. Gen Thorac Cardiovasc Surg 2015; 63: 640-643.
19. D'Andrilli A, Venuta F, Maurizi G, Rendina EA. Bronchial and arterial sleeve resection after induction therapy for lung cancer. Thorac Surg Clin 2014; 24: 411-421.
20. Gonzalez-Rivas D, Fieira E, Delgado M, de la Torre M, Mendez L, Fernandez R. Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections. J Thorac Dis 2014; 6: S674-S681.
21. Kara HV, Balderson SS, D'Amico TA. Challenging cases: thoracoscopic lobectomy with chest wall resection and sleeve lobectomy-Duke experience. J Thorac Dis 2014; 6: S637-S640.
22. Guan Y, Huang J, Xia T, You X, He J, He J. Preoperative evaluation of stage T3, central-type non-small cell lung cancer with double sleeve lobectomy under complete video-assisted thoracoscopic surgery using spiral computed tomography post-processing techniques. J Thorac Dis 2016; 8: 1738-1746.
23. Shao F, Liu Z, Pan Y, Cao H, Yang R. Bronchoplasty using continuous suture in complete monitor view: a suitable method of thoracoscopic sleeve lobectomy for non-small cell lung cancer. World J Surg Oncol 2016; 14: 134.
24. Huang J, Li S, Hao Z, Chen H, He J, Xu X, Qiu Y, Dong Q, Liang L, Pan H, He J. Complete video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy. J Thorac Dis 2016; 8: 553-574.
25. Gonzalez-Rivas D, Yang Y, Sekhniaidze D, Stupnik T, Fernandez R, Lei J, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchoplastic and carinal sleeve procedures. J Thorac Dis. 2016; 8: S210-22.
26. Lin J, Kang M, Chen S, Lin J, Han W, Chen M. Video-assisted thoracoscopic right upper lobe sleeve lobectomy combined with carinal resection and reconstruction. J Thorac Dis 2015; 7: 1861-1864.
27. Gonzalez-Rivas D, Marin JC, Granados JP, Llano JD, Cañas SR, Arqueta AO, de la Torre M. Uniportal video-assisted thoracoscopic right upper sleeve lobectomy and  tracheoplasty in a 10-year-old patient. J Thorac Dis 2016; 8: E966-E969.
28. Ma Q, Liu D. VATS right upper lobe bronchial sleeve resection. J Thorac Dis 2016; 8: 2269-2271.
29. Chen H, Huang L, Xu G, Zheng B, Zheng W, Zhu Y, Guo Z, Chen C. Modified bronchial anastomosis in video-assisted thoracoscopic sleeve lobectomy: a report of 32 cases. J Thorac Dis 2016; 8: 2233-2240.
30. Chen H, Xu G, Zheng B, Zheng W, Zhu Y, Guo Z, Chen C. Initial experience of single-port video-assisted thoracoscopic surgery sleeve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer. J Thorac Dis 2016; 8: 2196-2202.
31. Lin MW, Kuo SW, Yang SM, Lee JM. Robotic-assisted thoracoscopic sleeve lobectomy for locally advanced lung cancer. J Thorac Dis 2016; 8: 1747-1752.
32. Maurizi G, D'Andrilli A, Venuta F, Rendina EA. Bronchial and arterial sleeve resection for centrally-located lung cancers. J Thorac Dis 2016; 8: S872-S881.
33. Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy. Ann Thorac Surg 2011; 91: 1961-1965.
34. Gómez-Caro A, Boada M, Reguart N, Viñolas N, Casas F, Molins L. Sleeve lobectomy after induction chemoradiotherapy. Eur J Cardiothorac Surg 2012; 41: 1052-1058.
35. Lee HK, Lee HS, Kim KI, Shin HS, Lee JW, Kim HS, Cho SW. Outcomes of Sleeve Lobectomy versus Pneumonectomy for Lung Cancer. Korean J Thorac Cardiovasc Surg 2011; 44: 413-417.
36. Ludwig C, Stoelben E. A new classification of bronchial anastomosis after sleeve lobectomy. J Thorac Cardiovasc Surg 2012; 144: 808-812.
37. Yu JA, Weyant MJ. Techniques of bronchial sleeve resection. Semin Cardiothorac Vasc Anesth 2012; 16: 196-202.
38. Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Tagawa T, Hayashi H, Nagayasu T. Primary adenocarcinoma of the bronchus;palliative resection with rigid bronchoscopy,followed curative pulmonary sleeve resection; report of a case. Ann Thorac Cardiovasc Surg 2014; 20: 546-549.
39. Gonzalez-Rivas D, Fernandez R, Fieira E, Rellan L. Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy: first report. J Thorac Cardiovasc Surg 2013; 145: 1676-1677.
40. Li Y, Wang J. Video-assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty: an improved operative technique. Eur J Cardiothorac Surg 2013; 44: 1108-1112.
41. Merritt RE, Mathisen DJ, Wain JC, Gaissert HA, Donahue D, Lanuti M, Allan JS, Morse CR, Wright CD. Long-term results of sleeve lobectomy in the management of non-small cell lung carcinoma and low-grade neoplasms. Ann Thorac Surg 2009; 88: 1574-1581.
42. Yavuzer S, Yüksel C, Kutlay H. Segmental bronchial sleeve resection: preserving all lung parenchyma for benign/low-grade neoplasms. Ann Thorac Surg 2010; 89: 1737-1743.
43. Berthet JP, Paradela M, Jimenez MJ, Molins L, Gómez-Caro A. Extended sleeve lobectomy: one more step toward avoiding pneumonectomy in centrally located lung cancer. Ann Thorac Surg 2013; 96: 1988-1997.

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