[Show abstract][Hide abstract] ABSTRACT: This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC.
The American surgeon 12/2014; 80(12). · 0.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a novel technique of laparoscopic hepatectomy(lap-HT)performed at our hospital and the outcomes.Lap -HT was performed in 90 cases at our hospital, including 38 cases of anatomical resection of the liver.After mobilization of the right lobe with the patient in the half-lateral position, we resected the liver tissue using cavitron ultrasonic surgical aspirator (CUSA)and AquamantysTM Bipolar®.This surgical instrument is useful for laparoscopic anatomical resection of the liver because it is based on vessel sealing technology.In the 90 cases in which lap-HT was performed, the mean duration of surgery and mean blood loss were 332.9 minutes and 381 mL, respectively.The mean duration of hospitalization after surgery was 12.1 days, and postoperative complications were noted in 5 cases(5.6%).Comparison of the clinical factors and short-term performance of the surgery between liver cirrhosis patients who underwent open hepatectomy and lap-HT revealed that blood loss was significantly lower and the hospital stay duration was significantly shorter in patients who underwent lap-HT. Our findings suggest that laparoscopic anatomical resection of the liver can be safely performed using this novel technique and surgical instrument.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):1494-6.
[Show abstract][Hide abstract] ABSTRACT: A 76-year-old woman was diagnosed as having hepatocellular carcinoma( HCC), and partial hepatectomy was performed in 2007. Transarterial chemoembolization (TACE) was performed for recurrent HCCs in 2009. Ileocecal resection was performed for peritoneal dissemination of HCC localized in the ileocecal area, and sorafenib therapy was initiated in October 2009. TACE was performed for recurrent HCCs in December 2009 and March 2010. Positron emission tomography( PET) revealed a solitary intrahepatic recurrent HCC and left ovarian metastasis, and partial hepatectomy and left ovariectomy were performed in June 2010. Multiple lung metastases were detected, and systemic chemotherapy with cisplatin was initiated in February 2011. The lung metastatic tumors disappeared after 3 courses of treatment. The patient is disease free at 2 years after treatment. We encountered a case of advanced recurrent HCC is which complete response (CR) was achieved with multimodality therapy using sorafenib and surgical treatment.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):1678-80.
[Show abstract][Hide abstract] ABSTRACT: Excessive intraoperative blood loss and the possible requirement for blood transfusion are major problems in hepatic resection for liver tumors. The decrease of blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose. The aim of this prospective randomized study was to compare the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) with a radiofrequency-based bipolar hemostatic sealer versus CUSA with standard bipolar cautery (BC) in patients undergoing hepatic resection.
One hundred nine patients with liver tumors were randomized to undergo hepatic transection via CUSA with a bipolar sealer (Aquamantys 2.3 Bipolar Sealer; n = 55) or BC (n = 54). Blood loss during parenchymal transection and speed of transection were the primary end points, whereas the degree of postoperative liver injury and morbidity were secondary end points.
Compared with the BC group, the bipolar sealer showed lesser blood loss during transection and blood loss divided by resection area (P = .0079 and .0008, respectively), shorter transection time (P = .0025), faster speed of transection (P < .0001), and fewer ties and ties divided by resection area required during transection (P < .0001).
CUSA with a bipolar sealer is superior to CUSA with standard BC for various hepatectomy in terms of less blood loss and faster speed of transection, with no increase in morbidity.
Surgery 09/2013; 154(5). DOI:10.1016/j.surg.2013.04.053 · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Successful liver surgery requires an understanding of the patient's particular liver characteristics, including shape and vessel distribution. In clinical medicine, there is a high demand for surgical assistance systems to assess individual patients. Our aims in this study were to segment the liver based on computed tomography volume data and to develop surgical plans for individual patients.
The hepatic vessels were semi-automatically extracted from the segmented liver images, and the 3D shape of the liver and extracted vessel distribution were visualized using a surgical simulation system.
The 3D visualization of the liver allowed easy recognition of vessel and tumor location and selection of these structures with the 3D pointing device. The surgeon's prior knowledge and clinical experience were integrated into the visualization system to create a practical virtual surgery, leading to improved functionality and accuracy of information recognition in the surgical simulation system.
The 3D visualization demonstrated details of individual liver structure, resulting in better understanding and practical surgical simulation.
Journal of Gastrointestinal Surgery 06/2013; 17(8). DOI:10.1007/s11605-013-2262-x · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Intravenous injection of the indocyanine green (ICG) reagent was performed as a liver function test 1 to 2 weeks prior to surgery. ICG fluorescent imaging was performed using the Photodynamic Eye (PDE) infrared camera (Hamamatsu Photonics k. k., Shizuoka, Japan).
Intravenous injection of the ICG reagent was performed as a liver function test 1 to 2 weeks before surgery. ICG fluorescent imaging was performed using the PDE infrared camera.
ICG fluorescent imaging was useful for liver surgical navigation as follows: three cases of recurrent hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization or thermal ablation therapy; three cases of colorectal metastatic liver tumors after chemotherapy as conversion therapy; two cases of intrahepatic cholangiocellular carcinoma (ICC); and two cases of surface HCC that were not detected by preoperative computed tomography (CT) scan. In the ICC cases, although dilatation of the bile duct could be detected, the tumor margins were ambiguous by ultrasonography(US). ICG fluorescent imaging clearly described the dilatation of the bile duct including the tumor.
ICG fluorescent imaging was useful for liver surgical navigation including selection of the mode of hepatic resection.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1978-81.
[Show abstract][Hide abstract] ABSTRACT: An 84-year-old woman experienced epigastralgia with increasing serum protein induced by vitamin K absence or antagonists -II(PIVKA-II) levels, and she was referred to our hospital. The serum levels of tumor markers were elevated[ alpha -fetoprotein(AFP) 22,640 ng/mL, PIVKA-II 35,140 mAU/mL], and a mass lesion of 7 cm in diameter in the right lobe of the liver with portal vein tumor thrombus (PVTT) in the major trunk was detected by abdominal computed tomography (CT) scan. She was diagnosed with unresectable hepatocellular carcinoma (HCC) with PVTT, and sorafenib in combination with intermittent cisplatin(CDDP) hepatic arterial infusion chemotherapy(HAIC)was performed. After 3 courses of the therapy, the serum levels of tumor markers were decreased (AFP: 16,283 ng/mL, PIVKA-II: 2,924 mAU/mL), and the size of the tumor had also decreased to 2 cm in diameter. PVTT decreased from Vp4 to Vp3. We judged that it was resectable, and extended right hepatectomy and portal vein embolectomy was performed. Complete tumor necrosis was seen during pathologic inspection of PVTT. Although she presented with refractory pleural effusion and ascites after operation, she recovered and left our hospital on postoperative day 70. No recurrences have occurred during the 6 months after the operation. Sorafenib in combination with intermittent CDDP HAIC is considered to be an effective therapy for advanced HCC with PVTT in the major trunk.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1991-3.
[Show abstract][Hide abstract] ABSTRACT: In 2006, a 70-year-old man who underwent low anterior resection for rectal cancer (SS, N0, H1, Stage IV)at a nearby hospital was referred to our hospital. He was noted to have multiple liver metastases of approximately 1 cm in diameter in S2, S3, S6, and S7, and was subsequently treated with chemotherapy for 5 courses of mFOLFOX6 regimen. He achieved a complete response radiographically. Thereafter, he underwent lateral segmentectomy of the liver and was noted to have residual tumor cells by histopathological examination of the resected tissue. Seven months after the hepatectomy, recurrence occurred in S6 and S7 and a new lesion in S8 was noted. He then underwent 12 courses of mFOLFOX6. As of June 2012, the patient is alive without recurrence. A prolonged survival may be possible if downstaging is achieved with successful chemotherapy. However, similar to the present case, the detection of residual cancer cells during histopathological examination of the resected tissues has been reported in the literature. Thus, further investigation is needed to determine the optimal treatment of cases achieving a radiographic complete response.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2231-3.
[Show abstract][Hide abstract] ABSTRACT: A 55-year-old man who underwent eye enucleation at our hospital's ophthalmology department was pathologically diagnosed with malignant melanoma. Four months later after diagnosis, he underwent positron emission tomography/computed tomography for detecting systemic metastasis. Abnormal accumulation was found in S4 of the liver. He was therefore referred to the gastrointestinal department, where liver metastasis from malignant melanoma was diagnosed by biopsy. He underwent radiofrequency ablation therapy. A recurrence 3 months later was judged difficult to manage medically. He was thus sent to our department. Preoperative magnetic resonance imaging revealed multiple tumors in both liver lobes. Thus far, no treatment strategy has been established for hepatic metastases of malignant melanoma. After receiving a thorough explanation, he agreed to partial hepatectomy. We identified 14 tumors by intraoperative ultrasonography as sites for partial hepatectomy. Postoperative chemotherapy was administered. He died of hepatic failure 9 months after the operation. It is necessary to accumulate further cases on a national scale, because establishment of appropriate therapy for this condition is urgently needed.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2009-11.
[Show abstract][Hide abstract] ABSTRACT: We report here the experience of the treatment with sorafenib for advanced hepatocellular carcinoma (HCC) in our department. Forty patients received the therapy of sorafenib until April 2011. Twenty seven unresectable advanced HCC, 7 lung metastasis, 6 bone metastasis, 3 abdominal lymph node metastasis, and 2 peritoneal dissemination were included. The median duration of sorafenib treatment was 197 days. Grade 3 adverse event occurred in 9 patients (22.5%), and grade 4 adverse event occurred in 1 patient (3%). The response rate and disease control rate were 5% and 55%, respectively (CR 2, PR 0, SD 20, PD 9). The median overall survival was 15.2 months, and median recurrence-free survival was 3.7 months. These results suggested that a prevention of adverse events would lead to a continued treatment with sorafenib, and could expect to have a prolonged survival in patients with advanced HCC.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2493-5.