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ABSTRACT: For the purpose of prophylactic treatment of splenic aneurysms, both examinations and treatments should be minimally invasive. Here, we report a case of a patient who underwent three-dimensional arterial computed tomography (CT) and laparoscope-assisted splenectomy with aneurysm resection as a combination of minimally invasive examination and treatment.
Journal of Laparoendoscopic & Advanced Surgical Techniques 07/1997; 7(3):183-6. · 1.40 Impact Factor
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ABSTRACT: To our knowledge, we introduce a new technique to treat a patient with hepatocellular carcinoma having a main tumor and a small satellite nodule in segments IV and VI, respectively. The liver was laparoscopically mobilized; the dissection line was adequately exposed through a 12-cm anterior thoracic incision. Segment VI was resected without hilar dissection or parenchymal compression. The satellite nodule was coagulated with microwaves. The patient had an uneventful postoperative recovery. This technique potentially alleviates postoperative adhesion and allows a minimally invasive surgery.
Archives of Surgery 03/1997; 132(2):206-8. · 4.24 Impact Factor
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ABSTRACT: Surgical resection is not always feasible in patients with hepatocellular carcinoma. Microwave coagulation therapy has been used as an alternative to resection, and its efficacy has been evaluated.
Nineteen patients with unresectable hepatocellular carcinoma underwent microwave coagulation therapy through laparotomy (n = 12), laparoscopy (n = 5), or thoracotomy (n = 2) because of advanced liver cirrhosis and/or intrahepatic metastases. One nodule was treated in 13 patients, tumor size ranged from 5 to 90 mm. Patient outcomes were studied.
Microwave coagulation therapy created a reproducible regional necrosis. Fourteen patients underwent potentially curative treatment; the remaining 5 patients underwent palliative treatment (n = 4) or incomplete tumor coagulation (n = 1). Of the 31 nodules treated, 28 underwent complete tumor ablation. Only 2 patients undergoing laparoscopic microwave coagulation therapy developed local recurrence. The coagulated area subsequently shrank. Patients showed rapid recovery without hepatic dysfunction. Thirteen patients, including 2 long-term survivors, are alive either without tumor (n = 10; 14-64 months) or with tumor (n = 3; 17-22 months). Six patients died of hepatocellular carcinoma (n = 4) or liver insufficiency (n = 2).
This preliminary study suggests the efficacy of microwave coagulation therapy, including safety and potential curability, in patients with hepatocellular carcinoma with advanced liver cirrhosis and multifocal or central tumors.
Gastroenterology 05/1996; 110(5):1507-14. · 11.68 Impact Factor
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ABSTRACT: The clinical characteristics of mucinous ductal ectasia (MDE) of the pancreas without overt carcinoma have not been clarified. To clarify MDE and assess the optimal treatment procedure, including the technique of duodenum-preserving resection of the pancreatic head (DpRPH), we studied four patients.
Our patients consisted of three men and one woman, with a mean age of 71 years. The patients underwent DpRPH (n=3) or the pylorus-preserving Whipple procedure (PpW) (n=1). Clinicopathological features, postoperative pancreatic function, and technique to preserve duodenal blood flow were studied.
All patients had intraductal mucin-hypersecretion and multilocular cysts lined by hyperplastic epithelium. The lesions were located in the uncinate process (n=3) or head-body (n=1) of the pancreas. DpRPH totally removed the lesions in the uncinate process. Of the three patients receiving DpRPH, dusky duodenum and a postoperative duodenal ulcer developed in two whose gastroduodenal arteries (GDA) were divided, but did not develop in one with undivided GDA. Postoperative glucose tolerance test and peptide para-aminobenzoic acid test after DpRPH showed better values than those after PpW. All patients are alive and well 22 to 40 months after surgery.
DpRPH is a new standard for MDE. During DpRPH, preservation of the GDA and the superior portion of the pancreatic head is recommended to maintain an adequate duodenal blood flow.
Hepato-gastroenterology 45(22):1117-24. · 0.66 Impact Factor
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ABSTRACT: Portal venous stenosis caused by cancer invasion has been difficult to treat and patients do not have any treatment options. On the other hand, protal venous stents have been applied to patients with variceal haemorrhaging associated with portal vein thrombosis. However, there have not been any reports concerning portal venous stents for malignant portal stenosis. The aim of this report was to apply metallic stent for malignant portal stenosis to reduce portal hypertension and restore portal venous blood flow, which in turn leads to the recovery of liver function.
Two patients with portal hypertension caused by malignant portal stenosis were treated by metallic stent implantation. In one case, the stent was applied intraoperatively via the ileal vein and in the other case, it was applied postoperatively via transhepatic portal cannulation.
In the first case, portal pressure monitored before and after placement of the stent was 350 mmH2O and 200 mmH2O, respectively. Liver function tests showed normalization after stent placement. In the second case, over 3000 ml of ascites, which were drained through the drainage catheter every day, could be reduced remarkably, and one week later, the catheter could be withdrawn. Portal pressure before and after embedding the stent was 410 and 275 mmH2O, respectively. Both patients were discharged from the hospital and their recovery was uneventfully.
Both cases had an uneventful postoperative course, with normalization of liver function and cessation of ascites on the next postoperative day in case 2. Thus, portal venous stent should be considered a viable option for the treatment of malignant portal stenosis.
Hepato-gastroenterology 45(20):551-3. · 0.66 Impact Factor
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ABSTRACT: Management of 36 patients who developed intrahepatic recurrence (IHR) after curative hepatic resection for hepatocellular carcinoma (HCC) was studied.
IHRs were classified into type I with a solitary lesion (n = 16), type II with 2-4 lesions (n = 11), and type III with > or = 5 lesions (n = 11).
Periodic angiography and Lipiodol CT first detected IHRs in six patients. Most IHRs in type I and II were smaller than 20 mm. Thirty-three patients underwent regional treatments including transarterial infusion of Lipiodol containing anticancer drugs (TAIL) (n = 19), combined TAIL and percutaneous ethanol injection PEI (n = 12), surgery (n = 3), and PEI (n = 1). Post-recurrence 5-yr survival rate of type I (51%) was higher than that of type II (0%) or III (0%) (p < 0.01). Of the 27 patients with type I and II recurrences, seven became tumor-free for 11-67 months after regional treatments including TAIL + PEI (n = 5), TAIL (n = 1), and surgery (n = 1); 13 developed multiple IHRs.
Postoperative close follow-up with qualified imaging and vigorous treatments prolong the survival of the patients with HCC who developed IHRs. Type I or type II IHR can be curable with the combination of TAIL and PEI or repeated surgery.
Hepato-gastroenterology 43(12):1421-6. · 0.66 Impact Factor
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ABSTRACT: HCC is well known for its high incidence of intrahepatic tumor recurrence and many patients suffering from them, usually undergo further treatments, such as PEI, TAE, MCNT or hepatic resection. However, conventional hepatic resection by large skin incision causes severe intraabdominal adhesions, which disturb US examination and further treatments. The aim of the laparoscopic procedure is to prevent intraabdominal adhesions. This is a study of the feasibility of laparoscopic hepatic resection without CO2 pneumoperitoneum, which is not yet popular, as a safe and effective procedure. The patient in this study had a solitary HCC in the lateral segment. Mobilization of the lateral segment, dissections of the left hepatic artery and portal venous branches, i.e. P2 and P3, were performed under CO2 gas insufflation. However, to avoid CO2 gas embolism, further procedures, including parenchymal compression and hepatic venous dissection, were performed using the abdominal wall lifting method without pneumoperitoneum. The patient could eat on the second postoperative day and had an uneventful postoperative recovery and was discharged from the hospital 13 days after surgery. Hospital stay was shorter than conventional hepatic resections with large skin incisions. The importance of this procedure lies in that it is not only a minimally invasive procedure, but also provides us with the possibilities of further treatments, including PEI and re-hepatic resection.
Hepato-gastroenterology 44(13):143-7. · 0.66 Impact Factor
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ABSTRACT: We present two long-term survivors who underwent microwave coagulation therapy (MCT) for hepatocellular carcinoma (HCC). One patient was a 55-yr-old man having a solitary HCC of 25 mm in diameter associated with advanced liver cirrhosis. He underwent MCT instead of hepatic resection because he developed bleeding tendency during surgery. The other patient was a 78-yr-old woman having a 7 cm tumor in segment II and a 15 mm satellite lesion in segment IV. Because manipulation of the left hepatic lobe caused prolonged hypotension, only the main tumor was resected. The satellite lesion was treated with MCT. In both cases, tumors and surrounding liver parenchyma were widely coagulated. Postoperative courses were uneventful. The coagulated area shrank subsequently after surgery. Both patients are alive 39 and 55 months after MCT without tumor recurrence. This report proves that MCT is a curative treatment and an alternative to hepatic resection in selected patients with HCCs.
Hepato-gastroenterology 43(10):1035-9. · 0.66 Impact Factor
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ABSTRACT: Despite sporadic reports of cholangiocarcinoma (CC) associated with hepatolithiasis, this entity has not been widely studied. The purpose of this study was to clarify its clinical features and optimal management by studying the 10 patients we have encountered with this condition.
There were six women and four men, with a mean age of 61 years. The patients underwent anatomic hepatic resection (n = 5) or biliary drainage (n = 5). The clinical features and results of surgery were studied.
The characteristic findings included tumor-related symptoms, irregular ductal stricture or obstruction, and hepatic lobar atrophy with a whitish mass. The tumor and stones were located in the same hepatic lobe. Eight patients had advanced CC with periductal tumor infiltration, while two had in situ carcinoma characterized by intraductal tumor growth, papillary adenocarcinoma, and mucin-hypersecretion. Seven patients died within 6 months after surgery, while the remaining three, including the two with in situ carcinomas and one with an involved node at the dissected hilum, are alive more than 4 years after anatomic hepatic resection.
Recognition of the clinical features of CC associated with hepatolithiasis, which were clarified in this study, is important in treating patients with hepatolithiasis. An anatomic hepatic resection with hilar nodal dissection offers long-term survival in selected patients.
Hepato-gastroenterology 45(19):137-44. · 0.66 Impact Factor
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ABSTRACT: To investigate the feasibility of a technique with minimal skin incision, while retaining a rate of cure and safety equivalent to conventional rectal amputation, by making use of the advantages of laparoscopic procedures, we performed a minimally invasive laparoscopic rectal amputation.
Six patients suffering from rectal cancer with cardiac and/or respiratory disorders underwent laparoscope-assisted rectal amputation. The procedure was performed in three steps: 1) sacral approach, 2) laparoscope-assisted abdominal approach under CO2 insufflation, and 3) extracorporeal resection of the inferior mesenteric artery (IMA) and stoma making without CO2 insufflation.
Intra-operative cardiopulmonary functions were maintained within normal range during CO2 insufflation. Although all patients had severe respiratory or cardiac disorder or diabetes mellitus, no complications were observed during and after surgery. The post-operative course was uneventful for our patients, each of whom could eat on the first post-operative day and walk on the third post-operative day. All patients were discharged from the hospital uneventfully.
Laparoscope-assisted rectal amputation is technically feasible, adequate tumor excision can be achieved with it and post-operative recovery is improved. Sacrolaparoscopic rectal amputation appears to be a safe alternative procedure for patients with rectal cancer and even with severe cardiopulmonary disorders.
Hepato-gastroenterology 46(26):909-13. · 0.66 Impact Factor
