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A Case of Intramural Esophageal Bronchogenic Cyst
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-04-01 DOI: 10.1111/ases.70055
Mototsugu Watanabe, Noriaki Shiraha, Toshio Shiotani

A bronchogenic cyst is a congenital malformation with a rare esophageal origin. Occasionally, it is discovered incidentally, and excision is the only treatment. A 43-year-old patient was referred to our hospital for treatment of a cystic tumor in the left posterior mediastinum. We suspected the tumor was a bronchogenic cyst by imaging findings; therefore, we performed video-assisted thoracoscopic resection. The patient was discharged 9 days postoperatively. The tumor origin was found to be the esophageal wall. This report presents a rare case in which the esophageal wall was the origin of the bronchogenic cyst.

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引用次数: 0
The Efficacy of a Silicone Plate for the Prevention of Re-Adhesions in Asherman Syndrome: A Case Study
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-04-01 DOI: 10.1111/ases.70053
Yuya Makino, Kaoru Tejima, Yuko Ikemoto, Saki Nagai, Juichiro Saito

This study highlights the effectiveness of using silicone plates to manage intrauterine adhesions (IUAs) in an enlarged uterine cavity caused by multiple fibroids. A 42-year-old woman developed Asherman syndrome following fibroid resection surgery, and despite initial attempts to prevent recurrence with an intrauterine device (IUD), IUAs reappeared. After successful hysteroscopic adhesiolysis, a customized silicone plate was introduced, preventing further IUAs for 1 month. The patient was then deemed suitable for fertility treatment. This case underscores the importance of innovative approaches in complex Asherman syndrome, particularly when standard treatments fail. Silicone plates prove useful for addressing enlarged or deformed uterine cavities caused by fibroids, expanding existing strategies for managing post-hysteroscopic complications.

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引用次数: 0
Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Comparison in Effectiveness and Safety Profile
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-30 DOI: 10.1111/ases.70050
Razan Dankar, Toni Habib, Mira Tfaily, Dina Makkouk, Salim Barakat, Bruno Habib, Chris Kaspar, Ali Khalil

Background and Objectives

Current treatment options for obesity typically involve a combination of lifestyle changes, medications, and bariatric surgeries. This study aimed to assess the safety profile of the endoscopic sleeve gastroplasty (ESG), which is a novel non-invasive approach, as compared to laparoscopic sleeve gastrectomy (LSG) and to correlate their weight loss effectiveness and complication risk in Lebanese patients.

Subjects and Methods

This is a retrospective study, including 70 patients who underwent ESG at Fouad Khoury Hospital and 70 patients who underwent LSG at Trad Hospital, between September 2021 and March 2023. Data collection targeted the patients' medical records and included their demographic characteristics (age, sex, weight, height, BMI), comorbidities, and post-procedural information. Weight and BMI (pre-op, 6-months post-op, and 1-year post-op) were collected. Total body weight loss was calculated, and analysis was performed using SPSS version 25.

Results

Patients who underwent ESG were distributed between 43 (61.4%) females and 27 (38.6%) males, with an average age of 38.07 ± 10.78 years. Patients who underwent LSG were distributed between 42 (60%) females and 28 (40%) males, with an average age of 33.99 ± 10.55 years. Both ESG and LSG resulted in significant weight loss, but LSG achieved greater total body weight loss at 6 and 12 months. ESG was associated with significantly shorter hospital stays (9.14 h vs. 27.77 h, p < 0.001) and fewer adverse events (8.5% vs. 17.1%, p = 0.111). New-onset GERD was more frequent after LSG (20% vs. 4.3%, p = 0.004).

Conclusion

ESG offers a less invasive approach with a potentially more favorable short-term safety profile and faster recovery, while LSG yields greater total body weight loss. ESG may be a suitable alternative for patients with a higher BMI. Further research is needed to assess long-term outcomes and cost-effectiveness.

背景和目的 目前治疗肥胖症的方法通常包括改变生活方式、药物治疗和减肥手术。本研究旨在评估内镜袖状胃成形术(ESG)的安全性,与腹腔镜袖状胃切除术(LSG)相比,内镜袖状胃成形术是一种新型的非侵入性方法,并对黎巴嫩患者的减肥效果和并发症风险进行相关分析。 研究对象和方法 这是一项回顾性研究,包括 2021 年 9 月至 2023 年 3 月期间在 Fouad Khoury 医院接受 ESG 手术的 70 名患者和在 Trad 医院接受 LSG 手术的 70 名患者。数据收集以患者病历为目标,包括其人口统计学特征(年龄、性别、体重、身高、体重指数)、合并症和术后信息。收集体重和体重指数(术前、术后 6 个月和术后 1 年)。计算总减重,并使用 SPSS 25 版进行分析。 结果 接受 ESG 的患者中,女性 43 人(61.4%),男性 27 人(38.6%),平均年龄为 38.07±10.78 岁。接受 LSG 的患者中,女性 42 人(60%),男性 28 人(40%),平均年龄为(33.99 ± 10.55)岁。ESG和LSG都能显著减轻体重,但LSG在6个月和12个月时减轻的总重量更大。ESG 的住院时间明显更短(9.14 小时 vs. 27.77 小时,p < 0.001),不良反应更少(8.5% vs. 17.1%,p = 0.111)。LSG术后新发胃食管反流病的发生率更高(20% 对 4.3%,P = 0.004)。 结论 ESG 是一种创伤较小的方法,其短期安全性可能更佳,恢复也更快,而 LSG 可使总体重减轻更多。对于体重指数(BMI)较高的患者来说,ESG 可能是一种合适的替代方法。还需要进一步的研究来评估长期疗效和成本效益。
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引用次数: 0
Laparoscopic Surgery for Advanced Transverse Colon Cancer With Gastric Invasion on a Child-Pugh Grade B Liver Cirrhosis Patient
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-27 DOI: 10.1111/ases.70051
Daisuke Tomita, Yudai Fukui, Jumpei Kashiwagi, Yasuhiro Takahashi, Kentoku Fujisawa, Yusuke Maeda, Kosuke Hiramatsu, Yu Ohkura, Yutaka Hanaoka, Shigeo Toda, Masaki Ueno, Shuichiro Matoba, Masashi Ueno, Hiroya Kuroyanagi

In high-risk patients undergoing surgery for colorectal cancer with organ invasion, a thorough evaluation of surgical indications and careful selection of optimal approaches is essential. We report a case of advanced transverse colon cancer with gastric invasion in a 58-year-old male with Child-Pugh grade B liver cirrhosis. The patient underwent laparoscopic transverse colectomy combined with gastric wedge resection. Intraoperative upper gastrointestinal endoscopy facilitated precise gastric resection. The primary tumor was excised with a clear margin, and the postoperative course was uneventful. This case highlights the feasibility of laparoscopic surgery for locally advanced colorectal cancer with organ invasion in high-risk cirrhotic patients, emphasizing the importance of meticulous operative planning and minimally invasive approaches to optimize outcomes.

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引用次数: 0
A Novel Liver Retraction Method Using a Polypropylene Suture in Robotic Gastrectomy for Gastric Cancer: The Subphrenic Pulley Method
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-25 DOI: 10.1111/ases.70047
Masashi Negita, Kazunari Misawa, Yuichi Ito, Seiji Ito, Tetsuya Abe, Koji Komori, Yasuhiro Shimizu

Introduction

Effective liver retraction is crucial in minimally invasive upper gastrointestinal surgeries, including laparoscopic gastrectomy and robotic gastrectomy (RG) for gastric cancer, to ensure optimal visualization and sufficient working space. Various techniques have been developed to improve the surgical view, simplify procedures, and reduce complications. However, liver enzyme elevation has been a notable concern in these procedures. To address these challenges, we developed the subphrenic pulley (SP) method, a novel liver retraction technique, and evaluated its safety and feasibility in RG.

Methods

We retrospectively analyzed the initial 111 consecutive cases of RG for gastric cancer at a single center between January 2016 and September 2023. The SP method used a 2-0 polypropylene suture with a curved needle, which was placed in the left subphrenic peritoneum, the right side of the esophageal hiatus, and the right subphrenic peritoneum. The suture ends were pulled out from the left upper abdominal wall, achieving ventral and cranial retractions of both the lateral segment and round ligament of the liver.

Results

No case required re-retraction or additional methods, and no case of liver laceration was observed. The incidence of Grade ≥ 3 liver enzyme elevation was 12.6% (14/111) in all cases and 3.5% (3/86) in the subset of cases without aberrant left hepatic artery dissection. Additionally, no patient needed treatment for liver dysfunction.

Conclusion

The SP method is a valuable, simple, and safe liver retraction technique in minimally invasive upper gastrointestinal surgeries, ensuring effective retraction without requiring additional skin incisions.

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引用次数: 0
Optimal Intracorporeal Anastomosis for Colectomy: A Comparative Experimental Evaluation Using 3D Anastomosis Models
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-17 DOI: 10.1111/ases.70048
Yoshiaki Fujii, Seiya Yamamoto, Sho Kimura, Shogo Suzuki, Hirotaka Miyai, Hiroki Takahashi, Yoichi Matsuo, Kenji Kobayashi, Shuji Takiguchi

Introduction

Application of intracorporeal anastomosis is gradually becoming widespread; however, there are no detailed reports on its configuration. We aimed to create three-dimensional intracorporeal anastomosis models and compare their configurations in detail.

Methods

Three types of intracorporeal anastomosis models were used: overlap anastomosis, delta-shaped anastomosis, and functional end-to-end anastomosis. In experiment 1, three-dimensional images of each anastomosis model were created. Additionally, the length of each staple line comprising the anastomotic site was measured. In experiment 2, the lengths of intestinal mobilization required for different anastomoses were compared.

Results

The circumference of the anastomosis in overlap anastomosis (141.5 ± 3.3 mm) was significantly greater than that in delta-shaped anastomosis (87.9 ± 0.9 mm; p < 0.001) and functional end-to-end anastomosis (89.6 ± 10 mm; p < 0.0001). The length of the intestinal tract after anastomosis in delta-shaped anastomosis (33 ± 6.9 mm) was significantly shorter than that in functional end-to-end anastomosis (76 ± 2 mm; p < 0.0001) and overlap anastomosis (60 ± 5 mm; p < 0.002).

Conclusions

We successfully constructed three-dimensional images of intracorporeal anastomosis models. These results suggest that overlap anastomosis led to the formation of the largest anastomotic site, while minimal bowel mobilization was required in the delta-shaped anastomosis.

引言 体腔内吻合术的应用正逐渐广泛,但有关其构造的详细报道却不多。我们旨在创建三维体腔内吻合术模型,并详细比较其构造。 方法 我们使用了三种体腔内吻合术模型:重叠吻合术、三角型吻合术和功能性端对端吻合术。实验 1 制作了每种吻合模型的三维图像。此外,还测量了吻合部位每条缝合线的长度。在实验 2 中,比较了不同吻合术所需的肠道移动长度。 结果 重叠吻合术的吻合口周长(141.5 ± 3.3 mm)明显大于三角吻合术(87.9 ± 0.9 mm; p < 0.001)和功能性端对端吻合术(89.6 ± 10 mm; p < 0.0001)。三角吻合术吻合后的肠道长度(33 ± 6.9 mm)明显短于功能性端端吻合术(76 ± 2 mm;p <;0.0001)和重叠吻合术(60 ± 5 mm;p <;0.002)。 结论 我们成功构建了体腔内吻合模型的三维图像。这些结果表明,重叠吻合可形成最大的吻合部位,而三角型吻合则需要最小的肠道移动。
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引用次数: 0
Comparison Between Robotic and Conventional Laparoscopic Hysterectomy Performed Using Single-Port Approach
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-16 DOI: 10.1111/ases.70044
Akiko Ohwaki, Kyohei Takada, Arata Kobayashi, Mayuko Ito, Ryoko Ichikawa, Hironori Miyamura, Haruki Nishizawa

Introduction

Robotic surgery is being rapidly implemented globally, and new robotic surgery techniques are being developed. The da Vinci SP surgical system, a new robotic surgery system using a single-port approach, was introduced for the first time in Japan, and its surgical results were compared with those of the conventional single-port plus one-port laparoscopic hysterectomy.

Methods

The study included 20 patients who underwent single-port robotic hysterectomy using the da Vinci SP surgical system (SP-RH) between March 2023 and December 2023, and 37 patients who underwent single-port plus one-port laparoscopic hysterectomy (SP + 1-LH) between March 2018 and December 2023. The surgical outcomes and complications were retrospectively compared.

Result

When the SP-RH group was compared with the SP + 1-LH group, intraoperative blood loss was observed to be significantly lower in the SP-RH group. However, no difference in the incidence of intraoperative complications between the two groups was observed. Furthermore, when comparing postoperative inflammatory responses, C-reactive protein levels were significantly lower in the SP + 1-LH group on the third day after surgery, but no other differences were observed.

Conclusion

This study demonstrated that single-port robotic hysterectomy using the da Vinci SP surgical system can be safely introduced and performed in clinical settings. The da Vinci SP surgical system, which uses a single-port platform, can be used in minimally invasive surgeries as a novel operational system.

{"title":"Comparison Between Robotic and Conventional Laparoscopic Hysterectomy Performed Using Single-Port Approach","authors":"Akiko Ohwaki,&nbsp;Kyohei Takada,&nbsp;Arata Kobayashi,&nbsp;Mayuko Ito,&nbsp;Ryoko Ichikawa,&nbsp;Hironori Miyamura,&nbsp;Haruki Nishizawa","doi":"10.1111/ases.70044","DOIUrl":"https://doi.org/10.1111/ases.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robotic surgery is being rapidly implemented globally, and new robotic surgery techniques are being developed. The da Vinci SP surgical system, a new robotic surgery system using a single-port approach, was introduced for the first time in Japan, and its surgical results were compared with those of the conventional single-port plus one-port laparoscopic hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 20 patients who underwent single-port robotic hysterectomy using the da Vinci SP surgical system (SP-RH) between March 2023 and December 2023, and 37 patients who underwent single-port plus one-port laparoscopic hysterectomy (SP + 1-LH) between March 2018 and December 2023. The surgical outcomes and complications were retrospectively compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>When the SP-RH group was compared with the SP + 1-LH group, intraoperative blood loss was observed to be significantly lower in the SP-RH group. However, no difference in the incidence of intraoperative complications between the two groups was observed. Furthermore, when comparing postoperative inflammatory responses, C-reactive protein levels were significantly lower in the SP + 1-LH group on the third day after surgery, but no other differences were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that single-port robotic hysterectomy using the da Vinci SP surgical system can be safely introduced and performed in clinical settings. The da Vinci SP surgical system, which uses a single-port platform, can be used in minimally invasive surgeries as a novel operational system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Usefulness of Bidirectional Barbed Sutures for Temporary Closure of Entry Hole for Delta-Shaped Anastomosis in Minimally Invasive Gastrectomy
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-11 DOI: 10.1111/ases.70046
Hironori Tsujimoto, Hiroyuki Horiguchi, Yoshihisa Yaguchi, Naoyuki Uehata, Risa Kariya, Asuma Ide, Keita Kouzu, Hideki Ueno

Introduction

Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies.

Materials and Surgical Technique

The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing.

Conclusion

Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.

{"title":"Usefulness of Bidirectional Barbed Sutures for Temporary Closure of Entry Hole for Delta-Shaped Anastomosis in Minimally Invasive Gastrectomy","authors":"Hironori Tsujimoto,&nbsp;Hiroyuki Horiguchi,&nbsp;Yoshihisa Yaguchi,&nbsp;Naoyuki Uehata,&nbsp;Risa Kariya,&nbsp;Asuma Ide,&nbsp;Keita Kouzu,&nbsp;Hideki Ueno","doi":"10.1111/ases.70046","DOIUrl":"https://doi.org/10.1111/ases.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic and robotic gastrectomies have become standard procedures for the treatment of gastric cancer. Among the reconstruction methods used following distal gastrectomy, the Billroth-I technique is often preferred owing to its low complication rates. Delta-shaped anastomosis, a method that eliminates the need for a mini-laparotomy, represents a significant advancement in minimally invasive surgeries. In this report, we aim to present a novel technique using bidirectional barbed sutures for temporary closure of the entry hole during delta-shaped anastomosis in laparoscopic and robotic gastrectomies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>The entry hole was closed using a bidirectional barbed suture, starting centrally to prevent overlapping of the gastric and duodenal staple lines. The suture length was meticulously adjusted to align with the stapler dimensions. All the procedures were successfully completed without any complications in both laparoscopic and robotic gastrectomies. Bidirectional barbed sutures enabled precise tissue alignment and prevented slippage, thereby facilitating secure, full-thickness closure of the entry hole while minimizing the risk of incomplete stapler firing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bidirectional barbed sutures offer a safe and feasible alternative option for the temporary closure of the entry hole during a stapled anastomotic technique in robotic and laparoscopic gastrectomies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Laparoscopic Donor Left Lateral Sectionectomy Using the Glissonean Pedicle Approach: Technical Details With Video
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-10 DOI: 10.1111/ases.70043
Yasushi Hasegawa, Yuta Abe, Hideaki Obara, Yohei Yamada, Minoru Kitago, Akihiro Fujino, Yuko Kitagawa

Introduction

Pure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery.

Surgical Technique

After liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved.

Discussion

Our Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.

{"title":"Laparoscopic Donor Left Lateral Sectionectomy Using the Glissonean Pedicle Approach: Technical Details With Video","authors":"Yasushi Hasegawa,&nbsp;Yuta Abe,&nbsp;Hideaki Obara,&nbsp;Yohei Yamada,&nbsp;Minoru Kitago,&nbsp;Akihiro Fujino,&nbsp;Yuko Kitagawa","doi":"10.1111/ases.70043","DOIUrl":"https://doi.org/10.1111/ases.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Surgical Technique</h3>\u0000 \u0000 <p>After liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utility of Laparoscopic Distal Pancreatectomy Following Esophagectomy With Gastric Roll Reconstruction Through the Retrosternal Route
IF 0.9 Q4 ORTHOPEDICS Pub Date : 2025-03-05 DOI: 10.1111/ases.70039
Yusuke Yamamoto, Ryo Morimura, Taisuke Imamura, Hisashi Ikoma, Hitoshi Fujiwara, Atsushi Shiozaki, Hirotaka Konishi, Kenji Nanishi, Jun Kiuchi, Hiroki Shimizu, Tomohiro Arita, Yoshiaki Kuriu, Takeshi Kubota, Eigo Otsuji

Background

Esophagectomy with gastric roll reconstruction through the retrosternal route can result in significant anatomical shifts in the pancreatic head and neck. These shifts must be carefully considered when planning distal pancreatectomy (DP) after esophagectomy.

Methods

We analyzed 15 patients who underwent CT scans after discharge following esophagectomy with gastric roll reconstruction via the retrosternal route. Using CT images, we examined the anatomical features necessary to safely perform DP after esophagectomy.

Results

The horizontal distances from the vertebral body to the superior mesenteric vein (SMV), superior mesenteric artery (SMA), and gastroduodenal artery (GDA) post-esophagectomy were 12.0, 21.7, and − 4.0 mm, respectively, indicating significant leftward shifts compared with preoperative measurements (SMV: 2.7 mm, p = 0.023; SMA: 9.2 mm, p = 0.046; GDA: −17.5 mm, p < 0.001). The angles between the horizontal line through the center of the SMA and the line connecting the SMA to the SMV (34.5°) and GDA (34.7°) were wider compared with the preoperative SMV (18.4°, p = 0.050) and GDA (17.9°, p = 0.018). Based on sagittal CT sections, the distance between the caudal edge of the gastric roll and the xiphoid process was 100.7 mm.

Video Presentation

We present a case of laparoscopic DP for pancreatic tail cancer after esophagectomy with gastric roll reconstruction via the retrosternal route.

Conclusion

The altered vascular positioning and the presence of the gastric roll make minimally invasive approaches, particularly laparoscopic DP, advantageous, as they reduce the risk of damaging the gastric roll and the right gastroepiploic artery (RGEA).

{"title":"Utility of Laparoscopic Distal Pancreatectomy Following Esophagectomy With Gastric Roll Reconstruction Through the Retrosternal Route","authors":"Yusuke Yamamoto,&nbsp;Ryo Morimura,&nbsp;Taisuke Imamura,&nbsp;Hisashi Ikoma,&nbsp;Hitoshi Fujiwara,&nbsp;Atsushi Shiozaki,&nbsp;Hirotaka Konishi,&nbsp;Kenji Nanishi,&nbsp;Jun Kiuchi,&nbsp;Hiroki Shimizu,&nbsp;Tomohiro Arita,&nbsp;Yoshiaki Kuriu,&nbsp;Takeshi Kubota,&nbsp;Eigo Otsuji","doi":"10.1111/ases.70039","DOIUrl":"https://doi.org/10.1111/ases.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Esophagectomy with gastric roll reconstruction through the retrosternal route can result in significant anatomical shifts in the pancreatic head and neck. These shifts must be carefully considered when planning distal pancreatectomy (DP) after esophagectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 15 patients who underwent CT scans after discharge following esophagectomy with gastric roll reconstruction via the retrosternal route. Using CT images, we examined the anatomical features necessary to safely perform DP after esophagectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The horizontal distances from the vertebral body to the superior mesenteric vein (SMV), superior mesenteric artery (SMA), and gastroduodenal artery (GDA) post-esophagectomy were 12.0, 21.7, and − 4.0 mm, respectively, indicating significant leftward shifts compared with preoperative measurements (SMV: 2.7 mm, <i>p</i> = 0.023; SMA: 9.2 mm, <i>p</i> = 0.046; GDA: −17.5 mm, <i>p</i> &lt; 0.001). The angles between the horizontal line through the center of the SMA and the line connecting the SMA to the SMV (34.5°) and GDA (34.7°) were wider compared with the preoperative SMV (18.4°, <i>p</i> = 0.050) and GDA (17.9°, <i>p</i> = 0.018). Based on sagittal CT sections, the distance between the caudal edge of the gastric roll and the xiphoid process was 100.7 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Video Presentation</h3>\u0000 \u0000 <p>We present a case of laparoscopic DP for pancreatic tail cancer after esophagectomy with gastric roll reconstruction via the retrosternal route.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The altered vascular positioning and the presence of the gastric roll make minimally invasive approaches, particularly laparoscopic DP, advantageous, as they reduce the risk of damaging the gastric roll and the right gastroepiploic artery (RGEA).</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Asian Journal of Endoscopic Surgery
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