Asian Journal of Endoscopic Surgery最新文献

Robotic surgery is gaining traction in Japan due to its technological advancements, but its financial viability for hospitals remains uncertain. This study investigates the impact of robotic surgery on hospital gross profits, comparing it to laparoscopic surgery using data from surgeries performed at Red Cross Hospital Osaka. The study spans multiple surgical fields, including gastrointestinal, urology, gynecology, and thoracic surgery. While the number of robotic surgeries has increased, they consistently generate lower gross profits for hospitals compared with laparoscopic surgeries, primarily due to the high costs of robotic instruments and maintenance. Certain procedures, such as hernia repair, proximal gastrectomy, and distal pancreatectomy, result in negative profits when performed robotically. This article highlights the financial challenges hospitals face under Japan's current healthcare reimbursement system, where the fees for robotic and laparoscopic surgeries are largely the same. Policy adjustments may be necessary to ensure the financial sustainability of robotic surgery.

Developmental cyst is occasionally seen in children but are less common in adults. Complete removal of developmental cyst is necessary because there are risk of infection, squamous cell carcinoma, and recurrence due to incomplete resection. The best approach for resection of developmental cyst is still controversial. Although transsacral approach, open abdominal approach, or a combination of both have been often employed to date, reports of laparoscopic surgery have been appearing in recent years. We performed laparoscopic surgery for four patients with this disease: (i) 29-year-old woman with epidermoid cyst; (ii) 21-year-old woman with dermoid cyst; (iii) 55-year-old woman with epidermoid cyst; and (iv) 77-year-old woman with epidermoid cyst. No perioperative complications occurred and no recurrence has developed so far in any patients. Laparoscopic surgery can be considered as one of the optimal treatment options for developmental cyst.

A 21-year-old man was diagnosed with segmental adenomyomatosis of the gallbladder based on ultrasonography and computed tomography images. Computed tomography with drip infusion cholangiography revealed that the cystic duct joined the infraportal type of the left lateral bile duct (IPLLBD), which runs caudal to the umbilical portion, and that the left medial bile duct joined the right hepatic duct without forming the left hepatic duct. We planned a single-incision laparoscopic cholecystectomy with fluorescent cholangiography. The fluorescent cholangiography visualized the anatomic variant of the biliary system, and the cystic duct was divided safely. Fluorescent cholangiography is a suitable procedure to depict complex biliary anatomic variations in this patient. IPLLBD without the formation of the left hepatic duct is potentially hazardous during cholecystectomy.

The biliopancreatic limb (BPL) obstruction occurrence after one-anastomosis gastric bypass (OAGB) has not been well described in the literature. A 65-year-old female with a history of OAGB surgery presented with acute weight loss and abdominal pain. Imaging studies revealed a bezoar in the duodenal diverticulum obstructing the small bowel. An urgent laparoscopic intervention was performed to remove the bezoar and alleviate the obstruction. The patient experienced postoperative complications, including gastrostomy drainage and subsequent biliobezoar migration. additional surgeries were required to address these complications. This is a rare condition, and it is usually seen in patients with predisposing factors like DM, previous surgery, and duodenal diverticulum. CT scan study is the useful diagnostic modality, and laparoscopic intervention is the choice treatment; this case highlights the importance of recognizing and managing bezoars as a potential complication following bariatric surgery.