Laparoscopy-assisted distal gastrectomy (LADG) with Billroth I (B-I) reconstruction is frequently performed for gastric cancer. However, the difference between the circular stapler technique (CS) and delta-shaped anastomosis (DA) remains unclear, especially regarding the postoperative endoscopic physiological findings.
Methods
Three hundred and one patients including 150 CS patients and 151 DA patients during LADG with B-I reconstruction between 2013 and 2019 at Saitama Medical University International Medical Center were chosen as study subjects. Postoperative endoscopic findings (1-year post-surgery) in the remnant stomach were evaluated according to the residue, gastritis, and bile-reflux classification, and the first-year postoperative weight changes were also recorded.
Results
The incidences of Grade 2 or higher remnant gastritis, bile reflux, and postoperative exacerbated reflux esophagitis were significantly higher in the DA group, while the amount of residual food was higher in the CS group. Multivariate analysis also revealed the higher risks of Grade 2 or higher gastritis and the postoperative existence or exacerbation of erosive reflux esophagitis in the DA group (OR [95% CI] was 2.737 [1.566–4.783], 3.533 [1.101–11.34], and 3.749 [1.021–13.76], respectively). However, none of these endoscopic differences but the broader extent of gastritis was the only endoscopic factor associated with severe postoperative weight loss.
Conclusion
There was a trend toward more exacerbation of residual gastritis and reflux esophagitis with the DA technique and more food remnants with the CS technique. Although the difference in the anastomotic technique did not directly result in weight loss, attention should be paid to prevent extensive residual gastritis.
{"title":"Comparisons in Postoperative Endoscopic Findings and Postoperative Weight Change Between Delta-Shaped Anastomosis and Circular-Stapled Anastomosis in Laparoscopy-Assisted Distal Gastrectomy With B-I Reconstruction","authors":"Shuichiro Oya, Shinichi Sakuramoto, Yosuke Morimoto, Kazuaki Matsui, Keiji Nishibeppu, Gen Ebara, Shohei Fujita, Shiro Fujihata, Seigi Lee, Yutaka Miyawaki, Hirofumi Sugita, Hiroshi Sato, Keishi Yamashita","doi":"10.1111/ases.70023","DOIUrl":"10.1111/ases.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Laparoscopy-assisted distal gastrectomy (LADG) with Billroth I (B-I) reconstruction is frequently performed for gastric cancer. However, the difference between the circular stapler technique (CS) and delta-shaped anastomosis (DA) remains unclear, especially regarding the postoperative endoscopic physiological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three hundred and one patients including 150 CS patients and 151 DA patients during LADG with B-I reconstruction between 2013 and 2019 at Saitama Medical University International Medical Center were chosen as study subjects. Postoperative endoscopic findings (1-year post-surgery) in the remnant stomach were evaluated according to the residue, gastritis, and bile-reflux classification, and the first-year postoperative weight changes were also recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidences of Grade 2 or higher remnant gastritis, bile reflux, and postoperative exacerbated reflux esophagitis were significantly higher in the DA group, while the amount of residual food was higher in the CS group. Multivariate analysis also revealed the higher risks of Grade 2 or higher gastritis and the postoperative existence or exacerbation of erosive reflux esophagitis in the DA group (OR [95% CI] was 2.737 [1.566–4.783], 3.533 [1.101–11.34], and 3.749 [1.021–13.76], respectively). However, none of these endoscopic differences but the broader extent of gastritis was the only endoscopic factor associated with severe postoperative weight loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was a trend toward more exacerbation of residual gastritis and reflux esophagitis with the DA technique and more food remnants with the CS technique. Although the difference in the anastomotic technique did not directly result in weight loss, attention should be paid to prevent extensive residual gastritis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034588","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}
This study demonstrates the feasibility of performing a Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy on a patient with a complex surgical history, including two renal transplants. The case involves a 42-year-old female presenting with persistent menorrhagia and hypermenorrhea, unresponsive to standard treatments, and diagnosed with adenomyosis and CIN3. A detailed, step-by-step procedure of the vNOTES technique is provided, marking the first video article to document vNOTES hysterectomy in such a medical context. The findings highlight vNOTES as a viable approach for treating refractory uterine bleeding and adenomyosis in patients with prior transplants, offering insights for young surgeons considering this minimally invasive technique in complex cases.
{"title":"Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Hysterectomy with Two Previous Renal Transplantations: The First Case in the Literature Two Renal Transplants","authors":"Burak Güler, Cem Erdoğan, Ömer Demir, Cihan Comba","doi":"10.1111/ases.70020","DOIUrl":"10.1111/ases.70020","url":null,"abstract":"<div>\u0000 \u0000 <p>This study demonstrates the feasibility of performing a Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy on a patient with a complex surgical history, including two renal transplants. The case involves a 42-year-old female presenting with persistent menorrhagia and hypermenorrhea, unresponsive to standard treatments, and diagnosed with adenomyosis and CIN3. A detailed, step-by-step procedure of the vNOTES technique is provided, marking the first video article to document vNOTES hysterectomy in such a medical context. The findings highlight vNOTES as a viable approach for treating refractory uterine bleeding and adenomyosis in patients with prior transplants, offering insights for young surgeons considering this minimally invasive technique in complex cases.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034596","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}
Rectal gastrointestinal stromal tumors (GISTs) are prevalent in the lower rectum, and the existing literature suggests that transanal interventions are advantageous for anorectal preservation. Herein, we present a case of rectal GIST resection using transanal minimally invasive surgery. A 75-year-old woman reported vaginal discomfort and was subsequently diagnosed with GIST via transanal tumor biopsy. Local excision using transanal minimally invasive surgery was performed with an operative duration of 203 min and minimal hemorrhage. No evidence of recurrence was observed at the one-year postoperative follow-up.
{"title":"Transanal Minimally Invasive Surgery for a Gastrointestinal Stromal Tumor of the Lower Rectum: A Case Report","authors":"Atsushi Naito, Hidekazu Takahasi, Terukazu Yoshihara, Kazuya Iwamoto, Nobuyoshi Ohara, Chu Matsuda, Shingo Noura","doi":"10.1111/ases.70025","DOIUrl":"10.1111/ases.70025","url":null,"abstract":"<p>Rectal gastrointestinal stromal tumors (GISTs) are prevalent in the lower rectum, and the existing literature suggests that transanal interventions are advantageous for anorectal preservation. Herein, we present a case of rectal GIST resection using transanal minimally invasive surgery. A 75-year-old woman reported vaginal discomfort and was subsequently diagnosed with GIST via transanal tumor biopsy. Local excision using transanal minimally invasive surgery was performed with an operative duration of 203 min and minimal hemorrhage. No evidence of recurrence was observed at the one-year postoperative follow-up.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034591","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}
Bladder invasion by appendiceal cancer resulting in a vesico-appendiceal fistula is an uncommon occurrence. Both radical tumor removal and functional preservation of the bladder are desirable in the surgical treatment of this disease, and there are few reports on detailed surgical methods. Here, we describe a case of primary appendiceal mucinous carcinoma with bladder invasion treated with robotic laparoscopy and endoscopy cooperative surgery (RECS). A woman in her 60s was initially considered to be bladder tumor and underwent transurethral resection. However, the tumor rapidly regrew, and she was rediagnosed with primary appendiceal cancer invading the bladder. RECS was performed, involving ileocecal resection with partial cystectomy. The postoperative course was favorable, with no bladder anastomotic leakage or ureteral obstruction. In the RECS procedure, the robotic operability facilitates bladder wall repair, and simultaneous cystoscopic observation allows for identification of the ureteral orifices, making the combined bladder resection radical and safe.
{"title":"Robotic Laparoscopy and Endoscopy Cooperative Surgery for Primary Appendiceal Mucinous Carcinoma Masquerading as Bladder Cancer: A Case Report","authors":"Ryosuke Mizuno, Hisatsugu Maekawa, Koya Hida, Takayuki Goto, Yuki Teramoto, Hiromitsu Kinoshita, Takashi Sakamoto, Shintaro Okumura, Keiko Kasahara, Nobuaki Hoshino, Tatsuto Nishigori, Ryosuke Okamura, Yoshiro Itatani, Shigeo Hisamori, Shigeru Tsunoda, Kazutaka Obama","doi":"10.1111/ases.70021","DOIUrl":"10.1111/ases.70021","url":null,"abstract":"<div>\u0000 \u0000 <p>Bladder invasion by appendiceal cancer resulting in a vesico-appendiceal fistula is an uncommon occurrence. Both radical tumor removal and functional preservation of the bladder are desirable in the surgical treatment of this disease, and there are few reports on detailed surgical methods. Here, we describe a case of primary appendiceal mucinous carcinoma with bladder invasion treated with robotic laparoscopy and endoscopy cooperative surgery (RECS). A woman in her 60s was initially considered to be bladder tumor and underwent transurethral resection. However, the tumor rapidly regrew, and she was rediagnosed with primary appendiceal cancer invading the bladder. RECS was performed, involving ileocecal resection with partial cystectomy. The postoperative course was favorable, with no bladder anastomotic leakage or ureteral obstruction. In the RECS procedure, the robotic operability facilitates bladder wall repair, and simultaneous cystoscopic observation allows for identification of the ureteral orifices, making the combined bladder resection radical and safe.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013837","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}
Annular pancreas is a rare congenital anatomical anomaly, in which the pancreatic parenchyma surrounds the descending duodenum. Generally, annular pancreas is diagnosed on the basis of symptoms associated with complications of peptic ulcer, pancreatitis, cholelithiasis, and rarely, malignant tumors. Herein, we report an 84-year-old man for whom, during hospitalization for a urinary tract infection, pancreatic cystic lesions and an annular pancreas were noted incidentally on computed tomography. These findings led to a diagnosis of intraductal papillary mucinous neoplasms on further examination. He safely underwent robot-assisted pylorus-preserving pancreatoduodenectomy, with an operative time of 478 min and blood loss of 37 g. He was discharged on postoperative day 8 without postoperative complications. In conclusion, it is important to note that, in this case, intraductal papillary mucinous neoplasms were detected before they became malignant, and minimally invasive surgery was performed safely despite the anatomical anomaly of an annular pancreas.
{"title":"A Case of Robot-Assisted Pylorus-Preserving Pancreatoduodenectomy for Branch-Duct Intraductal Papillary Mucinous Neoplasms Complicated With an Annular Pancreas","authors":"Aoi Hayasaki, Naohisa Kuriyama, Miki Usui, Motonori Nagata, Benson Kaluba, Tatsuya Sakamoto, Haruna Komatsubara, Koki Maeda, Toru Shinkai, Daisuke Noguchi, Takahiro Ito, Kazuyuki Gyoten, Takehiro Fujii, Yusuke Iizawa, Akihiro Tanemura, Yasuhiro Murata, Masashi Kishiwada, Shugo Mizuno","doi":"10.1111/ases.70022","DOIUrl":"10.1111/ases.70022","url":null,"abstract":"<p>Annular pancreas is a rare congenital anatomical anomaly, in which the pancreatic parenchyma surrounds the descending duodenum. Generally, annular pancreas is diagnosed on the basis of symptoms associated with complications of peptic ulcer, pancreatitis, cholelithiasis, and rarely, malignant tumors. Herein, we report an 84-year-old man for whom, during hospitalization for a urinary tract infection, pancreatic cystic lesions and an annular pancreas were noted incidentally on computed tomography. These findings led to a diagnosis of intraductal papillary mucinous neoplasms on further examination. He safely underwent robot-assisted pylorus-preserving pancreatoduodenectomy, with an operative time of 478 min and blood loss of 37 g. He was discharged on postoperative day 8 without postoperative complications. In conclusion, it is important to note that, in this case, intraductal papillary mucinous neoplasms were detected before they became malignant, and minimally invasive surgery was performed safely despite the anatomical anomaly of an annular pancreas.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972576","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}
Bronchial atresia (BA) and azygos lobe (AL) are rare congenital pulmonary abnormalities in pediatric patients. We herein report an infantile case of BA combined with AL that was treated with thoracoscopic surgery. The patient was an 8-month-old boy who was preoperatively diagnosed with BA of the right upper lobe (RUL) combined with an AL using fetal magnetic resonance imaging and postnatal enhanced computed tomography. Thoracoscopic surgery using indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) was performed for BA of the RUL. In the operative findings, the upper lobe bronchus was not recognized, and the pulmonary vessels of the RUL were confirmed using ICG-guided NIRF. The AL was connected to the right lower lobe (RLL). Partial RLL, including AL resection, was performed after RUL resection to prevent postoperative infections and torsion. The postoperative course was uneventful. Thoracoscopic surgery using ICG-guided NIRF was safely performed in an infant with a rare condition.
{"title":"Thoracoscopic Lobectomy for Right Upper Bronchial Atresia Combined With an Azygos Lobe of the Right Lower Lobe in an Infant Patient: A Case Report of a Rare Condition","authors":"Nanako Nishida, Keisuke Yano, Yumiko Tabata, Chihiro Kedoin, Ayaka Nagano, Toshio Harumatsu, Yudai Tsuruno, Masakazu Murakami, Koshiro Sugita, Shun Onishi, Koji Yamada, Waka Yamada, Takafumi Kawano, Satoshi Ieiri","doi":"10.1111/ases.70019","DOIUrl":"10.1111/ases.70019","url":null,"abstract":"<p>Bronchial atresia (BA) and azygos lobe (AL) are rare congenital pulmonary abnormalities in pediatric patients. We herein report an infantile case of BA combined with AL that was treated with thoracoscopic surgery. The patient was an 8-month-old boy who was preoperatively diagnosed with BA of the right upper lobe (RUL) combined with an AL using fetal magnetic resonance imaging and postnatal enhanced computed tomography. Thoracoscopic surgery using indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) was performed for BA of the RUL. In the operative findings, the upper lobe bronchus was not recognized, and the pulmonary vessels of the RUL were confirmed using ICG-guided NIRF. The AL was connected to the right lower lobe (RLL). Partial RLL, including AL resection, was performed after RUL resection to prevent postoperative infections and torsion. The postoperative course was uneventful. Thoracoscopic surgery using ICG-guided NIRF was safely performed in an infant with a rare condition.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956661","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}
Many institutions perform thoracoscopic surgery for pediatric extrapulmonary sequestration (EPS). This approach achieves good cosmetic outcomes due to the small skin incision in comparison to open surgery. However, an extension or additional incision is sometimes necessary to extract resected specimens from the thoracic cavity, which reduces the advantages of this procedure. We herein report 5 cases of two-site thoracoscopic surgery (TTS) using an extraction wound with left-sided EPS. In this procedure, a camera port was inserted inside the skin incision at the sixth intercostal space of the middle axillary line using optical methods, and the operator's left-hand port was inserted inside the same skin incision. The EPS was resected and extracted through a skin incision without extension or additional incision. A surgeon-in-training performed the procedure in 4 of the 5 cases. The postoperative course was uneventful in all cases. The patients showed quick recovery and good cosmetic outcomes. TTS is a cosmetically favorable approach for EPS.
{"title":"Two-Site Thoracoscopic Surgery for Extra-Pulmonary Sequestration Using an Extraction Wound: Five Pediatric Cases With Favorable Cosmetic Outcomes","authors":"Keisuke Yano, Nanako Nishida, Chihiro Kedoin, Yumiko Tabata, Yumiko Iwamoto, Masato Ogata, Lynne Takada, Ayaka Nagano, Yudai Tsuruno, Masakazu Murakami, Koshiro Sugita, Shun Onishi, Toshio Harumatsu, Takafumi Kawano, Mitsuru Muto, Tatsuru Kaji, Satoshi Ieiri","doi":"10.1111/ases.70005","DOIUrl":"10.1111/ases.70005","url":null,"abstract":"<p>Many institutions perform thoracoscopic surgery for pediatric extrapulmonary sequestration (EPS). This approach achieves good cosmetic outcomes due to the small skin incision in comparison to open surgery. However, an extension or additional incision is sometimes necessary to extract resected specimens from the thoracic cavity, which reduces the advantages of this procedure. We herein report 5 cases of two-site thoracoscopic surgery (TTS) using an extraction wound with left-sided EPS. In this procedure, a camera port was inserted inside the skin incision at the sixth intercostal space of the middle axillary line using optical methods, and the operator's left-hand port was inserted inside the same skin incision. The EPS was resected and extracted through a skin incision without extension or additional incision. A surgeon-in-training performed the procedure in 4 of the 5 cases. The postoperative course was uneventful in all cases. The patients showed quick recovery and good cosmetic outcomes. TTS is a cosmetically favorable approach for EPS.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956565","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}
Robotic total mesorectal excision (TME) with resection of adjacent organs has been increasingly used for locally advanced rectal cancer; however, few studies have focused on robotic TME with partial prostatectomy. Therefore, this study aimed to demonstrate the advantages of robotic TME with partial prostatectomy compared with open surgery for rectal cancer.
Method
This retrospective cohort study examined consecutive patients with rectal cancer who underwent robotic or open TME with partial prostatectomy at a high-volume center in Japan from April 2003 to March 2022. The patients were divided into robotic (n = 14) and open (n = 11) surgery groups. The short- and long-term outcomes of these patients were compared.
Results
More transabdominal partial prostatectomies were performed in the robotic surgery group than in the open surgery group (71.4% vs. 9.1%, p = 0.001). Moreover, sphincter-preserving surgery was performed in 35.7% of patients in the robotic surgery group. The robotic surgery group had shorter operative times (401 min vs. 435 min, p = 0.047), less blood loss (56 mL vs. 484 mL, p < 0.001), lower complication rates (28.6% vs. 72.7%, p = 0.047), and shorter postoperative hospital stays (8 days vs. 18 days, p < 0.001) than the open surgery group. No significant differences were observed in the positive radial margin rate (7.1% vs. 9.1%, p = 1.000) or long-term outcomes between the two groups.
Conclusion
Compared with open surgery, robotic TME with partial prostatectomy facilitates transabdominal partial prostatectomy, resulting in more sphincter-preserving surgeries and better short-term outcomes.
目的：机器人全肠系膜切除（TME）并切除邻近器官已越来越多地用于局部晚期直肠癌；然而，很少有研究关注机器人TME与部分前列腺切除术。因此，本研究旨在证明机器人TME与直肠癌部分前列腺切除术相比开放手术的优势。方法：这项回顾性队列研究于2003年4月至2022年3月在日本的一个大容量中心对接受机器人或开放式TME联合部分前列腺切除术的连续直肠癌患者进行了研究。将患者分为机器人手术组（n = 14）和开放手术组（n = 11）。比较这些患者的短期和长期预后。结果：机器人手术组经腹部分前列腺切除术的发生率高于开放手术组（71.4%比9.1%,p = 0.001）。此外，机器人手术组中35.7%的患者进行了保留括约肌手术。机器人手术组手术时间更短（401 min vs. 435 min, p = 0.047），出血量更少(56 mL vs. 484 mL， p结论：与开放手术相比，机器人TME联合部分前列腺切除术更方便经腹部分前列腺切除术，保留括约肌手术次数更多，近期疗效更好。
{"title":"Advantages of Robotic Total Mesorectal Excision With Partial Prostatectomy Compared With Open Surgery for Rectal Cancer: A Single-Center Retrospective Cohort Study","authors":"Rumi Shimano, Shunsuke Kasai, Hiroyasu Kagawa, Akio Shiomi, Shoichi Manabe, Yusuke Yamaoka, Yusuke Tanaka, Takahiro Igaki, Akitoshi Nankaku, Yusuke Kinugasa","doi":"10.1111/ases.70003","DOIUrl":"10.1111/ases.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Robotic total mesorectal excision (TME) with resection of adjacent organs has been increasingly used for locally advanced rectal cancer; however, few studies have focused on robotic TME with partial prostatectomy. Therefore, this study aimed to demonstrate the advantages of robotic TME with partial prostatectomy compared with open surgery for rectal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This retrospective cohort study examined consecutive patients with rectal cancer who underwent robotic or open TME with partial prostatectomy at a high-volume center in Japan from April 2003 to March 2022. The patients were divided into robotic (<i>n</i> = 14) and open (<i>n</i> = 11) surgery groups. The short- and long-term outcomes of these patients were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More transabdominal partial prostatectomies were performed in the robotic surgery group than in the open surgery group (71.4% vs. 9.1%, <i>p</i> = 0.001). Moreover, sphincter-preserving surgery was performed in 35.7% of patients in the robotic surgery group. The robotic surgery group had shorter operative times (401 min vs. 435 min, <i>p</i> = 0.047), less blood loss (56 mL vs. 484 mL, <i>p</i> < 0.001), lower complication rates (28.6% vs. 72.7%, <i>p</i> = 0.047), and shorter postoperative hospital stays (8 days vs. 18 days, <i>p</i> < 0.001) than the open surgery group. No significant differences were observed in the positive radial margin rate (7.1% vs. 9.1%, <i>p</i> = 1.000) or long-term outcomes between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with open surgery, robotic TME with partial prostatectomy facilitates transabdominal partial prostatectomy, resulting in more sphincter-preserving surgeries and better short-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956658","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}
An aberrant right subclavian artery (ARSA) is a rare vascular anomaly accompanied by nonrecurrent inferior laryngeal nerve (NRILN). Here, we described the cervical-first approach in thoracoscopic esophagectomy for an esophageal cancer patient with ARSA using the intraoperative nerve monitoring (IONM) system. First, a left cervical procedure proceeded to expose the left vagus nerve to attach the APS electrode of the IONM system, and the left cervical paraesophageal lymph nodes was dissected separately. Subsequently, the NRILN was identified using the IONM system by tracing the right vagal nerve with intermittent manual stimulation. In the thoracoscopic procedures, the right vagal nerve was traced cranially from the bronchial bifurcation, and the dissection continued through the cervicothoracic border up to NRILN without difficulty. Continuous nerve monitoring can ensure safe left upper mediastinal dissection ensuring the left recurrent laryngeal nerve integrity in the narrow upper mediastinum. The postoperative course was uneventful and, the patient was discharged on postoperative Day 21. In patients with ARSA, the cervical-first method in thoracoscopic esophagectomy with IONM is a safer alternative, and left upper mediastinal dissection by the dorsal approach over the esophagus is useful in the restricted space of the upper mediastinum.
{"title":"Cervical-First Approach in Thoracoscopic Esophagectomy With Intraoperative Nerve Monitoring for an Esophageal Cancer Patient With Aberrant Right Subclavian Artery","authors":"Masato Mochizuki, Shigeru Tsunoda, Shintaro Okumura, Tatsuto Nishigori, Shigeo Hisamori, Keiko Kasahara, Takashi Sakamoto, Hiromitsu Kinoshita, Yoshiro Itatani, Nobuaki Hoshino, Ryosuke Okamura, Hisatsugu Maekawa, Koya Hida, Kazutaka Obama","doi":"10.1111/ases.70018","DOIUrl":"10.1111/ases.70018","url":null,"abstract":"<div>\u0000 \u0000 <p>An aberrant right subclavian artery (ARSA) is a rare vascular anomaly accompanied by nonrecurrent inferior laryngeal nerve (NRILN). Here, we described the cervical-first approach in thoracoscopic esophagectomy for an esophageal cancer patient with ARSA using the intraoperative nerve monitoring (IONM) system. First, a left cervical procedure proceeded to expose the left vagus nerve to attach the APS electrode of the IONM system, and the left cervical paraesophageal lymph nodes was dissected separately. Subsequently, the NRILN was identified using the IONM system by tracing the right vagal nerve with intermittent manual stimulation. In the thoracoscopic procedures, the right vagal nerve was traced cranially from the bronchial bifurcation, and the dissection continued through the cervicothoracic border up to NRILN without difficulty. Continuous nerve monitoring can ensure safe left upper mediastinal dissection ensuring the left recurrent laryngeal nerve integrity in the narrow upper mediastinum. The postoperative course was uneventful and, the patient was discharged on postoperative Day 21. In patients with ARSA, the cervical-first method in thoracoscopic esophagectomy with IONM is a safer alternative, and left upper mediastinal dissection by the dorsal approach over the esophagus is useful in the restricted space of the upper mediastinum.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932995","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}
This study examined factors that affected sentinel lymph node (SLN) identification of patients with endometrial cancer having a preoperative estimation of low recurrent risk.
Methods
This study included 97 patients with endometrial cancer who attempted to identify SLN using a uterine cervical injection of technetium-99 m phytate under laparoscopic or robotic-assisted surgery at our institute. A preoperative single photon emission computed tomography (SPECT) and intraoperative gamma probe were used to detect hot nodes. Multiple clinical factors, including age, body mass index (BMI), and so on, were investigated for their association with SLN mapping failure.
Results
Among 97 cases, SPECT failed to detect SLN unilaterally in 38 cases (39%) and on both sides in 9 cases (9%). Meanwhile, the gamma probe failed to detect SLN unilaterally in 23 cases (24%) and on both sides in 3 cases (3%). While only age was significantly associated with SLN detection failure using the SPECT detection system, both age and BMI were significantly associated with SLN detection failure using the gamma probe detection system. When limiting to the preoperative SLN detection failure cohort of 47 cases, there was a strong association between intraoperative SLN detection failure and BMI, but not age.
Conclusion
The SLN biopsy system was effectively applied to patients with endometrial cancer who underwent minimally invasive surgery (MIS). Attempts to improve SLN identification in older patients and those with obesity are warranted to obtain maximum benefits of MIS for low- or medium-risk cases.
{"title":"Sentinel Lymph Node Detection Using SPECT and Gamma Probe in Low-Risk Endometrial Cancer: Efficacy and Factors Associated With Detection Failure","authors":"Kazuo Asanoma, Hideaki Yahata, Keisuke Kodama, Kaoru Okugawa, Masafumi Yasunaga, Ichiro Onoyama, Hiroshi Yagi, Shoji Maenohara, Kazuhisa Hachisuga, Takuro Isoda, Mototsugu Shimokawa, Kousei Ishigami, Yoshinao Oda, Kiyoko Kato","doi":"10.1111/ases.70015","DOIUrl":"10.1111/ases.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study examined factors that affected sentinel lymph node (SLN) identification of patients with endometrial cancer having a preoperative estimation of low recurrent risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 97 patients with endometrial cancer who attempted to identify SLN using a uterine cervical injection of technetium-99 m phytate under laparoscopic or robotic-assisted surgery at our institute. A preoperative single photon emission computed tomography (SPECT) and intraoperative gamma probe were used to detect hot nodes. Multiple clinical factors, including age, body mass index (BMI), and so on, were investigated for their association with SLN mapping failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 97 cases, SPECT failed to detect SLN unilaterally in 38 cases (39%) and on both sides in 9 cases (9%). Meanwhile, the gamma probe failed to detect SLN unilaterally in 23 cases (24%) and on both sides in 3 cases (3%). While only age was significantly associated with SLN detection failure using the SPECT detection system, both age and BMI were significantly associated with SLN detection failure using the gamma probe detection system. When limiting to the preoperative SLN detection failure cohort of 47 cases, there was a strong association between intraoperative SLN detection failure and BMI, but not age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The SLN biopsy system was effectively applied to patients with endometrial cancer who underwent minimally invasive surgery (MIS). Attempts to improve SLN identification in older patients and those with obesity are warranted to obtain maximum benefits of MIS for low- or medium-risk cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932996","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}
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