Asian Journal of Endoscopic Surgery最新文献

Constitutional indocyanine green (ICG) excretion defect (CIED) is a rare clinical condition characterized by markedly delayed ICG disappearance with other normal liver function tests. Here, we report a case of CIED in which laparoscopic anatomical liver resection was successfully performed using ICG fluorescence staining. A 64-year-old man with a 4-cm tumor located in the liver segment 5 was referred to our hospital. His ICG retention rate at 15 min was 70%, but other liver function tests including ^99mTc-galactosyl human serum albumin scintigraphy were normal. We then planned laparoscopic segmentectomy under the diagnosis of hepatocellular carcinoma and suspected CIED. Laparoscopic hepatectomy was started after confirming a histologically normal liver. After clamping the Glissonean pedicle of segment 5, ICG was injected and the demarcation line was identified. Liver dissection was performed along the demarcation line and the operation was completed. The patient was discharged on postoperative day 10 without any complications.

Radical surgery for rectal cancer with bulky lateral pelvic lymph node (LPLN) metastasis involving the sciatic nerve presents both technical and oncological challenges. Preoperative multidisciplinary treatments have recently been anticipated to control the disease as well as to preserve organ function. A 51-year-old man, presenting with right buttock pain and impairment of walking, was diagnosed with sciatic nerve impairment due to right LPLN metastasis from rectal cancer. He was initially treated with palliative radiotherapy followed by FOLFOX plus bevacizumab. After 13 cycles of the chemotherapy, his symptoms disappeared and the LPLN shrank. Then, conversion surgery via robot-assisted low anterior resection with right LPLN dissection was performed. Although he had moderate right leg pain postoperatively, there were no motor deficits or other complications. Pathological examination of the specimen revealed microscopic residual disease at the resection margin, but he is currently surviving recurrence-free for 1.5 years. Preoperative multidisciplinary treatment enabled the preservation of the sciatic nerve in the robot-assisted conversion surgery.

Sciatic hernia, a rare type of pelvic floor hernia, presents significant diagnostic and therapeutic challenges. We report the first totally extraperitoneal (TEP) repair of a sciatic hernia, which was performed in a 63-year-old woman who presented with vomiting and poor dietary intake. Computed tomography revealed a strangulated femoral hernia and an incidental herniation of the sigmoid colon through the right sciatic foramen. Simultaneous TEP repair of both hernias was successfully performed. The TEP approach offered a wide field of view without disturbing the abdominal organs and facilitated the management of concurrent hernias, making it particularly beneficial when the diagnosis of sciatic hernia is certain.

Internal hernia following colorectal surgery is an uncommon but serious complication. Most reported cases have involved hernias resulting from mesenteric defects after left-sided colon resection. We herein report a case of laparoscopic repair of an internal hernia at the pelvic floor following low anterior resection. A 78-year-old woman with a history of robotic low anterior resection for rectal cancer presented to our hospital with severe abdominal pain and vomiting. Computed tomography revealed a strangulated bowel passing dorsally behind the reconstructed colon in the pelvis, prompting emergency surgery. The hernia orifice was formed by the levator ani and the reconstructed colon. We successfully reduced the hernia, laparoscopically sutured the orifice, and resected the strangulated bowel segment. The patient was discharged without complications and has experienced no hernia recurrence to date. Although internal hernia at the pelvic floor is very rare, this case demonstrates that safe laparoscopic reduction and repair are possible.

Management of a small renal mass and a renal stone in the same kidney presents several dilemmas. Simultaneous robot-assisted partial nephrectomy and pyelolithotomy via the same surgical access site is a reasonable approach in a patient with both entities. An 80-year-old woman was diagnosed with a 2.3-cm enhancing mass in the lower pole of the right kidney (cT1aN0M0, RENAL score 4a) and a 1.5-cm ipsilateral partial staghorn calculus. Concurrent robot-assisted partial nephrectomy and pyelolithotomy was planned. Partial nephrectomy was performed first, followed by pyelolithotomy performed through the same surgical access. Both operations were completed successfully. The total operation time was 319 min and the estimated blood loss was 30 mL. Warm ischemia time was 22 min. There were no intraoperative or postoperative complications. Simultaneous robot-assisted partial nephrectomy and pyelolithotomy was technically feasible and safe. This minimally invasive approach should be considered when managing a kidney that contains both entities.