We report a case in which a giant hepatic cyst located at the hepatic hilum and compressing the inferior vena cava was safely treated laparoscopically with careful attention to hemodynamics in a difficult fenestrated resection in a patient with severe kyphosis. The anatomic location of the cyst was evaluated preoperatively via 3D reconstruction of computed tomography images to identify a site where safe fenestrated resection could be performed. This was challenging because the surgical field was narrow due to the presence of severe kyphosis, and there was a risk of damage to surrounding organs during fenestrated resection. The cyst was filled with a greater omentum because the opening site was covered due to compression of the liver by the costal arch, and there was a risk of recurrence. Even when severe kyphosis makes fenestration of the cyst difficult, laparoscopic surgery may be a useful option given the appropriate preoperative preparation.
{"title":"Safe Laparoscopic Treatment of a Giant Hepatic Cyst That Compressed the Inferior Vena Cava With Severe Kyphosis","authors":"Tatsuhiro Araki, Yasunori Tsuchiya, Tetsuya Omura, Nagayoshi Ota, Katsuo Shimada, Tsutomu Fujii","doi":"10.1111/ases.70008","DOIUrl":"10.1111/ases.70008","url":null,"abstract":"<div>\u0000 \u0000 <p>We report a case in which a giant hepatic cyst located at the hepatic hilum and compressing the inferior vena cava was safely treated laparoscopically with careful attention to hemodynamics in a difficult fenestrated resection in a patient with severe kyphosis. The anatomic location of the cyst was evaluated preoperatively via 3D reconstruction of computed tomography images to identify a site where safe fenestrated resection could be performed. This was challenging because the surgical field was narrow due to the presence of severe kyphosis, and there was a risk of damage to surrounding organs during fenestrated resection. The cyst was filled with a greater omentum because the opening site was covered due to compression of the liver by the costal arch, and there was a risk of recurrence. Even when severe kyphosis makes fenestration of the cyst difficult, laparoscopic surgery may be a useful option given the appropriate preoperative preparation.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899199","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}
Regional disparities in medical practice between urban and rural areas in Japan represent a critical issue, and extend to the field of surgical education. To address these disparities, we evaluated the effectiveness of simultaneous remote coaching across multiple facilities using a standardized laparoscopic training method.
Methods
A total of 28 trainees from a university hospital and 3 rural hospitals were categorized into remote and on-site coaching groups. The training curriculum included lectures, practical training, and assessments, conducted for 1 h per week using three sessions. The primary endpoint of the study was the change in time for ligation of one suture between the on-site and remote coaching groups, expressed as the median of the reduction suture time rate (RTR). Secondary endpoints included the RTR categorized by years of graduation and the results of a questionnaire survey of participants.
Results
Participants included 19 trainees in postgraduate year (PGY) 1–2 and 9 those in PGY 3–5. The median suture ligation time for the first attempt was 145 s (remote: 136 s vs. on-site: 160 s; p = 0.33) and that for the third attempt was 51 s (remote: 33 s vs. direct: 52 s; p = 0.91). The median RTR was 57%, with no significant difference observed between the remote and on-site coaching groups (43.2% vs. 71.2%, p = 0.26). The trainees' ratings for the training were generally favorable, with median ratings of 4 (range: 3–5) for the content of practical skills and 5 (4, 5) for the distance learning aspect, based on a 5-point Likert scale.
Conclusion
Simultaneous remote laparoscopic training could be effective in reducing disparities in surgical education.
导言：日本城乡医疗实践的区域差异是一个关键问题，并延伸到外科教育领域。为了解决这些差异，我们评估了使用标准化腹腔镜训练方法跨多个设施同时远程指导的有效性。方法：选取1所大学附属医院和3所农村附属医院的28名学员，分为远程指导组和现场指导组。培训课程包括讲座、实践培训和评估，每周三次，每次1小时。本研究的主要终点是现场和远程指导组之间一次缝线结扎时间的变化，以减少缝线时间率（RTR）的中位数表示。次要终点包括按毕业年限分类的RTR和参与者问卷调查的结果。结果：研究对象为研究生1-2年级19名，研究生3-5年级9名。首次尝试中位缝合时间为145 s(远程：136 s，现场：160 s；P = 0.33)，第三次尝试用时51秒(远程：33秒vs.直接：52秒；p = 0.91)。中位RTR为57%，远程和现场训练组之间无显著差异（43.2% vs. 71.2%, p = 0.26）。学员对培训的评分总体上是有利的，基于5点李克特量表，实用技能内容的中位数评分为4（范围：3-5），远程学习方面的中位数评分为5（4,5）。结论：同步远程腹腔镜培训可有效减少外科教育的差异。
{"title":"Simultaneous Remote Laparoscopic Training for Trainees Among Multiple Institutions: Can Remote Coaching Replace On-Site Coaching?","authors":"Kenji Baba, Yuto Hozaka, Kan Tanabe, Masumi Wada, Naoki Kuroshima, Kinjo Takara, Shizuka Yoshidome, Shunya Iio, Keishi Okubo, Yoshikazu Uenosono, Masakata Shimonosono, Yota Kawasaki, Ken Sasaki, Takaaki Arigami, Takao Ohtsuka","doi":"10.1111/ases.70007","DOIUrl":"10.1111/ases.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Regional disparities in medical practice between urban and rural areas in Japan represent a critical issue, and extend to the field of surgical education. To address these disparities, we evaluated the effectiveness of simultaneous remote coaching across multiple facilities using a standardized laparoscopic training method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 28 trainees from a university hospital and 3 rural hospitals were categorized into remote and on-site coaching groups. The training curriculum included lectures, practical training, and assessments, conducted for 1 h per week using three sessions. The primary endpoint of the study was the change in time for ligation of one suture between the on-site and remote coaching groups, expressed as the median of the reduction suture time rate (RTR). Secondary endpoints included the RTR categorized by years of graduation and the results of a questionnaire survey of participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants included 19 trainees in postgraduate year (PGY) 1–2 and 9 those in PGY 3–5. The median suture ligation time for the first attempt was 145 s (remote: 136 s vs. on-site: 160 s; <i>p</i> = 0.33) and that for the third attempt was 51 s (remote: 33 s vs. direct: 52 s; <i>p</i> = 0.91). The median RTR was 57%, with no significant difference observed between the remote and on-site coaching groups (43.2% vs. 71.2%, <i>p</i> = 0.26). The trainees' ratings for the training were generally favorable, with median ratings of 4 (range: 3–5) for the content of practical skills and 5 (4, 5) for the distance learning aspect, based on a 5-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Simultaneous remote laparoscopic training could be effective in reducing disparities in surgical education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878419","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}
Due to the growing medical need for gynecologic robotic surgery, several robotic surgeries may be performed in a single day at high-volume centers. This study evaluated the safety of performing multiple robot-assisted hysterectomies (RAHs) per day by the same surgeon.
Methods
We reviewed the clinical data of patients who underwent robotic surgery from April 2018 to September 2024 at the Department of Gynecology, Yamanashi Central Hospital, and also examined the surgical type, order, and surgeon for each procedure.
Results
A total of 352 RAHs performed by the same surgeon were included. Among them, 267 were the first and second cases performed on the same day (Group A), and 85 were the third to fifth cases (Group B). There were no statistically significant differences between the two groups regarding age, body mass index, uterine weight, surgical indication, and history of abdominal surgery. The median operative time of 68 (35–179) min in Group A and 66 (37–187) min in Group B was similar (p = 0.141). Both groups also had similar estimated blood loss (p = 0.744). Each group had two perioperative complications, and no patient underwent conversion to open or laparoscopic surgery.
Conclusion
Performing multiple RAHs by the same surgeon in a single day may be a safe procedure with no negative impact on operative time, blood loss, or perioperative complications. Hence, it could be a useful treatment option for high-volume centers.
{"title":"Surgical Outcomes of Multiple Robot-Assisted Hysterectomies in a Single Workday by the Same Surgeon","authors":"Takahiro Nozaki, Kosuke Matsuda, Ayaka Hosaka, Yoshihiko Ito, Keiko Kagami, Ikuko Sakamoto","doi":"10.1111/ases.70004","DOIUrl":"https://doi.org/10.1111/ases.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Due to the growing medical need for gynecologic robotic surgery, several robotic surgeries may be performed in a single day at high-volume centers. This study evaluated the safety of performing multiple robot-assisted hysterectomies (RAHs) per day by the same surgeon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the clinical data of patients who underwent robotic surgery from April 2018 to September 2024 at the Department of Gynecology, Yamanashi Central Hospital, and also examined the surgical type, order, and surgeon for each procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 352 RAHs performed by the same surgeon were included. Among them, 267 were the first and second cases performed on the same day (Group A), and 85 were the third to fifth cases (Group B). There were no statistically significant differences between the two groups regarding age, body mass index, uterine weight, surgical indication, and history of abdominal surgery. The median operative time of 68 (35–179) min in Group A and 66 (37–187) min in Group B was similar (<i>p</i> = 0.141). Both groups also had similar estimated blood loss (<i>p</i> = 0.744). Each group had two perioperative complications, and no patient underwent conversion to open or laparoscopic surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Performing multiple RAHs by the same surgeon in a single day may be a safe procedure with no negative impact on operative time, blood loss, or perioperative complications. Hence, it could be a useful treatment option for high-volume centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142861876","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}
The three-arm approach is mainly selected, despite the multiple robotic arms in da Vinci Xi. This type of surgical setup may provide less autonomy to the console surgeon and result in greater dependence on the bedside surgical assistant. Therefore, the 4th arm is used instead of the assist port, which is why we developed “pure” robot simple hysterectomy (PRSH) as a novel surgical technique, in which all ports are operated by robotic arms.
Materials and Surgical Technique
After pneumoperitoneum was established, trocars were inserted under visual control: three 8 mm robotic ports on the same horizontal line spaced 8 cm apart at the level of the endoscope port. The 2nd arm was used to insert the endoscope, and the fenestrated bipolar forceps in the 1st arm and Maryland bipolar forceps in the 3rd arm were operated using the double bipolar method. In this technique, the uterine manipulator is not used because the Cadiere forceps in the 4th arm manipulate the uterus. For suturing, the 3rd arm was equipped with a SutureCut needle driver from Maryland bipolar forceps, which enabled suturing and thread cutting. Suction and intra-abdominal transport of the needle was introduced into the abdominal cavity by pulling out the instrument in the 3rd arm. Hence, since all robotic arms are used for all ports, we named this technique “pure” robot simple hysterectomy.
Discussion
The routine use of a fourth robotic arm “4+0” mode during PRSH provides the operating surgeon with greater independence during critical phases of the procedure without requiring a uterine manipulator and assistant.
{"title":"Feasible Techniques Named “Pure” Robotic Simple Hysterectomy With 4 Robotic Arms “4+0” Mode for Hysterectomy in da Vinci Xi","authors":"Kuniaki Ota, Yoshiaki Ota, Shogo Kawamura, Hitomi Fujiwara, Keitaro Tasaka, Hana Okamoto, Yumiko Morimoto, Wataru Saito, Mika Sugihara, Eiji Koike, Mitsuru Shiota, Koichiro Shimoya","doi":"10.1111/ases.13419","DOIUrl":"https://doi.org/10.1111/ases.13419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The three-arm approach is mainly selected, despite the multiple robotic arms in da Vinci Xi. This type of surgical setup may provide less autonomy to the console surgeon and result in greater dependence on the bedside surgical assistant. Therefore, the 4th arm is used instead of the assist port, which is why we developed “pure” robot simple hysterectomy (PRSH) as a novel surgical technique, in which all ports are operated by robotic arms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Surgical Technique</h3>\u0000 \u0000 <p>After pneumoperitoneum was established, trocars were inserted under visual control: three 8 mm robotic ports on the same horizontal line spaced 8 cm apart at the level of the endoscope port. The 2nd arm was used to insert the endoscope, and the fenestrated bipolar forceps in the 1st arm and Maryland bipolar forceps in the 3rd arm were operated using the double bipolar method. In this technique, the uterine manipulator is not used because the Cadiere forceps in the 4th arm manipulate the uterus. For suturing, the 3rd arm was equipped with a SutureCut needle driver from Maryland bipolar forceps, which enabled suturing and thread cutting. Suction and intra-abdominal transport of the needle was introduced into the abdominal cavity by pulling out the instrument in the 3rd arm. Hence, since all robotic arms are used for all ports, we named this technique “pure” robot simple hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The routine use of a fourth robotic arm “4+0” mode during PRSH provides the operating surgeon with greater independence during critical phases of the procedure without requiring a uterine manipulator and assistant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>5043-03</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142861626","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}
A case of redo pyeloplasty using robot-assisted retroperitoneoscopic pyeloplasty (RARP) for failed primary laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is reported. A 12-year-old boy had LP elsewhere. He was referred for management of persistent left hydronephrosis, but was managed conservatively due to minimal symptoms and stable radioisotopic renography. When 26, he had a sudden onset of severe left flank caused by ureteropelvic anastomosis (UPA) stenosis. A double J stent was inserted and RARP was planned. A large retroperitoneal space was created using conventional retroperitoneoscopy and the proximal end of the stenosed UPA was excised. After docking a robotic surgical system, the most distal part of the renal pelvis was incised. Redo UPA was performed with interrupted sutures while approximating the edges by applying traction. There were no intraoperative complications. He remains asymptomatic 3 years postoperatively. Traction-aligned suturing during RARP facilitated redo pyeloplasty by enhancing the precision of suturing.
{"title":"Robot-Assisted Retroperitoneoscopic Traction-Aligned Suture Repair of Failed Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction","authors":"Hideaki Nakajima, Takafumi Tsukui, Hiroyuki Koga, Geoffrey J. Lane, Atsuyuki Yamataka","doi":"10.1111/ases.70002","DOIUrl":"10.1111/ases.70002","url":null,"abstract":"<div>\u0000 \u0000 <p>A case of redo pyeloplasty using robot-assisted retroperitoneoscopic pyeloplasty (RARP) for failed primary laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is reported. A 12-year-old boy had LP elsewhere. He was referred for management of persistent left hydronephrosis, but was managed conservatively due to minimal symptoms and stable radioisotopic renography. When 26, he had a sudden onset of severe left flank caused by ureteropelvic anastomosis (UPA) stenosis. A double J stent was inserted and RARP was planned. A large retroperitoneal space was created using conventional retroperitoneoscopy and the proximal end of the stenosed UPA was excised. After docking a robotic surgical system, the most distal part of the renal pelvis was incised. Redo UPA was performed with interrupted sutures while approximating the edges by applying traction. There were no intraoperative complications. He remains asymptomatic 3 years postoperatively. Traction-aligned suturing during RARP facilitated redo pyeloplasty by enhancing the precision of suturing.</p>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856110","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}
Robot-assisted transabdominal preperitoneal inguinal hernia repair (RTAPP) has been rapidly gaining popularity. However, RTAPP is currently limited to university hospitals and large medical centers and is performed mainly by experts in robotic surgery in Japan. In this study, we report the introduction of RTAPP at a municipal hospital by a robotic surgery novice and its short-term outcomes.
Methods
We reviewed the data of patients with inguinal hernias who underwent RTAPP performed by a single surgeon between November 2023 and May 2024 and evaluated its safety and short-term outcomes. A comparative study was conducted using laparoscopic transabdominal preperitoneal inguinal hernia repair (LTAPP) performed by the same surgeon.
Results
We identified 13 lesions in 11 patients (unilateral in nine; bilateral in two) in the RTAPP group. The median operative time for unilateral cases was 137 (interquartile range [IQR], 75–200) min, with a console time of 98 (IQR, 40–156) min. The time for dissection, mesh placement, and peritoneal suturing was 67 (IQR, 44–79), 5 (IQR, 5–7), and 11 (IQR, 11–15) min, respectively. To date, no complications or recurrence has been observed in any of these cases. No significant difference in operational time was observed for unilateral cases between the RTAPP and LTAPP groups (137 min vs. 104; p = 0.129).
Conclusion
Our study suggests that RTAPP is safe and feasible, even at a municipal hospital, by a robotic surgery novice. Moreover, RTAPP is comparable to LTAPP in terms of performance.
机器人辅助经腹腹膜前腹股沟疝修补术（RTAPP）已迅速普及。然而，RTAPP目前仅限于大学医院和大型医疗中心，主要由日本的机器人手术专家进行。在本研究中，我们报告了一名机器人外科新手在一家市立医院引入RTAPP及其短期效果。方法：我们回顾了2023年11月至2024年5月期间由一名外科医生实施RTAPP的腹股沟疝患者的资料，并评估其安全性和短期预后。一项比较研究进行了腹腔镜经腹膜前腹股沟疝修补术（LTAPP）由同一外科医生。结果：我们在11例患者中发现了13个病变(9例单侧；RTAPP组双侧2例)。单侧病例的中位手术时间为137（四分位间距[IQR]， 75-200） min，中间时间为98 (IQR, 40-156) min。解剖、补片放置和腹膜缝合时间分别为67 （IQR, 44-79）、5 （IQR, 5-7）和11 (IQR, 11-15) min。到目前为止，在这些病例中没有观察到并发症或复发。RTAPP组和LTAPP组在单侧病例的手术时间上无显著差异(137 min vs. 104 min；p = 0.129)。结论：我们的研究表明RTAPP是安全可行的，即使在市立医院，由机器人手术新手进行。此外，RTAPP在性能方面与LTAPP相当。
{"title":"Introduction and Short-Term Outcomes of Robot-Assisted Transabdominal Preperitoneal Inguinal Hernia Repair at a Municipal Hospital by a Robotic Surgery Novice: A Single-Center, Observational Study","authors":"Hiroto Arai, Hidenobu Matsushita, Yoshihisa Kawase, Osamu Okochi, Shigeomi Takeda, Koichi Yoshida, Hideaki Tanaka, Taichi Hirayama, Hiroyasu Yamamoto, Takuma Tsuboi, Yuta Noji, Kaito Kimura, Koji Makinoya","doi":"10.1111/ases.13421","DOIUrl":"10.1111/ases.13421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robot-assisted transabdominal preperitoneal inguinal hernia repair (RTAPP) has been rapidly gaining popularity. However, RTAPP is currently limited to university hospitals and large medical centers and is performed mainly by experts in robotic surgery in Japan. In this study, we report the introduction of RTAPP at a municipal hospital by a robotic surgery novice and its short-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the data of patients with inguinal hernias who underwent RTAPP performed by a single surgeon between November 2023 and May 2024 and evaluated its safety and short-term outcomes. A comparative study was conducted using laparoscopic transabdominal preperitoneal inguinal hernia repair (LTAPP) performed by the same surgeon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 13 lesions in 11 patients (unilateral in nine; bilateral in two) in the RTAPP group. The median operative time for unilateral cases was 137 (interquartile range [IQR], 75–200) min, with a console time of 98 (IQR, 40–156) min. The time for dissection, mesh placement, and peritoneal suturing was 67 (IQR, 44–79), 5 (IQR, 5–7), and 11 (IQR, 11–15) min, respectively. To date, no complications or recurrence has been observed in any of these cases. No significant difference in operational time was observed for unilateral cases between the RTAPP and LTAPP groups (137 min vs. 104; <i>p</i> = 0.129).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study suggests that RTAPP is safe and feasible, even at a municipal hospital, by a robotic surgery novice. Moreover, RTAPP is comparable to LTAPP in terms of performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847954","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}
Double-tract reconstruction (DTR) is one of the major procedures following proximal gastrectomy (PG) with anti-reflex function for the esophagus. Although many studies demonstrated the feasibility of laparoscopic DTR, there is a lack of research on robotic DTR. We aimed to assess the safety and feasibility of robotic DTR following PG.
Methods
Esophagojejunostomy was performed with a robotic stapler under endoscopic observation using the TilePro function of the Davinci Xi surgical system. The gastrojejunostomy procedure slightly differed depending on the size of the remnant stomach. Along with short-term surgical outcomes, long-term outcomes were compared based on the size of the remnant stomach.
Result
Thirty patients underwent robotic DTR. The median value of operative bleeding was 10 mL, although the median operative and reconstruction times were 398 and 119 min, respectively. Anastomotic complications were absent, and reflux esophagitis was not observed endoscopically 1 year after operation. Body weight loss, symptoms, and blood test findings did not differ significantly.
Conclusion
Robotic DTR may be a safe and favorable procedure in terms of the postoperative course and incidence of reflux esophagitis.
{"title":"The Safety and Anti-Reflex Effect of Robotic Double-Tract Reconstruction After Proximal Gastrectomy for Gastric Cancer","authors":"Mikito Inokuchi, Kazuya Yamaguchi, Taichi Ogo, Taiki Masuda, Hiroto Nagano, Takumi Irie","doi":"10.1111/ases.70001","DOIUrl":"10.1111/ases.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Double-tract reconstruction (DTR) is one of the major procedures following proximal gastrectomy (PG) with anti-reflex function for the esophagus. Although many studies demonstrated the feasibility of laparoscopic DTR, there is a lack of research on robotic DTR. We aimed to assess the safety and feasibility of robotic DTR following PG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Esophagojejunostomy was performed with a robotic stapler under endoscopic observation using the TilePro function of the Davinci Xi surgical system. The gastrojejunostomy procedure slightly differed depending on the size of the remnant stomach. Along with short-term surgical outcomes, long-term outcomes were compared based on the size of the remnant stomach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Thirty patients underwent robotic DTR. The median value of operative bleeding was 10 mL, although the median operative and reconstruction times were 398 and 119 min, respectively. Anastomotic complications were absent, and reflux esophagitis was not observed endoscopically 1 year after operation. Body weight loss, symptoms, and blood test findings did not differ significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robotic DTR may be a safe and favorable procedure in terms of the postoperative course and incidence of reflux esophagitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830289","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}
Intrahepatic portal and hepatic venous shunts have been reported in children (Takama et al. Surg Case Rep 2020;6(1):73) but are very rare in adults (Papamichail et al. Hepatobiliary Pancreat Dis Int 2016;15(3):329–333). Treatment is indicated in cases of portal hypertension or hyperammonemia. We evaluated and reported the usefulness, safety, and effectiveness of laparoscopic liver resection for this case. After performing intraoperative ultrasonography, the hilar plate was manipulated to identify the target Glissonean branch of segment 5 (G5). Bulldog forceps were then used for test clamping, which was identified by negative staining, Segment 5 was dissected and hepatic parenchymal resection was performed. The hepatic veins running within the ischemic area were dissected, and hepatic parenchymal resection, including intrahepatic portal and hepatic venous shunts, was performed. The operation time was 257 min, and she was discharged on the 8th postoperative day, with no complications. Serum ammonia levels decreased rapidly postoperatively. Laparoscopic liver resection may be effective for intrahepatic portal and hepatic venous shunts.
{"title":"New strategy using laparoscopic hepatectomy for an intrahepatic portal-hepatic venous shunt with hyperammonemia (with video)","authors":"Jungo Yasuda, Hironori Shiozaki, Yasuro Futagawa, Tomoyoshi Okamoto, Toru Ikegami","doi":"10.1111/ases.13408","DOIUrl":"10.1111/ases.13408","url":null,"abstract":"<p>Intrahepatic portal and hepatic venous shunts have been reported in children (Takama et al. Surg Case Rep 2020;6(1):73) but are very rare in adults (Papamichail et al. Hepatobiliary Pancreat Dis Int 2016;15(3):329–333). Treatment is indicated in cases of portal hypertension or hyperammonemia. We evaluated and reported the usefulness, safety, and effectiveness of laparoscopic liver resection for this case. After performing intraoperative ultrasonography, the hilar plate was manipulated to identify the target Glissonean branch of segment 5 (G5). Bulldog forceps were then used for test clamping, which was identified by negative staining, Segment 5 was dissected and hepatic parenchymal resection was performed. The hepatic veins running within the ischemic area were dissected, and hepatic parenchymal resection, including intrahepatic portal and hepatic venous shunts, was performed. The operation time was 257 min, and she was discharged on the 8th postoperative day, with no complications. Serum ammonia levels decreased rapidly postoperatively. Laparoscopic liver resection may be effective for intrahepatic portal and hepatic venous shunts.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814563","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}
We herein report a neonatal case showing specific findings of blood perfusion in the anastomosed esophagus of esophageal atresia (EA) and tracheoesophageal fistula (TEF) using indocyanine green (ICG) fluorescence during thoracoscopic surgery. The patient was a 3054 g, 0-day neonatal boy diagnosed with EA-TEF based on a coil-up sign of the nasogastric tube. Thoracoscopic surgery was performed on Day 4 after birth. After TEF transection, esophageal anastomosis was performed using interrupted sutures. ICG was administered intravenously to confirm blood perfusion at the anastomotic site. Initially, the upper esophagus was visualized, and 5 s later, the lower esophagus was visualized. However, no fluorescence signal was detected at the anastomotic site. The postoperative course was uneventful without anastomotic leakage. After discharge, mild anastomotic stenosis was observed, which required balloon dilatation. The time lag of fluorescent findings was considered to reflect differences in the feeding artery.
{"title":"Specific Findings of Blood Perfusion on Anastomosed Esophagus of Neonatal Esophageal Atresia and Tracheoesophageal Fistula Using Indocyanine Green Fluorescence During Thoracoscopic Surgery","authors":"Yudai Tsuruno, Toshio Harumatsu, Yumiko Tabata, Chihiro Kedoin, Masakazu Murakami, Koshiro Sugita, Keisuke Yano, Shun Onishi, Takafumi Kawano, Satoshi Ieiri","doi":"10.1111/ases.13422","DOIUrl":"10.1111/ases.13422","url":null,"abstract":"<p>We herein report a neonatal case showing specific findings of blood perfusion in the anastomosed esophagus of esophageal atresia (EA) and tracheoesophageal fistula (TEF) using indocyanine green (ICG) fluorescence during thoracoscopic surgery. The patient was a 3054 g, 0-day neonatal boy diagnosed with EA-TEF based on a coil-up sign of the nasogastric tube. Thoracoscopic surgery was performed on Day 4 after birth. After TEF transection, esophageal anastomosis was performed using interrupted sutures. ICG was administered intravenously to confirm blood perfusion at the anastomotic site. Initially, the upper esophagus was visualized, and 5 s later, the lower esophagus was visualized. However, no fluorescence signal was detected at the anastomotic site. The postoperative course was uneventful without anastomotic leakage. After discharge, mild anastomotic stenosis was observed, which required balloon dilatation. The time lag of fluorescent findings was considered to reflect differences in the feeding artery.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.13422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830261","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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