Annals of Gastroenterological Surgery最新文献

Retroperitoneal sarcoma (RPS) is a rare tumor classified into many histological types. It is also often detected only after it has grown to a considerable size and requires extensive resection of the surrounding organs, making it difficult to offer optimal patient-tailored management. Evidence supporting specific treatment modalities for RPS is insufficient, owing to its rarity. The Japanese clinical practice guidelines for RPS were published in December 2021, with the aim of accumulating existing evidence and indicating the optimal practice for RPS. These guidelines provide important clinical questions (CQs) concerning the diagnosis and treatment of RPS. This review, with a particular focus on primary RPS, attempts to introduce clinical problems in the diagnosis and treatment of RPS and to assess those problems along with the CQs in the guidelines. According to these guidelines, although chemotherapy and radiotherapy are expected to have therapeutic effects, the level of evidence to support these treatments is not very high at present. Accordingly, complete resection of the tumor is the first and only option for managing primary RPS. However, as with other tumors, the demand for multidisciplinary treatment for RPS is increasing. These guidelines will undoubtedly represent a milestone in clinical practice in relation to RPS in the future, and further evidence is expected to be accumulated based on the CQs that have been proposed.

Robotic surgery technology is now fusing with ICT (information and communications technology) and AI (artificial intelligence) to bring about new changes in surgical education.

In robotic surgery, images of the surgical field are converted into digital signals by a 3D high-definition camera and transmitted to the surgeon's viewer, and surgical operations are digitally converted into 3D coordinate axis information and acceleration information, which are transmitted to the robotic arm and accurately reproduced as forceps manipulations. Therefore, robotic surgery can be described as a digitization technology for surgery.

Robotic surgery enables surgery without motion restrictions under detailed images deep inside the body, and the number of surgeries, especially in the field of gastrointestinal surgery, is increasing due to expectations for precision. In this volume, McCarron et al. report that they started a robotic HPB program in 2008, performed 100% of Whipple procedures by 2020, and over 1600 complex hepatobiliary surgeries by robotic surgery to date. Unfortunately, at this time, there is still little evidence of a clinical long-term outcome advantage of robotic surgery over laparoscopic surgery, but the digitization technology of surgery offers two major enhancements besides precision.

The first is telesurgery integrated with ICT. Robotic surgery began to be developed in the 1970s for use in outer space and on the battlefield. Later, as military technology was converted to civilian use, development progressed as surgical robots for general medical use. In 2001, the world's first cholecystectomy was performed by connecting New York and Strasbourg, France via a dedicated line, followed by 22 cases of abdominal surgery in Canada. All these early attempts were reportedly successful, but unacceptably long transmission delay times, high communication costs, inadequate communication security, and even the discontinuation of surgical robotics led to a setback in the development of telesurgery technology. However, recent advances in ICT, the development of high-speed communication networks, and the development of new telesurgery-compatible robots have led to a re-evaluation of telerobotic surgery.

In Japan, following the legal establishment of telesurgery in 2019, the Japan Surgical Society has established a project team to conduct research on the social implementation of telesurgery. It was found that the transmission delay, which is the biggest barrier in implementing telesurgery, does not affect surgical operations as long as it is less than 100 ms.¹ In 15 telesurgery experiments conducted using commercial lines by September 2023, the communication delay between two sites 100–700 km apart was 4–25 ms round-trip, and the total delay time, including the video information processing time, was about 50 ms.^2-4 In these remote surgical environments, we have performed several porcine