[Experience of Introduction of Robotic-Assist Surgery at Regional Hospital].

Our hospital introduced the da Vinci Xi Surgical System in April 2022. At the same time, laparoscopic surgery was also introduced to produce endoscopic surgical skill qualification system: qualified surgeon. Open surgery for trainees was also continued as before, and young surgeons were instructed to always keep their motivation high. After the introduction of robotic surgery, conferences that were accessible to trainees were held on a regular basis. In addition, the environment was designed to allow anyone to train da Vinci Surgical System. The introduction of robotic surgery has certainly reduced the number of procedures performed by trainees, especially in rectal cancer. However, surgical outcomes were better after the introduction of robotic surgery. The trend was similar for both open and laparoscopic surgery. We report on our efforts to introduce robot-assisted surgery and the actual situation in which surgeons at various stages of their education can work together to achieve a win-win situation.

Multiple aneurysms arising from the posterior inferior cerebellar artery with unknown etiology--case report--.

A 67-year-old man presented with multiple aneurysms arising from the caudal loop of the posterior inferior cerebellar artery (PICA), possibly as a result of blunt trauma. Computed tomography of the head revealed subarachnoid hemorrhage in the posterior fossa and sylvian fissure. Repeated angiography demonstrated an aneurysmal dilatation and an irregular wall on the caudal loop of the PICA. Under the operating microscope, two lesions were observed 10 mm distal to the apex of the caudal loop, both consisting of a tiny hole on the vessel wall with a fragile fringe of connective tissue and covered with a firm clot. The height of the lesions corresponded to the C-l lamina, so the lesions were probably traumatic rather than saccular.

[A case of intractable epilepsy presenting epileptic spasm treated with callosotomy in childhood].

We present a case of intractable epilepsy presenting epileptic spasm successfully treated with anterior callosotomy in childhood. A 12-year-old boy had seizures frequently since the age of 11 months which were diagnosed as an infantile spasm. He underwent various treatments including ACTH therapy, but the seizures were intractable. Characteristics of his seizures were an abrupt axial movement leading to sustained posturing, most often truncal, and neck flexion with pronounced arm extension and abduction. He lost consciousness transiently and these seizures frequently occurred in clusters and the duration of seizure was 1 to 3 seconds. Neurologically he had no deficit, but his intelligence was below the standard level. Magnetic resonance image (MRI) showed no abnormalities in the brain. Electroencephalogram (EEG) demonstrated secondary bilateral synchrony (SBS) with left frontal dominance in amplitude. Subdural strip electrodes were implanted bilaterally over the frontal lobes to detect an epileptogenic region. However intracranial ictal-EEG demonstrated an abrupt bilateral desynchronization for 1-3 seconds. As the epileptogenic zone was not clearly identified and an abrupt bilateral desynchronization was identified, anterior callosotomy was performed. Since surgery, he has remained seizure-free for two years while taking anticonvulsants and the SBS has disappeared. This case may indicate that the corpus callosum influences the occurrence of epileptic spasm and SBS on EEG.