Robotic vs. laparoscopic distal gastrectomy for gastric cancer: A propensity score-matched retrospective comparative study at a single institution.

BACKGROUND: Although robotic surgery is becoming more widespread worldwide, it is still in its infancy. This study aimed to confirm the safety and feasibility of the induction of robotic-assisted gastric surgery at a local hospital. METHODS: For five years, between 2016 and 2020, 42 laparoscopic and 71 robotic distal gastrectomies were performed at the same institution. Patients diagnosed with gastric cancer were retrieved from the database. Propensity score matching was performed based on covariates such as Age, Sex, BMI, the American Society of Anesthesiologists Physical Status, Tumor Location, pT, and pN. Clinicopathological characteristics, surgical performance, postoperative outcomes, and pathological data were retrospectively collected and compared by the Chi-square test, the Fisher's exact test, the Student's t-test, and the Mann-Whitney U test. RESULTS: Billroth II reconstruction was often selected for the robotic group more than the laparoscopic group (59.4% and 15.6%, respectively). In addition, the number of lymph nodes harvested after D2 dissection tended to be more significant in the robotic group than in the laparoscopic group (52.1 ± 7.6 and 29.1 ± 3.7, respectively; p = 0.00934). The mean operative time was 271.4 ± 10.5 min for the robotic group and 220.8 ± 12.3 min for the laparoscopic group (p = 0.00005). There were no differences in short-term clinical outcomes between the two groups. CONCLUSIONS: Although a single-center, small comparative study, the results showed that the robotic surgery group was not inferior to the laparoscopic group in feasibility and safety. Moreover, robotic surgery enables harvesting a higher number of lymph nodes, which may be more advantageous than laparoscopic surgery. This study also showed that as the surgeon gains experience with robotic surgery, its operative time becomes significantly shorter.

A case of recurrent epiphrenic esophageal diverticulum treated with lower esophagogastric resection and interstitial jejunal reconstruction.

The patient is a 60-year-old female with a history of multiple times of recurrences of an esophageal diverticulum. She was referred for a diagnosis of persistent dysphagia and vomiting. Balloon dilation did not improve the symptoms; thus, she was referred for surgery. Esophageal fluoroscopy revealed a 5 cm diverticulum. There was no significant change in the size before and after dilation. Gastrointestinal endoscopy revealed a diverticulum in the lower esophagus, with a residue accumulation. The esophagus directly below the diverticulum was narrowed. The patient was diagnosed with recurrent lower esophageal diverticulum and underwent surgery. The operative findings showed poor coloration of the gastric fundus surrounding operated before by Nissen's method, so the patient underwent lower esophagogastric resection and interstitial jejunal reconstruction. The postoperative course was uneventful and discharged on the 19th day. She is 6 years postoperatively and gained six kg compared to her preoperative weight. She has remained in excellent health.

Metachronous triple cancers of the stomach, duodenum and rectum in a patient with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder characterized by the presence of at least 100 adenomatous polyps in the colon and rectum. The risk of upper gastrointestinal tumors is relatively high in patients with FAP, but a case of triple cancers has not been reported in the literature. We herein report a case of metachronous triple cancers of the stomach, duodenum and rectum in a patient with FAP.

A case report of anaplastic carcinoma with osteoclast-like giant cells arising in the pancreatic body.

The patient is a 58-year-old woman. She was referred to our hospital following a computed tomography scan that revealed a 2-cm tumor-like lesion in the pancreatic body. Endoscopic ultrasound fine-needle aspiration examination revealed a suspected undifferentiated carcinoma with pleomorphic type. The patient was diagnosed with anaplastic carcinoma of the pancreas (ACP) and underwent distal pancreatectomy with lymph nodes dissection. The resected body and tail of the pancreas had a nodular tumor measuring 30 mm in diameter. Histologically, the main lesion of the tumor showed well-differentiated adenocarcinoma, and diffuse proliferation of atypical short spindle cells and round cells accompanied by multinucleated giant cells aggregation was observed around the tubular structure; hence, it was diagnosed with ACP. The postoperative course was uneventful, and the patient was discharged 14 days after the operation. It has already been about 5 years since the surgery, and although the tumor has recurred, the patient is still alive and undergoing chemotherapy.

A case of post-operative stenosis caused by colonic ischemia after low anterior resection for rectal cancer, followed by delayed colo-anal anastomosis.

Cases of delayed colo-anal anastomosis (DCAA) are currently reported instead of the colo-anal anastomosis with a protective loop ileostomy for rectal cancer. Post-operative colonic ischemia is considered as one of the serious complications of colorectal resection. Although indication of DCAA should be carefully selected, we experienced a case of post-operative stenosis caused by colonic ischemia after low anterior resection for rectal cancer, followed by this procedure.

Robot-assisted excision of rectal duplication cysts: A case report.

Rectal duplication cysts are extremely rare and account for only 4% of all gastrointestinal duplication cysts. They may become challenging for removal in the case of a large tumor in a narrow pelvis. Herein, we report a case of rectal duplication cysts excision via robotic-assisted laparoscopic surgery and its utility.

A case of emergency pancreatoduodenectomy for bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head.

A rare case of bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head is reported. Caution needs to be observed, then excision may be necessary since noninvasive treatment such as coil embolization is not enough for complete hemostasis when patient suddenly decompensates.

Supplementation before endoscopic therapy for esophageal varices reduces mental stress in patients with liver cirrhosis.

BACKGROUND/AIMS: Esophageal varices are often seen in cirrhotic patients. Because endoscopic therapy for esophageal varices forces such patients to go on an extended fast until the endoscopic therapy occurs, physical and psychological stresses are induced. The aims of this study were to investigate the effects of a nutritional supplement before endoscopic therapy on such stresses, and on the safety of therapy. METHODOLOGY: Thirty-six cirrhotic patients with esophageal varices were enrolled in this study and classified into two groups. In the fasting group, no energy was supplied to patients prior to endoscopic therapy (n=18). In the supplement group, a supplement of 200kcal was given prior to endoscopic therapy (n=18). The effects of the supplement on the safety of therapy and on stresses were evaluated by the endoscopist and by the self-rating questionnaire. RESULTS: There were no significant differences in age, gender, BMI, or Child-Pugh score between the two groups. There was no interference with endoscopic therapy in the supplement group. Although physical symptoms were not significantly different between the two groups, stress scores for hypodynamia, was significantly lower in the supplement group than in the fasting group. CONCLUSION: We first demonstrated that the supplementation before endoscopic therapy does not interfere with endoscopic treatment for esophageal varices in cirrhotic patients. Supplementation improves fasting-related hypodynamia.

Evaluation of image quality of personal ultrasound imager: Comparison with the conventional machine.

OBJECTIVE: To determine if the image quality of a personal ultrasound imager (PUI) is as good as that of a conventional machine (CM). MATERIALS AND METHODS: Ninety patients were studied by the same operator using both the PUI and CM. The quality of the B-mode images obtained from these patients was scored 0, 1 or 2, defined as poor, fair, or good, respectively. Liver-tumor vascularity depicted by power Doppler imaging (PDI) and directional PDI (DPDI) was classified as 0, no blood signal; 1, dot-like blood signal within the tumor; 2, mild blood-flow signal within the tumor; and 3, abundant blood-flow signal within the tumor. RESULTS: The mean score of PUI and CM B-mode image quality was 7.47±0.92 and 7.54±0.99 (mean±SD), respectively (p=0.531). On PDI, grade of vascularity of the liver tumors determined with the PUI was 4.44 and 4.68 in those determined with the CM (p=0.78). On DPDI, tumor vascularity was 3.12 when scored by the PUI and 4.29 when scored with the CM (p=0.03). The qualities of images acquired by the PUI and CM were significantly correlated. CONCLUSION: The quality of B-mode images acquired using the PUI and CM are statistically the same, and they share a similar ability to detect intratumoral blood-flow signals on PDI. Because of its extreme portability, the PUI is expected to become a valuable diagnostic tool in the clinic.