Less invasive ultrasonography-guided high ligation of great saphenous vein in endovenous laser ablation.

ENDOVENOUS LASER ABLATION (EVLA) HAS TWO PITFALLS: endovenous heat-induced thrombosis (EHIT) and great saphenous vein (GSV) recanalization. To eliminate these complications, we developed ultrasonographyguided high ligation (UGHL) using a puncture-sized incision as an adjunct treatment to EVLA. UGHL combined with EVLA was used in 20 patients. The GSV was encircled with 2-0 silk thread at 2 cm distal to the saphenofemoral junction through two incisions of 2-3 mm by using a Deschamps aneurysm needle under ultrasonographic guidance. UGHL was technically feasible in all cases, and no case presented with complications. UGHL may be used in addition to EVLA.

Novel use of Weerda laryngoscope to remove early cervical esophageal cancer.

A 65-year-old man was followed up after endoscopic mucosal resection for esophageal cancer in February 2000. Thereafter, he received endoscopic mucosal resection, radiation therapy, and argon plasma coagulation for recurrent and multiple primary esophageal cancers. On follow-up examination, two additional esophageal cancers were detected by endoscopy in September 2003. One lesion was located 16 cm from the incisor close to the entrance to the esophagus. To preserve the larynx, this lesion was removed by mucosal resection using a Weerda distending operating laryngoscope. This report describes this novel use of a Weerda distending operating laryngoscope to remove superficial cervical esophageal cancer.

Laparoscopy-assisted abdominal aortic aneurysm repair: first case reports from Japan.

Laparoscopy-assisted abdominal aortic aneurysm (AAA) repair consists of retroperitoneal laparoscopic dissection of the AAA and graft replacement performed via a mini-laparotomy. Two patients with infrarenal AAA underwent successful straight graft replacement using this hybrid approach. The retroperitoneal space was bluntly dissected under carbon dioxide pneumoretroperitoneum and further dissection was performed laparoscopically. This enabled proximal and distal control of the aneurysm, and occlusion of the lumbar arteries and the inferior mesenteric artery with hemoclips. A 7 cm mini-laparotomy was sufficient for the straight graft replacement. Laparoscopy-assisted repair is a less invasive technique for the treatment of AAA and can be regarded as the initial step towards totally endoscopic repair.

Study of the intrahepatic surgical margin of hilar bile duct carcinoma.

BACKGROUND/AIMS: The diagnosis and treatment for hilar bile duct carcinoma has greatly improved. Frozen section is one of the modalities used to determine the intrahepatic surgical margin and the surgical approach for tumor resection. But we are sometimes faced with the case where we are perplexed whether to carry out additional surgical resection or not according to the result of frozen section, due to its inaccuracy. We studied herein the relation between the prognosis and the intrahepatic surgical margin according to the result of frozen section. METHODOLOGY: We reviewed 23 cases of hilar bile duct carcinoma whose intrahepatic surgical margin was determined by frozen section and studied the cause of death and surgical procedure. Results of the frozen sections were compared with the permanent paraffin sections. RESULTS: The overall survival rates at 1, 3 and 5 years after operation were 68.1, 41.3, and 33.0%, respectively. The accuracy, sensitivity and specificity of frozen section was 56.5%, 75.0%, and 46.7%, respectively. CONCLUSIONS: We concluded that by evaluating the diagnosis of frozen section during the surgery it was difficult to determine intrahepatic surgical margin. Aggressive hepatic resection sometimes causes a high risk of hepatic failure in which case the histological diagnosis of the frozen section throughout should not be carried out.