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1.
Clin J Gastroenterol ; 14(6): 1791-1797, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34386941

RESUMO

Lymphangiomas are classified as lymphatic malformations, which are more common in children and rare in adults. It frequently occurs in the cervical and axillary regions and uncommonly in the retroperitoneum. A 39-year-old woman presented to our department for the investigation for a 55 mm asymptomatic mass in the right anterior adrenal cavity. Abdominal ultrasound showed a tumor containing cysts in the right anterior adrenal cavity. Contrast-enhanced computed tomography showed that the tumor was poorly contrasted and ill-defined. Magnetic resonance imaging suggested that the tumor contained a small amount of fat. The tumor tended to grow, and the possibility of malignant diseases such as liposarcoma could not be excluded. Therefore, surgical resection was performed. Since intraoperative findings showed that the tumor tightly invaded to the duodenum and pancreatic head, a pancreaticoduodenectomy was selected. The entire tumor was removed without exposing the tumor. Macroscopic findings indicated that the specimen was 55 mm in size, indistinctly demarcated, yellow-white in color, and polycystic. Histologically, lymphovascular proliferation was observed with infiltration of the pancreatic head and the duodenal muscle layer. The diagnosis of lymphangioma was finally made. There was no recurrence 2 years after surgery.


Assuntos
Linfangioma , Neoplasias Retroperitoneais , Adulto , Criança , Feminino , Humanos , Linfangioma/diagnóstico por imagem , Linfangioma/cirurgia , Recidiva Local de Neoplasia , Pâncreas , Pancreatectomia , Pancreaticoduodenectomia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia
2.
Int J Med Robot ; 17(6): e2322, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34405536

RESUMO

BACKGROUND: Previously, we developed an image-guided navigation system (IG-NS) incorporating augmented reality technology. Nevertheless, the system could still only aid the operator by presenting imagery and was short of achieving the goal of developing a real navigation system. Therefore, we developed a recognised position-guided navigation system (RP-NS) and herein reported the functionality and usefulness of this system in a phantom model for clinical applications. METHODS: We developed RP-NS which was reconstructed by adding the positional recognition and instruction functions with the cautions by displaying the images on the monitor with a voice to the IG-NS. We evaluated accuracy of positional recognition and instruction functions using phantom model. By utilising the chronological recording of the tip position of the surgical apparatus, the surgical precision of the operators was assessed. Finally, the feasibility of improvements in surgical precision using this system was evaluated. RESULTS: The RP-NS indicated an accuracy of the position recognition functions with an error of 2.7 mm. The surgeons could perform partial hepatectomies within mean value of 7.5% error as compared with calculated volume according to the instruction. Improvements in surgical precision using this system were obtained on the surgeons with different levels. CONCLUSIONS: The RP-NS was highly effective as a navigation system owing to precise positional recognition and adequate instruction functions. Therefore, these results indicate that the use of this system may complement differences in proficiency, and numerically evaluate surgical skills and analyse tendencies of surgeons.


Assuntos
Cirurgia Assistida por Computador , Hepatectomia , Humanos , Tomografia Computadorizada por Raios X
3.
Int J Clin Oncol ; 26(10): 1929-1937, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34232427

RESUMO

INTRODUCTION: Osteopenia, which is defined as a decrease in bone mineral density, has been recently recognized as a metabolic and an oncological biomarker for surgery in patients with malignancy. We aimed to study the prognostic impact of osteopenia in patients with pancreatic cancer (PC) after resection. METHODS: A total of 56 patients who underwent curative resection of PC were retrospectively investigated. The skeletal muscle index at the third lumbar spine and bone mineral density at the 11th thoracic vertebra were measured using computed tomography. RESULTS: Sarcopenia and osteopenia were identified in 24 (43%) and 27 (48%) patients, respectively. The overall and disease-free survival rates were significantly lower in the sarcopenia group than in the non-sarcopenia group (p < 0.01 and p < 0.01, respectively) and in the osteopenia group than in the non-osteopenia group (p < 0.01 and p < 0.01, respectively). In multivariate analysis, sarcopenia (odds ratio [OR] 4.05; 95% confidence interval [CI] 1.23-13.38; p = 0.02) was a significant independent predictor of 1-year disease-free survival. Further, sarcopenia (OR 6.00; 95% CI 1.46-24.6; p = 0.01) and osteopenia (OR 4.66; 95% CI 1.15-18.82; p = 0.03) were significant independent predictors of 2-year overall survival. CONCLUSION: Osteopenia is a significant negative factor for 2-year overall survival after curative resection of PC.


Assuntos
Doenças Ósseas Metabólicas , Neoplasias Pancreáticas , Sarcopenia , Doenças Ósseas Metabólicas/patologia , Humanos , Músculo Esquelético/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos , Sarcopenia/complicações , Sarcopenia/patologia
4.
J Gastrointest Surg ; 25(11): 2835-2841, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33772400

RESUMO

BACKGROUND: The superiority of outcomes associated with anatomical resection (AR) versus those associated with non-anatomical resection (NAR) remains controversial in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance of AR on therapeutic outcomes of patients with small HCCs (≤ 5 cm), using propensity score-matched (PSM) analysis. METHODS: A total of 195 patients who had undergone elective hepatic resection for small HCCs (≤ 5 cm) were included in this study. We conducted PSM analysis for baseline characteristics (age, sex, hepatitis virus status, retention rate of indocyanine green at 15 min, and Child-Pugh grade), preoperative serum α-fetoprotein, and tumor characteristics (tumor size, tumor number, portal vein invasion, and surgical margin status) to eliminate potential selection bias. The prognostic significance of AR on the disease-free and overall survival was analyzed in patients selected by PSM analysis. RESULTS: Applying PSM analysis, the patients were divided into PSM-AR (N = 66) and PSM-NAR (N = 66) groups. Disease-free survival was significantly better in the PSM-AR group than that of the PSM-NAR group (P = 0.018), while there was no significant difference in the overall survival between the PSM-AR and PSM-NAR groups (P = 0.292). The univariate HRs of the PSM-AR group were 0.55 (95% CI, 0.33-0.90) for disease-free survival and 0.61 (95% CI, 0.24-1.53) for overall survival, respectively. Remnant liver recurrence was significantly lower in the AR group (P = 0.014). CONCLUSIONS: AR may improve the disease-free survival in HCC patients with tumors of ≤5 cm diameter.

5.
Surg Case Rep ; 6(1): 313, 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33296039

RESUMO

BACKGROUND: Peritoneal dissemination associated with the postoperative recurrence of breast cancer is relatively low (3-6%). Although the prognosis of patients with peritoneal metastasis is generally short (7-26 months), we experienced a unique case in which complete remission was achieved for more than 6 years with endocrine therapy alone. CASE PRESENTATION: An 81-year-old woman presented an upper abdominal tumor and loss of appetite. Computer tomography (CT) scan revealed a tumor in the duodenum and the head of pancreas, which malignant lymphoma was suspected. The exploratory laparotomy demonstrated a tumor located in the greater curvature of the pylorus to the transverse colon, and peritoneal dissemination. Because of the previous history of breast cancer 11 years ago and the immunopathological findings, recurrence of breast cancer was diagnosed. Lung metastasis was also detected postoperatively and the endocrine therapy using letrozole was introduced. After a year, CT scan confirmed complete remission from the metastasis. Two years later, tumor markers fell within the normal limit. CONCLUSIONS: A rare case of late-phase metachronous peritoneal metastasis of the breast cancer where complete remission was obtained by a single endocrine agent was presented.

6.
Surg Case Rep ; 6(1): 58, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32232598

RESUMO

BACKGROUND: Breast metastasis from extra-mammary primary tumors is extremely rare. We recently experienced a rare case of a male breast metastasis of ureteral cancer and will provide a case report. CASE PRESENTATION: A 74-year-old man developed a ureteral cancer and underwent left nephroureterectomy with lymph node dissection. Although enlarged abdominal lymph nodes did not disappear completely after chemoradiotherapy, further extensive therapy was not performed. A mass just below the nipple of his right breast was acknowledged and he visited our department. Histological diagnosis was invasive carcinoma. It was initially diagnosed as a primary breast cancer, and he underwent a mastectomy and a sentinel lymph node biopsy. There was no intraductal lesion and the border of the tumor was clear. It was very similar to that of the previous ureteral cancer. The final diagnosis was breast metastasis of ureteral cancer rather than primary breast cancer. The postoperative course was good, but multiple lung metastases appeared 2 months after surgery. He eventually died of cancerous lymphangiopathy. CONCLUSION: It is important to accurately diagnose primary breast cancer or breast metastasis so as not to cause extra-invasion, but it was considered difficult to make a complete preoperative diagnosis.

7.
Int J Breast Cancer ; 2020: 7156574, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32099680

RESUMO

There are currently no established second- and later-line therapies for postmenopausal women with hormone receptor-positive advanced or metastatic breast cancer. We examined the efficacy of high-dose toremifene (HD-TOR) for this patient group and whether aromatase inhibitor (AI) resistance influences HD-TOR treatment outcome. This retrospective analysis investigated the outcomes of 19 women with postmenopausal hormone-sensitive recurrent or metastatic breast cancer who received HD-TOR, defined as 120 mg daily from 2012 to 2016. The median follow-up duration was 9.67 months. The overall response rate (ORR) and clinical benefit rate (CBR) were compared between various clinical subgroups, including patients exhibiting primary or secondary AI resistance as defined by the timing of recurrence or progression. Time to treatment failure (TTF) was estimated by the Kaplan-Meier method and compared between subgroups by the log-rank test. The overall ORR was 21.1%, and the CBR was 31.6%. CBR was significantly higher for patients without liver metastasis (50% vs. 0%, p = 0.044). Nine cases exhibited primary and eight cases secondary AI resistance. Both ORR and CBR were higher in patients with secondary AI resistance (25% vs. 0%, p = 0.087; 38% vs. 11%, p = 0.29). The median TTF was 6.2 months in the entire AI-resistant group (n = 17) and was longer in the secondary resistance subgroup than in the primary resistance subgroup (8.40 vs. 4.87 months; log-rank: p = 0.159). High-dose TOR appears to be most effective for postmenopausal breast cancer cases with secondary resistance to AIs, cases without prior AI treatment, and cases without liver metastasis. The detailed mechanisms of AI resistance and the clinical features of responsive cases need to be further clarified to identify the best candidates for HD-TOR.

8.
Anticancer Res ; 40(1): 293-298, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892579

RESUMO

BACKGROUND/AIM: The prognosis of pancreatic cancer remains poor with a high incidence of recurrence even after curative resection. The aim of this study was to investigate prognostic factors in patients with recurrent pancreatic cancer using the multicenter database. PATIENTS AND METHODS: The subjects were 196 patients with recurrent pancreatic cancer who underwent resection between 2008 and 2015. We retrospectively investigated the relation between clinicopathological characteristics of the patients and overall survival from recurrence using univariate and multivariate analyses. RESULTS: In univariate analysis, the positive lymphatic invasion (p=0.0240), time to recurrence from resection <1 year (p<0.0001), sites of recurrence except for local or lymph node (p=0.0273), liver recurrence (p=0.0389) and peritoneal recurrence (p<0.0001) were significantly associated with poor overall survival from recurrence. In multivariate analysis, time to recurrence from resection <1 year (p<0.0001) and peritoneal recurrence (p<0.0001) were independently associated with poor overall survival from recurrence. CONCLUSION: Time to recurrence from resection <1 year and peritoneal recurrence were significant independent predictors of poor overall survival from recurrence in patients with recurrent pancreatic cancer.


Assuntos
Recidiva Local de Neoplasia/patologia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Peritoneais/patologia , Prognóstico
9.
Anticancer Res ; 40(1): 373-377, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892589

RESUMO

AIM: In colorectal cancer surgery, the efficacy of intestinal blood flow evaluation with the indocyanine green (ICG) fluorescence method using the VISERA ELITE2 system was investigated. PATIENTS AND METHODS: Participants in this study comprised 50 patients who underwent elective laparoscopic colorectal cancer surgery at the Department of Surgery, the Jikei Daisan Hospital. With the ICG fluorescence method, whether it was necessary to change the intestinal transection line for anastomosis was evaluated. RESULTS: For three cases of rectal cancer, the oral transection line determined from macroscopic observation was judged to offer insufficient blood flow according to the ICG fluorescence method. The transection line for anastomosis was changed according to fluorescence. None of these cases showed complications. CONCLUSION: The ICG fluorescence method may allow safe anastomosis in colorectal surgery for cancer.


Assuntos
Cirurgia Colorretal , Verde de Indocianina/química , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Cirurgia Colorretal/efeitos adversos , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
10.
Asian J Endosc Surg ; 13(1): 39-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30945434

RESUMO

BACKGROUND: To achieve safety of the operation, preoperative simulation became a routine practice for hepatobiliary and pancreatic (HBP) surgery. The use of intraoperative ultrasonography (IOUS) is essential in HBP surgery. There is a limitation in the use of IOUS in laparoscopic surgery (LS), for which a new intraoperative system is expected. We have developed an image-guided navigation system (IG-NS) for open HBP surgery since 2006, and we have applied our system to LS. The aim of this study is to evaluate the results of clinical application of IG-NS in LS. MATERIALS AND METHODS: Eight patients underwent LS using IG-NS; LS consisted of cholecystectomy and hepatectomy in four patients each. After registration, the 3D models were superimposed on the surgical field. We performed LS while observing the navigation image. Moreover, we developed a support system for operations. RESULTS: The average registration error was 8.8 mm for LS. Repeated registration was effective for organ deformation and improved the precision of IG-NS. By using various countermeasures, identification of the tumor's position and the setting of the resection line became easy. CONCLUSION: As IG-NS provided real-time detailed and intuitive information, this intraoperative assist system may be an effective tool in LS.


Assuntos
Doenças Biliares/cirurgia , Colecistectomia Laparoscópica/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Cirurgia Assistida por Computador , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Cuidados Intraoperatórios , Laparoscopia , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Técnicas Estereotáxicas , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Dig Surg ; 37(4): 275-281, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31722357

RESUMO

INTRODUCTION: A preoperative scoring system to predict carcinoma in patients with gallbladder polyps (GBPs). METHODS: Preoperative parameters of patients with GBPs who underwent cholecystectomies were used to construct a scoring system to ascertain the risk of malignancy (reference group). The scoring system developed from this approach was applied to the validation group. RESULTS: In the reference group, 11.5% of patients had carcinomas, in whom the median age was 68 years and the polyp size was 16.9 mm. According to the univariate analysis, the significant factors for carcinoma were age ≥65 years, the presence of gallstones, polyp size ≥13 mm, solitary polyp, and sessile polyp. Age ≥65 years and polyp size ≥13 mm were significant factors according to the multivariate analysis. From these results, we developed a preoperative scoring system to predict carcinoma. The patients were divided into 1 of 2 groups: low-risk and high-risk and their malignancy rates were 4.1 and 61.1% respectively (p < 0.001). In the validation group, the malignancy rate was higher for those in the high-risk group (p = 0.016). CONCLUSIONS: The proposed preoperative scoring system based on simple clinical variables appears to be useful for predicting malignancy in patients with GBPs.


Assuntos
Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Pólipos/diagnóstico por imagem , Pólipos/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma/cirurgia , Colecistectomia Laparoscópica , Diagnóstico Diferencial , Endossonografia , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Cálculos Biliares/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos/cirurgia , Valor Preditivo dos Testes , Período Pré-Operatório , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Adulto Jovem
12.
Anticancer Res ; 39(6): 3009-3013, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177142

RESUMO

BACKGROUND/AIM: Indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels. The efficacy of real-time fluorescence vessel navigation (FVN) using ICG for ligation of the inferior mesenteric vein (IMV) and left colic artery (LCA) during laparoscopic left colorectal cancer surgery was investigated. PATIENTS AND METHODS: Participants were 59 patients who underwent laparoscopic left colorectal cancer surgery from February 2017 to November 2018, and were divided into groups: i) with FVN (FVN+, n=21) and ii) without FVN (FVN-, n=38). Groups were compared for the time it took to ligate their IMV and LCA. RESULTS: The results are expressed as median values. The time to ligate the IMV and LCA was significantly shorter for FVN+ (230 seconds; range 126-346) than for FVN- (417.5 seconds; range 137-1327) (p<0.001). CONCLUSION: Real-time FVN using ICG shortened the times for IMV and LCA ligation. This was enabled by clear visualization of the direction of the bloodstream flow inside the vessels. This technique simplifies vessel ligation and safer laparoscopic surgery for left colorectal cancer.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Corantes Fluorescentes/administração & dosagem , Verde de Indocianina/administração & dosagem , Laparoscopia/métodos , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/cirurgia , Imagem Óptica/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Ligadura , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
Anticancer Res ; 39(6): 3227-3230, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177172

RESUMO

BACKGROUND: We advocated the usefulness of pylorus-reconstruction gastrectomy (PRG) to improve quality of life following surgery for gastric cancer. The current study assessed gastric emptying following PRG in comparison with those who underwent conventional Billroth-I (B-I) reconstruction and in healthy controls using a 13C breath test. PATIENTS AND METHODS: The study group consisted of 24 patients who underwent PRG from September 20, 2007 to July 26, 2012 at the Department of Surgery at Daisan Hospital (affiliated with The Jikei University School of Medicine). These patients underwent the 'standard' version of a gastric-emptying study using a 13C breath test at 20.5±11.8 months after surgery. During the study, the half gastric-emptying time (T1/2) and gastric retention at 5 min after ingestion (RR5) were measured. The data of the PRG group were compared to those for 26 patients who underwent conventional B-I reconstruction and with a group consisting of 20 healthy controls. RESULTS: RR5 was 69.6±21.8% in the patients who underwent PRG, 45.3±28.6% in those who underwent B-I reconstruction, and 93.7±5.7% in healthy controls. T1/2 was 17.0±13.0 min in patients who underwent PRG, 5.9±4.0 min in those who underwent B-I reconstruction, and 23.3±4.9 min in healthy controls. Gastric emptying was delayed in patients who underwent PRG compared to those who underwent B-I reconstruction (RR5: p<0.0014, T1/2: p<0.0002), and was comparable to that of healthy controls. CONCLUSION: Gastric emptying improved significantly after PRG compared to B-I reconstruction, and approached that of healthy controls.


Assuntos
Testes Respiratórios , Gastrectomia/métodos , Esvaziamento Gástrico , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Int Cancer Conf J ; 8(3): 101-104, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31218183

RESUMO

It is generally reported that prognosis of patients who have unresectable gastric cancer is from 3 to 5 months with best supportive care. Despite the improvement of survival after the appearance of S-1, the outcome of treatment for advanced gastric cancer is still unfavorable. Here we present a valuable case of advanced gastric cancer with synchronous liver metastasis, which was treated by S-1 + CDDP and S-1 therapy without surgery. A 58-year-old man was referred to our hospital with a diagnosis of advanced gastric cancer with liver metastasis at stage of cT3N0M1. He underwent first-line chemotherapy consisting of S-1 plus cispatin. 3 months later, a follow-up endoscopy revealed complete response (CR) of the gastric lesion. 3 months later, computed tomography (CT) also demonstrated disappearance of liver metastasis. Then he underwent maintenance chemotherapy with S-1 alone for 8 months. To date, there has been no recurrence for 6 years and 6 months since the acquisition of CR.

15.
Asian J Endosc Surg ; 12(2): 222-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30549252

RESUMO

INTRODUCTION: Recently, single-incision laparoscopic cholecystectomy has been accepted as an alternative to conventional laparoscopic cholecystectomy. The aim of this study was to retrospectively evaluate the safety and feasibility of unique gallbladder retraction methods using an ENDOLOOP® (Ethicon, Tokyo, Japan) and Lapaherclosure™ (Hakko Medical, Tokyo, Japan). MATERIALS AND SURGICAL TECHNIQUE: From May 2013 to April 2015, 77 patients underwent single-incision laparoscopic cholecystectomy with this retraction technique. During the same period, conventional laparoscopic cholecystectomy was performed in 85 patients; these patients were the control group. The patients' data, including the operative time, total blood loss, conversion rate to laparotomy, and perioperative complications, were compared. Alexis® Wound Retractor XS (Applied Medical, Tokyo, Japan) was inserted through a 25-30-mm vertical transumbilical incision to prevent bile contamination. Next, a SILS Port (Covidien, Tokyo, Japan) was inserted. A flexible 5-mm laparoscope was inserted through the port with a grasper (SILS Clinch, Covidien) and a normal 5-mm scalpel. The fundus of the gallbladder was tied by the ENDOLOOP. The Lapaherclosure was then directly inserted through a right lower intercostal space to capture and pull the Lapaherclosure out. After the cystic artery and duct were cut, the resected gallbladder was directly extracted from the umbilical incision. DISCUSSION: Several methods and devices have been developed to perform single-incision laparoscopic cholecystectomy, including the suturing method, the Mini Loop Retractor II (Covidien), and the EndoGrab (Virtual Ports, Caesarea, Israel). However, considering medical costs and safety, our retraction method seems to be feasible and comparable to existing methods.


Assuntos
Colecistectomia Laparoscópica/métodos , Vesícula Biliar/cirurgia , Instrumentos Cirúrgicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
In Vivo ; 32(6): 1643-1646, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30348728

RESUMO

AIM: To retrospectively examine efficacy and safety of oral combination of trifluridine and tipiracil hydrochloride (TAS-102) as the second-line therapeutic agent for unresectable colorectal cancer. PATIENT AND METHODS: Treatment outcomes of 17 patients who had received TAS-102 at our Institution from January 2015 to January 2017 were analyzed. The indications for second-line TAS-102 treatment were intolerance to other multi-drug combination (four patients) or patient refusal of the standard second-line therapy (13 patients). RESULTS: Among 17 patients who received TAS-102 as second-line therapy, partial response was observed in two (12%) and stable disease in two (12%). Outcomes of TAS-102 given as second-line therapy were: median overall survival of 5 months, response rate of 12% and disease control of 24%. Overall, no adverse events other than neutropenia were noted. CONCLUSION: Our findings suggest a beneficial role of TAS-102 in second-line therapy for unresectable colorectal carcinoma.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Trifluridina/administração & dosagem , Administração Oral , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirrolidinas , Timina , Resultado do Tratamento , Trifluridina/efeitos adversos , Uracila/análogos & derivados
17.
Kyobu Geka ; 71(7): 556-559, 2018 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-30042261

RESUMO

Pulmonary cryptococcosis is difficult to distinguish from lung cancer clinically, and is often diagnosed by surgery. A 72-year-old woman, who underwent distal pancreatectomy and splenectomy for pancreatic carcinoma. Four months after surgery, a tumor shadow was detected in the left lung as a groundglass nodule (GGN)of 12 mm in diameter, which was found to change to 15 mm with increased density by the computed tomography(CT)scan after 2 months. The nodule showed positive accumulation of fluorodeoxyglucose(FDG)by positron emission tomography(PET), and was suspected of malignant tumor. She underwent a partial resection of the left lung under thoracoscopy.


Assuntos
Criptococose/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X
18.
Int J Med Robot ; 14(5): e1921, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29749069

RESUMO

BACKGROUND: We previously developed an image-guided navigation system (IG-NS) using augmented reality technology for hepatobiliary and pancreatic (HBP) surgery. This system superimposed a 3D model onto a stereoscope-captured surgical field (i.e., the scope method). Unfortunately, this method requires an expensive stereoscope, surgeons have to shift their eyesight away from the surgical field, and the method has poor controllability. Therefore, an IG-NS using a tablet PC (i.e., the tablet method) was developed. The aim of the current study is to evaluate the efficiency of this novel method. METHODS: We studied 9 patients, for whom a 3D model was created from computed tomography images. After registration was performed, the 3D model was superimposed onto the surgical field, which was captured by the tablet PC's camera. RESULTS: The IG-NS could be applied with very little time lag. The visibility and controllability of the tablet method were superior to those of the scope method. It was especially useful in surgery for multiple metastatic liver carcinoma due to easy localization of the position of the carcinomas and vessels. CONCLUSIONS: We successfully developed the tablet method and tested it in a clinical setting. This system may contribute to surgical efficacy and improve the educational effects.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Computadores de Mão , Neoplasias Hepáticas/cirurgia , Neoplasias Pancreáticas/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Asian J Endosc Surg ; 11(4): 378-384, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29573191

RESUMO

INTRODUCTION: The ideal surgical technique for large incisional hernia repair has not yet been identified. The aim of this study was to evaluate surgical outcomes of standard intraperitoneal onlay mesh (sIPOM) versus fascial defect closure with intraperitoneal onlay mesh (IPOM-Plus) for large incisional hernia repair. METHODS: Of 49 patients who underwent laparoscopic incisional hernia repair between November 2005 and December 2016, 26 cases with large incisional hernia (transverse diameter ≥10 cm) were examined to compare surgical outcomes between sIPOM (n = 12) and IPOM-Plus (n = 14). Statistical analysis was performed using the Mann-Whitney U-test and Fisher's exact test. P < 0.05 was considered to be statistically significant. RESULTS: We compared sIPOM with IPOM-Plus for similar hernia types during median follow-up periods of 53 and 21 months, respectively. The operation time was 150 min for sIPOM and 148 min for IPOM-Plus (P = 0.6220). Early postoperative complications including seroma formation were observed in four sIPOM patients (33%) and three IPOM-Plus patients (21%) (P = 0.6652). Significantly more mesh bulged with sIPOM than with IPOM-Plus (50% vs 0%; P = 0.0082). Chronic pain lasting 3 months after the operation was found in two cases of IPOM-Plus (14%), but this was not statistically significant. Postoperative hospital stay was longer for sIPOM patients than for IPOM-Plus patients. Only one recurrence was observed in the sIPOM group (8%), but this was not statistically significant. CONCLUSION: For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging.


Assuntos
Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas , Idoso , Idoso de 80 Anos ou mais , Fáscia , Feminino , Seguimentos , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Peritônio , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
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