Atraumatic curvilinear atrial retractors and related methods

Cardiac retractors include a rod having opposing forward and rearward portions and a length sufficient to position the rearward portion of the rod outside a patient's body and the forward portion inside a patient proximate a lumen of cardiac tissue. The forward portion comprises a distal curvilinear portion that is sized and configured to reside in the left atrium and lift a roof of the left atrium. The retractors may be sized and configured to enter the body through a single small incision into the trans-thoracic cavity. The devices may be sized and configured to reside in situ proximate the mitral valve site at a left atria to splint open the mitral valve in response to robotic controlled direction of a surgeon for a mitral valve repair

形状記憶超弾性合金を用いた低侵襲僧房弁輪形成術の開発

金沢大学附属病院心臓弁膜症,特に僧房弁形成術における弁輪形成において,通常手術だけではなく内視鏡下手術あるいはロボット支援下の手術においても容易かつ短時間で施行可能な僧房弁輪形成術の確立を目指すものである材質は形状記憶超弾性合金(Ni-Ti合金)で僧房弁輪組織内に埋め込むタイプの人工弁輪の開発を目的とした.1. 人工弁輪の形状の検討:豚の心臓を用い,ステンレス製の針金を用い有効な弁輪形成を行うための埋め込み式人工弁輪の形状について検討し,C型とO型の2つのタイプを検討した,C型は固定力が弱く弁輪の形状を保持できないことが理由となりO型を採用した.2. 縫着方法の検討:プロトタイプを作製し,豚の心臓に対し埋め込み術を施行し,有用性を検討した.実際にロボットを用いブタ心臓への縫着実験を行った.ロボット鉗子(EndoWrist)を用い金属部から糸を介し接続された針を把持,僧房弁輪内組織に埋め込むように縫着し,針の縫着を進めることで金属部分は遅れて僧房弁輪内を進むものであり,ロボット鉗子を用いることで容易に行い得えることがわかった.針-糸-針金の構造を持つプロトタイプを作製の作成が難しく難渋したが,糸部分も針金を用いることで解決した.3. 埋め込み後の固定方法の検討:人工弁輪装着後の弁輪固定方法について現在検討中である.試行錯誤を繰り返している情況であり,現在はナイチノール性クリップを用いた固定方法と,手術用の糸を用いた固定方法で検討した結果ナイチノール性クリップでの固定が有用であることが分かった.4. 形状記憶合金を人工弁輪となりうるような大きさに加工し,合金-細径ワイヤー-針となる新しい人工弁輪を作成.ブタ心臓にロボット鉗子を用い上記2のごとく縫着.O型として端々はナイチノール性クリップにて固定した.十分に人工弁輪となりうるものとなった.研究課題/領域番号:19659350, 研究期間(年度):2007 – 2008出典：研究課題「形状記憶超弾性合金を用いた低侵襲僧房弁輪形成術の開発」課題番号19659350（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-19659350/）を加工して作

Underwater robotic suturing

Background Laparoscopic and robotic surgeries have become popular, and this popularity is increasing. However, the environment in which such surgeries are performed is rarely discussed. Similar to arthrosurgery performed in water, artificial ascites could be a new environment for laparoscopic surgery. This study was performed to determine whether robotic surgery is applicable to complicated suturing underwater. Material and methods A da Vinci Surgical System S was used. A weighted fabric sheet was placed at the bottom of a tank. Identical sets were made for each environment: One tank was dry, and the other was filled with water. The suturing task involved placement of a running silk suture around the perimeter of a small circle. The task was performed eight times in each environment. The task time and integrity score were determined. The integrity score was calculated by evaluating accuracy, tightness, thread damage, and uniformity; each factor was evaluated using a five-point scale. Results Although statistically significant differences were not shown in either task time or integrity score between the underwater and air environments, robotic suturing underwater is not inferior to performance in air. Conclusions The feasibility of robotic suturing underwater was confirmed under the herein-described experimental conditions. © 2016 Taylor & FrancisEmbargo Period 12 month

Saline-filled laparoscopic surgery: A basic study on partial hepatectomy in a rabbit model

Background: There is still a poor understanding of the effects of pneumoperitoneum with insufflation of carbon dioxide gas (CO2) on malignant cells, and pneumoperitoneum has a negative impact on cardiopulmonary responses. A novel saline-filled laparoscopic surgery (SAFLS) is proposed, and the technical feasibility of performing saline-filled laparoscopic partial hepatectomy (LPH) was evaluated in a rabbit model. Material and methods: Twelve LPH were performed in rabbits, with six procedures performed using an ultrasonic device with CO2 pneumoperitoneum (CO2 group) and six procedures performed using a bipolar resectoscope (RS) in a saline-filled environment (saline group). Resection time, CO2 and saline consumption, vital signs, blood gas analysis, complications, interleukin-1 beta (IL-1β) and C-reactive protein (CRP) levels were measured. The effectiveness of the resections was evaluated by the pathological findings. Results: LPH was successfully performed with clear observation by irrigation and good control of bleeding by coagulation with RS. There were no significant differences in all perioperative values, IL-1βand CRP levels between the two groups. All pathological specimens of the saline group showed that the resected lesions were coagulated and regenerated as well as in the CO2 group. Conclusions: SAFLS is feasible and provides a good surgical view with irrigation and identification of bleeding sites. © 2014 Informa Healthcare

Thyroidectomy using pure natural orifice transluminal endoscopic surgery in a porcine model

Surgical procedures for thyroid disease that provide cosmetically acceptable results are in demand. Natural orifice transluminal endoscopic surgery (NOTES) is performed through natural orifices and thus avoids incision of the body wall. This study aimed to develop an incision-free surgical procedure for thyroid lobectomy using pure NOTES with an oral approach. In six pig carcasses, an incision was made between the mandible and subcutaneous tissue under direct vision. After subcutaneous dissection and identification of the hyoid bone, the operative field was developed under endoscopic view. After the thyrohyoid membrane was identified, dissection was continued along the thyroid cartilage until the cricoid cartilage was identified and the thyroid isthmus was reached. An original retractor was inserted between dissected tissues to lift and fix the carcass. The thyroid gland was successfully removed through the incision. Similar macroscopic and histological findings were observed on the normal and treated sides, with no damage to the recurrent laryngeal nerves. The times required for securing the operative field and thyroidectomy improved with each operation. This study suggests the feasibility and safety of using pure NOTES for thyroidectomy through a subcutaneous route with an original retractor

Single incision endoscopic surgery for lumbar hernia

Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit. © 2011 Informa Healthcare

Transrectal robotic natural orifice translumenal endoscopic surgery (NOTES) applied to intestinal anastomosis in a porcine intestine model

Background: Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive operation using devices such as flexible endoscopes and linear or circular staplers. Nevertheless, hand-sewn anastomosis in NOTES remains challenging. This study aimed to investigate the feasibility of transrectal robotic NOTES requiring intracorporeal small intestinal anastomosis and closure of the rectal anterior wall incision in a relevant human model. Methods: The authors developed a flexible rectal proctoscope with a diameter of 43 mm for transrectal robotic NOTES. Small intestinal anastomosis was performed in a porcine intestinal transrectal NOTES model using two robotic arms and a camera inserted through the proctoscope and a rectal anterior wall incision. The quality of transrectal small intestinal anastomosis using the da Vinci surgical system (transrectal robotic NOTES group) was compared with that of transabdominal anastomosis using the da Vinci surgical system (transabdominal robot-assisted surgery group) and transrectal anastomosis using traditional transanal endoscopic microsurgery (TEM) instruments (TEM NOTES group). The quality of transrectal rectal anterior wall suturing in the transrectal robotic NOTES group was compared with that of the TEM NOTES group and the open surgical instruments group (open group). Results: Robotic intracorporeal suturing was performed successfully in the porcine intestine model. During small intestinal anastomosis, burst pressure in the transrectal robotic NOTES group (67.7 ± 29.3 mmHg) was similar to that in the transabdominal robot-assisted surgery group (73.3 ± 18.2 mmHg) but significantly higher than in the TEM NOTES group (20.3 ± 24.0 mmHg; p < 0.01). During rectal anterior wall suturing, the burst pressure did not differ significantly between the transrectal robotic NOTES group (149.9 ± 81.1 mmHg) and the open group (195.0 ± 60.5 mmHg). Conclusions: The preliminary safety and efficacy of transrectal robotic NOTES was established. Further studies are required to determine the practical feasibility of this procedure. © 2013 Springer Science+Business Media New York.in Pres

Origami using da Vinci Surgical System

金沢大学大学院医学系研究

Laparoscopic pancreaticoduodenectomy after endovascular repair for abdominal aortic aneurysm

INTRODUCTION Most gastroenterological surgeries, even pancreatic surgery, can now be performed laparoscopically. However, the management of concomitant abdominal aortic aneurysm (AAA) and intra-abdominal malignancy is controversial. The performance of endovascular repair (EVAR) for AAA has been increasing; however, there is no report of laparoscopic pancreaticoduodenectomy after EVAR. PRESENTATION OF CASE A pancreatic tumor was detected during follow-up after EVAR for AAA. The enlarging tumor was diagnosed as an intraductal papillary mucinous tumor with a nodule. Laparoscopic pancreaticoduodenectomy was safely performed. After laparoscopic dissection around the pancreas head, an additional incision was made in the upper abdomen, and pancreatic reconstruction was performed through the incision. In spite of grade B pancreatic fistulae, the patient recovered with medical therapy. The pathological diagnosis was intraductal papillary mucinous adenoma with small foci of carcinoma in situ. The patient has been well with neither recurrence of the tumor nor any cardiovascular events for 18 months. DISCUSSION The management of concomitant malignancy and AAA is challenging, especially in patients with a pancreatic tumor. The reasons for the rarity of treatment include prognosis, anatomical vicinity, and postoperative complications. EVAR reduces retroperitoneal adhesions. A laparoscopic approach provides a small operative field and decreases mutual interference with AAA. Moreover, reconstruction is performed through an upper abdominal incision apart from the AAA. Hand-sewing provides more reliable stability of the anastomosis. CONCLUSION The increasing frequency of performance of EVAR for AAA and subsequent computed tomography may help to detect malignancy. Laparoscopic surgery appears to be a valid approach to malignancy after EVAR. © 2013 The Authors