Comparison of Surgeon Stress and Workload between Reduced-port and Laparoscopic Cholecystectomy : A Prospective Study

Single-port laparoscopic surgery（SPLS）has attracted attention in the field of minimally invasive surgery; however, the associated technical difficulty has delayed its adoption by all surgeons. Reduced-port laparoscopic surgery might be easier to perform than SPLS, and in this prospective study, we compared surgeon stress and workload between reduced-port laparoscopic cholecystectomy（RPLC）and conventional laparoscopic cholecystectomy（CLC）. Twenty consecutive patients were assigned to undergo either RPLC or CLC between July 2016 and April 2017. Two surgeons performed the operations. The differences in surgeon workload and stress between RPLC and CLC were evaluated. Patient factors and operative outcomes were not significantly different between RPLC and CLC. In the surgeon-reported Surgery Task Load Index, the task demand subscale was significantly higher for RPLC than for CLC（P＝0.005）, although the salivary amylase levels were not significantly different between RPLC and CLC. RPLC was similar to CLC with respect to surgeon stress. Considering workload, the task demand was higher in CLC than in RPLC, which therefore might be an acceptable alternative to CLC for treating benign gallbladder disease

Initial Surgical Versus Conservative Strategies in Patients With Asymptomatic Severe Aortic Stenosis

AbstractBackgroundCurrent guidelines generally recommend watchful waiting until symptoms emerge for aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS).ObjectivesThe study sought to compare the long-term outcomes of initial AVR versus conservative strategies following the diagnosis of asymptomatic severe AS.MethodsWe used data from a large multicenter registry enrolling 3,815 consecutive patients with severe AS (peak aortic jet velocity >4.0 m/s, or mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm2) between January 2003 and December 2011. Among 1,808 asymptomatic patients, the initial AVR and conservative strategies were chosen in 291 patients, and 1,517 patients, respectively. Median follow-up was 1,361 days with 90% follow-up rate at 2 years. The propensity score–matched cohort of 582 patients (n = 291 in each group) was developed as the main analysis set for the current report.ResultsBaseline characteristics of the propensity score–matched cohort were largely comparable, except for the slightly younger age and the greater AS severity in the initial AVR group. In the conservative group, AVR was performed in 41% of patients during follow-up. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group than in the conservative group (15.4% vs. 26.4%, p = 0.009; 3.8% vs. 19.9%, p < 0.001, respectively).ConclusionsThe long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140

Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Both endoscopic and surgical approaches are employed in the treatment of early gastric cancer (EGC). The aim of this study was to establish appropriate treatment strategies for early gastric cancer.</p> <p>Methods</p> <p>We retrospectively examined clinicopathological data of EGC patients who had undergone surgery.</p> <p>Results</p> <p>A total of 327 patients (204 males and 123 females, mean age 63.2 years) were eligible for inclusion in the study. The median follow-up period was 31 months. Of 161 mucosal (pT1a) tumors, 87 were mainly undifferentiated and 110 had an undifferentiated component. Four patients with pT1a tumors had lymph node metastases; all these tumors were signet-ring cell carcinomas and were macroscopic type 0-IIc with ulceration, and only one of them had lymphatic invasion. Among patients with submucosal tumors, four of 43 patients with pT1b1 tumors and 37 of 123 patients with pT1b2 tumors had nodal metastases. Lymph node metastases were significantly higher in mixed undifferentiated type group than differentiated type group for both groups, pT1a-pT1b1 (p = 0.0251) and pT1b2 (p = 0.0430) subgroups. Only four of 45 patients with nodal metastases were diagnosed preoperatively by computed tomography (sensitivity 8.9%, specificity 96.2%). Nine patients with pT1b tumors had recurrence after surgery, and died. The sites of initial recurrence were liver, bone, peritoneum, distant nodes, and the surgical anastomosis.</p> <p>Conclusions</p> <p>The incidence of nodal metastases was approximately 5% in undifferentiated type mucosal (pT1a) tumors, and higher in submucosal (pT1b) tumors. The sensitivity of preoperative diagnosis of nodal metastases in EGC using computed tomography was relatively low in this study. Therefore at present surgery with adequate lymphadenectomy should be performed as curative treatment for undifferentiated type EGC.</p

ショウニ イリョウ センター ノ ツキソイ カゾク ニ タイスル カンゴ ノ テイリョウカ カンゴ ヒツヨウド Fコウモク F Family ノ カイハツ

資料Informations【目的】付き添い家族（以下、家族）に直接行う看護を定量化するための新たな尺度として、看護必要度F項目（F：Family）を開発する。【方法】F項目を次の手順で開発した。1)家族ケアの評価項目として、がん患者の家族に対する看護ケアの実践評価指標（26項目）を選定した。2)当センターの現状に沿って評価項目を修正し、20項目とした。3)看護師54人を対象に質問紙調査を実施し、当センターの看護実践を反映した項目であることを確認した。4)項目数を削減するために主成分分析を行った。固有値1以上で4主成分を抽出し（累積寄与率72.2％）、「心理的支援」「退院後を見据えた支援」「意思決定支援」「環境調整支援」と命名した。家族に関する看護記録とF項目を照合し、F項目の項目内容が妥当であるかを検証した。【結果】2021年10月1日～2022年9月30日までに当センターを退院した患者1,407人において「家族」、「父」、「母」のいずれかの単語を含む家族に関する看護記録は2,146件あり、F項目と照合した結果、すべてを上記の4項目に分類できた。【結論】家族看護を定量化するために看護必要度F項目を開発し、日々家族に行っている看護を反映した内容であることを検証した

Single-Incision Laparoscopic Cholecystectomy Using a Dome-Down Approach for a Patient with Left-Sided Gallbladder

True left-sided gallbladder (sinistroposition) is a rare anatomic anomaly in which the gallbladder is found to the left of the falciform ligament under the left lobe of the liver. Though uncommon, it is important for the surgeon to identify this anomaly because the ductal anatomy is unique and the surgery is technically challenging. Multiple case reports have documented safe management of sinistroposition encountered during conventional laparoscopic cholecystectomy. We present a case of sinistroposition encountered during a single-incision laparoscopic cholecystectomy. We conclude that this single-site laparoscopic technique is not only safe when sinistroposition is encountered, but it may actually provide certain ergonomic benefits for surgeons

Bile duct stone formation around a nylon suture after gastrectomy: A case report

BACKGROUND: Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case. CASE PRESENTATION: A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far. CONCLUSION: The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy