Technical Progress in Single-Incision Laparoscopic Cholecystectomy in Our Initial Experience

Single-incision laparoscopic cholecystectomy (SILC) has rapidly spread throughout the world because of its low invasiveness and because it is a scarless procedure. Various surgical methods of performing SILC are present in each institute; however, it is necessary to develop a standardized procedure that we can perform safely, such as the conventional 4-port laparoscopic cholecystectomy (LC). The SILC experiment in our institute was started by use of the commercial SILS Port and changed from a 3-port method via an umbilicus to a 2-port method to improve some problems. Although none of the conversions to conventional 4-port LC and also none of the complications such as bile duct injury occurred in each method, the 2-port method functioned best and was also economical. However, it is most important to adopt strict criteria and select the patients suitable for SILC to demonstrate SILC safety same as 4-port LC

A Non-Randomized Comparative Study of Laparoscopy-Assisted Pancreaticoduodenectomy and Open Pancreaticoduodenectomy

Background/Aims: Laparoscopic surgery for periampullary disease is still a challenging operation. The aim of this study was to compare the perioperative outcomes of patients undergoing conventional pancreaticoduodenectomy (PD) with the outcomes of those undergoing laparoscopy-assisted PD. Methodology: A retrospective analysis was conducted on 51 consecutive patients who underwent laparoscopy-assisted or open PD for periampullary disease. Results: There were no significant differences in the preoperative demographic or clinical data of the two study groups. Although there were no significant differences in the operative time between the two study groups, blood loss in the laparoscopy-assisted PD group was significantly smaller than that in the open PD group. There were no significant differences in the occurrence of postoperative complications between the two groups. Conclusions: Laparoscopy-assisted PD is a feasible and safe surgical procedure that provides the advantages expected from a minimally invasive surgery including less blood loss

Minimally invasive surgical necrosectomy for infected walled-off necrosis using endoscopy with the flexible overtube technique : A case report

Background: Minimally invasive surgery with a step-up approach is essential for treating infected walled - off necrosis (WON) which has a high mortality rate. Percutaneous endoscopic necrosectomy with a flexible overtube which has various advantages is performed in our institution. We herein introduce safety and easy percutaneous endoscopy with flexible overtube technique for minimally invasive surgical necrosectomy.Case presentation: The patient was placed in the supine position and tilted to the right lateral side. The skin was incised 8cm according to the situated percutaneous drains. Following the tract of the drain, the cavity of infected WON was reached in the retroperitoneum. The percutaneous drain was removed, and a flexible overtube was inserted. An endoscope was inserted through the flexible overtube. The necrosis was then crushed with saline flushing and removed by suction or forceps. A new drain was placed in the cavity to allow continuous drainage after surgery. Necrosectomy should be limited to a glimpse of normal granulation tissue, as aggressive debridement carries a risk of bleeding and/or organ injury. Using the step-up approach, endoscopy may be useful in cases of minimal residual necrosis.Conclusion: Percutaneous endoscopy with the flexible overtube technique for minimally invasive surgical necrosectomy is easy to perform and safe for treating infected WON

Single-incision laparoscopic distal pancreatectomy.

Single-incision laparoscopic surgery (SILS) is a novel area of minimally invasive surgery, and rapidly evolving in the field of abdominal surgery. However, SILS is not a common procedure for pancreatic surgery. We describe our first experience with a SILS approach in a patient with a metastatic pancreatic tumor. We performed a SILS distal pancreatectomy (SILS-DP) using 3 trocars placed through a single port at an umbilical incision. In our case, the most important surgical technique was the stomach-hanging method to obtain a favorable laparoscopic view of the pancreas. Although SILS-DP is a safe and feasible procedure, further studies are required to determine the advantages of this procedure in comparison with the standard laparoscopic method

Laparoscopic Single-Branch Resection of the Pancreas for Intraductal Papillary Mucinous Neoplasm

Although laparoscopic pancreatic resections have become more common, laparoscopic minimally invasive and function-preserving pancreatic resections have not been widely accepted. Branch-type intraductal papillary mucinous neoplasm (IPMN) has a low-grade malignant potential and shows a favorable prognosis. In branch-type IPMN, minimal resection techniques with preservation of the pancreatic functional reserve have advantages over the more conventional pancreaticoduodenectomy. We describe herein laparoscopic single-branch resection of the pancreas for branch-type IPMN. This surgical procedure is a novel and an ideal minimally invasive method for the resection of branch-type IPMN. In addition, our endoscopic nasopancreatic drainage (ENPD) tube-guided technique is useful for precise resection of the tumor and for the prevention of pancreatic fistula

Metastases of soft tissue sarcoma to the liver: A Historical Cohort Study from a Hospital-based Cancer Registry

Background: Hepatic metastasis of soft tissue sarcoma is rare compared to lung metastasis, and the literature is scarce. We examined the risk of hepatic metastasis according to the site of occurrence and histological type. Methods: From a Hospital-based Cancer Registry, 658 patients registered between 2007 and 2017 with soft tissue sarcomas were evaluated. The exclusion criteria were gastrointestinal stromal tumors, tumors of unknown origin, and follow-up periods of less than 1 month. SPSS 25 was used for statistical analysis. Results: The risk of hepatic metastasis was significantly higher in the retroperitoneum (HR, 5.981; 95% CI, 2.793-12.808) and leiomyosarcoma (HR, 4.303; 95% CI, 1.782-10.390). Multivariate analysis showed that the risk of hepatic metastasis as first distant metastasis was high in leiomyosarcoma (HR, 4.546; 95% CI, 2.275-9.086) and retroperitoneal onset (HR, 4.588; 95% CI, 2.280-9.231). The 2-year survival rate after hepatic metastasis was 21.7%. Conclusions: The onset of hepatic metastasis indicates a poor prognosis. However, hepatic metastasis from retroperitoneal sarcoma and leiomyosarcoma may be the first distant metastasis in some cases. For retroperitoneal sarcoma and leiomyosarcoma, additional screening for hepatic metastasis such as contrast CT should be considered during staging and follow-up after treatment.ArticleCancer medicine 17(17) : 6159-6165(2020)journal articl

GDE7 produces cyclic phosphatidic acid in the ER lumen functioning as a lysophospholipid mediator

Cyclic phosphatidic acid (cPA) is a lipid mediator, which regulates adipogenic differentiation and glucose homeostasis by suppressing nuclear peroxisome proliferator-activated receptor γ (PPARγ). Glycerophosphodiesterase 7 (GDE7) is a Ca2+-dependent lysophospholipase D that localizes in the endoplasmic reticulum. Although mouse GDE7 catalyzes cPA production in a cell-free system, it is unknown whether GDE7 generates cPA in living cells. Here, we demonstrate that human GDE7 possesses cPA-producing activity in living cells as well as in a cell-free system. Furthermore, the active site of human GDE7 is directed towards the luminal side of the endoplasmic reticulum. Mutagenesis revealed that amino acid residues F227 and Y238 are important for catalytic activity. GDE7 suppresses the PPARγ pathway in human mammary MCF-7 and mouse preadipocyte 3T3-L1 cells, suggesting that cPA functions as an intracellular lipid mediator. These findings lead to a better understanding of the biological role of GDE7 and its product, cPA

Fluid collection and pancreatic fistula after pancreaticoduodenectomy

Background: Although postoperative abdominal fluid collection (POFC) is an important predictive factor for clinically relevant postoperative pancreatic fistula (CR-POPF), many patients are asymptomatic and resolve spontaneously. Triple-drug therapy consisting of gabexate mesylate, octreotide, and carbapenem antibiotics has been used at our institution to prevent pancreatic fistula after pancreatectomy. The present study aimed to evaluate the management and outcomes of patients with POFC and to determine the efficacy of triple-drug therapy to prevent CR-POPF after pancreaticoduodenectomy (PD).Methods: From 2016 to 2021, 125 patients who underwent PD were retrospectively analyzed to determine their postoperative fluid collection status. Triple-drug therapy was administered to patients who showed high amylase levels in their drainage (> 10,000 IU/L) on POD 1, 3, or 5, and who had any clinical symptoms associated with POFC.Results: The overall rate of POFC was 26% (n=33). Among these patients, CR-POPF developed in 16 patients (48%). There was no CR-POPF patient in the NO-POFC patient group. Triple-drug therapy was performed for 30 patients according to a preexisting treatment algorithm. Among these 30 patients, there were 23 POFC and 7 No-POFC patients. Twelve (52%) of the POFC patients developed CR-POPF despite treatment with triple-drug therapy. There were no CR-POPF patients in the NoPOFC patient group.Conclusions: Although POFC after PD is an important finding for CR-POPF, it does not necessarily develop into CR-POPF. The administration of triple-drug therapy is effective for the prevention of CR-POPF in cases without POFC fluid drainage aswell as in those with POFC

Marionette method for transumbilical single-incision, two-trocar laparoscopic cholecystectomy: a new, simple technique.

Single-incision laparoscopic cholecystectomy (SILC) has recently become a topic of interest among types of minimally invasive surgery

Clinical impact of primary tumour location, early tumour shrinkage, and depth of response in the treatment of metastatic colorectal cancer with first‑line chemotherapy plus cetuximab or bevacizumab

The primary tumour location is an important prognostic factor for previously untreated metastatic colorectal cancer (mCRC). However, the predictive efficacies of primary tumour location, early tumour shrinkage (ETS), and depth of response (DpR) on mCRC treatment has not been fully evaluated. This study aimed to investigate the predictive efficacies of these traits in mCRC patients treated with first-line 5-fluorouracil-based chemotherapy plus biologic agents, namely, cetuximab and bevacizumab. This was a retrospective analysis of the medical records of 110 patients with pathology-documented unresectable mCRC. Patients with left-sided mCRC receiving any first-line regimen showed better overall survival (OS) than those with right-sided mCRC [33.3 vs 16.3 months; hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27–0.74; p < 0.001]. In patients with left-sided tumours, treatment with chemotherapy plus cetuximab yielded longer OS than chemotherapy plus bevacizumab (50.6 vs 27.8 months, HR 0.55; 95% CI 0.32–0.97; p = 0.0378). mCRC patients with ETS and high DpR showed better OS than those lacking ETS and with low DpR (33.5 vs 19.6 months, HR 0.50, 95% CI 0.32–0.79, p = 0.023 and 38.3 vs 19.0 months, HR 0.43, 95% CI 0.28–0.68, p < 0.001, respectively). Moreover, ETS and/or high DpR achieved in patients with right-sided mCRC receiving chemotherapy plus cetuximab were associated with significantly better OS than in those lacking ETS and with low DpR (34.3 vs 10.4 months, HR 0.19, 95% CI 0.04–0.94, p = 0.025 and 34.3 vs 10.4 months, HR 0.19, 95% CI 0.04–0.94, p = 0.0257, respectively). Taken together, our study demonstrates that primary tumour location is not only a well-known prognostic factor but also a relevant predictive factor in patients with mCRC receiving chemotherapy plus cetuximab. Additionally, both ETS and DpR could predict treatment outcomes and also potentially guide cetuximab treatment even in right-sided mCRCs