Our ideas for introduction of single-port surgery

Single-port surgery, which is also called single-incision laparoscopic surgery (SILS), laparoscopic single-site surgery, or single-port access surgery, has been performed in several countries. However, it has not been widely adopted throughout the world because there still remain some challenging problems to be solved, in terms of safety and technology, and the majority of devices specific to SILS are under development and have not been approved by the Japanese Pharmaceutical Affairs Law. Herein, we introduce single-incision access using existing surgical devices that will give us the opportunity to adopt SILS to our hospital

Our ideas for introduction of single-port surgery

Single-port surgery, which is also called single-incision laparoscopic surgery (SILS), laparoscopic single-site surgery, or single-port access surgery, has been performed in several countries. However, it has not been widely adopted throughout the world because there still remain some challenging problems to be solved, in terms of safety and technology, and the majority of devices specific to SILS are under development and have not been approved by the Japanese Pharmaceutical Affairs Law. Herein, we introduce single-incision access using existing surgical devices that will give us the opportunity to adopt SILS to our hospital

Influence of obesity on the short-term outcome of laparoscopic colectomy for colorectal cancer

Purpose: Obesity has been generally associated with increased surgical risk. However, data on the outcome of laparoscopic colectomy in obese and non-obese patients are controversial. The aim of this study is to assess the short-term outcome of laparoscopic colectomy for colorectal cancer (CRC) in obese patients as compared with non-obese patients. Materials and Methods: Sixty-nine patients who underwent laparoscopic anterior resection for CRC during the past six years were retrospectively evaluated. The patients with CRC involving the sigmoid or rectosigmoid colon and subjected to intracorporeal anastomosis were included in this study. They were divided into three groups according to body mass index (BMI): obese (BMI ≥ 28.0 kg/m 2 ), pre-obese (BMI: 25.0-27.9 kg/m 2 ) and non-obese (BMI < 25.0 kg/m 2 ). Results: Nine patients (13.0 %) were obese, 11 patients (15.9%) were pre-obese and 49 patients (71.1%) were non-obese. Patient characteristics, such as age, gender, tumor location, previous laparotomy, were similar among the three groups. There were no significant differences in operative time, blood loss, intraoperative complications and conversion rates. Postoperative complications and duration of postoperative hospital stay were also similar among the three groups. However, two of the three patients in the pre-obese group had to be operated on again due to incarceration of the small bowel into a port site. Conclusions: Laparoscopic colectomy can be safely performed in obese patients with short-term results similar to those obtained in non-obese and pre-obese patients

Influence of obesity on the short-term outcome of laparoscopic colectomy for colorectal cancer

Purpose: Obesity has been generally associated with increased surgical risk. However, data on the outcome of laparoscopic colectomy in obese and non-obese patients are controversial. The aim of this study is to assess the short-term outcome of laparoscopic colectomy for colorectal cancer (CRC) in obese patients as compared with non-obese patients. Materials and Methods: Sixty-nine patients who underwent laparoscopic anterior resection for CRC during the past six years were retrospectively evaluated. The patients with CRC involving the sigmoid or rectosigmoid colon and subjected to intracorporeal anastomosis were included in this study. They were divided into three groups according to body mass index (BMI): obese (BMI &#8805; 28.0 kg/m 2 ), pre-obese (BMI: 25.0-27.9 kg/m 2 ) and non-obese (BMI &lt; 25.0 kg/m 2 ). Results: Nine patients (13.0 &#x0025;) were obese, 11 patients (15.9&#x0025;) were pre-obese and 49 patients (71.1&#x0025;) were non-obese. Patient characteristics, such as age, gender, tumor location, previous laparotomy, were similar among the three groups. There were no significant differences in operative time, blood loss, intraoperative complications and conversion rates. Postoperative complications and duration of postoperative hospital stay were also similar among the three groups. However, two of the three patients in the pre-obese group had to be operated on again due to incarceration of the small bowel into a port site. Conclusions: Laparoscopic colectomy can be safely performed in obese patients with short-term results similar to those obtained in non-obese and pre-obese patients

Accessory liver lobe attached to the gallbladder wall preoperatively detected by ultrasonography: A case report

Introduction: An accessory liver lobe is a rare developmental abnormality, which is often not diagnosed preoperatively, and is usually detected incidentally during abdominal surgery. This condition is often asymptomatic; here, we report on a case where the accessory liver lobe was diagnosed preoperatively using ultrasonography. Case presentation: A 59-year-old woman presented to our hospital with right upper abdominal pain. An abdominal ultrasonography indicated the presence of gallbladder debris and an accessory liver lobe. She underwent laparoscopic cholecystectomy and resection of the accessory liver lobe without any complications. Discussion: An accessory liver lobe is a rare anomaly of the liver. It is typically asymptomatic and is detected incidentally during surgery or autopsy in most cases. However, we diagnosed the accessory liver lobe using ultrasonography. An accessory liver lobe can occasionally result in complications, such as bleeding, portal vein obstruction, or malignant transformation to hepatocellular carcinoma. Conclusion: An accessory liver lobe should be resected to prevent complications and malignant transformation. Ultrasonography is useful for preoperative diagnosis in cases with an accessory liver lobe

Effects of COVID-19 on Japanese medical students' knowledge and attitudes toward e-learning in relation to performance on achievement tests.

The COVID-19 pandemic forced many educational institutions to turn to electronic learning to allow education to continue under the stay-at-home orders/requests that were commonly instituted in early 2020. In this cross-sectional study, we evaluated the effects of the COVID-19 pandemic on medical education in terms of students' attitudes toward online classes and their online accessibility; additionally, we examined the impacts of any disruption caused by the pandemic on achievement test performance based on the test results. The participants were 674 students (412 in pre-clinical, 262 in clinical) at Juntendo University Faculty of Medicine; descriptive analysis was used to examine the respondents' characteristics and responses. The majority of respondents (54.2%) preferred asynchronous classes. Mann-Whitney U tests revealed that while pre-clinical students preferred asynchronous classes significantly more than clinical students (39.6%, p < .001), students who preferred face-to-face classes had significantly higher total achievement test scores (U = 1082, p = .021, r = .22). To examine the impacts of pandemic-induced changes in learning, we conducted Kruskal-Wallis tests and found that the 2020 and 2021 scores were significantly higher than those over the last three years. These results suggest that while medical students may have experienced challenges adapting to electronic learning, the impact of this means of study on their performance on achievement tests was relatively low. Our study found that if possible, face-to-face classes are preferable in an electronic learning environment. However, the benefit of asynchronous classes, such as those that allow multiple viewings, should continue to be recognized even after the pandemic

Benefit of an action camera in endoscopy education for medical students under COVID-19

Abstract Background Endoscopy is an important form of clinical gastroenterology education because it gives students the opportunity to learn about diagnosis procedures and even treatment. During the COVID-19 pandemic, medical students were observed from outside the endoscopy room due to the risk of airborne infection. In this study, we investigated the efficacy of combining endoscopy education with doctor’s-eye-view videos of the procedure obtained using live-action cameras (GoPro®). Methods From February to May 2021, endoscopists wore GoPro Hero8 cameras on their heads to display a doctor’s-eye view video outside the room. The efficacy of the GoPro videos in combination with endoscopic monitoring was evaluated by 15 participating medical students. The participants rated the efficacy on a 5-point scale and commented on the positive and negative points. Results A total of 78.6% of participants evaluated the GoPro as good; 57.2% answered that it increased their understanding, with 71.4% stating that it increased their understanding of procedures in particular. A total of 85.7% of the students answered that their interest in endoscopy had increased, and 85.7% evaluated the benefit of the GoPro videos as good. In addition, 64.3% answered that the method was effective in preventing COVID-19 infection. Education using GoPro videos enabled students to feel as if they were conducting the endoscopy themselves and enabled them to concentrate on learning. Conclusions Practical endoscopic education using a GoPro is an effective educational tool that not only increases understanding of endoscopic practice but also stimulates students’ interest and awareness of their future as doctors

Complete Endoscopic Submucosal Dissection of a Giant Rectal Villous Adenocarcinoma with Electrolyte Depletion Syndrome

An 81-year-old female consulted a local physician due to diarrhea. Since general fatigue and body weight loss were observed, she was admitted for detailed examination and treatment. Colonoscopy revealed a circumferential giant tumor with a maximum diameter of 10 cm in the rectum, and biopsy findings indicated villous adenoma. The tumor secreted a large amount of mucus, and a diagnosis of electrolyte depletion syndrome causing electrolyte disorders was made. We performed endoscopic submucosal dissection (ESD) as a less invasive procedure. The tumor was so big that the procedure had to be completed in two separate steps and it took 1,381 min in total. The tumor was histologically diagnosed as well-differentiated adenocarcinoma in high-grade adenoma located in the lower to upper rectum, invading into the mucosa without lymphatic or venous invasion. The stump of the resected specimen was negative for adenocarcinoma, however the horizontal stump was positive for adenoma. We administered steroid suppositories to prevent stenosis. After ESD, general fatigue and diarrhea disappeared and electrolyte disorders resolved. The patient had good clinical outcome without recurrence or stenosis