Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery.

Background And Objective: The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC.

Pancreatic duct holder for facilitating duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy.

Duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy may be technically difficult, particularly in cases in which the remnant pancreas is soft with a small main pancreatic duct. We devised a pancreatic duct holder for duct-to-mucosa pancreatojejunostomy. The holder has a cone-shaped tip.

Cholecystectomy by a combined transgastric and transparietal approach using two flexible endoscopes.

Objective: This experimental study was designed to assess the technical feasibility and benefits of our novel approach for transgastric NOTES (natural orifice translumenal endoscopic surgery) cholecystectomy.

Methods: Four pigs were subjected to NOTES cholecystectomy by the combined transgastric and transparietal approach using two flexible endoscopes. Under the guidance of a transparietal endoscope inserted through a trocar placed in the right upper abdomen, a gastrotomy was constructed, and a peroral endoscope was advanced into the peritoneal cavity through the gastrotomy and moved on retroflexion toward the gallbladder.

Intraoperative radiotherapy for oncological and function-preserving surgery in patients with advanced lower rectal cancer.

Background: Pelvic autonomic nerve preservation (PANP) with lateral lymph node dissection (LLND) has been introduced in rectal cancer surgery in Japan; however, its indication has not been standardized yet.

Materials And Methods: Forty-four patients with advanced lower rectal cancer were randomized to either the standard treatment group (control group) or the intraoperative radiotherapy (IORT) group. All patients underwent potentially curative resection of the rectum with total mesorectal excision.

Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer.

Background And Objective: Endoscopic submucosal dissection (ESD), a newly developed endoscopic mucosal resection (EMR) technique, can completely cure a differentiated mucosal gastric cancer smaller than 2 cm. For early-stage gastric cancers (EGCs) deviating from the above-mentioned criterion, gastrectomy with lymph node dissection is performed for potential risk of lymph node metastasis (LNM). However, many of surgical EGC cases actually do not have LNM, indicating this surgery may not be necessary for many cases of EGC.

En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen.

A new endoscopic mucosal resection using an insulation-tipped diathermic knife (IT knife-EMR) is a promising procedure for en bloc resection of an early stage gastric cancer. However, the use of this procedure for a large lesion on the greater curvature of the gastric middle-upper body is technically difficult. With the help of a grasping forceps percutaneously inserted into the gastric lumen, which allowed traction to be applied to the lesion, a 66-year-old man with a large tumor (49mm in diameter) on the greater curvature of the gastric middle body underwent IT knife-EMR.

Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer.

Background: For early gastric cancer, submucosal invasion may be unrecognized until histopathologic examination of the specimen obtained by EMR. Gastrectomy with lymphadenectomy is the standard treatment for such submucosal cancers. However, approximately 80% of submucosal cancers do not have lymph node metastasis.

A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy.

Background: With the aim of preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy (PPPD), we devised a new reconstruction method in which the pancreas and the bile duct are anastomosed to the proximal jejunum brought through the transverse mesocolon, and the duodenum is antecolically anastomosed to the jejunum below the mesocolon. The right gastric artery is divided in order to place the stomach, the duodenum, and the jejunum in a straight line.

Methods: Thirty patients underwent PPPD with the new reconstruction method (n = 12) or the conventional method (all anastomoses performed retrocolically; n = 18).