Evaluation of the 10-year history of a 2-day standardized laparoscopic surgical skills training program at Kyushu University.

Purpose: Laparoscopic and open surgical skills differ distinctly from one another. Our institute provides laparoscopic surgical skills training for currently active surgeons throughout Japan. This study was performed to evaluate the effectiveness of our 2-day standardized laparoscopic surgical skills training program over its 10-year history.

Augmented reality navigation system for laparoscopic splenectomy in children based on preoperative CT image using optical tracking device.

Purpose: In endoscopic surgery, limited views and lack of tactile sensation restrict the surgeon's abilities and cause stress to the surgeon. Therefore, an intra-operative navigation system is strongly recommended. We developed an augmented reality (AR) navigation system based on preoperative CT imaging.

Design of a surgical robot with dynamic vision field control for Single Port Endoscopic Surgery.

Recently, a robotic system was developed to assist Single Port Endoscopic Surgery (SPS). However, the existing system required a manual change of vision field, hindering the surgical task and increasing the degrees of freedom (DOFs) of the manipulator. We proposed a surgical robot for SPS with dynamic vision field control, the endoscope view being manipulated by a master controller.

Objective assessment of laparoscopic suturing skills using a motion-tracking system.

Background: Laparoscopic suturing skills are important for advanced laparoscopic surgery. However, objective assessment of these skills has not yet been established. The aim of this study was to assess the laparoscopic suturing skills of novice and experienced surgeons using an electromagnetic motion-tracking system.

A surgical robot with vision field control for single port endoscopic surgery.

Background: Robotic end-effectors for single port endoscopic surgery (SPS) require a manual change of vision field that slows surgery and increases the degrees of freedom (DOFs) of the manipulator.

Methods: A new surgical prototype robot has dynamic vision field control and a master controller to manipulate the endoscopic view. It uses positioning (4 DOF) and sheath (2 DOF) manipulators for vision field control, and dual tool tissue manipulators (gripping, 5 DOF; cautery, 3 DOF).

Effectiveness of basic endoscopic surgical skill training for pediatric surgeons.

Purpose: Pediatric surgeons require highly advanced skills when performing endoscopic surgery, but their experience with such cases tend to be limited in comparison to general surgeons. The aim of this study was to evaluate the effectiveness of basic endoscopic surgery training for less-experienced young pediatric surgeons and then compare their skills with those of general surgeons.

Methods: The surgeons (n = 477) subjected to this study underwent a 2-day endoscopic skill training program, consisting of lectures, box training, VR simulator training, tissue training, and live tissue training.

Real-time 3-dimensional virtual reality navigation system with open MRI for breast-conserving surgery.

Background: The aim of this study was to report on the early experiences using a real-time 3-dimensional (3D) virtual reality navigation system with open MRI for breast-conserving surgery.

Study Design: We developed a real-time 3D virtual reality navigation system with open MRI, and evaluated the mismatch between the navigation system and real distance using a 3D phantom. Two patients with nonpalpable MRI-detected breast tumors underwent breast-conserving surgery under the guidance of the navigation system.

Skills assessment using a virtual reality simulator, LapSim, after training to develop fundamental skills for endoscopic surgery.

Education and training to maintain medical safety are very important within clinical settings. We have established a training center for endoscopic surgery and we regularly hold a unique training course, which focuses on the development of fundamental skills. One hundred and ninety-four surgeons who participated in our training course were divided into four groups according to their experience in performing laparoscopic procedures.

The effect of CyberDome, a novel 3-dimensional dome-shaped display system, on laparoscopic procedures.

Background: Laparoscopic surgeons require extended experience of cases to overcome the lack of depth perception on a two-dimensional (2D) display. Although a three-dimensional (3D) display was reported to be useful over two decades ago, 3D systems have not been widely used. Recently, we developed a novel 3D dome-shaped display (3DD) system, CyberDome.

Tele-control of an endoscopic surgical robot system between Japan and Thailand for tele-NOTES.

We describe our experience of the development of a endoscopic surgical robot system that can penetrate into the body through the esophagus and perform surgeries in the upper gastric tubes and several organs in the abdominal cavity. In this paper, we describe the results of an experiment using this robot. We describe the configuration of the control system using a gigabit ethernet system named JGN2 for the endoscopic surgical robot.

The frontal cortex is activated during learning of endoscopic procedures.

Background: To date, several training and evaluation systems for endoscopic surgery have been developed, such as virtual-reality simulators and box trainers. However, despite current advances in these objective assessments, no functional brain studies during learning of endoscopic surgical skills have been carried out. In the present study, we investigated cortical activation using near-infrared spectroscopy (NIRS) during endoscopic surgical tasks.

Tumor ablation therapy of liver cancers with an open magnetic resonance imaging-based navigation system.

Background: As minimally invasive treatments for liver cancers, percutaneous ablation therapies represent a valid alternative to liver resections, especially in patients with poor liver function. Recently, image-guided surgical and interventional procedures using open magnetic resonance imaging (MRI) have been introduced.

Methods: We performed percutaneous ablation therapy for 51 nodules of liver cancer in 34 patients using a navigation system based on open MRI.

Significance of ERK nitration in portal hypertensive gastropathy and its therapeutic implications.

Portal hypertensive (PHT) gastric mucosa increases susceptibility to injury and delayed mucosal healing. It is possible that nitration of ERK by peroxynitrite might alter MAPK (ERK) signaling in PHT gastric mucosa, leading to delayed mucosal healing, since excessive nitric oxide production is implicated in PHT gastric mucosa and MAPK (ERK) signaling induces cell proliferation and leads to gastric mucosal healing in response to injury. Portal hypertension was produced by staged portal vein ligation, and sham-operation (SO) rats served as controls.

Construct validity for eye-hand coordination skill on a virtual reality laparoscopic surgical simulator.

Background: This study was carried out to investigate whether eye-hand coordination skill on a virtual reality laparoscopic surgical simulator (the LAP Mentor) was able to differentiate among subjects with different laparoscopic experience and thus confirm its construct validity.

Methods: A total of 31 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: experienced surgeons (more than 50 laparoscopic procedures) and novice surgeons (fewer than 10 laparoscopic procedures). The subjects were tested using the eye-hand coordination task of the LAP Mentor, and performance was compared between the two groups.

Ten-year survival of patients with hepatocellular carcinoma after hepatectomy.

Background/aims: The characteristics in patients with hepatocellular carcinoma who survive more than 10 years after hepatectomy remain unclear.

Methodology: Eighty-five cases of hepatocellular carcinoma were retrospectively identified as short-term survivors (S-group: <5 years, n=41), medium-term survivors (M-group: > or =5 and <10 years, n=25), and long-term survivors (L-group: > or =10 years, n=19) to examine the clinicopathologic factors for the 10-year survival after curative hepatectomy.

Results: In the L-group, platelet count and albumin level were higher and total bilirubin level was lower than those in the S-group.

The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma.

Background: The authors evaluated the significance of the preoperative serum C-reactive protein (CRP) level as a prognostic indicator in patients with hepatocellular carcinoma (HCC).

Methods: One hundred forty-one patients who underwent curative resection for HCC were reviewed retrospectively. Clinicopathologic variables were compared between patients with serum CRP levels >/= 1.

Laparoscopic splenectomy for portal hypertension.

Background/aims: Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension.

Methodology: Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated.

The effect of prostacyclin on the gastric mucosa in portal-hypertensive rats.

Background/aims: This study investigates the effect of prostacyclin, which is thought to be involved in the hemodynamic circulation, on the gastric mucosa of rats with portal hypertension.

Methodology: Various gastric functions were evaluated in portal vein ligated rats after the intraperitoneal administration of either a placebo or prostacyclin for 7 days.

Results: The gastric mucosal damage induced by the instillation of 90% ethanol was significantly greater in the prostacyclin-treated group than in placebo-treated group.

Role of the spleen in liver fibrosis in rats may be mediated by transforming growth factor beta-1.

Background: The effect of the spleen on the cirrhotic liver is unknown. Transforming growth factor-beta 1 (TGF-beta 1), which plays a crucial role in the matrix production during liver fibrosis, is an inhibitory factor regarding the regeneration of hepatocytes. In this study, we investigated the TGF-beta 1 production in the spleen of cirrhotic rats and the effects of a splenectomy on the healing process from liver fibrosis.

Laparoscopic splenectomy for hematologic diseases.

Background: Laparoscopic splenectomy has been demonstrated to be technically feasible and safe for the treatment of hematologic diseases.

Methods: The study comprised 64 consecutive patients with chronic immune thrombocytopenia purpura (ITP) who were admitted to our hospital from 1992 to 2000 and underwent laparoscopic splenectomy. Forty-one consecutive patients with ITP who underwent open splenectomy performed at the same hospital by the same surgical team between 1986 and 2000 were selected as the control group.

Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience.

Background: The long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) were evaluated as the initial treatment for bleeding gastric varices.

Patients And Methods: Fifty-two patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis over a 10-year period. Histoacryl was injected intravariceally.