This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry of Health &amp; Welfare, Republic of Korea (1320270).

윤리 정책 : 인체를 이용한이 절차는 아주 대학교 병원의 임상 시험 심사위원회 (IRB)에 의해 승인되었습니다. 수술 1. 준비 <ol><li> 수술 전 자정 이후 입으로 아무것도, 부드러운식이 요법을 수술 전 하루 허용합니다. 참고 : 이전과 수술 중에 비위 관을 삽입하지 마십시오. 이 프로토콜은 위장을 수축하는 모든 튜브를 사용하지 않습니다. 위장은 복강경 수술에 대한 제한된보기를 일으키는 팽창시킨다 경우 대신 그, 인트라 위 가스는 복강경 천자 바늘로 흡입 될 수있다. </li><li> 작동 테이블에 환자를 배치 한 후, 유도 화제 (티 오펜 탈 나트륨, 100 mg)을 관리. </li><li> 근육 이완제의 정​​맥 주사 (Rocuronium 브로마이드, 1.0 ㎎ / ㎏) 후 구강을 통해 기관 내 튜브를 삽입합니다. </li><li> 다음 회를 모니터링, 기관 내 튜브를 통해 - 마취 가스 (3 % 세보, 2)를 시작합니다수술 중 안정성을위한 전자 환자. </li></ol> 수술 중 위 내시경 전에 2. 수술 <ol><li> 역 Trendelenburg 위치에서 환자를 놓고 환자의 오른쪽에 서있다. </li><li> infraumbilical 지역에서 10mm 절개를 확인하고 복강에 처음 투관침을 삽입합니다. </li><li> 18mm 수은 - 즉시 투관침 삽입 될 때, (15)의 pneumoperitoneum을 만들 투관침과 이산화탄소 가스 튜브를 연결한다. </li><li> 투관침을 통해 단단한 30 ° 복강경을 삽입하고 복강경 시스템과 연결된 모니터에 복강을 탐구한다. </li><li> 작업 포트와 4 개의 추가 트로 카를 (한 12mm 세 5mm)를 삽입합니다. 배꼽의 우측 상단에 12mm의 투관침을 삽입합니다. 배꼽과 복부의 양쪽 상단 외부 사분면의 왼쪽 상부에 다른 세 5mm의 트로 카를 삽입합니다. </li><li> inferi 방향으로 횡행 결장 함께 gastrocolic 인대를 해부하다또는 비장의 극 초음파 내시경 가위를 사용하여. </li><li> 왼쪽 대망 동맥을 결찰 및 복강경 클립 루트에 비장 혈관에서 발생 정맥과 췌장 꼬리의 우수한 테두리에 노출 된 후, 초음파 내시경 가위를 사용하여 절제. </li><li> 초음파 내시경 가위를 사용하면, 유문 및 췌장의 머리 주위에 peripyloric 림프절을 해부하고, 그들의 기원에 적절한 대망 혈관을 절제. </li><li> 십이지장의 제 1 부분 절제 전에 gastroscopic 수순 (도 1) 중 소장으로 가스의 이동을 방지하는 복강경 클램프 십이지장 클램프. </li></ol> 3. 수술 중 위 내시경 <ol><li> 내시경 수술을 수행하기 위해 환자의 머리를 왼쪽으로 이동한다. </li><li> 수술 중 내시경 동안 치아와 잇몸을 보호하기 위해 고무 실드를 삽입합니다. </li><li> 난방을 돌립니다내시경의 삽입을 위해 좌측으로 환자의 D. </li><li> 구강, 식도, 위장의 점막에 손상을 피하기 위해 조심스럽게 입과 식도를 통해 위장에 내시경을 삽입합니다. </li><li> 주 병변을 찾기 위해 위 내시경을 통해 가스를 주입하여 배를 Insufflate. 참고 : 대부분의 위 내시경이 절차를 수행하는 동안 장에 가스를 주입하는 특정 버튼이 있습니다. </li><li> 거리가 인접 위를 회수하기에 너무 짧은 경우 (전술 한 바와 같이) (도 2) 종양의 근위 마진 및 내시경에 표시 눈금을 사용하여 식도 접합부 사이의 거리를 대략, 총 절제술을 수행한다. (10) </li><li> 위전 절제술이 필요없는 경우에는 내시경의 작은 구멍을 통해 내시경 인젝터를 넣고이 주입 - 3cm의 PROX - 영역 (2)으로 내시경 인젝터를 사용하여 위벽에 인디고 카민 3 CC를종양 여백에서 imal, 인트라 피하거나 extraluminal 누설 (그림 3A). <ol><li> 바늘에 의해 위 벽의 구멍을 피하기 위해 비스듬히 위 벽에 주사기의 바늘을 삽입합니다. 또한, 주입시 관내 누설을 확인하기 매우 느리게 인디고 카민 주입. </li></ol></li><li> 염료를 주입 한 후, 내시경을 통해 흡 팽창 가스는 복강경 절차를 용이하게한다. 참고 : 대부분의 위 내시경이 절차를 수행하는 동안 팽창 가스를 흡인하는 특정 버튼이 있습니다. </li></ol> 수술 중 위 내시경 후 4. 절차 <ol><li> gastroscopic 절차 후 환자의 우측으로 리턴한다. </li><li> 복강경보기에서 파란색 염료 (그림 3B)에 의해 장막 염색을 식별하여 종양의 근위 부분을 확인합니다. </li><li> 재에서 종양의 침범을 방지 내시경 클립으로 절제 할 수있는 얼룩진 부분을 표시섹션 마진 (그림 4A). 참고 : 5에서이 절차를 수행하는 것이 좋습니다 - 수술 시작 후 염료가 때로는 이후의 과정에서 세척 할 수 있기 때문에, 10 분. </li><li> 염료는 장막에서 검출 할 수없는 경우에는 즉시 gastroscopic 시각화 하에서 염료를 다시 주입. </li></ol> 수술 중 위 내시경 후 5 절차 <ol><li> 십이지장을 절제하고, 일본의 치료 지침에 따라 림프절 절제술을위한 다른 절차를 수행합니다. (11) </li><li> 림프절 후,이 내시경 스테이플러를 사용하여 표시 클립에 의해 안내 종양 가장자리로부터 적절한 위치 적어도 3cm 근위의 위장을 절제. </li><li> 즉시 원위부 위를 절제 한, 내시경 가방에 시료를 삽입하고 (2)를 통해 복강에서 철회 - infraumbilical 투관침 사이트의 3cm 확장. </li><li> 에 인접 마진에서 조직 보내기수술 중 조직 학적 평가를위한 병리학. </li><li> 절제 위의 근위 부분에 종양이없는 조직의 확인 후, 나머지 위장과 체내 선형 스테이플러 (그림 4B)와 근위 공장 사이의 문합을 수행합니다. </li></ol>

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The authors have no conflicts of interest or financial ties to disclose.

이러한 프로토콜에서는, 정확하고 확실하게 위의 중간 1/3 종양의 위치를​​ 식별하는 내시경 수술하는 과정을 도입 하였다. 우리는 성공적으로 수술 중 내시경의 결과에 따라 원위부 소계 절제술을 수행 할 수 있었다. 지금까지 다양한 방법이 복강경 관점에서 조기 위암의 위치를​​ 식별하기 위해 적용되어왔다. 가장 일반적인 방법은 수술 전 gastroscopic 클리핑을 사용하?...

복강경 수술은 한국과 일본 등 동아시아 국가에서 조기 위암에 대한 선택의 처리가되었습니다. (1)이 수술의 장점은 잘 조기 위암 (EGC)에 대한 몇 가지 임상 시험에서 입증되었다. 2-4 대부분의 이 시험 절차는 복강경에 의해 수행되었지만, 종양의 위치 식별은 상기 주 종양을 포함한 위, 및 재건 절제 minilaparotomy 통해 수행 하였다. 따라서, 수술 minilaparotomy는 &quot;위 절제술을 복강경을 이용한.&quot;로 표시되어 요구 그러나 최근 수술은 환자의 삶의 질을 향상 수술후 외상을 최소화하도록 진화했다. 이 개념은 또한 위암 복강경 수술에 적용 되었기 때문에, 약간의 경험 복강경 외과 의사 minilaparotomy을 피하기 위해 노력했다. gastri에 대한 완전 복강경 위 절제술 (TLG)C 암은 모든 절차가 표본 절제술 및 문합에 대한 추가 minilaparotomy을 요구하지 않고, 단지 복강경 장치를 사용하여 완료해야합니다. 개복술을 필요로이 열 적은 통증과 빠른 회복 상대적으로 수술 결과의 유형 또는 복강경 보조 수술, 이후 더 많은 외과 의사를 선호합니다. 5,6 그러나, 위암 TLG에 장애물이 직접 시각화 또는 촉진하지 않고 종양 현지화가 위 절제술의 영역을 결정합니다. 절제의 여백에서 종양의 부재는 위암 수술의 성공을 달성하는 것이 매우 중요합니다. 위암 원위부 위 절제술시 절제 연에 종양 침범이있는 경우, 추가 절제가 남아있는 위의 종양을 떠나 방지하기 위해 필요하다. 개방적이고 복강경 보조 수술에서 기본 종양은 쉽게 임시 위루를 통해 촉진 또는 직접 시각화하여 지역화 할 수 있습니다. 그러나, 프리마 때문에공예 종양은 쉽게 어려울 수 있습니다 TLG에서 조기 위암에 대한 절제술 마진을 결정, 복강경보기에서 검색되지 않습니다. 절제를 결정하기 위해 추가 내시경 수술을 필요로하는 다른 여러 방법이 제안되어있다. 7-9 그러나, 추가 수술 내시경은 환자에게 불편할 수있다. 수술 중 내시경 직접 위의 중간 세 번째 위암에 대한 TLG 동안 종양을 표시하는 우리는 절차를 소개했다. 이 프로토콜에서는 내시경 점막하 박리 절대 표시에 포함되지 않은 수술 전 연구에서 조기 위암 암 환자에 대한 복강경 수술을 적용했다.

<table><tbody><tr><td>Pentothal Sodium</td><td>JW pharmatheutical Co.</td><td>644912100</td><td>It was used as induction asgent</td></tr><tr><td>Rocumeron</td><td>&amp;nbsp;Ilsung pharmatheutical Co.</td><td>655402960</td><td>It was used for general anesthestia as muscle relaxant.</td></tr><tr><td>SevoFRAN</td><td>Hana pharmatheutical Co.</td><td>657801060</td><td>It was used as general anesthetics</td></tr><tr><td>Endoscopy system</td><td>Olympus Corp.</td><td>CLV-260</td><td>It was used for intraoperative GFS</td></tr><tr><td>Laparoscopic surgery system</td><td>Striker Endoscopy</td><td>1488 HD 3-CHIP</td><td>It was a system for laparoscopic surgery</td></tr><tr><td>Ultrasonic scissor</td><td>Johnson and Johnson Medical Corp.</td><td>HAR23</td><td>It was used during tissue dissection</td></tr><tr><td>Laparoscopic clip</td><td>Johnson and Johnson Medical Corp.</td><td>ER420</td><td>It was used for ligation of the vessels.</td></tr><tr><td>Indigo carmine</td><td>Korea United Pharma</td><td>Carmine</td><td>It was injected into the gastric wall</td></tr><tr><td>Linear stapler</td><td>Johnson and Johnson Medical Corp.</td><td>ECHELON FLEX Powered Endopath Stapler</td><td>It was used for resection the stomach</td></tr><tr><td>Gastroscopic injector</td><td>TaeWoong Medical</td><td>Cobra injector</td><td>I was used for gastroscopic injection of blue dye</td></tr></tbody></table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

위의 장막 표면에 노출되지 위암 결정 절제 마진은 완전히 복강경 위 절제술 (TLG) 중 가장 중요한 절차입니다. 이 프로토콜의 목적은 바로 위의 중간 1/3 위암 TLG 동안 종양을 표시하기 위해, 내시경 수술하는 과정을 도입한다. 위의 중간 3 위 선암으로 진단받은 환자는이 경우 시리즈를 대상으로 하였다. 수술 전에 종양의 현지화에 대한 추가 내시경이 수행되지 않습니다. 전신 마취 하에서, 위의 복강경 동원 먼저 수행된다. 십이지장의 제 1 부분은 췌장 동원 및 gastroscopic 절차는 다른쪽에 의사 이동 클램핑 후. 위장에 구강을 통해 내시경의 삽입에, 2 - 인디고 카민의 3 CC는 위 무에 내시경 주사를 통해 투여위의 근위 여백 scle 층. 복강경 뷰 염색 장막의 위치는 종양이 식도 접합부에 너무 가까우면 선단부 소계 절제술 그러나 위전 절제술 행하는 안내하는 데 사용된다. 시편은 재건 전에 종양 절제에서 충분한 길이를 확인 원위부 위 절제술 후 샘플링된다. 우리의 경우 시리즈에서 모든 환자는 종양이없는 여백이 있고 추가 절제를 할 필요가 없습니다. gastroscopic 절차와 관련된 어떠한 이환율, 서서히 5 분으로 감소있는 절차에 필요한 시간은 없었다. 종양 현지화를위한 수술 중 내시경 완전히 복강경 원위부 위 절제술을받은 위암 환자에 대한 정확하고 내약성 방법이다.

수술 중 내시경을 시행받은 20 명의 환자 중 18 위 내시경에서 발견에 의해 유도 말단 소계 절제술을 시행 하였다. 근위부 종양 마진이 식도 접합부에 너무 가까이 있었기 때문에 수술 중 내시경 결정하지만, 우리는,이 환자 총 절제술을 시행 하였다. 근위부 절제 연에 종양에서의 거리가 3.5 cm이 두 환자의 2.5 cm, 각각 (표 1)이었다. <p class="jove_content" fo:keep-toge...

Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

위 선암에 대한 복강경 수술에서 종양 현지화를위한 수술 중 위 내시경

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

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JoVE Journal

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12.7K 조회수.  Ajou University, School of Medicine. In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

비디오: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Laparoscopic Anatomical Hepatectomy Using Takasaki's Approach and Indocyanine Green Fluorescence Navigation

Laparoscopic anatomical liver resection is a standard treatment for liver cancer. Segmental resection of S4/5/7/8 is complex and lacks standardized procedures, leading to common complications. Innovative techniques are essential for enhancing safety and outcomes. A 45-year-old male with a history of hepatitis B, Child-Pugh Class A liver function, performance status (PS) score 0, and alpha-fetoprotein (AFP) level of 198.3 ng/mL was diagnosed with a 4 cm &#215; 5 cm &#215; 5 cm mass in S4/7/8, indicating primary hepatocellular carcinoma (HCC), closely associated with the middle and right hepatic veins (BCLC A). The 15-min retention rate of indocyanine green (ICG) was 7.8%. The standard liver volume (SLV) was 1073 mL, and the actual liver volume was 1345 mL. We performed laparoscopic resection of segments S4/5/8 and partial S7, resecting the middle hepatic vein (MHV) while preserving the right hepatic vein (RHV) because MHV was so closed with the tumor. The future liver remnant (FLR) was 590 mL, with an FLR/SLV ratio of 55%. The surgical procedure utilized Takasaki's approach to block the right anterior hepatic pedicle and fluorescence staining to identify the transection line. The operation lasted 205 min with an estimated blood loss of 150 mL. The patient experienced no postoperative complications and was discharged on the sixth day. Histopathology confirmed hepatocellular carcinoma with clear resection margins. Takasaki's approach, combined with ICG fluorescence navigation, significantly improves laparoscopic anatomical hepatectomy. This technique enhances visualization, reduces complications, and offers a new standard for complex liver resections.

Here, we present a protocol for laparoscopic anatomical hepatectomy using Takasaki's approach and indocyanine green fluorescence navigation in S4/5/7/8 resection.

Takasaki의 접근법을 사용한 복강경 해부학적 간절제술과 인도시아닌 녹색 형광 항법

Laparoscopic anatomical liver resection is a standard treatment for liver cancer. Segmental resection of S4/5/7/8 is complex and lacks standardized ...

연구

암 연구학

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

최소 침습성 경막식 식도 절제술에서 경피 성 접근을위한 저비용 단일 포트 (LoCoSP) 장치

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

의학

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

위장 기질 종양의 치료를위한 복강경 내시경 검사 협동 수술

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

자연 오리피스 표본 추출을 통한 대장암에 대한 단일 외과의, 3포트, 복강경 절제술의 임상 적용

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to the anatomical characteristics of the liver, with intraoperative hemorrhage being a primary concern. Intraoperative blood loss is the leading cause of conversion to open surgery; therefore, effective management of bleeding and hemostasis is crucial for a successful LAH.
The two-surgeon technique is proposed as an alternative to the traditional single-surgeon approach, with potential benefits in reducing intraoperative bleeding during laparoscopic hepatectomy. However, there remains a lack of evidence to determine which mode of the two-surgeon technique yields superior patient outcomes. Besides, to our knowledge, the LAH technique, which involves the use of a cavitron ultrasonic surgical aspirator (CUSA) by the primary surgeon while an ultrasonic dissector by the second surgeon, has been rarely reported before.
Herein, we present a modified, two-surgeon LAH technique, wherein one surgeon employs a CUSA while the other uses an ultrasonic dissector. This technique is combined with a simple extracorporeal Pringle maneuver and low central venous pressure (CVP) approach. In this modified technique, the primary and secondary surgeons utilize a laparoscopic CUSA and an ultrasonic dissectorconcurrently to achieve precise and expeditious hepatectomy. A simple extracorporeal Pringle maneuver, combined with the maintenance of low CVP, is employed to regulate the hepatic inflow and outflow in order to minimize intraoperative bleeding. This approach facilitates the attainment of a dry and clean operative field, which allows for the precise ligation and dissection of blood vessels and bile ducts. The modified LAH procedure is simpler and safer due to its effective control over bleeding as well as the seamless transition between the roles of primary and secondary surgeons. It holds great promise for future clinical applications.

Here, we present a protocol to perform a modified laparoscopic anatomic hepatectomy using improved techniques and instruments.

수정된 복강경 해부학적 간 절제술: 단순 체외 프링글 조작과 결합된 2명의 외과 의사 기술

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to ...

Advancing LRPS: Optimal Techniques for Challenging Liver Resections

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver resections, including less blood loss, reduced wound pain, and shorter hospital stays with a comparable oncological outcome. However, laparoscopic resection of lesions in the right posterior section of the liver is challenging due to difficulties in bleeding control and visualizing the surgical field. In the past, laparoscopic right posterior sectionectomy (LRPS) was still in the exploration phase, with undefined risks in the Second International Consensus Conference on LLR in 2014. However, recent technological advancements and increased surgical experience have shown that LRPS can be safe and feasible. It has been found to reduce hospital stay and blood loss compared to open surgery. This manuscript aims to provide a detailed description of the steps involved in LRPS. The key factors contributing to our success in this challenging procedure include proper liver retraction and exposure, the use of an intrahepatic Glissonian approach for inflow control, a technique called the 'ultrasonic scalpel mimic Cavitron ultrasonic surgical aspirator (CUSA)' for parenchymal transection, early identification of the right hepatic vein, and meticulous bleeding control using bipolar diathermy.

Here, we present a protocol to perform laparoscopic right posterior sectionectomy, focusing on two key aspects: the intrahepatic Glissonian approach for inflow control and a parenchymal transection technique using an ultrasonic surgical aspirator.

복강경 우측 후방 절제술의 기술: 글리소니언 접근법과 실질 절제술

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver ...

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the digestive tract, including the abdominal cavity, albeit rarely. In the present case, the tumor was resected endoscopically through the anterior gastric wall. Computed tomography (CT) scan and gastroscopy of a 60-year-old woman revealed submucosal lesions in the gastric body. The possibility of a stromal tumor was considered more likely. The endoscopic surgery was performed under endotracheal anesthesia. After a solution had been injected at the lesion site in the stomach, the entire gastric wall was dissected to expose the tumor. As the lesion was in the abdominal cavity and its base was attached to the abdominal wall, it was accessed using a sterilized PCF colonoscope. A sodium chloride injection was administered at the base. The tumor was then peeled along its boundaries using the hooking and excision knife combined with the precutting knife. Subsequently, the tumor was pulled into the stomach through the incision made in the stomach and then extracted externally through the upper digestive tract using the ERCP spiral mesh basket. After confirming the absence of bleeding at the incision site, the endoscope was returned to the stomach, and the stomach opening was closed using purse-string sutures. The patient recovered satisfactorily following the surgery and was discharged on day 4. Histological examination revealed a low-risk stromal tumor (spindle cell type, &lt;5 mitosis/50 high-power fields [HPF]). Immunohistochemistry revealed positive staining for CD34 and CD117, negative staining for SMA, positive staining for DOG1, and negative staining for S100. Additionally, the expression of ki67 was 3%.

<meta charset="utf8"></head><body>복강 내 중간엽 종양의 경배부 내시경 절제술(Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor)

The article introduces the surgical method, endoscopic submucosal dissection (ESD) for the complete removal of intra-abdominal tumors using natural orifice transluminal endoscopic surgery (NOTES). The procedure reaches the stomach by using gastrointestinal endoscopy, creating a controlled perforation for tumor removal, followed by stitching the gastric incision.

복강 내 중간엽 종양의 경배부 내시경 절제술(Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor)

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the ...

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for treating proximal gastric cancer. This technique includes comprehensive laparoscopic resection of the proximal stomach, lymph node dissection, and double-tract anastomosis. By integrating single-port laparoscopic surgery with an auxiliary operating hole, SILT-DT reduces procedural difficulty while facilitating the placement of an abdominal drainage tube. Compared to the traditional five-port laparoscopic gastrectomy, SILT-DT requires fewer ports and results in shorter incision lengths, contributing to reduced postoperative pain and faster recovery. A thorough preoperative evaluation was conducted to ensure procedural success, with factors such as tumor size, stage, location, and patient BMI carefully considered. This comprehensive assessment allowed for optimal patient selection and surgical planning. Postoperative follow-up demonstrated no significant complications, underscoring the safety and efficacy of SILT-DT. This innovative technique offers a promising minimally invasive alternative for managing proximal gastric cancer while maintaining excellent clinical outcomes.

The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for ...

Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was approved for in-human use in Europe. Possible applications for this new robotic system are being explored, and standardized approaches are evolving. In lieu of this, a gastric wedge resection and the standardized setup for upper gastrointestinal procedures using this new system are presented here. This safe and feasible robotic procedure is demonstrated in a 69-year-old patient with a gastric tumor. All steps of the surgery are described in a detailed and reproducible manner. The article also details trocar positioning, arm adjustments, and required surgical instruments. Docking time amounted to 13 min, whereas the console time took 115 min. The patient was discharged after 4 days after ensuring an uneventful course. The presented method is also suitable for other surgical purposes, such as fundoplications or hiatoplasties, and ensures both generalizability and reproducibility.

Robotically assisted surgery has become highly popular in recent years. Presented here is the standard care for upper gastrointestinal procedures, including a demonstration of a robotic-assisted gastric wedge resection using a modular robotic device.

수술에서의 로봇 공학: 모듈식 로봇 플랫폼 기반 위 쐐기 절제술

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was ...

위 선암에 대한 복강경 수술에서 종양 현지화를위한 수술 중 위 내시경

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