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).

倫理文：ヒトを対象とするこの手順では、亜洲大学校病院の治験審査委員会（IRB）によって承認されています。 外科1.準備<ol><li>手術前に真夜中の後、口から何も、1日の手術前にソフトな食を許可します。 注：前と手術中に経鼻胃管を挿入しないでください。このプロトコルは、胃を収縮するために、任意のチューブを使用していません。その代わりに、胃が腹腔鏡手術のための制限されたビューを引き起こして膨張している場合、胃内ガスは、腹腔鏡下穿刺針で吸引することができます。 </li><li>手術台に患者を配置した後、誘導剤（チオペンタールナトリウム、100 mg）を投与します。 </li><li>筋弛緩薬（臭化ロクロニウム、1.0ミリグラム/キログラム）の静脈内注射した後、口腔を介して気管内チューブを挿入します。 </li><li>その後、目を監視、気管内チューブを介して - 麻酔ガス（3％セボフルラン、2）を起動します手術中の安定性のための電子患者。 </li></ol>術中胃内視鏡の前に2.手術手順<ol><li>逆トレンデレンブルグの位置に患者を置き、患者の右側に立っています。 </li><li>臍下の面積で10ミリメートルの切開を行い、腹腔内に最初にトロカールを挿入します。 </li><li> 18ミリメートルHgの - とすぐにトロカールが挿入されるように、15の気腹を作成するために、トロカールと二酸化炭素ガス管を接続します。 </li><li>トロカールを通して剛性の30°腹腔鏡を挿入し、腹腔鏡システムに接続されたモニターに腹腔を探ります。 </li><li>ワーキングポートとして4追加のトロカール（1 12ミリメートルと3 5ミリメートル）を挿入します。臍の右側上部に12ミリメートルのトロカールを挿入します。へそと腹部の両方の上部外側象限の左上側の他の3 5ミリメートルのトロカールを挿入します。 </li><li> inferiに向けて横行結腸に沿って胃結腸靭帯を解剖または脾臓のポールは、超音波内視鏡のはさみを使用して。 </li><li>腹腔鏡クリップでルートに脾臓の血管由来の左胃大網動脈と静脈を結紮し、膵臓の尾部の上縁の露光後に、超音波内視鏡のはさみを使用してそれらを切除。 </li><li>超音波内視鏡のはさみを使用して、幽門と膵臓の頭の周り幽門周囲のリンパ節を分析し、その原点に右胃の血管を切除します。 </li><li>十二指腸の第1の部分の切除前に、胃内視鏡手順（ 図1）の間に小腸へのガスの移動を防止するために、腹腔鏡鉗子で十二指腸をクランプします。 </li></ol> 3.術中胃内視鏡<ol><li>術中胃鏡検査を実行するために、患者の頭部の左側に移動します。 </li><li>術中胃の間、歯と歯茎を保護するためのガムシールドを挿入します。 </li><li>ょんを回し胃カメラの挿入のための左側に患者のd-。 </li><li>口腔、食道、胃の粘膜への損傷を避けるために、慎重に口と食道を通って胃の中へ胃鏡を挿入します。 </li><li>原発巣を見つけるために胃鏡を通してガスを注入することによって胃を吹き込み。 注：ほとんどの胃鏡は、処置中に腸内にガスを注入するための特定のボタンを持っています。 </li><li>距離が近位胃をサルベージするには短すぎる場合（前述のように）（ 図2）腫瘍の近位マージンと胃にマークスケールを用いて食道胃接合部の間の距離を近似し、胃全摘術を行う。10 </li><li>胃全摘術が必要でない場合は、胃カメラの小さな穴から内視鏡注射器を挿入し、2注入 - 3センチPROX - エリア2で、内視鏡注射器を使用して胃壁にインジゴカルミンの3ccのを腫瘍マージンからimal、イントラ回避又は管腔外漏れ（ 図3A）。 <ol><li>針によって胃壁の穿孔を避けるために、斜めに胃の壁に注射器の針を挿入します。また、注入中に管腔内の漏れを識別するために、非常にゆっくりとインジゴカルミンを注入します。 </li></ol></li><li>染料注入した後、胃鏡を通して吸引膨張ガスは、腹腔鏡処置を容易にします。 注：ほとんどの胃鏡は、手順の間に膨張ガスを吸引する特定のボタンを持っています。 </li></ol>術中胃内視鏡後4.手順<ol><li>胃内視鏡処置後の患者の右側に戻ります。 </li><li>腹腔鏡ビューでは、青色色素（ 図3B）によって漿膜染色を識別することにより、腫瘍の近位部を確認します。 </li><li>再で腫瘍の関与を避け、内視鏡クリップで切除する染色された部分をマークセクションマージン（ 図4A）。 注：我々は5以内に、この手順を実行するお勧めします - 手術開始後に色素が時々、その後の処置中に洗い流すことができるので、10分。 </li><li>染料が漿膜に検出することができない場合は、すぐに胃内視鏡可視化の下で色素を再注入します。 </li></ol>術中胃内視鏡後5.手順<ol><li>十二指腸を切除し、日本の治療ガイドラインに従って、リンパ節郭清のための他の手順を実行します。11 </li><li>リンパ節郭清後に、2の内視鏡用ステープラーを使用して、マーキングクリップによって導か腫瘍マージン、から適切な場所で少なくとも3センチメートルの近位で胃を切除。 </li><li>すぐ遠位胃を切除されるように、内視鏡袋に試料を挿入し、2を介して腹腔からそれを撤回 - 臍下のトロカール部位の3センチ延長。 </li><li>近位のマージンから組織を送ります術中組織学的評価のための病理学。 </li><li>切除胃の近位部における無腫瘍組織を確認した後、残りの胃及び体内リニアステープラー（ 図4B）と近位空腸の間の吻合を行います。 </li></ol>

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

このプロトコルでは、我々は正確かつ確実に胃の中央三分の一に腫瘍の位置を特定するために術中胃内視鏡検査のための手順を導入しました。我々が正常に術中胃の知見に基づいて、遠位小計胃切除を行うことができました。 現在までに、様々な方法が、腹腔鏡視で早期胃癌の位置を特定するために適用されています。最も一般的な方法は、術前の胃内視鏡クリッピン?...

腹腔鏡手術は、韓国と日本を含む東アジア諸国、早期胃癌のための選択の治療法となってきた。1、この手術の利点を十分に早期胃癌（EGC）のためのいくつかの臨床試験で実証されている。2-4ほとんどのこれらの試験の手順は、腹腔鏡検査によって達成されたが、腫瘍の位置、原発腫瘍を含む胃の切除、および復興の同定はminilaparotomyを介して行われました。したがって、minilaparotomyを必要とする手術は「腹腔鏡補助胃切除を。」と記されたされていますしかし最近では、外科手術は、患者の生活の術後の質を改善する、外傷を最小限にするために進化してきました。この概念はまた、胃癌のための腹腔鏡手術に適用されているので、いくつかの経験豊富な腹腔鏡外科医はminilaparotomyを回避しようとしています。ガストリのための完全腹腔鏡下胃切除術（TLG）C癌はすべての手続きが試料の切除と吻合のための追加minilaparotomyを必要とせず、唯一の腹腔鏡デバイスを使用して完了している必要があります。開腹手術を必要とし、この開くには痛みが少なく、より速く回復相対での手術の結果の種類や腹腔鏡補助手術、以来、より多くの外科医がそれを好む。5,6しかしながら、胃がんのためTLGに障害物が直接可視化または触診することなく、腫瘍の局在があります胃切除の領域を決定します。 切除縁で腫瘍の不在は、胃癌手術の成功を達成することが非常に重要です。胃癌のため幽門側胃切除時に切除縁に腫瘍の関与がある場合は、追加の切除は、残りの胃に腫瘍が残らないように必要とされています。オープンと腹腔鏡補助手術では、原発腫瘍が容易に一時的胃瘻造設術を通じて、触診または直接可視化することによってローカライズすることができます。しかし、プリマ理由RY腫瘍が容易に腹腔鏡視野内で検出されない、TLGにEGCのための切除マージンを決定することは困難な場合があります。 切除マージンを決定するために、追加の術前胃を必要とする他のいくつかの方法が提案されている。7-9しかし 、付加的な術前の胃の患者のために不便です。私たちは、直接胃の中央3に胃癌のためにTLG中に腫瘍をマークする術中胃内視鏡検査のための手順を導入しました。 このプロトコルでは、我々は内視鏡的粘膜下層剥離術のための絶対的適応には含まれていない術前の研究では、早期胃癌の患者のための腹腔鏡手術を適用しました。

<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

胃の漿膜表面に露出していない胃癌切除縁を、決定する、完全腹腔鏡下胃切除術（TLG）中に最も重要な手順です。このプロトコルの目的は、直接胃の中央3に胃癌のためにTLG中に腫瘍をマークするために、術中胃のための手順を導入することです。胃の中央3分の1で腺癌と診断された患者は、このケースシリーズに参加しました。手術前に、腫瘍局在化のための追加の胃内視鏡検査が行われていません。全身麻酔下で、胃の腹腔鏡動員が最初に実行されます。十二指腸の第1の部分は膵臓から動員し、胃内視鏡手順のために、他の側に外科医の動きをクランプされた後。胃の中に口腔を通して胃カメラの挿入時に、2 - インジゴカルミンの3 ccが胃ムーに、内視鏡インジェクタを介して投与されます胃の近縁でSCLE層。腹腔鏡視で染色漿膜の位置は、腫瘍が食道胃接合部に​​近すぎる場合は、胃全摘術が行われ、遠位小計胃切除を案内するために使用されます。試料は、再構成の前に腫瘍を切除縁から十分な長​​さを確認するために幽門側胃切除後にサンプリングされます。私たちのケースシリーズでは、すべての患者が無腫瘍マージンを持っていたし、追加の切除を必要としません。胃内視鏡手順に関連する一切の罹患率、徐々に約5分に減少していた手順に必要な時間はありませんでした。腫瘍局在化のための術中胃内視鏡検査は完全腹腔鏡下幽門側胃切除術を受けた胃癌患者のための正確かつ許容方法です。

術中胃内視鏡検査を受けた20人の患者のうち、18は、胃での所見によって導かれ、遠位小計胃切除術を施行しました。術中胃に決定されるように、近位腫瘍マージンは、食道胃接合部に​​近すぎだったのでしかし、我々は、2人の患者の胃全摘術を行いました。近位切除マージンに対する腫瘍からの距離は、それぞれ、これら2人の患者に（ 表1）3.5センチ...

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.

胃腺癌のための腹腔鏡下手術で腫瘍局在化のための術中胃内視鏡

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

intraoperative-gastroscopy-for-tumor-localization-laparoscopic

Universidad de Cartagena UDEC

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JoVE Journal

Medicine

12.7K ビュー.  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.

ビデオ: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

婦人科腫瘍におけるセンチネルリンパ節の術中検出のためのマルチスペクトルのリアルタイム蛍光イメージング

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

医学

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.

低侵襲性経食道術における経子宮頸アプローチのための低コストシングルポート(LoCoSP)デバイス

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

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.

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

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.

天然オリフィス検体抽出による大腸癌に対する単一外科医、3ポート、腹腔鏡下切除術の臨床応用

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.

修正腹腔鏡下解剖学的肝切除術:単純な体外プリングル操作と組み合わせた2人の外科医技術

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.

腹腔鏡下右後部切除術の技術:グリッソニアンアプローチと実質離断術

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%.

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.

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.

胃がん治療のためのシングル切開と 1 ポート腹腔鏡下近位胃切除術 ダブルチャネル吻合術

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.

手術におけるロボティクス:モジュール式ロボットプラットフォーム駆動胃楔状切除術

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

Gastroscope-assisted Trans-Trocar Gastrostomy and Abdominal Exploration

Advanced endoscopic technologies have revolutionized gastrointestinal surgical procedures, transitioning from open or laparoscopic methods to endoscopic interventions. Gastrostomy is a classic clinical technique for patients with swallowing impediments due to obstructions in the cardiac or esophageal regions and has evolved significantly with the establishment of percutaneous endoscopic gastrostomy (PEG). While PEG offers reduced trauma and swift recovery, it falls short of exploratory capabilities and risks damaging adjacent organs. Therefore, we developed an innovative approach-gastroscope-assisted trans-Trocar gastrostomy (GTTG), which not only takes full play to the advantages of PEG with less trauma and faster postoperative recovery but also takes into account the advantages of laparoscopic gastrostomy with a good exploration of the abdominal cavity. This technique is characterized by ease of operation, minimal trauma (including short operation time and no redundant incision), rapid recovery, the ability to explore the abdominal cavity, and avoidance of injury to adjacent organs, which is quite worthy of widespread promotion in clinical settings.

Here, we introduce a novel technique of gastrostomy, which integrates laparoscopic and gastroscopic techniques, offering a streamlined approach with reduced invasiveness, expedited recovery, and the capacity for abdominal exploration while minimizing the risk of adjacent organ injury.

胃鏡補助トランストロカール胃瘻造設術と腹部探索

Advanced endoscopic technologies have revolutionized gastrointestinal surgical procedures, transitioning from open or laparoscopic methods to endoscopic ...

胃腺癌のための腹腔鏡下手術で腫瘍局在化のための術中胃内視鏡

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婦人科腫瘍におけるセンチネルリンパ節の術中検出のためのマルチスペクトルのリアルタイム蛍光イメージング

低侵襲性経食道術における経子宮頸アプローチのための低コストシングルポート(LoCoSP)デバイス

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

天然オリフィス検体抽出による大腸癌に対する単一外科医、3ポート、腹腔鏡下切除術の臨床応用

修正腹腔鏡下解剖学的肝切除術:単純な体外プリングル操作と組み合わせた2人の外科医技術

腹腔鏡下右後部切除術の技術:グリッソニアンアプローチと実質離断術

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

胃がん治療のためのシングル切開と 1 ポート腹腔鏡下近位胃切除術ダブルチャネル吻合術

手術におけるロボティクス:モジュール式ロボットプラットフォーム駆動胃楔状切除術

胃鏡補助トランストロカール胃瘻造設術と腹部探索

胃腺癌のための腹腔鏡下手術で腫瘍局在化のための術中胃内視鏡

要約

さらに動画を探す

この動画の章

婦人科腫瘍におけるセンチネルリンパ節の術中検出のためのマルチスペクトルのリアルタイム蛍光イメージング

低侵襲性経食道術における経子宮頸アプローチのための低コストシングルポート(LoCoSP)デバイス

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

天然オリフィス検体抽出による大腸癌に対する単一外科医、3ポート、腹腔鏡下切除術の臨床応用

修正腹腔鏡下解剖学的肝切除術:単純な体外プリングル操作と組み合わせた2人の外科医技術

腹腔鏡下右後部切除術の技術:グリッソニアンアプローチと実質離断術

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

胃がん治療のためのシングル切開と 1 ポート腹腔鏡下近位胃切除術 ダブルチャネル吻合術

手術におけるロボティクス:モジュール式ロボットプラットフォーム駆動胃楔状切除術

胃鏡補助トランストロカール胃瘻造設術と腹部探索

胃がん治療のためのシングル切開と 1 ポート腹腔鏡下近位胃切除術ダブルチャネル吻合術