Fumio Matsumoto

Hepatic resection using the harmonic scalpel.

We describe herein our technique of performing extensive resection of the liver by blunt dissection in combination with excision using a harmonic scalpel. A ball coagulator was inserted at 3-cm intervals along the proposed cutting line in the liver, and the liver parenchyma between these holes was then cut using coagulation shears. Regardless of the condition of the liver, good coagulation and cutting were achieved using the harmonic scalpel without vascular occlusion when dividing the shallow layer of the liver, and no complications in association with the harmonic scalpel, such as postoperative bleeding, bile leakage, or abscess formation at the cut margins, occurred. In the deep layer below the main trunk of the hepatic vein, blunt dissection was used, since it was difficult to achieve sufficient control of bleeding from large vessels using the harmonic scalpel alone. Therefore, when used in combination with other techniques, the harmonic scalpel appears to be an effective device for liver surgery that minimizes bleeding and decreases the vascular clamping time.

Laparoscopic Resection of Schwannoma of the Ascending Colon

Schwannomas of the colon are rare and difficult to diagnose preoperatively. We report a case of schwannoma of the ascending colon that was resected laparoscopically. A 64-year-old woman was referred to our hospital by her local clinic for further evaluation and management of a submucosal tumor of the ascending colon. A definitive preoperative diagnosis could not be reached despite examinations. Gastrointestinal stromal tumor, leiomyoma and lymphoma were the differential diagnoses. We performed a laparoscopic right hemicolectomy with D2 lymph node dissection. Histological findings with hematoxylin-eosin staining revealed spindle-like tumor cells, and immunohistochemical analysis showed that the tumor was positive for S-100 but negative for c-kit, CD34, smooth muscle actin and desmin, with a Ki-67 index of <5%. Thus, the diagnosis in this case was benign schwannoma of the ascending colon.

Report of a case: Retroperitoneal mucinous cystadenocarcinoma with rapid progression

Highlights • A very rare case of large retroperitoneal mucinous cystadenocarcinoma and little-known clinical course of the disease is reported.• The disease took unexpectedly aggressive progression despite the small portion of adenocarcinoma for the multiple and large cysts.• Informative findings in imaging of primary retroperitoneal mucinous cyst adenocarcinoma, and impressive imaging after recurrence are presented.

A Case of Congenital Esophageal Stenosis Operated on at the Age of 23.

症例は23歳の女性で, 離乳食開始時より食後の嘔吐を認められていた. 徐々に嚥下困難が進行し, 6歳時に先天性食道狭窄症と診断されたが, 合併奇形は認められていない. 以後, 近医で内視鏡検査, 食道造影にて経過観察をし, 時にbougieを行っていた. 22歳時の検査にて内視鏡ファイバーが通過困難となり, 手術目的にて当院外科入院となった. 当院での内視鏡検査にて切歯より約30cmと40cmの部位2か所に狭窄が認められた. 平成10年11月12日, 右開胸開腹食道亜全摘, 胸腔内胃管食道吻合, 胆摘, 幽門形成が施行された. 病理組織診断にて2か所の狭窄とも筋性線維性食道狭窄症と診断された. 本症例は狭窄部が2か所認められたこと, 保存的治療が無効であったことより食道亜全摘術が施行された. 成人例の先天性食道狭窄症の報告は少なく, また, 2か所に狭窄を有した筋性線維性狭窄は本邦での報告がなくまれな症例である.