Hidemaro Yoshiba

Near-infrared spectroscopy for assessment of tissue oxygen saturation of transplanted jejunal autografts in cervical esophageal reconstruction

PurposeChecking bowel viability is difficult but important during surgery for ischemic bowel disease or jejunal autotransplantation. We investigated the effectiveness of two-wavelength near-infrared spectroscopy (NIRS) to quantify tissue oxygen saturation (StO2), which can affect bowel viability during reconstruction of the cervical esophagus using a free jejunal graft.MethodsFree jejunal autotransplantation was performed after resection of the hypopharynx, larynx, and cervical esophagus in 12 pigs. The arterial blood flow and StO2 of the graft were measured before harvesting the graft and after reperfusion. We analyzed the measurement site of the graft and the anastomotic method as possible factors influencing StO2. We also examined the relationship between the blood flow and StO2 of the autograft.ResultsThe StO2 at the distal site of the graft was significantly lower than that at the midpoint of the graft (P < 0.05). There was a correlation between the blood flow of the graft artery, measured by the transonic volume flowmeter, and the StO2 of the graft, measured by NIRS.ConclusionsTissue oxygen saturation of the free jejunal graft can be safely and reliably measured with two-wavelength NIRS. Therefore, NIRS is a promising new method for evaluating the viability of the gastrointestinal tract.

Laparoscopic Intra-Gastric Resection of Gastric Sub-Mucosal Tumors under Oral Endoscopic Guidance

Introduction: A laparoscopic approach is often selected for resection of gastric submucosal tumor (GST), and several variations of this procedure have been reported. The approach selected greatly depends on the characteristics of the tumor, including its size or location, and also the experience and skill of the surgeon. Here we report our experience with intragastric resection of GSTs under oral endoscopic guidance. Methods: We performed laparoscopic intragastric resection of GSTs in 13 patients. The criteria for this approach were a tumor less than 5 cm in diameter and 8 cm2 in cross-section, and a tumor location on the posterior gastric wall in the upper and middle stomach or near the esophagogastric junction. Under general anesthesia, two or three ports were directly inserted into the stomach. Partial resection of the stomach including the tumor and an adequate margin in all directions was performed using a linear stapler. The resected specimen was retrieved orally using a plastic bag. Results: Laparoscopic intragastric resection of GST was successful in all patients. The mean maximum tumor diameter was 27 mm. The mean operation time was 176 min, and intraoperative blood loss was minimal. One patient required a gastrostomy and enlargement of one of the port sites in order to remove the tumor. There was no intra- or postoperative complications. The mean postoperative hospital stay was 7.5 days. The diagnosis after pathological examination of the tumor was gastrointestinal stromal tumor in 8 patients, leiomyoma in 4 and a cyst in one in one. There were no recurrences during a mean follow-up period of 121.7 months. Conclusion: A laparoscopic intragastric approach is well suited for patients who have a GST located in the upper and middle part of the stomach. It is anticipated that an oral endoscope will be used increasingly during laparoscopic procedures in the future.