Naoto Chihara

Single-incision Laparoscopic Cholecystectomy with an Additional Needle Grasper: A Novel Technique

BACKGROUND Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, the technique remains technically challenging for most surgeons. We developed a new technique utilizing a needle grasper held in the surgeons left hand as an alternative to conventional single-incision laparoscopic cholecystectomy (SILC). PATIENTS AND METHODS From August 2011 through May 2013, 29 patients at Nippon Medical School Musashi Kosugi Hospital, with gallbladder stones or polyps underwent single-incision laparoscopic cholecystectomy (SILC) with an additional needle grasper that was held in the surgeons left hand (SILCAN) and introduced in the right subcostal region without a trocar. We analyzed intraoperative and postoperative outcomes of 29 patients for whom SILCAN was performed and retrospectively compared these outcomes to those of 32 patients who underwent conventional 4-port laparoscopic cholecystectomy (CLC) from January 2011 through May 2013. RESULTS No differences in patient characteristics or intraoperative/postoperative outcomes were observed between the groups. None of the patients in either group required conversion to an open procedure or additional ports. In the SILCAN group, no patients had complications within the first 4 weeks after surgery, with the exception of 1 patient with severe chronic cholecystitis in whom bile duct stenosis developed due to inadvertent clipping of the common hepatic duct. The frequency of postoperative analgesic use was similar in both groups, although none of the patients in the SILCAN group received analgesics for pain from the small, inconspicuous wound in the right subcostal region. CONCLUSIONS SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC.

Absorbable barbed suture device for laparoscopic peritoneal closure after hernia repair via the transabdominal preperitoneal approach: A single-center experience with 257 cases: V-Loc 180 for TAPP

The laparoscopic transabdominal preperitoneal approach requires peritoneal closure and technically skilled knotting. We have started to use a barbed running suturing device (V‐Loc 180) without knotting for transabdominal preperitoneal repair of hernias. This study aimed to determine whether using V‐Loc 180 was safe and shortened the time for laparoscopic peritoneal closure.

Totally Extraperitoneal (TEP) Removal of an Infected Mesh by Laparoscopy after Open Preperitoneal Repair: Initial Case Report

Prosthetic mesh infection after open or laparoscopic hernia repair is a rare complication. Superficial wound infection can be resolved by treatment with a combination of antibiotics and wound drainage, whereas deep-seated mesh infection, which can lead to chronic groin sepsis, usually requires removal of the mesh. A 56-year-old Japanese man was admitted to our hospital for the treatment of deep-seated mesh infection. The patient had undergone inguinal hernia repair at another hospital 18 months earlier. The operation was prosthetic mesh repair via an anterior approach. The patient developed deep-seated mesh infection despite conservative treatment for infection, such as abscess drainage and antibiotic therapy. Since the patient eventually developed chronic groin sepsis, he was referred to our hospital, and infected mesh was removed successfully by laparoscopic surgery via a totally extraperitoneal approach. The laparoscopic approach provides several advantages, including less postoperative pain, a shorter hospital stay, and earlier rehabilitation. Furthermore, seeding of the abdominal cavity with pus never occurs with this approach unlike the laparoscopic transabdominal preperitoneal approach.

Time‐dependent changes in endoscopic findings of intestine in patient with acute superior mesenteric arterial thrombosis after pancreaticoduodenectomy

Superior mesenteric arterial thrombosis (SMAT) is a disorder with high mortality because of extensive necrosis of the intestine.Even if necrosis does not occur, subsequent stricture with sclerosis and the impairment of intestinal absorption are common. We report a case of SMAT in a woman in which time-dependent changes of small intestinal endoscopy could be observed. She had previously undergone anastomosis of the stomach and small intestine during subtotal stomachpreserving pancreaticoduodenectomy. She suddenly developed abdominal pain 10 days after the operation.At 24 h after the onset, she was diagnosed with SMAT, and per-catheteric thrombus aspiration was carried out.After 2 days, endoscopy was carried out for the first time since the onset. The color of the intestinal lumen was cyanotic and dark. A pseudomembrane appearance was observed. Hunter green mucosal nodules were apt to drop off from the wall. Petechial hemorrhages interspersed with pale areas were visible (Fig. 1a,b). Seven days after the onset, the small intestine had a bloody pink color with a wet glossy appearance. After 14 days, the color of the lumen improved significantly. Kerckring folds and local regeneration of the mucosa were observed (Fig. 1c,d). The passage through the intestine was good. After 3 weeks, the patient developed mild stricture(Fig. 1e,f).After 4 weeks, strong stricture was formed with massive sclerosing fibrosis, and Kerckring folds had disappeared. Furthermore, regeneration of the mucosa stopped, and erosive mucosa was seen in the tongue fur (Fig. 1g,h). A contrast examination demonstrated multiple apple-core like lesions throughout the small bowel. After 1 month, no progressive stricture has been observed. This case provides us with interesting endoscopic findings of SMAT in a timedependent manner.