Seiichiro Yoshikawa

Pretreatment of sivelestat sodium hydrate improves the lung microcirculation and alveolar damage in lipopolysaccharide-induced acute lung inflammation in hamsters

ABSTRACT Damage to the lung microcirculation and alveoli caused by activated leukocytes is known to play an important role in the development of acute lung injury (ALI). The aim of this study is to evaluate the difference in the effect of pretreatment and posttreatment of a synthetic neutrophil elastase inhibitor sivelestat on ALI. Hamsters were instilled with 10.0 mg/kg of lipopolysaccharide (LPS) intratrachealy for 1 h to simulate ALI. Two milligrams per kilogram of sivelestat was injected intraperitoneally either previously or after LPS infusion. One and 24 hours after the infusion of LPS, pulmonary microcirculation was observed under the intravital microscopy. In another series, the blood cell counts were evaluated. The adhesive leukocyte count on the endothelium was significantly lower in pretreatment group compared with control group (P < 0.01), whereas the difference was not significant in the posttreatment group. Similarly, the number of obstructed capillary was significantly lower in the pretreatment group (P < 0.01). The width of interstitum was significantly lower in the pretreatment and posttreatment group (P < 0.01 and 0.05, respectively). A comparison of white blood cell counts showed a better maintenance in pretreatment group (P < 0.05). Pretreatment of sivelestat demonstrated a protective effect on both intravascular and extravascular damage in the lung, whereas posttreatment only suppressed the latter damage.

Laparoscopy-Assisted Low Anterior Resection with a Prolapsing Technique for Low Rectal Cancer

Laparoscopy-assisted low anterior resection (LAR) for low rectal cancer is a difficult procedure, presenting problems with rectal washout, selecting the appropriate distal transection line, and achieving safe anastomosis. To resolve these problems, we used a prolapsing technique to perform laparoscopy-assisted LAR. Total mesorectal excision (TME) is performed laparoscopically. The proximal colon is transected laparoscopically with the aid of an endoscopic stapler, and the distal rectum, including the lesion, are everted and pulled transanally to outside the body. Only washout of and wiping off the distal rectum and intestinal resection are performed extracorporeally. The distal rectum is pushed back through the anus into the pelvis, and intracorporeal anastomosis is completed laparoscopically with a double-stapling technique. Our limited experience suggests that the prolapsing technique helps to prevent problems with laparoscopy-assisted LAR in selected patients with low rectal cancer.

Kinetics of cytokines and PMN-E in thoracoscopic esophagectomy

BACKGROUND Perioperative increases in the levels of cytokines and polymorphonuclear leukocyte elastase (PMN-E) have been shown to be related to degree of surgical trauma. METHODS We measured the changes in levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and PMN-E in the perioperative period in patients undergoing thoracoscopic esophagectomy (n = 15) and conventional transthoracic esophagectomy (n = 15) for thoracic esophageal cancer. RESULTS Both IL-6 and IL-8 increased markedly immediately after transthoracic esophagectomy and thereafter, but only a slight increase was observed after the thoracoscopic procedure (IL-6: p = 0.047; IL-8: p = 0.03). A difference was also seen in the pattern of changes in PMN-E. Levels of PMN-E increased immediately after transthoracic esophagectomy and continued to be high up to the 3rd postoperative day, but they remained low after the thoracoscopic procedure and showed no increase (p <lt; 0.01). CONCLUSION These results suggest that, compared with transthoracic esophagectomy, thoracoscopic esophagectomy results in less production of cytokines and PMN-E and thus causes less surgical trauma.

Laparoscopic one-stage resection of right and left colon complicated diverticulitis equivalent to hinchey stage I–II

PurposeThe safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I–II.MethodsIn this study, the Hinchey classification (I–IV) was also adopted for right-sided diverticulitis (I′–IV′). We reviewed the clinical records of 58 patients who underwent colon resection for complicated colon diverticulitis (Hinchey stage I–IV or I′–IV′) between May 1994 and December 2008. Fifty-two patients underwent colon resection for Hinchey I–II or I′–II′ disease; as LAPH in 36 and as OPH in 16. Only one patient required conversion to the open procedure after laparoscopy.ResultsThe overall complication rate was significantly higher in the OPH group (43.8%) than in the LAPH group (16.7%; P < 0.05). Wound infection was significantly more common in the OPH group (37.5%) than in the LAPH group (11.1%; P < 0.05). Hospital stay was significantly shorter in the LAPH group (P < 0.05). Hartmann procedure was performed in one patient from each group. No anastomotic leakage occurred in either group.ConclusionOur findings indicate that laparoscopic surgery can be performed safely and effectively even for patients with Hinchey I–II, I′–II′ colonic diverticulitis.

Natural orifice specimen extraction using prolapsing technique in single-incision laparoscopic colorectal resections for colorectal cancers

It is often technically difficult to cut the lower rectum with an endoscopic linear stapler in single‐incision laparoscopic colorectal resections (SILC) because some surgical devices are inserted through the same access platform. If the rectum is cut incorrectly, it may cause anastomotic leakage. We recently applied natural orifice specimen extraction (NOSE) using the prolapsing technique to overcome this technical difficulty in SILC procedures in selected patients.

Incisionless Laparoscopic Colectomy for Colorectal Cancer âÂÂHybrid NOTES Technique Applied to Traditional Laparoscopic Colorectal ResectionâÂÂ

Background: We recently developed a new technique of laparoscopic colectomy (LAC) for colorectal cancer. This procedure, called “Incisionless LAC (iLAC)”, involves completely laparoscopic double stapling technique (DST) without mini-laparotomy. Methods: This technique was applied in the cases with relatively early-stage cancer of the sigmoid colon or rectum. The procedure involved 5 ports. Lymph node dissection and mobilization of the bowel were carried out completely via a laparoscope. The specimen was extracted through the original anus. Anastomosis was laparoscopically performed with DST. Method A: The proximal and distal parts of the lesion are transected with laparoscopic staplers. The staple at the upper rectum is released, and the lesion is removed out of the body through the anus. The anvil is attached to the proximal part of the bowel laparoscopically, followed by intracorporeal side-to-end anastomosis with DST. Method B: The proximal part of the lesion is transected with laparoscopic staplers. Then, the lesion and bowel are pulled out of the body through the anus by means of inversion, followed by transection of the distal side of the bowel with a stapler. The distal side of the bowel is pushed back into the body, and the anvil is attached to the proximal part of the bowel laparoscopically. Then, intr acorporeal anastomosis with DST is performed. Results: Method A was applied in eight cases. Method B was applied in twelve cases. Postoperative complications developed in none of the cases. Although the postoperative follow-up period to date is still short, no tumor recurrence in the stump has occurred in any of the cases. Conclusion: Our experience indicates this “iLAC” technique is feasible for selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be prevented completely with this hybrid approach.

A case of omental herniation through the esophageal hiatus successfully treated by laparoscopic surgery

We report a rare case of omental herniation through the esophageal hiatus. A 46‐year‐old man visited our emergency department complaining of epigastralgia. Abdominal examination revealed muscular defense and rebound tenderness in his upper abdomen. A computed tomography scan showed a fat density mass in the posterior mediastinum. A laparoscopic operation was carried out under the diagnosis of omental herniation through the esophageal hiatus.

Anterior Resection of the Rectum

Single-port laparoscopic surgery (SPLS) for colorectal cancer is a recent development in minimally invasive surgery. Although the devices and techniques for SPLS are being improved year by year, some technical diffi culties remain. In this chapter, we explain how to perform SPLS for sigmoid and rectal cancer. SPLS is usually applied to patients with a relatively small tumor (less than 4 cm) and without peritonitis carcinomatosa. A vertical incision (approximately 2.5 cm in length) is made. After insertion of an atraumatic wound retractor (Alexis™ (Applied Medical, Rancho Santa Margarita, CA, USA)), which remains in place throughout the procedure, a multi-access platform (MAP) is manually inserted into the incision. In most cases, standard straight laparoscopic instruments are used. All SPLS proce- dures are performed with surgical techniques similar to those used in our standard laparoscopic procedures. Left-sided anastomoses are performed intracorporeally with a circular stapler. We usually divide the colon or rectum using a fl exible laparoscopic linear stapler inserted through the MAP. However, when it is techni- cally diffi cult to divide the rectum at the lower level, we often use the prolapsing technique to cut the rectum more confi dently.