Shin Kobayashi

An Experimental Study on the Relationship Among Airway Pressure, Pneumoperitoneum Pressure, and Central Venous Pressure in Pure Laparoscopic Hepatectomy.

Objectives:To determine optimal settings for airway pressure (AWP), pneumoperitoneum pressure (PPP), and central venous pressure (CVP) in pure laparoscopic hepatectomy. Background:High PPP is often employed to control bleeding from the hepatic vein during pure laparoscopic hepatectomy; however, there is a risk of pulmonary gas embolism. We noted that decreases in AWP were often effective. Methods:After establishing carbon dioxide pneumoperitoneum in 6 male piglets and maintaining PPP at 25 mmHg, CVP was measured 3 times at each of 9 levels of airway pressure, which was increased in increments of 5 cmH2O from 0 to 40 cmH2O. CVP was measured in the same manner by maintaining PPP at 20, 15, 10, 5, and 0 mmHg, and in laparotomy. Correlation and regression analyses were performed among airway pressure, CVP, and pneumoperitoneum pressure. Results:Positive correlations were observed between AWP and CVP and between PPP and CVP (P < 0.001). Under high airway pressure, CVP was persistently higher than pneumoperitoneum pressure. Under low airway pressure, CVP did not increase or often decreased when PPP was higher than CVP. Conclusions:By increasing pneumoperitoneum pressure, bleeding from the hepatic vein cannot be controlled under high airway pressure, but can be controlled under low airway pressure. However, under low airway pressure, the risk of pulmonary gas embolism increases when PPP is higher than CVP. We consider that reducing AWP is also effective for controlling bleeding from the hepatic vein and safer than increasing pneumoperitoneum pressure.

A Safe and Valid Procedure for Pure Laparoscopic Partial Hepatectomy of the Most Posterosuperior Area: The Top of Segment 7

Although laparoscopic hepatectomy, which was first reported in the 1990s, has become widely used worldwide due to its minimal invasiveness, segments 1, 7, and 8 and the superior part of segment 4, according to the classification of Couinaud, are considered unfavorable portions for laparoscopic hepatectomy even now, due to the limited visualization and the difficulty of handling the laparoscopic devices. Especially in the most posterosuperior area (the top of segment 7), it is not easy to secure a sufficient surgical margin, even during nonanatomical resection. Recently, laparoscopic hepatectomy for lesions located in this unfavorable region has often been reported by surgeons with substantial experience; however, the surgical details have never been described adequately. We describe here our safe and valid procedure for pure laparoscopic partial hepatectomy of this poorly accessible area.

Preoperative detection and handling of aberrant right posterior sectoral hepatic duct during laparoscopic cholecystectomy

An aberrant right posterior sectoral hepatic duct (PHD) draining into extrahepatic bile duct, gallbladder or cystic duct directly is a common and critical anomaly during cholecystectomy. This study aimed to investigate the frequency of aberrant PHD and describe why PHD is critical.

Comprehensive data of 3,820 patients newly diagnosed with colorectal liver metastasis between 2005 and 2007: report of a nationwide survey in Japan

To collect big data for further research to improve treatment outcomes in patients with colorectal liver metastasis (CRLM), the Joint Committee for Nationwide Survey on CRLM was established by the Japanese Society for Cancer of the Colon and Rectum and the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery. The joint committee initiated data collection since 2014. The data of 4,237 patients newly diagnosed with CRLM between 2005 and 2007 were registered from 134 departments of 127 institutions (64%) among 209 departments (from 201 institutions) that agreed to participate in this study. Finally, 3,820 patients were enrolled in this report after a quality management process by the joint committee. We report the comprehensive data obtained from 3,820 patients, clinicopathological findings, treatment strategies, prognoses, and implementation status of chemotherapy. The joint committee is prospectively collecting data of patients newly diagnosed with CRLM after 2013 and will provide these raw data, including data of patients diagnosed between 2005 and 2007, to researchers who will conduct meaningful studies that meet the aim of the joint committee.

Endoscopic and roentgenological studies on the pattern of the ampulla of vater

Development of Fibergastroscope (FGS), especially introduction of the light guide system and Fiberduodenoscope (FDS), becomes possible to observe the duodenum. Many references of the ampulla have been reported anatomically and roentgenologically, but there is no reference of this endoscopic observation. Therefore, an at tempt to observe the ampulla has been done by using FGS-BL, -CL and FDS-L, and its endoscopic whole aspect was studied in comparison with X-ray findings in 45 cases, of these cases, post-gastrectomy BI ; 32 cases, non-operative ; 13 cases. Certification of the ampulla and opening of duct are performed by the intravenous injection of Pancreozeimin (1 u./kg). When the ampulla is confirmed, the polyethylene-tube is inserted through the tube of biopsy and Radiopaque solution is injected, and hypotonic duodenography is carried out. I. Endoscopic aspects of the ampulla. These aspects are classified into three groups; 1. Papillary type; 17 cases 41.4%, 2. Hemispherical type; 15 cases 36.6%, 3. Flat type; 9 cases 22.0%. Most typical aspect of the ampulla shows the papillary form and has the opening of the duct in the center of the top area which has the white dapple pattern. Furthermore, there is a headband like fold around the ampulla and this fold is observed in 73.2%. Plica longitudinalis duodeni is observed in all cases but its height and width are various in case by case. This pattern of the ampulla as mentioned above corresponds with X-ray findings. II. The pattern of the opening of duct. The openings are classified into five types when the bile is being excreted. 1. Circular type; 34.8%, 2. Oval type; 30.4%, 3. Tricuspid type; 17.4%, 4. Polycuspid type; 13.1%, 5, Semilunar type; 4.3%. But it is difficult to classify these patterns because these openings are very small and various. In the X-ray film, the pattern of the opening can not be made out.