Takuya Inagaki

Three-Dimensional Printing Model of Anomalous Bronchi before Surgery

Lung surgeries in patients with bronchial variations have rarely been reported. Here, we describe the case of a patient along with lung cancer with variant anatomy of the right upper lobe bronchus. This variation was evaluated by three-dimensional multi-detector computed tomography angiography with bronchography and a three-dimensional printing model using rapid prototyping. The variant anterior segment bronchus (S3) of the right upper lobe arising from the middle lobe bronchus was confirmed before surgery using the printing model, which helped to determine the extent of resection required and facilitated the understanding of the patients anatomy during surgery. A thoracoscopic anterior segmentectomy and middle lobectomy were performed. The printing model was useful for detecting and evaluating the variant bronchi.

Thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping

Thoracoscopic segmentectomies and subsegmentectomies are more difficult than lobectomy because of the complexity of the procedure; therefore, preoperative decision-making and surgical procedure planning are essential. In the literature, we could successfully perform thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping. This innovative surgical support model is extremely useful for planning a surgical procedure and identifying the surgical margin.

A rare case of primary intercostal leiomyoma: complete resection followed by reconstruction using a Gore-Tex(®) dual mesh.

We report the case of a 28-year-old woman with primary intercostal leiomyoma who presented with a complaint of right chest pain. Contrast-enhanced computed tomography (CT) demonstrated a slightly enhanced solid mass in the right anterior fifth intercostal space. Percutaneous needle biopsy revealed spindle cells without evidence of malignancy. Wide en bloc excision of the chest wall, including the anterior fifth and sixth ribs and the upper costal arch, was performed. This way, the mass was completely resected without exposure, and the chest wall defect was reconstructed using a Gore-Tex(®) dual mesh. Histopathological analysis confirmed localized primary intercostal leiomyoma. The patient has been disease-free for more than 2 months since surgery.Primary leiomyomas of the chest wall are extremely rare. To the best of our knowledge, 9 cases of leiomyoma of the pleura have been reported till date, but this is the first case report of an intercostal leiomyoma of the chest wall. This case report describes the clinical course of this case and presents a review of the relevant literature.

Three-Dimensional Pulmonary Model Using Rapid-Prototyping in Patient with Lung Cancer Requiring Segmentectomy

Thoracoscopic pulmonary segmentectomy of the lung is sometime adopted for the lung cancer, but a problem with segmentectomy is variable anatomy. Recently, we are exploring the impact of three-dimensional models using rapid-prototyping technique. It is useful for decision making, surgical planning, and intraoperative orientation for surgical treatment in patient with lung cancer who underwent pulmonary segmentectomy. These newly created models allow us to clearly identify the surgical margin and the intersegmental plane, vessels, and bronchi related to the cancer in the posterior segment. To the best of our knowledge, there are few reports describing a pulmonary model so far.

Anomalous Systemic Arterial Supply to Separate Lingular and Basal Segments of the Lung: An Anatomic Consideration

A 22-year-old man was referred for hemoptysis and general fatigue after exercise. Arteriography demonstrated an anomalous artery arising from the descending aorta supplying the lingular and all of the basal segments of the left lung. The feeding areas of the pulmonary and anomalous arteries were mutually exclusive. He underwent division of the anomalous artery and combined resection of the diseased segments. The upper division of the upper lobe and the superior segment of the lower lobe were spared. His symptoms were greatly improved postoperatively. The preoperative anatomic evaluation of anomalous vessels is crucial in surgical management.

A Three-Dimensional Mediastinal Model Created with Rapid Prototyping in a Patient with Ectopic Thymoma

Preoperative three-dimensional (3D) imaging of a mediastinal tumor using two-dimensional (2D) axial computed tomography is sometimes difficult, and an unexpected appearance of the tumor may be encountered during surgery. In order to evaluate the preoperative feasibility of a 3D mediastinal model that used the rapid prototyping technique, we created a model and report its results. The 2D image showed some of the relationship between the tumor and the pericardium, but the 3D mediastinal model that was created using the rapid prototyping technique showed the 3D lesion in the outer side of the extrapericardium. The patient underwent a thoracoscopic resection of the tumor, and the pathological examination showed a rare middle mediastinal ectopic thymoma. We believe that the construction of mediastinal models is useful for thoracoscopic surgery and other complicated surgeries of the chest diseases.

Simulation of the Fissureless Technique for Thoracoscopic Segmentectomy Using Rapid Prototyping

The fissureless lobectomy or anterior fissureless technique is a novel surgical technique, which avoids dissection of the lung parenchyma over the pulmonary artery during lobectomy by open thoracotomy approach or direct vision thoracoscopic surgery. This technique is indicated for fused lobes. We present two cases where thoracoscopic pulmonary segmentectomy was performed using the fissureless technique simulated by three-dimensional (3D) pulmonary models. The 3D model and rapid prototyping provided an accurate anatomical understanding of the operative field in both cases. We believe that the construction of these models is useful for thoracoscopic and other complicated surgeries of the chest.

Blood transfusion requirement for gastric cancer surgery: Reasonable preparation for transfusion in the comprehensive health insurance system

We investigated the necessity of preparation for blood transfusion in gastric cancer surgery to save costs for blood typing, antibody screening, cross-matching, and disposal of the blood product. The subjects of the study were 52 patients who underwent gastric cancer surgery at our department between 2000 and 2004. The requirement for blood transfusion during surgery was investigated in terms of patient characteristics, hemoglobin before surgery, and performance status as well as treatment regimen. Furthermore, economic effects were investigated when typing and screening (T&S) were performed instead of typing and cross-matching (T&X). Of 9 patients who received blood transfusion, 8 had gastric cancer of stage IIIB or higher, or underwent combined resection. Blood transfusion was not used in surgery for patients with early gastric cancer. The volumes of blood prepared, lost, and disposed of in 28 patients who underwent T&X were 831.3+/-249.4, 219.3+/-228.5 and 600+/-333.1 ml, respectively, whereas the blood loss in 24 patients who underwent T&S was 161.1+/-95.6 ml; this difference had a major economic effect. The practice of T&S for patients undergoing gastric surgery in the absence of combined resection for early gastric cancer seems to be a safe and cost-effective practice that abrogates disposal of blood in hospital management.

Thymic Cavernous Hemangioma With a Left Innominate Vein Aneurysm.

Here we report a case of thymic cavernous haemangioma with the left innominate vein aneurysm. A 43-year-old man presented with chest pain. Enhanced chest computed tomography revealed an anterior mediastinal tumor measuring 60 × 52 × 38 mm with multiple venous lakes and focal specks of calcification, composed of a low-density soft tissue mass along with a left innominate vein aneurysm. We preoperatively diagnosed the mass as a thymic hemangioma and subsequently performed surgical resection. Pathologic diagnosis was a thymic cavernous hemangioma with a left innominate vein aneurysm, which is very rare.

A Case of a Retroesophageal Parathyroid Adenoma with an Aberrant Right Subclavian Artery: A Potential Surgical Pitfall

We report a case of retroesophageal parathyroid adenoma coexisting with an aberrant right subclavian artery (ARSA). A 63-year-old female presented with elevated serum calcium and intact parathyroid hormone levels. 99mTc-methoxyisobutylisonitrile scintigram and enhanced chest computed tomography (CT) revealed a mediastinal tumor measuring 25×15×7 mm located posterior to the esophagus. Three-dimensional CT provided accurate anatomical location of the tumor and the ARSA. We safely resected the ectopic parathyroid adenoma using video-assisted thoracic surgery owing to the accurate location of the adenoma and its relationship to the surrounding anatomical structures including the ARSA.