Tohru Sakuragi

Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery

We present and examine two cases of the dramatic hemostasis with SOFT COAG in general thoracic surgery. SOFT COAG is a coagulation mode unique to VIO electrosurgical units (ERBE Elektromedizin GmbH, Germany). This system regulates the temperature rise below boiling point without generating sparks, which is high enough to denature protein. In addition to clinical applications, this coagulation system makes use of a reusable device, Slim line hand switch, which has economically and ecologically major advantages for ecosurgery.

Complete resection of recurrent thymic carcinoid using cardiopulmonary bypass

We report a case of recurrent thymic carcinoid (multiple episodes of recurrence over a 14-year period) invading the right atrium and superior vena cava, which was resected using cardiopulmonary bypass. In our case with dense adhesion between the great vessels and the sternum as a result of repeated operations and therapeutic irradiation, the innominate artery was injured while re-sternotomy, which was successfully repaired under deep hypothermic circulatory arrest. Repeated aggressive surgical resection might improve prognosis of the recurrent thymic carcinoid even in patients with extended lesions, which could be completely resected only on cardiopulmonary bypass.

Lymph node metastasis, recurrence, and prognosis in small peripheral lung adenocarcinoma. Analysis based on replacement.

OBJECTIVE We studied clinical and pathological features of small peripheral adenocarcinoma of the lung, focusing on tumor typing based on Noguchis classification of small adenocarcinoma and determining whether these tumors grew by replacing alveolar lining cells. METHODS Subjects were 51 patients with small peripheral adenocarcinoma 2 cm or less in diameter resected between 1994 and 2001. Mediastinal and hilar lymph node dissection was done in 37 (72.5%). Patients were divided into 2 groups by replacement or nonreplacement tumors. We compared patient profiles, lymph node involvement, and recurrence and survival patterns. RESULTS No significant difference was seen between groups in mean age, surgical procedure, or primary tumor location. Women predominated in replacement tumors at 71% vs 41%, p = 0.04. The incidence of lymph node metastasis at 40% vs 4.5%, p = 0.007 and distant metastasis at 47% vs 2.9%, p < 0.001 was significantly higher in nonreplacement than replacement tumors. Replacements tumor thus showed significantly better disease-free survival at 95% vs 53%, p < 0.001, and overall 3-year survival at 95.4% vs 62.7% than did nonreplacement tumors. CONCLUSION We found distant metastasis and lymph node involvement to be more frequent in nonreplacement than replacement small peripheral adenocarcinoma, on suggesting that pretreatment tumor typing and accurate nodal status determination are essential to improve disease staging.

Arterial embolization to preoperatively manage pulmonary disease associated with inflammation

Preoperative arterial embolization is used in pulmonary disease to reduce intraoperative blood loss resulting from exposure of extensive adherent pleura due to repeated inflammation. Between January 1996 and February 2001, 5 patients underwent surgery with this procedure. Underlying diseases were 3 cases of aspergilloma and 1 each of chronic expanding hematoma and lung cancer. All embolization was permanent, involving coil insertion. Surgical treatment was successful in all 5 patients without mortality. Such preoperative management proved useful in reducing intraoperative blood loss in hypervascular collateral feeding vessels in the area of resection or decortication.

Stereolithographic biomodelling of pulmonary hilum by multislice computed tomography imaging

Figure 1: (A) Posterior cavity view of the right pulmonary hilum in multislice computed tomography (CT) image. (B) The stereolithographic biomodel of the right pulmonary hilum corresponding to the multislice CT image

The utility of BiClamp for intraoperative air leakage control in video-assisted thoracic surgery for pulmonary lobectomy

We describe a simple technique of controlling air leakage from the lung parenchyma using BiClamp®. The device creates appropriate protein coagulation at an air leakage point of the lung parenchyma. The leakage point and adjacent area are grasped with BiClamp® forceps and coagulated without tissue carbonization. After the procedure, no air leakage was recognized under airway pressure test of 15–20 cmH2O. This method is easy to handle, especially in video-assisted thoracic surgery lobectomy with an economical advantage as “Ecosurgery”.