Yasuo Hashizume

Hybrid single-incision laparoscopic sigmoidectomy: the effective use of small incision.

AIM Single-incision laparoscopic colectomy (SILC) often requires steeper Trendelenburg positioning to displace or keep the small intestine away from the operative site. We have developed hybrid SILC in which we make a transumbilical incision to extract the specimen first and utilize a multiflap gate (MFG). METHODS MFG was inserted through a 4.0-cm transumbilical incision, and a surgical towel was inserted via MFG and displaced the small intestine away from the operative site. Three 5-mm ports were placed in the converter sheet. Almost all the operative procedures were the same as usual laparoscopic sigmoidectomy. In the course of laparoscopic procedures, whenever we felt stress, we used the techniques of open surgery via MFG. RESULTS In 3 patients, the procedure was successfully completed without any complications. CONCLUSIONS Our procedure can be easily performed, which enables surgeons to achieve SILC safe and easy compared with conventional technique.

Laparoscopic Surgery for the Ascending Colon Cancer Associated with Malrotation of the Midgut

Malrotation of the midgut is a congenital anomaly of the gastrointestinal tract that usually presents in neonates. Moreover, synchronous colon cancer has rarely been reported. In the present article, we report a preliminary experience with laparoscopic approach for intestinal malrotation with early colon cancer in a 68-year-old woman who presented with bloody stools. Colonoscopy revealed a lateral spreading tumor of the ascending colon. An air-barium contrast enema showed that the entire colon lay within the left hemiabdomen. A computed tomography revealed the superior mesenteric vein rotation sign. At surgery, a condition of malrotation of the midgut was observed: the third and the fourth part of the duodenum descended vertically without Treitz’s ligament, and the small bowel and colon were located in the right and left side of the abdominal cavity, respectively. We mobilized the terminal ileum and the right colon with laparoscopic approach. A 3-cm abdominal incision was made via the umbilicus. Right colectomy with lymph node dissection was achieved following extracorporealization. Pathological examination revealed well-differentiated tubular adenocarcinoma without nodal involvement. The patient had an uneventful postoperative course. Laparoscopic surgery for colon cancer associated with malrotation of the midgut is feasible and a promising method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

Single-incision laparoscopic surgery for stage IV colon cancer.

Aim:The safety and efficacy of single-incision laparoscopic resections for patients with stage IV colorectal cancer have not been examined explicitly. This article describes our experience with single-incision laparoscopic procedures for patients with stage IV colorectal cancer. Methods:Seventy-seven patients who underwent single-incision laparoscopic colectomy between August 2010 and January 2012 were investigated retrospectively. Eleven patients were in clinical stage IV (ST4 group) and were compared with 66 patients in clinical stages 0 to III (control group). Results:There were no differences in the intraoperative and the postoperative complications, the 30-day mortality rate, the number of the lymph nodes harvested, and the duration of postoperative hospital stay between the 2 groups. Conclusions:Our initial experiences suggested that single-incision laparoscopic colectomy is feasible for stage IV colon cancer patients. This is a good start comparing the outcomes of single-incision colectomy in stage IV patients with open and traditional laparoscopic colectomy.

the outcome of single-incision laparoscopic right colectomy for colon carcinoma in the elderly.

Purpose: Surgeons are increasingly being faced with the problem of treating elderly colon cancer patients. The purpose of this study was to elucidate the feasibility of single-incision laparoscopic surgery for these patients. Methods: Among 34 right colon cancer patients treated with single-incision laparoscopic surgery procedure between August 2010 and September 2011, 9 (26.5%) were aged 80 or over. The results of treatment in this elderly group were compared retrospectively with those in 10 younger colon cancer patients (age, 59 to 67 y; control group, 29.5%). Results: The sex distribution, body mass index, and the tumor location were similar between the groups. The elderly had a higher incidence of preoperative risk factors (77.7% vs. 40.0%; P=0.17). However, operative time and estimated blood loss were similar and postoperative complications had not occurred in both groups. Conclusions: We believe that single-incision laparoscopic colectomy can be carried out safely in elderly patients with colon cancer.

Short-Term Clinical and Oncological Outcomes after Single-Incision Plus One Port Laparoscopic Anterior Resection for Rectal Cancer

Aim: In the past, we developed and reported single-incision plus one port laparoscopic anterior resection (SILS + 1-AR) of the rectum. In this study, we reviewed our experiences with 141 consecutive patients admitted in a community hospital for undergoing SILS + 1-AR for rectal cancer and evaluated the short-term clinical and oncological outcomes. Methods: A lap protector (LP) was inserted through a 2.5 cm transumbilical incision; an EZ-access was mounted to the LP and three 5-mm ports were placed. A 12-mm port was inserted in the right lower quadrant. Results: One hundred thirty-six patients (96.5%) completed their treatment with SILA+1-AR. The number of tumor locations in the rectosigmoid, rectum area above the peritoneal reflection (Ra), and rectum area below the peritoneal reflection (Rb) were 44, 63, and 29 respectively. Six (5.6%) tumor recurrences or metastasis occurred in 107 patients with stages I-III disease with a median follow-up of 30 months. One patient with a positive surgical margin rejected additional resection of the positive margin and died of recurrent disease. Conclusion: Our initial experiences suggested that SILS + 1-AR is a feasible and a safe treatment option for rectal cancer patients treated by experienced surgeons specialized in SILS. However, further studies are needed to demonstrate the advantages of this procedure compared to the benefits of conventional laparoscopic AR.

Pediatric ileoileal intussusception with a lipoma lead point: a case report.

Intussusception is a common cause of mechanical bowel obstruction among children, with older children being more likely to have a pathological lead point. Intestinal neoplasms are rare and small intestinal lipomas are even less common. Herein we describe a case of a 7-year-old boy with ileoileal intussusception, with an ileal lipoma as the pathological lead point. Computed tomography was useful pre-operatively for revealing intussusception due to lipoma as the pathologic lead point.

A New Laparoscopic Rectal Transection Method via Umbilical Incision Using Endo GIA™ Radial Reload

We have developed a new laparoscopic rectal transection method via umbilical incision using Endo GIA™ Radial Reload with a Tri-Staple™ Technology (RR) (Covidien, New Haven, CT) stapler. A 65-year-old woman with a rectal carcinoid tumor underwent a laparoscopic low anterior resection. We successfully performed a rectal transection via umbilical incision using this stapler. The postoperative course was uneventful. The possibility of a rectal transection via umbilical incision was demonstrated in the current case. However, further studies are needed to confirm the safety and feasibility of this procedure.

Magnetic Traction System-Assisted Thoracoscopic Surgery

We described here a method of port-reduced thoracoscopic surgery by application of a magnetic traction system. We applied this technique for a 28-year-old male with spontaneous pneumothorax and a 68-year-old male with peripheral lung nodule. To reduce postoperative chest wall paresthesia related to the portal sites, new methods such as single-incision thoracoscopic surgery (SITS) have been exploited. However, this technique has a few limitations, such as reduced working space, triangulation difficulty, and instrument collision. To overcome these limitations, development of new instruments is needed. This is the first report on use of a magnetic traction system for thoracoscopic surgery.

The Use of the EndoGrab™ Port-Free Endocavity Retractor in Single-Incision Laparoscopic Right Hemicolectomy

The EndoGrab™ Port-Free Endocavity Retractor is an internally anchored retracting device that enables surgeons to reduce not only the number of ports and incisions but also the number of assistant surgeons. Our institution performs single-incision laparoscopic colectomy (SILC) as a routine procedure. Forty-nine patients underwent a single-incision laparoscopic right hemicolectomy. In this procedure, we use this retractor to the mesenteric tissue, including the ileocolic vessels and the mesentery of the transverse colon, and overcame the technical problems related to SILC and showed excellent short-term outcomes. To perform SILC safely while maintaining the minimal invasiveness and the quality, the use of this retractor is essential, especially in difficult situations, such as an unfavorable visual field when performing a lymph node dissection around the middle colic vessels in right hemicolectomy.

Single incision laparoscopic surgery for multiple colorectal cancers

The aim of this study was to evaluate short‐term outcomes of single‐incision surgery with two segmental colorectal resections and anastomoses for multiple synchronous colorectal cancers.