Intraoperative holography navigation using a mixed-reality wearable computer during laparoscopic cholecystectomy.

BACKGROUND: Mixed-reality technology, a new digital holographic image technology, is used to present 3-dimensional (3D) images in the surgical space using a wearable mixed-reality device. This study aimed to assess the safety and efficacy of laparoscopic cholecystectomy using a holography-guided navigation system as an intraoperative support image.In this prospective observational study, 27 patients with cholelithiasis or mild cholecystitis underwent laparoscopic cholecystectomy between April 2020 and November 2020. Nine patients underwent laparoscopic cholecystectomy with 3D models generated by a wearable mixed-reality device (laparoscopic cholecystectomy with 3D models) and 18 underwent laparoscopic cholecystectomy with conventional two-dimensional images (laparoscopic cholecystectomy with 2D images) as surgical support images. Surgical outcomes such as operative time, blood loss, and perioperative complication rate were measured, and a four-item questionnaire was used for subjective assessment. All surgeries were performed by a mid-career and an experienced surgeon. RESULTS: Median operative times of laparoscopic cholecystectomy with 3-dimensional models and 2-dimensional images were 74.0 and 58.0 minutes, respectively. No intraoperative blood loss or perioperative complications occurred. Although the midcareer surgeon indicated that laparoscopic cholecystectomy with 3-dimensional models was "normal" or "easy" compared with 2-dimensional images in all cases, the experienced surgeon rated 3-dimensional models as more difficult in 3 (33%) of 9 cases. CONCLUSION: This study provides evidence that laparoscopic cholecystectomy with 3-dimensional models is feasible. However, the efficacy of laparoscopic cholecystectomy with 3-dimensional models may depend on the surgeon's experience, as indicated by the different ratings provided by the surgeons.

Revisional Bariatric Surgery for Insufficient Weight Loss and Gastroesophageal Reflux Disease: Our 12-Year Experience.

INTRODUCTION: Although bariatric surgery is increasing in Japan, revision surgery is uncommon. To clarify indications for the various revision surgeries available, we retrospectively assessed perioperative/postoperative outcomes of revisional weight loss surgeries performed at our medical center between July 2006 and July 2017. METHODS: The study group comprised patients treated for insufficient weight loss (IWL group, n = 15) or intractable postoperative gastroesophageal reflux disease (GERD group, n = 9). Clinical characteristics and perioperative/postoperative outcomes were assessed for the total patients, per patient group, and per type of revision surgery performed. RESULTS: In the IWL group, BMI decreased from 47.3 ± 9.2 kg/m2 at the time of revision surgery to 36.9 ± 7.4 kg/m2 1 year later, and excess weight loss (%EWL) reached 62.7 ± 14.6%. Among patients whose primary surgery was laparoscopic sleeve gastrectomy, %EWL and total weight loss (%) were greater after laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) or duodenojejunal bypass (DJB) than after other revision surgeries. Complete or partial remission of the GERD was achieved in all GERD group patients (9/9, 100%), and six (6/9, 66.7%) were able to discontinue proton pump inhibitor therapy. Serious complications occurred in four patients (4/24, 16.7%) following laparoscopic Roux-en-Y gastric bypass (LRYGB): stump leakage in one, gastrojejunal leak in one, and gastrojejunal stricture in two. CONCLUSION: LBPD/DS or DJB as revision surgery appears to be effective for further weight loss in the medium term, and LRYGB appears to be effective for GERD remission. Bariatric surgeons should bear in mind, however, that the post-LRYGB complication rate appears to be relatively high.

Reduced-Port Sleeve Gastrectomy for Morbidly Obese Japanese Patients: a Retrospective Case-Matched Study.

BACKGROUND: Reduced-port laparoscopic surgery remains controversial due to technical challenges that can lead to suboptimal outcomes, and data pertaining to operative and clinical outcomes of reduced-port sleeve gastrectomy (RPSG) vs. conventional laparoscopic sleeve gastrectomy (CLSG) are lacking. AIMS: This retrospective case-matched study aimed to compare midterm (2-year) outcomes of RPSG and of CLSG. METHODS: Patients included in the study had undergone laparoscopic bariatric surgery at our center between 2010 and 2017. Thirty-one consecutive female patients who underwent RPSG were compared to a sex-, age-, body mass index-matched group of 31 patients who underwent CLSG. Outcomes were evaluated and compared between groups. RESULTS: Estimated blood loss volume, incidences of intraoperative and postoperative complications, and length of postoperative hospital stay did not differ significantly between the 2 groups. Operation time was significantly greater in the RPSG group than in the CLSG group (148.7 ± 22.6 vs. 120.2 ± 25.9 min, respectively; p < 0.001). Excess weight loss at 1 year was 105.9% and 109.7%, respectively (p = 0.94) and at 2 years was 101.1% and 105.3%, respectively (p = 0.64). One RPSG patient required placement of additional trocars because of bleeding from short gastric vessels, but conversion to open surgery was not required. CONCLUSIONS: RPSG is feasible in carefully selected bariatric patients and results in midterm outcomes comparable to those observed after CLSG. Good cosmesis is a potential benefit of RPSG.

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy in patient with liver cirrhosis.

Laparoscopic sleeve gastrectomy (LSG) has become the dominant bariatric procedure because of its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PMVT) after LSG is an infrequent complication that can lead to serious consequences. Here, we report a patient who presented with abdominal pain 11 days after LSG for the treatment of morbid obesity. Contrast CT of the abdomen revealed PMVT. The patient had liver cirrhosis, which is a major risk factor for PMVT. When LSG is performed on an obese patient with liver cirrhosis, careful attention must be paid to the onset of PMVT.

Development of portable mass spectrometer with electron cyclotron resonance ion source for detection of chemical warfare agents in air.

A portable mass spectrometer with an electron cyclotron resonance ion source (miniECRIS-MS) was developed. It was used for in situ monitoring of trace amounts of chemical warfare agents (CWAs) in atmospheric air. Instrumental construction and parameters were optimized to realize a fast response, high sensitivity, and a small body size. Three types of CWAs, i.e., phosgene, mustard gas, and hydrogen cyanide were examined to check if the mass spectrometer was able to detect characteristic elements and atomic groups. From the results, it was found that CWAs were effectively ionized in the miniECRIS-MS, and their specific signals could be discerned over the background signals of air. In phosgene, the signals of the 35Cl+ and 37Cl+ ions were clearly observed with high dose-response relationships in the parts-per-billion level, which could lead to the quantitative on-site analysis of CWAs. A parts-per-million level of mustard gas, which was far lower than its lethal dosage (LCt50), was successfully detected with a high signal-stability of the plasma ion source. It was also found that the chemical forms of CWAs ionized in the plasma, i.e., monoatomic ions, fragment ions, and molecular ions, could be detected, thereby enabling the effective identification of the target CWAs. Despite the disadvantages associated with miniaturization, the overall performance (sensitivity and response time) of the miniECRIS-MS in detecting CWAs exceeded those of sector-type ECRIS-MS, showing its potential for on-site detection in the future.

Granular cell tumor of the common bile duct: a Japanese case.

Granular cell tumor (GCT) of the biliary system is rare. It is reported that it occurs more commonly in young black women. We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation. A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation. A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images. As a result of pathological evaluation, GCT was diagnosed. By the preoperative organization biomicroscopy result, it was not able to be attachd a right diagnosis. It was thought that this tumor, although rare, should be considered as one of the causes of biliary stenosis in the younger population.

[A case of multiple lung metastases of sigmoid colon cancer responding well to oral UFT+leucovorin therapy].

Chemotherapy combining 5-fluorouracil (5-FU) with leucovorin is now used as a standard regimen for chemotherapy of inoperative, recurrent or distantly-metastasized colorectal carcinoma. We recently treated a patient with multiple metastases of sigmoid colon cancer by sigmoidectomy and oral drug therapy using a combination of Uzel (dl-leucovorin) and UFT (uracil and tegafur). Three courses of this therapy were administered, with each course consisting of treatment for 4 consecutive week (UFT 400 mg/day, Uzel 75 mg/day) and a one week interval between successive courses. The therapy resulted in marked reduction of tumor and this response was rated as PR (partial response). The lower lobe of the right lung, which showed the largest tumor (34.5 x 35.7 mm), was resected, and the upper lobe of the same lung, showing a small metastastic tumor (4.4 x 4.6 mm), was partially resected. Oral chemotherapy, which had begun before surgery, was continued after lobectomy and partial pneumonectomy. To date (January 15, 2005), the patient has received 5 courses of this therapy and has shown no signs of tumor exacerbation. Because this therapy has allowed satisfactory control of metastatic tumor for about one year since surgery without causing any adverse reaction or requiring re-hospitalization, it is fair to say that the therapy has successfully maintained the quality of life (QOL) of this patient.