[Novel Liver Retraction Method Using the FJ Clip and Silicon Disk for Laparoscopic Gastrectomy].

Laparoscopic gastrectomy(LG)has been developed, and its use has spread widely. One of the merits of this methodology for surgeons is its magnifying effect, which largely contributes to precise lymphadenectomy and lower blood loss. However, by contrast, its restricted view could be a demerit, and care should be taken to avoid trouble duringan operation. Liver retraction is an essential operative procedure to maintain a good surgical field and ensure sufficient working space during LG. We present a novel approach that uses the free jaw(FJ)clip and silicon disk. Our novel approach involved 1 ) exposingthe right crus of the diaphragm and grasping it using a FJ clip; 2 ) elevatingthe left lobe of the liver by usingfree loop plus with a 10- cm Penrose drain attached to the FJ clip grasping the right crus; and 3 ) insertingthe silicon disk between the Penrose drain and the left lobe of the liver. The FJ clip is reusable and easily maneuvered with the commonly used laparoscopy forceps. The last step enables prevention of intraoperative complications such as injury by forceps or energy devices. Therefore, we believe this procedure might be useful for LG, and we will prospectively confirm its usefulness in terms of hepatic function, operative time, and other factors.

Granulocyte colony-stimulating factor-producing hepatocellular carcinoma with abrupt changes.

Granulocyte colony-stimulating factor (G-CSF)-producing tumor is one of the rare types of cancer clinically characterized by an elevated fever and white blood cell (WBC) increment. Although G-CSF producing tumors have been reported in several types of cancer including those of the lungs, cervix and bladder, G-CSF producing hepatocellular carcinoma is extremely rare. Here, we report the case of a rapidly growing and poorly differentiated hepatocellular carcinoma producing G-CSF. The patient showed symptoms of continuous high fever, stomach pain and cough, and high serum WBC counts, C-reactive protein (CRP) and G-CSF levels were found in laboratory tests. After a radical hepatectomy, the patient completely recovered from the above symptoms and inflammatory state. The serum levels of G-CSF were reduced to normal levels after radical surgery. An immunohistochemical analysis revealed the overexpression of G-CSF in the cytoplasm of certain hepatocellular carcinoma (HCC) cell. The patient's serum WBC, CRP and G-CSF levels remained within normal levels in the six months after surgery without recurrence. This is the 9th case report of G-CSF producing hepatocellular carcinoma in English literature. We review the clinical characteristics of the G-CSF producing HCC and discuss a possible treatment strategy.