Robot-assisted thoracoscopic right upper lobectomy with displaced B3 and absence of minor fissure: a case report.

INTRODUCTION: B3 downward-shifting is a rare bronchial anomaly characterized by abnormal pulmonary arteries associated with downward displacement of B3 and complete fusion between the right upper and middle lobes. CASE PRESENTATION: We report a case of robot-assisted thoracoscopic right upper lobectomy in a patient with lung cancer with B3 downward-shifting. An 81-year-old male was diagnosed with non-small cell lung cancer in S3 of the right upper lung. Preoperative three-dimensional computed tomography angiography revealed a B3 bronchus derived from the middle lobe bronchus and an anterior segmental pulmonary artery variation. Robot-assisted thoracoscopic surgery right upper lobectomy with ND2a-1 was performed via four-port incisions and an assist incision. No interlobar fissure was observed between the right upper and middle lobes. After dissecting B1+2, the displaced B3 root was dissected. The displaced A3a was difficult to dissect because of an extremely severe complete fissure. Therefore, we dissected the bronchus preceding from the cranial side. To confirm a minor fissure, indocyanine green was administered intravenously, and the interlobar boundary was identified as the line separating the dark and green lung parenchyma. The boundary was divided using mechanical staples. No surgical complications occurred. CONCLUSIONS: Using three-dimensional reconstruction imaging and systemic indocyanine green administration, we successfully performed a right upper lobectomy through robot-assisted thoracic surgery.

Mutations conferring SO42- pumping ability on the cyanobacterial anion pump rhodopsin and the resultant unique features of the mutant.

Membrane transport proteins can be divided into two types: those that bind substrates in a resting state and those that do not. In this study, we demonstrate that these types can be converted by mutations through a study of two cyanobacterial anion-pumping rhodopsins, Mastigocladopsis repens halorhodopsin (MrHR) and Synechocystis halorhodopsin (SyHR). Anion pump rhodopsins, including MrHR and SyHR, initially bind substrate anions to the protein center and transport them upon illumination. MrHR transports only smaller halide ions, Cl- and Br-, but SyHR also transports SO42-, despite the close sequence similarity to MrHR. We sought a determinant that could confer SO42- pumping ability on MrHR and found that the removal of a negative charge at the anion entrance is a prerequisite for SO42- transport by MrHR. Consistently, the reverse mutation in SyHR significantly weakened SO42- pump activity. Notably, the MrHR and SyHR mutants did not show SO42- induced absorption spectral shifts or changes in the photoreactions, suggesting no bindings of SO42- in their initial states or the bindings to the sites far from the protein centers. In other words, unlike wild-type SyHR, these mutants take up SO42- into their centers after illumination and release it before the ends of the photoreactions.

Efficacy of TachoSil, a Fibrin-Based Hemostat, for Anterior Lumbar Spine Surgery.

STUDY DESIGN: Retrospective case series. PURPOSE: To examine the efficacy of TachoSil for vessel injury in 6 patients who underwent anterior lumbar fusion surgery (ALF). OVERVIEW OF LITERATURE: ALF for the lumbar spine has a high rate of success, although intraoperative concerns and iatrogenic complications are known, and injury of a major vessel is sometimes a complication. The efficacy of TachoSil, a fibrin-based hemostat, has been reported for several types of surgery; however, use of TachoSil for ALF surgery has not been described. Here, we report on the efficacy of TachoSil in 6 patients, who underwent ALF after vascular surgeons having difficulty in repairing vessels. METHODS: Two man and 4 women with average age of 50.8±10.9 (mean±standard deviation) were diagnosed with a vertebral tumor (2 patients), L4 degenerative spondylolisthesis (2 patients), and L5 spondylolytic spondylolisthesis (2 patients) and underwent ALF. The blood vessels injured included the common iliac vein in 2 patients and a branch of a segmental artery from the aorta in 4 patients. We consulted a vascular surgeon to suture or repair the vessels during surgery, and although the vascular surgeon attempted to address the injuries, suturing or repair was not possible in these cases. For this reason, we used TachoSil to repair the injury in the vessels walls or to stop the bleeding. RESULTS: Time to pressure hemostasis using TachoSil was 34±12 minutes, and total blood loss was 1,488±1,711 mL. Nevertheless, all vessel injuries were controlled by the use of TachoSil. CONCLUSIONS: We recommend the use of TachoSil for vessel injuries that vascular surgeons cannot suture or repair during ALF surgery.