Surgical experience of using the endoscope manipulator robot EMARO in totally extraperitoneal inguinal hernia repair: A case report.

Robot-assisted surgery has advanced rapidly since the 1980s. However, new equipment is still needed to overcome problems in conventional endoscopic surgery, including unique risks, such as camera shake and communication difficulties between the operator and the scopist. EMARO, an endoscope manipulator robot, is the world's first pneumatically driven endoscope-holder robot that can operate flexibly and smoothly with the use of air pressure. We herein report the surgical experience of using EMARO in totally extraperitoneal inguinal hernia repair. A 77-year-old Japanese man presented with bulging in the right groin area. After we diagnosed a right inguinal hernia, endoscopic inguinal hernia repair was performed. We selected the totally extraperitoneal approach with EMARO. The endoscopic procedure time was 100 minutes, and no intraoperative complications occurred. EMARO brings together features of smooth motion and good manipulation performance. This operation was performed safely and was comparable to a conventional operation completed with human assistants. Solo surgery with EMARO was beneficial in this inguinal hernia patient.

Laparoscopic intraperitoneal mesh repair of Spigelian hernia: A case report.

Spigelian hernia is a rare congenital defect of the anterior abdominal wall located along the semilunar line through the aponeurosis fascia of the transversus abdominis muscle. It represents 1%-2% of all abdominal wall hernias. Few cases of laparoscopic treatment for Spigelian hernia have been reported, especially in Japan. However, several reports of laparoscopic surgery to repair Spigelian hernias have been published, and some have shown that the laparoscopic approach repair is feasible because it is associated with less morbidity and a shorter hospital stay than open surgery. We herein describe a 63-year-old Japanese woman who presented with painful bulging in the right lower abdominal quadrant. A preoperative diagnosis of Spigelian hernia was made, and we performed laparoscopic intraperitoneal repair. The patient was discharged 6 days after laparoscopic surgery with no perioperative complications. This report describes the first successful laparoscopic intraperitoneal mesh repair of Spigelian hernia in Japan.

Pancreatogastrostomy with an elastic purse-string suture around the gastric orifice after pancreatoduodenectomy.

Postoperative pancreatic fistula (POPF) is a potentially fatal complication of pancreatoduodenectomy (PD). Fixation of the remnant pancreas to the gastric wall is considered essential to prevent anastomotic leakage in patients undergoing pancreatogastrostomy (PG) after PD. PG was performed with invagination of the pancreatic stump. To limit the number of sutures in the pancreas parenchyma to three or four, we placed an elastic purse string suture around the orifice of the posterior gastric wall in an attempt to fix the gastric wall to the remnant pancreas. We performed PG using this technique in 30 patients. According to the international POPF criteria, POPF developed in three (10%) patients; as grade A in one, and grade B in two. These results demonstrate the potential advantage of performing PG after PD, by using this invaginated technique with an elastic suture.