Clinical evaluation of complete solo surgery with the "ViKY®" robotic laparoscope manipulator.

BACKGROUND: Advancement in both surgical technique and medical equipment has enabled solo surgery. ViKY® Endoscope Positioning System (ViKY®) is a robotic system that remotely controls an endoscope and provides direct vision control to the surgeon. Here, we report our experience with ViKY®-assisted solo surgery. METHODS: We retrospectively examined 25 cases of solo surgery TAPP with ViKY®. ViKY® was setup by the surgeon alone, and the setup duration was determined as the time at which the side rail was positioned and that when the endoscope was installed. For assessing the control unit, the number of false movements was counted. We compared the operative results between ViKY®-assisted solo surgery TAPP and the conventional method with an assistant. RESULTS: The average time to set up ViKY® was 7.9 min. The average number of commands for ViKY® during surgery was 98.3, and the average number of errors and no response of control unit was 7.9. The mean duration of surgery was 136 min for the ViKY® group, including the setup time, and 117 min for the conventional method. No case required an assistant during the operation. There was also no difference between the two groups with regard to postoperative complications and the rate of recurrence. CONCLUSIONS: ViKY® proved reliable in recognizing orders with very few failures, and the operations were performed safely and were comparable to the conventional operations with assistants. Solo surgery with ViKY® was beneficial in this clinical evaluation.

[A case of gastric cancer with severe lymph node metastasis effectively treated with docetaxel / S-1 as neoadjuvant chemotherapy].

A 75-year-old male patient had advanced gastric cancer with severe lymph node metastasis. He was treated with docetaxel 60 mg/body (day 1) and S-1 120 mg/body (2 weeks administration and 1 week rest) as neoadjuvant chemotherapy. After two courses of this neoadjuvant chemotherapy, the primary lesion and lymph node swelling were remarkably improved. The patient underwent total gastrectomy and D2 lymph node dissection. The histological effect was judged to be Grade 3, and no viable cancer cell was detected in the primary lesion and lymph node (pCR). Docetaxel and S-1 combination therapy were thought to be an effective method as neoadjuvant chemotherapy for advanced gastric cancer with severe lymph node metastasis.

[Chemoradiotherapy using platinum analogs/5-FU for advanced esophageal cancer].

We evaluated the efficacy of concurrent chemoradiotherapy (CRT) using cisplatin/nedaplatin and 5-FU for advanced esophageal cancer. Thirteen patients with locally advanced esophageal cancer (T4 cases) and 3 with recurrence of esophageal cancer were treated with radiotherapy (40-70 Gy) and 5-FU combined with cisplatin/nedaplatin concurrently. T4 patients who obtained down-staging by CRT also underwent esophagectomy. A complete response was obtained in one case, partial response in 8 cases, and no change in 7 cases. The overall response rate was 56.3%. A pathological complete response was obtained in one case in which curative resection was performed after CRT. Bone marrow suppression was observed in 68.8% and grade 3 and 4 bone marrow suppression was observed in 43.8%. Concurrent CRT using cisplatin/nedaplatin and 5-FU for advanced esophageal cancer has a high response rate and patients obtaining down-staging by CRT as a neoadjuvant therapy have a chance for long survival after curative resection in locally advanced cases.

Neoplastic changes in saccharide sequence of dermatan sulfate chains derived from human colon cancer.

Decorin, a small proteoglycan containing a dermatan sulfate (DS) chain, is expressed abnormally in human colon cancer stroma. The aim of this study was to determine neoplastic changes in DS chains from human colon cancer and normal colonic mucosa. Proteoglycans were extracted from human colon cancer and normal colonic mucosa and successively digested with enzymes. The glycosaminoglycan obtained was fluoro-labeled with 2-aminopyridine at reducing terminals and fractionated by HPLC. Fluoro-labeled DS chains were collected and digested with bovine testicular hyaluronidase, followed by HPLC. The repeating disaccharide connected to the linkage region [glucuronosyl-galactosyl-galactosyl-xylosyl(2-aminopyridine)] of pyridylaminated DS chains from both types of tissue was glucuronosyl-N-acetylgalactosamine. The other glucuronic acid of the pyridylaminated DS chain was located 12 saccharides from the reducing terminal in colon cancer, and 18 saccharides from the reducing terminal in normal colon. The saccharide sequence of DS chains from human colon cancer is altered from that in normal colon.