151 research outputs found
SP_Fig – Supplemental material for An Unmodulated Very-Low-Voltage Electrosurgical Technology Creates Predictable and Ultimate Tissue Coagulation: From Experimental Data to Clinical Use
No full textSupplemental material, SP_Fig for An Unmodulated Very-Low-Voltage Electrosurgical Technology Creates Predictable and Ultimate Tissue Coagulation: From Experimental Data to Clinical Use by Yusuke Watanabe, Pascal Fuchshuber, Takafumi Homma, Elif Bilgic, Amin Madani, Naoki Hiki, Ivor Cammack, Takehiro Noji, Yo Kurashima, Toshiaki Shichinohe and Satoshi Hirano in Surgical Innovation</p
Left hepatectomy with concomitant the right hepatic artery and the portal vein resection
No full textThe supplemental video shows our procedure for HAR in PHCC (supplemental video). The first step of the surgical procedure for HAR was similar to the standard resection for PHCC surgery: lymphadenectomy (skeletonization) for the hepatoduodenal ligament and distal bile duct resection just above the posterior superior pancreatic duodenal artery. We usually pick up the right hepatic artery (or posterior branch) at Rouviere’s sulcus before skeletonization around the proper hepatic artery to confirm resectability. Hepatic artery reconstruction is usually performed as the final step after bile duct and portal vein resection and reconstruction
Laparoscopic transdiaphragmatic RFA for hepatic tumor
No full textBackground: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence
CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer.
No full textBackground The extent of paraaortic lymph node (PAN) metastasis parellels that of distant metastases in patients with biliary carcinoma. Accurate preoperative assessment of PAN metastasis has a crucial impact on surgical indications. In this retrospective study, we evaluated whether computed tomography (CT) scans were useful for diagnosing PAN metastases and excluding patients with PAN metastases from an indication for surgery.
Methods Between March 1999 and November 2003, 57 patients with biliary carcinoma underwent radical lymphadenectomy or surgical biopsy of PANs. Nine of these patients were diagnosed as having PAN metastasis microscopically. All patients had undergone abdominal CT scans before surgery. To diagnose PAN metastases, we used the following diagnostic criteria. (1) Size; when lymph nodes were greater than 12mm, 10mm, 8mm, or 6mm in longo or short-axis diameter, the nodes were considered metastatic. (2) Shape and size; when the axial ratio of a lymph node was greater than 0.5, 0.7, 1.0, and the maximum diameter of the long or short axis was greater than 12mm, 10mm, 8mm, or 6mm, the node was considered metastatic. (3) Internal structure; if the internal structure of a PAN was heterogeneous, the node was considered metastatic. A positive predictive value was calculated for each included criterion when patients numbered ten or more.
Results Positive predictive values using the above criteria ranged from 13% to 36%. Only one patient had PANs with heterogeneous internal structures.
Conclusions We were unable to determine surgical indications based on the morphological criteria revealed by a CT scan
A new prognostic scoring system using factors available preoperatively to predict survival after operative resection of perihilar cholangiocarcinoma
No full textBackground: Perihilar cholangiocarcinoma has one of the poorest prognoses of all cancers. However, mortality and morbidity rates after surgical resection are 0-15% and 14-66%, respectively. Additionally, the 5-year overall survival rates are reported at 22-40%. These findings indicate that only selected patients achieve satisfactory beneficial effects from operative treatment. This retrospective study sought to investigate preoperatively available prognostic factors and establish a new preoperative staging system to predict survival after major hepatectomy of perihilar cholangiocarcinoma. Patients and methods: We evaluated 121 consecutive patients who underwent operative exploration for perihilar cholangiocarcinoma. Results: Univariate and multivariate analysis using the identified preoperative factors revealed that 4 factors (platelet-lymphocyte ratio [PLR] > 150, serum C-reactive protein [CRP] levels > 0.5 mg/dL, albumin levels 7.0 ng/mL) were independent prognostic factors of postoperative survival. These 4 preoperative factors were allocated 1 point each. The total score was defined as the Preoperative Prognostic Score (PPS). Patients with a PPS of 0, 1, 2, or 3/4 had a 5-year survival of 84.3%, 51.3%, 46.4%, and 0%, respectively. There were also differences in the 5-year survival according to the PPS (0 vs 1 [P = .013] and 2 vs 3/4 [P < .001]). Patients with a total PPS of 3/4 had a dismal prognosis, with a median survival of 11.3 months. Conclusion: A new preoperative scoring system using PLR, serum CRP, albumin, and CEA levels could predict postoperative survival resection of perihilar cholangiocarcinoma
AC Loss Calculation of REBCO Cables by the Combination of Electric Circuit Model and 2D Finite Element Method
No full textAbstractThis study investigates the losses in a two conducting-layer REBCO cable fabricated by researchers at Furukawa Electric Co. Ltd. The losses were calculated using a combination of my electric circuit (EC) model with a two-dimensional finite element method (2D FEM). The helical pitches of the tapes in each layer, P1 and P2, were adjusted to equalize the current in both cable layers, although the loss calculation assumed infinite helical pitches and the same current in each layer at first. The results showed that the losses depended on the relative tape-position angle between the layers (θ/θ’), because the vertical field between adjacent tapes in the same layer varied with θ/θ’. When simulating the real cable, the helical pitches were adjusted and the layer currents were calculated by the EC model. These currents were input to the 2D FEM to compute the losses. The losses changed along the cable length because the difference between P1 and P2 altered the θ/θ’ along this direction. The average angle-dependent and position-dependent losses were equal and closely approximated the measured losses. As an example to reduce the loss in this cable, the angle and the helical pitches were fixed at θ/θ’ = 0.5 and P1 = P2 = 100mm (S-direction). The calculation with these conditions indicated that the loss is about one order of magnitude lower than the measurement
Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment
No full textBackground: Conversion surgery (CS) is expected as a new therapeutic strategy for patients with unresectable pancreatic cancer (UR-PC). We analyzed outcomes of CS for patients with UR-PC and evaluated the survival benefit of CS. Methods: Thirty-four patients diagnosed with UR-PC according to the National Comprehensive Cancer Network guideline underwent CS in our hospital. Resectability was considered by multimodal images in patients who underwent nonsurgical treatment (NST) for more than 6 months. CS was performed only in patients who were judged to be able to undergo R0 resection. Results: Twenty-six patients had locally advanced PC, and eight had distant metastases. The median duration of NST was 9 (range 5-44) months. R0 resection was achieved in 30 patients (88.2%). Six patients (17.6%) showed Evans grade ≥III. Three- and 5-year overall survival (OS) rates from initial treatment were 74% and 56.9%, respectively, with median survival time (MST) of 5.3 years. The actual 5-year OS rate in 19 patients was 47.4% with an MST of 4.0 years. Patients with Evans grade ≥III had a better prognosis than those with Evans grade <III (P = 0.0092, log-rank test). Conclusions: Conversion surgery might have survival benefits to patients with UR-PC who responded favorably to NST
Risk factors for dysfunction of preoperative endoscopic biliary drainage for malignant hilar biliary obstruction
No full textBackground Few studies have focused on the risk factors for dysfunction of endoscopic biliary drainage (EBD) in preoperative patients with malignant hilar biliary obstruction (MHBO). Methods We searched the database between February 2011 and December 2018 and identified patients with MHBO who underwent radical operation. The rate of dysfunction of the initial EBD, risk factors for dysfunction of the initial EBD and survival after surgery were retrospectively evaluated. Results We analyzed a total of 131 patients [95 males (72.5%); mean age, 69.5 (+/- 7.3) years; Bismuth-Corlette classification (BC) I/II/IIIa/IIIb/IV, 50/26/22/17/16; hilar cholangiocarcinoma/gall bladder cancer, 115/16]. Dysfunction of the initial EBD occurred in 28 patients (21.4%). The cumulative incidences of dysfunction of the initial EBD in all patients were 18.4%, 38.2% and 47.0% at 30, 60 and 90 days, respectively (Kaplan-Meier method). The rate of dysfunction of the initial EBD increased in patients with BC-IV (P = .03). Multivariate analysis showed that BC-IV and pre-EBD cholangitis were significantly associated with the occurrence of dysfunction of the initial EBD. Survival rates were not significantly different according to the initial biliary drainage methods and presence/absence of the initial EBD dysfunction. Conclusions Dysfunction of the initial EBD frequently occurs in patients with the BC-IV and those with pre-EBD cholangitis
Preoperative risk factors for skeletal muscle mass loss in patients with biliary tract cancer
No full textBackground Endoscopic retrograde cholangiography (ERC)-related procedures, usually performed before biliary tract cancer (BTC) surgery, are associated with increased risk for various complications, which can cause sarcopenia. No study has previously elucidated the relationship between preoperative ERC-related procedures and sarcopenia/skeletal muscle mass loss. Methods Patients with BTC who underwent radical surgical resection following ERC-related procedures were included. Skeletal muscle mass was evaluated using the psoas muscle mass index (PMI), which was determined using computed tomography images, and the change in PMI before the initial pre-ERC and surgery (ΔPMI) was calculated. Risk factors for advanced skeletal muscle mass loss, defined as a large ΔPMI, were evaluated. Results The study cohort included 90 patients with a median age of 72 (interquartile range, 65–75) years. The median PMI pre-ERC and surgery was 4.40 and 4.15 cm2/m2, respectively (p < .01). The median ΔPMI was −6.2% (interquartile range, −10.9% to 0.5%). By multivariate analysis, post-ERC pancreatitis and cholangitis before surgery were independent predictive factors for large PMI loss (odds ratio, 4.57 and 3.18, respectively; p = .03 and p = .02, respectively). Conclusions Skeletal muscle mass decreases preoperatively in most patients with BTC undergoing ERC. Post-ERC pancreatitis and cholangitis before surgery were independent risk factors for large skeletal muscle mass loss
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