Saku Central Hospital

Nagano-shi, Japan

Saku Central Hospital

Nagano-shi, Japan

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Morimoto A.,Shiga University of Medical Science | Morimoto A.,Osaka University | Tatsumi Y.,Shiga University of Medical Science | Tatsumi Y.,Osaka University | And 5 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: To assess the impact of impaired insulin secretion (IIS) and insulin resistance (IR) on type 2 diabetes incidence in a Japanese population. Methods: This 4 year cohort study included 3,059 participants aged 30-69 without diabetes at baseline who underwent comprehensive medical check-ups between April 2006 and March 2007 at Saku Central Hospital. Based on their insulinogenic index and HOMA-IR values, participants were classified by the criteria of the Japan Diabetes Society into four categories: normal; isolated IIS (i-IIS); isolated IR (i-IR); and IIS plus IR. They were followed up until March 2011. The incidence of type 2 diabetes was determined from fasting and 2 h post-load plasma glucose concentrations and from receiving medical treatment for diabetes. Results: At baseline, 1,550 individuals (50.7%) were classified as normal, 900 (29.4%) i-IIS, 505 (16.5%) i-IR, and 104 (3.4%) IIS plus IR. During 10,553 person-years of follow-up, 219 individuals developed type 2 diabetes, with 126 (57.5%) having i-IIS at baseline. Relative to the normal group, the multivariable-adjusted HRs for type 2 diabetes in the i-IIS, i-IR and IIS plus IR groups were 8.27 (95% CI 5.33, 12.83), 4.90 (95% CI 2.94, 8.17) and 16.93 (95% CI 9.80, 29.25), respectively. The population-attributable fractions of type 2 diabetes onset due to i-IIS, i-IR, and IIS plus IR were 50.6% (95% CI 46.7%, 53.0%), 14.2% (95% CI 11.8%, 15.6%) and 12.9% (95% CI 12.3%, 13.2%), respectively. Conclusions/interpretation: Compared with IR, IIS had a greater impact on the incidence of type 2 diabetes in a Japanese population. © 2013 Springer-Verlag Berlin Heidelberg.


Uematsu D.,Saku Central Hospital
Diseases of the colon and rectum | Year: 2012

Only a limited number of instruments can be used in single-access laparoscopic colectomy, and triangulation must be forfeited to avoid instrument collision. We investigated whether this problem could be overcome by performing laparoscopic colectomy by the use of the lateral decubitus position, making full use of gravity. The aim of this study was to determine whether single-access laparoscopic colectomy could be achieved while maintaining patients in the lateral decubitus position. This was a prospective study. This single-center study was conducted in a hospital. Ten consecutive patients (4 men and 6 women) with stage II or III colon cancer were included. Each patient was placed in the lateral decubitus position. Single-port access to the abdomen was provided by a 3.0-cm incision at the umbilicus. The roots of the supplying or draining vessels were isolated and divided for lymphadenectomy. Next, the colon was dissected from a lateral approach, without the help of the assistant. The specimen was extracted from the single-access incision. Extracorporeal or intracorporeal anastomosis was performed. The primary outcome measured was the feasibility of single-access laparoscopic colectomy in the lateral decubitus position. There were no intraoperative complications and no need for conversions to conventional laparoscopic surgery, open surgery, or the supine position. The median total surgical time was 154 minutes (interquartile range, 135-220 minutes). Surgical blood loss was slight (<20 mL) in all patients. No postoperative complications occurred. The median postoperative hospital stay was 7 days (interquartile range, 5-7 days). The sample size was small. Our results show that single-access laparoscopic colectomy in the lateral decubitus position is safe and feasible.


Oyama T.,Saku Central Hospital
Techniques in Gastrointestinal Endoscopy | Year: 2011

The hook knife is a robust device for marking and cutting mucosa, submucosal fibers, and vessels, as well as for hemostasis of minor bleeding. The tip of the knife is bent at a right angle. The length of the hook part is 1.3 mm and that of the arm is 4.5 mm. The knife is hosted within an outer sheath. The tip of the sheath has a hood-like shape that allows the hook of the knife to be retracted within it. The direction of the hook can be adjusted by rotating a handle located on the proximal side of the knife. The hook direction is easily adjusted when the handle is simultaneously rotated and moved slightly back and forth. The hook direction is fixed when the handle is maximally extended. Importantly, the direction of the hook knife should be controlled and kept parallel with the muscularis propria layer to prevent perforation during endoscopic submucosal dissection. When minor bleeding occurs during mucosal incision or dissection, it can be stopped using the hook knife by positioning the tip of the knife close to the bleeding site and using the spray mode to obtain hemostasis. © 2011 Elsevier Inc.


Uematsu D.,Saku Central Hospital | Akiyama G.,Saku Central Hospital | Magishi A.,Saku Central Hospital | Nakamura J.,Saku Central Hospital | Hotta K.,Saku Central Hospital
Diseases of the Colon and Rectum | Year: 2010

PURPOSE: In single-access laparoscopic colectomy, the number of forceps inserted through the umbilical incision is limited. To compensate for the single-access site, triangulation must be lost or instrument collision must be sustained. Extracorporeal magnetic retraction can overcome this problem. This report describes the use of this new procedure for colon cancer resection. METHODS: All patients had advanced cancer of the descending or the ascending colon. Single access to the abdomen was achieved with a 3.0- to 4.0-cm umbilical incision. Short vascular forceps and 2 rolls of gauze were inserted into the incision and a columnar magnet was placed on the surface of the abdominal wall. A specially made port access device was attached at the incision. The vascular forceps grasping the tissue were retracted by moving the magnet, enabling triangulation in cooperation with a second forceps. The mesocolon was dissected using a medial to lateral approach. The roots of the vascular pedicles were isolated and divided from the superior or the inferior mesenteric artery during lymph node dissection. Extracorporeal anastomosis was performed. RESULTS: There were no intraoperative complications, no need to convert to open surgery, and no need to add a second port. The median total surgical time was 255 (range, 220-315) minutes. Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 7 days for each patient. CONCLUSIONS: This procedure can be safely and feasibly performed using extracorporeal magnetic retraction. © The ASCRS 2010.


Uematsu D.,Saku Central Hospital | Akiyama G.,Saku Central Hospital | Matsuura M.,Saku Central Hospital | Hotta K.,Saku Central Hospital
Diseases of the Colon and Rectum | Year: 2010

PURPOSE: Laparoscopic-assisted colectomy is a common procedure for colorectal disease, and laparoscopic colectomy from a single access point is rapidly evolving. This report describes the use of single-access laparoscopic colectomy (SALC) with a novel multiport device in sigmoidectomy for colon cancer. METHODS: Data were collected retrospectively on 5 patients who underwent the procedure for colon cancers in the period from November 2008 through January 2009. The abdomen was approached through a 3-to 4-cm incision via the umbilicus in every case. To ensure maintenance of the pneumoperitoneum, the procedure was performed with a specially developed multiport device enveloped by a glove containing 3 5-mm ports. In all 5 patients, the root of the inferior mesenteric artery was isolated and divided at the distal side where the left colic artery branched off. RESULTS: The median total surgical time was 185 (range, 176-210) minutes. In all patients, surgical blood loss was slight (range, 0-20 mL). Only one patient required conversion into laparoscopic- assisted colectomy by the addition of 2 ports, because the location adjacent to the descending colon made it necessary to mobilize the splenic flexure. The median number of harvested lymph nodes was 17 (range, 12-24). No postoperative complications occurred. The postoperative hospital stay was 7 days for every patient. CONCLUSIONS: Single-access laparoscopic sigmoidectomy seems to be feasible and safe when performed by experienced laparoscopic surgeons who are familiar with the unique principles of this procedure. Additional experience and continued investigations are warranted. © The ASCRS 2010.


Oyama T.,Saku Central Hospital
Clinical Endoscopy | Year: 2012

Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier. 2012 Korean Society of Gastrointestinal Endoscopy. © 2012 Korean Society of Gastrointestinal Endoscopy.


Hull T.,Saku Central Hospital | Uematsu D.,Saku Central Hospital | Akiyama G.,Saku Central Hospital | Narita M.,Saku Central Hospital | Magishi A.,Saku Central Hospital
Diseases of the Colon and Rectum | Year: 2011

PURPOSE: Single-access laparoscopic surgery was first introduced for colectomy and later adapted for anterior resection. During single-access laparoscopic pelvic procedures, such as total mesorectal excision, it is often difficult to obtain an adequate operative field. By suspending the rectum vertically, we were able to execute a total mesorectal excision with single-access laparoscopy. We describe here the use of this new procedure to treat rectal cancer. METHODS: The selected 7 patients (1 male and 6 female) with stage II or III rectal cancer underwent the procedure. Single-port access to the abdomen was provided by a 3.0-cm incision at the right iliac fossa. The descending mesocolon was dissected by use of a medial approach, and a columnar magnet was placed on the surface of the abdominal wall to restore triangulation. The inferior mesenteric artery was skeletonized and the superior rectal artery divided during lymph node dissection. The total mesorectal excision extended to the pelvic floor and the rectum was vertically retracted with a suspending bar in collaboration with an extracorporeal magnet tool. The rectum was then transected below the reflection of the peritoneum. Intracorporeal anastomosis was performed with the double-stapling technique. Two pelvic drains were inserted through the single incision and the anus, respectively, for all patients. A defunctioning ileostomy was not created in any patient. RESULTS: Median total surgical time was 205 minutes (range, 175-245 min). Intraoperative blood loss was minimal in all patients (range, 1-20 mL). None of the cases required conversion to open surgery or addition of a second port. The only preoperative or postoperative complication occurred in one patient with clinical anastomotic leakage. CONCLUSION: Low anterior single-access laparoscopic resection seems safe and feasible when the rectum is suspended like a swing to ensure an adequate operative field. © 2011 The ASCRS.


Oyama T.,Saku Central Hospital
Gastrointestinal Endoscopy Clinics of North America | Year: 2014

The advantage of endoscopic submucosal dissection (ESD) is the ability to achieve high R0 resection, providing low local recurrence rate. Esophageal ESD is technically more difficult than gastric ESD due to the narrower space of the esophagus for endoscopic maneuvers. Also, the risk of perforation is higher because of the thin muscle layer of the esophageal wall. Blind dissection should be avoided to prevent perforation. A clip with line method is useful to keep a good endoscopic view with countertraction. Only an operator who has adequate skill should perform esophageal ESD. © 2014 Elsevier Inc.


Oyama T.,Saku Central Hospital
Recent Results in Cancer Research | Year: 2012

Esophageal endoscopic mucosal resection (EMR) was developed in the late 1980s (Makuuchi 1996; Yoshida T 2004; Inoue et al. 1993; Pech et al. 2004). And EMR was widely accepted as the treatment for superficial esophageal Squamous cell carcinoma (SCC). However, there was limitation in size, and precise resection was impossible. Piecemeal resection was performed for big lesion, and local recurrence after piece meal EMR was high (Momma 2007). Therefore, a novel endoscopic treatment, endoscopic submucosal dissection (ESD) was developed to resolve such disadvantage of EMR (Oyama and Kikuchi 2002; Oyama et al. 2005; Fujishiro et al. 2006; Ishihara et al. 2008; Hiroaki et al. 2010) © Springer-Verlag Berlin Heidelberg 2012.


The indication of endoscopic submucosal dissection for Barrett's esophageal adenocarcinoma (BEA) is superficial BEA without lymph node metastasis. The characteristic endoscopic findings of superficial BEA are elevation, depression, and color change. Indigocarmine spreading is useful for the diagnosis of lateral extension. It is a simple and easy enhancement method. The observation of surface and vascular pattern by magnifying endoscopy with narrow-band imaging is also useful for the diagnosis of lateral extension. The incidence of gastric cancer is high in Japan. The majority of early gastric cancer is detected by conventional endoscopy without random biopsy, or target biopsydiagnosis. The background mucosa of gastric cancer has gastritis, and the carcinogenesis based on inflammation is the same as early BEA. However, random biopsy remains the universal standard for early detection of Barrett's high-grade dysplasia and superficial BEA. A surveillance system that does not use random biopsy can and should be established using high-resolution endoscopy with target biopsy. © 2013 The Author. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

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