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Saku, Japan

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. Source

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. Source

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. Source

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. Source

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. Source

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