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Hattori A.,Jikei University School of Medicine | Onda S.,Jikei University School of Medicine | Okamoto T.,The Jikei Daisan Hospital | Suzuki F.,The Jikei Daisan Hospital | And 4 more authors.
Transactions of Japanese Society for Medical and Biological Engineering | Year: 2014

Our aim is to develop a surgical navigation system for safer implementation of open surgery. The navigation system uses short 3D laparoscope to obtain surgical field image. By overlaying 3D models of surgery targets such as organs, tumors and blood vessels on the image, we aim to develop a system in which the operator will be able to instinctively grasp information such as how deep the blood vessels are in the surgical field. In addition to developing a basic system for the navigation, we have also developed a function that would complete registration at the shortest time possible, annotation function for anatomical names for surgical staff to share navigation information and a function to reflect organ resection plane planned before operation. © 2014, Japan Soc. of Med. Electronics and Biol. Engineering. All rights reserved.


PubMed | Jikei University School of Medicine and The Jikei Daisan Hospital
Type: Journal Article | Journal: Surgical case reports | Year: 2016

Hemorrhage from ruptured pseudoaneurysm is a rapidly progressing and potentially fatal complication after pancreaticoduodenectomy (PD). Stent graft placement for hepatic artery pseudoaneurysm has recently been reported as a valid alternative to transcatheter arterial embolization (TAE). We report a case of pseudoaneurysm of the common hepatic artery (CHA) with distal arterial stenosis treated by stent graft placement for pseudoaneurysm and balloon dilation for arterial stenosis due to pancreatic fistula after PD. A 67-year-old man underwent PD for intraductal papillary mucinous neoplasm with concomitant early gastric cancer. After the operation, pancreatic fistula developed, for which conservative management by drainage was continued. On the postoperative day 30, melena started. Emergency abdominal angiography revealed a pseudoaneurysm in the CHA, as well as distal arterial stenosis extending from the proper hepatic artery (PHA) to bilateral hepatic arteries. The portal vein was also stenotic due to pancreatic fistula, for which TAE was not judged suitable because of the risk of liver failure. Therefore, stent graft placement and balloon dilation were chosen. Three pieces of coronary covered stent were placed in a coaxial overlapping manner followed by balloon dilation of the proper and left hepatic arteries. Balloon dilation of the right hepatic artery failed by technical reasons. Completion arteriography confirmed the patency from the CHA to the left hepatic artery as well as the exclusion of the pseudoaneurysm. A liver abscess that developed in the right hepatic lobe after intervention was successfully treated by percutaneous drainage, and the patient discharged on day 27 after stent graft placement. Non-embolic management with preservation of the liver arterial flow may be an option for complicated pseudoaneurysm after PD.


PubMed | Jikei University School of Medicine and The Jikei Daisan Hospital
Type: Journal Article | Journal: Surgical case reports | Year: 2016

A 53-year-old male visited his primary physician for epigastric and back pain. Abdominal-enhanced computed tomography (CT) revealed a simple cyst of the pancreatic tail attached to the stomach. A distal main pancreatic duct (MPD) was clearly dilated, but no pancreatic tumor was identified around the stenosis of MPD by CT scan and magnetic resonance cholangiopancreatography (MRCP). Endoscopic retrograde pancreatography (ERP) revealed stenosis and distal dilation of the MPD located between the body and tail of the pancreas. Endoscopic ultrasound (EUS) revealed a low density mass of 7mm in size with distal dilation of the MPD. With the suspicion of a small pancreatic cancer, the patient underwent distal pancreatectomy and splenectomy with lymph node dissection (D2). On histopathological evaluation, a small pancreatic adenocarcinoma of 6mm in size was detected around the stenosis of MPD. Final pathological diagnosis was moderately differentiated invasive ductal adenocarcinoma of the pancreas with no lymph node metastasis (Japan Pancreatic Society (JPS) classification 7th edition; Pbt, TS1 (6mm), tub2, intermediate type, INF , ly1, v1, ne1, mpd(-), pT1b, pN0, pM0, stage IA,PCM(-), DCM(-) and the Union International Control Cancer (UICC) classification of malignant tumors 6th edition; pT1, pN0, pM0, stage IA, R0). We herein reported a patient who underwent radical resection for T1 pancreatic adenocarcinoma of 6mm in diameter which caused acute pancreatitis and a pseudocyst due to obstruction of the MPD.

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