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Aim: Nurses' skills and confidence in providing oral care to patients play important roles in healthcare. Studies have proved that peer-to-peer learning and assessment can help improve nurses' skills and confidence. However, no study has investigated it using an objective assessment checklist. This study investigated an oral hygiene practice training program for nursing students. It focused on their oral healthcare skills, confidence, and perspectives regarding implementing an objective structured clinical examination (OSCE)., Methods: A pre- and post-survey of 97 nursing students from a nursing school in Japan was conducted as a peer-to-peer oral health education training program that included an assessment and performance checklist., Results: Confidence in performing and assessing oral care significantly improved after attending the program. Furthermore, the changes were significantly greater in the developed program than in the training program without the checklist. The mean total assessment scores (0-25) of the first, second, third, and fourth participants in the four-student groups were 22.1, 23.4, 23.9, and 24.1, respectively. The mean scores of the second, third, and fourth participant groups were significantly higher than that of the first participant group (p < .01). Fifty-two positive and 58 negative comments were received regarding the implementation of the program with professional assessments and the checklist. The most common positive comment mentioned that the evaluation by professionals improved oral care learning and skills., Conclusions: This study developed a program to improve nursing students' confidence and oral care delivery skill building in an OSCE-style delivery., (© 2024 Japan Academy of Nursing Science.)

Purpose: This study aimed to investigate the usefulness of a newly developed oral simulator for nursing students' oral assessment education on oral diseases and symptoms., Materials and Methods: The participants were first-year students (n=105) at a nursing school in Japan. Ten identical oral simulators with angular cheilitis, missing teeth, dental caries, calculus, periodontitis, hypoglossal induration, food debris, and crust formation were created by a team of dentists. After a 45-minute lecture programme for oral assessment performance with the Oral Health Assessment Tool (OHAT), the ability test with the simulators and the OHAT as well as test feedback were conducted in a 30-minute practical programme. To evaluate the effectiveness of the programmes, questionnaires and ability tests with slides of oral images were conducted at baseline and after the programme., Results: Ninety-nine students (94.3%) participated in this study. The results of the ability test with the simulators and the OHAT in the practical programme showed that the correct answer rates of assessing tongue, gingiva, present teeth, and oral pain were less than 40%. Their levels of confidence, perception, and oral assessment performance were statistically significantly higher after the programmes than they were at baseline. Their level of confidence in assessing the need for dental referral had the largest increase in scores compared to the lowest scores at baseline in the nine post-programme assessment categories., Conclusions: This study identified several problems with nursing students' oral assessment skills and improvements of their oral assessment confidence, perceptions and performance.

Background: Interprofessional education (IPE) is essential for healthcare students to collaborate effectively in multidisciplinary teams. This study aimed to identify the effect of IPE programmes in nursing care and oral healthcare on dental and nursing students' perceptions of interprofessional collaboration., Methods: The study included 101 third-year dental and 98 fourth-year nursing students. The participants were divided into mixed-professional groups of four (2 dental and 2 nursing students). They participated in nursing care and oral healthcare training programmes that included student-on-student training and discussion groups. Questionnaires regarding perceptions of interprofessional collaboration were distributed to the participants before and after the programmes to compare the programmes before and after and between the dental and nursing students. The Wilcoxon signed-rank test and chi-square test were used to compare the data., Results: Data from 79 dental students (42 males and 37 females) and 89 nursing students (4 males and 85 females) who completed both questionnaires were used for the comparisons. Perceptions of the differences between the approaches of different health professionals to nursing care, the roles of other professionals, and the need for multiprofessional collaboration improved significantly among both dental and nursing students after the programmes. Although the perception of their ability to communicate with unfamiliar or new people improved significantly only among the nursing students, other perceptions of their ability to communicate did not improve for either group. More dental students than nursing students chose nursing trainings as good programmes to participate in with other professional students, while more nursing students than dental students chose oral care trainings as good programmes. Many students commented that they learned about nursing and oral healthcare skills as well as the importance of teamwork and communication with other professionals. Seven students commented that they were more motivated to become dentists and nurses., Conclusions: This study showed that IPE programmes for nursing care and oral healthcare might be effective at helping students understand other professionals and promoting multiprofessional collaboration. However, further studies are needed to develop IPE programmes to improve attitudes and abilities related to interprofessional communication skills., (© 2024. The Author(s).)

Objectives: This study aimed to investigate the performance of oral assessment and health care education at nursing schools across Japan to identify problems and the need for oral health professional support., Methods: The participants were the academic staff in charge of oral health care education in the basic, adult, gerontological, and home nursing fields of 295 schools in Japan that offered a bachelor's degree in nursing. A questionnaire was sent to 1180 heads of the nursing fields of these schools. They were requested to have oral health care educators complete the survey; data on the performance of oral assessment and health care education and human resources allocated were collected through a questionnaire., Results: A total of 311 (26%) questionnaires were returned, 196 (63%) of which were completed by oral health care educators. Regarding the performance of oral assessment education, the majority (71%) of them spent less than 2 hours in teaching, and only 24.5% taught the usage of oral assessment tools. Regarding the performance of oral health care education, more than 90% spent less than 2 hours in lecture-based and practical oral health care education, respectively. Less than half taught the association of periodontal diseases with diabetes and cardiovascular diseases and use of fluoride for caries prevention in the lectures, and only approximately 30% taught the usage of an interspace brush or dental floss. Moreover, less than 10% of oral health professionals taught oral health care in lectures or practical oral health care., Conclusions: This study revealed problems associated with oral assessment and health care education in Japanese nursing schools. To address these, support from oral health care professionals is required. Further studies are also required to reveal problems in oral assessment and health care education in other nursing schools that do not offer a bachelor's degree programme in Japan and other countries., Competing Interests: Conflict of interest None disclosed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study sought to investigate the current status and faculty members' perceptions of oral care education in Bachelor of Nursing curriculums in Japan., Method: Data were gathered through a questionnaire survey of 196 participants, who were faculty members in charge of oral care education in the basic, adult, gerontological, and home nursing fields, from 295 nursing schools that offered Bachelor degrees in nursing across Japan., Results: The quantitative data showed that 38.5% of the participants worked for less than 5 years as oral care educators, only 15.5% taught oral care in perioperative wards, only 62.2% used an oral care training simulator, and less than 30% believed that training in the prevention of oral diseases should be enhanced. From the descriptive responses, this study identified such problems as the inability of students to perform student-on-student and patient-based oral care training owing to the risk of SARS-CoV-2 transmission, and the lack of teaching materials, time, and human resources, and cooperation with other nursing fields and health professionals., Conclusions: This study revealed several problems in oral care education in the Bachelor of Nursing curriculums in Japan. To tackle these challenges, this study suggests the development of an interdisciplinary course that unifies oral care education in nursing fields, in order to promote collaborative oral care education and to improve nursing students' knowledge and skills of oral care., (© 2022 Japan Academy of Nursing Science.)

Objective: This study aimed to investigate nurses' perceptions of oral health care provision to inpatients in Japanese hospitals and the infection control measures taken by them after the coronavirus disease 2019 (COVID-19) lockdown to promote collaborative oral health care., Method: The participants were 1037 nurses working in inpatient wards at 4 hospitals in Fukuoka Prefecture, Japan. Data were collected through a questionnaire survey approximately 6 months after the first COVID-19 lockdown., Results: More than 90% of the 734 nurses participating in this study positively perceived the preventive effect of oral health care on aspiration pneumonia, ventilator-associated pneumonia, and viral infection. However, approximately half of them had negative perceptions about their knowledge and confidence regarding the control of COVID-19 with oral health care provision, and 84.7% expected to be provided with the necessary information by oral health professionals. Further, 537 nurses (73.2%) provided oral health care to their patients; 9 nurses (1.7%) responded that those patients who received oral health care decreased after the lockdown; and 12 (2.4%) responded that they could no longer collaborate with oral health professionals because of the lockdown. Additionally, 41.7% of them used neither protective glasses nor face shields even after the lockdown began., Conclusions: This study showed that almost all the nurses perceived the benefcial effect of oral health care for the prevention of viral infection and pneumonia. However, some nurses perceived that their oral health care provision and collaborative oral health care were negatively affected. It also showed that most nurses' knowledge, confidence, and use of infection control measures were insufficient. The results indicate that oral health professionals should support nurses in providing oral health care by providing them with information on COVID-19 infection control measures to prevent infection transmission., Competing Interests: Conflict of interest None disclosed., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

A female in her forties was diagnosed with rectal cancer involving the uterus and bladder and with multiple lymph node metastasis. Chemotherapy was successful and resulted in complete clinical response 1 year and 2 months after commencement. She continues chemotherapy without resection of the primary tumor. The complete response has been maintained for 8 years and 11 months.

Background: The relationship between oral and cognitive functions among older people is highly debated., Objective: To examine whether oral functions are related to changes in the levels of mild cognitive impairment (MCI) biomarkers in older Japanese outpatients., Methods: This observational study included 52 outpatients aged ≥65 years who underwent dental examinations at the Fukuoka Dental College Hospital. The Mini-Mental State Examination (MMSE) was performed, and MCI blood biomarker levels were assessed at baseline and after 2 years. The present dental and periodontal conditions and the oral functions (tongue pressure and masticatory performance) were evaluated. Changes in parameters from baseline to follow-up were compared using the Wilcoxon signed-rank test, McNemar test or chi-squared test. Associations among changes in the parameters were analysed using Spearman's rank correlation coefficient., Results: The follow-up rate in this study was 67%. The masticatory performance was improved (p < 0.001), whereas gingival inflammation was decreased (p < 0.001) over the 2-year period. A significant increase in the MMSE score (p < 0.001) and a decrease in MCI risk (p < 0.001) were noted. The decrease in MCI risk was correlated with the increase in both masticatory performance (ρ = -0.34; p < 0.05) and MMSE score (ρ = -0.56; p < 0.01)., Conclusion: A decrease in MCI risk, as demonstrated by the levels of the blood biomarkers, was correlated with an increase in the masticatory performance in Japanese outpatients., (© 2021 John Wiley & Sons Ltd.)

Objective: This study investigates the effects of a study course in oral health care on the perceptions of nursing students. The course was designed and evaluated by a multi-professional team at a Japanese nursing school., Method: The subjects were 119 nursing students. They participated in the oral health course that comprised 45h of training in 4 years. These were designed and taught by oral health professionals, a certified speech-hearing therapist, and nurses. Questionnaires were distributed to subjects to compare their perceptions and awareness about oral health care before, in between, and after the courses. A chi-square test was used to compare the data., Results: After completing the courses, more than 95% of the participants were interested in the oral health care practice and expected to collaborate with oral health professionals after getting qualified. Additionally, they understood the effectiveness of oral health care for the prevention of aspiration pneumonia and perceived that oral health care should be provided to hospitalized patients and community-dwelling older adults. Their awareness of the need to learn techniques for tooth brushing support, salivary gland massage, oral management, swallowing training, removing tongue coating, and gargling, both in theory and practice, was significantly improved., Conclusion: Multi-professional education has the potential to improve the awareness of nursing students of oral health care and promote collaborative oral health care in the future., (© 2021 American Dental Education Association.)

Background: Oral healthcare education for health professional students is important to promote collaborative oral healthcare practice among health professionals. The purpose of this follow-up, cross-sectional study was to investigate attitudes, awareness, and perceptions regarding oral healthcare among dental and nursing students and to compare them both between baseline and the completion of the education programme and between dental and nursing students to identify problems with oral healthcare programmes in dental education., Method: The subjects included 88 dental and 119 nursing students. The dental students participated in geriatric and preventive dentistry courses for oral healthcare education. The nursing students participated in independent oral healthcare courses comprising 45 h of training with case-based learning and were taught and instructed by multiple health professionals, including dentists. Questionnaires were distributed to the participants to compare attitudes, awareness, and perceptions regarding oral healthcare between baseline and the completion of the education programme and between dental and nursing students. A chi-square test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to compare the data., Result and Conclusion: The data of 48 (28 male and 20 female) dental students and 103 (9 male and 94 female) nursing students who completed the questionnaires both at baseline and after the education programme were used for the comparisons. After the education programme, more than 90% of the students were interested in oral healthcare practice; hoped to practise oral healthcare post-qualification; and perceived oral healthcare to be effective for preventing dental caries, periodontal diseases, and aspiration pneumonia. These attitudes and perceptions were statistically significantly improved after the education. However, the level of awareness of oral healthcare and the level of perception of the importance of collaboration with healthcare workers in oral healthcare practice after education were lower in the dental students than in the nursing students. Multi-professional oral healthcare education with case-based learning has the potential to improve awareness of oral healthcare and perceptions of the importance of collaborative oral healthcare practice.

Background: As the general population of Japan ages, the population of hospitalized psychiatric patients is also ageing. The purpose of this study was to investigate the associations of oral health-related quality of life (OHRQoL) with age and oral health, including oral and swallowing function, among psychiatric inpatients., Methods: The subjects included 165 psychiatric inpatients in psychiatric hospitals in Japan. The General Oral Health Assessment Index (GOHAI) and the Eating Assessment Tool (EAT-10) were included in the questionnaire survey for the measurement of OHRQoL and the screening of dysphagia. A score ≥ 3 on the EAT-10 was defined as suspected dysphagia. Oral examinations and oral diadochokinesis (ODK) measurements for the tongue-lip motor function evaluation were conducted. The inpatients with acute psychiatric symptoms, moderate and severe dementia, and cognitive impairment that affected their ability to communicate and relate their feelings were excluded. A chi-squared test, the Mann-Whitney U test, and linear regression analysis were used for the analysis. The data were analysed at the 5% significance level., Results: A total of 100 (64.5%) psychiatric inpatients (mean age, 67.3 [SD, 14.5] years, 49% males, and 51% females) participated in this study. The means ± SDs for the decayed missing filled teeth (DMFT) index and GOHAI score were 20.6 ± 6 and 49.7 ± 7.9, respectively. The GOHAI score in the older age group (≥ 65 years) was significantly lower than that in the younger age group (< 65 years). The mean ODK scores were less than 3 times/s for all syllables. The percentage of the participants with suspected dysphagia was 45.0%. Tooth loss and suspected dysphagia were significantly associated with low GOHAI scores. The EAT-10 score was significantly correlated with the GOHAI score only after adjusting for age and sex (β = - 0.725, 95% CI - 0.97, - 0.64)., Conclusions: In hospitalized psychiatric patients, impaired oral health in the older subjects was more pronounced compared with that among general adults. Tooth loss and swallowing function were associated with OHRQoL. Therefore, oral care for the recovery of occlusal and swallowing functions may be needed to improve OHRQoL among psychiatric patients.

Objective: Collaborative oral health care among health-care workers (HCWs) is important to prevent oral and systemic diseases. The purpose of this study was to investigate the perceptions, attitudes and performance of HCWs regarding collaborative oral health care and to compare them among HCWs., Method: The subjects were dentists (DTs), dental hygienists (DHs), hospital nurses (HNs), speech-language-hearing therapists (STs) and certified care workers (CCWs) in Fukuoka Prefecture, Japan. DTs were members of the Fukuoka Dental Association, and DHs worked in dental clinics. HNs worked in hospitals without dental departments. STs and CCWs were members of professional associations. Data were collected by a mail survey. The chi-square test and Kruskal-Wallis test were used to compare the data among HCWs., Results: A total of 119 DTs, 91 DHs, 229 HNs, 119 STs and 121 CCWs participated in this study. The total response rate was 20.6%. There were significant differences in perceptions of what should be performed as part of oral health care among HCWs. Only 20%-60% of HCWs performed collaborative oral health care, while more than 75% were willing to perform such care. Levels of collaborative oral health care with other types of professionals and positive willingness to perform such care were lower among HNs than among the other HCWs., Conclusions: It is suggested that oral health professionals should recognise the presence of differences in the perceptions, attitudes and performance among other types of HCW and try to improve these to promote interprofessional collaboration of oral health care in hospitals., (© 2020 World Dental Federation. Published by John Wiley & Sons Ltd.)

Background: Nurses' oral assessment and dental referral performance for inpatients are important to provide appropriate oral care services in hospitals. The purpose of this study was to investigate the knowledge, attitudes, and performance of oral assessments and dental referrals for their inpatients among nurses and to identify factors associated with that performance to promote oral health care in hospitals., Methods: All nurses (n = 919) who worked at five hospitals in Japan were recruited as responders. A questionnaire regarding their performance of oral assessments and dental referrals was distributed to the subjects in each hospital. The data were collected from August 2018 to September 2018., Results: A total of 757 (82.4%) nurses (82 males and 675 females) responded to the questionnaire. With respect to each of the 8 oral assessment categories, 16.2-41.2% of the nurses performed oral assessments for more than 50% of their inpatients, and 20.3-29.9% had encouraged more than one inpatient to see a dentist within the previous 3 months. Significant differences were found by ward and hospital in their performance of oral assessments for inpatients. Additionally, their oral assessment performance, knowledge of the usage of oral assessment tools, wards, and hospitals were significantly associated with their dental referral performance., Conclusions: The performance of oral assessment and dental referral was not developed sufficiently in the hospitals. Thus, oral health professionals should support oral assessment education for nurses, including usage of assessment tools, to promote dental referral by nurses. These results may contribute to promotion of dental referral performance by nurses and provision of oral health care by oral health professionals for hospital inpatients.

Objectives: The purpose of this study was to investigate the effect of interprofessional educational programmes on the improvement of nursing students' oral assessment performances by comparing their attitudes, confidence, abilities, and self-performance before and after the education., Materials and Methods: The subjects included 112 first-year nursing students in a Japanese nursing school. They participated in the oral assessment educational programmes, which were supported by dentists and introduced into the 1-year curriculum. The first programme was a 1.5-hr lecture with a self-oral assessment training in May 2018, and the second was a 1-hr oral assessment training in October 2018. The questionnaire surveys investigating nursing students' attitudes, confidence, and self-performance regarding oral assessment and the tests measuring their oral assessment abilities were conducted before and after the programmes. The total scores on the tests were 0-9 points., Results: A total of 101 (90.2%) nursing students responded to all the questionnaires and tests. Their attitudes and confidence regarding oral assessment were significantly improved after the programmes. The total average scores on the tests were significantly increased from 6.8 points at baseline to 7.9 points after the programmes. The percentage of their performance of self-oral assessment every day significantly increased from 15.8% at baseline to 32.7% after the programmes., Conclusions: These results suggested that the educational programme might be effective in improving not only the students' attitudes and confidence regarding oral assessment but also their oral assessment abilities and self-oral assessment performance. Therefore, future programmes must focus on training them to improve oral health care referrals., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been reported as possibly associated with Fournier's gangrene (FG). This case report describes a 34-year-old Japanese man who was diagnosed with FG after the administration of empagliflozin for type 2 diabetes mellitus (T2DM). He presented with pain and swelling in the perineum and groin 142 days after initiating empagliflozin. The clinical features, laboratory data, and computed tomographic findings were consistent with FG. Surgical drainage and debridement of necrotic tissues were performed immediately after admission to our hospital. The patient had no complications of diabetes before the onset of FG. Glycemic management was good at the time of FG onset. This case suggests a possible association between empagliflozin and FG. We report a case of FG in a patient during a period of good glycemic management following treatment with empagliflozin. We recommend further awareness of this relationship and suggest the need for additional research.

Aim: To investigate nursing faculty members' perceptions of oral care and to identify the effects of an educational environment on their perceptions., Methods: A cross-sectional questionnaire regarding oral care was conducted at eight nursing schools in Japan. A total of 156 (71.6%) faculty members participated in this study. Their perceptions of oral care practice were compared by using a statistical analysis according to the length of work experience, teaching field, school, and facility setting (defined as whether the school had an affiliated hospital with a dental department)., Results: Almost all of the faculty members were nurses and most were female. Almost all perceived that oral care was effective in the prevention of aspiration pneumonia and frailty. There were significant differences by teaching field in the nurses' perceptions regarding with whom they should collaborate to conduct oral care and there were significant differences by school in the nurses' perceptions regarding who should provide oral care, where it should be provided, and what kinds of knowledge are important for practice. Perceptions of low involvement in oral care were significantly associated with the schools having an affiliated university hospital with a dental department., Conclusion: There were different perceptions regarding oral care among nursing faculty members and their perceptions might have been affected by their educational environment. Therefore, it is suggested that oral care education should be standardized and nursing faculty members should standardize the curriculum regarding oral care for nursing students., (© 2018 Japan Academy of Nursing Science.)

Objective: The aim was to investigate the relationships between subjective well-being and the existence of primary care dentists in community-dwelling elderly people., Background: Some studies have reported subjective well-being focusing on oral health, but no studies have examined the relationship between subjective well-being and primary care dentists., Methods: This cross-sectional study used data from community-dwelling elderly people aged ≥70 years (n = 624). The Philadelphia Geriatric Center Morale Scale (PGCMS; range = 0 [low morale]-17) was used to assess subjective well-being. Additional information regarding age group, sex, medical consulting situation (ambulatory care/home care), primary care dentists, family structure, economic status, health status was collected via questionnaire., Results: The average PGCMS score in ambulatory care patients (ACP) group who have primary care dentists was highest among community-dwelling elderly people. In a logistic regression model, a low PGCMS score (0-11) was independently correlated to 80-89 age group (OR = 1.70; 95% CI, 1.13-2.54; P = 0.008), ≥90 age group (OR = 3.86; 95% CI, 1.83-8.18; P < 0.001), unsatisfied for economic status (OR = 2.68; 95% CI, 1.59-4.53; P < 0.001), unsatisfied for health status (OR = 3.94; 95% CI, 2.60-5.98; P < 0.001) and having no primary care dentists (OR = 1.81; 95% CI, 1.09-3.01; P = 0.021) in ACP group., Conclusions: The subjective well-being of ACP who have primary care dentists was higher than in other people. Primary dentists contributed to the subjective well-being of elderly people., (© 2019 Gerodontology Association and John Wiley & Sons Ltd.)

A 56-year-old man was diagnosed with advanced adenocarcinoma of the esophagogastric junction. He received 1 course of neoadjuvant chemotherapy with S-1. After neoadjuvant chemotherapy, the primary tumor showed a remarkable decrease in size. Subtotalesophagectomy, D2 lymph node dissection, and reconstruction with a gastric tube through the posterior mediastinal route were performed. Pathological examination showed that most of the cancer cells had been destroyed, with a part where adenocarcinoma mucosa was seen. We successfully treated a case of advanced adenocarcinoma of the esophagogastric junction, with neoadjuvant S-1 chemotherapy and surgicalresection.

Purpose: To investigate the practices, attitudes, and confidence of nurses in the performance of oral health checkups in order to develop an educational oral health checkup training programme for nurses., Materials and Methods: A cross-sectional questionnaire survey was distributed to nurses (n = 184) who worked in a hospital and an affiliated long-term care facility in Japan from September to October in 2016. The questionnaire survey investigated their practices, attitudes and confidence in the performance of oral health checkups for elderly patients who were in their care and the factors that were associated with the performance of oral health checkups., Results: A total of 143 (77.7%) nurses participated in this study. Almost half (51.7%) performed oral health checkups for elderly patients. More than 60% examined the lip, tongue and tongue coating, gingiva and oral mucosa, and oral cleanliness; however only 32.4% examined the present teeth and 8.1% examined the saliva. Approximately 90% of the nurses felt that all health professionals should perform oral health checkups for elderly patients who were in their care. Their confidence of the oral examination was statistically significantly associated with their performance of oral health checkups for elderly patients., Conclusions: This is the first survey to investigate the practices, attitudes, and confidence of nurses in the performance of oral health checkups. These findings will contribute to the development of a training programme for nurses who perform oral health checkups in elderly patients.

Background: We have started clinical application of 8K ultra-high definition (UHD; 7680 × 4320 pixels) imaging technology, which is a 16-fold higher resolution than the current 2K high-definition (HD; 1920 × 1080 pixels) technology, to an endoscope for advanced laparoscopic surgery., Results: Based on preliminary testing experience and with subsequent technical and system improvements, we then proceeded to perform two cases of cholecystectomy and were able to achieve clinical success with an 8K UHD endoscopic system, which consisted of an 8K camera, a 30-degrees angled rigid endoscope with a lens adapter, a pair of 300-W xenon light sources, an 85-inch 8K LCD and an 8K video recorder. These experimental and clinical studies revealed the engineering and clinical feasibility of the 8K UHD endoscope, enabling us to have a positive outlook on its prospective use in clinical practice., Conclusions: The 8K UHD endoscopy promises to open up new possibilities for intricate procedures including anastomoses of thin nerves and blood vessels as well as more confident surgical resections of a diversity of cancer tissues. 8K endoscopic imaging, compared to imaging by the current 2K imaging technology, is very likely to lead to major changes in the future of medical practice.

Background: We developed a new ultrahigh-sensitive CMOS camera using a specific sensor that has a wide range of spectral sensitivity characteristics. The objective of this study is to present our updated endoscopic technology that has successfully integrated two innovative functions; ultrasensitive imaging as well as advanced fluorescent viewing., Methods: Two different experiments were conducted. One was carried out to evaluate the function of the ultrahigh-sensitive camera. The other was to test the availability of the newly developed sensor and its performance as a fluorescence endoscope. In both studies, the distance from the endoscopic tip to the target was varied and those endoscopic images in each setting were taken for further comparison., Results: In the first experiment, the 3-CCD camera failed to display the clear images under low illumination, and the target was hardly seen. In contrast, the CMOS camera was able to display the targets regardless of the camera-target distance under low illumination. Under high illumination, imaging quality given by both cameras was quite alike. In the second experiment as a fluorescence endoscope, the CMOS camera was capable of clearly showing the fluorescent-activated organs., Conclusions: The ultrahigh sensitivity CMOS HD endoscopic camera is expected to provide us with clear images under low illumination in addition to the fluorescent images under high illumination in the field of laparoscopic surgery.

Background and Objective: We hypothesized that using a flexible endoscope as a working scope in laparoscopic surgery through a single incision might provide many benefits. To this end, a short-type flexible endoscope with a working length of 600 mm was newly developed. In this animal experimental study, we aimed to evaluate the technical feasibility of our new approach, single-incision multiport laparoendoscopic (SIMPLE) cholecystectomy, using this endoscope., Methods: Eight pigs were subjected to SIMPLE cholecystectomy using the short-type flexible endoscope. The endoscope was inserted through a 12-mm trocar in an SILS Port followed by the insertion of two additional 5-mm trocars in the SILS Port. Encirculation and ligation of the pedicle of the cystic artery and duct were carried out using laparoscopic instruments through the 5-mm trocars, while the dissection of the gallbladder from the intrahepatic fossa was predominantly performed using a cutting device through the endoscope., Results: A complete gallbladder excision, with complete encirculation and ligation of the pedicle, was completed in all cases. The mean operating time was 58 min (range 34-78 min). The endoscope provided a good view of the operating field, and it allowed some degree of freedom to the working laparoscopic instruments without compromising the field of view. Dissection of the gallbladder using the cutting device through the endoscope was much easier than that using the laparoscopic device, because the articulating instruments together with the endoscope enabled operation with triangulation. Furthermore, the water-jet and suctioning functions and the self-cleaning lens capability of the endoscope served the surgery well., Conclusions: SIMPLE cholecystectomy using the newly developed short-type flexible endoscope is a technically feasible procedure. Using this flexible endoscope for various tasks, such as resection, suctioning, and smoke evacuation, can make the surgical procedures easier.

Background: Many hepatobiliary centres are increasingly utilizing thermocoagulative devices such as bipolar-radiofrequency ablation (B-RFA). Compared with monopolar-radiofrequency ablation (M-RFA), B-RFA does not require grounding pads, thereby avoiding dermal burn injuries, and does not position probes directly into the tumour but rather on the perimeter. Additionally, B-RFA can precoagulate parenchyma to assist in hepatic resection. Herein, we report our early experience using B-RFA., Methods: A retrospective review identified 68 patients who underwent M-RFA or B-RFA between June 2004 and September 2010 in an academic centre. Peri-operative metrics were analysed., Results: M-RFA was used to treat 30 patients, whereas B-RFA was used for 17 patients. There were no differences in peri-operative metrics, survival or disease recurrence between M-RFA and B-RFA. Seventeen additional patients underwent B-RFA precoagulation during laparoscopic resection (segmentectomy in eleven patients and multi-segmental resection in six patients). Four patients with multifocal disease underwent procedures that combined B-RFA with resection., Conclusions: The early experience utilizing B-RFA demonstrates equivalency to M-RFA with respect to peri-operative metrics and survival. Moreover, B-RFA can be utilized to precoagulate tissue during a planned resection, making it not only a useful tool for tumour therapy but also a useful adjunct during surgical resections., (© 2011 International Hepato-Pancreato-Biliary Association.)

Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese people. The aim of this study was to examine the safety and efficacy of accessing the peritoneal cavity using an optical, bladeless trocar without previous pneumoperitoneum in morbidly obese patients. The patients' characteristics and outcomes with consecutive and preferential use of an optical, bladeless, first trocar insertion without previous pneumoperitoneum in morbidly obese patients (body mass index > 35 kg/m2) was reviewed. A total of 208 morbidly obese patients were included. The trocar insertion technique was used in 196 patients. No bowel or major abdominal vessel injuries occurred. Ninety-eight patients (50%) had previous abdominal operations. Trocar-related injuries occurred in 3 patients: a superficial mesenteric laceration in 2 and a laceration of a greater omentum vessel in 1. The direct first trocar insertion technique provides safe entry into the peritoneal cavity in morbidly obese patients.

Intestinal malrotation is a congenital anomaly occurring in one of 500 live births. It typically presents during the first months of life, but in rare instances, it can persist undetected into adulthood when it is identified during a radiographic or surgical procedure. We present a case of intestinal malrotation discovered at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP), detail the technical aspects needed to be incorporated to complete the operation, followed by a literature review of this rare clinical scenario. Incomplete malrotation is not a contraindication to performing a LRYGBP for morbid obesity.