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Various innovative robotic systems have been developed to improve surgery precision. The Senhance Surgical System (SSS) is a digital laparoscopic system offering eye tracking and haptic feedback. Several reports have described application of the SSS to general surgeries, including cholecystectomy and colectomy. However, use of the SSS for gastric tumor has not been reported. We experienced a case of laparoscopic local gastrectomy (LLG) for gastrointestinal stromal tumor (GIST) with the SSS. A 74-year-old man diagnosed with GIST underwent LLG with the SSS. Operation, docking, and console times were 117, 11, and 59 minutes, respectively. No perioperative complications were encountered. This study is the first to report LLG for GIST with the SSS. LLG with the SSS was safe and feasible. The SSS can use reusable forceps and contribute to reducing medical costs. The development of instruments is also progressing, and various kinds of surgery are likely to be indicated.

In esophageal cancer surgery, the significance of preserving the azygos arch during thoracoscopic esophagectomy remains unknown. To determine the significance, we examined the difference in postoperative courses between patients who underwent an azygos arch-preserving technique and patients whose azygos arch had been dissected. We retrospectively analyzed 119 patients with esophageal cancer who underwent thoracoscopic esophagectomy from January 2017 to December 2019. Statistical tests, including univariate or multivariate analyses and propensity score-matched analysis, were performed focusing on changes in fluid balance caused by the preservation of the azygos arch. The azygos arch was preserved in 65 patients and dissected in 54 patients. Urine output on postoperative day 2 was higher, and the IN-OUT balance on postoperative day 2 or accumulated IN-OUT balance up to postoperative day 2 tended to be lower in the azygos arch-preserving group than in the dissected group. The azygos arch-preserving technique did not affect the number of dissected mediastinal lymph nodes. The azygos arch-preserving technique during thoracoscopic esophagectomy facilitated postoperative refilling and avoided postoperative fluid excess. This technique might be a novel minimally invasive option for an otherwise highly invasive esophageal cancer surgery.

Esophageal gastrointestinal stromal tumors (E-GIST) are very rare tumors, and there is no consensus regarding the optimal surgical approach for E-GISTs. Here, we report a case of a large E-GIST that was resected via video-assisted thoracoscopic surgery (VATS) and hand-assisted laparoscopic surgery (HALS). When examining for comorbidities of myasthenia gravis using computed tomography, a 7-cm-sized tumor was detected in the lower esophagus of a 68-year-old woman. Further examination revealed the tumor to be an E-GIST with high malignant potential, and thus, esophagectomy was performed. The hybrid procedure for VATS and HALS techniques was safe and minimally invasive for this E-GIST that required esophagectomy. Thus, esophagectomy with VATS and HALS is thought to be a reasonable surgical option for resecting large E-GISTs, for which enucleation is not recommended.

Additional surgery is recommended for patients with noncurative resection after endoscopic submucosal dissection (ESD) for early gastric cancer. Additional resection requires the excision of an area larger than that of the resected mucosa in ESD, which is larger than the lesion, with convergence of the gastric mucosa due to scarring. Thus, the selection of the surgical procedure for lesion removal in specific areas can be affected by ESD. This study therefore aimed to evaluate the impact of ESD on the selection of additional gastrectomy in patients with early gastric cancer in the boundary area between the upper third and middle third of the stomach (UM boundary region). Between January 2013 and June 2018, laparoscopic gastrectomy was performed in 89 patients with cT1N0M0 gastric cancer located only in the UM boundary region. The patients’ backgrounds and surgical and pathological results were retrospectively investigated. The predictive factors for performing laparoscopic distal gastrectomy (LDG) were evaluated by multivariate analysis. Among 89 patients, 23 patients underwent ESD before surgery. LDG was significantly less often performed in the ESD-surgery group than in the surgery-only group (34.8% vs. 72.7%; p = 0.003). Preoperative ESD was an independent negative predictor of LDG (odds ratio = 0.266; p = 0.025). Preoperative ESD has an impact on the selection of the type of additional gastrectomy, including reducing the conduct of LDG for early gastric cancer in the UM boundary region.

Advancements in thoracoscopic surgery have provided us with a deeper anatomical understanding of recurrent laryngeal nerve paralysis (RLNP), which is likely to occur after lymph node dissection. Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy. RLNP occurred in six of the 24 patient cohort. The rate of hoarseness and difficulty in discharging sputum was significantly higher in the paralyzed group than in the non-paralyzed group. The diagnostic accuracy of RLNP by ultrasonography had a sensitivity of 83.3% (5/6), a specificity of 88.8% (16/18), a false positive rate of 5.6% (1/18), and a false negative rate of 0% (0/6). Although it is not completely accurate, our findings indicate that ultrasonography is quite effective for diagnosing RLNP, more so in combination with clinical symptoms. Ultrasonography may also be effective for identifying patients who are amenable to laryngoscopy for diagnosing RLNP, or for evaluating the recovery status of nerve paralysis.