Search

Post-operative paralytic ileus (POI) occurs after surgery because of gastrointestinal dysfunction caused by surgical invasion. We therefore investigated the frequency of POI after laparoscopic colorectal surgery in patients with colorectal cancer using a strictly defined POI diagnosis and identified associated risk factors.Patients who underwent initial laparoscopic surgery for colorectal cancer between January 2014 and December 2018 were included. The primary end point was the incidence of POI. A multivariate logistic regression analysis revealed the contributing risk factors for POI.Of the 436 patients, 94 (21.6%) had POI. Compared with the non-POI group, the POI group had significantly higher frequencies of infectious complications (p 0.001), pneumonia (p 0.001), intra-abdominal abscess (p = 0.012), anastomotic leakage (p = 0.016), and post-operative bleeding (p = 0.001). In the multivariate analysis, the right colon (odds ratio [OR] 2.180, p = 0.005), pre-operative chemotherapy (OR 2.530, p = 0.047), pre-operative antithrombotic drug (OR 2.210, p = 0.032), and post-operative complications of CD grade ≥ 3 (OR 12.90, p 0.001) were independent risk factors for POI.Post-operative management considering the risk of post-operative bowel palsy may be necessary for patients with right colon, pre-operative chemotherapy, pre-operative antithrombotic drug or severe post-operative complications.

Background: Although inguinal hernia occurs frequently after radical prostatectomy, transabdominal preperitoneal (TAPP) inguinal hernia repair occasionally poses challenges due to fibrosis of the p...

The question as to whether laparoscopic surgery should be applied for inguinal hernia after radical prostatectomy remains a debate due to surgical difficulty arising from adhesions in the prevesical space. We report the surgical technique used in our department, its outcomes, and its safety and effectiveness compared with the surgical outcomes of primary transabdominal preperitoneal inguinal hernia repair (TAPP) cases. From February 2013 to January 2017, 30 patients with inguinal hernia were treated with TAPP after radical prostatectomy. At our institution, to avoid bladder injury, we dissect the prevesical space with the layer between the transversalis fascia and superficial layers of the preperitoneal fascia as the dissection plane. The practitioners were three qualified surgeons. Surgical outcome were compared with those of primary TAPP cases. For statistical analyses, we used t test to compare the mean operative durations and Chi square test to compare all other surgical outcomes. The median observation period was 19 months. Intraoperative and postoperative complications did not occur; no onset of recurrence and chronic pain was observed. The mean operative duration was 116.2 min, which was significantly longer than that of primary TAPP patients (87.9 min). However, the operative duration for the last 14 patients had reduced to 101.6 min, which was not significantly different from that of primary TAPP patients. In TAPP for patients following prostatectomy, surgery can be performed safely and reliably without prolonging the operative duration by selecting a skilled practitioner and standardizing the technique.

Background There are few reports of metastases from colon cancer to an inguinal hernia sac, and few reports of colon cancer originating in diverticula. We report a patient with carcinoma of the sigmoid colon arising in two diverticula, who presented with peritoneal seeding to an inguinal hernia sac, and a review of the literature. Case presentation A 55-year-old male underwent open herniorrhaphy for a left inguinal hernia. At operation, a nodule in the inguinal hernia sac was resected and histologic examination revealed adenocarcinoma, which was suspected to be a metastasis from a distant primary lesion. Postoperative evaluation included colonoscopy and positron emission tomography which showed two suspected lesions in sigmoid diverticula. Laparoscopic subtotal colectomy was performed, and pathology revealed adenocarcinoma in two sigmoid diverticula. Conclusions If a nodule is found in an inguinal hernia sac, especially in older patients, peritoneal metastases should be considered. Resection of the nodule with histopathologic evaluation is essential. Colon cancer arising in a diverticulum should be considered as a possible site of the primary lesion.

The appropriate surgical treatment for inguinal hernia in patients with liver cirrhosis and ascites remains controversial. A 79-year-old male undergoing treatment for Child–Pugh B hepatitis C-induced liver cirrhosis and hepatocellular carcinoma complicated with bilateral inguinal hernia underwent transabdominal preperitoneal (TAPP) repair. During surgery, barbed sutures were used to facilitate appropriate peritoneal closure. His postoperative course was uneventful. Information on TAPP repair for inguinal hernia in patients with liver cirrhosis and ascites is limited. The International Guidelines for Inguinal Hernia Management recommend Lichtenstein repair for patients with ascites. TAPP repair requires peritonectomy via a posterior endoscopic approach; therefore, proper peritoneal closure is important to prevent the leakage of ascitic fluid. Herein, TAPP repair was safely and successfully completed using barbed sutures to achieve proper and strong peritoneal closure. TAPP repair using barbed sutures can be an effective treatment option for patients with liver cirrhosis and ascites.

Laparoscopic surgery is performed worldwide, even for cases of rectal cancer close to the anus, and advances in surgical instruments and techniques have increased the number of cases for which anastomosis can be performed, even those cases for which abdominoperineal resection was performed previously. Consequently, as a measure to avoid complications in the event of suture failure after surgery, the number of cases of establishing diverting stoma has also increased. Diverting ostomy may require a closure operation earlier than planned due to colostomy complications, cases requiring a long period of time until closure due to postoperative complications, and cases in which closure operation cannot be performed. Herein, we report cases that took more than 36 months to allow closure of the diverting stoma.

Introduction: The prompt assessment and the reversal of direct oral anticoagulants (DOACs) are urgent matters in the emergency care setting. Thus, we planned to elucidate the adequate prothrombin time (PT) test for the evaluation of the anticoagulant effects of various DOACs. Methods: The anticoagulant effects of rivaroxaban, apixaban, and edoxaban were measured with 3 PT tests (Triniclot PT Excel S, Neoplastin R, and Thromborel S). Human plasma was spiked with each DOAC at a range of 0 to 1000 ng/mL, and the PT was measured using each PT test. In another series, the reversal effect of either 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) was evaluated with each PT test. Results: All PT reagents correlated with the concentrations of each DOAC, however, the reactivity was considerably different between the DOACs and the PT tests. A prolonged PT with DOACs was reversed both by PCC and aPCC in a dose-dependent manner; however, Triniclot PT Excel S showed reprolongation of the PT with a higher dose of PCC. Conclusion: The proper choice of PT test is necessary for the assessments of the anticoagulant activity of DOACs. It is also important to understand the different characteristics of each PT test for the assessment of the reversal effects of PCC.

症例は25歳，女性．腫瘤触知にて当科受診．画像診断で腹部正中総腸骨動脈分岐部直下に約5cm大の下腹部腫瘤が判明．腹腔鏡下摘出術を施行．術中高血圧のほか術中術後合併症認めず，第8病日退院となった．病理組織学的検査ではparagangliomaと診断された．副腎褐色細胞腫の腹腔鏡下手術は普及しているが，後腹膜paragangliomaの腹腔鏡下手術はその発生頻度が少ないことに加え，悪性度や解剖学的特徴，またカテコラミン放出に対する懸念から一般的であるとはいえない．腹腔鏡下手術のポイントとしては1）多発性発生が多いので十分な腹腔内観察を行うこと2）慎重な操作による血管神経損傷の回避3）愛護的操作による高血圧クリーゼの予防などがあげられる．腹腔鏡の拡大視効果と水平方向の視野により低侵襲かつ安全に手術を行うことが可能と考えられる．

症例は19歳の男性で，嘔気，嘔吐，脱水を認め精査加療目的に当科入院となった．腹部CTにて上腹部に小腸壁のターゲット状肥厚を認め，小腸造影検査にて十二指腸の第3部に蟹のつめ所見を認めた．腸重積症の診断にて腹腔鏡下手術を施行した．Treitz靭帯近傍に空腸の逆行性腸重積を認めた．腹腔鏡下に腸重積を整復すると3cm大の腫瘍を認めた．腹腔鏡下に小腸部分切除および吻合を施行した．病理組織学的検査はpeutz-jeghers（以下,P-Jと略記）型ポリープであった．単発のP-J型ポリープはまれである．本症例には，粘膜，皮膚の色素沈着および遺伝性疾患を疑うような家族歴もなく不完全型P-J症候群と考えられた．まれな逆行性腸重積を呈したP-J型ポリープに対し完全腹腔鏡下手術を施行した1例を経験したので報告する．

はじめに : 高齢者胃癌患者における腹腔鏡下幽門側胃切除術（Laparoscopy-Assisted Distal Gastrectomy；以下，LADGと略記）の術後短期成績を非高齢者と比較し，その安全性と有用性を検討した．方法 : 対象は2001年1月から2009年9月までにLADGを施行した胃癌症例197例．70歳以上の高齢者群（63例）と70歳未満の非高齢者群（134例）に分け，患者背景や手術成績を比較検討した．またLADGを施行した197例に対して多変量解析を用いて術後合併症の危険因子を検討した．結果 : 術前併存疾患を有する頻度は高齢者群60.3%で，非高齢者群34.3%に比較して有意に高かった（p＜0.001）．手術時間は高齢者群で有意に短く（p=0.008），リンパ節郭清個数にも有意差がみられた（p=0.001）．術後合併症の頻度は，高齢者群4例（6.3%），非高齢者群7例（5.2%）と有意差は認められず，術後排ガス日や在院日数にも差はみられなかった．患者背景や術中因子の中から年齢，性別，BMI，術前併存疾患，手術時間，出血量，リンパ節郭清度，fStageの8項目を選択し多変量解析を行ったが，いずれの項目も術後合併症の独立した危険因子とはなりえなかった．考察 : LADGは合併症も少なく，術前併存疾患の多い高齢者に対しても安全に施行できる低侵襲な術式であると考えられた．

The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis.The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0-I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumorsT4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI30.No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7%, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95% (p = 0.125) and 5-year disease-free survival rates in stages 0-III were 97 and 94% (p = 0.189), 100 and 92% in stage II and 90 and 85% in stage III, respectively.This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.

This study investigated the potential benefits of combination therapy using antithrombin (AT) with danaparoid sodium (DA) compared with the use of AT with unfractionated heparin (UFH) in the treatment of sepsis.Rats infused with lipopolysaccharide were treated with either DA alone, AT alone, AT plus DA, AT plus UFH, or human serum albumin as controls. AT (125 U/kg) was injected into the AT group immediately after lipopolysaccharide infusion. The AT/DA and AT/UFH groups received the same dose of AT in conjunction with either DA (400 U/kg) or UFH (400 U/kg). The status of the mesenteric microcirculation was examined by intra-vital microscopy and the laboratory indices of coagulation, inflammation, and organ dysfunction were measured.The coagulation markers were improved following the administration of DA or UFH. The decreases in the WBC counts were significantly suppressed in the AT/DA group. The elevation of IL-6 decreased in the AT, DA, and AT/DA groups (all p0.01) but not in the AT/UFH group. The prostaglandin I2 levels were significantly elevated only in the AT/DA group (p0.05). The WBC adhesion was significantly suppressed in the DA, AT/UFH, and AT/DA groups (p0.05), and the RBC velocity was best maintained in the AT/DA group with no associated increase in capillary hemorrhage. The elevation of ALT and BUN significantly improved only in the AT/DA group. ONCLUSION: Organ dysfunction can thus be alleviated by even moderate doses of AT replacement when co-administered with DA.

Objective: Abnormalities in the vascular endothelial function play an important role in the development of septic organ dysfunction. The aim of the study was to examine the effect of recombinant human activated protein C on leukocyte-endothelial interaction in endotoxemia. Design: Experimental animal model of sepsis. Setting: University research laboratory. Subjects: Normal Wistar rats. Each animal was infused with 4.5 mg/kg lipopolysaccharide to simulate severe sepsis. Interventions: Rats were injected with endotoxin simultaneously with either a low or a high dose of recombinant human activated protein C (n = 7). One, 2, and 3 hrs after injection, mesenteric microcirculation was observed under intravital microscopy. In another series, tumor necrosis factor, interleukin-6, alanine transaminase, and blood urea nitrogen levels were evaluated (n = 5). Measurements and Main Results: The adhesive leukocyte count on the endothelium was significantly suppressed in both high-dose and low-dose groups (p

目的:エンドトキシン血症における活性化プロテインC(APC)のサイトカイン産生,白血球接着調節作用を検証する。方法:ラットにAPCを投与した後にエンドトキシン(LPS)を投与するAPC群(n=12)と0.5%アルブミンをした後にLPSを投与するコントロール群(n=12)を設定し,1,3時間後に炎症性サイトカイン(各群n=5),1,2,3時間後に腸間膜細小静脈における接着白血球を算定した(各群n=7)。結果:tumor necrosis factor, interleukin-6, cytokine-induced neutrophil chemoattractantレベルはAPC群において有意に抑制された。一方monocyte chemoattractant protein-1には差がなかった。さらにAPC群では白血球接着が有意に抑制された(P

Single-port laparoscopic surgery (SPLS) for colorectal cancer is a recent development in minimally invasive surgery. Although the devices and techniques for SPLS are being improved year by year, some technical difficulties remain. In this chapter, we explain how to perform SPLS for sigmoid and rectal cancer. SPLS is usually applied to patients with a relatively small tumor (less than 4 cm) and without peritonitis carcinomatosa. A vertical incision (approximately 2.5 cm in length) is made. After insertion of an atraumatic wound retractor (Alexis™ (Applied Medical, Rancho Santa Margarita, CA, USA)), which remains in place throughout the procedure, a multi-access platform (MAP) is manually inserted into the incision. In most cases, standard straight laparoscopic instruments are used. All SPLS procedures are performed with surgical techniques similar to those used in our standard laparoscopic procedures. Left-sided anastomoses are performed intracorporeally with a circular stapler. We usually divide the colon or rectum using a flexible laparoscopic linear stapler inserted through the MAP. However, when it is technically difficult to divide the rectum at the lower level, we often use the prolapsing technique to cut the rectum more confidently.

早期胃癌症例に対するD1+αリンパ節郭清を伴う腹腔鏡下幽門側胃切除術の手術侵襲度を, メディエータの推移から, 開腹による幽門側胃切除術と比較検討した. 対象は各群10例ずつで, Interleukin-6 (IL-6), Interleukin-10(IL-10)と好中球elastase(PMN-E)を術前から術後第3病日まで測定した. 結果, IL-6, IL-10の推移の比較では, 両群ともに術後軽度の上昇を示し群間で違いはみられなかった (IL-6: p=0.1, IL-10: p=0.78). PMN-E の推移の比較では, 腹腔鏡下幽門側胃切除術では術後の上昇が少なく, 開腹下幽門側胃切除術では継続的な上昇がみられその推移に違いがみられた (p=0.04).以上よりIL-6, IL-10は両群ともに上昇が少なく差が見られなかったが, PMN-E の推移の違いから腹腔鏡下幽門側胃切除術の開腹幽門側胃切除に対する低侵襲性が示唆された.

重症敗血症に対して行われるアンチトロンビンIII投与には,凝固機能抑制以外にも血管内皮機能調節やサイトカイン産生調節などが期待されている。今回われわれは,エンドトキシン投与ラットを用いてアンチトロンビンIII大量投与がサイトカイン産生に及ぼす影響を検証した。対象と方法:Wistar系ラットに中心静脈カテーテルを挿入してアンチトロンビンIII 250U/kgもしくは500U/kgをone-shotで静脈内に投与し,その30分後よりエンドトキシン5.0mg/kgを3時間かけて静脈内に持続投与した。そしてエンドトキシン投与終了6時間後に採血を行って血液生化学検査を行い,また投与終了後0hr, 3hr, 6hrの各時間における血中TNFα, IL-4, CINCレベルの測定を行った。結果と考察:AT-III 250, 500U/kgの投与により,AT-III活性はそれぞれ120%および170%程度を維持することが可能であった。そしていわゆるsupranormal levelに達したAT-III 500U/kg投与群においては血小板数の減少や,フィブリノーゲンの減少が有意に抑制された(各々p

重症敗血症に対して行われるアンチトロンビンIII (AT-III)投与には,凝固機能抑制以外にも血管内皮機能調節作用が期待されている。今回われわれは,エンドトキシン(LPS)投与ラットを用いて,AT-III大量投与が血管内皮細胞の血管作動因子産生に及ぼす影響を検討した。対象と方法:Wistarラットに中心静脈カテーテルを挿入して,翌日よりLPSを24時間かけて静脈内に持続投与し敗血症モデルとした。そして,これと同時にAT-III 250U/kgもしくは500U/kgを24時間静脈内に持続投与して,投与終了時における生存率,およびprostaglandin (PG)I2やendothelin-1を含む各種血中マーカーの測定を行った。なお,コントロールとしてAT-IIIの代わりに生理食塩水のみを投与する群も設定した。結果と考察:LPS 10.0mg/kg投与時のコントロール群の生存率は0%であったが,250U/kg投与群では50% (p

プロテインCは血管内皮表面のトロンボモジュリンによって活性化される,ビタミンK依存性のタンパクで抗凝固,線溶活性化に中心的な役割を担っている。今回SIRSの基準を3日間以上連続して満たした30症例においてプロテインC活性の測定を行い,敗血症時の挙動に関して検討を行った。対象例のうち15例においては臓器障害がみられず(SIRS群),11例ではDIC以外の臓器障害の合併がみられた(MODS群)。また4例ではDICを含む多臓器障害の合併がみられた(DIC群)。MODS, DIC群におけるSIRS発症後第3日のPC活性は各々47.3±23.3%, 32.0±9.0%で,SIRS群における68.9±22.5%よりも有意に低下していた(各々p

Background This study was designed to determine whether 5-fluorouracil combined with intermittent low-dose cisplatin (cis-diaminedichloroplatinum, CDDP), a 5-fluorouracil modulator, would be an effective antitumor regimen.

敗血症では比較的早期から過凝固状態が存在するが,これには単球/マクロファージや血管内皮細胞におけるtissue factor (TF)の表出による外因系凝固の活性化が考えられている。今回敗血症症例において血中のTFおよびその阻害作用を持つtissue factor pathway inhibitor (TFPI)の測定を行い,臓器障害やDICとの関連性を検討した。さらにインターロイキン6 (IL-6),好中球エラスターゼ(PMN-E),トロンボモジュリン(TM),エンドセリン1 (ET-1), thrombin antithrombin III complex (AT III), plasmin-α2 plasmin inhibitor complex (PIC)とTF, TFPIとの関係も検討した。対象はSIRSの基準を3日間以上連続して満たした敗血症38例で,このうち20例では臓器障害はみとめられず(SIRS群),10例はDIC以外の臓器障害を合併し(MODS群),8例はDICを含む多臓器障害を合併した(DIC群)。結果:DIC群におけるTFレベルは254.2±144.1pg/mlでMODS群やSIRS群よりも有意に高値であった。DIC群におけるTFPIも同様に,その他の群に比し有意に高値をとっていた。そして,TFは血管内皮の障害の指標であるTMやET-1と比較的高い相関を示したが,IL-6やPMN-E, TAT, PICとの間には相関はみられなかった。一方,TFPIではTMやET-1に加えIL-6やPMN-Eとの正相関もみられた。TF, TFPIとも凝固・線溶の指標したTAT, PICとの相関はみられなかった。結語:TFやTFPIは敗血症時に血管内皮の障害に伴って血中に放出され,DICのような内皮障害が高度である状態で高値を示すものと考えられた。しかしTFの分布はばらつきが大きく,TFPIは変動が軽度であるため重症度指標としての有用性には疑問が残った。

It is often technically difficult to cut the lower rectum with an endoscopic linear stapler in single-incision laparoscopic colorectal resections (SILC) because some surgical devices are inserted through the same access platform. If the rectum is cut incorrectly, it may cause anastomotic leakage. We recently applied natural orifice specimen extraction (NOSE) using the prolapsing technique to overcome this technical difficulty in SILC procedures in selected patients.The access platform is placed in the small umbilical incision area. SILC is performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach. The proximal part of the tumor site is transected with laparoscopic staplers. Then, the tumor lesion and bowel are pulled out of the body through the anus by means of inversion. Next, the distal side of the bowel is cut with a stapler and the rectal stump is reinforced with sutures under direct vision. The distal side of the bowel is then pushed back into the body. NOSE with prolapsing technique is then complete. After that, the anvil is attached to the proximal part of the bowel at the umbilical incision site, and intracorporeal anastomosis is performed.NOSE with prolapsing technique was applied in 14 SILC procedures for colorectal cancer patients. All procedures were successful, and there were no anastomotic leakages in the series. This technique enabled us to perform pure SILC safely without affecting cosmesis, even in cases where we needed to cut the lower rectum.

We investigated the feasibility of laparoscopic surgery for transverse colon cancer (TCC) by examining the results of this procedure, and comparing the short- and long-term outcomes with those for right-sided and sigmoid colon cancer (OSCC). The subjects consisted of 117 patients with TCC. Their complications, forms of recurrence and disease-free and 5-year survival rates were compared to those of 564 patients with OSCC. There were no significant between-group differences in the patient background. The average length of the operation in the TCC group was 215 min and that in the OSCC group was 184 min (p

Background: We recently developed a new technique of laparoscopic colectomy (LAC) for colorectal cancer. This procedure, called “Incisionless LAC (iLAC)”, involves completely laparoscopic double stapling technique (DST) without mini-laparotomy. Methods: This technique was applied in the cases with relatively early-stage cancer of the sigmoid colon or rectum. The procedure involved 5 ports. Lymph node dissection and mobilization of the bowel were carried out completely via a laparoscope. The specimen was extracted through the original anus. Anastomosis was laparoscopically performed with DST. Method A: The proximal and distal parts of the lesion are transected with laparoscopic staplers. The staple at the upper rectum is released, and the lesion is removed out of the body through the anus. The anvil is attached to the proximal part of the bowel laparoscopically, followed by intracorporeal side-to-end anastomosis with DST. Method B: The proximal part of the lesion is transected with laparoscopic staplers. Then, the lesion and bowel are pulled out of the body through the anus by means of inversion, followed by transection of the distal side of the bowel with a stapler. The distal side of the bowel is pushed back into the body, and the anvil is attached to the proximal part of the bowel laparoscopically. Then, intr acorporeal anastomosis with DST is performed. Results: Method A was applied in eight cases. Method B was applied in twelve cases. Postoperative complications developed in none of the cases. Although the postoperative follow-up period to date is still short, no tumor recurrence in the stump has occurred in any of the cases. Conclusion: Our experience indicates this “iLAC” technique is feasible for selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be prevented completely with this hybrid approach.

The ForceTriad™ generator has been recently developed. This new electrosurgical generator would demonstrate improved quality and efficiency in blood vessel sealing.To compare currently available 10-mm laparoscopic electrosurgical devices with the LigaSure™ Vessel Sealing System and ForceTriad generator (Valleylab, Inc., a division of Tyco Healthcare) for use in vessel sealing.Blood vessels of various types and diameters were harvested from alive four pigs using three instruments: LigaSure Atlas™ with LigaSure Vessel Sealing Generator (LSAt), LigaSure Atlas with ForceTriad Generator (LSAtFT), and Endoclip™ II (Autosuture, USSC; a division of Tyco Healthcare). A total of 100 arteries were processed by removal of fatty and connective tissue from the adventitia before sealing. An additional set of specimens was sealed and histopathologically analyzed after being stained with hematoxylin and eosin.The mean burst pressure was significantly higher with LSAtFT compared to LSAt (P 0.01). The sealing process was significantly shorter with LSAtFT (P 0.05). With regard to the degree of thermal injury, adventitial collagen denaturation and proximal thermal injury to the smooth muscle in the media of the vessel wall were less common with LSAtFT; however, the numbers were too small for statistical analysis.Both the LSAt and LSAtFT secured all vessel sizes to well above physiologic levels. The LSAtFT could be used more confidently in vessels up to 7 mm. Our findings indicate that LSAtFT could be a safer and more efficient instrument for advanced laparoscopic surgery.

The safety and effectiveness of laparoscopic surgery is well established for recurrent, uncomplicated diverticular disease, but not for complicated diverticular disease. Using the Hinchey classification, we compared laparoscopic colon resection (LAPH) with conventional open colon resection (OPH) for the treatment of complicated diverticulitis equivalent to Hinchey stage I-II.In this study, the Hinchey classification (I-IV) was also adopted for right-sided diverticulitis (I'-IV'). We reviewed the clinical records of 58 patients who underwent colon resection for complicated colon diverticulitis (Hinchey stage I-IV or I'-IV') between May 1994 and December 2008. Fifty-two patients underwent colon resection for Hinchey I-II or I'-II' disease; as LAPH in 36 and as OPH in 16. Only one patient required conversion to the open procedure after laparoscopy.The overall complication rate was significantly higher in the OPH group (43.8%) than in the LAPH group (16.7%; P0.05). Wound infection was significantly more common in the OPH group (37.5%) than in the LAPH group (11.1%; P0.05). Hospital stay was significantly shorter in the LAPH group (P0.05). Hartmann procedure was performed in one patient from each group. No anastomotic leakage occurred in either group.Our findings indicate that laparoscopic surgery can be performed safely and effectively even for patients with Hinchey I-II, I'-II' colonic diverticulitis.

Laparoscopy-assisted low anterior resection (LAR) for low rectal cancer is a difficult procedure, presenting problems with rectal washout, selecting the appropriate distal transection line, and achieving safe anastomosis. To resolve these problems, we used a prolapsing technique to perform laparoscopy-assisted LAR. Total mesorectal excision (TME) is performed laparoscopically. The proximal colon is transected laparoscopically with the aid of an endoscopic stapler, and the distal rectum, including the lesion, are everted and pulled transanally to outside the body. Only washout of and wiping off the distal rectum and intestinal resection are performed extracorporeally. The distal rectum is pushed back through the anus into the pelvis, and intracorporeal anastomosis is completed laparoscopically with a double-stapling technique. Our limited experience suggests that the prolapsing technique helps to prevent problems with laparoscopy-assisted LAR in selected patients with low rectal cancer.