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MVW1-5<br />
Novelhepaticinflowcontrolmethodenlarge<br />
indicationoflaparoscopicliverresseciton<br />
Sapporo Medical University<br />
○…TORU…MIZUGUCHI,Masaki…Kawamoto,Yukio…Nakamura,<br />
Makoto…Meguro,Masafumi…Imamura,Yasutoshi…Kimura,<br />
Toshihiko…Nishidate,Takayuki…Nobuoka,<br />
Tomohisa…Furuhata,Koichi…Hirata<br />
Background:…Indication…of…laparoscopic…liver…resection…is…limited…to…<br />
small…tumors…where…located…at…peripheral…of…the…liver…edge…and…liver…<br />
surface.……Unlike…open…liver…resection,…it…is…difficult…to…control…bleeding…<br />
in…pure…laparoscopic…liver…resection…(pure…Lap).……The…obstacle…to…<br />
conduct… pure… Lap… is… bleeding… from… Glisson… pedicle.……We… have…<br />
developed…a…new…technique…for…the…Pringle…maneuver…by…clamping…<br />
outside…the… abdominal…wall.……Our… technique…successfully…controls…<br />
bleeding…and…enables…pure…Lap…to…be…completed…without…any…events…<br />
even…for…a…large…tumor.……Methods:…A…prospective…study…of…pure…Lap…<br />
was…initiated…in…January…2008.……In…2009,…we…have…developed…a…new…<br />
Pringle… method… outside… the… abdominal… wall.……We… compared… the…<br />
patients…who…received…pure…Lap…with…(n=11)…and…without…(n=7)…<br />
this… Pringle…maneuver.……We… used… six… trocars…which… two… was… for…<br />
operator,…two…is…for…assistant,…one…is…for…the…camera,…and…one…is…for…<br />
Pringle…maneuver.……An…intermittent…Pringle…maneuver…was…applied…<br />
from…outside…the…abdominal…wall…with…10…min…warm…ischemia…and…5…<br />
min…reperfusion…when…bleeding…was…seen…at…the…dissecting…plane.<br />
Results:…There…was…no…difference…between…the…groups…regarding…<br />
clinical…demographics.……Although…tumor…size…in…the…Pringle…group…<br />
was…significantly…larger…than…in…the…no-…Pringle…group…(3.35…+…1.64…<br />
vs.…1.11…+…0.29…cm,…respectively),…intraoperative…bleeding…was…not…<br />
significantly… different…(165.5… +… 188.5… vs.… 177.9… +… 364.4… ml,…<br />
respectively).……On… the… other… hand,… operation… time… in… the… Pringle…<br />
group…was…significantly…longer…than…in…the…no-Pringle…group…(343.1…+…<br />
99.5…vs.…199.6…+…63.2…min,…respectively).Conclusions:…We…developed…<br />
a…new…Pringle…maneuver…outside…the…abdominal…wall…for…pure…Lap.…<br />
Pure…Lap…for…large…tumors…is…feasible…when…employing…this…method.…<br />
MVW1-6<br />
Laparoendoscopicsingle-site(LESS)<br />
fenestrationforlivercyst<br />
University of Occupational and Environmental Health<br />
○…TOSHIHISA…TAMURA,Noritaka…Minagawa,<br />
Kazunori…Shibao,Aiichirou…Higure,Koji…Yamaguchi<br />
Few… have…reported…about…LESS… surgery…for… liver… cyst.…We… have…<br />
performed… LESS… fenestration… of… liver… cyst… until… December… 2011.…<br />
They…were…two…men…and…three…women…with…the…median…age…of…69.4…<br />
years…(56-87).…The…mean…body…mass…index…was…21.1… ±…1.0…kg/m2.…<br />
The…mean…greatest…diameter…of…the…liver…cysts…was…11.4…±…3.4…mm…<br />
(6-15).…Three…had…liver…cysts…in…the…right…lobe…and…the…other…two…in…<br />
the… bilateral… lobes.… They… had… all… multiple… liver… cysts.… The… Mean…<br />
operation…time…was…105.8…±…21.8…min…and…the…mean…blood…loss…was…5…<br />
±…0…ml.…The…mean…postoperative…hospital…stay…was…5.8…±…1.5…days.…<br />
LESS… fenestration… was… successfully… performed… without… any…<br />
difficulties.…They…had…an…uneventful…postoperative…course.…The…LESS…<br />
surgery…has…been…successfully…applied…to…liver…cyst…fenestration…as…<br />
an…available…alternative…to…conventional…laparoscopic…fenestration.…<br />
This…method…is…technically…feasible…and…results…in…superior…cosmesis.<br />
MVW2-1<br />
Laparoscopicexcisionofcholedochalcysts<br />
Department of Surgery, Seoul National University<br />
College of Medicine, Seoul, Korea<br />
○…JIN-YOUNG…JANG<br />
Introduction:…In…spite…of…benign…disease,…choledochal…cyst…must…be…<br />
removed…with…the…gallbladder…(GB)…due…to…the…cancer…risk…in…the…<br />
biliary…tract.…The…most…of…patients…are…young…female…or…children,…<br />
who…have…strong…interest…in…cosmetic…results…in…addition…to…complete…<br />
resolution… of… medical… problems.… Here… we… introduce… laparoscopic…<br />
management…of…choledochal…cyst.<br />
Methods:… Between… 2003… and… 2012,… we… performed… laparoscopic…<br />
choledochal…cyst…excision…in…92…patients…using…4…hole…method.…There…<br />
were… 3… open… conversion… cases.… There… was… one… case… of… robotic…<br />
surgery…and…one…case…of…combined…laparoscopic…liver…resection…due…<br />
to…liver…involvement…of…cyst.…Excision…of…cyst…and…anastomosis…were…<br />
performed…laparoscopically.…We…will…present…our…method…showing…<br />
video.<br />
Results:……The…mean…operation…time…was…220…minutes.…The…estimated…<br />
blood…loss…was…190ml.…The…average…length…of…hospital…stay…was…8.3…<br />
days.…The…most…common…complication…was…minor…bile…leakage…(6.5%)…<br />
and…fluid…collection…(2.5%),…which…was…managed…conservatively.……<br />
Conclusions:…The…laparoscopic…management…can…be…a…treatment…of…<br />
choice…for…the…most…of…choledochal…cyst…considering…good…cosmetic…<br />
result…as…well…as…operative…safety.<br />
MVW2-2<br />
DistalPancreatectomy<br />
1<br />
Tohoku University、 2 Division of Integrated Surgery and<br />
Oncology, Tohoku University, Sendai, Japan<br />
○…SHINICHI…EGAWA 1 ,Shigeru…Ottomo 1 ,Takaho…Okada 1 ,<br />
Masaharu…Ishida 1 ,Koji…Fukase 1 ,Masamichi…Mizuma 1 ,<br />
Naoaki…Sakata 1,2 ,Hideo…Ohtsuka 1 ,Takanori…Morikawa 1 ,<br />
Hiroki…Hayashi 1 ,Kei…Nakagawa 2 ,Hiroshi…Yoshida 1 ,<br />
Tohru…Onogawa 1 ,Fuyuhiko…Motoi 1 ,Takeshi…Naitoh 1 ,<br />
Toshiki…Rikiyama 1 ,Yu…Katayose 2 ,Michiaki…Unno 2<br />
Distal…pancreatectomy…is…indicated…for…the…lesions…in…pancreatic…body…<br />
and…tail.…It…is…both…fundamental…technique…of…left…upper…abdominal…<br />
surgery… and… can… be… a… radical… final… approach… including… combined…<br />
resection…of… celiac… axis… or… other… surrounding…organs… for… invasive…<br />
cancer.… Preoperative… assessment… of… the… disease… extension… and…<br />
understanding… of… anatomical… structure… of… pancreas… and… its…<br />
surroundings… is… essential.… The… spleen… preserving… distal…<br />
pancreatectomy…is…indicated…for…the…benign…or…low…malignant…lesions…<br />
confined…in…the…pancreas.…Warshaw…procedure…that…conserve…spleen…<br />
by…the…blood…flow…from…short…gastric…vessels…and…Kimura…procedure…<br />
that… preserve… spleen… with… splenic… vessels… are… two… major… spleen…<br />
preserving… procedures… reported.… Even… laparoscopically,… splenic…<br />
vessels…can…be…preserved…by…dissecting…the…pancreas…from…median…<br />
toward… the… splenic… hilum… without… mobilization… of… the… spleen.… In…<br />
standard… distal… pancreatectomy,… dividing… splenic… artery… first… and…<br />
dissecting…pancreas…from…right-to-left…make…it…possible…to…decrease…<br />
bleeding… from… splenic… capsule… and… to… achieve… sufficient…<br />
retroperitoneal… negative…margins.…Standard…distal…pancreatectomy…<br />
by… medial… approach… is… video… presented.The… intraoperative…<br />
complications… of… distal… pancreatectomy… can… be… minimized… by…<br />
avoiding…splenic…capsule…injury,…by…secure…differentiation…of…splenic…<br />
artery… from… common… hepatic… artery,… and… by… secure… closure… of…<br />
splenic… vein… stump.… We… are… using… 5-0… monofilament… to… ligate… or…<br />
suture…the…main…pancreatic…duct…at…the…cut…end,…then…unabsorbable…<br />
5-0…monofilament…is…to…close…the…pancreatic…stump…in…a…fish…mouth…<br />
method.… Postoperative… pancreatic… fistula…(Grade… B/C)… of… distal…<br />
pancreatectomy… is… reported… to… be… 9.1-13.6 %… in… an… international…<br />
randomized…trial…of…stapler…vs.…hand-sewn…closure…(DISPACT)…trial.…<br />
Based…on…the…results,…the…closure…method…of…the…pancreatic…stump…<br />
can…be…a…surgeon’s…choice.…Board…certified…HBP…surgeon,…however,…<br />
should…understand…the…value…of…this…clinical…trial…that…accomplished…<br />
standardization…of… surgical…intervention…with… feasibility…and… high…<br />
validity…to…seek…the…next…step…to…improve…this…serious…complication.<br />
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