Background
Given the worldwide popularization of conventional minimally invasive esophagectomy (C-MIE), robot-assisted MIE (RAMIE) can be expected to provide a finer procedure. However, controversy ...remains regarding whether RAMIE is superior to C-MIE in preventing recurrent laryngeal nerve (RLN) palsy. Considering the shallow learning curve for RAMIE, a novel procedure for lymphadenectomy along the RLN during RAMIE is needed.
Methods
Based on a logical and simple understanding of the left upper mediastinum anatomy, the authors developed a novel “modified bascule method” for RAMIE that could simplify lymphadenectomy along the left RLN and prevent it from being touched and stretched. Between 2018 and 2020, 46 patients with esophageal carcinoma underwent RAMIE using this method at Kobe University.
Results
The modified bascule method was used to perform RAMIE for 29 men and 17 women with a median age of 67 years (range, 49–82 years). The median thoracoscopic procedure time was 438 min (range, 344–625 min), and the median console time was 351 min (range 273–518 min). The study harvested a median of 24 (range, 8–34) lymph nodes from the thoracic portion and 4 (range, 0–10) lymph nodes from along the left RLN. The mortality rate was 0%. Postoperative left RLN palsy classified as Clavien–Dindo (C–D) grade 1 or higher was observed for 9 patients (19%), whereas grade 2 or higher was not seen (0%). Pneumonia and anastomotic leakage rates higher than C–D grade 2 were respectively 13% and 19%.
Conclusions
The novel modified bascule method for RAMIE can promote feasible lymphadenectomy along the left RLN even when performed during the learning period.
Background
Subtotal cholecystectomy (SC) is a useful procedure for avoiding bile duct injury in patients with difficult gallbladder. However, risk factors for conversion to SC, especially ...preoperative magnetic resonance cholangiopancreatography (MRCP) findings that predict conversion to SC, have not been investigated in detail.
Methods
A total of 290 patients with acute cholecystitis who underwent laparoscopic cholecystectomy at our hospital between November 2011 and March 2020 were included. Patient characteristics and perioperative outcomes were reviewed, and preoperative clinical factors predicting conversion to SC were investigated.
Results
Forty-three patients underwent SC, whereas the remaining 247 patients underwent total cholecystectomy. An American Society of Anesthesiologists (ASA) score of 3 or greater (
p
= 0.011), surgery on or after 9 days from symptom onset (
p
< 0.001), obscuration of the gallbladder wall around the neck on MRCP images (
p
= 0.010) and disruption of the common hepatic duct on MRCP images (
p
< 0.001) were significantly associated with conversion to SC. Logistic regression analyses revealed that an ASA score of 3 or greater (odds ratio = 2.667,
p
= 0.020), surgery on or after 9 days from symptom onset (odds ratio = 4.229,
p
< 0.001) and disruption of the common hepatic duct on MRCP images (odds ratio = 4.478,
p
= 0.002) were independent predictors for conversion to SC.
Conclusions
Early surgery yielded a lower risk for conversion to SC. Disruption of the common hepatic duct on preoperative MRCP images is associated with a risk for conversion to SC.
Background
Esophagectomy with lymphadenectomy is the principal treatment for localized esophageal cancer. Conventional minimally invasive esophagectomy (C-MIE) in prone position has spread worldwide ...as it is less invasive. However, its efficacy remains controversial. Robot-assisted MIE (RAMIE) can have more advantages than C-MIE. Therefore, the current study aimed to validate whether RAMIE is associated with lower incidence of left recurrent laryngeal nerve (RLN) palsy compared with C-MIE in prone position.
Patients and Methods
In total, 404 patients with esophageal carcinoma underwent MIE (353 C-MIEs and 51 RAMIEs) in prone position at Kobe University between 2010 and 2020. Then, propensity score matching was performed, and results showed that 51 patients should be included in each group. Thereafter, the perioperative outcomes between the two groups were compared.
Results
The RAMIE group had a significantly longer operative time than the C-MIE group (
P
< 0.0001). However, the number of lymph nodes resected along the left RLN was similar in both groups. Moreover, the incidence of left RLN palsy was significantly lower in the RAMIE group than in the C-MIE Clavien–Dindo classification grade II; 0 (0%) versus 32 (9%),
P
= 0.022 in entire cohort, and 0 (0%) versus 5 (10%),
P
= 0.022 in matched cohort. Esophagectomy Complications Consensus Group definitions type I; 8 (16%) versus 101 (29%),
P
= 0.041 in entire cohort and 8 (16%) versus 18 (35%) in matched cohort,
P
= 0.023.
Conclusion
RAMIE is superior to C-MIE in prone position in decreasing the incidence of left RLN palsy.
Background
Esophageal squamous cell cancer (ESCC) is one of the deadliest cancers in the world. Esophagectomy remains the principal treatment, and minimally invasive esophagectomy (MIE) has been ...performed worldwide. This study aimed to clarify whether the lymph node ratio (LNR), defined as the ratio of metastatic lymph nodes (LNs) to examined, is a prognostic factor for ESCC after MIE.
Methods
This study included 327 MIEs with the patient in the prone position at two institutions from 2010 to 2015. Cox proportional hazards regression analyses using clinicopathologic characteristics and the LNR were performed for the pN1 patients and the whole cohort.
Results
In the multivariate analysis for all stages, independent prognostic factors were depth of tumor invasion (
P
< 0.0001), LNR (
P
= 0.014), operative time (
P
= 0.003), and pneumonia (
P
= 0.012). In the analysis of the pN1 subgroup, the optimum LNR cutoff level for overall survival (OS) was 9 based on receiver operation characteristic analysis. The LNR was significantly associated with depth of tumor invasion (
P
= 0.004) and number of metastatic LNs (
P
< 0.0001). The OS curve for the group with an LNR of 9 or higher was significantly worse than for the group with an LNR lower than 9 (
P
< 0.001). Multivariate analyses demonstrated that the LNR is a unique independent prognostic factor for the pN1 subgroup (hazard ratio, 6.811; 95% confidence interval, 2.009–23.087;
P
= 0.002).
Conclusions
The LNR is an independent prognostic factor in ESCC after MIE. Especially for patients with pN1 status, the LNR is more useful than the number of metastatic LNs for predicting survival outcome.
Hydroxyapatite (HAp), a type of calcium phosphate found in bones and teeth, exhibits proton conductivity. In this study, its conductivity is investigated by measuring the complex permittivity of ...polycrystalline hydroxyapatite samples obtained via a sintering process. The dielectric dispersions measured from samples with different grain sizes are successfully explained using the Maxwell-Wagner interfacial polarization model. The results show that polycrystalline hydroxyapatite consists of both a high impedance grain boundary and a proton-conductive grain that has a conductivity of about 1.0×10−7Scm−1 at 573K. The interfacial polarization is confirmed using thermally stimulated depolarization current measurements. Additionally, electrets are prepared with the polycrystalline HAp via a poling process, and it is demonstrated that the electret formation is caused by the interfacial polarization.
•Hydroxyapatite conductivity is studied via complex permittivity measurements.•The hydroxyapatite consists of conductive grains and insulative grain boundaries.•Interfacial polarization is confirmed via depolarization current measurements.•The interfacial polarization makes the hydroxyapatite an electret.
We developed herein photoluminescent glass ceramics based on rare-earth ion-doped Na5YSi4O12-type materials according to the Na3+3xY1−x−yRySi3O9 (R: Sm3+, Eu3+, Dy3+, Tb3+) composition. Glass ...ceramics generally have the advantages of excellent chemical durability, heat resistance, and moldability over sintered ceramics. Upon irradiation with near-ultraviolet light, Sm3+-, Eu3+-, Dy3+-, and Tb3+-doped glass ceramics emit purplish orange, reddish orange, yellow, and green lights, respectively. The photoluminescent emission intensity of glass ceramics is higher than that of the original glasses, and the emission intensity depends on the crystalline phase. The highest emission intensity of various rare-earth ion-doped glass ceramics is obtained when the parameter y is equal to 0.03, 0.16, and 0.02 for the Sm3+-, Eu3+-, and Dy3+-doped glass ceramic samples, respectively. The internal quantum efficiency is 3%, 37%, 7% and 23% for the Sm3+-, Eu3+-, Dy3+-, and Tb3+-doped samples, respectively. Thus the Na superionic conducting Na5YSi4O12-type glass-ceramics were proved to have potentiality as novel phosphors.
Background
Recently, several new imaging technologies, such as three-dimensional (3D)/high-definition (HD) stereovision and high-resolution two-dimensional (2D)/4K monitors, have been introduced in ...laparoscopic surgery. However, it is still unclear whether these technologies actually improve surgical performance.
Methods
Participants were 11 expert laparoscopic surgeons. We designed three laparoscopic suturing tasks (task 1: simple suturing, task 2: knotting thread in a small box, and task 3: suturing in a narrow space) in training boxes. Performances were recorded by an optical position tracker. All participants first performed each task five times consecutively using a conventional 2D/HD monitor. Then they were randomly divided into two groups: six participants performed the tasks using 3D/HD before using 2D/4K; the other five participants performed the tasks using a 2D/4K monitor before the 3D/HD monitor. After the trials, we evaluated the performance scores (operative time, path length of forceps, and technical errors) and compared performance scores across all monitors.
Results
Surgical performances of participants were ranked in decreasing order: 3D/HD, 2D/4K, and 2D/HD using the total scores for each task. In task 1 (simple suturing), some surgical performances using 3D/HD were significantly better than those using 2D/4K (
P
= 0.017,
P
= 0.033,
P
= 0.492 for operative time, path length, and technical errors, respectively). On the other hand, with operation in narrow spaces such as in tasks 2 and 3, performances using 2D/4K were not inferior to 3D/HD performances. The high-resolution images from the 2D/4K monitor may enhance depth perception in narrow spaces and may complement stereoscopic vision almost as well as using 3D/HD.
Conclusions
Compared to a 2D/HD monitor, a 3D/HD monitor improved the laparoscopic surgical technique of expert surgeons more than a 2D/4K monitor. However, the advantage of 2D/4K high-resolution images may be comparable to a 3D/HD monitor especially in narrow spaces.
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