No abstract

A 74-year-old man seen for anemic symptoms was found in abdominal computed tomography (CT) to have small -intestine wall thickening and an enlarged mesentery lymph node. Positron emission tomography (PET) showed a 4 cm tumor near the left pelvic intestinal tract. Double -balloon endoscopy showed a circumferential hemorrhagic type 2 tumor in the upper jejunum diagnosed as moderately differentiated adenocarcinoma based on site biopsy. The man was also diagnosed with primary small -intestine cancer and underwent partial small -intestine resection, local lymph node dissection, and functional end -to -end anastomosis. Histopathological findings yielded a final diagnosis of type 2 papillary adenocarcinoma, ly2, v1, pSS, pN1, sP0, sH0, and pM0. The postoperative course was satisfactory and he was discharged on postoperative day 12.

In this study, the trajectory planning method of the knife position of a slitter robot is proposed, and the experimental and numerical simulation results are demonstrated. The slitter robot consists of upper and lower knife driving mechanisms, and a knife driving mechanism was constructed with a worm gear, a ball screw and an alternating current (AC) motor. In the trajectory planning, first, the identification algorithm of the friction and the viscous damping is derived by using the equation of motion of the knife drive mechanism and the experimental results of the dynamic response with constant AC motor torque. Then, the trajectory planning algorithm of the knife position is presented, and a knife position control system is constructed. Furthermore, the experiments and numerical calculations have been carried out, and the usefulness of the present trajectory planning method is confirmed.

The objective of the present study was to investigate the utility of placing a chimney-type (stacked subcutaneous Penrose) drain to prevent surgical site infection (SSI), and particularly superficial SSI (sSSI), following surgery performed for lower gastrointestinal perforation. Subjects and methods: Our subjects were 93 patients who underwent emergency surgery after being diagnosed as having lower gastrointestinal perforation at our hospital from October 2009 to August 2020. All patients not meeting the inclusion criteria were excluded from the study. Subjects were divided into three groups (listed in chronological order): group C, 36 subjects with no drain inserted from 2009 to 2012; group B, 39 subjects in whom closed negative-pressure drains were placed from 2012 to 2017; and group A, 18 subjects in whom chimney-type drains were placed from 2017 to 2020. We retrospectively investigated patient factors, surgical factors, postoperative drain indwelling time, whether sSSI onset occurred and days until sSSI onset. sSSI was diagnosed based on the criteria published by the Japan Nosocomial Infection Surveillance (JANIS) program run by the Japanese Ministry of Health, Labour and Welfare. Results: The incidence of sSSI was lower in group B than in group C, but the difference was not statistically significant. The incidence of sSSI was significantly lower in group A than in group C (5.6% vs 33.3%, p=0.04) and was also lower in group A than in group B, but not statistically significantly so (5.6% vs 20.5%, p=0.24) Discussion: We believe that insertion of a chimney-type drain is useful for preventing sSSI in patients who have undergone surgery to treat lower gastrointestinal perforation.

Objectives: During laparoscopic right hemicolectomy, many surgeons make a small incision near the umbilicus after the routine intraperitoneal operation. In this study, we created a precursory small epigastric incision at the center of a line connecting the xiphoid process and umbilicus (the M point, an empirically determined position) at the start of surgery prior to laparoscopic manipulation. This study aimed to determine whether the small incision at the center of the M point was a suitable position through which the right hemicolon is extracted. Methods: The subjects included 148 patients who underwent laparoscopic right hemicolectomy at our hospital between January 2013 and December 2019. We measured the distance between the M point and the gastrocolic trunk (GCT) root at the base of the transverse mesocolon and the middle colic artery (MCA) root on preoperative contrast-enhanced computed tomography images. Results: We found that the GCT and MCA roots are located within a radius of 1.5 cm from the M point, suggesting that the base of the transverse mesentery was located almost directly below the M point. Comparisons based on sex differences and body mass index (BMI) also revealed that the transverse mesocolon root is closer to the M point in men and overweight patients. Conclusions: From these results, the placement of a precursory small epigastric midline incision not only allows for a safe insertion of the first laparoscopic port in a short period of time but also facilitates safe transection and anastomosis due to the proximity of the M point to the transverse mesocolon root.