Biomedical subjects
Publications and source records attributed to Tomoyuki Nakagiri.
A 70-year-old woman was admitted for surgical treatment of a thymoma. She underwent thymectomy with left brachiocephalic vein resection because of invasion. Left pleural effusion appeared from postoperative day 4 and resolved with drainage. Herein, we report a rare case of pleural effusion associated with brachiocephalic vein resection.
BACKGROUND: Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (stage IA). METHODS: A multi-institutional, retrospective review was performed in 145 consecutive patients. Patients with clinical stage IA disease, with tumor size less than or equal to 2 cm in diameter, from three institutions underwent a complete VATS (c-VATS, n = 56), an assisted VATS (a-VATS, n = 34), or a conventional open (open, n = 55) approach for pulmonary lobectomy and lymph node dissection. RESULTS: Patients undergoing lobectomy and lymph node dissection with c-VATS had less blood loss, faster recovery, shorter hospitalization, and longer operating times than did patients undergoing the lobectomy with the a-VATS and open approaches. At a mean follow-up of 38.8 months, Kaplan-Meier probabilities of survival at 5 years were as follows: c-VATS, 96.7%; a-VATS, 95.2%; open, 97.2%. There was no significant difference in the rate of recurrence among the 3 different procedures. CONCLUSION: VATS lobectomy, a safe procedure with earlier return to normal activities, can be regarded as an acceptable cancer operation for the patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (clinical stage IA) with the same long-term survivals as open surgery.
When a conventional approach is used to perform a rib resection, a skin incision longer than the rib to be resected must be made. As a result, a conventional rib resection leaves a rather large and esthetically unfavorable scar. After considering pain management, esthetics, and quality of life, we devised a new technique for thoracoscopic rib resection that uses a Gigli saw. This new technique was performed on an overweight woman with a solitary metastatic bone tumor of the right eighth rib, whose case is described herein. The patient's postoperative course was satisfactory. Since this technique does not require a long skin incision, pain management and aesthetic results are improved compared with conventional techniques.
PURPOSE: Mediastinal exclusion type of empyema (MEE) is known as a type of chronic matrical empyema with no retention of pus. However, the number of patients with this condition who undergo treatment is still very limited because the indications for a panpleuropneumonectomy, namely the main surgical treatment for MEE, are extremely rare due to their unfavorable conditions. As a result, most cases of this disease are left untreated. METHODS: From April 2000 to December 2002, we experienced four cases of MEE, in which the conditions were so aggravated that cardiorespiratory insufficiencies were involved with them. All of them had been receiving oxygen therapy at home and the severity of symptoms were rated as III or IV according to the Hugh-Jones classification. The patients required surgical treatment as a semiemergency. RESULTS: We successfully performed safe and effective treatment in all cases through a novel approach with a devised incision and the severance of the osseous thorax for a panpleuropneumonectomy. CONCLUSION: We hope our newly devised operative method discussed herein will improve the outcome and postoperative management of chronic MEE patients.
BACKGROUND: We conducted a trial of a new less invasive, locoregional modality for lung cancer with pleural spread. This study was planned to investigate the feasibility, safety, and pharmacokinetics of pleural perfusion thermochemotherapy (PPTC) under video-assisted thoracoscopic surgery (VATS) and its modified method with a short perfusion time for preventing heat damage to the lung during the procedure. METHODS: Seventeen patients, 59 to 79 years old, underwent surgical resection of the primary lesions and PPTC under VATS without thoracotomy. All had pleural spread with malignant effusion due to lung cancer proven before the treatment. PPTC consists of irrigating the pleural space with 42 degrees C saline solution containing cisplatin (200 mg/m(2)) using a devised circuit. The time for perfusion was two hours in 10 patients (group L), and one hour in 7 patients (group S). RESULTS: All patients successfully completed this treatment with acceptable toxicities. The pharmacokinetic analysis showed that high platinum levels for the regional pleural exposure, which was 20- to 40-fold greater than those for the plasma in both groups. These values were equivalent between the groups, although the levels for the plasma were higher in group L than in group S. Postoperative lung damage was seen in 4 patients with no serious conditions in group L, and none in group S. The median survival for the L and S groups was 17 and 19 months, respectively. CONCLUSIONS: This less invasive modality seems to offer a safe, feasible, and pharmacokinetically advantageous procedure to have excellent local control for lung cancer with pleural spread.
PURPOSE: We present our initial evaluation of a new surgical technique of lung tissue sealing for nonanatomical pulmonary resection composed of sutureless and stapleless thoracoscopic surgery. DESCRIPTION: Twelve patients who required therapeutic thoracoscopic pulmonary resection from April 2001 to April 2002 were recruited for this study. Resection of lung parenchyma was performed with an ultrasound-driven scalpel, and the cut end was sealed using LigaSure, a new bipolar system. Measurement of the cut surface after resection during the surgery and assessment of LigaSure sealing strength was performed. EVALUATION: There were no deaths or major intraoperative complications. The mean operation time was 65 minutes, and mean hemorrhage volume was 46 mL. Average chest drain duration was 3 days, and average hospital stay was 6 days. One patient with a giant bulla and cut surface diameter of 50 mm experienced persistent air leak for 1 week. Late complications did not occur over the 8-month follow-up period. CONCLUSIONS: Video-assisted thoracoscopic surgery pulmonary resection using LigaSure instead of staplers appears technically feasible and easy, and produces satisfactory preliminary results. Although further studies are required to confirm the sealing strength and reliability of LigaSure, this technique should be considered for use in nonanatomical pulmonary resections.
This study was conducted to evaluate the use of quantitative scintigraphy with a newly designed marker to assess and predict the efficacy of lung volume reduction surgery in treating emphysema. In a series of 50 patients with severe emphysema who underwent the operation, ventilation/perfusion scintigraphy was performed and 2 markers of area ratio and lung uniformity were measured before and 6 months after surgery. The markers were correlated with the results of pulmonary function tests. The histopathological subtype of emphysema was also determined in the resected specimen and related to improvement in the markers. The markers were closely related to improvement in forced expiratory volume in 1 second, with the highest correlation being the marker lung uniformity measured by perfusion scintigraphy. Improvement in this marker was significantly greater in centrilobular than in panlobular emphysema. This quantitative method of scintigraphy could provide an excellent reflection of surgical efficacy as well as predict the surgical outcome. Additionally, it provides a mechanistic explanation for the differential improvement between the histopathological subtypes of emphysema following surgery.
OBJECTIVE: The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter. METHOD: According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm). RESULTS: The conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39+/-17 min vs. 56+/-22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems. CONCLUSION: The needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure.
We report a man with intrathoracic extramedullary hematopoiesis accompanied by marble bone disease who underwent thoracoscopic resection safely and definitively, followed by a radionuclide scan. Although intrathoracic extramedullary hematopoiesis is almost always accompanied by hemolytic anemia, this man's hematological data normalized. A consensus on the tumor genesis mechanism has yet to be reached, but the existence of marble bone disease in our case throws new light on the genetic mechanism in intrathoracic extramedullary hematopoiesis.
Thoracoscopic bullectomy performed with staplers is the main treatment for giant bullae in many institutions. However, there are certain problems associated with the increasing use of stapling devices. In response, we have applied a new operative method in which we excised a bulla with an ultrasonic-driven scalpel and successfully sealed the cut ends using the LigaSure Vessel Sealing System, a new bipolar system developed by Valleylab Inc. Herein we describe our experience with this newly designed technique which could render possible 'sutureless and stapleless' thoracoscopic surgery in the future.