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Protocol for laparoscopic cholecystectomy: Is it rocket science?

World Journal of Gastroenterology 2016年第47期22卷 10287-10303页

作者： Tomohide Hori fumitaka oike Hiroaki Furuyama Takafumi Machimoto Yoshio Kadokawa Toshiyuki Hata Shigeru Kato Daiki Yasukawa Yuki Aisu Maho Sasaki Yusuke Kimura Yuichiro Takamatsu Masato Naito Masaya Nakauchi Takahiro Tanaka Daigo Gunji Kiyokuni Nakamura Kiyoko Sato Masahiro Mizuno Taku Iida Shintaro Yagi Shinji Uemoto Tsunehiro Yoshimura Department of Gastrointestinal and General Surgery Tenriyorodusoudanjyo Hospital Department of Gastrointestinal Surgery Mitsubishi Kyoto Hospital Department of Anesthesiology Mitsubishi Kyoto Hospital Department of Gastroenterology and Hepatology Mitsubishi Kyoto Hospital Department of Hepatobiliary Pancreatic Surgery Kyoto University Hospital

Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical ***, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

关键词： Laparoscopic 胆囊炎胆囊安全的批评看法胆汁的损害协议

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Thrombotic microangiopathy-like disorder after living-donor liver transplantation:A single-center experience in Japan

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World Journal of Gastroenterology 2011年第14期17卷 1848-1857页

作者： Tomohide Hori Toshimi Kaido fumitaka oike Yasuhiro Ogura Kohei Ogawa Yukihide Yonekawa Koichiro Hata Yoshiya Kawaguchi Mikiko Ueda Akira Mori Yasutsugu Takada Hiroto Egawa Atsushi Yoshizawa Shinji Uemoto Hajime Segawa Kimiko Yurugi Takuma Kato Kanako Saito Linan Wan Mie Torii Feng Chen Ann-Marie T Baine Lindsay B Gardner Departments of Hepato-pancreato-biliary Transplant and Pediatric Surgery Kyoto University Hospital Kyoto 606-8507 Japan Department of Critical Care Medicine Kyoto University Hospital Kyoto 606-8507 Japan Department of Transfusion Medicine and Cell Therapy Kyoto University Hospital Kyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Hospital Graduate School of Medicine Mie 514-8507 Japan Department of Neuroscience Mayo Clinic Florida FL 32224 United States

AIM:To investigate thrombotic microangiopathy (TMA)in liver transplantion,because TMA is an infrequent but life-threatening complication in the transplantation field. METHODS:A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated,and the TMA-like disorder (TMALD) occurred in seven recipients. RESULTS:These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered,the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells,the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD,the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD,such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies,must be decided according to each case. CONCLUSION:The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT.

关键词：肝移植微血管血栓性活体血管性血友病因子金属蛋白酶血小板计数日本

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Comprehensive and innovative techniques for livertransplantation in rats: A surgical guide

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World Journal of Gastroenterology 2010年第25期16卷 3120-3132页

作者： Tomohide Hori Justin H Nguyen Yasuhiro Ogura Toshiyuki Hata Shintaro Yagi Ann-Marie T Baine Norifumi Ohashi Christopher B Eckman Aimee R Herdt Hiroto Egawa Yasutsugu Takada fumitaka oike Seisuke Saka-moto Mureo Kasahara Kohei Ogawa Koichiro Hata Taku Iida Yukihide Yonekawa Lena Sibulesky Kagemasa Kuribayashi Takuma Kato Kanako Saito Mie Torii Naruhiko Sahara Naoko Kamo Tomoko Sahara Motohiko Yasutomi Shinji Uemoto Department of Neuroscience Mayo Clinic Jacksonville Florida FL 32224 United States Division of Hepato-Pancreato-Biliary Transplant and Pediatric Surgery Department of Surgery Kyoto University HospitalSakyo-ku Kyoto 606-8507 Japan Division of Transplant Surgery Department of Transplantation Mayo Clinic Jackson-ville Florida FL 32224 United States Institute for Laboratory Animal Science and Ex-perimental Surgery RWTH-Aachen University D-52074 AachenGermany Department of Cellular and Molecular Immu-nology Mie University Graduate School of Medicine Tsu Mie514-8507 Japan New Zealand Liver Transplant Unit Auckland City Hospital Auckland 92024 New Zealand

AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful ***: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.

关键词： Animal model Liver transplantation Microsurgery Rat Reperfusion injury Ultra-microsurgery

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Laparoscopic-assisted catheter insertion for continuous ambulatory peritoneal dialysis:A case report of simple technique for optimal placement

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World Journal of Gastrointestinal Surgery 2013年第10期5卷 268-271页

作者： Tomohide Hori Masaya Nakauchi Kazuhiro Nagao fumitaka oike Takahiro Tanaka Daigo Gunji Noriyuki Okada Department of Surgery Mitsubishi Kyoto Hospital Department of Internal Medicine Mitsubishi Kyoto Hospital

A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative *** adequate gradient for tube fixation to the abdominal wall was *** CAPD tube was passed through a subcutaneous *** was induced to confirm that there was no air leakage from the sites of CAPD *** trocars were placed,and we confirmed that the CAPD tube led to the rectovesical *** position was reliably observed *** patency of the CAPD tube was confirmed during *** of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and *** technique should be considered the first choice for CAPD tube insertion.

关键词： Continuous ambulatory peritoneal dialysis Dialysis catheter Tube insertion Surgical technique

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Recycling of ironmaking and steelmaking slags in Japan and China

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International Journal of Minerals,Metallurgy and Materials 2022年第4期29卷 739-749页

作者： Hiroyuki Matsuura Xiao Yang Guangqiang Li Zhangfu Yuan fumitaka Tsukihashi Graduate School of Engineering The University of TokyoTokyo 113-8656Japan Key Laboratory of Coastal Environment and Resources of Zhejiang Province School of EngineeringWestlake UniversityHangzhou 310024China Institute of Advanced Technology Westlake Institute for Advanced StudyHangzhou 310024China Key Laboratory for Ferrous Metallurgy and Resources Utilization of Ministry of Education Wuhan University of Science and TechnologyWuhan 430081China Collaborative Innovation Center of Steel Technology University of Science and Technology BeijingBeijing 100083China The University of Tokyo Tokyo 113-8656Japan

The mass production of steel is inevitably accompanied by large quantities of *** treatment of ironmaking and steelmaking slags is a great challenge in the sustainable development of the steel *** and China are two major steel producing countries that have placed a large emphasis on developing new technologies to decrease slag emission or promote slag *** are almost completely reused or recycled in ***,due to stagnant infrastructural investments,future applications of slags in conventional sectors are expected to be *** new functions or applications of slags has become a research priority in *** example,the utilization of steelmaking slags in offshore seabeds to create marine forests is under *** is the top steel producer in the *** utilization ratios of ironmaking and steelmaking slags have risen steadily in recent years,driven largely by technological *** example,hot stage processing of slags for materials as well as heat recovery techniques has been widely applied in steel plants with good ***,increasing the utilization ratio of basic oxygen furnace slags remains a major *** innovations in slag recycling are crucial for the steel industries in Japan and ***,the current status and developing trends of utilization technologies of slags in both countries are reviewed.

关键词： ironmaking steelmaking slag recycling seawater stabilization

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Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

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World Journal of Gastrointestinal Surgery 2013年第10期5卷 272-277页

作者： Tomohide Hori Noriyuki Okada Masaya Nakauchi Shuji Hiramoto Ayako Kikuchi-Mizota Masahisa Kyogoku fumitaka oike Hidemitsu Sugimoto Junya Tanaka Yoshiki Morikami Kaori Shigemoto Toyotsugu Ota Masanobu Kaneko Masato Nakatsuji Shunji Okae Takahiro Tanaka Daigo Gunji Akira Yoshioka Department of Surgery Mitsubishi Kyoto Hospital Department of Medical Oncology Mitsubishi Kyoto Hospital Department of Histopathology Mitsubishi Kyoto Hospital Department of Gastroenterology Mitsubishi Kyoto Hospital Department of Radiology Mitsubishi Kyoto Hospital Department of Internal Medicine Mitsubishi Kyoto Hospital

Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic *** malignancies are located in the abdomen or *** with SMJN have a poor *** 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical *** findings revealed advanced transverse colon *** tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left *** feeding arteries and drainage veins for the SMJN were the inferior epigastric *** findings of the left lung tumor allowed for identification of the primary lung cancer,and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was *** patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node ***-abdominal dissemination to the mesocolon was confirmed during ***,the transverse colon cancer was confirmed to be moderately differentiated tubular *** suspect that SMJN may occur via a hematogenous *** chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home *** months after surgery,she died of rapidly growing lung cancer.

关键词： Umbilicus Sister Mary Joseph Singleincision laparoscopic surgery Palliative operation Hematogenous metastasis

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右叶活体供肝移植术中的胆道重建：321例受者间不同术式的比较研究

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医学信息（手术学分册） 2007年第8期20卷 763-763页

作者： Kasahara, Mureo Egawa, Hiroto Takada, Yasutsugu oike , fumitaka Sakamoto, Seisuke Kiuchi, Tetsuya Yazumi, Syujiro Shibata, Toshiya Tanaka, Koichi

目的：旨在确定右叶活体供肝移植术（Living—Donor Liver Transplantation，LDLT）后，接受胆总管端端吻合术或Roux—en—Y胆总管空肠吻合术重建胆道的患者其胆道并发症的发生率。概要背景资料：胆道并发症一直以来都是肝移植术后最严... 详细信息

目的：旨在确定右叶活体供肝移植术（Living—Donor Liver Transplantation，LDLT）后，接受胆总管端端吻合术或Roux—en—Y胆总管空肠吻合术重建胆道的患者其胆道并发症的发生率。概要背景资料：胆道并发症一直以来都是肝移植术后最严重的并发症之一。迄今未进行过任何大型系列研究比较LDLT中的这两种技术。本研究对应用的胆道重建方法利报道的并发症间的关系作了一项刚顷性评价。方法：1998年2月至2004年6月间，共有321例患者接受了柯叶LDLT。121例接受Roux—en—Y胆总管空肠吻合术，192例接受胆总管端端吻合术，8例接受Roux—en—Y和端端胆总管吻合术，均成功重建胆道。对胆管移植物和吻合数量、吻合方法、支架的应用，胆道并发症的处理都作了分析。结果：胆道并发症的总发病率为24．0％。单变量分析显示，肝动脉片发症，臣细胞病毒感染和由型不合址发生胆道并发症的重要危险闲素。Roux—en—Y和端端吻合重建术的胆漏和胆道狭窄的发病率分别为12．4％与8．3％和4．7％与26．6％。研究显示，胆总管端端吻合术中胆漏发生率较低而胆道狭窄的发生率较高；然而，74．5％的胆道狭窄都可通过内镜得到治疗。结论：作者发现胆总管端端吻合术中，胆道狭窄的发生率增高。端端吻合的胆道重建术由于保持较好的胆肠生理连续性，所以胆漏发生率更低，加之内镜治疗的简便易行，它成为石叶LDLT中较为适宜的一种手术方法。

关键词：胆道重建术肝移植术后胆总管端端吻合术胆总管空肠吻合术活体右叶胆道并发症 Roux

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Large Eddy Simulation for Unsteady Turbulent Field in Thin Slab Continuous Casting Mold

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Journal of Iron and Steel Research(International) 2011年第S2期18卷 243-250页

作者： fumitaka Tsukihashi Department of Advanced Materials Science Graduate School of Frontier Science University of Tokyo Kashiwa 277-8561 Japan

The unsteady turbulent flow during the continuous casting of steel is important, because it influences critical phenomena that affect steel quality. Unsteady three-dimensional flow in the mold region of the liquid pool during continuous casting of steel slabs has been computed using realistic geometries starting from the submerged inlet nozzle to the mold. The cassette filter function was used to deal with unsteady Navier-Stokes equation, and then the turbulent flow in the thin slab CCM was simulated with the large eddy simulation method combined with the Smagorinsky sub-grid scale model in this paper. And the model was verified by the Particle Image Velocimetry (PIV) experimental results which was got from a relate scientific literature. In this thesis, by means of LES, the flow characteristics in the thin slab CCM were acquired, such as the vortex distribution, the formation of the large eddy coherent structures, development, shedding and fracture process. In the same time, the turbulent asymmetric distribution was revealed even the nozzle in the centre position. Interactions between the two halves cause large velocity fluctuations near the meniscus. And the vortex is located at the low velocity side adjacent to the SEN. Along with the unsteady time development, the unsteady turbulent large vortex structures of the liquid steel in the CCM presented periodic bias flow distribution, and the period is about 20 seconds.

关键词： continuous casting mold unsteady large eddy simulation vortex coherent structures

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Study of Argon/Molten Steel Two-Phase Flow in Refining of High Clean Steel Using Two-Fluid Model

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Journal of Iron and Steel Research(International) 2011年第S2期18卷 176-181页

作者： TSUKIHASHI fumitaka Department of Advanced Materials Science Graduate School of Frontier Science University of Tokyo Kashiwa 277-8561 Japan

RH vacuum degasser is a very important secondary refining device in the production of high quality steels. The flow field of molten steel in RH system plays a significant role in determining productivity of the equipment. The homogeneous model and VOF method were often used to predict the flow field in RH system, but these kinds of models simplified the interaction between gas bubbles and molten steel. In the present work, a numerical model of a whole RH system, including vacuum degasser, immersed legs and ladle,was built based on gas-liquid two-fluid model, and it could be used to analyze the interaction between argon bubbles and molten steel, to understand the effect of the bubble size to the flow field.

关键词： RH vacuum degasser gas-liquid two-phase flow two-fluid model interaction

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Phase Equilibrium for the CaO-SiO_2-FeO-P_2O_5 System at 1673K for Dephosphorization With Multi Phase Flux

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Journal of Iron and Steel Research(International) 2011年第S2期18卷 84-86页

作者： Hiroyuki MATSUURA fumitaka TSUKIHASHI Graduate School of Frontier Sciences The University of Tokyo Kashiwa Chiba 277-8561 Japan

Development of the efficient hot metal dephosphorization processes during steelmaking process is one of the most essential topics for the production of high grade clean steels. Since the formation of solid solution composed of tricalcium phosphate and dicalcium silicate could obtain a considerable mass transfer of phosphorus from liquid slag into solid phase during hot metal dephosphorization, itcould obviously sustain a high phosphatecapacityof theliquid slag without huge consumption of lime or addition of fluxes, such as fluorite. The above outlines are the main idea of multi phase flux dephosphorization. For the last few decades, many studies have been done towards the scientific principles and the commercial utilization of this technique. However, the reaction mechanism by using multi phase fluxes remains unclear even by now due tolack of evidence. Based on those previous works, providing a reliable and available phase diagram for the fundamental understanding of the reaction mechanism of multi phase flux dephosphorization has become the main purpose of present research. As well known, the CaO-SiO2-FeO-P2O5 slag is the main component of current steelmaking process. Hence the CaO-SiO2-FeO-P2O5 system at equilibrium has been studied at 1673K with low oxygen partial pressure. The solid phase coexisting with liquid flux is approved to be the solid solution composed of CaO, SiO2 and P2O5. Phosphorus distributes mainly in solid solution rather than liquid phase.

关键词： steelmaking dephosphorization multi phase flux thermodynamics phase diagram

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