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Reduced port surgery for appendectomy:Early experience and surgical technique

World Journal of Surgical Procedures 2013年第2期3卷 8-12页

作者： Shinichiro Mori Kenji Baba Shigehiro Yanagita Yoshiaki Kita Kosei Maemura Yuko Mataki Yasuto Uchikado Hiroshi Okumura Tetsuhiro Nakajyo Shoji Natsugoe Sonshin Takao kuniaki aridome Department of Digestive Surgery Breast and Thyroid Surgery Graduate School of Medicine Kagoshima University Kagoshima 890-8520 Japan Frontier Science Research Center Kagoshima University Kagoshima 890-8520 Japan Department of Surgery Nanpuh Hospital NKagoshima 892-8512 Japan

AIM: To evaluate our experience and surgical technique of laparoscopic appendectomy via reduced port surgery(LARPS). METHODS: Sixteen patients(8 men and 8 women; median age: 31.0 years) who underwent LARPS between November 2009 and May 2012 were included in the present study. We performed LARPS, in which access devices were inserted through an umbilical skin incision with 1 additional skin incision in the left lower abdomen. After setting access devices, pneumoperitoneum was maintained at 10 mmH g using CO2 and a 3 mm trocar was positioned(or direct puncture was performed by the Endo Relief system) under laparoscopic guidance. The mesoappendix was dissected using an ultrasonically activated device. After mesoappendix dissection, ligation was performed near the appendix base and the appendix was dissected using an ultrasonically activated device. The appendix was then removed. At the end of surgery, we administered local anesthesia with ropivacaine 1%(10 mL) for the skin incisions. The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of postoperative hospital stay and surgical complications. RESULTS: Our surgical procedure allowed operators to use instruments as in conventional laparoscopic appendectomy. The basic principle of triangulation of instrumentation was maintained to some degree. LARPS was performed in 9 patients with catarrhal appendicitis, 5 with phlegmonous appendicitis, and 2 with gangrenous appendicitis. The median surgery time was 60 min and the median intraoperative blood loss was 1.2 mL. The median length of postoperative hospitalization was 4 d. There were no conversions to open surgery, no operation-related complications or mortality. CONCLUSION: Our experience and surgical technique suggest that LARPS is a safe and feasible procedure for patients with appendicitis.

关键词： Reduced port surgery Appendectomy Laparoscopy Cosmesis Single incision

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Autoimmune pancreatitis with IgG4-positive plasma cell infiltration in salivary glands and biliary tract

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World Journal of Gastroenterology 2005年第35期11卷 5577-5581页

作者： Masashi Taguchi Gentaro aridome Shintaro Abe Keiichiro Kume Mitsuo Tashiro Mitsuyoshi Yamamoto Yasuyuki Kihara Hayato Nakamura Makoto Otsuki Third Department of Internal Medicine University of Occupational and Environmental Health Japan School of Medicine Kitakyushu Japan

A 62-year-old male was referred to our hospital because of liver dysfunction, diffuse pancreatic swelling, and trachelophyma. At admission, the patient was free of pain. Physical examination showed enlarged and palpable bilateral submandibular masses, but no palpable mass or organomegaly in the abdomen. Laboratory findings were as follows： total protein 90 g/L with γ-globulin of 37.3% （33 g/L）, total bilirubin 4 mg/L, aspartate aminotransferase 39 IU/L, alanine aminotransferase 67 IU/L,γ-glutamyl transpeptidase 1 647 IU/L, and amylase 135 IU/L. Autoantibodies were negative, and tumor markers were within the normal range. Serum IgG4 level was markedly elevated （18 900 rag/L）. Computed tomography （CT） showed diffuse swelling of the pancreas and dilatation of both common and intra-hepatic bile ducts. Endoscopic retrograde pancreatography （ERP） revealed diffuse irregular and narrow main pancreatic duct and stenosis of the lower common bile duct. Biopsy specimens from the pancreas, salivary gland and liver showed marked periductal IgG4-positive plasma cell infiltration with fibrosis. We considered this patient to be autoimmune pancreatitis （AIP） with fibrosclerosis of the salivary gland and biliary tract, prescribed prednisolone at an initial dose of 40 mg/d. Three months later, the laboratory data improved almost to normal. Abdominal CT reflected prominent improvement in the pancreatic lesion. Swelling of the salivary gland also improved. At present, the patient is on 10 mg/d of prednisolone without recurrence of the pancreatitis. We present here a case of AIP with fibrosclerosis of salivary gland and biliary tract.

关键词： Autoimmune pancreatitis Fibrosclerosis IgG4-positive plasma cell Salivary gland

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