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Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

World Journal of Gastroenterology 2017年第32期23卷 5849-5859页

作者： tomohide hori takafumi machimoto yoshio kadokawa toshiyuki hata tatsuo ito shigeru kato daiki yasukawa yuki aisu yusuke kimura Maho Sasaki yuichi takamatsu taku kitano shigeo hisamori tsunehiro yoshimura department of gastrointestinal surgery tenriyorodusoudanjyo hospital

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

关键词： Laparoscopic 阑尾切除术急性阑尾炎间隔阑尾切除术外科推迟的阑尾切除术

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Protocol for laparoscopic cholecystectomy: Is it rocket science?

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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 considerations.Finally, 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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