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Comprehensive and innovative techniques for laparoscopic choledocholithotomy:A surgical guide to successfully accomplish this advanced manipulation

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World Journal of Gastroenterology 2019年第13期25卷 1531-1549页

作者： tomohide hori Department of Hepato-Biliary-Pancreatic Surgery Kyoto University Graduate School of Medicine

Surgeries for benign diseases of the extrahepatic bile duct(EHBD) are classified as lithotomy(i.e., choledocholithotomy) or diversion(i.e.,choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures,and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of *** choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes;however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.

关键词： Laparoscopic surgery Choledocholithotomy Bile duct Laparoscopy General surgery

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Technical aspects in pancreaticoduodenectomy and therapeutic strategies for pancreatic cancer:History,current status,and future perspectives

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Hepatobiliary & Pancreatic Diseases International 2022年第6期21卷 600-602页

作者： tomohide hori Daiki Yasukawa Department of Surgery Shiga General HospitalMoriyama 524-8524Japan Department of Surgery Shiga University of Medical ScienceOtsu 520-2192Japan

The incidence of pancreatic cancer(PC)has increased,and in-vasive ductal adenocarcinoma is the most common among PC pa-tients[1].Even in patients who receive radical treatments,namely chemotherapy and surgery,the five-year survival is only 2%-9%[1].Currently,many physicians recognize that further developments in multidisciplinary therapy are crucial to overcome PC[1].

关键词： cancer chemotherapy surgery

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Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

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World Journal of Gastrointestinal Oncology 2018年第11期10卷 381-397页

作者： Yuki Aisu Daiki Yasukawa Yusuke Kimura tomohide hori Department of Digestive Surgery Tenri Hospital Department of Surgery Shiga University of Medical Science Department of Hepato-Biliary-Pancreatic Surgery and Transplantation Graduate School of Medicine Kyoto University Department of Surgery Shiga General Hospital

Laparoscopic and endoscopic cooperative surgery(LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors(GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to av-oid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according tothe concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

关键词： Minimally invasive surgery Laparoscopic and endoscopic cooperative surgery Facility-based Gastrointestinal stromal tumor Early gastric cancer

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Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

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World Journal of Gastrointestinal Surgery 2020年第7期12卷 307-325页

作者： Daiki Yasukawa Yuki Aisu tomohide hori Department of Surgery Shiga University of Medical ScienceOtsu 520-2192Japan Department of Surgery Kyoto University Graduate School of MedicineKyoto 606-8507Japan

Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal(TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal(posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

关键词： Inguinal hernia Femoral hernia Obturator hernia Laparoscopic surgery Laparoscope Anatomy

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Progressive familial intrahepatic cholestasis

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Hepatobiliary & Pancreatic Diseases International 2010年第6期9卷 570-578页

作者： tomohide hori Justin H.Nguyen Shinji Uemoto Department of Neuroscience Mayo Clinic in Florida Division of Transplant Surgery Department of Transplantation Mayo Clinic in Florida Divisions of Hepato-Biliary-Pancreatic Pediatric and Transplant SurgeryDepartment of SurgeryKyoto University Hospital

BACKGROUND:Three types of progressive familial intrahepatic cholestasis(PFIC)have been identified,but their etiologies include unknown mechanisms. DATA SOURCES:A PubMed search on'progressive familial intrahepatic cholestasis'and'PFIC'was performed on the topic,and the relevant articles were reviewed. RESULTS:The etiologies of the three PFIC types still include unknown *** in PFIC type 1,enterohepatic circulation of bile acid should be *** acid,partial external biliary diversion and liver transplantation have been used for the treatment of PFIC patients according to disease course. CONCLUSIONS:Since the etiologies and disease mechanisms of PFIC are still unclear,detailed studies are urgently required. Strategies for more advanced therapies are also *** developments in the future are indispensable,especially for PFIC type 1 patients.

关键词： progressive familial intrahepatic cholestasis Byler's disease liver transplantation steatosis

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Fulminant liver failure models with subsequent encephalopathy in the mouse

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Hepatobiliary & Pancreatic Diseases International 2011年第6期10卷 611-619页

作者： Ann-Marie T Baine tomohide hori Lindsay B Gardner Shinji Uemoto Justin H Nguyen Department of Neuroscience Mayo Clinic in Florida JacksonvilleFL 32224USA Divisions of Hepato-Pancreato-Biliary Transplant and Pediatric SurgeryDepartment of SurgeryKyoto University Graduate School of MedicineKyoto 606-8507Japan Division of Transplant Surgery Department of TransplantationMayo Clinic in FloridaJacksonvilleFL 32224USA

BACKGROUND:A reliable model of fulminant liver failure (FLF) is urgently required in this research *** study aimed to develop a murine FLF ***:We used three groups of male C57BL/6 mice:control,with azoxymethane treatment (AOM group),and with galactosamine and tumor necrosis factor-alpha treatment (Gal+TNF-α group).The effects of body temperature (BT) control on survival in all three groups were investigated Using BT control,we compared the survival,histopathological findings and biochemical/coagulation profiles between the two experimental *** effects of hydration on international normalized ratios of prothrombin time (PT INRs) were also ***-dependent survival curves were constructed for both experimental *** behavior was assessed using a coma ***:No unexpected BT effects were seen in the control *** AOM group,but not the Gal+TNF-α group showed a significant difference in survival curves between those with and without BT *** assessment showed consistent FLF findings in both experimental groups with BT *** were significant differences between the experimental groups in aspartate aminotransferase levels and PT-INRs,and significant differences in PT-INRs between the sufficiently and insufficiently hydrated *** were significant differences between FLF models in the duration of each coma stage,with significant differences in stages 1 and 3 as percentages of the disease state (stages 1-4).The two FLF models with BT care showed different survival curves in the dose-dependent survival ***:AOM provides a good FLF model,but requires a specialized environment and careful BT *** FLF models may also be useful,depending on the research *** attention to caregiving and close observation are indispensable for successful FLF models.

关键词： animal model acute liver failure azoxymethane galactosamine tumor necrosis factor-alpha

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Matrix metalloproteinase-9 in the initial injury after hepatectomy in mice

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World Journal of Gastroenterology 2013年第20期19卷 3027-3042页

作者： Norifumi Ohashi tomohide hori Florence Chen Sura Jermanus Akimasa Nakao Shinji Uemoto Justin H Nguyen Gastroenterological Surgery Nagoya University Graduate School of MedicineNagoyaAichi 466-8550Japan Divisions of Hepato-PancreatoBiliary Transplant and Pediatric SurgeryDepartment of SurgeryKyoto University Graduate School of MedicineKyoto 606-8507Japan Department of Neuroscience Mayo ClinicJacksonvilleFL 32224United States Division of Transplant Surgery Department of TransplantationMayo Clinic in FloridaJacksonvilleFL 32224United States

AIM:To investigate the role of matrix metalloproteinase(MMP)-9 in the pathogenesis of postoperative liver failure(PLF) after extended hepatectomy(EH).METHODS:An insufficient volume of the remnant liver(RL) results in higher morbidity and mortality,and a murine model with 80%-hepatectomy was *** investigations were performed 6 h after *** were first divided into two groups based on the postoperative course(i.e.,the PLF caused or did not),and MMP-9 expression was measured by Western *** source of MMP-9 was then determined by immunohistological *** inhibitor of metalloproteinase(TIMP)-1 is the endogenous inhibitor of MMP-9,and MMP-9 behavior was assessed by the experiments in wild-type,MMP-9(-/-) and TIMP-1(-/-) mice by Western blotting and gelatin *** behavior of neutrophils was also assessed by immunohistological *** anti-MMP-9 monoclonal antibody and a broadspectrum MMP inhibitor were used to examine the role of ***:Symptomatic mice showed more severe PLF(histopathological assessments:2.97 ± 0.92 vs 0.11 ± 0.08,P < 0.05) and a higher expression of MMP-9(71085 ± 18274 vs 192856 ± 22263,P < 0.01).Nonnative leukocytes appeared to be the main source of MMP-9,because MMP-9 expression corresponding with CD11b positive-cell was observed in the findings of immunohistological *** the histopathological findings,the PLF was improved in MMP-9(-/-) mice(1.65% ± 0.23% vs 0.65% ± 0.19%,P < 0.01) and it was worse in TIMP-1(-/-) mice(1.65% ± 0.23% vs 1.78% ± 0.31%,P < 0.01).Moreover,neutrophil migration was disturbed in MMP-9(-/-) mice in the immunohistological *** methods of MMP-9 inhibition revealed reduced PLF,and neutrophil migration was strongly disturbed in MMP-9-blocked mice in the histopathological assessments(9.6 ± 1.9 vs 4.2 ± 1.2,P < 0.05,and 9.9 ± 1.5 vs 5.7 ± 1.1,P < 0.05).CONCLUSION:MMP-9 is important for the process of *** initial injury is associated with MMP-9 derived from neutrophil

关键词： Matrix metalloproteinase Shear stress Sinusoidal injury Hepatectomy Portal hypertension

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Sinistral portal hypertension and distal splenorenal shunt during pancreatic surgery

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 73-75页

作者： tomohide hori Ryuhei Aoyama Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto Masahiro Yamada Takefumi Yazawa Masazumi Zaima Department of Surgery Shiga General Hospital5-4-30 MoriyamaMoriyama CityShiga Prefecture524-8524Japan

Locally advanced pancreatic cancer located in the head or un-cinate process(i.e.,uncus)often invades the confluence of the superior mesenteric vein(SMV),portal vein(PV),and splenic vein(SV)[1,2].Additionally,chronic pancreatitis easily occludes drainage flow via the SV[3].These pancreatic diseases force sur-geons to perform en bloc resection of the *** ligation of the remnant SV without venous resection results in sinistral por-tal hypertension(PH)(i.e.,left-sided PH),gastrointestinal bleeding,splenic congestion,and hypersplenism over the long term[1,2].

关键词： hypertension shunt diseases

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Assessment of cardiac output in liver transplantation recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 362-366页

作者： tomohide hori Chiduru Yamamoto Shintaro Yagi Taku Iida Kentaro Taniguchi Takashi Hasegawa Koichiro Yamakado Yukinobu hori Kan Takeda Kazuo Maruyama Shinji Uemoto Department of Hepato-Pancreato-Biliary Surgery and Transplantation Kyoto University Hospital54 Shogoinkawara- choSakyo-kuKyoto606-8507Japan Department of Hepatobiliary Pancreatic Surgery Mie University Hospital2-174 EdobashiTsu CityMie Prefecture514-8507 Japan Department of Anesthesiology and Critical Care Medicine Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Department of Radiology Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Nagoya Economic University Graduate School of Law 61-1 UchikuboInuyama City Aichi Prefecture 484-8504Japan

BACKGROUND:Liver cirrhosis causes peculiar systemic hemodynamics,and accurate evaluation of systemic hemodynamic state is important for cirrhotic recipients who underwent living donor liver transplantation(LDLT). We investigated the clinical advantages of a novel non- invasive method for measuring systemic hemodynamic parameters using indocyanine green(ICG). METHODS:Twenty-eight LDLT recipients were evaluated. Simultaneous measurements of cardiac output(CO)using Swan-Ganz catheters and pulse dye densitometry(PDD) were performed every 12 hours after LDLT.A total of 155 sets of simultaneous CO measurements were obtained. RESULTS:The CO values obtained by PDD correlated well with those obtained by the invasive catheter *** addition,none of the recipients developed any side-effects, and we verified the safety of repeated ICG *** is safe,even for repeated use over time in the same recipient. Moreover,PDD can measure the blood volume(BV).CONCLUSIONS:Since the cirrhotic systemic hemody- namics characterized by high CO and large BV remains, even after LDLT,the ability to measure CO and BV in a non-invasive,simple and real-time manner using PDD has advantages for cirrhotic LDLT recipients.

关键词： liver transplantation indocyanine green pulse dye densitometry blood volume cardiac output liver cirrhosis

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Fascinating history of groin hernias:Comprehensive recognition of anatomy,classic considerations for herniorrhaphy,and current controversies in hernioplasty

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World Journal of Methodology 2021年第4期11卷 160-186页

作者： tomohide hori Daiki Yasukawa Department of Surgery Shiga General HospitalMoriyama 524-8524ShigaJapan Department of Surgery Shiga University of Medical ScienceOtsu 520-2192Japan

Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical ***,we summarize historical turning points,anatomical recognition and surgical *** hernias have a fascinating history in the fields of anatomy and *** concept of tension-free repair is generally accepted among *** repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered *** various surgical approaches have been developed,the surgical technique should be carefully chosen for each *** as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,*** of debate are also reviewed;important points are shown using illustrations and *** hope this systematic review is surgical guide for general surgeons including *** a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.

关键词： Inguinal hernia Groin History Anatomy Hernioplasty Herniorrhaphy

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