Use of an Endoscopic Surgical Spacer during Laparoscopic Pancreatic Tumor Enucleation

Invention of Two Instruments Fitted with SECUREA™ Useful for Laparoscopic Liver Resection

Laparoscopic liver resection (LLR) became common in Japan when advanced techniques and instruments for the procedure became available and the national medical insurance began covering partial resection and lateral segmentectomy. A successful LLR requires a gentle and powerful hold on the specimens, a steady operating field, and fast and rapid compression of the bleeding point to achieve hemostasis. In this paper we describe two instruments developed in our department by attaching the SECUREA™ endoscopic surgical spacer to the forceps and suction tube used for LLR. The instruments are useful and practical for any type of LLR, even in the hands of less experienced surgeons.

Thoracoscopic mediastinal lymph node dissection using an endoscopic spacer

Although fewer lymph nodes are dissected with video-assisted thoracic surgery than with open lobectomy, thoracoscopic lobectomy is increasingly becoming the preferred surgical approach for early-stage lung cancers. The endoscopic surgical spacer SECUREA™ is a medical device that has been effectively employed in laparoscopic surgery, but no study has evaluated its efficacy in thoracoscopic surgery. In this report, we demonstrate the utility of SECUREA for complete thoracoscopic mediastinal lymph node dissection in patients with non-small cell lung cancer.

Esophageal stripping creates a clear operative field for lymph node dissection along the left recurrent laryngeal nerve in prone video-assisted thoracoscopic surgery

We describe a 54-year-old man in whom esophageal carcinoma was diagnosed and who underwent video-assisted thoracoscopic surgery of the esophagus (VATS-E) in the prone position. Initially, the patient was fixed in a semiprone position, from which he could be rotated to a prone or left lateral position. Four ports were inserted, and then the patient was rotated to the prone position. Once the patient was prone, gravity caused the lung to move downwards. Next, the chest cavity was inflated with a CO(2) insufflation pressure of 6 mm Hg. Esophagectomy was then performed, and the lymph nodes in the middle and lower mediastinum and along the right recurrent laryngeal nerve were dissected. In the left upper mediastinum, lymph node dissection was performed after the residual esophagus was stripped. Stripping of the residual esophagus created sufficient working space and a clear operative field for lymph node dissection. VATS-E in the prone position has achieved remarkable results in Japan. It allows a clear operative view of the middle and lower mediastinum, but the working space in the upper mediastinum is limited. Our results indicate that esophageal stripping in prone VATS-E allows for safe and straightforward lymph node dissection along the left recurrent laryngeal nerve. Our technique overcame the difficulties usually encountered with this type of lymph node dissection.