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 v...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.展开更多
Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-o...Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical mass.Endoscopic findings revealed advanced transverse colon cancer.computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left lung.The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels.Imaging 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 made.The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection.Intra-abdominal dissemination to the mesocolon was confirmed during surgery.Histopathologically,the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma.We suspect that SMJN may occur via a hematogenous pathway.Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home hospice.Seven months after surgery,she died of rapidly growing lung cancer.展开更多
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,doub...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 leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.展开更多
In recent years, the number of traffic accidents caused by elderly drivers has increased in Japan. However, a car is an important mode of transportation for the elderly. Therefore, to ensure safe driving, a system tha...In recent years, the number of traffic accidents caused by elderly drivers has increased in Japan. However, a car is an important mode of transportation for the elderly. Therefore, to ensure safe driving, a system that can assist elderly drivers is required. In this study, we propose a driver-agent system that provides support to elderly drivers during and after driving and encourages them to improve their driving. This paper describes the prototype system based on the analysis of the teaching records of a human instructor, and the subjective evaluation of driving support to elderly and non-elderly driver from three different agent forms, a voice, visual, and robot. The result revealed that the robot form is more noticeable, familiar, and acceptable to the elderly and non-elderly than other forms.展开更多
Recently, traffic accidents caused by elderly drivers have been increasing. It is thought that the reasons of accidents are functions such as decline of eyesight, cognition and physical strength caused by aging. In or...Recently, traffic accidents caused by elderly drivers have been increasing. It is thought that the reasons of accidents are functions such as decline of eyesight, cognition and physical strength caused by aging. In order to assist safe driving for elderly drivers, it is necessary to sufficiently understand any possible relationship of various senior drivers’ cognition, physical strength and driving behavior. In this paper relationship of elderly driver’s cognition, physical strength and driving behaviors were analyzed using the result of driving instructions on urban road by driving school instructors.展开更多
Japan has become a more aged society and there are more drivers, 65 years of age and above. Cars represent an important mode of transportation for the elderly;however, in recent years, the number of traffic accidents ...Japan has become a more aged society and there are more drivers, 65 years of age and above. Cars represent an important mode of transportation for the elderly;however, in recent years, the number of traffic accidents caused by elderly drivers has been on the rise, and this has become a social issue. Thus, for the elderly drivers to encourage them to improve their driving, we study a driver agent system which consists of smartphone, communication robot and cloud service and provides the driving support by attention awakening and the feedback support based on driving behavior evaluation. In this paper, we presented a summary of the proposed agent and reported on a set of preliminary experiments using our agent in an actual car environment. From the analysis of subjective evaluations and fixation points during driving, the results revealed the possibility that the drivers accept the agent and supports from the agent during driving and that the agent in an actual car environment did not distract the driver.展开更多
文摘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.
文摘Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical mass.Endoscopic findings revealed advanced transverse colon cancer.computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left lung.The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels.Imaging 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 made.The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection.Intra-abdominal dissemination to the mesocolon was confirmed during surgery.Histopathologically,the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma.We suspect that SMJN may occur via a hematogenous pathway.Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home hospice.Seven months after surgery,she died of rapidly growing lung cancer.
文摘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 leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.
文摘In recent years, the number of traffic accidents caused by elderly drivers has increased in Japan. However, a car is an important mode of transportation for the elderly. Therefore, to ensure safe driving, a system that can assist elderly drivers is required. In this study, we propose a driver-agent system that provides support to elderly drivers during and after driving and encourages them to improve their driving. This paper describes the prototype system based on the analysis of the teaching records of a human instructor, and the subjective evaluation of driving support to elderly and non-elderly driver from three different agent forms, a voice, visual, and robot. The result revealed that the robot form is more noticeable, familiar, and acceptable to the elderly and non-elderly than other forms.
文摘Recently, traffic accidents caused by elderly drivers have been increasing. It is thought that the reasons of accidents are functions such as decline of eyesight, cognition and physical strength caused by aging. In order to assist safe driving for elderly drivers, it is necessary to sufficiently understand any possible relationship of various senior drivers’ cognition, physical strength and driving behavior. In this paper relationship of elderly driver’s cognition, physical strength and driving behaviors were analyzed using the result of driving instructions on urban road by driving school instructors.
文摘Japan has become a more aged society and there are more drivers, 65 years of age and above. Cars represent an important mode of transportation for the elderly;however, in recent years, the number of traffic accidents caused by elderly drivers has been on the rise, and this has become a social issue. Thus, for the elderly drivers to encourage them to improve their driving, we study a driver agent system which consists of smartphone, communication robot and cloud service and provides the driving support by attention awakening and the feedback support based on driving behavior evaluation. In this paper, we presented a summary of the proposed agent and reported on a set of preliminary experiments using our agent in an actual car environment. From the analysis of subjective evaluations and fixation points during driving, the results revealed the possibility that the drivers accept the agent and supports from the agent during driving and that the agent in an actual car environment did not distract the driver.
