Gallbladder involvement in patients with renal cell carcinoma (RCC) is extremely rare. We present a report of a 61-year-old man with a synchronous RCC metastasis to the gallbladder presenting as an intraluminal polypoid mass simulating primary gallbladder carcinoma. Enhanced abdominal computed tomography demonstrated a well-enhanced polypoid lesion in the gallbladder. Intraoperative rapid pathological examination of the gallbladder tumor showed clear cell-type cancerous cells. Microscopically, tumor cells of both the resected kidney and gallbladder had round uniform nuclei, clear cytoplasm, and well-defined cytoplasmic borders, forming alveolar patterns. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) and carcinoembryonic antigen (CEA), which is usually positive in primary clear cell carcinoma of the gallbladder. Therefore, the final diagnosis was RCC with a synchronous gallbladder metastasis.
Although many reports have described laparoscopic minor liver resections, major hepatic resection, including right or left lobectomy, has not been widely developed because of technical difficulties. This article describes a new technique for performing laparoscopy-assisted right or left hepatic lobectomy using hilar Glissonean pedicle transection. Laparoscopic mobilization of the right or left hepatic lobe is performed, including dissection of the round, faliciform, triangular, and coronary ligaments. The right or left Glissonean pedicle is encircled and divided laparoscopically. A parenchymal dissection is then performed though the upper median or right subcostal incision, through which the resected liver is removed. We successfully performed this procedure in 6 patients without blood transfusion or serious complications. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection can be feasible and safe in highly selected patients.
Socio-ecological resilience is vital for the long-term sustainability of communities in production landscapes and seascapes, but community members often find it difficult to understand and assess their own resilience in the face of changes that affect them over time due to economic and natural drivers, demographic changes, and market forces among others, due to the complexity of the concept of resilience and the many factors influencing the landscape or seascape. This chapter provides an overview of a project and its resilience assessment process using an indicator-based approach, which has been implemented under the International Partnership for the Satoyama Initiative (IPSI). In this project, a set of 20 indicators were identified to capture different aspects of resilience in SEPLS, and examples are included from various contexts around the world, with the purpose of identifying lessons learned and good practices for resilience assessment. These indicators have now been used by communities in many countries, often with the guidance of project implementers, with the goal of assessing, considering, and monitoring their landscape or seascape's circumstances, identifying important issues, and ultimately improving their resilience. While this particular approach is limited in that it cannot be used for comparison of different landscapes and seascapes, as it relies on community members' individual perceptions, it is found useful to understand multiple aspects of resilience and changes over time within a landscape or seascape.
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