Background: A clear operative view of the middle and lower mediastinum is possible in prone position during video-assisted thorocoscopic surgery of esophagus (VATS-E), but the working space in the upper mediastinum is limited and lymph node dissection along the left recurrent laryngeal nerve (RLN) is difficult in this position.Methods: Esophagectomy and lymph node dissection are performed for pneumothorax by maintaining CO 2 insufflation in the prone position. Working space in the left upper mediastinal area for lymph node dissection around RLN is limited in this position. To create space, the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose. Lymph node dissection is performed after stripping the residual esophagus. Results:We could obtain a clear operative field in the upper left mediastinum by stripping the residual esophagus in the prone position, enabling safe and straightforward lymph node dissection along the left RLN. The rate of permanent RLN paralysis was 1.2%.Conclusions: Lymph node dissection along the left RLN after esophageal stripping is possible in the prone position during VATS-E. left mediastinum with the patient in the prone position, enabling safe and straightforward lymph node dissection along the left RLN. We would like to describe our lymph node dissection method along the left RLN in this report. Methods Patient selection and workup (Table 1)One hundred patients with esophageal carcinomas underwent video-assisted thorocoscopic surgery of esophagus (VATS-E) (27 in left lateral position and 73 in prone position). At first VATS-E in left lateral position, and then the prone position were selected for patients with superficial esophageal carcinoma from 2005. VATS-E in the prone position is indicated for all patients with resectable esophageal carcinomas with or without chemotherapy or chemoradiotherapy since 2011. Equipment preferenceElectrical devices used for VATS-E in the prone position were SonoSurg (Olympus Medical Systems, Tokyo, Japan) or LigaSure Maryland jaw sealer (Covidien, Mansfield, MA, USA). Single-port devices were ENDOPATH XCEL ® Trocars (Ethicon, Cincinnati, OH, USA): three ports: 5 mm (one port long and three ports short) and one port: 12 mm (short).Retractors: End retract mini (Covidien, Mansfield, MA, USA).Others: 5 mm flexible laparoscope (Olympus Medical Systems, Tokyo, Japan); Endoscopic scissors and forceps. Pre-operative preparationGeneral anesthesia with one lung ventilation was performed using a double lumen endotracheal tube. An epidural anesthesia tube was inserted to relieve pain in the upper abdomen. The patient was placed in a semi-prone position with a "magic bed" (or vacuum fixing bed) and a shoulder roll that was placed under the axillary. Procedure Position and port sitesThe patient is immobilized in the semi-prone position. For an esophagectomy, the patient is rotated from the semiprone position to the prone position. For an emergency thoracotomy, the patient is rotated ...

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Objective The spleen is part of the lymphatic system and is one of the least understood organs of the human body. It is involved in the production of blood cells and helps filter the blood, remove old blood cells, and fight infection. Partial splenic artery embolization (PSE) is widely used to treat pancytopenia and portal hypertension. The efficacy of PSE for improving thrombocytopenia has been well demonstrated. In this study, we evaluated the splenic infarction ratio and platelet increase ratio after PSE. Methods Forty-five consecutive patients underwent PSE from January 2014 to August 2022. We retrospectively evaluated the splenic infarction volume and ratio after PSE and analyzed the relationship between the splenic infarction ratio and platelet increase ratio after PSE. Results The platelet increase ratio was correlated with the splenic infarction ratio after PSE. The cutoff value for the splenic infarction ratio with a two-fold platelet increase was 63.0%. Conclusion We suggest performance of PSE in patients with a splenic infarction ratio of 63% to double the expected platelet count.

The patient was a 71-year-old man who underwent low anterior resection for rectal cancer, wherein the reconstruction was performed by forming an anastomotic blind end of the sigmoid colon. There were perioperative complications, including acute renal failure and acute cardiac insufficiency, aspiration pneumonitis, and intra-abdominal abscess formation. At 15 months after the operation, the patient presented to us complaining of a sense of abdominal fullness and subcutaneous emphysema in the region of the closed drain hole in the left lower quadrant of the abdomen. Abdominal computed tomography showed intraperitoneal free air. An abdominal needle aspiration failed to have any favorable effect and gastrointestinal perforation was suspected. Then, lower gastrointestinal tract endoscopy revealed a perforation measuring 2 mm in diameter at the anastomotic blind end, that was closed with clips. Although we did not confirm perfect clip closure, the patient's symptoms improved and the intraperitoneal free air steadily decreased. The patient visits the hospital regularly for follow-up and is in good general condition.

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Background: The vein that runs between ventral and dorsal Segment VIII is called the anterior fissure vein (AFV). AFV is sometimes needed as a boundary for subsegmental resection of Segment VIII. Methods: We analyzed data from 151 patients who had undergone abdominal computed tomographic (CT) examinations. The position of the AFV is identified by determining whether the AFV drains flows into the proximal, medial, or distal portion of the middle hepatic vein (MHV) or right hepatic vein (RHV). Furthermore, the proximal region is divided into 2 halves; the proximal portion is designated as P1 and the distal portion is designated as P2. Results: The AFV could be identified in 78.8% (119/151) of the patients. The AFV flowed into the MHV in 84.9% of the patients and into the RHV in 15.1%. Among the former, the AFV flowed into the proximal MHV in 69.7% of the patients. Conclusions: Although the AFV might not be easily identifiable, the AVF can be used to determine the border between the ventral and dorsal portions of Segment VIII. The AFV should thus be used as a landmark for subsegmentectomy.

Background and aims:The prognosis of esophageal squamous cell carcinoma varies according to the degree of invasion of the tumor in the organ wall. When the trachea and the main bronchus are involved in esophageal carcinoma, the disease is classified as incurable and the mortality is lower than that for patients who can be treated with curative surgery.To evaluate the carcinoma invading the trachea and main bronchus, retrospectively, we investigated computed tomography (CT) findings.Methods: Of 74 patients with or without proven tracheobronchial involvement who underwent thoracotomy for esophagectomy and Surgery disclosed tumor invasion in pericardium, aorta, pleura, trachea, left main bronchus and parenchyma. Ten patients were not operated upon but exhibited invasion to respiratory tract by broncho-fiber scope.Results: Lt. main bronchus (NMS angle) were statistically significant in patients with and without invasion. (P<0.05) Conclusion:It is our conclusion that preoperative evaluation by CT plays an important role whether the tumor is resectable or not.