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論文 - 宮島　正博

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Robot-assisted and video-assisted thoracoscopic surgery for thymoma: comparison of the perioperative outcomes using inverse probability of treatment weighting method.

Yoshiki Chiba, Masahiro Miyajima, Yoshiaki Takase, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Daichi Ishii, Taiki Sato, Miho Aoyagi, Tomoko Shiraishi, Tomoko Sonoda, Atsushi Watanabe

Gland surgery 11 ( 8 ) 1287 - 1300 2022年08月 [査読有り] [国際誌]

BACKGROUND: Minimally invasive surgery is the standard treatment for early-stage thymoma. We compared the perioperative outcomes between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for thymoma. METHODS: Between April 2011 and August 2021, patients with thymoma who underwent thymectomy by RATS (n=20) or VATS (n=37) at our hospital were retrospectively reviewed. We evaluated the postoperative quality of life (QOL), surgical outcomes, complications, mortality, and pain grade. Postoperative QOL was assessed according to the time to achieve "B duration" and "CIII duration" based on the Nursing Dependency Score and Nursing Criteria, respectively. RESULTS: After the inverse probability of treatment weighting (IPTW), the B duration and CIII duration were significantly shorter with RATS than with VATS (P<0.001 and P=0.037, respectively). These superior results of RATS group compared to those of the VATS group were confirmed with logistic regression analysis (OR 0.25, 95% CI: 0.10-0.63, P=0.003; and OR 0.31, 95% CI: 0.12-0.76, P=0.011, respectively). After the IPTW, the VATS group had significantly fewer patients with epidural analgesia than the RATS group (P=0.018). In contrast, additional regular analgesics (including those for wound pain and neuralgia) were prescribed significantly more often during postoperative hospitalization in the VATS group (P=0.033). Patients in both groups had no myasthenic crisis or mortality. The postoperative pain grade at the first and second follow-ups did not significantly differ between the two groups after the IPTW (P=0.376 and P=0.109, respectively). CONCLUSIONS: RATS offered the advantages of improved postoperative QOL according to nursing care systems compared to VATS.

DOI PubMed

Anatomy of the left subsuperior segment for segmentectomy.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

Surgery today 52 ( 7 ) 1054 - 1062 2022年07月 [査読有り] [国内誌]

PURPOSE: The subsuperior segmental bronchi (B*) forms the subsuperior segment (S*) between the superior (S6) and basal segment (S7, S8, S9, S10) of the lung. However, the anatomical planes of S* remains undefined. The present study clarified the anatomical features of S*. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus in 539 patients using three-dimensional computed tomography. We report the anatomic structure in S*. RESULTS: A total of 537 patients were analyzed. B* was observed in 129 (24.0%) patients. The intersegmental vein between S6 and S* was complete in all cases. The absence of intersegmental veins of S* was observed in 77 (14.3%) patients, reaching 59.7% of B* cases. Twenty-two (4.1%) cases of B* diverged from the trunk of the basal bronchus, and about half of the B* branched to the dorsolateral (n = 77, 14.3%) or dorsal (n = 2, 0.37%) direction. CONCLUSION: Our study revealed the branching patterns of B* and anatomical intersegmental veins of S*. Our results provide useful information regarding anatomical segmentectomy including or adjusting to the left S*.

DOI PubMed

Interlobar division using vessel-sealing system in robot-assisted pulmonary lobectomy.

Masahiro Miyajima, Yuma Shindo, Kodai Tsuruta, Yasuyuki Nakamura, Yoshiaki Takase, Miho Aoyagi, Atsushi Watanabe

JTCVS techniques 13 211 - 216 2022年06月 [査読有り] [国際誌]

担当区分：筆頭著者 , 責任著者

OBJECTIVE: We investigated the safety of a novel interlobar fissure division technique using the da Vinci vessel sealing system in robot-assisted pulmonary lobectomy. METHODS: The medical records of patients who underwent robotic pulmonary lobectomy with node dissection for primary lung cancer between 2018 and 2020 were reviewed. The inclusion criteria were fulfilled by 111 patients, whose perioperative factors and postoperative results were compared with those previously reported. Furthermore, the new robotic lung interlobar division technique using the da Vinci vessel sealing system without a robotic stapler was evaluated in patients with low-grade incomplete fissure. We considered the Craig and Walker classification of lung fissures grades 1 and 2 as a good adaptation for the vessel sealing system interlobar fissure division. RESULTS: The vessel sealing system group had shorter mean operative and console times (P = .03 and P = .01, respectively) and lesser median intraoperative blood loss (20 mL vs 50 mL; P = .01). The vessel sealing system group had lower surgical complication rates (2.2% vs 20.0%; P = .01). The incidence of persistent postoperative air leak was lower (0% vs 10.0%; P = .06), and fewer robotic stapler cartridges were used during surgery (3.4 vs 5.6; P < .001) in the vessel sealing system group than in the stapler group. CONCLUSIONS: We report the safety of using the da Vinci vessel sealing system as an alternative to the use of robotic staples for interlobar fissure division in robot-assisted pulmonary lobectomy. This technique seems easy and feasible though limited to the low-grade incomplete fissure.

DOI PubMed

Robot-assisted vs. video-assisted thoracoscopic surgery in lung cancer.

Masahiro Miyajima, Ryunosuke Maki, Wataru Arai, Kodai Tsuruta, Yuma Shindo, Yasuyuki Nakamura, Atsushi Watanabe

Journal of thoracic disease 14 ( 6 ) 1890 - 1899 2022年06月 [国際誌]

BACKGROUND: The major advantages of robot-assisted surgery are the fine field of view provided by the high-precision three-dimensional (3D) images and the good operability provided by the robotic arms that enables precise movements. A growing number of retrospective studies have compared robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS), but the number of cases is limited and the results are contradictory. METHODS: We studied the medical records of primary lung cancer patients who underwent lobectomy with lymph node dissection between 2017 and 2020. Four hundred and eleven patients fulfilled the inclusion criteria in this study (RATS: 103; VATS: 308). We compared the perioperative factors and postoperative results of the VATS and RATS groups. Further, we adjusted background factors using propensity score matching (PSM) then compared the results of 200 patients (100 patients in each group). In this study, we matched interlobar fissure completeness, which affects operative difficulty and operative time; however, this has been superficially compared in previous studies. RESULTS: After PSM, a significant difference was observed in the intraoperative blood loss (RATS: 53.3 mL, VATS: 120.3 mL, P=0.04). The rates of surgical complications were comparable between the groups (10.0% vs. 13.0%, P=0.66) with similar mean operation times (RATS: 215.0 min, VATS: 210.1 min, P=0.57). The mean postoperative stay in the RATS group was shorter than that in the VATS group (10.0 vs. 11.5 days, P=0.04). CONCLUSIONS: Initial experience of RATS had no obvious drawbacks when compared with that of VATS on propensity-matched analysis.

DOI PubMed

Robotic single right anterior medial (S3b) subsegmentectomy for early primary lung cancer in a patient with a small physique.

Yoshiaki Takase, Masahiro Miyajima, Atsushi Watanabe

Multimedia manual of cardiothoracic surgery : MMCTS 2022 2022年05月 [国際誌]

Subsegmentectomy is an optional treatment for early primary lung cancer presenting without adequate surgical margins for wedge resection. There are no previous reports regarding a robotic single subsegmentectomy. We report a robotic single subsegmentectomy of the right anterior medial subsegment (S3b). The lung parenchyma was dissected with a Vessel Sealer Extend along the intersubsegmental veins for proper lung mobilization to solve the directional limitations of the robotic stapler. Additionally, we inserted the most ventral port from the subcostal region to increase the distance between the ports. Performing a robotic single subsegmentectomy is challenging. However, our techniques help to achieve a safe and effective operation.

DOI PubMed

Pulmonary vessels and bronchus anatomy of the left upper lobe.

Ryunosuke Maki, Masahiro Miyajima, Keishi Ogura, Makoto Tada, Yuki Takahashi, Hirofumi Adachi, Atsushi Watanabe

Surgery today 52 ( 4 ) 550 - 558 2022年04月 [国内誌]

PURPOSES: The bronchopulmonary vascular bifurcation patterns in the upper lobe of the left lung are diverse. Therefore, it is important for general thoracic surgeons to understand the detailed anatomy of the pulmonary segments when performing thoracoscopic anatomical pulmonary resection. This study aimed to analyze the bronchovascular patterns of the left upper lobe and summarize the anatomical information associated with pulmonary anatomical pulmonary resection. METHODS: We reviewed the anatomical patterns of pulmonary vessels and the left lung bronchus of 539 patients using computed tomography imaging data including those obtained using three-dimensional computed tomography. We herein report the anatomic structure in the left upper lobe. RESULTS: Regarding the superior division bronchi, a pattern of trifurcation into B1+2, B3, lingular division bronchus was observed in nine patients (1.7%). A pattern of proximal bifurcation of B4 was found in eight patients (1.5%). Regarding the lingular veins (LV), patterns of LV drainage into the left lower pulmonary vein were observed in 22 patients (4.1%). Regarding the pulmonary artery, mediastinal lingular arteries (MLA) were found in 161 patients (29.9%). CONCLUSION: The bifurcation patterns of the bronchovascular region in the upper lobe of the left lung were clarified. These results should be carefully noted when performing anatomical pulmonary resection.

DOI PubMed

Subcarinal Lymph Node Dissection in Solo Robot-assisted Thoracic Surgery.

Ryunosuke Maki, Masahiro Miyajima, Kodai Tsuruta, Atsushi Watanabe

The Annals of thoracic surgery 113 ( 3 ) e235-e237 2022年03月 [国際誌]

The surgical instruments used in robot-assisted thoracic surgery are flexible to enable the surgeon to approach the surgical field from any direction. However even in robot-assisted thoracic surgery subcarinal lymph node dissection requires a precise technique suitable for a small area surrounded by important organs. We present a method of subcarinal node dissection with solo robot-assisted thoracic surgery using a bronchial traction method and a metal basket suction device, the Dobon (Senko Medical Instrument Mfg, Tokyo, Japan).

DOI PubMed

症例胸腔鏡下左肺上葉切除術時に偶然発見された先天性心膜欠損症の1例

中村泰幸, 鶴田航大, 進藤悠真, 新井航, 槙龍之輔, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 74 ( 12 ) 1051 - 1054 2021年11月

DOI CiNii

Easy Suction Technique During Robotic-Assisted Thoracoscopic Lobectomy.

Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

The Annals of thoracic surgery 112 ( 5 ) e381-e382 2021年11月 [国際誌]

In robotic-assisted thoracoscopic surgery, surgeons may encounter bleeding issues requiring compression techniques and time to achieve hemostasis. During this time, surgeons cannot use the robot arm and may require an assistant to perform suction, thus increasing the cost of the procedure. This report describes an alternative suction device, Dobon (Senko Medical Instrument Mfg, Tokyo, Japan), which is usually used for pediatric cardiac surgery, for use in robotic-assisted thoracoscopic surgery. The report presents the technique for using this device and comments on the advantages, including decreased cost and an improved surgical visual field.

DOI PubMed

[Congenital Pericardial Defect Incidentally Found at Thoracoscopic Left Upper Lobe Resection:Report of a Case].

Yasuyuki Nakamura, Kodai Tsuruta, Yuma Shindo, Wataru Arai, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 74 ( 12 ) 1051 - 1054 2021年11月 [国内誌]

We report a rare case of a congenital pericardial defect that was incidentally found at thoracoscopic left upper lobe resection in a patient with lung cancer. A 75-year-old man with a left upper lobe lung cancer was referred to our hospital. We performed thoracoscopic left upper lobectomy and incidentally found a pericardial defect intraoperatively. Careful lymph node dissection was necessary to avoid injury of phrenic nerve and pulmonary artery. Surgery for lung cancer was completed without pericardial repair. After surgery, no complications associated with the pericardial defect has not been encountered.

PubMed

臨床経験右上葉胸壁合併切除後の脊髄梗塞

中村泰幸, 槙龍之輔, 進藤悠真, 新井航, 鶴田航大, 宮島正博, 渡辺敦

胸部外科 ( 南江堂 ) 74 ( 9 ) 664 - 667 2021年09月

DOI

[Spinal Cord Infarction after Right Upper Lobectomy Combined with Chest Wall Resection].

Yasuyuki Nakamura, Ryuunosuke Maki, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Masahiro Miyajima, Atsushi Watanabe

Kyobu geka. The Japanese journal of thoracic surgery 74 ( 9 ) 664 - 667 2021年09月 [国内誌]

A 42-year-old man presented with a one-month history of back pain. Chest computed tomography revealed a mass (7.6×5.7 cm) in the right upper lobe, suspicious of chest wall invasion. We performed right upper lobectomy combined with chest wall resection. Partial dissections of the second to sixth ribs and the third and fourth vertebral bodies were conducted. Postoperatively, motor paralysis of the right lower extremity was observed and a diagnosis of spinal infarction was made. After cerebrospinal fluid drainage and administration of edaravone with early rehabilitation, he was able to walk with a brace and was discharged from the hospital.

PubMed

Two cases of left recurrent laryngeal nerve paralysis after right superior mediastinal node dissection.

Yasuyuki Nakamura, Yuma Shindo, Wataru Arai, Kodai Tsuruta, Ryunosuke Maki, Masahiro Miyajima, Atsushi Watanabe

Surgical case reports 7 ( 1 ) 151 - 151 2021年06月 [国際誌]

BACKGROUND: Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. CASE PRESENTATION: Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. CONCLUSION: Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

DOI PubMed

Effects of histone deacetylase inhibitors Tricostatin A and Quisinostat on tight junction proteins of human lung adenocarcinoma A549 cells and normal lung epithelial cells.

Yuma Shindo, Wataru Arai, Takumi Konno, Takayuki Kohno, Yuki Kodera, Hirofumi Chiba, Masahiro Miyajima, Yuji Sakuma, Atsushi Watanabe, Takashi Kojima

Histochemistry and cell biology 155 ( 6 ) 637 - 653 2021年06月 [国際誌]

Histone deacetylase (HDAC) inhibitors have a potential therapeutic role for non-small cell lung cancer (NSCLC). However, more preclinical studies of HDAC inhibitors in NSCLC and normal lung epithelial cells are required to evaluate their antitumor activities and mechanisms. The bicellular tight junction molecule claudin-2 (CLDN-2) is highly expressed in lung adenocarcinoma tissues and increase the proliferation of adenocarcinoma cells. Downregulation of the tricellular tight junction molecule angulin-1/LSR induces malignancy via EGF-dependent CLDN-2 and TGF-β-dependent cellular metabolism in human lung adenocarcinoma cells. In the present study, to investigate the detailed mechanisms of the antitumor activities of HDAC inhibitors in lung adenocarcinoma, human lung adenocarcinoma A549 cells and normal lung epithelial cells were treated with the HDAC inibitors Trichostatin A (TSA) and Quisinostat (JNJ-2648158) with or without TGF-β. Both HDAC inhibitors increased anguin-1/LSR, decrease CLDN-2, promoted G1 arrest and prevented the migration of A549 cells. Furthermore, TSA but not Quisinostat with or without TGF-β induced cellular metabolism indicated as the mitochondrial respiration measured using the oxygen consumption rate. In normal human lung epithelial cells, treatment with TSA and Quisinostat increased expression of LSR and CLDN-2 and decreased that of CLDN-1 with or without TGF-β in 2D culture. Quisinostat but not TSA with TGF-β increased CLDN-7 expression in 2D culture. Both HDAC inhibitors prevented disruption of the epithelial barrier measured as the permeability of FD-4 induced by TGF-β in 2.5D culture. TSA and Quisinostat have potential for use in therapy for lung adenocarcinoma via changes in the expression of angulin-1/LSR and CLDN-2.

DOI PubMed

Vessel sealing system for video-assisted lung resection for cancer reduces chylothorax and bleeding.

Masahiro Miyajima, Ryunosuke Maki, Makoto Tada, Kodai Tsuruta, Yuki Takahashi, Wataru Arai, Atsushi Watanabe

Journal of thoracic disease 13 ( 6 ) 3458 - 3466 2021年06月 [国際誌]

BACKGROUND: The objective of this study was to analyze the efficacy of the LigaSureTM vessel sealing system for lung cancer resection with node dissection, as this has not been sufficiently evaluated. METHODS: From 2004 to 2018, 948 patients underwent anatomical pulmonary resection with node dissection for non-small cell lung carcinoma (NSCLC) via the video-assisted thoracoscopic surgery (VATS) approach. Medical records of these patients were reviewed retrospectively. Univariate and multivariate analyses were conducted to determine the risk factors for chylothorax and blood loss. RESULTS: Of the 948 patients, 318 (33.5%) who underwent anatomical lung resection with node dissection by conventional methods without vessel sealing system and 630 (66.5%) who underwent lung resection with node dissection with the vessel sealing system were included. The median intraoperative blood loss was 100 mL. Postoperative chylothorax occurred in 9 (2.8%) patients in the conventional method group with 2 (0.3%) patients in the vessel sealing system group (P=0.001). Patients in the vessel sealing group who developed chylothorax were cured by conservative treatment. Univariate and multivariate analyses identified male sex [odds ratio (OR) 2.053; 95% confidence interval (CI): 1.494-2.820; P<0.001] and the use of vessel sealing system (OR 0.342; 95% CI: 0.256-0.457; P<0.001) as independent predictors of intraoperative blood loss. The univariate and multivariate analyses identified the use of the vessel sealing system (OR 0.108; 95% CI: 0.023-0.504; P=0.005) as an independent predictor of chylothorax incidence. CONCLUSIONS: Vessel sealing system for lung cancer resection could decrease chest tube duration, amount of intraoperative bleeding, and incidence of chylothorax in patients who undergo lung resection with node dissection.

DOI PubMed

正常ヒト肺上皮細胞におけるTGF-βとHDAC阻害剤のタイト結合分子および上皮バリアへの影響

進藤悠真, 新井航, 金野匠, 幸野貴之, 宮島正博, 小島隆, 渡辺敦

日本呼吸器外科学会雑誌 ( (一社)日本呼吸器外科学会 ) 35 ( 3 ) RO18 - 3 2021年05月

臨床経験縦隔腫瘍との鑑別を要した準確定診断免疫グロブリンG4(IgG4)関連大動脈周囲炎

千葉慶宜, 新井航, 大川美穂, 多田周, 槙龍之輔, 三品泰二郎, 宮島正博, 渡辺敦, 杉田真太朗

胸部外科 ( 南江堂 ) 74 ( 2 ) 108 - 111 2021年02月

DOI

区域切除のための左肺下葉における気管支肺血管の解剖—Pulmonary vessels and bronchial anatomy of the left lower lobe

槙龍之輔, 宮島正博, 小倉圭史, 多田周, 高橋有毅, 安達大史, 渡辺敦, Wataru Arai

北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会編 ( 北海道外科学会 ) 65 ( 2 ) 186 - 188 2020年12月

CiNii

The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report.

Yuma Shindo, Masahiro Miyajima, Yasuyuki Nakamura, Wataru Arai, Ryunosuke Maki, Kodai Tsuruta, Atsushi Watanabe

Surgical case reports 6 ( 1 ) 291 - 291 2020年11月 [国際誌]

BACKGROUND: Several severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected. CASE PRESENTATION: A 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy. CONCLUSIONS: We experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

DOI PubMed

今月の話題左上縦隔腫瘍に対するロボット支援下手術

進藤悠真, 宮島正博, 槙龍之輔, 高橋有毅, 鶴田航大, 新井航, 渡辺敦

胸部外科 ( 南江堂 ) 73 ( 9 ) 663 - 666 2020年09月

DOI

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