直江 篤樹

The da Vinci SP, a robotic surgical platform capable of single-port surgery, offers cosmetic advantages; however, its use in pediatric patients has been limited. This report presents the first da Vinci SP operation for a choledochal cyst in a 7-year-old girl with Type Ic disease. The procedure was completed in 300 min, including 192 min of console time, with no intraoperative complications. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 7. The SP robot enables precise surgical interventions within small anatomical spaces without the need for extensive planning of port placement to avoid forceps interference. Additionally, its ability to adjust the position of the remote center expands the potential for a wide range of pediatric operations, particularly for surgeries in close proximity to target organs.

AIM OF THE STUDY: This study aimed to establish an objective, simple, and minimally invasive screening method to detect patients with biliary atresia during neonatal checkups by using indocyanine green (ICG) fluorescence in the stool. MATERIAL AND METHODS: We produced a rat model of extrahepatic biliary obstruction (group O, n = 9) and compared the stools from these rats with those of control group rats (group C, n = 6) by a fluorescence technique. ICG was administered (0.5 mg/kg) through the caudal vein; group O received ICG at the end of surgery. RESULTS: In group C, we collected stools at 3, 6, 12, 24, 48, and 72 hours, and fluorescence disappeared at 48 hours. In group O, stools were collected at 24, 48, 72, 96, and 120 hours after surgery, and fluorescence continued at 120 hours without the loss of fluorescence. Quantitative assessment of lightness showed significant differences between the groups at 48 and 72 hours (p = 0.0016 and p = 0.0004, respectively). CONCLUSIONS: This study shows that ICG is excreted into the gastrointestinal tract via a route other than the bile duct in a rat model of extrahepatic biliary obstruction. Our findings also suggest that ICG has the potential for initial screening of biliary congestive disease in the neonatal period, which could be followed up by detailed testing.

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory disease of unknown etiology. Although various new drugs have been developed in recent years, many of them are expensive, generating a demand for inexpensive and useful therapeutic drugs. Ogikenchuto (TJ‐98), an existing Kampo medicine, has been used to treat ulcers and similar conditions for some time. The current study therefore investigated whether TJ‐98 could be a new therapeutic agent for UC, a chronic inflammatory disease. Methods This study used 6‐week‐old female C57BL/6J mice to establish a mouse model of dextran sulfate sodium (DSS)‐induced colitis. We then evaluated the therapeutic effects of tacrolimus and TJ‐98 on colitis based on body weight, intestinal length, intestinal fibrosis, and cytokines. Sirius red staining was used to evaluate intestinal fibrosis, while interleukin‐1 beta (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor‐alpha (TNF‐α) were used to evaluate cytokines involved in inflammation. Results Neither tacrolimus nor TJ‐98 ameliorated weight loss. Although tacrolimus did not remediate intestinal shortening, intestinal fibrosis, or cytokine levels (IL‐1β, IL‐6, and TNF‐α), TJ‐98 did ameliorate intestinal shortening and intestinal fibrosis and decrease IL‐1β levels. Conclusions This study confirmed that TJ‐98 suppressed the inflammation caused by DSS‐induced enteritis and decreased the associated intestinal fibrosis, highlighting its potential as an inexpensive novel therapeutic agent for UC.

An 11-year-old girl presented with recurrent right lower quadrant (RLQ) pain. There was no evidence of inflammation and appendiceal swelling except at the initial onset. The repeated presence of a small amount of ascites at the time of abdominal pain triggered the performance of exploratory laparoscopy. Intraoperative examination revealed a non-inflamed, unswollen appendix with a cord-like atretic segment at the middle part and an appendectomy was performed. At 46 months follow-up, she remained asymptomatic. In patients with recurrent RLQ pain of unknown cause, it is necessary to consider diagnostic laparoscopy while keeping appendiceal atresia in mind as a differential diagnosis.