医学部 総合消化器外科学

nakamura kenichi

  (中村 謙一)

Profile Information

Affiliation
Fujita Health University
Degree
Doctor of Philosophy in Medicine(Mar, 2019, Fujita Health University)

J-GLOBAL ID
201501002551124150
researchmap Member ID
7000013143

Research Areas

 1

Papers

 37
  • Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Yuko Chikaishi, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Tsunekazu Hanai, Zenichi Morise
    World journal of surgical oncology, 22(1) 215-215, Aug 22, 2024  
    BACKGROUND: The da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms. METHODS: The present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection. RESULTS: The study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified. CONCLUSIONS: The introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection.
  • Kenichi Nakamura, Mitsuru Nakagawa, Mizuki Ariga, Takahiko Higashiguchi, Yuko Chikaishi, Kazuhiro Matsuo, Aki Nishijima, Tomoyoshi Endo, Kenji Kikuchi, Koji Morohara, Hidetoshi Katsuno, Yoshihiko Tachi, Ichiro Uyama, Koichi Suda, Zenichi Morise
    Surgical case reports, 10(1) 189-189, Aug 16, 2024  
    BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) accounts for only 1-4% of all pancreatic exocrine cancers and has a particularly poor prognosis. The efficacy of chemotherapy for ASCP remains unknown because of the small number of cases, and few studies have evaluated conversion-intended chemotherapy. CASE PRESENTATION: A 76-year-old woman was referred to our hospital because of epigastric pain and nausea. A preoperative contrast-enhanced multidetector row computed tomography (MDCT) scan revealed a 17 × 17 mm low-density tumor with an ill-defined margin at the arterial phase in the pancreatic head. The tumor involved the common hepatic artery, left hepatic artery bifurcated from the common hepatic artery, and gastroduodenal artery, and was in contact with the portal vein. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed an uptake in the pancreatic head but no evidence of distant metastasis. The tumor was diagnosed as an adenocarcinoma of the pancreatic head and staged unresectable because the common and left hepatic arteries were involved. Hence, the patient underwent seven courses of conversion-intended chemotherapy using gemcitabine and nab-paclitaxel for pancreatic ductal adenocarcinoma over 7 months. After chemotherapy, the tumor shrank to 10 × 10 mm on contrast-enhanced MDCT. Consequently, the boundary between the tumor and major vessels of the common and left hepatic arteries and the portal vein became clear, and the involvement of the arteries with the tumor was evaluated to be released. The contact of the tumor to the portal vein also reduced to less than half the circumference of the portal vein. FDG-PET showed decreased accumulation in the tumor. Hence, the tumor was judged resectable, and pancreaticoduodenectomy was performed. The tumor and major blood vessels were easily dissected and R0 resection was achieved. The patient experienced no major complications and was discharged on postoperative day 28. The tumor was revealed as ASCP via pathological examination. The patient is alive and recurrence-free seven months after surgery. This is the first report of successful R0 resection for an initially unresectable ASCP following conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen. CONCLUSIONS: Conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen may be effective for ASCP.
  • Takayuki Ochi, Hidetoshi Katsuno, Hiroyuki Kato, Shinya Takagi, Kenji Kikuchi, Kenichi Nakamura, Tomoyoshi Endo, Kazuhiro Matsuo, Hironobu Yasuoka, Akihiro Nishimura, Akihiko Horiguchi, Zenichi Morise
    World journal of surgical oncology, 22(1) 85-85, Apr 3, 2024  
    BACKGROUND: This study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery. METHODS: A total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups. RESULTS: The use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle. CONCLUSION: These results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.
  • Kenichi Nakamura, Takahiko Higashiguchi, Yuko Chikaishi, Kazuhiro Matsuo, Tomoyoshi Endo, Koji Morohara, Kenji Kikuchi, Susumu Shibasaki, Hidetoshi Katsuno, Ichiro Uyama, Koichi Suda, Zenichi Morise
    Surgical case reports, 10(1) 31-31, Feb 2, 2024  
    BACKGROUND: Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION: A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS: Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.
  • Kenichi Nakamura, Susumu Shibasaki, Koichi Suda
    Asian journal of endoscopic surgery, 17(1) e13244, Jan, 2024  

Misc.

 59
  • 木村 大輝, 中内 雅也, 藤田 正博, 梅木 祐介, 後藤 愛, 芹澤 朗子, 秋元 信吾, 中村 謙一, 田中 毅, 柴崎 晋, 稲葉 一樹, 宇山 一朗, 須田 康一
    癌と化学療法, 49(13) 1820-1822, Dec, 2022  
    症例は46歳,男性。健診で胃角部後壁に20mm大の粘膜下腫瘍を指摘された。超音波内視鏡検査では,第4層由来で内部不均一な低エコー腫瘤を認め,生検では確定診断に至らなかった。造影CT検査では同腫瘍は造影効果増強を受け,リンパ節や遠隔臓器に転移を認めなかった。GIST疑いとして手術適応となったが,残胃狭窄を考慮し,ロボット支援下幽門側胃切除術の方針とした。術中所見で残胃の通過に問題なく,局所切除術を施行した。術後経過は良好で9日目に退院となった。病理組織学的検査所見では顆粒細胞腫と診断された。また,手術支援ロボットにより胃局所切除にも安全,柔軟に対応できたと考えられた。(著者抄録)
  • 松本 航一, 中内 雅也, 藤田 正博, 梅木 祐介, 後藤 愛, 芹澤 朗子, 秋元 信吾, 中村 謙一, 田中 毅, 柴崎 晋, 稲葉 一樹, 宇山 一朗, 須田 康一
    癌と化学療法, 49(13) 1862-1864, Dec, 2022  
    症例は79歳,男性。心窩部不快感,食欲低下を主訴に近医を受診し,上部消化管内視鏡で胃体下部大彎に1型進行胃癌を認めた。造影CTで胃下壁からトライツ靱帯に及ぶ造影増強を伴う7cm大の腫瘤を認めたが,他に遠隔転移を認めなかった。進行胃癌とリンパ節転移,腹膜播種または胃GISTの診断で審査腹腔鏡を施行した。腫瘤は横行結腸に約3cm接していたが腫瘍の可動性は良好であり,腹膜播種を認めず,切除可能と判断し手術方針となった。胃全摘および横行結腸部分切除を施行し,病理検査ではpT3N1で胃大彎の腫瘤は胃癌による#4saリンパ節転移であった。現在,術後12ヵ月が経過し,再発を認めず生存中である。本症例について多少の文献的考察を加えて考察する。(著者抄録)
  • 西村 彰博, 中内 雅也, 藤田 正博, 梅木 祐介, 後藤 愛, 芹澤 朗子, 秋元 信吾, 中村 謙一, 田中 毅, 柴崎 晋, 稲葉 一樹, 宇山 一朗, 須田 康一
    癌と化学療法, 49(13) 1867-1869, Dec, 2022  
    症例は78歳,男性。胃上部癌に対して前医で腹腔鏡下胃全摘術を施行された(U,Gre,pT3N0,pStage IIB)。術後2年6ヵ月で脾門部に腫瘤を認め,脾門部リンパ節転移または播種の疑いでSOXを2コース施行したが,増大傾向を認めた。他に病変を認めないため手術の方針となった。ロボット支援下膵尾部脾臓切除術を施行した(手術時間384分,出血量22mL)。経過良好で術後12日目に退院となった。病理検査では胃癌膵転移の診断であった。退院後にSOXを計3コース施行したが,再手術後2ヵ月で傍大動脈リンパ節転移と肝転移を認めたためsecond-lineとしてramucirumab+weekly paclitaxelを計16コース施行し,再手術から11ヵ月後の時点で再発巣は縮小を維持している。ロボット支援手術は腹腔鏡手術や開腹手術と比較して合併症が少ないという報告もあり,胃癌術後の孤発性転移の症例でもスムーズな周術期化学療法との連携に適していると考えられた。(著者抄録)
  • 中村 謙一, 柴崎 晋, 鈴木 和光, 芹澤 朗子, 秋元 信吾, 中内 雅也, 田中 毅, 稲葉 一樹, 宇山 一朗, 須田 康一
    臨床外科, 77(11) 51-57, Oct, 2022  
    <文献概要>食道胃接合部(esophagogastric junction:EGJ)は,本邦では西分類に基づいて「EGJ(食道筋層と胃筋層の境界)の上下2cmの部位」と定義されている.そしてEGJ癌は,組織型にかかわらずこの領域内に中心をもつ癌と定義されている.近年ではKurokawaらにより報告された多施設共同前向き研究の結果をもとに手術アプローチとリンパ節郭清のアルゴリズムが定められ,一定のコンセンサスが得られている.腫瘍の食道浸潤長により術式が変わる可能性だけでなく手術難易度にも大きく影響してくるため,術前の正確な食道浸潤長の評価が重要となる.本稿では,EGJ癌に対する術前診断や術式選択のポイントにつき,解説する.
  • 田中 毅, 宇山 一朗, 中村 謙一, 芹澤 朗子, 秋元 信吾, 中内 雅也, 菊地 健司, 柴崎 晋, 稲葉 一樹, 須田 康一
    臨床外科, 77(9) 1032-1035, Sep, 2022  
    <文献概要>ポイント ◆保険適用の拡大に伴って,ロボット支援下手術件数は急激に増加している.◆手術支援ロボットでは,da Vinciが先行していたが,国産手術支援ロボットをはじめ,今後,群雄割拠時代の到来が予想される.◆フルスペック型の手術支援ロボットだけでなく,カスタマイズ型も含め,選択の幅が広がることが期待される.