髙原 武志

PURPOSE: To improve the handling characteristics of suture needles, two novel needle designs, the Bi-curve and the G-curve, were developed by modifying conventional curvature designs. METHODS: Ten surgeons with varying levels of experience performed standardized open and robotic suturing tasks using half-circle, Bi-curve, and G-curve needles in a simulation environment. Suturing times were evaluated under both conditions. Moreover, advanced laparoscopic suturing tasks were performed using a robotic system. Needle trajectory parameters, burst pressure resistance, and subjective assessments of manipulability were analyzed to assess technical performance and potential tissue impact. RESULTS: During open forward suturing, both the Bi-curve and G-curve needles reduced suturing time significantly from that required with the half-circle needle, whereas no significant differences were observed among needle types in robotic suturing tasks. In advanced laparoscopic tasks, needle-passage quality scores were significantly higher for the Bi-curve and G-curve needles. Needle trajectory metrics and burst pressure resistance were comparable for all needle designs. Subjective evaluations revealed that no surgeon rated the novel needles as inferior to the conventional needle in terms of manipulability. CONCLUSIONS: In this exploratory study, the Bi-curve and G-curve needles demonstrated handling performance comparable to, and in some aspects favorable to, that of the conventional half-circle needle, without causing more tissue damage.

Fukuoka and colleagues, with accompanying videos, described single-arm robotic pancreaticoduodenectomy using the da Vinci SP Surgical System. Combining a right posterior approach with external traction using an internal organ retractor provided stable exposure while preserving robotic arm availability, facilitating secure dissection around the superior mesenteric artery and improving procedural reproducibility.

Pancreatic cancer is a highly intractable malignancy that necessitates personalized treatment strategies. Conventional patient-derived models, such as three-dimensional organoids, are often limited by intellectual property constraints and high costs. In this study, we developed an affordable adherent culture system for patient-derived pancreatic cancer cells using a proprietary medium and laminin-coated dishes. Primary cultures were successfully established from 28 patients with pancreatic ductal adenocarcinoma, exceeding a 90% success rate. Validation of eight samples confirmed maintenance of epithelial cell adhesion molecule expression and preservation of oncogenic KRAS mutations. Transcriptomic profiling revealed consistent upregulation of a six-gene signature (FAP, IGFBP5, PRRX1, SPARC, WNT5A, and ADAMTS12), which is associated with malignancy. In vitro drug sensitivity assays revealed interpatient heterogeneity with preliminary clinical associations. In conclusion, this simplified platform provides high-purity cancer cells and serves as a functional precision medicine tool. Beyond conventional chemotherapy, this platform has the potential to support applications ranging from biomarker validation and exploratory preclinical testing of novel therapeutics, including immune checkpoint inhibitors and antibody-drug conjugates. This optimization can lead to personalized therapeutic strategies for pancreatic cancer.

BACKGROUND: Stapler transection during robotic distal pancreatectomy (RDP) has limitations, including device cost, difficulty in thick pancreas, and challenges in pathological assessment of the margin. We developed the crush and clip (CC) technique, in which the parenchyma is crushed using Maryland forceps and the main pancreatic duct is clipped without stump reinforcement. This study aimed to describe the CC technique and assess its non-inferiority to stapler transection regarding postoperative pancreatic fistula (POPF). METHODS: We retrospectively analyzed 127 RDP cases at a high-volume center (CC: 23; stapler: 104) between 2010 and 2025. Procedures used included da Vinci Xi, da Vinci SP, or hinotori™ systems. The primary endpoint includes clinically relevant POPF (ISGPS grade B/C). Body mass index, stump thickness, and robotic platform were used to estimate the propensity score, and overlap weighting was applied. Non-inferiority was prespecified as a risk difference (CC - stapler) of less than + 5% with a 90% bootstrap confidence interval (CI). RESULTS: POPF occurred in 13% of CC and 26% of stapler cases (p = 0.280). The weighted analysis revealed incidences of 16.0% and 32.0%, respectively. The weighted risk difference was - 16.0% (90% CI, - 34.0% to + 4.3%), thereby meeting the non-inferiority margin. POPF was significantly lower with CC (6% vs. 47%, p = 0.013) when the pancreatic stump thickness was ≥ 14 mm. Major complications (Clavien-Dindo ≥ III) occurred in 14% of stapler cases but in none of the CC cases (p = 0.071). CONCLUSIONS: The CC technique was feasible and safe and statistically non-inferior to stapler transection for POPF, while providing technical advantages.