研究者詳細 - 城田　千代栄

Therapeutic strategy for thoracoscopic repair of esophageal atresia and its outcome 査読有り

Shirota, C; Tanaka, Y; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Oshima, K; Tanaka, T; Tani, Y; Uchida, H

PEDIATRIC SURGERY INTERNATIONAL 35 巻 ( 10 ) 頁： 1071 - 1076 2019年10月

記述言語：英語出版者・発行元：Pediatric Surgery International

Purpose: Thoracoscopic repair can be safely performed in most types of congenital esophageal atresia (EA), including in patients with long gap EA or very low birth weight. Accordingly, we performed single- or multistage thoracoscopic repair for various EA types. We aimed to report our therapeutic strategy for thoracoscopic radical surgery for treating EA and its outcome. Methods: Outcomes of radical surgeries for treating congenital EA at our institute from 2013 to 2018 were retrospectively evaluated. Results: Thirty-eight radical surgeries were evaluated: 3 Gross type-A, 1 type-B, 30 type-C, 1 type-D, and 3 type-E. The cervical approach was performed in 5 cases and thoracoscopic esophageal anastomosis in 33, including 26 single-stage (all type-C) and 7 multistage surgeries (3 type-A, 3 type-C, and 1 type-D). There were no cases of thoracotomies or intraoperative thoracoscopic surgery complications. Three cases of minor leakage were conservatively resolved. Three postoperative chylothorax surgeries (9%) and seven balloon dilatations (21%) for anastomotic stenosis were performed. Conclusion: Thoracoscopic radical surgery for treating EA, including single- and multistage procedures, can be performed, except in type-E cases or when the end of the proximal esophagus is located higher than the clavicle.

DOI： 10.1007/s00383-019-04541-x

Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia with prolapsed ovary 査読有り

Shirota, C; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Amano, H; Okamoto, M; Takimoto, A; Yasui, A; Nakagawa, Y; Hinoki, A; Uchida, H

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 36 巻 ( 6 ) 頁： 4328 - 4332 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Surgical Endoscopy

Background: Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. Methods: We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. Results: A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Conclusion: Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

DOI： 10.1007/s00464-021-08777-4

Double-balloon endoscopic retrograde cholangiography can make a reliable diagnosis and good prognosis for postoperative complications of congenital biliary dilatation 査読有り Open Access

Shirota, C; Kawashima, H; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Amano, H; Takimoto, A; Hinoki, A; Uchida, H

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 11052 2021年5月

記述言語：英語出版者・発行元：Scientific Reports

Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as “bile duct strictures” if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as “anastomotic strictures” if the mucosa was absent. The median patient age was 4 (range 0–67) years at the time of primary surgery for CBD and 27.5 (range 8–76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1–2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

DOI： 10.1038/s41598-021-90550-7

Multicenter, retrospective, comparative study of laparoscopic and open Kasai portoenterostomy in children with biliary atresia from Japanese high-volume centers 査読有り Open Access

Murase, N; Hinoki, A; Shirota, C; Tomita, H; Shimojima, N; Sasaki, H; Nio, M; Tahara, K; Kanamori, Y; Shinkai, M; Yamamoto, H; Sugawara, Y; Hibi, T; Ishimaru, T; Kawashima, H; Koga, H; Yamataka, A; Uchida, H

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 26 巻 ( 1 ) 頁： 43 - 50 2019年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Hepato Biliary Pancreatic Sciences

Background: Multicenter study was undertaken to analyze the results of laparoscopic and open Kasai portoenterostomy. Methods: Subjects were infants with type III biliary atresia who underwent open operation (n = 106) or laparoscopic operation (n = 21) between January 2012 and December 2015. Clinical data were compared between open and laparoscopic operations (2016-0534). Propensity score matching was performed to reduce the effect of treatment selection bias. Multivariate analyses were used to estimate the effect of the surgical approach on the jaundice clearance rate and the native liver survival rate. Results: The postoperative jaundice clearance rate and the 1-year native liver survival rate were not significantly different between open and laparoscopic operations. Rates of cholangitis and major complications of laparoscopic operation were comparable to those of open operation. Blood loss, time to resume oral intake, time to drain removal, and duration of analgesic usage of laparoscopic operation were significantly superior to those of open operation. Similar results were observed when analysis was adjusted based on propensity score. Multivariate analyses demonstrated that only age at operation was a poor prognostic factor. Conclusion: Laparoscopic Kasai portoenterostomy was associated with several favorable perioperative outcomes compared with open Kasai portoenterostomy. The difference of surgical approach was not a significant independent predictor.

DOI： 10.1002/jhbp.594

Usefulness of fetal magnetic resonance imaging for postnatal management of congenital lung cysts: prediction of probability for emergency surgery 査読有り Open Access

Shirota, C; Tainaka, T; Nakane, T; Tanaka, Y; Hinoki, A; Sumida, W; Murase, N; Oshima, K; Chiba, K; Shirotsuki, R; Uchida, H

BMC PEDIATRICS 18 巻 ( 1 ) 頁： 105 2018年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMC Pediatrics

Background: Emergency rescue lung resection is rarely performed to treat congenital lung cysts (CLCs) in neonates. Many reports have described fetal CLC treatment; however, prenatal predictors for postnatal respiratory failure have not been characterized. We hypothesized that fetal imaging findings are useful predictors of emergency surgery. Methods: We retrospectively studied patients with CLC who underwent lung surgery during the neonatal period in our hospital between January 2001 and December 2015. The demographic data, fetal imaging findings, and intra- and postoperative courses of patients who underwent emergency surgery (Em group) were compared with those of patients who received elective surgery, i.e., non-emergency surgery (Ne group). Results: The Em group and Ne group included 7 and 11 patients, respectively. No significant difference was noted in gestational age, time at prenatal diagnosis, birth weight, and body weight at surgery. The volumes of contralateral lung per thoracic volume were significantly smaller in the Em group than in the Ne group (p = 0.0188). Mediastinal compression was more common in the Em group (7/7) than in the Ne group (4/11) (p = 0.0128). Conclusions: This is the report describing neonatal emergency lobectomy in patients with CLC evaluated by fetal MRI using the lung volume ratio and mediastinal shift. In patients with CLC, mediastinal shift and significant decreases in contralateral lung volumes during the fetal stages are good prenatal predictors of postnatal emergency lung resection.

DOI： 10.1186/s12887-018-1085-z

Laparoscopic resection of neuroblastomas in low-to high-risk patients without image-defined risk factors is safe and feasible 査読有り Open Access

Shirota, C; Tainaka, T; Uchida, H; Hinoki, A; Chiba, K; Tanaka, Y

BMC PEDIATRICS 17 巻 ( 1 ) 頁： 71 2017年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMC Pediatrics

Background: Several studies have reported that minimally invasive surgery (MIS) might be considered for resecting neuroblastomas without image-defined risk factors (IDRFs); however, there are no studies comparing the outcomes of laparotomy and laparoscopy in IDRF-negative patients. Thus, we investigated the feasibility of laparoscopic surgery and compared the two abovementioned approaches. Methods: To compare the effects of laparotomy with those of laparoscopy in patients with neuroblastomas without IDRFs, the following items were retrospectively compared: largest tumor dimension, volume of blood loss, time required to initiate postoperative feeding, locoregional recurrence rate, survival, etc. Results: Nine patients without IDRFs (three at low-to-medium risk and six at high risk) underwent laparotomy, and seven patients without IDRFs (two at low-to-medium risk and five at high risk) underwent laparoscopy. Median duration of surgery was 221 (130-304) and 172 (122-253) min in the laparotomy and laparoscopy groups, respectively, showing no significant difference. Median postoperative time required for resuming meal consumption was significantly longer in the laparotomy (4 days; 2-5) group than that in the laparoscopy group (3 days; 2-3; p = 0.023). Median blood loss was significantly higher in the laparotomy group (5 ml/Kg;2.6-16) than that in the laparoscopy group (2.1 ml/Kg;0.1-4.0; P = 0.037). Median follow-up period was 81 (52-94) and 21 (17-28) months, locoregional recurrence rates were 22 and 0% at 1 year, 1-year progression-free survival rates were 78 and 100%, and overall survival rates were 67 and 100% in the laparotomy and laparoscopy groups, respectively, with no significant differences. Conclusions: MIS for the treatment of neuroblastomas without IDRFs in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome.

DOI： 10.1186/s12887-017-0826-8

Prolonged survival of porcine hepatocytes in cynomolgus monkeys. 査読有り Open Access

Nagata H, Nishitai R, Shirota C, Zhang JL, Koch CA, Cai J, Awwad M, Schuurman HJ, Christians U, Abe M, Baranowska-Kortylewicz J, Platt JL, Fox IJ

Gastroenterology 132 巻 ( 1 ) 頁： 321-9 2007年1月

New Navigation Surgery for Resection of Lymphatic Malformations Using Indocyanine Green Fluorescence Imaging. 査読有り

Shirota C, Hinoki A, Takahashi M, Tanaka Y, Tainaka T, Sumida W, Murase N, Oshima K, Shirotsuki R, Chiba K, Morimoto Y, Uchida H

The American journal of case reports 18 巻頁： 529 - 531 2017年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Journal of Case Reports

Objective: Unusual or unexpected effect of treatment Background: We used indocyanine green (ICG) fluorescence imaging to completely resect lymphatic malformations (LMs). This is the first report of navigation surgery utilizing ICG fluorescence imaging for resection of LMs. Case Report: A 15-year-old boy was diagnosed with LMs in the abdominal wall. The extent of the tumor was determined by an ultrasound, and ICG (Diagnogreen®, Daiichi-Sankyo Pharma, Tokyo, Japan) was injected subcutaneously and intradermally into the core and 2 marginal regions of the tumor (3 injections in total), respectively. During surgery, the extent of the tumor was confirmed with a photodynamic eye, and the tumor was completely resected. A fluorescent portion macroscopically estimated as normal was additionally resected and no residual fluorescence or tumor were confirmed in the remaining tissue. Abnormal lymphatic vessels were histopathologically observed in the additionally resected tissue, indicating the invasion of LMs. The surgery had a good outcome with no evidence of recurrence. Conclusions: We performed near-infrared fluorescence-guided imaging surgery for the resection of LMs in the abdominal wall. This is a single case study; therefore, assessment of more cases is warranted for further validation. This procedure could provide significant benefit to patients requiring resection of LMs.

DOI： 10.12659/ajcr.903465

Late postoperative complications of congenital biliary dilatation in pediatric patients: a single-center experience of managing complications for over 20 years Open Access

Route of hepatocyte delivery affects hepatocyte engraftment in the spleen. 査読有り

Nagata H, Ito M, Shirota C, Edge A, McCowan TC, Fox IJ

Transplantation 76 巻 ( 4 ) 頁： 732-4 2003年8月

Amano, H; Shirota, C; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Takimoto, A; Tanaka, Y; Hinoki, A; Kawashima, H; Uchida, H

SURGERY TODAY 51 巻 ( 9 ) 頁： 1488 - 1495 2021年9月

記述言語：英語出版者・発行元：Surgery Today

Purpose: To investigate late complications after surgery for congenital biliary dilatation (CBD). Methods: We retrospectively reviewed the patients treated for late postoperative complications of extrahepatic bile duct resection with bilioenteric anastomosis for CBD at our hospital between 1999 and 2019. Results: Twenty-seven complications, including bile duct stenosis with (n = 19) or without (n = 3) hepatolithiasis, remnant intrapancreatic bile duct (n = 2), intestinal obstruction (n = 2), and refractory cholangitis (n = 1) were treated in 26 patients. The median age at radical surgery and the initial treatment of complications was 3 years, 2 months and 14 years, 5 months, respectively. The median period from radical surgery to initial treatment of complications was 7 years, 1 month. Before 2013, bile duct stenosis was initially treated with bile duct plasty (n = 11) or hepatectomy (n = 3), and 71.4% (n = 10) of patients needed further treatment; after 2013, double-balloon endoscopic retrograde cholangiography (DBERC) was used (n = 8), and 25% (n = 2) of patients needed further treatment. Patients with remnant intrapancreatic bile duct, intestinal obstruction, and refractory cholangitis required surgery. Conclusion: Long-term follow-up is necessary after surgery for congenital biliary dilatation. DBERC is thus considered to be useful for bile duct stenosis management.

DOI： 10.1007/s00595-021-02238-0

手術経験数による腹腔鏡下胆道閉鎖症手術成績の検討査読有り Open Access

藏野結衣, 城田千代栄, 檜顕成, 田井中貴久, 住田亙, 横田一樹, 牧田智, 滝本愛太朗, 内田広夫

日本小児外科学会雑誌 57 巻 ( 3 ) 頁： 596 - 599 2021年4月

記述言語：日本語出版者・発行元：特定非営利活動法人日本小児外科学会

【目的】腹腔鏡下胆道閉鎖症手術（腹腔鏡下肝門部空腸吻合術）の執刀を熟練した術者に限定する必要性の有無を明らかにすることを目的として，自施設での治療成績を後方視的に検討した．【方法】2014年4月から2018年8月の期間中，胆道閉鎖症に対して当院で腹腔鏡下肝門部空腸吻合術を施行した35例を対象とした．腹腔鏡下肝門部空腸吻合術を5例以上経験した術者が執刀した患者（A群：12例）と執刀経験4例以下の術者が執刀した患者（B群：23例）とに分類し，手術，術後経過と術後6か月，1年，2年の各時点における無黄疸自己肝生存についてそれぞれ統計学的解析を行い比較，検討した．【結果】A群とB群で手術日齢，体重，出血量，ドレーン抜去時期，経口開始時期に有意差は認められなかったが，手術時間はA群が有意に短かった（p＝0.0049）．無黄疸自己肝生存率は術後6か月（A群58.3％，B群60.9％，p＝0.506），術後1年（A群66.7％，B群65.2％，p＝0.932），術後2年（A群58.3％，B群56.5％，p＝0.918）でいずれの時点でも有意差は認められなかった．【結論】今回の検討では，腹腔鏡下胆道閉鎖症手術に熟練した術者の指導の下では，執刀経験量による減黄率の有意な差は認められなかった．

DOI： 10.11164/jjsps.57.3_596

Open Access

CiNii Research

Biodegradable Surgical Staple Composed of Magnesium Alloy 査読有り Open Access

Amano, H; Hanada, K; Hinoki, A; Tainaka, T; Shirota, C; Sumida, W; Yokota, K; Murase, N; Oshima, K; Chiba, K; Tanaka, Y; Uchida, H

SCIENTIFIC REPORTS 9 巻 ( 1 ) 頁： 14671 2019年10月

記述言語：英語出版者・発行元：Scientific Reports

Currently, surgical staples are composed of non–biodegradable titanium (Ti) that can cause allergic reactions and interfere with imaging. This paper proposes a novel biodegradable magnesium (Mg) alloy staple and discusses analyses conducted to evaluate its safety and feasibility. Specifically, finite element analysis revealed that the proposed staple has a suitable stress distribution while stapling and maintaining closure. Further, an immersion test using artificial intestinal juice produced satisfactory biodegradable behavior, mechanical durability, and biocompatibility in vitro. Hydrogen resulting from rapid corrosion of Mg was observed in small quantities only in the first week of immersion, and most staples maintained their shapes until at least the fourth week. Further, the tensile force was maintained for more than a week and was reduced to approximately one-half by the fourth week. In addition, the Mg concentration of the intestinal artificial juice was at a low cytotoxic level. In porcine intestinal anastomoses, the Mg alloy staples caused neither technical failure nor such complications as anastomotic leakage, hematoma, or adhesion. No necrosis or serious inflammation reaction was histopathologically recognized. Thus, the proposed Mg alloy staple offers a promising alternative to Ti alloy staples.

DOI： 10.1038/s41598-019-51123-x

Novel thoracoscopic navigation surgery for neonatal chylothorax using indocyanine-green fluorescent lymphography

Shirotsuki, R; Uchida, H; Tanaka, Y; Shirota, C; Yokota, K; Murase, N; Hinoki, A; Oshima, K; Chiba, K; Sumida, W; Hayakawa, M; Tainaka, T

JOURNAL OF PEDIATRIC SURGERY 53 巻 ( 6 ) 頁： 1246 - 1249 2018年6月

記述言語：英語出版者・発行元：Journal of Pediatric Surgery

Background: Postoperative chylothorax after surgery for esophageal atresia/tracheoesophageal fistula (TEF) is a rare but serious complication, especially in neonates. This study aimed to identify the thoracic duct and ligate chylous leakage sites, using thoracoscopic navigation of an indocyanine-green (ICG)-based near-infrared (NIR) fluorescence imaging system. Methods: From November 2014 to April 2017, thoracoscopic intraoperative ICG-NIR imaging was performed in 10 newborns (11 surgeries) with first TEF operation or with persistent postoperative chylothorax after TEF operation. NIR imaging was performed 1 h after an inter-toe injection of ICG. Thoracoscopic ligations against the NIR-detected leakage sites were performed with sutures. Results: The thoracic duct or lymphatic leakage was directly visualized in each patient. In 8 surgeries with first thoracoscopic TEF operation, one case had suspected minor chylous leakage without postoperative chylothorax. Another case with no chylous leakage at the first operation resulted in chylothorax at postoperative day 11. In three neonates with postoperative chylothorax, leakage points were detected near the ablation site of the azygos vein during the first operation. These points were properly ligated, and postoperative chylous leakage ceased with no adverse events. Conclusions: Thoracoscopic ICG-NIR imaging encourages the repair of refractory chylothorax and seems reliable. Level of Evidence: IV

DOI： 10.1016/j.jpedsurg.2018.01.019

NOVEL BIOMARKER DISCOVERY FOR CHILDHOOD RHABDOMYOSARCOMA USING URINARY METABOLITES

Initial treatment of septated parapneumonic empyema with drainage plus fibrinolytic agents is equally effective as video-assisted thoracoscopic surgery, and is suitable as first-line therapy. 査読有り

Shirota C, Uchida H

Translational pediatrics 4 巻 ( 1 ) 頁： 41-4 2015年1月

Amano, H; Hinoki, A; Uchida, H; Yokota, K; Ishigaki, T; Sakairi, M; Abe, M; Terui, Y; Oda, H; Tainaka, T; Shirota, C; Sumida, W; Makita, S; Takimoto, A; Kano, Y; Okamoto, M; Yasui, A; Nakagawa, Y

PEDIATRIC BLOOD & CANCER 68 巻頁： S46 - S46 2021年6月

Identification of novel neuroblastoma biomarkers in urine samples Open Access

Yokota, K; Uchida, H; Sakairi, M; Abe, M; Tanaka, Y; Tainaka, T; Shirota, C; Sumida, W; Oshima, K; Makita, S; Amano, H; Hinoki, A

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 4055 2021年2月

記述言語：英語出版者・発行元：Scientific Reports

Urine is a complex liquid containing numerous small molecular metabolites. The ability to non-invasively test for cancer biomarkers in urine is especially beneficial for screening child patients. This study attempted to identify neuroblastoma biomarkers by comprehensively analysing urinary metabolite samples from children. A total of 87 urine samples were collected from 54 participants (15 children with neuroblastoma and 39 without cancer) and used to perform a comprehensive analysis. Urine metabolites were extracted using liquid chromatography/mass spectrometry and analysed by Metabolon, Inc. Biomarker candidates were extracted using the Wilcoxon rank sum test, random forest method (RF), and orthogonal partial least squares discriminant analysis (OPLS-DA). RF identified three important metabolic pathways in 15 samples from children with neuroblastoma. One metabolite was selected from each of the three identified pathways and combined to create a biomarker candidate (3-MTS, CTN, and COR) that represented each of the three pathways; using this candidate, all 15 cases were accurately distinguishable from the control group. Two cases in which known biomarkers were negative tested positive using this new biomarker. Furthermore, the predictive value did not decrease in cases with a low therapeutic effect. This approach could be effectively applied to identify biomarkers for other cancer types.

DOI： 10.1038/s41598-021-83619-w

Effect of General Anesthesia on Liver and Spleen Stiffness for Predicting High-Risk Varices in Biliary Atresia Open Access

Yokoyama, S; Honda, T; Ishizu, Y; Imai, N; Ito, T; Yamamoto, K; Shirota, C; Tainaka, T; Makita, S; Nakamura, M; Uchida, H; Kawashima, H

HEPATOLOGY RESEARCH 56 巻 ( 2 ) 頁： 223 - 232 2026年2月

記述言語：英語出版者・発行元：Hepatology Research

Aim: Liver and spleen stiffness (LS and SS) measurements in predicting high risk varices (HRVs) are reported useful in biliary atresia (BA). In children, inability to temporarily hold their breath may pose challenges in obtaining accurate measurements. This cross-sectional prospective study aimed to evaluate the diagnostic accuracy of LS and SS measurements obtained under general anesthesia during brief pauses in ventilation compared with those obtained in the awake state, in predicting HRVs. Methods: Among patients with BA aged 15 years or younger who underwent esophagogastroduodenoscopy under general anesthesia for evaluation of varices, 43 patients with LS and SS measured both in the awake and anaesthetized states were enrolled. HRVs were defined as large esophagogastric varices or esophagogastric varices of any size with red color signs. Results: The median age was 4 years. Nineteen patients had HRVs. In the HRVs group compared with the non-HRVs group, awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were significantly higher: 2.23 versus 1.71, 4.40 versus 3.45, 2.56 versus 1.73, and 4.13 versus 3.62 m/s, respectively. The area under the curve for awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were 0.784, 0.794, 0.814, and 0.698, respectively. Awake-LS and anesthesia-LS showed a strong positive correlation (ρ = 0.894), whereas awake-SS and anesthesia-SS showed a weak correlation (ρ = 0.468). Conclusions: As anesthetics and mechanical ventilation affect abdominal hemodynamics, SS measurements obtained under general anesthesia deviated from those obtained during the awake state. Further research is needed to determine whether mild sedation could help optimize measurement conditions. Trial Registration: This study was registered on the University Hospital Medical Information Network (UMIN000033123).

DOI： 10.1111/hepr.70049

The First Case of Bile Duct Resection Using the da Vinci SP for Congenital Biliary Dilatation in an Infant

Makita, S; Uchida, H; Hinoki, A; Shirota, C; Tainaka, T; Amano, H; Ogawa, K; Okamoto, M; Takimoto, A; Yasui, A; Takada, S; Hayashi, K; Nakagawa, Y; Kato, D; Ishii, H; Asai, H; Ota, K; Murata, Y; Liu, JH; Guo, YH

ASIAN JOURNAL OF ENDOSCOPIC SURGERY 19 巻 ( 1 ) 頁： e70246 2026年1月

記述言語：英語出版者・発行元：Asian Journal of Endoscopic Surgery

We report the first infant case of congenital biliary dilatation (CBD) treated using the da Vinci SP system. A 4-month-old boy (7.9 kg) with Todani type IV-A CBD underwent complete extrahepatic bile duct excision, hilar bile duct plasty, and hepaticojejunostomy through a 2.7-cm umbilical incision with an additional 3-mm assistant port. Operative time was 343 min with minimal blood loss. Recovery was uneventful, and the patient was discharged on postoperative day 7. This case demonstrates the feasibility of SP-assisted minimally invasive surgery in small infants.

DOI： 10.1111/ases.70246