Faculty Profiles - UENO Harushi

Papers - UENO Harushi

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Impact of Postoperative Therapy on Survival Outcomes in Non-small Cell Lung Cancer Patients With Microscopic Residual Disease Open Access

Watanabe, H; Nakamura, S; Imamura, Y; Okado, S; Nomata, Y; Kawasumi, Y; Kadomatsu, Y; Ueno, H; Kato, T; Mizuno, T; Chen, TF

ANTICANCER RESEARCH Vol. 45 ( 3 ) page： 1193 - 1204 2025.3

Language：English Publisher：Anticancer research

BACKGROUND/AIM: The aim of the study was to describe the specific characteristics of patients with microscopic residual disease (R1) after surgical resection for non-small cell lung cancer and to evaluate the effect of postoperative therapy in R1 patients. PATIENTS AND METHODS: We retrospectively reviewed the clinical data of 3,296 patients. Enrolled R1 patients were divided into two groups: those who received postoperative therapy (PT) and those who did not receive postoperative therapy (NPT). RESULTS: A total of 52 R1 patients were enrolled. Of those, 27 (51.9%) underwent extended resections in addition to the standard surgery, 37 patients were assigned to the PT group and 15 to the NPT group. The PT group exhibited significantly longer overall survival (OS) than the NPT group (p<0.01, 5-year OS rate: 62.7% vs. 17.9%). There was no difference in progression-free survival (PFS) between the two groups (p=0.34, 5-year PFS rate: 38.7% vs. 22.2%). Age (<70 years old) and postoperative therapy positively impacted OS (p=0.03, and p=0.01, respectively). CONCLUSION: R1 resection after surgical resection for non-small cell lung cancer was more likely to occur in the patients receiving extended surgical resection. The PT group demonstrated a significantly better prognosis than the NPT group.

DOI： 10.21873/anticanres.17506

Lobectomy for primary lung cancer: a comparison of perioperative and postoperative outcomes between robot-assisted thoracic surgery and video-assisted thoracic surgery Open Access

Ueno, H; Imamura, Y; Okado, S; Nomata, Y; Watanabe, H; Kawasumi, Y; Nakanishi, K; Kadomatsu, Y; Kato, T; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

SURGERY TODAY 2025.2

Language：English Publisher：Surgery Today

Purpose: This study compared the peri- and postoperative outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer. Methods: This retrospective cohort study included patients who underwent RATS or VATS at Nagoya University Hospital between April 2018 and March 2022. Propensity score matching was used to balance patient characteristics between the two groups. The following long-term outcomes were assessed: the 3-year overall survival (OS), causes of death, 3-year disease-free survival (DFS), and recurrence patterns. Various peri- and postoperative outcomes were examined as short-term outcomes. Results: After propensity score-matching, 137 patients were included in each group. RATS was associated with a longer operative time (median 180 vs. 144 min, p < 0.001), less blood loss (median 5 vs. 12 ml, p = 0.005), and a lower rate of conversion to open thoracotomy (1 [0.7%] vs. 10 [7.4%], p = 0.010) than VATS. The 3-year OS and DFS were comparable between the groups. Conclusion: In lobectomy for lung cancer, RATS demonstrated long-term outcomes that were comparable to those of VATS. Although RATS has a longer operative time, it is associated with less blood loss and a lower conversion rate to open thoracotomy than VATS, suggesting that it is a beneficial surgical approach for patients.

DOI： 10.1007/s00595-025-03000-6

Accuracy of lung structure constructed by three-dimensional image analysis with non-enhanced computed tomography Open Access

Noritake, O; Okado, S; Kadomatsu, Y; Ueno, H; Kato, T; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

JOURNAL OF THORACIC DISEASE Vol. 17 ( 2 ) page： 816 - 823 2025.2

Language：English Publisher：Journal of Thoracic Disease

Background: There are few papers on three-dimensional (3D) images of the lungs using non-enhanced computed tomography (CT). This study aimed to investigate the accuracy of 3D images of the lungs using non-enhanced CT. Methods: The study included 10 consecutive cases for each lung lobe, totalling 50 cases between March and December 2022. The patients had both non-enhanced and contrast-enhanced CT taken within 2 months before surgery. A 3D image analysis system (SYNAPSE VINCENT) was used to obtain 3D images of the pulmonary artery (PA), pulmonary vein (PV), and bronchus (Br). The system automatically generated 3D images based on both non-enhanced and contrast-enhanced CTs, which were then compared with each other and also with actual surgical findings. Results: The coincidence rate of PA, PV, and Br between 3D images based on non-enhanced CT and enhanced CT was 70% for the right lung and 65% for the left lung. The coincidence rate of PA, PV, and Br between 3D images based on non-enhanced CT and actual surgical findings was 100% for the right middle, right lower, and left lower lobes, but 50% for the right upper lobe and 60% for the left upper lobe. Conclusions: The 3D images of the lungs based on non-enhanced CT showed that the right middle lobe and both lower lobes were correctly depicted. The right and left upper lobes were poorly visualized using non-enhanced CT, while the right upper lobe was poorly visualized using contrast-enhanced CT.

DOI： 10.21037/jtd-24-1406

Robot-Assisted Complex Anatomical Segmentectomy Using Resection Process Map. Open Access

Nakamura S, Nakao M, Okado S, Kadomatsu Y, Ueno H, Chen-Yoshikawa TF

Annals of thoracic surgery short reports Vol. 2 ( 4 ) page： 643 - 645 2024.12

A case of peribronchiolar metaplasia of the lung appearing as a solid nodule on computed tomography Open Access

Takada, Y; Nakamura, S; Imamura, Y; Okado, S; Nomata, Y; Watanabe, H; Kadomatsu, Y; Ueno, H; Kato, T; Mizuno, T; Kojima, I; Chen-Yoshikawa, TF

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 4 ) page： 720 - 725 2024.11

Language：English Publisher：Nagoya Journal of Medical Science

Peribronchiolar metaplasia is an uncommon lesion characterized by fibrosis and bronchiolar epithelial cell proliferation along the peribronchiolar alveolar walls, primarily in response to bronchiolar and peribronchiolar injuries. Peribronchiolar metaplasia usually appears as ground glass nodules or sub-solid nodules on computed tomography. However, we present an exceptional case of peribronchiolar metaplasia that appeared as a solitary solid nodule on computed tomography. A 62-year-old woman with conjunctival icterus was diagnosed with ampullary cancer and nodal metastasis. A solid predominant nodule (0.7 cm maximum diameter) in the left lower lobe was identified on computed tomography, requiring accurate differentiation between primary lung cancer and pulmonary metastasis. Due to the location, histological confirmation via transbronchial biopsy was not feasible. Hence, the patient underwent surgery for both diagnosis and treatment. The pathological findings revealed the growth of columnar epithelium containing ciliated cells replacing alveolar epithelium in the bronchioloalveolar wall with no malignant component. The final pathological diagnosis of the lesion was peribronchiolar metaplasia. This unique case highlights an atypical presentation of peribronchiolar metaplasia as a solitary solid nodule on computed tomography. Recognizing that peribronchiolar metaplasia can also manifest as solid nodules, as illustrated in our current case, is essential.

DOI： 10.18999/nagjms.86.4.720

Impact of the expanded indication of robot-assisted thoracic surgery for mediastinal tumors

Kato, T; Watanabe, H; Kawasumi, Y; Kadomatsu, Y; Ueno, H; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

GENERAL THORACIC AND CARDIOVASCULAR SURGERY 2024.10

Language：English Publisher：General Thoracic and Cardiovascular Surgery

Objective: Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors. Methods: Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups. Results: Ninety-six surgical procedures were performed in the first half and 113 in the second half. The percentage of RATS approach was significantly higher in the second half compared with the first half (P < 0.001). Indications for RATS in the second half compared with the first half were significantly increased in patients with stage II (P < 0.001) and stage III (P = 0.026) thymomas, tumor diameter ≥ 50 mm (P < 0.011), and patients undergoing extended thymectomy for myasthenia gravis (P < 0.009). In respect of short-term postoperative parameters, the estimated intraoperative blood loss (P < 0.035), postoperative drain duration (P < 0.037), and postoperative hospital stay (P < 0.011) were significantly lower in the second half than in the first half. Conclusions: RATS has recently been expanded for mediastinal tumors with improved short-term outcomes in our hospital after health insurance was applied in Japan. In the future, it will be necessary to discuss the further expansion of its indications by taking into account safety and long-term outcomes.

DOI： 10.1007/s11748-024-02093-z

Virtual thoracoscopic imaging for accurate pulmonary nodule localization: clinical experience Open Access

Kadomatsu, Y; Nakao, M; Okado, S; Ueno, H; Kato, T; Nakamura, S; Chen-Yoshikawa, TF

SURGERY TODAY 2024.10

Language：English Publisher：Surgery Today

The increasing detection of small pulmonary nodules on computed tomography (CT) warrants simple and effective nodule localization methods. We describe our clinical experience using an experimental computer that displays virtual thoracoscopic images. This device constructs three-dimensional images from preoperative CT scans and simulates the deflated lung parenchyma in the lateral decubitus position. Five patients underwent lung resection using this technology. The device provided images that closely resembled actual thoracoscopic images in all cases. This method addresses the limitations of other localization techniques such as allergic reactions and mechanical marker-related complications. The method only requires preoperative CT images, and the process is semi-automatically performed by specifying the nodule location, thoracoscopic camera insertion site, and camera angle. This study is still in the preliminary phase and has several limitations. However, this method has the potential to accurately predict nodule locations and eliminate the many risks associated with other techniques.

DOI： 10.1007/s00595-024-02945-4

Incidence of air leaks in patients undergoing robotic thoracic surgery and video-assisted thoracic surgery Open Access

Ueno, H; Takada, Y; Imamura, Y; Okado, S; Nomata, Y; Watanabe, H; Nakanishi, K; Kadomatsu, Y; Kato, T; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 3 ) page： 464 - 471 2024.8

Language：English Publisher：Nagoya Journal of Medical Science

Postoperative air leakage is the most common complication in surgery for malignant lung tumors, leading to extended hospital stays and substantial medical expenses. This study aimed to identify the incidence and characteristics of intraoperative and postoperative air leaks in both robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), as well as the causes of persistent air leakage following RATS. We conducted a retrospective analysis of patients who underwent lung resection for malignant lung tumors at our institution from October 2018 to August 2022. We compared the incidence rates of intraoperative air leak, postoperative air leak, and persistent air leak between patients who underwent RATS and those who underwent VATS. Background factors were adjusted using propensity score matching. A subanalysis was performed to compare unexpected air leaks, defined as air leaks not observed intraoperatively but confirmed postoperatively. The study included 295 cases of RATS and 227 cases of VATS. In both the overall population and the matched group (187 cases each for RATS and VATS), RATS demonstrated a significantly higher incidence of persistent air leaks compared to VATS (11% vs 3%, p < 0.01; 9% vs 3%, p = 0.02, respectively). RATS also had a significantly higher incidence of unexpected air leaks compared with VATS (29% vs 18%, p = 0.05). Although there was no statistically significant difference in hospital stays, RATS showed a higher incidence of postoperative persistent air leaks and unexpected postoperative air leaks than VATS.

DOI： 10.18999/nagjms.86.3.464

Transcriptomic profiling of a late recurrent nuclear protein in testis carcinoma of the lung 14 years after the initial operation: a case report Open Access

Kato, T; Oyamatsu, H; Hanamatsu, Y; Huang, H; Okado, S; Imamura, Y; Nomata, Y; Watanabe, H; Kadomatsu, Y; Ueno, H; Nakamura, S; Mizuno, T; Hase, T; Takeuchi, T; Chen-Yoshikawa, TF

TRANSLATIONAL LUNG CANCER RESEARCH Vol. 13 ( 7 ) page： 1756 - 1762 2024.7

Language：English Publisher：Translational Lung Cancer Research

Background: Nuclear protein in testis (NUT) carcinoma (NC) of the lung is a rare cancer that occurs mainly in young adolescents and adults. NC is genetically characterized by NUTM1 rearrangements, which usually take the form of BRD4-NUT fusions. The prognosis for NC is dismal, and treatment with conventional chemotherapeutic regimens is ineffective. Case Description: We herein describe the case of a 53-year-old woman with recurrent NC of the lung 14 years after surgery for nasal cavity cancer. Chest computed tomography revealed a 5.5-cm tumor in the lower lobe of the left lung. We completely resected the recurrent lung NC via thoracotomy. Immunohistochemistry (IHC) of the lung and nasal cavity cancers showed diffuse strong expression of NUT. RNA-seq of the lung NC revealed NUTM1 rearrangement, with a fusion of BRD4 exon 10 to NUTM1 exon 4. This breakpoint has never been reported before. In addition, IHC revealed elevated expression of parathyroid hormone-like hormone in the lung NC but not in the nasal cavity NC, indicating that the lung and nasal cavity NCs were metachronous multiple primary cancers. Conclusions: We experienced a rare recurrence of lung NC 14 years after the initial surgery. The BRD4-NUT fusion consisted of a new breakpoint. Furthermore, the expression pattern of parathyroid hormone-like hormone (PTHLH) suggested that the NCs in the nasal cavity and lung may be metachronous multiple lung cancers. This extremely rare case highlighted the possibility of identifying less malignant NCs in patients with poorly differentiated tumors via fusion gene analysis and the need to develop more effective treatment strategies for this malignancy.

DOI： 10.21037/tlcr-24-259

CHST4 Gene as a Potential Predictor of Clinical Outcome in Malignant Pleural Mesothelioma

Okado, S; Kato, T; Hanamatsu, Y; Emoto, R; Imamura, Y; Watanabe, H; Kawasumi, Y; Kadomatsu, Y; Ueno, H; Nakamura, S; Mizuno, T; Takeuchi, T; Matsui, S; Chen-Yoshikawa, TF

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol. 25 ( 4 ) 2024.2

Language：English Publisher：International Journal of Molecular Sciences

Malignant pleural mesothelioma (MPM) develops primarily from asbestos exposures and has a poor prognosis. In this study, The Cancer Genome Atlas was used to perform a comprehensive survival analysis, which identified the CHST4 gene as a potential predictor of favorable overall survival for patients with MPM. An enrichment analysis of favorable prognostic genes, including CHST4, showed immune-related ontological terms, whereas an analysis of unfavorable prognostic genes indicated cell-cycle-related terms. CHST4 mRNA expression in MPM was significantly correlated with Bindea immune-gene signatures. To validate the relationship between CHST4 expression and prognosis, we performed an immunohistochemical analysis of CHST4 protein expression in 23 surgical specimens from surgically treated patients with MPM who achieved macroscopic complete resection. The score calculated from the proportion and intensity staining was used to compare the intensity of CHST4 gene expression, which showed that CHST4 expression was stronger in patients with a better postoperative prognosis. The median overall postoperative survival was 107.8 months in the high-expression-score group and 38.0 months in the low-score group (p = 0.044, log-rank test). Survival after recurrence was also significantly improved by CHST4 expression. These results suggest that CHST4 is useful as a prognostic biomarker in MPM.

DOI： 10.3390/ijms25042270

Thoracoscopic Wedge Resection for Low-Grade Fibromyxoid Sarcoma (Evans Tumor) with Massive Calcification and Originating from the Lung: A Rare Case in an Unexpected Location

Watanabe Hiroki, Nakanishi Keita, Ueno Harushi, Kato Taketo, Shimoyama Yoshie, Chen-Yoshikawa Toyofumi Fengshi

Annals of Thoracic and Cardiovascular Surgery Vol. 30 ( 1 ) page： n/a 2024

Language：English Publisher：The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

<p>We encountered a rare case of low-grade fibromyxoid sarcoma, which is generally known as Evans tumor, with massive calcification originating from the lung. The patient was a 22-year-old man with Duchenne muscular dystrophy who was referred for a detailed investigation of an intrathoracic tumor with massive calcification. Although our preoperative diagnosis was a solitary fibrous tumor originating from the mediastinum or diaphragm, intraoperative thoracoscopy revealed the tumor arising from the left lower lobe without adhesion to the other organs. Considering his medical history, we aimed to preserve lung function and chose wedge resection, which completely removed the tumor. Based on the pathological findings, the tumor was diagnosed as low-grade fibromyxoid sarcoma with massive calcification originating from the lung. Although extremely rare, this tumor should be considered as a differential diagnosis for a solitary lung mass with massive calcification in young adults.</p>

DOI： 10.5761/atcs.cr.23-00170

Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration Open Access

Ueno, H; Setogawa, T; Makita, A; Ohara, Y; Imamura, Y; Okado, S; Watanabe, H; Kawasumi, Y; Kadomatsu, Y; Kato, T; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

CANCERS Vol. 15 ( 24 ) 2023.12

Language：English Publisher：Cancers

Accurate identification of the intersegmental plane is essential in segmentectomy, and Indocyanine Green (ICG) assists in visualizing lung segments. Various factors, including patient-related, intraoperative, and technical issues, can influence boundary delineation. This study aims to assess the rate of unsuccessful intersegmental identification and identify the contributing factors. We analyzed cases of lung segmentectomy from April 2020 to March 2023, where intraoperative ICG was intravenously administered during robot-assisted or video-assisted thoracoscopic surgery. Cases where fluorescence extended beyond expected boundaries within 30 s were classified as the “unclear boundary group”. This group was then compared to the “clear boundary group”. The study encompassed 111 cases, 104 (94%) of which were classified under the “clear boundary group” and 7 (6%) under the “unclear boundary group”. The “unclear boundary group” had a significantly lower DLCO (15.7 vs. 11.8, p = 0.03) and DLCO/VA (4.3 vs. 3.0, p = 0.01) compared to the “clear boundary group”. All cases in the “unclear boundary group” underwent lower lobe segmentectomy. ICG administration effectively outlines pulmonary segments. Challenges in segment demarcation may occur in cases with low DLCO and DLCO/VA values, particularly during lower lobe segmentectomy.

DOI： 10.3390/cancers15245876

The Prognostic Impact of Postoperative EGFR Mutation Status in Lung Cancer Patients with Stage II - III

Nakamura, S; Hase, T; Takada, Y; Iwashimizu, H; Imamura, Y; Okado, S; Nomata, Y; Watanabe, H; Noritake, O; Nakanishi, K; Kadomatsu, Y; Ueno, H; Kato, T; Mizuno, T; Ishii, M; Chen-Yoshikawa, TF

JOURNAL OF THORACIC ONCOLOGY Vol. 18 ( 11 ) page： S489 - S490 2023.11

Complete visualization using indocyanine green in thoracic surgery for pulmonary sequestration

Nakanishi, K; Kadomatsu, Y; Ueno, H; Kato, T; Nakamura, S; Mizuno, T; Chen-Yoshikawa, TF

JOURNAL OF THORACIC DISEASE Vol. 15 ( 10 ) page： 5714 - + 2023.10

Language：English Publisher：Journal of Thoracic Disease

Preoperative three-dimensional computed tomography (CT) facilitates accurate identification of aberrant systemic arteries in thoracic surgery for pulmonary sequestration (PS). Furthermore, the boundary between normal and sequestrated lungs can be visualized using the spread of fluorescent indocyanine green (ICG) when performing surgery for PS. This study aimed to determine how to completely visualize anatomical variations, safely treat aberrant arteries, remove only sequestrated lungs, and perform minimally invasive surgery for PS. Seventeen patients underwent lung resection for intralobar PS at our institution between 2009 and 2022. We retrospectively reviewed the surgical outcomes and intraoperative images using ICG to assess the efficacy and feasibility of near-infrared fluorescence imaging. Since 2019, intraoperative near-infrared fluorescence imaging with ICG has been used in six patients, including four females and two males (median age, 56 years), to visualize the boundary between normal and sequestrated lungs. Aberrant arteries were identified using preoperative three-dimensional CT, and the boundary between sequestrated and normal lungs could be clearly delineated intraoperatively using ICG in all cases. The median operative time was 145 min (range, 88–167 min), and the median blood loss was 5 mL (range, 1–191 mL). The overlay mode using near-infrared thoracoscopy, which merges visible light images with fluorescent images, was safer and more useful than conventional thoracoscopy for delineating boundaries with electrocautery. No intraoperative or postoperative complications occurred. The median postoperative hospital stay was 5 days (range, 3–7 days). Intraoperative identification of the boundary between normal and sequestrated lungs using ICG was simple and feasible. We suggested that this technique was effective for lesion resection and normal lung preservation during surgery for intralobar PS.

DOI： 10.21037/jtd-23-892

Cadaver surgical training for brain-dead donor lung procurement: Educational note

Nakamura, S; Ueno, H; Mutsuga, M; Chen-Yoshikawa, TF

JTCVS TECHNIQUES Vol. 21 page： 261 - 264 2023.10

New method for delineation of the intersegmental line in a deflated lung

Okado, S; Kadomatsu, Y; Nakao, M; Ueno, H; Fukumoto, K; Nakamura, S; Chen-Yoshikawa, TF

JOURNAL OF THORACIC DISEASE Vol. 15 ( 9 ) page： 4736 - 4744 2023.9

Language：English Publisher：Journal of Thoracic Disease

Background: Preoperative three-dimensional (3D) computed tomography (CT) images have been widely used as surgical guides in lung surgery; however, the lungs tend to be deflated during surgery. Discrepancies between the preoperatively constructed 3D image and the intraoperative view of the deflated lungs often require preoperative and/or intraoperative marking methods for sublobar pulmonary resection. We have developed a lung deflation simulation algorithm in which 3D CT images of the deflated lungs can be predicted only based on the preoperative CT taken in an inflated phase of respiration. Using this system, we conducted a preliminary study to retrospectively compare the intersegmental line predicted by our lung deflation simulation algorithm with the intersegmental line delineated by the intravenous administration of indocyanine green. Methods: Sixteen patients who underwent unilateral segmentectomy between January 1, 2020, and June 30, 2022, were included in the study. The identified intersegmental lines were confirmed intraoperatively using indocyanine green. These actual intersegmental lines were compared with those delineated on 3D images using the lung deflation simulation algorithm. Results: Of the 16 patients who underwent pulmonary segmentectomy, the consistency of these intersegmental lines was in complete agreement in twelve patients, partial agreement in three patients, and disagreement in one patient. The concordance rate of the intersegmental lines was 75%. Conclusions: The lung deflation simulation algorithm provides a new surgical guide in addition to the currently utilized ones. Continuous innovation might lead to a less invasive surgical technique for delineating the intersegmental line.

DOI： 10.21037/jtd-23-421

Setting a quality indicator for actual surgery time relative to scheduled surgery time in the context of increasing robotic-assisted thoracic surgery cases

Ozeki, N; Ueno, H; Saeki, J; Kadomatsu, Y; Kato, T; Nakamura, S; Fukumoto, K; Fukui, T; Chen-Yoshikawa, TF

GENERAL THORACIC AND CARDIOVASCULAR SURGERY Vol. 71 ( 7 ) page： 396 - 402 2023.7

Language：English Publisher：General Thoracic and Cardiovascular Surgery

Objective: This study aimed to demonstrate to the involved departments the goal of increasing the number of robotic-assisted thoracic surgery (RATS) cases/surgeons and acceptable surgery times. Methods: This retrospective study included 1572 patients who underwent thoracic surgery from fiscal year (FY) 2018 to FY 2021. The factors evaluated included the number of surgery cases and actual and scheduled surgery times. Results: The total number of RATS and total surgery cases increased after the quality indicator (QI) setting (n = 363, 360, 417, and 432 in FY 2018, 2019, 2020, and 2021, respectively). In FY 2020, 93.3% of the QI target was achieved, while in FY 2021, 88% was achieved. The number of RATS lobectomy/segmentectomy increased as the FY progressed (n = 31, 47, 58, and 116 in FY 2018, 2019, 2020, and 2021, respectively). The mean surgical time by RATS starters decreased in FY 2020 and 2021 (171.4 min.; 74 cases; seven RATS starters) compared with those in FY 2018 and 2019 (198.0 min.; 57 cases; six RATS starters) (P = 0.002). Conclusions: The goal of increasing the number of surgery cases and RATS cases/surgeons within the given framework was achieved by setting the QI.

DOI： 10.1007/s11748-022-01903-6

Lingular-segment torsion after extended left-upper division segmentectomy by video-assisted thoracic surgery with indocyanine green fluorescence imaging

Kato, T; Ohara, Y; Okado, S; Noritake, O; Nakanishi, K; Kadomatsu, Y; Ueno, H; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

ASIAN JOURNAL OF ENDOSCOPIC SURGERY Vol. 16 ( 3 ) page： 584 - 587 2023.7

Language：English Publisher：Asian Journal of Endoscopic Surgery

Lingular-segment torsion after left-upper division segmentectomy (LUDS) is a rare complication, and the cause remains unclear. Here we report the case of a patient who developed lingular-segment torsion after LUDS for multiple lung metastases of breast cancer. One lung nodule was located in the S1 + 2 segment and another between the upper lobe and S6 on an incomplete interlobar fissure. The lung metastases were resected by extended LUDS using video-assisted thoracic surgery with indocyanine green fluorescence imaging. The staple line on the lingular segment was vertically tilted against the interlobar line because of the atypical defect of the fluorescence plane and nodule position. Chest X-ray and contrast-enhanced computed tomography indicated ischemia and torsion of the lingular segment on the second postoperative day, and completion of lingular segmentectomy was performed. This case showed the vertical intersegment staple line during LUDS was one of the important causes of postoperative torsion of the lingular segment.

DOI： 10.1111/ases.13189

[Robot-assisted Extended Thymectomy via a Bilateral Approach for Patients with Myasthenia Gravis].

Nakamura S, Nakanishi K, Kadomatsu Y, Ueno H, Kato T, Chen-Yoshikawa TF

Kyobu geka. The Japanese journal of thoracic surgery Vol. 76 ( 7 ) page： 523 - 527 2023.7

Clinical application of resection process map as a novel surgical guide in thoracic surgery

Kadomatsu, Y; Nakao, M; Ueno, H; Nakamura, S; Fukumoto, K; Chen-Yoshikawa, TF

INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY Vol. 36 ( 4 ) 2023.4

Language：English Publisher：Interdisciplinary cardiovascular and thoracic surgery

Resection Process Map (RPM) is a surgical simulation system that uses preoperative three-dimensional computed tomography. Unlike the usual static simulation, this system provides surgeons an individualized dynamic deformation of the lung parenchyma and vessels. RPM was first introduced in 2020. Although the intraoperative usefulness of this system has been evaluated experimentally, there have been no reports on its clinical use. Herein, we presented in detail the first experience on RPM during robot-assisted anatomical lung resection in the real clinical setting.

DOI： 10.1093/icvts/ivad059

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