This study was intended to identify new risk factors for biliary complications (BCs) in recipients after living donor liver transplantation (LDLT), focusing on the biliary anatomy of the donor. A total of 123 living donors who underwent donor hepatectomy between 2007 and 2024 were retrospectively analyzed. Using three-dimensional reconstructed drip infusion cholangiographic computed tomography images, we evaluated biliary branching patterns, the maximum bifurcation angle and rotation angle of the hepatic ducts, and the bifurcation position relative to the portal vein. BCs occurred in 25 recipients (20.3

Background:Staging laparoscopy (SL) for pancreatic ductal adenocarcinoma (PDAC) is considered useful in improving the accuracy of staging and resectability. However, currently, there are no standard criteria for selecting patients who may benefit from SL prior to determining the appropriate treatment. In this report, we aimed to determine the role of SL before therapy in patients with PDAC. Methods:This study was a single-center, prospective cohort study comprising patients with PDAC at Iwate Medical University Hospital during the period from November 2021 to June 2025. SL was performed in all patients with PDAC with no radiological distant metastasis before they underwent pancreatic resection or chemotherapy or chemoradiotherapy. The baseline characteristics, operative outcomes, changes of resectability status, complete resection rate and mid-term survival were examined. Results:102 patients were finally included in the present study. Before SL, according to resectability status, 45 patients (44.1%) were classified as resectable (R), 36 (35.0%) as borderline resectable (BR), and 21 (20.6%) as unresectable locally advanced (UR-LA). SL revealed distant metastasis in 24 (23.5%) patients. The univariate analysis revealed that the factors of CEA positive and CA19-9 ≥ 150, U/mL were associated with a significantly higher risk of occult metastasis. The multivariate analysis revealed that having a CEA positive and CA19-9 ≥ 150, U/mL were the only factors that were independently associated with occult metastasis. For patients with R PDAC before SL, distant metastasis was found after SL in 17.8% of patients. Even in cases where none of the tumor markers were elevated, one case was found to have distant metastasis after SL. There was no morbidity and mortality in this case series. In the intention-to-treat population, the median overall survival (OS) were not reached [95% CI: 22.0 months-not estimable (NE)]. The median DFS was 22.0 months (95% CI: 15.0 months-27.0 months). Of the patients with UR-LA PDAC, despite stage migration, no improvement in OS was observed after SL. Conclusion:SL is safe and effective in determining accurate staging, which may allow for more appropriate treatment. Therefore, SL is actively recommended for patients with R PDAC or BR PDAC who are planning to undergo complete resection shortly to avoid unnecessary surgical exploration, especially those CEA positive or with CA19-9 ≥ 150 U/mL.

Metabolic and bariatric surgery (MBS) alters the gut microbiota (GM). Changes in oral microbiota (OM) after MBS have not yet been thoroughly investigated. In this study, we evaluated the changes in GM and OM before and after laparoscopic sleeve gastrectomy (LSG) in patients with severe obesity and investigated the relationship between improvements in GM/OM, weight loss, and the metabolic effects. Thirty-seven severely obese patients who underwent LSG were enrolled in this study. We retrieved samples from the feces and oral mucosa from baseline to 1-year after LSG. These samples were subjected to a 16 S rRNA metagenomic analysis using a next-generation sequencer. We evaluated the significant changes in GM/OM and compared the results with clinical outcomes. Regarding OM diversity, g_Actinomyces (p = 0.003), o_Rothia (p = 0.020), and g_Streptococcus (p = 0.004) increased. With regard to GM, g_Slackia (p = 0.039), g_Bacillus (p = 0.030), g_Roseburia (p = 0.027), and g_Faecalibacterium (P = 0.003) increased, the proportion of p_ Firmicutes increased, and p_Bacteroidetes decreased in both groups. Changes in g_Akkermansia did not contribute to GM/OM diversity. The weight loss and remission rates of type 2 diabetes were higher in patients with increased normal oral flora and a recovery of g_Faecalibacterium in GM. We clarified that the LSG reconstructs GM/OM as weight loss and the metabolic effects are enhanced.

Aligning light spots into arbitrary shapes is a fundamental challenge in holography, leading to various applications across diverse fields in science and engineering. However, as the spot interval approaches the wavelength of light, interference effects among the spots become prominent, which complicates the generation of a distortion-free alignment. Herein, we introduce a hologram design method based on the optimization of a nonlinear cost function using a holographic phase pattern as the optimization parameter. We confirmed generation of a 5 x 5 multispot pattern, in which each spot is separated clearly by a distance of 0.952(1) mu m, on the focal plane of a high-numerical-aperture (0.75) objective by observing the near-infrared (wavelength: 820 nm) holographic output light from a spatial light modulator device. This result breaks through the spot spacing of a few micrometers that is a typical value achieved so far under similar experimental conditions. Furthermore, we propose redefinition of the Rayleigh diffraction limit by taking account of the separation of spot as well as the spot spacing. The proposed method is expected to advance laser fabrication, scanning laser microscopy, and cold atom physics, among other fields.

BACKGROUND:Robotic liver resection (RLR) is widely performed as an alternative to laparoscopic liver resection. Many different surgical robot systems (SRSs) have been developed; however, there are relatively few standardized RLR procedures that can be applied to the use of different SRSs. We present a standardized robotic left hepatectomy (RLH) procedure for different SRSs and the learning curve derived via cumulative sum analysis. MATERIALS AND SURGICAL TECHNIQUE:We performed 14 cases of RLH using our standardized procedure. We mobilized the left lobe, and the round ligament was drawn to the caudal side. The omental bursa is opened, and the Arantius duct is carefully transected. The left Glissonean pedicle was encircled and transected using a linear stapler after confirming the demarcation line. Parenchymal transection is gently performed using the clamp-crush technique (intermittent Pringle's maneuver). The root of the left hepatic vein was visualized at the end of the parenchymal transection, and this vein was transected using a linear stapler. DISCUSSION:In our series, there were no intraoperative transfusions or conversions. One case of bile leakage required endoscopic treatment, and the patient survived. The learning curve plateaued at seven cases of RLH. Our standardized RLH procedure, which includes the Glissonean approach and the clamp-crush method, can be applied to all SRSs without any specific energy devices.

INTRODUCTION:An extrahepatic biliary neuroendocrine tumor (EB-NET) is an extremely rare malignancy with a poor prognosis and no established standard of care. CASE PRESENTATION:We herein report the case of a 35-year-old Japanese woman with no significant past medical or family history who presented with epigastric and back pain and was diagnosed with an EB-NET after pylorus-preserving pancreaticoduodenectomy. Despite initial resection, she developed recurrent liver metastases that required repeated hepatic resections and multiple systemic therapies, including chemotherapy, somatostatin analogs, everolimus, and peptide receptor radionuclide therapy (PRRT). Eventually, owing to progressive liver metastasis, she underwent living-donor liver transplantation (LDLT) from her brother 6 years after the initial surgery. Post-transplantation, the patient has remained disease-free for >3 years while on maintenance immunosuppression. CONCLUSIONS:Multimodal treatment, including resection of metastases, PRRT, and LDLT, significantly prolonged survival. This case highlights the potential role of LDLT as a curative strategy for patients with EB-NETs and controlled extrahepatic disease following multimodal treatment. Our case suggests that liver transplantation may provide long-term survival even in cases of a rare primary EB-NET, prompting the consideration of broader transplant indications in selected patients.

INTRODUCTION:Laparoscopic liver resection (LLR) is a difficult procedure that requires the scopist to have a high skill level. Scopists play an important role in ensuring an appropriate surgical field. This is the first study that focuses on the scopist's skills in perioperative outcomes of LLR. MATERIALS AND METHODS:Patients who underwent LLR from April 2018 to March 2023 were included in this study. The scopists were separated into expert (≥ 10 LLR procedures as a scopist) and beginner (< 10 LLR procedures as a scopist) groups. The effects of the scopists' skills on the perioperative outcomes of LLR between the two groups were examined retrospectively. In addition to listing baseline characteristics and perioperative outcomes, this study viewed video recordings to list intraoperative surgical manipulation factors as new attempts. RESULTS:No significant differences were observed in the baseline characteristics or perioperative outcomes between the two groups. The duration of the time during which the surgical procedure was interrupted due to scope operation errors during the Pringle maneuver was significantly longer in the beginner group (71 vs. 198 s, p < 0.001). CONCLUSION:The scope manipulation by the less experienced LLR scopists sometimes hindered the progress of the surgery. The scopist's skills may lead to an increased psychological burden on the surgeon and prolonged operative times.

Recently, reports of robotic hepatectomies have increased. In a laparoscopic hepatectomy, various energy devices are used for parenchymal transections, especially the clamp-crush method and the Cavitron Ultrasonic Surgical Aspirator (CUSA) system are popular; however, there is no CUSA that can be operated from the robot console. We believe that conventional clamp-crush method can be classified into four categories and have tried to verbalize them. We aim to explain the four types of clamp-crush techniques of robotic hepatectomy that we have performed and to assess their outcomes, safety, and feasibility. The data of patients who underwent robotic hepatectomy at Iwate Medical University Hospital between June 2022 and April 2024 were retrospectively reviewed. For comparison, 298 patients who underwent pure laparoscopic hepatectomy at Iwate Medical University Hospital between January 2014 and December 2020 were enrolled and analyzed. Our four clamp-crush techniques (Clamp, Peck, Open, Sweep) are demonstrated in the video clips provided with our study's electronic data. In the present study, 58 patients were included. In 27 cases (46.6%), a limited resection was performed; in 9 cases (15.5%), a subsegmentectomy; in 15 cases (25.9%), a sectionectomy; and in 7 cases (12.1%), a hemihepatectomy. The mean operative time was 205.9±90.5 min, and the mean intraoperative blood loss was 103.1±200.7 mL. There were no cases of conversion to a laparotomy. In comparison with laparoscopic hepatectomies, there were no significant differences in perioperative outcomes. The present findings indicate that robotic hepatectomies are safe and feasible in high-volume specialized centers with a team experienced in laparoscopic liver surgeries. It is possible to transition from laparoscopic hepatectomy to robotic hepatectomy without stress due to the fact that the same four clamp-crush techniques that are used in laparoscopic hepatectomy, which can be done in a robotic hepatectomy.

Metabolic surgery, including laparoscopic sleeve gastrectomy (LSG), may improve hypertension (HTN) complicated by severe obesity; however, insufficient deliberation exists regarding the therapeutic effect of post-metabolic surgery on HTN. This study aimed to analyze the factors correlated with HTN remission and recurrence post-LSG in patients who have severe obesity, and to create a classification system to predict HTN remission and recurrence. Of the 102 patients who underwent LSG at Iwate Medical University Hospital between 2008 and 2020, 62 were enrolled in this study. Factors correlated with HTN remission and recurrence post-LSG were retrospectively analyzed. The HTN remission rate 12-months post-LSG was 40.3%. The remission cohort had a lower number of preoperative antihypertensive drugs (ADs) than that of the non-remission cohort (one and two tablets, respectively; p< 0.001). Additionally, the remission cohort had a statistically significantly smaller visceral fat area (VFA) than that of the non-remission cohort, at all time points. Logistic regression analysis revealed that the number of preoperative ADs and VFA were independent predictors of remission. The HTN recurrence rate 36-months post-LSG was 36.0%. In the recurrence cohort, the number of preoperative ADs and VFA were higher and larger than that in the non-recurrence cohort, respectively. Stratification, based on the number of preoperative ADs and VFA, revealed that the HTN remission and recurrence rates in the sub-cohort with a small number of preoperative ADs and small VFA (100% and 16.7%, respectively) were better than those in the sub-cohort with a large number of preoperative ADs and large VFA (5.3% and 100%, respectively). In Japanese patients with severe obesity, the number of preoperative ADs and VFA were correlated with HTN remission and recurrence post-LSG. Stratification, by combining the number of preoperative ADs and VFA, may be useful in predicting HTN remission and recurrence.

Introduction: Autoimmune pancreatitis (AIP) is recognized as a disease with a good prognosis that responds well to steroids, but the complication of pancreatic ductal adenocarcinoma (PDAC) in AIP is a rare condition. We report a case of PDAC encapsulated by tumor-forming type 1 AIP. Case Presentation: The patient, a 65-year-old female, was found to have high CA19-9 levels and a pancreatic mass with a diameter of 30 mm on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a 40-mm mass in the tail of the pancreas that had a 27-mm oligemic mass inside it. From these work-up examinations, this tumor was diagnosed as PDAC, with evidence of colonic invasion. As curative resection for PDAC, a distal pancreatectomy with splenectomy and combined colon resection were performed. Histopathological examination showed invasive PDAC surrounded by IgG4-positive plasma cell infiltration. Based on these findings, a diagnosis was made of PDAC located in the pancreatic tail capsulized by type 1 AIP. The postoperative course was uneventful, and the patient was discharged on postoperative day 15. She underwent postoperative adjuvant chemotherapy with S-1 for 6 months, and no recurrence was noted for 2 years after operation. Conclusion: Currently, there are two hypothetical mechanisms of PDAC induction by AIP: (1) carcinogenic stimulation due to chronic inflammation and (2) paraneoplastic syndrome caused by AIP. Further study of the relationship between AIP and pancreatic cancer is needed, and follow-up should be conducted while keeping in mind the possibility of complications.

Although an optical vortex (OV) is a promising means for driving cyclic Brownian dynamics of a small particle, the OV-driven dynamics cannot avoid producing additional nonequilibrium heat dissipation of a few tens of k_{B}T per cycle due to distortion of a light wavefront. We propose an adaptive wavefront-optimization concept, where minor wavefront distortion in microscopy can be probed by the additional heat dissipation itself. As a result, the additional heat dissipation was suppressed to <0.6k_{B}T, which makes OVs applicable to examining small nonequilibrium changes in thermodynamic systems. The present approach is expected to become an experimental standard in the nonequilibrium physics field.

We introduce a concept of aberration correction under microscopy that is based on observation of circular Brownian motion of an object driven by orbital angular momentum of a Laguerre-Gaussian (LG) beam. Following the concept, we establish an aberration-correction scheme by using a holographic optical tweezers setup equipped with a spatial light modulator that produces the LG beam as well as corrects the light wavefront. The light wavefront is modified adaptively to improve circular symmetry and uniformity of the orbit of a colloidal dielectric sphere revolving in mid-water under the irradiation of the LG beam. We reveal that the proposed scheme is sensitive to tiny phase difference of less than the accuracy of a highest-grade optical flat, 0.05λ, and is applicable to aberrations of up to the first 21 terms of the Zernike series expansion. The scheme not only improves the quality of optical tweezers but also enables to distinguish individual objective lenses assigned a common product code from difference in aberration-correction patterns. The present contribution therefore provides a useful tool for microscopy and laser fabrication in addition to the immediate application to optical trapping.

Laparoscopic parenchymal-sparing hepatectomy (PSH) for lesions with proximity to major vessels (PMV) in posterosuperior segments (PSS) has not yet been sufficiently examined. The aim of this study is to examine the safety and feasibility of laparoscopic PSH for lesions with PMV in PSS 7 and 8. We retrospectively reviewed the outcomes of laparoscopic liver resection (LLR) and open liver resection (OLR) for PSS lesions and focused on patients who underwent laparoscopic PSH for lesions with PMV in PSS. Blood loss was lower in the LLR group (n = 110) than the OLR group (n = 16) (p = 0.009), and no other short-term outcomes were significantly different. Compared to the pure LLR group (n = 93), there were no positive surgical margins or complications in hand-assisted laparoscopic surgery (HALS) (n = 17), despite more tumors with PMV (p = 0.009). Regarding pure LLR for one tumor lesion, any short-term outcomes in addition to the operative time were not significantly different between the PMV (n = 23) and no-PMV (n = 48) groups. The present findings indicate that laparoscopic PSH for lesions with PMV in PSS is safe and feasible in a matured team, and the HALS technique still plays an important role.

Studies on pure laparoscopic donor hepatectomy (PLDH) have been reported. However, only few studies have reported on the learning curve of PLDH. In this report, we aimed to determine the learning curve of PLDH in adult patients using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses. The data of donors who underwent PLDH at a single center between December 2012 and May 2022 were retrospectively reviewed. The learning curve was evaluated using the CUSUM and RA-CUSUM methods based on surgery duration. Forty-eight patients were finally included in the present study. The mean operation time was 393.6 ± 80.3 min. PLDH was converted to laparotomy in three cases (6.3

Background Severely obese patients can have other diseases requiring surgical treatment. In such patients, bariatric surgeries are considered a precursor to operations targeting the original disease for the purpose of reducing severe perioperative complications. Pancreatic ectopic fat deposition increases pancreas volume (PV) and thickness, which can worsen insulin resistance and islet β cell function. To address this problem, we present a novel two-stage surgical strategy performed on a severely obese patient with pancreatic neuroendocrine tumor (PNET) consisting of laparoscopic sleeve gastrectomy (LSG) as a metabolic surgery followed by laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Case presentation A 56-year-old man was referred to our hospital for further investigation of a pancreatic tumor. His initial body weight and body mass index (BMI) were 94.0 kg and 37.2 kg/m 2 , respectively. Contrast computed tomography revealed an enhanced tumor measuring 15 mm on the pancreatic body. The pancreas thickness and PV were 32 mm and 148 mL, respectively. An endoscopic ultrasonographic fine needle aspiration identified the tumor as PNET-G1. We first performed LSG, the patient’s body weight and BMI had decreased dramatically to 64.0 kg and 25.3 kg/m 2 at 6 months after LSG. The pancreas thickness and PV had also decreased to 17 mm and 99 mL, respectively, with no tumor growth. Since LSG has been shown to reduce the perioperative risk factors of LSPDP, and to improve insulin resistance and recovery of islet β cell function, we performed LSPDP for PNET-G1 as a second-stage surgery. The postoperative course was unremarkable, and the patient was discharged on postoperative day 14 without symptomatic postoperative pancreatic fistula (POPF). He was followed without recurrence or type 2 diabetes (T2D) onset for 6 months after LSPDP. Conclusions We present a novel two-stage surgical strategy for a severely obese patient with PNET, consisting of LSG as a metabolic surgery for severe obesity, followed by LSPDP after confirmation of good weight loss and metabolic effects. LSG before pancreatectomy may have a potential to reduce pancreas thickness and recovery of islet β cell function in severely obese patients, thereby reducing the risk of clinically relevant POPF and post-pancreatectomy T2D onset.

Laparoscopic deroofing of liver cysts is widely accepted as the treatment of symptomatic huge liver cysts. As bile leakage is a common complication of this procedure, indocyanine green (ICG) imaging has played an active role in detecting intrahepatic biliary tract. However, infusion ICG imaging needs time rag after injection due to moving from bloodstream to bile, and also, additional injection is needed when the fluorescent imaging is not clear. To cover this weakness of ICG imaging, we first applied ICG imaging via 5-Fr endoscopic nasal biliary drainage (ENBD) during laparoscopic deroofing of liver cysts. This technique promptly gives us ICG imaging after ICG injection from ENBD; in addition, direct ICG imaging sometimes reveals minor leakage from sealing line and staple lines; therefore, we believe that direct ICG imaging via ENBD helps us to prevent post-operative bile leakage.