The Gastrointestinal Group manages surgical treatment of digestive diseases, chief among them being malignant diseases such as esophageal, gastric, and colorectal cancers; neoplastic lesions such as gastrointestinal stromal tumors (GIST) and leiomyoma; benign diseases such as esophageal achalasia, gastroesophageal reflux disease, diverticulitis of the colon, and inflammatory bowel disease (IBD); as well as emergency conditions such as GI ulcer perforation and appendicitis. In the department of Gastroenterological Surgery II, our group focuses on endoscopic surgery for esophageal and gastric cancers. Further, as a designated cancer hospital, we collaborate with hospitals all over Hokkaido to provide best medical care to our patients.
Endoscopic Surgery consists of making small incisions, and inserting a laparoscope or a thoracoscope (camera), as well as surgical instruments. Surgery can then be performed by viewing a monitor screen. Using this method, scars are smaller, and postoperative recovery accelerated compared to conventional procedures. The implementation of endoscopic surgery into cancer surgery has recently been expanding, and our department has introduced the procedure in early period, as well as a leader in its research and development. With two of our specialists in endoscopic surgery, Drs. Toshiaki Shichinohe and Yuma Ebihara recognized as endoscopic surgical skill qualification system qualified surgeon by Japan society for endoscopic surgery, we perform most of gastroenterological surgery using minimally invasive approach.
Since 1996, our department has been one of the earliest to perform thoraco-laparoscopic esophagectomy in order to improve the quality of life (QOL) and prognosis of patients after surgery. Although the surgery itself is a high risk surgery and has a number of complications associated with this procedure, endoscopic surgery has enabled us to perform surgeries on most of the esophageal cancer patients including those who would normally not be a candidate for thoracotomy operation due to their co-morbidities, or patients who have relapse and need salvage operation after definitive chemo-radiotherapy.
In addition to surgical treatment of esophageal cancer, combining a number of methods, such as endoscopic mucosal resection, chemotherapy and radiation therapy, are crucial to achieve multidisciplinary therapy. The Department of Gastroenterological Surgery II of Hokkaido University conducts surgical therapy, but also brings in specialists in endoscopic therapy (Endoscopic treatment department, gastroenterologists), chemotherapy (gastroenterologists, medical oncologists), and radiation therapy (radiologists), to form a cooperative and communicative group, which responds with considerable care to medical conditions of the individual patient.
The role of the Hokkaido University Hospital is to set up adjuvant therapy to improve both quality of life (QOL) and postoperative outcomes through the development, dissemination, and prevention of recurrence after surgery. Endoscopic surgeries like laparoscopic gastrectomy and laparoscopic colorectal resections have been proactively implemented. Endoscopy makes it possible to carry out resections and lymphadenectomy in the same manner as conventional surgery. As surgical techniques advances, most surgeries for gastric and colorectal cancers can be performed using endoscopy. In addition, to prevent recurrence and improve prognosis, we continue research in advanced medicine and adjuvant therapy (pre- and post-surgery chemotherapy, immunotherapy) through clinical studies.
We also receive a number of requests from the emergency department for surgery in various emergency conditions like injury after traffic accident, acute abdomen, strangulation ileus, perforation of the stomach, duodenum, or bowels, and superior mesentery arterial thrombosis. Our staff and residents have abundant experiences in acute care surgery.
Our work in cooperation with the Chitose Institute of Science and Technology has led to the development of an endoscopic system, which facilitates the detection of lymph nodes during surgery. Using a near infrared ray, we can produce an image of deep tissue, and combined with an endoscopic image, we can accurately determine the presence of a lymph node closest to a tumor. We can then examine the lymph node and therefore reduce the area of surgical excision, leading to lesser burden on the body.
In collaboration with Chiba University, we are also developing an instrument allowing us to inject liquid into the abdominal space during laparoscopic surgery instead of carbon dioxide. Since we often encounter the cloudiness and the dirt impairs the field of vision during laparoscopic surgery, there is a need for frequent cleaning of the scope. Under the environment using liquid, humidity and pressure are controlled, and it facilitates the smooth progression of surgery. Further, we will search whether liquid pressure can contribute to reduce blood loss during surgery.