Recently, endoscopic surgery has been rapidly spreading in the field of gastroenterological surgery, where it is mostly used in the treatment of early gastric and colon cancer. However, the procedure is not yet regularly used for refractory cancers such as esophageal, hepatobiliary and pancreatic cancer, and there is an urgent need to establish the safe and effective approach in this field.
Our department has been treating esophageal cancer using endoscopic surgery from its early days. We have recently adopted endoscopic esophagectomy in prone position, which has been popular approach in recent days. With this procedure, surgery can be performed using bilateral lung ventilation. We are currently studying its effect in reducing respiratory complications.
In endoscopic surgery, a part of hepatectomy and distal pancreatectomy have been recently covered by health insurance in Japan. We are starting the research on the expansion of endoscopic surgery for these fields.
Our department is also developing new instruments to safely and effectively carry out endoscopic 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.