Simulation of the Fissureless Technique for Thoracoscopic Segmentectomy Using Rapid Prototyping

The fissureless lobectomy or anterior fissureless technique is a novel surgical technique, which avoids dissection of the lung parenchyma over the pulmonary artery during lobectomy by open thoracotomy approach or direct vision thoracoscopic surgery. This technique is indicated for fused lobes. We present two cases where thoracoscopic pulmonary segmentectomy was performed using the fissureless technique simulated by three-dimensional (3D) pulmonary models. The 3D model and rapid prototyping provided an accurate anatomical understanding of the operative field in both cases. We believe that the construction of these models is useful for thoracoscopic and other complicated surgeries of the chest.     

Use of dermal fat grafts for treating anetoderma with lipoatrophy following involution of hemangiomas

Infantile hemangioma (IH) is a benign vascular tumor that gradually involutes over several years. Rapidly involuting congenital hemangioma (RICH) is the relatively rare congenital vascular tumor that is fully grown at birth and does not undergo postnatal growth and involutes during the first year. However, after involution of both IH and RICH, some have severe sequelae, such as redundant skin or conspicuous scarring, requiring additional treatment. We present the case of a 6-year-old girl with a concave deformity due to subcutaneous atrophy, skin darkening, and altered skin texture of her left zygomatic region following involution of a hemangioma. We successfully treated this patient by transferring a dermal fat graft. This technique can be beneficial for atrophic sequelae after regression of a hemangioma and is easy to perform and cosmetically effective.     

Indocyanine green fluorescence and three-dimensional imaging of right gastroepiploic artery in gastric tube cancer

A 79-year-old male was admitted to our hospital for the treatment of cancer of the gastric tube.Gastrointestinal examination revealed a T1 b Union for International Cancer Control(UICC) tumor at the pyloric region of the gastric tube.Laparotomy did not reveal infiltration intothe serosa,peritoneal dissemination,regional lymph node swelling,or distant metastasis.We performed a distal gastrectomy preserving the right gastroepiploic artery by referencing the preoperative three-dimensional computed tomoangiography.We also evaluated the blood flow of the right gastroepiploic artery and in the proximal gastric tube by using indocyanine green fluorescence imaging intra-operatively and then followed with a gastrojejunal anastomosis with Roux-en-Y reconstruction.The definitive diagnosis was moderately differentiated adenocarcinoma of the gastric tube,pT 1bN 0M0,pS tage IA(UICC).His postoperative course was uneventful.Three-dimensional computed tomographic imaging is effective for assessing the course of blood vessels and the relationship with the surrounding structures.Intraoperative evaluation of blood flow of the right gastroepiploic artery and of the gastric tube in the anastomotic portion is very valuable information and could contribute to a safe gastrointestinal reconstruction.     

Primary small cell carcinoma of prostate without immunoreactive neuroendocrine proteins but with expressions of KIT and platelet‐derived growth factor‐α

Primary small cell carcinoma of the prostate is extremely rare. Herein reported is a case of primary small cell carcinoma of the prostate with immunohistochemical examination of KIT and platelet‐derived growth factor‐α. The present case is unique in that the small cell carcinoma did not express neuroendocrine antigens. A 68‐year‐old man was found to have high serum prostate‐specific antigen, and biopsy showed malignant small tumor cells fulfilling the small cell carcinoma criteria of the World Health Organization. Immunohistochemically, tumor cells were positive for pan‐cytokeratin, KIT, platelet‐derived growth factor‐α, p53, Ki‐67 labeling = 65%, prostate‐specific antigen and alpha‐methylacyl‐CoA racemase. Tumor cells were negative for vimentin, CD56, synaptophysin, chromogranin and neuron‐specific enolase. Imaging modalities showed multiple metastases, and the patient was treated by chemotherapy. The present report is the fifth with immunohistochemistry of prostatic small cell carcinoma.