岡山医学会雑誌

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We previously reported a non-invasive, transperineal, urodynamic technique using Doppler ultrasonography. Recently, we developed a new tele-operating system to control the robotic arm of the ultrasound probe that has a pressure-regulating function and a touch-panel that allows the operator to monitor the exact position of the probe.
From January 2008 to April 2010, 61 cases were examined using this system. Among them, 41 cases were examined by 2 experienced doctors and 20 cases were examined by 5 inexperienced nurses. We then compared the success rate of taking images sufficient for analyzing the velocity parameters and preparation time for setup between these two groups. In 45 out of 61 cases, whose examinations were successfully carried out, the velocity-flow parameters were compared between 19 cases with bladder outlet obstruction (BOO) and 26 without BOO.
Satisfactory images were obtained in 32 cases (78%) by doctors and in 13 cases (65%) by nurses. The preparation time was 9.8 seconds for doctors and 13.2 seconds for nurses, with no statistical difference. The functional cross-sectional area in the prostatic urethra (A1) was significantly smaller in the BOO(+) group (0.056cm²) compared to the BOO(-) group (0.360cm²). The velocity ratio (VR) was significantly higher in the BOO(+) group (1.89) than in the BOO(-) group (0.41).
In conclusion, the newly developed tele-operating system has made it easier for an inexperienced examiner to obtain velocity parameters using Doppler ultrasound urodynamic measurement.

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We experienced 63 patients with non-inflammatory disease who underwent single-incision laparoscopic cholecystectomy (TANKO-LC). Herein we report the procedure of operation and the short-term results. We compared 63 cases of TANKO-LC with 109 cases of non-inflammatory conventional laparoscopic cholecystectomy (S-LC) within the same period. At first, our standard procedure was to insert multiple trocars in the abdominal cavity through a single wound ; now, we insert only a single trocar all cases. In the 63 cases investigation, 3 cases required trocar addition and one case converted to open surgery. Intra and postoperative complications were recognized in 2 cases (port-site infection). No significant complications were recognized. In comparing the TANKO-LC group and the S-LC group, the operation time was intentionally longer in the TANKO-LC group (TANKO-LC group : 118 min, S-LC group : 90 min), but there were no differences in the blood loss, the rates of intra and postoperative complications and the conversion rate. Laparoscopic cholecystectomy is a standard operation for gallbladder removal, but single-incision laparoscopic cholecystectomy is considered a useful operation with the same low operative complication rate yet more satisfactory cosmetic results.

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A 41-year-old woman was admitted to our hospital because of lower abdominal pain. She had no history of laparotomy. An abdominal CT scan at the time of admission indicated closed-loop intestinal obstruction of the small intestine within the pelvis and deviation of the uterus to the right. We diagnosed this as a strangulated internal hernia and decided to conduct an emergency operation. The ileum had herniated through a defect in the broad ligament of the uterus. The strangulated intestinal loop, which was about 25cm long, was released, and the defect of the broad ligament was closed. The postoperative course was uneventful. The differential diagnosis of intestinal obstruction should include internal hernia, especially in the absence of a previous laparotomy. An abdominal CT scan is quite useful for the preoperative and prompt diagnosis of internal hernia through a defect in the broad ligament of the uterus.

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