The number of robotic surgery for gastroenterological malignant diseases performed using the da Vinci Surgical System (DVSS) has been rapidly increasing in Japan, after approval for national medical insurance coverage in April 2018. Various regulations and systems to safely introduce robotic surgery, including the latest guideline for robotic surgery from the Japan Society for Endoscopic Surgery, institution criteria, registry system, and proctor certification system have been developed. Accordingly, reports about robotic surgery for upper gastrointestinal cancer from Japan have also been increasing, and they suggest that robotic gastrectomy can possibly reduce the incidence of morbidities. There are still several problems such as cost and restriction of operators or facilities. However, a novel surgical robot, the hinotori™ Surgical Robot System, have been developed, the promising project to realize the practical use of telesurgery is undergoing. We believe that further progression of medical technology would enable surgeons to perform robotic surgery more comfortably and safely and would consequently help in achieving less invasive surgery.

Serological diagnosis, including testing gastrin levels, was performed as a supplementary diagnosis for 145 patients with chronic atrophic gastritis. As a result, eight patients with autoimmune gastritis were diagnosed with hypergastrinemia as the key finding. These patients had sparse reverse gastric mucosal atrophy findings on endoscopy, which made it difficult to detect and diagnose autoimmune gastritis. All cases had findings which were difficult to classify as a typical type A gastritis presentation, including atrophic changes in the antrum, and they accounted for a larger proportion than the four patients who were diagnosed on the basis of reverse gastric mucosal atrophy found on endoscopy. The results of this study suggest that using serological diagnosis as part of medical care for chronic gastritis, including in general clinics, would improve the efficiency of detecting and diagnosing autoimmune gastritis, and it may also contribute to diagnosis of a wide range of the disease, including atypical cases.

A male in his 30's, did an abdominal X-ray as population-based screening, a submucosal tumor-like projection of about 20 mm in size of the lower body of the stomach was detected. Esophagogastroduodenoscopy revealed a submucosal lesion with a depression on the top. No tumor cells were detected by biopsy, and malignant findings were considered by endoscopic ultrasound (EUS). Adenocarcinoma was diagnosed by EUS fine needle aspiration biopsy (FNAB). No metastasis was observed, and curative resection was performed with distal gastrectomy and Billroth I reconstruction. Histopathology indicated that the resected specimens revealed gastric cancer arising from the ectopic pancreas. Postoperative 15 months, liver metastasis was observed, and partial resection of the liver was performed. As a result of partial hepatectomy, the patient was diagnosed with adenocarcinoma with enteroblastic differentiation (ACED). He has been without recurrence or metastasis 18 months after hepatectomy.

In a 43-year-old woman, a tumor at the orifice of the appendix was identified by lower gastrointestinal endoscopy. The biopsy result indicated that the tumor was of Group 1, and tumor marker levels were not elevated. Plain abdominal computed tomography revealed a neoplastic lesion spanning from the appendix to the cecum. Magnetic resonance imaging revealed a uniformly thickened appendiceal wall with no clear neoplastic lesion or inflammatory change. For diagnostic and therapeutic purposes, laparoscopic ileocecal resection was performed. Histopathological examination led to a diagnosis of intestinal endometriosis of the appendix. At 4 months postoperatively, the patient remains asymptomatic and relapse-free.

A 70s year-old female was referred to our hospital for the further examination of gastric subepithelial lesion (SEL) which increased in size compared with four years ago. EGD showed a SEL of about 15 mm in size in the anterior wall of gastric antrum. EUS revealed a homogeneously low-echoic mass with a clear margin existing in the 3rd layer of the stomach. A boring biopsy was performed from the top of tumor, but no definitive diagnosis was made. The patient underwent ESD for total biopsy. Histological examination revealed poorly differentiated adenocarcinoma limited to the submucosal layer with profusely infiltrating lymphoid cells, showing gastric carcinoma with lymphoid stroma. The tumor was diagnosed as Epstein-Barr virus-negative cancer.

The patient was a 72-year-old man. He developed anastomotic recurrence twice and solitary peritoneal recurrence twice after radical surgery for descending colon cancer. The patient was treated with surgery and chemotherapy. He has survived without recurrence for approximately 12 years since the first surgery and for 10 years since the resection for a second solitary peritoneal recurrence. In the present case, anastomotic recurrence occurred twice after stapled anastomosis, providing useful information on the choice of reconstruction method of the anastomotic site. Herein, we report a rare case of long-term survival after multiple resections of recurrent solitary peritoneal lesion.

A 64-year-old female was referred to our hospital for investigation of recurrent anemia of unknown cause without obvious gastrointestinal bleeding symptoms. Upper and lower gastrointestinal endoscopy and abdominal contrast CT showed no bleeding lesions. Small intestine capsule endoscopy and transanal double-balloon small intestine endoscopy revealed a 5 mm smooth reddish raised lesion in the ileum. A partial laparoscopic small bowel resection was performed in our hospital's Department of Surgery. The postoperative pathological diagnosis was capillary hemangioma. Six months postoperatively, there was no progression of anemia.