Background: Laparoscopic gastrectomy has several difficult points including, lymph node dissection and resection of several blood vessels for trainee surgeons. Recently, preoperative evaluation of vasculature based three-dimensional (3D) imaging technique resulted in a significantly improved clinical outcome in abdominal surgery. The aim of this study is to investigate the usefulness of the 3D image in laparoscopic gastrectomy for trainee surgeons. Method: We adopted a multiphase CT protocol to acquire 3 image sets (arterial, portal, and equilibrium phases). 3D-reconstruction of gastric vasculature was made using data from a contrast enhanced MDCT and SYNAPSE VINCENT software. Whole pancreas, spleen, gastric vasculature were extracted from MDCT scans and traced. Thirty three patients, who underwent laparoscopic gastrectomy for gastric cancer during the period between Jan 2013 and May 2014 were examined in this study. Four trainees performed a 19 laparoscopic gastrectomy, while 14 laparoscopic gastrectomy were conducted by the two trainers. The surgical outcomes in both groups and the pattern of gastric vasculatures were evaluated. Result: 3D imaging technique showed a correct positional relationship between the stomach, gastric vessels, pancreas and spleen. Surgical outcome including estimated blood loss, and operative time in trainee group were not significantly different compared to trainer group. 3D imaging technique showed a correct positional relationship between the stomach, gastric vessels, pancreas and spleen. Regarding vascular pattern detected by 3D imaging, the origins of IPA were RGEA in 12 cases (36%), GDA in 8 cases (24%).bifurcation of RGEA and GDA in7 cases (21%), and not detected in 1 case (3%), respectively. The types of confluence of IPV were RGEV in 16 cases (48%), ASPDV in 10 cases (30%), and not detected in 7 cases (21%), respectively. Conclusions: 3D imaging technique might contribute to successful laparoscopic gastrectomy. Preoperative 3D-simulation techniques enabled trainee surgeons to easily and safely perform laparoscopic gastrectomy.

Background: Laparoscopic gastrectomy has several difficult points including,lymph node dissection and resection of several blood vessels for trainee surgeons.Recently, preoperative evaluation of vasculature based three-dimensional (3D)imaging technique resulted in a significantly improved clinical outcome inabdominal surgery. The aim of this study is to investigate the usefulness of the 3Dimage in laparoscopic gastrectomy for trainee surgeons.Method: We adopted a multiphase CT protocol to acquire 3 image sets (arterial,portal, and equilibrium phases). 3D-reconstruction of gastric vasculature wasmade using data from a contrast enhanced MDCT and SYNAPSE VINCENTsoftware. Whole pancreas, spleen, gastric vasculature were extracted from MDCTscans and traced. Thirty three patients, who underwent laparoscopic gastrectomyfor gastric cancer during the period between Jan 2013 and May 2014 wereexamined in this study. Four trainees performed a 19 laparoscopic gastrectomy,while 14 laparoscopic gastrectomy were conducted by the two trainers. Thesurgical outcomes in both groups and the pattern of gastric vasculatures wereevaluated.Result: 3D imaging technique showed a correct positional relationship betweenthe stomach, gastric vessels, pancreas and spleen. Surgical outcome includingestimated blood loss, and operative time in trainee group were not significantlydifferent compared to trainer group. 3D imaging technique showed a correctpositional relationship between the stomach, gastric vessels, pancreas and spleen.Regarding vascular pattern detected by 3D imaging, the origins of IPA were RGEAin 12 cases (36%), GDA in 8 cases (24%).bifurcation of RGEA and GDA in7 cases(21%), and not detected in 1 case (3%), respectively. The types of confluence ofIPV were RGEV in 16 cases (48%), ASPDV in 10 cases (30%), and not detectedin 7 cases (21%), respectively.Conclusions: 3D imaging technique might contribute to successful laparoscopicgastrectomy. Preoperative 3D-simulation techniques enabled trainee surgeons toeasily and safely perform laparoscopic gastrectomy.

Kampo medicine is well known to play an important role in cancer therapy, especially as a supportive therapy. We literally investigated the significance of Kampo medicine on antitumor effect including our data in the era that cancer immunotherapy using immune checkpoint inhibitors is a main stream. Up to now, many reports have been published regarding the mechanism of Kampo medicine on augmentation of immunity, particularly innate immunity. Regarding the effect of Kampo medicine on cancel of immune suppression by cancer, a few reports have been published including our data that juzentaihoto reduced regulatory T cell ratio in advanced pancreas cancer patients. Interestingly, a certain kind of Kampo medicine has possibility to induce immune tolerance in murine cardiac transplant model through increased regulatory T cells, and to suppress intestinal inflammation by anticancer drug by functioning immune checkpoint (PD-1). We hope that Kampo medicine would be proved to possibly regulate immune function from the viewpoint of immune checkpoint in the near future.