Background/Aims: Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called “non-injection resection using bipolar soft coagulation mode (NIRBS)” method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method. Methods: We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer. Results: A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1–35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation. Conclusions NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.

The transition to the new specialist certification system has progressed in cardiovascular surgery, enabling many surgeons to obtain specialist certification earlier than before. This study focuses on conditions that are particularly easy to overlook factors in the application process, namely academic activities, surgical experience, and Off-the-Job Training (OJT). This report summarizes these changes to facilitate efficient specialist certification applications for trainees.

A 55-year-old man was brought to our hospital with a knife penetrating his left anterior chest wall following a suicide attempt. Massive left hemothorax was identified on echocardiography ; however, there was no evidence of cardiac tamponade. After draining blood from the left thorax, computed tomography (CT) revealed that the tip of the knife had penetrated the left lung and reached the left pulmonary vein. In preparation for cardiopulmonary bypass, an emergency thoracotomy was scheduled with a plan to access the left lung and left pulmonary vein. The patient was transferred to the operating room, and the procedure was started with the patient in the supine position. During dissection of the femoral vessels, the patient suddenly developed hypotension. After surgical access to the heart was achieved via median sternotomy, a pericardiotomy was performed and cardiopulmonary bypass was established. A 50-mm stab wound was identified at the lateral wall of the left ventricle. The knife was removed, and the left ventricular wound was repaired. The lingular segment of the left lung was partially resected. The patient had no postoperative complications and was transferred to the referral hospital on postoperative day 25. This case report emphasizes the importance of taking appropriate measures for thoracotomy and cardiopulmonary bypass in patients with penetrating thoracic trauma with massive hemothorax, even in the absence of cardiac tamponade on imaging. We were able to successfully manage a life-threatening condition by taking appropriate measures.

A 45-year-old male presented to a hospital for shortness of breath and palpitations, and an electrocardiogram abnormality was identified. Coronary angiography showed multiple spontaneous coronary artery dissection (SCAD) on the left anterior descending artery (LAD) and the right coronary artery (RCA）. Optical coherence tomography showed the LAD had two lumens, and the RCA had multiple lumens by SCAD. Furthermore, computed tomography depicted a bulky thrombus on the left ventricular apex. All lesions were revascularized with arterial grafts, and the concomitant thrombectomy was performed for the thrombus on the apex. The coronary arteries were clearly dissected, and the anastomosis was made to what appeared to be a true lumen based on various intraoperative assessments. The flow pattern and flow volume through the grafts were satisfactory using the ultrasound Doppler method. The patient's postoperative course was uneventful, and he was discharged on postoperative day 22. All grafts have been patent, and the cardiac function has remained improved for 2.5 years of follow-up in our outpatient clinic.