Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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女性外科医の生活の現状と展望

八木千晶, 吉田龍一, 黒田新士, 藤原俊義

日本臨床外科学会雑誌 81 ( 6 ) 1204 - 1204 2020.6

腹腔鏡下胃全摘術における食道空腸吻合の手技と治療成績

高田暢夫, 黒田新士, 庄司良平, 菊地覚次, 西崎正彦, 香川俊輔, 白川博靖, 藤原俊義

日本臨床外科学会雑誌 81 ( 6 ) 1202 - 1202 2020.6

Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study.

Yukiko Hikasa, Satoshi Suzuki, Yuko Mihara, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of anesthesia 34 ( 3 ) 404 - 412 2020.6

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

DOI： 10.1007/s00540-020-02766-y

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希少脾腫瘍の2例 SANT(sclerosing angiomatoid nodular transformation)とIPT(inflammatory pseudotumor)

村田光隆, 杭瀬崇, 畑七々子, 八木千晶, 松田達雄, 安井和也, 藤智和, 吉田一博, 吉田龍一, 楳田祐三, 八木孝仁, 藤原俊義

日本臨床外科学会雑誌 81 ( 6 ) 1203 - 1203 2020.6

Upregulation of microRNA-31 is associated with poor prognosis in patients with advanced colorectal cancer. International journal

Nobuhito Kubota, Fumitaka Taniguchi, Akihiro Nyuya, Yuzo Umeda, Yoshiko Mori, Toshiyoshi Fujiwara, Hiroaki Tanioka, Atsushi Tsuruta, Yoshiyuki Yamaguchi, Takeshi Nagasaka

Oncology letters 19 ( 4 ) 2685 - 2694 2020.4

Language：English Publishing type：Research paper (scientific journal)

Colorectal cancer (CRC) manifests after the accumulation of genetic and epigenetic alterations along with tumor microenvironments. MicroRNA (miRNA/miR) molecules have been revealed to serve in critical roles in the progression various types of cancer, and their expression level is often an important diagnostic, predictive or prognostic biomarker. The aim of the present study was to evaluate the potential of miRNAs as prognostic biomarkers for patients with advanced CRC. miRNA arrays were performed on CRC specimens obtained from tumors with various molecular statuses [e.g. KRAS proto-oncogene, GTPase (KRAS)/B-Raf proto-oncogene, serine/threonine kinase (BRAF)/microsatellite instability (MSI)], and their paired normal mucosal specimens. The miRNA array revealed that miR-31-5p (miR-31) was specifically upregulated in CRCs with the BRAF V600E mutation, the results of which were supported by subsequent analysis of a dataset retrieved from The Cancer Genome Atlas (TCGA) database, which contained information regarding 170 patients with CRC including 51 BRAF-mutant CRCs. Of our cohort of 67 patients with stage IV CRC, 15 (22%) and 4 (6%) showed KRAS and BRAF V600E mutations, respectively. Since the median miR-31 expression was 3.45 (range, 0.004-6330.531), the cut-off value was chosen as 3.5, and all tumors were categorized into two groups accordingly (high-/low-miR-31 expression). The high miR-31 expression group (n=33) was significantly associated with a poorer mortality (univariate hazard ratio=2.12; 95% confidence interval, 0.23-0.95; P=0.03) and exhibited a shorter median survival time (MST; 20.1 months) compared with the low miR-31 expression group (n=34) (MST, 38.3 months; P=0.03), indicating that miR-31 is a promising prognostic biomarker for patients with advanced CRC. Thus, performing a functional analysis of miR-31 expression may lead to the development of new targeted therapies for the various genetic subtypes of CRC.

DOI： 10.3892/ol.2020.11365

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Induction chemoradiotherapy including docetaxel, cisplatin, and 5-fluorouracil for locally advanced esophageal cancer.

Masashi Hashimoto, Yasuhiro Shirakawa, Naoaki Maeda, Shunsuke Tanabe, Kazuhiro Noma, Kazufumi Sakurama, Kuniaki Katsui, Masahiko Nishizaki, Toshiyoshi Fujiwara

Esophagus : official journal of the Japan Esophageal Society 17 ( 2 ) 127 - 134 2020.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Locally advanced esophageal cancer (EC) invading surrounding organs (T4b) is difficult to treat. In general, definitive chemoradiotherapy (d-CRT) has been chosen as treatment for such cases. However, the outcome has not been good. Recently, the effectiveness of d-CRT with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) has been reported. Furthermore, surgery after d-CRT has a better prognosis than d-CRT alone in some reports, although it has a high risk of surgical complications. This study investigated the effectiveness and safety of induction DCF-RT. METHODS: The subjects were EC patients who underwent induction DCF-RT in Okayama University Hospital between January 2011 and December 2017. Their background characteristics, treatment details, histopathological factors, adverse events during CRT, postoperative complications, and overall survival (OS) were assessed. RESULTS: A total of 16 cases were performed induction DCF-RT. In 10 cases, death occurred, with 9 cancer-related deaths, and 1 death due to other disease. For all cases, OS was 37.5% at 3 years. 12 cases underwent esophagectomy after DCF-RT. Their OS was 50% at 3 years. 13 patients (81.3%) had Grade 3 febrile neutropenia. In 7 cases (62.5%), fasting for the treatment of diarrhea was needed. Three patients (25%) developed anastomotic leakage. Some recurrent laryngeal nerve paralysis was observed in 6 cases (50%). CONCLUSION: Although the rates of adverse events and surgical complications were slightly higher than in past reports, they were acceptable. It is useful to perform induction DCF-RT for T4b EC.

DOI： 10.1007/s10388-019-00709-5

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術前SOX療法を施行した進行胃癌症例の治療成績(Outcomes of preoperative S-1 plus oxaliplatin(SOX) therapy for advanced gastric cancer)

香川俊輔, 黒田新士, 菊地覚次, 高田暢夫, 垣内慶彦, 武田正, 野間和広, 田辺俊介, 寺石文則, 近藤喜太, 矢野修也, 重安邦俊, 西崎正彦, 白川靖博, 藤原俊義

日本胃癌学会総会記事 92回 288 - 288 2020.3

術前SOX療法を施行した進行胃癌症例の治療成績(Outcomes of preoperative S-1 plus oxaliplatin(SOX) therapy for advanced gastric cancer)

日本胃癌学会総会記事 92回 288 - 288 2020.3

食道癌患者に対する腫瘍融解ウイルスの内視鏡的投与の実際病棟実施にむけた他部署連携

矢野朋美, 采女典子, 森隆弘, 笠原由美子, 石川貴子, 田辺俊介, 黒田新士, 野間和広, 田澤大, 香川俊輔, 白川靖博, 藤原俊義

日本消化器内視鏡技師会会報 ( 64 ) 111 - 112 2020.3

高齢者胃癌の治療成績と栄養状態向上を目指した治療戦略(Strategy to improve the outcome and nutritional status for elderly gastric cancer patients)

高田暢夫, 伊藤雅典, 庄司良平, 菊地覚次, 黒田新士, 西崎正彦, 香川俊輔, 藤原俊義

日本胃癌学会総会記事 92回 252 - 252 2020.3

【消化器外科手術の論点2020 誌上ディベートと手術手技】胃外科噴門側胃切除後の再建法観音開き法の立場から

黒田新士, 西崎正彦, 菊地覚次, 高田暢夫, 香川俊輔, 藤原俊義

手術 74 ( 4 ) 477 - 483 2020.3

Bone and Soft-Tissue Sarcoma: A New Target for Telomerase-Specific Oncolytic Virotherapy. Reviewed International journal

Hiroshi Tazawa, Joe Hasei, Shuya Yano, Shunsuke Kagawa, Toshifumi Ozaki, Toshiyoshi Fujiwara

Cancers 12 ( 2 ) 2020.2

Language：English Publishing type：Research paper (scientific journal)

Adenovirus serotype 5 (Ad5) is widely and frequently used as a virus vector in cancer gene therapy and oncolytic virotherapy. Oncolytic virotherapy is a novel antitumor treatment for inducing lytic cell death in tumor cells without affecting normal cells. Based on the Ad5 genome, we have generated three types of telomerase-specific replication-competent oncolytic adenoviruses: OBP-301 (Telomelysin), green fluorescent protein (GFP)-expressing OBP-401 (TelomeScan), and tumor suppressor p53-armed OBP-702. These viruses drive the expression of the adenoviral E1A and E1B genes under the control of the hTERT (human telomerase reverse transcriptase-encoding gene) promoter, providing tumor-specific virus replication. This review focuses on the therapeutic potential of three hTERT promoter-driven oncolytic adenoviruses against bone and soft-tissue sarcoma cells with telomerase activity. OBP-301 induces the antitumor effect in monotherapy or combination therapy with chemotherapeutic drugs via induction of autophagy and apoptosis. OBP-401 enables visualization of sarcoma cells within normal tissues by serving as a tumor-specific labeling reagent for fluorescence-guided surgery via induction of GFP expression. OBP-702 exhibits a profound antitumor effect in OBP-301-resistant sarcoma cells via activation of the p53 signaling pathway. Taken together, telomerase-specific oncolytic adenoviruses are promising antitumor reagents that are expected to provide novel therapeutic options for the treatment of bone and soft-tissue sarcomas.

DOI： 10.3390/cancers12020478

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Immune Modulation by Telomerase-Specific Oncolytic Adenovirus Synergistically Enhances Antitumor Efficacy with Anti-PD1 Antibody. Reviewed International journal

Nobuhiko Kanaya, Shinji Kuroda, Yoshihiko Kakiuchi, Kento Kumon, Tomoko Tsumura, Masashi Hashimoto, Toshiaki Morihiro, Tetsushi Kubota, Katsuyuki Aoyama, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Hiroshi Tazawa, Hiroyuki Mizuguchi, Yasuo Urata, Toshiyoshi Fujiwara

Molecular therapy : the journal of the American Society of Gene Therapy 28 ( 3 ) 794 - 804 2020.1

Language：English Publishing type：Research paper (scientific journal)

The clinical benefit of monotherapy involving immune checkpoint inhibitors (ICIs) such as anti-programmed death-1 antibody (PD-1 Ab) is limited to small populations. We previously developed a telomerase-specific oncolytic adenovirus, Telomelysin (OBP-301), the safety of which was confirmed in a phase I clinical study. Here, we examined the potential of OBP-502, an OBP-301 variant, as an agent for inducing immunogenic cell death (ICD) and synergistically enhancing the efficacy of OBP-502 with PD-1 Ab using CT26 murine colon cancer and PAN02 murine pancreatic cancer cell lines. OBP-502 induced the release of ICD molecules such as adenosine triphosphate (ATP) and high-mobility group box protein 1 (HMGB1) from CT26 and PAN02 cells, leading to recruitment of CD8-positive lymphocytes and inhibition of Foxp3-positive lymphocyte infiltration into tumors. Combination therapy involving OBP-502 intratumoral administration and PD-1 Ab systemic administration significantly suppressed the growth of not only OBP-502-treated tumors but also tumors not treated with OBP-502 (so-called abscopal effect) in CT26 and PAN02 bilateral subcutaneous tumor models, in which active recruitment of CD8-positve lymphocytes was observed even in tumors not treated with OBP-502. This combined efficacy was similar to that observed in a CT26 rectal orthotopic tumor model involving liver metastases. In conclusion, telomerase-specific oncolytic adenoviruses are promising candidates for combined therapies with ICIs.

DOI： 10.1016/j.ymthe.2020.01.003

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Development of a Novel Oncolytic Adenovirus Expressing a Short-hairpin RNA Against Cullin 4A. International journal

Keisaku Wakabayashi, Fuminori Sakurai, Ryosuke Ono, Toshiyoshi Fujiwara, Hiroyuki Mizuguchi

Anticancer research 40 ( 1 ) 161 - 168 2020.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Arming of an oncolytic adenovirus (OAd) by inserting expression cassettes of therapeutic transgenes into the OAd genome is a promising approach to enhance the therapeutic effects of an OAd. Ideally, this approach would simultaneously promote the replication of an OAd in tumor cells and transgene product-mediated antitumor effects by expressing therapeutic transgenes. We previously demonstrated that knockdown of cullin 4A (CUL4A), which is an E3 ubiquitin ligase, significantly promoted adenovirus replication by increasing the c-JUN protein level. In addition, previous studies reported that CUL4A was highly expressed in various types of tumor, and was involved in tumor growth and metastasis. MATERIALS AND METHODS: In this study, we developed a novel OAd expressing a short-hairpin RNA (shRNA) against CUL4A (OAd-shCUL4A). RESULTS: OAd-shCUL4 mediated higher levels of cytotoxic effects on various types of human tumor cell than a conventional OAd. Higher levels of OAd genome copy numbers were found in the tumor cells for OAd-shCUL4A, compared with a conventional OAd. CONCLUSION: OAd-shCUL4A showed efficient antitumor effects by both enhancing OAd replication and inhibiting tumor cell growth.

DOI： 10.21873/anticanres.13937

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"伝わる"肝胆膵外科手術記録 iPadを用いた効率的で効果的なイラスト作成法

楳田祐三, 藤原俊義

日本消化器外科学会雑誌 53 ( 1 ) 105 - 115 2020.1

Language：Japanese Publisher：(一社)日本消化器外科学会

手術記録は,診療情報にとどまらず,外科修練における研鑽,医療チーム内での手術情報の共有,そして紹介医へのfeed-backと,その意義は大きい.今回,iPadを用いた効率的で効果的なイラスト作成を中心に,我々が実践している"伝わる"肝胆膵外科手術記録の作成法を紹介する.従来の手描き法と異なり,iPad/Apple pencil/描画アプリを用いることで,自由な描き直し,レイヤー機能や多岐にわたる着色ツール,拡大・縮小機能による微細描画や着色時間の短縮,イラストパーツの貼付など,効率的で効果的なイラストの作成が可能となる.外科修練において,繰り返し手術イラストの作成に取り組むことは,観察力を養い,解剖構造の理解を深め,手術の本質を理解し修得するのに有用である.症例からの学びと反省,患者さん,そして紹介医の患者さんへの思い入れに報いるためにも,手術のみならず,外科医の想いが"伝わる"手術記録の作成に,外科医は一例入魂の精神で臨むことが望まれる.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01117&link_issn=&doc_id=20200131210016&doc_link_id=10.5833%2Fjjgs.2020.sr005&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2020.sr005&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Molecular radiosensitization of soft tissue sarcoma by oncolytic virus-mediated MCL1 ablation

Omori T, Tazawa H, Yamakawa Y, Osaki S, Hasei J, Sugiu K, Komatsubara T, Fujiwara T, Yoshida A, Kunisada T, Urata Y, Kagawa S, Ozaki T, Fujiwara T

2020.1

Short-term and long-term comparisons of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy by the double-flap technique and laparoscopy-assisted total gastrectomy for proximal gastric cancer. International journal

Tomoko Tsumura, Shinji Kuroda, Masahiko Nishizaki, Satoru Kikuchi, Yoshihiko Kakiuchi, Nobuo Takata, Atene Ito, Megumi Watanabe, Kazuya Kuwada, Shunsuke Kagawa, Toshiyoshi Fujiwara

PloS one 15 ( 11 ) e0242223 2020

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Although proximal gastrectomy (PG) is a recognized surgical procedure for early proximal gastric cancer, total gastrectomy (TG) is sometimes selected due to concern about severe gastroesophageal reflux. Esophagogastrostomy by the double-flap technique (DFT) is an anti-reflux reconstruction after PG, and its short-term effectiveness has been reported. However, little is known about the long-term effects on nutritional status and quality of life (QOL). METHODS: Gastric cancer patients who underwent laparoscopy-assisted PG (LAPG) with DFT or laparoscopy-assisted TG (LATG) between April 2011 and March 2014 were retrospectively analyzed. Body weight (BW), body mass index (BMI), and prognostic nutritional index (PNI) were reviewed to assess nutritional status, and the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 was used to assess QOL. RESULTS: A total of 36 patients (LATG: 17, LAPG: 19) were enrolled. Four of 17 LATG patients (24%) were diagnosed with Stage ≥II after surgery, and half received S-1 adjuvant chemotherapy. BW and PNI were better maintained in LAPG than in LATG patients until 1-year follow-up. Seven of 16 LATG patients (44%) were categorized as "underweight (BMI<18.5 kg/m2)" at 1-year follow-up, compared to three of 18 LAPG patients (17%; p = 0.0836). The PGSAS-45 showed no significant difference in all QOL categories except for decreased BW (p = 0.0132). Multivariate analysis showed that LATG was the only potential risk factor for severe BW loss (odds ratio: 3.03, p = 0.0722). CONCLUSIONS: LAPG with DFT was superior to LATG in postoperative nutritional maintenance, and can be the first option for early proximal gastric cancer.

DOI： 10.1371/journal.pone.0242223

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Efficacy of surgical management for recurrent intrahepatic cholangiocarcinoma: A multi-institutional study by the Okayama Study Group of HBP surgery. International journal

Toru Kojima, Yuzo Umeda, Tomokazu Fuji, Takefumi Niguma, Daisuke Sato, Yoshikatsu Endo, Kenta Sui, Masaru Inagaki, Masahiro Oishi, Tetsuya Ota, Katsuyoshi Hioki, Tadakazu Matsuda, Hideki Aoki, Ryuji Hirai, Masashi Kimura, Takahito Yagi, Toshiyoshi Fujiwara

PloS one 15 ( 9 ) e0238392 2020

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The prognosis of intrahepatic cholangiocarcinoma (ICC) has been poor, because of the high recurrence rate even after curative surgery. This study aimed to evaluate the prognostic impact of surgical resection of recurrent ICC. PATIENTS AND METHODS: A total of 345 cases of ICC who underwent hepatectomy with curative intent in 17 institutions were retrospectively analyzed, focusing on recurrence patterns and treatment modalities for recurrent ICC. RESULTS: Median survival time and overall 5-year recurrence-free survival rate were 17.8 months and 28.5%, respectively. Recurrences (n = 223) were classified as early (recurrence at ≤1 year, n = 131) or late (recurrence at >1 year, n = 92). Median survival time was poorer for early recurrence (16.3 months) than for late recurrence (47.7 months, p<0.0001). Treatment modalities for recurrence comprised surgical resection (n = 28), non-surgical treatment (n = 134), and best supportive care (BSC) (n = 61). Median and overall 1-/5-year survival rates after recurrence were 39.5 months and 84.6%/36.3% for surgical resection, 14.3 months and 62.5%/2.9% for non-surgical treatment, and 3 months and 4.8%/0% for BSC, respectively (p<0.0001). Multivariate analysis identified early recurrence, simultaneous intra- and extrahepatic recurrence, and surgical resection of recurrence as significant prognostic factors. In subgroup analyses, surgical resection may have positive prognostic impacts on intra- and extrahepatic recurrences, and even on early recurrence. However, simultaneous intra- and extrahepatic recurrence may not see any survival benefit from surgical management. CONCLUSION: Surgical resection of recurrent ICC could improve survival after recurrence, especially for patients with intra- or extrahepatic recurrence as resectable oligo-metastases.

DOI： 10.1371/journal.pone.0238392

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Laparoscopic liver resection of segment seven: A case report and review of surgical techniques. International journal

Kosei Takagi, Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Fuminori Teraishi, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 73 168 - 171 2020

Language：English

INTRODUCTION: Laparoscopic liver resection of segment seven (LLR-S7) is a technically challenging procedure due to its anatomical location and difficult accessibility. Herein, we present our experience with LLR-S7, and demonstrate a literature review regarding surgical techniques. PRESENTATION OF CASE: A 28-year-old female was diagnosed with rectosigmoid cancer and synchronous liver metastases at the segment three (S3) and S7, which were treated with laparoscopic procedure. After the completely mobilization of the right lobe, the Glissonean pedicle of S7 (G7) was intrahepatically transected. The right hepatic vein was exposed to identify the venous branch of S7 (V7). Finally the liver parenchyma between RHV and dissection line was divided. DISCUSSION: Various laparoscopic approaches for S7 have been reported including the Glissonian approach from the hilum, the intrahepatic Glissonean approach, the caudate lobe first approach, and the lateral approach from intercostal ports. To perform LLR-S7 safely, it is important to understand the advantage of each technique including the trocar placement and approaches to S7 by laparoscopy. CONCLUSION: We present our experience of LLR-S7 for the tumor located at the top of S7, successfully performed with the intrahepatic Glissonean approach. LLR-S7 can be performed safely with advanced laparoscopic techniques and sufficient knowledge on various approaches for S7.

DOI： 10.1016/j.ijscr.2020.06.107

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A novel modified hanging maneuver in laparoscopic left hemihepatectomy. International journal

Kosei Takagi, Yuzo Umeda, Takashi Kuise, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Yuma Tani, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 76 251 - 253 2020

Language：English

INTRODUCTION: The liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, however it is often difficult in laparoscopic major hepatectomy. The present study describes a novel modified hanging maneuver in laparoscopic left hemihepatectomy. PRESENTATION OF CASE: A 29-year-old female underwent laparoscopic left hemihepatectomy for mucinous cystic neoplasm. After mobilizing the left lobe, the liver parenchyma was dissected along the demarcation line. For the hanging technique, the upper edge of the hanging tape was placed on the lateral side of the left hepatic vein, and fixed with the Falciform ligament. The lower edge of the tape was extracted outside the abdomen. Accordingly the hanging tape can be controlled extraperitoneally during the liver parenchyma dissection. DISCUSSION: This technique includes several advantages including no need of assistance using forceps, easy control of the hanging tape extraperitoneally, outflow control, better exposure of surgical field, and helpful guide of the liver dissection line toward the root of the left hepatic vein. CONCLUSION: Our novel modified hanging maneuver is easy and reproducible to use in laparoscopic left hemihepatectomy. Moreover, this technique can be applied to other laparoscopic hepatectomy.

DOI： 10.1016/j.ijscr.2020.10.002

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Papers - FUJIWARA Toshiyoshi