2025/04/18 更新

写真a

タカギ コウセイ
高木 弘誠
Takagi Kosei
所属
学術研究院医療開発領域 講師
職名
講師
外部リンク

学位

  • 博士(医学) ( 岡山大学 )

 

論文

  • Impact of robotic surgery on postoperative pancreatic fistula for high-risk pancreaticojejunostomy after pancreatoduodenectomy. 国際誌

    Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara

    Digestive surgery   1 - 21   2025年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The safety and feasibility of robotic pancreatoduodenectomy (RPD) in high-risk patients with postoperative pancreatic fistula (POPF) have rarely been investigated, although the rate of POPF is lower than in open pancreatoduodenectomy (OPD). This study aimed to examine the impact of robotic surgery on POPF in high-risk patients after pancreatoduodenectomy (PD). METHODS: This retrospective analysis included 204 patients who underwent RPD between January 2018 and June 2023. Of the 204 patients, 126 with high-risk POPF were included. The outcomes of RPD and OPD were compared. Multivariate analyses were conducted to identify risk factors associated with the development of clinically relevant POPF (CR-POPF) after surgery. RESULTS: Of the 126 patients, 50 underwent RPD and 76 underwent OPD. The incidence of CR-POPF was significantly lower in the RPD group than in the OPD group (6.0% vs. 38.2%, P < 0.001). Multivariate analyses identified OPD as an independent risk factor associated with CR-POPF (odds ratio [OR]: 7.87, 95% confidence interval [CI]: 2.11-29.4, P = 0.002). CONCLUSIONS: This study demonstrated the impact of robotic surgery on POPF in high-risk patients after PD. These results suggest that RPD may be significantly associated with a decreased incidence of CR-POPF in high-risk anastomoses.

    DOI: 10.1159/000543737

    PubMed

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  • Hemodynamic Assessment Using SPY Laser Fluorescence Imaging During Pancreatoduodenectomy with Common Hepatic Artery Resection. 査読 国際誌

    Tomokazu Fuji, Kosei Takagi, Kazuya Yasui, Takeyoshi Nishiyama, Motohiko Yamada, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

    Annals of surgical oncology   2024年12月

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    担当区分:責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Pancreatectomies combined with arterial resection can be indicated for pancreatic cancer. In a pancreatectomy with arterial resection, intraoperative confirmation of blood flow through reconstructed vessels is crucial. This study highlights the usefulness of SPY laser fluorescence imaging during a pancreatoduodenectomy with common hepatic artery resection (PD-CHAR). PATIENT AND METHODS: A 55-year-old man with borderline resectable pancreatic head cancer underwent a PD-CHAR. After confirming tumor resectability, reconstruction of the CHA to the proper hepatic artery was performed. Subsequently, the superior mesenteric vein was reconstructed. RESULTS: SPY laser fluorescence imaging demonstrated arterial blood perfusion to the liver through the reconstructed hepatic artery, followed by perfusion from the portal vein. The operation lasted 493 min, with an estimated blood loss of 400 mL. The postoperative course was uneventful with good arterial blood flow. CONCLUSION: The SPY Portable Handheld Imager could be valuable for visualizing blood flow in reconstructed vessels and assessing tissue perfusion during a pancreatectomy combined with vascular reconstruction.

    DOI: 10.1245/s10434-024-16659-x

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  • Rare internal hernia following pancreatoduodenectomy: A case report. 査読 国際誌

    Teruyuki Tsujii, Kosei Takagi, Yasuo Nagai, Kazuya Yasui, Tomokazu Fuji, Toshiyoshi Fujiwara

    International journal of surgery case reports   126   110673 - 110673   2024年11月

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    担当区分:責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Pancreatoduodenectomy (PD) is a complex procedure with a high morbidity rate. Internal hernia following PD is a rare but potentially life-threatening complication. Herein, we describe a rare case of internal hernia after PD. PRESENTATION OF CASE: A 76-year-old man who underwent subtotal stomach-preserving PD 7 years ago presented with vomiting and abdominal pain. Abdominal computed tomography revealed an internal hernia. Because conservative treatment failed, surgical intervention was performed. Intraoperative findings revealed efferent loop herniation in the space between the afferent loop near the Braun anastomosis and transverse mesocolon. The hernia was repositioned and the mesenteric defect was closed. DISCUSSION: This is an extremely rare case of an internal hernia that developed 7 years after PD. As conservative management provides a little chance for improvement, precise diagnosis and prompt re-intervention are essential for the management of internal hernia. In this case, the hernial orifice developed in the space between the afferent and efferent loops and the transverse mesocolon. Internal hernia could be a differential diagnosis in patients with ileus after PD. CONCLUSION: This study provided a detailed description of an extremely rare case of internal hernia following PD. Therefore, internal hernias should be considered in patients undergoing PD.

    DOI: 10.1016/j.ijscr.2024.110673

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  • The required experience of open pancreaticoduodenectomy before becoming a specialist in hepatobiliary and pancreatic surgeons: a multicenter, cohort study of 334 open pancreaticoduodenectomies. 査読 国際誌

    Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Masayoshi Hioki, Ryuichi Yoshida, Yoshikatsu Endo, Kazuya Yasui, Daisuke Nobuoka, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

    BMC surgery   24 ( 1 )   366 - 366   2024年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Open pancreaticoduodenectomy (OPD) is an essential surgical procedure for expert hepato-biliary-pancreatic (HBP) surgeons. However, there is no standard for how many surgeries must be performed by a surgeon in training before they are considered to have enough experience to ensure surgical safety. METHODS: Cumulative Sum (CUSUM) analysis was performed using the surgical data of OPDs performed during the training period of board-certified expert surgeons of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. RESULTS: Fourteen HBP surgeons participated in this study and performed 334 OPDs during their training period. The median (interquartile range) values for operative time, blood loss, and length of hospital stay were 455 (397-519) minutes, 450 (234--716) ml, and 28 (21-38) days, respectively. CUSUM analysis showed inflection points at 20 surgeries performed for operative time. After 20 procedures, operative time was significantly shorter (461 min vs. 425 min, p = 0.021) and blood loss was significantly lower (470 ml vs. 340 ml, p = 0.038). No significant differences between within 20 and after 21 procedures were found in the complication rate (53% vs. 48%, p = 0.424) and rate of in-hospital deaths (1.5% vs.1.4%. p = 0.945). Up to 20 surgeries, PDAC and another malignant tumor had longer operative time than benign/low malignant diseases (486 min vs. 472 min vs. 429 min, p < 0.001), and higher blood loss (500 ml vs. 502 ml vs. 355 ml, p < 0.001). Mortality rate was higher at PDAC cases (5% vs. 0% vs. 0%, p = 0.01). After the 21 procedures, these outcomes were improved and no differences in by primary disease were observed. Multivariable analysis showed that within 20 surgeries were independent risk factors of longer operative time (HR2.6, p = 0.013) and higher blood loss (HR2.0, p = 0.049). CONCLUSIONS: To stabilize the surgical outcome of OPD for malignant disease, at least 20 surgeries should be performed at a certified institution during surgeon training. TRIAL REGISTRATION: Clinical trial number: Not applicable.

    DOI: 10.1186/s12893-024-02677-9

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  • Risk model for predicting failure to rescue after hepatectomy: Cohort study of 1371 consecutive patients. 査読 国際誌

    Jiro Kimura, Kosei Takagi, Yuzo Umeda, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

    Hepatology research : the official journal of the Japan Society of Hepatology   2024年11月

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    担当区分:責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIM: Although hepatectomy is a complex surgical procedure, its incidence among older patients has increased due to global aging. However, few studies have focused on the association between age and failure to rescue (FTR) posthepatectomy. This study aimed to investigate the association between age and FTR and develop a risk model for FTR following hepatectomy. METHODS: We analyzed a total of 1371 consecutive patients who underwent primary hepatectomy between July 2003 and September 2022. The patients were divided into three groups according to their age: young-old (<65 years), pre-old (65-74 years), and old group (≥75 years). Additionally, the associations among age, FTR, and risk factors for FTR were investigated. Subsequently, a risk model was developed to predict the FTR. RESULTS: Of the 1371 patients, 373 (27.2%) experienced major complications, and FTR occurred in 15 patients. The older group showed a higher FTR rate (8.4%) than the young-old (1.3%) and pre-old (4.3%) groups (p = 0.03). Multivariate analyses indicated that older age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15; p = 0.045) and American Society of Anesthesiologists Physical Status score ≥3 (OR 4.35; 95% CI 1.24-15.2; p = 0.02) were independent predictive factors for FTR. The risk model exhibited an accuracy with an area under the curve of 0.80 (95% CI 0.69-0.92). Calibration plots of the model revealed a concordance index of 0.73. CONCLUSIONS: This study identified an association between age, FTR, and risk factors for FTR posthepatectomy. Together, our risk model is a clinically relevant, internally validated, and useful tool for predicting FTR posthepatectomy.

    DOI: 10.1111/hepr.14134

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MISC

  • 膵臓の腫瘍 医療における膵臓腫瘍の外科

    高木弘誠, 山田元彦, 楳田祐三

    Joncol   20 ( 1 )   2024年

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  • Double-surgeon techniqueの腹腔鏡下肝切除への応用

    木村次郎, 藤智和, 高木弘誠, 木村裕司, 山田元彦, 楳田祐三, 藤原俊義

    日本内視鏡外科学会総会(Web)   36th   2023年

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  • ロボット支援下vs.開腹膵頭十二指腸切除術

    高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村裕司, 山田元彦, 木村次郎, 藤原俊義

    日本膵切研究会プログラム・抄録集   50th   2023年

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  • ロボット支援下膵体尾部切除術における脾臓温存の意義と短期成績

    山田元彦, 高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村祐司, 木村次郎, 萱野真史, 廣野欣司, 佐藤真歩, 藤原俊義

    日本膵切研究会プログラム・抄録集   50th   2023年

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  • ロボット支援下肝切除術におけるポート・機器セッティングのコツ

    高木弘誠, 楳田祐三, 藤智和, 安井和也, 山田元彦, 木村裕司, 木村次郎, 藤原俊義

    肝臓内視鏡外科研究会プログラム・抄録集   17th   2023年

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共同研究・競争的資金等の研究

  • ロボット支援下肝胆膵高難度手術におけるトレーニングプログラムの開発

    研究課題/領域番号:21K16447  2021年04月 - 2024年03月

    日本学術振興会  科学研究費助成事業  若手研究

    高木 弘誠

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    配分額:4550000円 ( 直接経費:3500000円 、 間接経費:1050000円 )

    本研究では、実際のロボット支援下肝胆膵高難度手術を想定したより実践的なSimulation training、Biotissue training、Video trainingを組み込んだ本邦初の新たな包括的トレーニングプログラムを確立することを目的としており、現在その効果を明らかにしている。①Simulation trainingを通して、ロボット手術の基本となる操作を習得し、その術者およびtrainee のラーニングカーブを評価している。現在、被験者をリクルートし、研究を継続している。②Biotissue trainingではBiotissueを用いた吻合トレーニングを行い、膵臓モデルや胆管モデルを用いて実際の臨床におけるロボット手術に極めて近い吻合トレーニングを行っている。また吻合の評価を行い、術者およびtrainee のラーニングカーブを評価している。引き続き被 者をリクルートし、研究を継続している③Video training:ロボット支援下肝胆膵高難度手術を安全に行うには、術式、手技の定型化が必須であるが、そのビデオ教材やテキストは本邦においてほとんど存在しない。本研究では、申請者が行った実際の症例ビデオを現在集積し、Tips & Pitfallsを含んだ教育的ビデオ教材や手術手技の詳細を記したテキストブックの作成を目指している。

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