Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

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Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 408 ( 1 ) 284 - 284 2023.7

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

PURPOSE: Biliary reconstruction remains a technically demanding and complicated procedure in minimally invasive hepatopancreatobiliary surgeries. No optimal hepaticojejunostomy (HJ) technique has been demonstrated to be superior for preventing biliary complications. This study aimed to investigate the feasibility of our unique technique of posterior double-layer interrupted sutures in robotic HJ. METHODS: We performed a retrospective analysis of a prospectively collected database. Forty-two patients who underwent robotic pancreatoduodenectomy using this technique between September 2020 and November 2022 at our center were reviewed. In the posterior double-layer interrupted technique, sutures were placed to bite the bile duct, posterior seromuscular layer of the jejunum, and full thickness of the jejunum. RESULTS: The median operative time was 410 (interquartile range [IQR], 388-478) min, and the median HJ time was 30 (IQR, 28-39) min. The median bile duct diameter was 7 (IQR, 6-10) mm. Of the 42 patients, one patient (2.4%) had grade B bile leakage. During the median follow-up of 12.6 months, one patient (2.4%) with bile leakage developed anastomotic stenosis. Perioperative mortality was not observed. A surgical video showing the posterior double-layer interrupted sutures in the robotic HJ is included. CONCLUSIONS: Posterior double-layer interrupted sutures in robotic HJ provided a simple and feasible method for biliary reconstruction with a low risk of biliary complications.

DOI： 10.1007/s00423-023-03020-1

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【肝胆膵】膵頭十二指腸切除術後膵液瘻の克服を目指した工夫膵頭十二指腸切除術のハイリスク膵空腸吻合におけるロボット支援下手術の役割

藤智和, 高木弘誠, 楳田祐三, 吉田龍一, 安井和也, 黒田新士, 野間和広, 寺石文則, 藤原俊儀

日本消化器外科学会総会 78回 WS32 - 7 2023.7

【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略血中循環腫瘍DNA内KRAS mutation profileとCA19-9値を組み合わせた膵癌予後の層別化戦略

安井和也, 吉田龍一, 宮本耕吉, 藤智和, 高木弘誠, 寺石文則, 黒田新士, 野間和広, 楳田祐三, 藤原俊義

日本消化器外科学会総会 78回 WS30 - 10 2023.7

非大腸癌由来の少数肝転移症例の切除適応を見極める

岡田尚大, 藤智和, 楳田祐三, 吉田龍一, 高木弘誠, 安井和也, 黒田新士, 野間和広, 寺石文則, 藤原俊義

日本消化器外科学会総会 78回 O11 - 6 2023.7

【肝胆膵】膵頭十二指腸切除術後膵液瘻の克服を目指した工夫膵頭十二指腸切除術のハイリスク膵空腸吻合におけるロボット支援下手術の役割

藤智和, 高木弘誠, 楳田祐三, 吉田龍一, 安井和也, 黒田新士, 野間和広, 寺石文則, 藤原俊儀

日本消化器外科学会総会 78回 WS32 - 7 2023.7

非大腸癌由来の少数肝転移症例の切除適応を見極める

岡田尚大, 藤智和, 楳田祐三, 吉田龍一, 高木弘誠, 安井和也, 黒田新士, 野間和広, 寺石文則, 藤原俊義

日本消化器外科学会総会 78回 O11 - 6 2023.7

【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略血中循環腫瘍DNA内KRAS mutation profileとCA19-9値を組み合わせた膵癌予後の層別化戦略

安井和也, 吉田龍一, 宮本耕吉, 藤智和, 高木弘誠, 寺石文則, 黒田新士, 野間和広, 楳田祐三, 藤原俊義

日本消化器外科学会総会 78回 WS30 - 10 2023.7

膵癌診療における検体固定の工夫と外科医と病理医間での相互フィードバックの実際

安井和也, 木村次郎, 高木弘誠, 藤智和, 楳田祐三, 藤原俊義

膵臓 38 ( 3 ) A461 - A461 2023.7

低侵襲時代の膵臓手術ロボット支援下膵切除術の定型化と普及にむけて

高木弘誠, 楳田祐三, 吉田龍一, 藤智和, 安井和也, 木村次郎, 八木孝仁, 藤原俊義

膵臓 38 ( 3 ) A179 - A179 2023.7

【必携ロボット支援下消化器外科手術-基本手技とトラブルシューティング】肝胆膵領域ロボット支援下先天性胆道拡張症手術

高木弘誠, 楳田祐三, 藤智和, 安井和也, 藤原俊義, 八木孝仁

手術 77 ( 8 ) 1231 - 1238 2023.7

The Feasibility, Proficiency, and Mastery Learning Curves in 635 Robotic Pancreatoduodenectomies Following A Multicenter Training Program: 'Standing on the Shoulders of Giants'. Reviewed International journal

Maurice J W Zwart, Bram van den Broek, Nine de Graaf, J Annelie Suurmeijer, Simone Augustinus, Wouter W Te Riele, Hjalmar C van Santvoort, Jeroen Hagendoorn, Inne H M Borel Rinkes, Jacob L van Dam, Kosei Takagi, T C Khé Tran, Jennifer Schreinemakers, George van der Schelling, Jan H Wijsman, Roeland F de Wilde, Sebastiaan Festen, Freek Daams, Misha D Luyer, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Daan J Lips, M Abu Hilal, Olivier R Busch, Olivier Saint-Marc, Herbert J Zeh 3rd, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, I Quintus Molenaar, Marc G Besselink

Annals of surgery 278 ( 6 ) e1232-e1241 2023.6

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

OBJECTIVE: To assess the feasibility, proficiency, and mastery learning curves for RPD in 'second generation' RPD centers following a multicenter training program adhering to the IDEAL framework. BACKGROUND: The long learning curves for robotic pancreatoduodenectomy (RPD) reported from 'pioneering' expert centers may discourage centers interested in starting a RPD program. However, the feasibility, proficiency, and mastery learning curves may be shorter in 'second generation' centers who participated in dedicated RPD training programs, although data are lacking. We report on the learning curves for RPD in 'second generation' centers trained in a dedicated nationwide program. METHODS: Post-hoc analysis of all consecutive patients undergoing RPD in seven centers that participated in the LAELAPS-3 training program, each with a minimum annual volume of 50 pancreatoduodenectomies, using the mandatory Dutch Pancreatic Cancer Audit (March 2016-December 2021). Cumulative sum (CUSUM) analysis determined cut-offs for the three learning curves: operative time for the feasibility (1), risk-adjusted major complication (Clavien-Dindo grade ≥III) for the proficiency (2), and textbook outcome for the mastery (3) learning curve. Outcomes before and after the cut-offs were compared for the proficiency and mastery learning curves. A survey was used to assess changes in practice and the most valued 'lessons learned'. RESULTS: Overall, 635 RPD were performed by 17 trained surgeons, with a conversion rate of 6.6% (n=42). The median annual volume of RPD per center was 22.5±6.8. From 2016-2021, the nationwide annual use of RPD increased from 0% to 23% whereas the use of laparoscopic PD decreased from 15% to 0%. The rate of major complications was 36.9% (n=234), surgical site infection (SSI) 6.3% (n=40), postoperative pancreatic fistula (grade B/C) 26.9% (n=171), and 30-day/in-hospital mortality 3.5% (n=22). Cut-offs for the feasibility, proficiency, and mastery learning curves were reached at 15, 62, and 84 RPD. Major morbidity and 30-day/in-hospital mortality did not differ significantly before and after the cut-offs for the proficiency and mastery learning curves. Previous experience in laparoscopic pancreatoduodenectomy shortened the feasibility (-12 RPDs, -44%), proficiency (-32 RPDs, -34%), and mastery phase learning curve (-34 RPDs, -23%), but did not improve clinical outcome. CONCLUSIONS: The feasibility, proficiency, and mastery learning curves for RPD at 15, 62, and 84 procedures in 'second generation' centers after a multicenter training program were considerably shorter as previously reported from 'pioneering' expert centers. The learning curve cut-offs and prior laparoscopic experience did not impact major morbidity and mortality. These findings demonstrate the safety and value of a nationwide training program for RPD in centers with sufficient volume.

DOI： 10.1097/SLA.0000000000005928

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Impact of sarcopenia on clinical outcomes for patients with resected hepatocellular carcinoma: A retrospective comparison of eastern and western cohorts. Reviewed International journal

Berend Robert Beumer, Kosei Takagi, Stefan Buettner, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara, Jeroen Laurens Ad van Vugt, Jan Nicolas Maria IJzermans

International journal of surgery (London, England) 109 ( 8 ) 2258 - 2266 2023.5

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

BACKGROUND: Patient fitness is important for guiding treatment. Muscle mass, as a reflection thereof, can be objectively measured. However, the role of east-west differences remains unclear. Therefore, we compared the impact of muscle mass on clinical outcomes after liver resection for HCC in a Dutch (NL) and Japanese (JP) setting and evaluated the predictive performance of different cut-off values for sarcopenia. METHOD: In this multicenter retrospective cohort study patients with hepatocellular carcinoma (HCC) undergoing liver resection were included. The skeletal muscle mass index (SMI) was determined on CT scans obtained within 3 months before surgery. The primary outcome measure was overall survival (OS). Secondary outcome measures were: 90-day mortality, severe complications, length of stay, and recurrence free survival. The predictive performance of several sarcopenia cut-off values was studied using the c-index and area under the curve. Interaction terms were used to study geographic effect modification of muscle mass. RESULTS: Demographics differed between NL and JP. Gender, age, and body mass index were associated with SMI. Significant effect modification between NL and JP was found for BMI. The predictive performance of sarcopenia for both short- and long-term outcomes was higher in JP compared to NL (max c-index: 0.58 vs 0.55, respectively). However, differences between cut-off values were small. For the association between sarcopenia and OS, a strong association was found in JP (Hazard ratio (HR) 2.00 95%CI[1.230 ; 3.08], P=0.002), where this was not found in NL (0.76 [0.42 ; 1.36], P=0.351). The interaction term confirmed that this difference was significant (HR 0.37 95%CI[0.19 ; 0.73], P=0.005). CONCLUSIONS: The impact of sarcopenia on survival differs between the east and west. Clinical trials and treatment guidelines using sarcopenia for risk stratification should be validated in race-dependent populations prior to clinical adoption.

DOI： 10.1097/JS9.0000000000000458

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Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index. Reviewed

Yuzo Umeda, Kosei Takagi, Tatsuo Matsuda, Tomokazu Fuji, Toru Kojima, Daisuke Satoh, Masayoshi Hioki, Yoshikatsu Endo, Masaru Inagaki, Masahiro Oishi, Takahito Yagi, Toshiyoshi Fujiwara

Annals of gastroenterological surgery 7 ( 3 ) 512 - 522 2023.5

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

AIMS: Lymph node metastases (LNM) are associated with lethal prognosis in intrahepatic cholangiocarcinoma (ICC). Lymphadenectomy is crucial for accurate staging and hopes of possible oncological treatment. However, the therapeutic implications and optimal extent of lymphadenectomy remain contentious. METHODS: To clarify the prognostic value and optimal extent of lymphadenectomy, the therapeutic index (TI) for each lymph node was analyzed for 279 cases that had undergone lymphadenectomy in a multi-institutional database. Tumor localization was divided into hilar lesions (n = 130), right peripheral lesions (n = 60), and left peripheral lesions (n = 89). In addition, the lymph node station was classified as Level 1 (LV1: hepatoduodenal ligament node), Level 2 (LV2: postpancreatic or common hepatic artery nodes), or Level 3 (LV3: gastrocardiac, left gastric artery, or celiac artery nodes). RESULTS: Lymph node metastases were confirmed in 109 patients (39%). Five-y survival rates were 45.3% for N0 disease, 27.1% for LV1-LNM, 22.9% for LV2-LNM, and 7.3% for LV3-LNM (P < 0.001). LV3-LNM were the most frequent and earliest recurrence outcome, including multisite recurrence, followed by LV2, LV1, and N0 disease. The 5-year TI (5year-TI) for lymphadenectomy was 7.2 for LV1, 5.5 for LV2, and 1.9 for LV3. Regarding tumor location, hilar lesions showed 5-year TI >5.0 in LV1 and LV2, whereas bilateral peripheral lesions showed 5-year TI > 5.0 in LV1. CONCLUSION: The implications and extent of lymphadenectomy for ICC appear to rely on tumor location. In the peripheral type, the benefit of lymphadenectomy would be limited and dissection beyond LV1 should be avoided, while in the hilar type, lymphadenectomy up to LV2 could be recommended.

DOI： 10.1002/ags3.12642

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ロボット支援下肝胆膵高難度手術の導入と教育システムの確立

高木弘誠, 吉田龍一, 藤智和, 安井和也, 八木孝仁, 藤原俊義

日本外科学会定期学術集会抄録集 123回 SF - 3 2023.4

Impact of educational video on performance in robotic simulation training (TAKUMI-1): a randomized controlled trial. Reviewed International journal

Kosei Takagi, Nanako Hata, Jiro Kimura, Satoru Kikuchi, Kazuhiro Noma, Kazuya Yasui, Tomokazu Fuji, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara

Journal of robotic surgery 17 ( 4 ) 1547 - 1553 2023.3

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received an educational video and robotic simulation training or the control group that received only simulation training. The da Vinci® Skills Simulator was used for the basic course, including nine drills. The primary endpoint was the overall score of nine drills in cycles 1-10. Secondary endpoints included overall, efficiency, and penalty scores in each cycle, as well as the learning curves evaluated by the cumulative sum (CUSUM) analysis. Between September 2021 and May 2022, 20 participants were assigned to the video (n = 10) and control (n = 10) groups. The video group had significantly higher overall scores than the control group (90.8 vs. 72.4, P < 0.001). Significantly higher overall scores and lower penalty scores were confirmed, mainly in cycles 1-5. CUSUM analysis revealed a shorter learning curve in the video group. The present study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.

DOI： 10.1007/s11701-023-01556-4

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Role of the Pfannenstiel Incision in Robotic Hepato-Pancreato-Biliary Surgery. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Takahito Yagi, Toshiyoshi Fujiwara

Journal of clinical medicine 12 ( 5 ) 2023.3

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

Studies remain limited on the role of the Pfannenstiel incision in minimally invasive hepato-pancreato-biliary (HPB) surgery, especially robotic surgery. The role of various extraction sites in robotic HPB surgery should be understood. Herein, we describe the surgical techniques, outcomes, advantages, and disadvantages of the Pfannenstiel incision in robotic pancreatic surgery. Seventy patients underwent robotic pancreatectomy at our institution between September 2020 and October 2022. The Pfannenstiel incision was used for specimen retrieval in 55 patients. Advantages of the Pfannenstiel incision include less pain, cosmetic benefits, and a lower incidence of complications. Moreover, the specimen could be removed using the robotic system docked. However, all complex reconstructions should be performed intra-abdominally during robotic pancreatoduodenectomies. The incidence of mortality and postoperative pancreatic fistula (grade B) was 0% and 9.1%, respectively. During the median follow-up (11.2 months) after surgery, complications at the Pfannenstiel incision site included surgical site infection (n = 1, 1.8%) and incisional hernia (n = 1, 1.8%). The Pfannenstiel incision can be a useful option for specimen retrieval in minimally invasive HPB surgery, according to the surgeon's preferences and the patient's condition.

DOI： 10.3390/jcm12051971

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【転移性肝癌を極める】大腸癌肝転移に対する肝切除

楳田祐三, 吉田龍一, 藤智和, 高木弘誠, 安井和也, 重安邦俊, 寺石文則, 八木孝仁, 藤原俊義

消化器外科 46 ( 3 ) 277 - 288 2023.3

Robotic surgery for congenital biliary dilatation using the scope switch technique (with video). Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

Asian journal of surgery 46 ( 10 ) 4399 - 4402 2023.2

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

TECHNIQUE: Minimally invasive congenital biliary dilatation (CBD) surgery is technically demanding. However, few studies have reported surgical approaches of robotic surgery for CBD. This report presents robotic CBD surgery using a scope-switch technique. Our robotic surgery technique for CBD consisted of four steps: step 1, Kocher's maneuver; step 2, dissection of the hepatoduodenal ligament using the scope switch technique; step 3, preparation for the Roux-en-Y loop; and step 4, hepaticojejunostomy. RESULTS: The scope switch technique can provide different surgical approaches for dissecting the bile duct, including anterior approach by the standard position and right approach by the scope switch position. When approaching the ventral and left side of the bile duct, anterior approach with the standard position is suitable. In contrast, the lateral view by the scope switch position is preferable for approaching the bile duct laterally and dorsally. Using this technique, the dilated bile duct can be dissected circumferentially from four directions: anterior, medial, lateral, and posterior. Thereafter, complete resection of the choledochal cyst can be achieved. CONCLUSIONS: The scope switch technique in robotic surgery for CBD can be useful for dissecting around the bile duct with different surgical views, leading to the complete resection of the choledochal cyst.

DOI： 10.1016/j.asjsur.2023.02.021

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Video Grading of Pancreatic Anastomoses During Robotic Pancreatoduodenectomy to Assess both Learning Curve and the Risk of Pancreatic Fistula - A Post Hoc Analysis of the LAELAPS-3 Training Program. Reviewed International journal

Bram L J van den Broek, Maurice J W Zwart, Bert A Bonsing, Olivier R Busch, Jacob L van Dam, Ignace H J T de Hingh, Melissa E Hogg, Misha D Luyer, J S D Mieog, Luna A Stibbe, Kosei Takagi, T C K Tran, Roeland F de Wilde, Herbert J Zeh 3rd, Amer H Zureikat, Bas Groot Koerkamp, Marc G Besselink

Annals of surgery 278 ( 5 ) e1048-e1054 2023.1

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

OBJECTIVE: To assess the learning curve of pancreaticojejunostomy during robotic pancreatoduodenectomy(RPD) and to predict the risk of postoperative pancreatic fistula(POPF) by using the objective structured assessment of technical skills(OSATS) score, taking the fistula risk score into account. SUMMARY BACKGROUND DATA: RPD is a challenging procedure that requires extensive training and confirmation of adequate surgical performance. Video grading, modified for RPD, of the pancreatic anastomosis could assess the learning curve of RPD and predict the risk of POPF. METHODS: Post-hoc assessment of patients prospectively included in four Dutch centers in a nationwide LAELAPS-3 training program for RPD. Video grading of the pancreaticojejunostomy was performed by two graders using OSATS (attainable scores 12-60). The main outcomes were the combined OSATS of the two graders and POPF (grade B/C). CUSUM analyzed a turning point in the learning curve for surgical skill. Logistic regression determined the cut-off for OSATS. Patients were categorized for POPF risk (i.e. low, intermediate, high) based on the updated alternative fistula risk scores (uaFRS). RESULTS: Videos from 153 pancreatic anastomoses were included. Median OSATS score was 48 (IQR 41-52) points and with a turning point at 33 procedures. POPF occurred in 39 patients (25.5%). An OSATS score below 49, present in 77 patients (50.3%), was associated with an increased risk of POPF, OR 4.01, P=0.004. The POPF rate was 43.6% with OSATS < 49 versus 15.8% with OSATS ≥49. The uaFRS category "soft pancreatic texture" was the second strongest prognostic factor of POPF (OR 3.37, P=0.040). Median cumulative surgical experience was 17 years (IQR 8-21) at their first anastomosis. CONCLUSIONS: Video grading of the pancreatic anastomosis in RPD using OSATS identified a learning curve and a reduced risk of POPF in case of better surgical performance. Video grading may provide a valid method to surgical training, quality control and improvement.

DOI： 10.1097/SLA.0000000000005796

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Surgical Techniques of Gastrojejunostomy in Robotic Pancreatoduodenectomy: Robot-Sewn versus Stapled Gastrojejunostomy Anastomosis. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Takahito Yagi, Toshiyoshi Fujiwara

Journal of clinical medicine 12 ( 2 ) 2023.1

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Delayed gastric emptying (DGE) is a major complication of pancreatoduodenectomy (PD). Several efforts have been made to decrease the incidence of DGE. However, the optimal anastomotic method for gastro/duodenojejunostomy (GJ) remains debatable. Moreover, few studies have reported the impact of GJ surgical techniques on outcomes following robotic pancreatoduodenectomy (RPD). This study aimed to investigate the surgical outcomes of robot-sewn and stapled GJ anastomoses in RPD. METHODS: Forty patients who underwent RPD at the Okayama University Hospital between September 2020 and October 2022 were included. The outcomes between robot-sewn and stapled anastomoses were compared. RESULTS: The mean [standard deviation (SD)] operative and GJ time were 428 (63.5) and 34.0 (15.0) minutes, respectively. Postoperative outcomes included an overall incidence of DGE of 15.0%, and the mean postoperative hospital stays were 11.6 (5.3) days in length. The stapled group (n = 21) had significantly shorter GJ time than the robot-sewn group (n = 19) (22.7 min versus 46.5 min, p < 0.001). Moreover, stapled GJ cases were significantly associated with a lower incidence of DGE (0% versus 21%, p = 0.01). Although not significant, the stapled group tended to have shorter postoperative hospital stays (9.9 days versus 13.5 days, p = 0.08). CONCLUSIONS: Our findings suggest that stapled GJ anastomosis might decrease anastomotic GJ time and incidence of DGE after RPD. Surgeons should select a suitable method for GJ anastomosis based on their experiences with RPD.

DOI： 10.3390/jcm12020732

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