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Laparoscopic surgery for colorectal cancer, not only early cancer but also advanced cancer, has become standardized by some randomized controlled studies. However, cases involving advanced transverse colon cancer were excluded from these studies due to the technical difficulty of the surgery. Hence, laparoscopic surgery for advanced transverse colon cancer is still a theme that we need to overcome. To solve these issues, it is necessary to establish a standardized approach and surgical technique. The advantage of our method, which approaches from both sides of the transverse mesocolon, is that it is easier to achieve hemostasis when active bleeding occurs because this approach provides space for ligating and sealing. This allows the surgeon to perform lymphadenectomy around the superior mesenteric artery and vein. We introduced the usefulness of the “Pincer approach of the transverse mesocolon” to standardize laparoscopic surgery for advanced transverse colon cancer.

The performance of endoscopic surgery has quickly become widespread as a minimally invasive therapy. However, complications still occur due to technical difficulties. In the present study, we focused on the problem of blind spots, which is one of the several problems that occur during endoscopic surgery and developed “BirdView,” a camera system with a wide field of view, with SHARP Corporation. In the present study, we conducted a clinical trial (Phase I) to confirm the safety and usefulness of the BirdView camera system. We herein report the results. In this study, surgical adverse events were reported in 2 cases (problems with ileus and urination). There were no cases of device failure, damage to the surrounding organs, or mortality. We evaluated the safety of the BirdView camera system. We believe that this camera system will contribute to the performance safe endoscopic surgery and the execution of robotic surgery, in which operators do not have the benefit of tactile feedback.

The image quality and performance of 3-dimensional video image systems has improved along with improvements in technology. However, objective evaluation on the usefulness of 3-dimensional video image systems is insufficient. Therefore, we decided to investigate the usefulness of 3-dimensional video image systems using the objective endoscopic surgery technology evaluating apparatus that we have developed, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). The participants were 28 student volunteers enrolled in Hiroshima University (17 men and 11 women, age: median 22.5, range 20–25), with no one having experienced endoscopic surgery training. Testing was carried out by dividing the subjects into two groups to initially carry out HUESAD with 2-dimensional video imaging (N = 14) and with 3-dimensional video imaging (N = 14). Questionnaires were carried out along with the investigation regarding both 2-dimensional and 3-dimensional video imaging. The task was carried out for approximately 15 min regarding both 2-dimensional and 3-dimensional video imaging. Lastly, the Mental Rotation Test, which is a standard space perception ability test, was used to evaluate the space perception ability. No difference was observed in the nauseous and uncomfortable feeling of practitioners between the two groups. Regarding smoothness, no difference was observed between 2-dimensional and 3-dimensional video imaging (p = 0.8665). Deviation (space perception ability) and approaching time (accuracy) were significantly lower with 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, the approaching time (accuracy) significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging in the group with low space perception ability (p = 0.0085). Objective evaluation using HUESAD and subjective evaluation by questionnaire revealed that endoscopic surgery techniques significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, it is believed that this effect is more effective in people with low space perception ability and beginner students.

Recently, the endoscopic surgical skills of surgeons have become a focus of many investigators and society as a whole. Hence, the importance of the training and education programs used to ensure safer endoscopic surgery has been gradually increasing. We developed our own motion analysis system called the HUESAD, and already demonstrated its construct validity. In this study, we verified that another motion analysis system (which uses the Dartfish Software program) could assess surgeons' endoscopic surgical skills.Experts (who had performed more than 100 laparoscopic surgeries) and novices (who had no experience performing laparoscopic surgery) were recruited for this study. The task was suturing in a dry box trainer. The time and the locus tracing of both sides' needle holders were analyzed using the new video analysis system (Dartfish Software).There were statistically significant differences between the experts and novices in all three variables assessed (task time: p = 0.0011, the locus tracing of the left sides' needle holders: p = 0.0011, the locus tracing of the right sides' needle holders: p = 0.0011).The results of this study demonstrated that the results of the motion analysis by the Dartfish Software were well correlated with the surgeon's skill level.

One of the disadvantages of laparoscopic surgery is its decreased tactile feedback. Surgical experience compensates for the decline in the sense of touch due to an improved ability to process visual information. Stochastic resonance (SR) is known to improve tactile sensation. In this study, we sought to improve the tactile feedback in laparoscopic surgery using SR to safely perform laparoscopic surgery. Ten surgeons (nine males and one female, age: 30–44 years, median age: 34) with the experiences of >50 laparoscopic surgeries volunteered to participate in this study. We tested the hypothesis that low-level noise applied to the hand can enhance the tactile sensation during surgery. We performed this experiment under three hand conditions (bare-handed conditions, gloved conditions and using the laparoscopic instrument with gloved hands). A piezoelectric actuator that generates vibrations was attached on the radial side of the participant’s index finger or to the grip of the laparoscopic instrument. Fine-touch tests were performed using the Semmes–Weinstein test kit. Moreover, we planned laparoscopic suturing and knot-tying tasks in the dry box and using an animal model under controlled vibrations. In the touch tests using bare hands, gloved hands and the laparoscopic instrument, the mean correct ratio was significantly lower than that observed in the test with no vibrations. Moreover, the OSATS scores for the laparoscopic suturing and knot-tying tasks showed significantly better scores with vibrations. This technique has a potential to be a great help in establishing safer and high-quality laparoscopic procedures.

Robot-assisted surgery using the da Vinci Surgical System provides three-dimensional images. However, no research has yet been done on the relationship between the system’s operation and spatial cognitive ability. This study focuses on the operator’s spatial cognitive ability which can impact acquisition of the skills required to operate the da Vinci Surgical System. The participants of the study were 20 volunteers who were students at Hiroshima University (9 men and 11 women, average age 21.1 ± 1.6 years). Depending on the mental rotation test’s score the participants were divided into two groups, one with High group (n = 10), and the other with Low group (n = 10). Both groups were tested using Hiroshima University endoscopic surgical assessment device (HUESAD) and the da Vinci Surgical System simulator dV-Trainer. HUESAD; No significant difference was noted between the two groups in terms of smoothness (p = 0.3867). In terms of accuracy and spatial cognitive ability, the High group scored significantly lower values than the Low group. dV-Trainer; In terms of overall Score, no significant difference was seen between the two groups (pick and place: p = 0.1639; peg board: p = 0.1883; thread the rings: p = 0.8928; suture sponge: p = 0.3238). This study indicates that differences in spatial cognitive ability have no impact at the initial stages to operate the da Vinci Surgical System. Despite this, it should be repeated that the da Vinci Surgical System is not something that facilitates simple surgery that can be implemented by anyone.