Department of Surgery, General Thoracic Surgery

The Department of Thoracic Surgery provides medical care, research, and educational activities for various thoracic diseases such as lung cancer, emphysema pulmonary disease, myasthenia gravis, mediastinal tumor, pneumothorax, and empyema.

Clinically, we experience more than 200 general anesthesia surgery cases and more than 100 lung malignancy surgery cases each year. With abundant surgical cases as background, we conduct various research activities in parallel with clinical practice. The following are representative research themes.

1. New image-guided thoracoscopic surgery for early lung cancer

   Increasing opportunities to detect small-sized lung cancer and pulmonary resection as part of multidisciplinary treatment for metastatic lung tumors. We have been developing a method to securely remove sub-centimeter pulmonary nodules less than 1 cm by minimally invasive surgical techniques. After conducting multiple CT scans of multiple pulmonary nodules in the Hybrid OR, a small-diameter bronchoscope was guided to near the lesion in the lung using a combination of navigation bronchoscope and c-arm fluoroscopy, and the tumor was marked with a small amount of fluorescent dye. We have developed a method for excision under fluorescent thoracoscopy (PIN-POINT, Stryker). This technique enables to excise multiple small-sized pulmonary nodules with minimally invasive technique.

2. Development and clinical application of fluorescent-guided surgery

   Fluorescence-guided surgery, including indocyanine green fluorescence, is developing rapidly in various areas of the surgical field. In the field of respiratory surgery, we will use ICG fluorescence technology to mark small lung masses, visualize the resected area in pulmonary segmentectomy, and evaluate the blood flow of various tissues using ICG fluorescence technology to verify its clinical usefulness.

3. Minimally invasive surgery with the latest robot-assisted surgery

   Our department started Robot-assisted surgery in 2015, and a total of 60 surgical cases have been experienced by March 2020. We perform 4-port robotic surgery using the latest surgical robot da Vinci Xi (intuitive surgical). We are also exploring the value of new robotic surgery based on the near-infrared fluorescence observation function (firefly) installed in da Vinci Xi.

4. Image guided surgery by Projection mapping of 3D images

   In order to use easily captured 3D image data such as CT, FDG-PET, MRI, etc. directly as an image guide for general surgery, project these 3D image data onto the patient's body surface without positional error. We have been developing a device that can check the position of structures inside the body from the body surface.

5. Anti-cancer drug sensitivity test by CD-DST method

   As an initiative to utilize surgical treatment for medical and multidisciplinary treatments, we have been running and conducting anti-cancer drug sensitivity tests using the CD-DST method since 2007. By conducting this test using part of the tumor obtained by surgery, if treatment with an anticancer drug is required later, treatment with a drug that can be expected to be effective is given priority. This test was performed as advanced medical treatment until 2011, but it has been applied for normal insurance medical treatment from 2012, but there are few facilities that have 3D culture technology and can perform it. We provides patients with CD-DST as a regular insurance medical test. We are also conducting various basic research applying this 3D culture technology.

6. Diagnosis of cancer-bearing condition by amino acid metabolism in blood

   It is known that the amino acid fraction in blood changes in cancer-bearing conditions. In this classroom, we report that AICS (amino-index cancer screening) may be able to efficiently extract the group that relapses from patients after radical surgery for lung cancer. In the future, we are conducting research to utilize amino acid analysis as a new biomarker useful for the treatment of lung cancer patients.