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Ist department of surgery, general and gastrointestinal surgery, and
IInd department of surgery, thoracic and cardiovascular surgery, were
founded as surgical divisions of Shiga University of Medical Science in
1975. In 2002, the two departments were integrated into a Department of
Surgery composed of 4 subdivisions (Cardiovascular surgery, Thoracic
surgery, Gastrointestinal surgery and General surgery). Each subdivision
comprises chief manager and the staffs of a specialty and the
residents.
The outlines of each subdivision are the followings.
1)
Service of cardiovascular surgery has focused on surgical treatments of
heart diseases and vascular diseases. As we go into the new millennium,
we are faced with increasing challenges, such as older and sicker
patients with more advanced multi organ diseases. Currently our clinical
practice is mainly concentrating on ischemic heart diseases, valvular
heart diseases and vascular diseases.
The techniques and methodology
of off-pump coronary artery bypass (OPCAB) has been well established in
our service and we have been known as one of the leading facilities in
this field. The development of the new method for harvesting graft
conduits (GEA), and the application of the new ultrasonic device are
also well recognized.
The valvular procedures are actively performed,
especially the reconstruction of the mitral valve with geometric
considerations. Complex valve operations and extensive aortic surgery
are also performed with steady protection of the heart and the brain.
Including described above, the number of major cardiovascular operations
are reaching over 200 cases. Our effort are presently directing to
pursue "Super Fast Track" recovery with ultimate minimally invasiveness
of surgical procedures.
2) Thoracic surgery covers primary and
metastatic lung cancers, mediastinal tumors, chest wall tumors,
pulmonary bullous diseases (pneumothoraces, giant bullae, and pulmonary
emphysema), pectus excavatum and respiratory tract constrictions, etc.
When the therapy for lung cancer is selected, QOL of a patient is
esteemed most. Minimally invasive surgery (including a thoracoscopic
surgery) or the reduction operations are adopted according to adaptation
criteria. To the advance malignant cases, chemotherapy and radiotherapy
are performed before operation, and it is striving for improvement in
the rate of complete excision. To the case with an inadequate lung
function, the thorax formation way (a method preventing a dislocation of
residual lung) was enforced simultaneously with lobectomy to
maintenance a good lung function. Adoptive cell transfer of activated
autologous lymphocytes (highly advanced medical treatment specified by
the Ministry of Health, Labor and Welfare) is enforced to the
non-respectable lung cancer, to the example of a recurrence and to the
malignant pleurisy cases. Minimal invasive surgery using thoracosope
with or without the help of hand assist (HATS; hand assisted
thoracoscopic surgery) is also introducing to the metastatic lung
tumors, mediastinal tumors, and pneumothoraces. To the respiratory tract
constriction, laser cauterization, balloon dilatation or various stents
are used properly. Nuss operation is selected to pectus excavatum,
which is a new minimally invasive technique and shows an excellent
cosmetic reform effect. Endoscopic thoracic sympathetic nerve
interception is adapted to palmer hyperhidrosis and upper-limbs blood
circulation obstacle and good result has been obtained.
3)
Gastrointestinal surgery covers digestive tract and
hepato-biliary-pancreatic surgery. Many leading operations using new
techniques have been applied since quite early in this division,
especially ileocolon or jejunal pouch interposition after total
gastrectomy, pylorus preserving subtotal gastrectomy, pylorus preserving
pancreatic duodenectomy, super low anterior dissection for rectal
cancer that avoids stoma. Laparoscopic surgery is introducing actively
as a minimal invasive surgery in recent years. We tried to select more
appropriate therapy including surgical and/or chemo-radio therapy
according to a degree of a cancer progression as for the malignant
tumors.
As a topic of new therapeutic maneuver, Shiga University of
Medical Science installed the first intraoperative MR machine (IVMR) in
Asia and has started clinical trials since 2000. This system has
enabled the application of minimally invasive MR-guided real time
surgery and interventional therapy. Ablation therapy using microwaves
under IVMR enables the minimally invasive therapy against liver tumor.
4)
General Surgery covers mainly breast, endocrine, pancreas, thyroid,
adrenal and parathyroid surgery, renal transplantation, retro peritoneal
or intraabdominal tumors and several diseases that a surgeon must be
known generally (ex. inguinal herniation, hemorrhoid, subcutaneous
tumor, etc).
Regarding to the breast cancer, mastectomy with lymph
node dissection have been indicated to the advanced cases. Recently,
breast conservative operation with wide resection of tumor, which aimed
for the cosmetic beauty, or trial of reserving the level of lymph node
dissection on the basis of the diagnosis of sentinel lymph nodes biopsy
is carried out to the cases of the early stage breast cancer.
This
subdivision provide for the resident supervised surgical training, which
encourages gradual development of clinical and operative skills. At the
end of the postgraduate program in General Surgery , the resident
should be a competent clinical surgeon who is qualified to practice in a
variety of clinical settings.
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