Japan Surgical Society Research Articles

Clinical practice guidelines for telesurgery 2022

Telesurgery is expected to improve medical access in areas with limited resources, facilitate the rapid dissemination of new surgical procedures, and advance surgical education. While previously hindered by communication delays and costs, recent advancements in information technology and the emergence of new surgical robots have created an environment conducive to societal implementation. In Japan, the legal framework established in 2019 allows for remote surgical support under the supervision of an actual surgeon. The Japan Surgical Society led a collaborative effort, involving various stakeholders, to conduct social verification experiments using telesurgery, resulting in the development of a Japanese version of the “Telesurgery Guidelines” in June 2022. These guidelines outline requirements for medical teams, communication environments, robotic systems, and security measures for communication lines, as well as responsibility allocation, cost burden, and the handling of adverse events during telesurgery. In addition, they address telementoring and full telesurgery. The guidelines are expected to be revised as needed, based on the utilization of telesurgery, advancements in surgical robots, and improvements in information technology.

Impact of the coronavirus disease 2019 pandemic on 20 representative surgical procedures in Japan based on the National Clinical Database: annual surveillance of 2021 by the Japan Surgical Society.

The volume of surgical services has significantly reduced globally due to the coronavirus disease 2019 (COVID-19) pandemic. This study evaluated the level of recovery in terms of the number of operations performed in Japan in 2021, based on nationwide periodic surveillance. Information on the weekly and annual volumes of 20 representative procedures in 6 surgical subspecialties in 2021 was extracted from the National Clinical Database. Statistical data for 2018 and 2019 (pre-pandemic era) were compared with those for 2020. Data on waves of infection, peak period, and high-prevalence areas (13 of 47 prefectures) were analyzed individually. The volumes of the 10 procedures, including gastrectomy, hepatectomy, valve replacement and valve plasty, coronary artery bypass grafting, infrarenal abdominal aorta replacement, ventricular septal defect closure, lung lobectomy, inguinal hernia repair (age < 16years old), and appendectomy (age < 16years old), did not reach 95% of that in the pre-pandemic era. The most striking decline in the surgical volume of these 10 procedures was observed during the peak period of wave 5 in high-prevalence areas. This near-complete enumeration survey identified the polarization of 20 representative procedures in terms of resumption of surgical service after the pandemic.

Current ethical considerations of cadaver surgical training for Japanese plastic and reconstructive surgeons

The guidelines for cadaver surgical training (CST) were published in 2012 by the Japan Surgical Society and Japanese Association of Anatomists. 1 Shichinohe T. Kondo T. Date H. Hiramatsu M. et al. Guidelines for cadaver Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists). Surg Today. 2022 Jul; 52: 989-994 Crossref PubMed Scopus (2) Google Scholar Ethical codes should be considered for donors and their families; however, the spread of CST programs and the development of social networking services are bringing about severe threats to the uncontrolled publication of photographs and videos. 2 De Caro R. Boscolo-Berto R. Artico M. et al. The Italian law on body donation: A position paper of the Italian College of Anatomists. Ann Anat. 2021 Nov; 238151761 Crossref PubMed Scopus (7) Google Scholar We therefore conducted a questionnaire survey to identify the current ethical considerations and problems encountered by university plastic and reconstructive surgery departments performing CST.

The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society.

A collapse in regional healthcare through the maldistribution of physicians has been a long-debated issue in Japan and amidst this situation, a new system of board certification was initiated. The Japan Surgical Society (JSS) conducted a nation-wide survey to grasp the current distribution of surgeons in Japan, and their roles. All 1976 JSS-certified teaching hospitals were invited to respond to a web-based questionnaire. The responses were analyzed to seek a solution to the current issues. Responses to the questionnaire were received from 1335 hospitals. The surgical departments of medical universities serve as an internal labor market and were the source of surgeons for most hospitals. More than 50% of teaching hospitals throughout the country claimed a shortage of surgeons even in well-populated prefectures such as Tokyo and Osaka. Hospitals rely on surgeons to cover the deficits in medical oncology, anesthesiology, and emergency medicine. These additional responsibilities were identified as significant predictors of a shortage of surgeons. Surgeon shortage is a serious issue throughout Japan. Given the limited number of surgeons and surgical trainees, hospitals should make every effort to recruit specialists in the additional fields where surgeons are filling the gaps and allow surgeons to engage more in surgery.

The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan.

Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.

Telesurgery and telesurgical support using a double-surgeon cockpit system allowing manipulation from two locations.

Although several studies on telesurgery have been reported globally, a clinically applicable technique has not yet been developed. As part of a telesurgical study series conducted by the Japan Surgical Society, this study describes the first application of a double-surgeon cockpit system to telesurgery. Surgeon cockpits were installed at a local site and a remote site 140km away. Three healthy pigs weighing between 26 and 29kg were selected for surgery. Non-specialized surgeons performed emergency hemostasis, cholecystectomy, and renal vein ligation with remote assistance using the double-surgeon cockpits and specialized surgeons performed actual telesurgery. Additionally, the impact of adding internet protocol security (IPsec) encryption to the internet protocol-virtual private network (IP-VPN) line on communication was evaluated to address clinical security concerns. The average time required for remote emergency hemostasis with the double-surgeon cockpit system was 10.64s. A non-specialized surgeon could safely perform cholecystectomy or renal vein ligation with remote assistance. Global Evaluative Assessment of Robotic Skills and System Usability Scale scores were higher for telesurgical support-assisted surgery by a non-specialized surgeon using the double-surgeon cockpits than for telesurgery performed by a specialized surgeon without the double-cockpit system. Adding IPsec encryption to the IP-VPN did not have a significant impact on communication. Telesurgical support through our double-surgeon cockpit system is feasible as first step toward clinical telesurgery.

Cadaver surgical training and research using donated cadavers in the field of surgery in Japan: an overview of reports from 2012 to 2021.

Subsequent to the publication of "Guidelines for cadaver dissection in education and research of clinical medicine" in 2012, cadaver surgical training (CST) was implemented in various surgical fields across Japan. This article summarizes the recent progress made in the implementation of CST using donated cadavers, and its associated research, focusing on the field of surgery, and discusses its future direction. All reports from 2012 to 2021 registered with the CST Promotion Committee of the Japan Surgical Society were analyzed. There were 292 (24.9%) programs in the field of surgery, including acute care surgery, out of a total of 1173 programs overall. Data were classified by the purpose of implementations and fields of surgery, with subclassification by organ, costs and participation fees. CST and its research were introduced in 27 (33.3%) of a total 81 universities. The total number of participants was 5564 and the major (80%) purpose of the program was to advance surgical techniques. When classified by objectives, 65, 59 and 11% were for mastering operations for malignant disease, minimally invasive surgery, and transplantation surgery, respectively. CST in the field of surgery is increasing progressively in Japan, but still with disproportionate dissemination. Further efforts are needed to achieve full adoption.

Assessment of reports on cadaver surgical training (CST) implementation in Japan: current status and challenges.

The contents and conflicts of interest of Cadaver Surgical Training (CST) programs in Japan were reported to the Japan Surgical Society CST Promotion Committee based on professional autonomy. After receiving the reports from participating universities, the committee evaluated the validity of these reports and provided advice on the proper implementation of CST. Over the past decade, 38 universities have been using cadavers for clinical education and research, such as CST. If inappropriate entries or unclear areas were identified, the universities could be asked to resubmit their report. This review clarifies the evaluation points of the CST reporting system, shows the status and problems of its reporting, and provides suggestions for the dissemination of CST in the future.

Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists)

This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.

Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists)

This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.

Updates on cadaver surgical training in Japan: a systematic facility at Chiba University.

Cadaver surgical training (CST), which ensures medical safety by improving the skills of surgeons, is popular overseas. However, training involves ethical issues given the use of cadavers. In 2012, the Japan Surgical Society and the Japanese Association of Anatomists compiled and opened the “Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine (Guideline 2012)” to the public. This has allowed Japan to conduct CST or research under the regulations of Postmortem Examination and Corpse Preservation Act and the Body Donation Act. However, its dissemination has been sluggish. The Clinical Anatomy Lab (CAL), established in 2010 at Chiba University, is a facility for conducting CST and research. In the 11 years since its inception, 250 programs have been implemented. Orthopedics had the most implemented in the clinical field, with 120 (48%), followed by emergency and critical care medicine with 27 (10.8%), and neurological surgery with 27 (10. 8%). Based on the purpose of the training, the most common objective for the programs (approximately 83%) was education. Further, the highest number of programs was recorded in 2018 (34) and participants in 2017 (631). The implementation of CST requires more than just guiding surgeons to a dissection practice room. There are several methods of preserving cadavers to make them suitable for CST. For various surgical simulations, an operating table is more suitable than a dissection table. The current paper provides information on how to implement CST in universities that have so far only worked on anatomy education for medical students.

Usage of cadavers in surgical training and research in Japan over the past decade

The “Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine” drafted by the Japan Surgical Society (JSS) and the Japanese Association of Anatomists in 2012 helped dispel legal concerns over cadaver surgical training (CST) and the usage of donated human bodies for research and development (R&D) in the country. Subsequently, in the fiscal year 2018, the Ministry of Health, Labour and Welfare increased the funding for CST, prompting its wider implementation. This study analyzed data obtained in 2012–2021 through the reporting system of the JSS-CST Promotion Committee to map the usage of cadavers for clinical purposes, specifically education and R&D, in Japan. We found that the number of medical universities using cadavers for CST and R&D programs was just 5 in 2012, and it reached 38 for the decade. Thus, about half of Japan’s medical universities implemented such programs over the period. Meanwhile, the total number of programs was 1,173. In the clinical field, the highest number of programs were implemented in orthopedics (27%), followed by surgery (21%), and neurosurgery (12%). Based on the purpose, the most common objective of the programs (approximately 70%) was acquiring advanced surgical techniques. Further, the highest number of programs and participants were recorded in 2019 (295 programs, 6,537 participants). Thus, the guidelines helped expand cadaver usage for clinical purposes in Japan. To further promote the clinical usage of cadavers in medical and dental universities throughout Japan, sharing know-how on operating cadaver laboratories and building understanding among the general public is recommended.

Women in thoracic surgery: Asian perspective.

There is a significant shortage of surgeons in Japan similar to many other countries. There are 40,267 registered surgeons for Japan Surgical Society, among them 23,723 are board certificated, and 7,246 are certified instructors. A total of 3,207 surgeons are members of The Japanese Associations for Chest Surgery, and 245 (7.6%) are female surgeons. Approximately 8,000 medical students graduate annually with medical license. The number of newly registered residents and surgeons has recently been declining overall in the last two decades, however, the percentage of female physicians entering into surgery has been increasing gradually along with increasing number of female medical students entering the medical schools and colleges. With regard to the issue of gender gap, our country is ranked as low as 121 out of 153 countries according to global gender gap report 2020 by World Economic Forum, dropping down from 110 out of 149 countries from previous report in 2018. As the numbers of female colleagues in our workplace increases, we must consider what we can do to build a better working environment for them that is more inclusive and supports their career. In this review, the brief history of surgery and female surgeons is described as well as current situations of female surgeons today in Japan.

How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society.

To identify the conflicts between a career as a surgeon and pregnancy and childbirth for women in Japan. The Japan Surgical Society conducted a nationwide survey on pregnancy and childbirth among its members who are women. The questionnaire included items regarding demography, working styles, and pregnancy and childbirth, including adverse events and harassment. The response rate was 29.9% (1068 responses, median age, 37years). Among the responders, 61% were married and 47% had children (average number of children, 1.7). Half of the respondents reported having experienced sexual harassment and 62% reported having received unwelcome comments about pregnancy. About 20% had undergone fertility treatment. In total, 51%had pregnancies, with miscarriages in 33% of these. The top answer for the best timing for pregnancy and childbirth was after becoming board-certified. Nearly one-third of first-time mothers experienced adverse events during pregnancy and delivery, and 28% quit or changed their job because of their pregnancy and the birth of their first child. Japanese women who choose a career as a surgeon face obstacles during pregnancy and childbirth. It is vital to share the findings of this study and understand the issues associated with pregnancy and childbirth regardless of gender. Interventions are essential to ensure that every pregnant surgeon has a safe working environment to allow unobstructed development of her career.

COVID-19 Pandemic: A Surgical Perspective from Japan

Japan reported its first COVID-19 case after a returnee from Wuhan, China tested positive for the virus on 16 January, 2020. On April 8, the Japanese government declared emergency in Tokyo and six other prefectures of the country; a nationwide emergency was declared on April 16. The total reported cases were 15,477 and total deaths 755 as of May 7, 2020.Japan Surgical Society (JSS) and Japanese Society of Gastroenterological Surgery (JSGS) have published recommendations for surgery and appropriate measures of safety. Patients are triaged based on the severity of their disease and level of outbreak. The Elective Surgery Acuity Scale (ESAS) by American College of Surgeons is recommended to triage the patients. The guidelines consider the risk of infection during the interventions that generate aerosol such as tracheal intubation, extubation, tracheostomy, mask ventilation, bronchoscopy,chest drainage, gastrointestinal endoscopy etc.

History of pancreatic surgery in Japan: Respect to the Japanese pioneers of pancreatic surgery.

The first report of pancreatoduodenectomy was the abstract of Japan Surgical Society in 1946 by Kuru, followed by a publication by Yoshioka (Geka, 1950). The first report of total pancreatectomy was done by Honjo in 1950 (Shujutsu). Thus, the history of pancreatic surgery in Japan dawned in the 1950s. From 1970 to 1980, the American surgeon Fortner had reported the drastic concept of regional pancreatectomy with extensive dissection of vessels and connective tissues around the pancreas. A lot of Japanese surgeons were influenced by this concept and attempted to perform the extensive surgery of pancreatic cancer, especially the Japanese pioneers who had investigated the clinical benefits of extensive surgery with dissection of nerve plexus and lymph nodes around the superior mesenteric artery. Then, Japanese surgeons had a great attention for limited resection of the pancreas for borderline malignancies, and Japan was the number one country for pancreatic surgery for all pancreatic diseases, from advanced pancreatic cancer to borderline malignancies. The next step for these pioneers was how to reduce morbidities after pancreatic surgery, especially pancreatoduodenectomy. Due to the effects of technical development, drain management, and nutritional consideration, the incidences of pancreatic fistula and delayed gastric emptying decreased dramatically in the past 10 years. Moreover, the development of chemotherapeutic drugs has provided a new era of conversion surgery, similar to esophageal surgery, and one should pay great attention to more aggressive surgery, including distal pancreatectomy with en bloc celiac axis resection (DP‐CAR). Thus, we have to inherit the passion and mentality of the Japanese pioneers of pancreatic surgery and develop safer and more secure surgical techniques to reduce the morbidities and elongate the survival of pancreatic cancer patients.

Stress at Work and in Private Life during Parenting: A Survey of Members of the Japan Surgical Society

Stress at Work and in Private Life during Parenting: A Survey of Members of the Japan Surgical Society

A snapshot of surgical resident training in Japan: results of a national-level needs assessment survey.

To evaluate the status of surgical training in Japan through a national-level needs assessment. A survey was sent to all 909 graduating residents (GRs) and their 611 program directors (PDs) for the year 2016. A working group of surgical educators from around the country was formed under the education committee of the Japan Surgical Society. The survey items were developed by consensus of this working group. The survey investigated the knowledge and problems of the current curriculum, and the status of the current residency training. The response rates were 56.3% of the GRs and 76.8% of the PDs. Among the participants, 47.6% of the GRs and 29.4% of the PDs believed that the residency curriculum did not match the clinical experience. Over 80% of the GRs and PDs agreed on the importance of training outside of the OR, whereas only 13% of the GRs had received such training regularly. Trainees also reported a lower satisfaction rate about the opportunity to train outside of the OR. This national-level needs assessment of surgical training in Japan identified several gaps in the curriculum. These results provide valuable data to assist the ongoing efforts for surgical residency curriculum improvement.

Progress of hepatic-biliary-pancreatic surgery in the 118th annual congress of Japan Surgical Society

The annual congress of Japan Surgical Society is a famous academic event in the field of surgery, and the participants can learn from the latest research results of all the major surgical disciplines. The authors selected topics of the 118th annual congress in 2018, including the latest research results and progresses of laparoscopic hepatectomy, liver transplantation, extrahepatic bile duct carcinoma and pancreatic surgery. The purpose of this study is to provide new information and reference for optimizing the diagnosis and treatment of hepatobiliary and pancreatic diseases. Key words: Hepatic neoplasms; Intrahepatic cho-langiocarcinoma; Pancreatic neoplasms; Liver transplantation; Hepatectomy; Laparoscopy; Translational medicine; Japan Surgical Society

Performing laparoscopic surgery - Perspectives of young Chinese hepatobiliary surgeons.

Laparoscopic liver resection (LLR) has garnered attention as a new form of liver surgery. In China, many hepatobiliary surgeons are now encouraging the examination and assessment of LLC in order to improve its outcomes, and several young hepatobiliary surgeons recently shared their clinical experiences and the results of their research in presentations at the Akamon Forum as part of the 118th Annual Congress of the Japan Surgical Society, which was held April 5-7, 2018 in Tokyo, Japan. In China, LLR has gradually improved over the past 20 years, including both expanded indications and improved surgical approaches. However, China is a vast country, and the level of medical care varies nationwide. Medical facilities that can perform advanced laparoscopic techniques are currently limited to those in large cities. Moreover, additional clinical studies of the long-term oncological outcomes of LLR need to be performed in the future.