Table Speech

“The Current State of Cutting-edge, People-Friendly, Individualized Cancer Healthcare”

April 9, 2008

Mr. Masaki Kitajima,
Vice President and Professor, International University of Health and Welfare,
Director for IUHW Mita Hospital

The direction of surgical treatment for cancer in the twenty-first century:
1. Take good care of the patient’s body after complete removal of the cancer
2. For early stage cancer, work to the individualization of surgery and treatment methods appropriate for each patient

There has been much progress in the diagnosis of early stage cancer. In addition, progress in the development of more precise medical tools has made it possible to lift up and expose the afflicted area that must be removed, making such surgeries easier to perform.
We have pioneered the world by performing laparoscopic surgeries since around 1991. By using ultrasonic scalpels to instantly cauterize the treated area, the need to apply ligatures has disappeared. Since then, we have introduced thoracoscopy to esophageal cancer surgeries, and endoscopes to perform surgeries for pancreatic cancer, breast cancer or thyroid cancer. However, surgeries performed under endoscopes limit the surgeon’s sense of vision and movements. There is also the problem of no sense of touch, since the entire surgery is performed using only forceps. We decided to solve this issue by collaborating with the Science and Engineering Department of our university.
Starting from the opening of the Japan Surgical Society’s 100th Annual Conference at the Tokyo Forum in 2000, we have been working with robots. In March 2000, the first surgical robot in Asia, called Da Vinci, was introduced at the Keio University Hospital. The Da Vinci robot stitches wounds almost as though there is an actual human hand at work inside it. Although this robot has yet to be approved in Japan, we can still say that we have reached the dawn of the new age of these kinds of robots. As our next step, we worked with the Science and Engineering Department to develop a tactile robot, equipped with a sense of touch, and succeeded in creating a compact size version of such a robot.
Furthermore, in order to see if perception can be transmitted to a remote area, we used a computer to transmit the tactile perception of the robot 10 thousand kilometers away to Slovenia. We also succeeded in transmission under a robotic system in which the distal end, or hand and arm portion of the device was set up in the Science and Engineering Department, and the actual control portion of the device in the Medical Department. These developments enable surgeries to be performed in distant islands, by remotely operating these tactile robot forceps.
The world’s first telesurgery, dubbed the “Lindbergh Operation”, was a gallbladder surgery performed from New York on a patient in Strasbourg, France, by Professor Jacques Marescaux of Strasbourg. The details of this surgery were reported in a research paper in September 2001. In Japan, a live demonstration was performed by connecting the Keio University Hospital and the Keio Plaza Hotel in 1996. In 2000, the Trauma Departments of Kyoto University and my university succeeded in a domino liver transplant between the two facilities.
Times have changed, and the treatment of cancer is no longer about removing 100 lymph nodes and being happy that there was no metastasis, like in the past. As a method to identify metastasized lymph nodes, we introduced the concept of “Sentinel Node Navigation”. The concept is based on the idea that an accurate and efficient metastasized lymph node diagnosis method should be developed in order to avoid removing areas where the cancer has not yet spread.
The “Sentinel Node Navigation” method views that the sentinel lymph nodes are the ones to which cancer first spreads, and attempts to determine whether there is metastasis in these areas. A clinical test is performed by injecting radioactive substances called technetium or sulfur colloids into the lymph nodes and scanning for them with an endoscope, much like searching for landmines. By using a special dye, this method can identify small lymph nodes which cannot be found at all by existing pathological tissue test methods. Furthermore, by using methods of molecular biology, we are now able to find even smaller incidents of metastasis.
Liver cancer has a high recurrence rate of 50 percent within 5 years after cancer removal, if the hepatitis virus remains in the body. The cryoablation treatment method was developed as a new approach to address this problem, by instantly freezing the cancerous areas of the liver using a needle frozen at around minus 150 degrees (Celsius). This method is applicable to affected areas that are close to blood vessels or the bile duct.
We are also involved in the treatment of many cases of advanced stage cancers. We are always determined to never give up. Surgeons must be masters of their art, and art needs science to back it up. However, I believe that the most important thing is compassionate humanity, and that is how I devote myself to my work.