Proximal gastrectomy (PG) has been tried as a function-preserving surgery for management of early upper gastric cancer. However, Reflux symptoms and stricture limit its applicability. We designed an anastomosis between the distal part of the posterior esophageal wall and the proximal part of the anterior wall of the stomach to make an anti-reflux mechanism. We named it the SPADE operation owing to its spade-like shape and because it is an acronym for a spade-shaped esophagogastrostomy after PG, which creates a partially duplicated esophagogastric wall. This video illustrates the case of a 74-year-old man diagnosed with early gastric cancer in the high body of the stomach along the greater curvature. We performed a totally laparoscopic proximal gastrectomy and a SPADE operation. He was discharged on the 7th postoperative day with an uneventful postoperative course and resumption of diet without reflux symptoms.
Aged ; Constriction, Pathologic ; Diet ; Gastrectomy* ; Gastroesophageal Reflux ; Humans ; Stomach ; Stomach Neoplasms

Transanal total mesorectal excision (taTME) is known to be a novel surgical approach for patients who are difficult to resolve with the traditional trans-abdominal approach. However, most of the colorectal surgeons are unfamiliar with the technique, which can lead to serious complications such as urethral injury. Hence, training through the fresh frozen cadaver has been gradually included in the formal taTME training course. The authors trained the taTME procedure with two cadavers in 2016. Two surgeons who were experts in trans-anal minimally invasive surgery and had minimal experiences in taTME performed the procedure. The total procedure time from the purse string suture to the anterior communication took about 65 minutes. The procedure proceeded well without any inadvertent injury to anatomic structures. The usefulness of the cadaveric model in training taTME was confirmed and the experience of single port surgery and trans-anal operation before the cadaveric training is considered to be important.
Cadaver* ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Rectal Neoplasms ; Surgeons ; Sutures

Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rare and its primary involvement occurs in less than 2% of cases. We report a case of primary giant splenic and hepatic hydatid cyst in a 28-year-old woman who was admitted for upper right quadrant pain. The abdominal ultrasonography and computed tomography showed two cystic tumors with hydatid features in liver and spleen. Total splenectomy was performed for the splenic cyst and partial pericystectomy with drainage for the liver cyst using a laparoscopic approach. One drain was kept in place for two months due to a biliary leak of about 20 ml/day and removed afterward. The patient was discharged on postoperative day 7. Laparoscopic approach for patients with concomitant splenic and hepatic hydatidosis is a safe and effective option.
Adult ; Drainage ; Echinococcosis ; Echinococcosis, Hepatic ; Echinococcus granulosus ; Female ; Humans ; Laparoscopy* ; Liver ; Lung ; Spleen ; Splenectomy ; Ultrasonography

PURPOSE: As the life expectancy increases, the population of elderly patients increases. We evaluated the complications and survival rate of patients over 80 years old, who underwent laparoscopic gastrectomy. METHODS: A retrospective analysis was conducted for a total of 1,912 patients, who underwent surgery with stomach cancer from 2008 to 2016. We analyzed postoperative complications and the survival rate between the middle old (70~79, n=255) group and the very old (≥80, n=37) group. RESULTS: Among 1,912 patients, 255 people in the middle old group and 37 people within the very old group underwent laparoscopic gastrectomy. We confirmed that there was no significant difference except for the age (p<0.001) between the two groups. Overall complications were not statistically significantly different between the Middle old (70~79) group and the very old (≥80) group, 11.8% and 16.2%, respectively. There were also no statistically significant differences in severe complications beyond Clavien-Dindo classification Grade III. Risk factors for overall complications were higher in males than in females (p=0.002). Overall survival was statistically significantly lower with very old group (p<0.001). CONCLUSION: Laparoscopic gastrectomy in gastric cancer patients over 80 years of age is feasible and safe in terms of complications. However, considering the life expectancy, it seems necessary to pay attention to the patients who apply surgery.
Aged ; Classification ; Female ; Gastrectomy* ; Humans ; Life Expectancy ; Male ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate*

PURPOSE: Laparoscopic surgery is accepted as a standard alternative to open procedures in the management of both benign and malignant colorectal disease. However, the safety and efficacy of the laparoscopic approach for emergency colorectal surgery has not been established. Hand-assisted laparoscopic (HAL) surgery might be a suitable option for colectomy in an emergency setting. The aim of this study was to report our experience of emergency HAL colectomy. METHODS: This was a retrospective review of consecutive colorectal emergency cases that were treated using HAL colectomy. Patient demographics, indications for surgery, operative details, and postoperative complications were examined. RESULTS: From March 2015 to April 2016, 18 patients underwent emergency HAL colectomy for complicated colorectal disease. Eight patients (44%) had an obstruction that required intraoperative decompression procedure. Sixteen patients (89%) had a perforation (five of which were sealed perforations involving large abscesses and inflammatory changes). Eight patients underwent sigmoidectomy, four underwent anterior resection, one underwent low anterior resection, two underwent left hemicolectomy, and three underwent Hartmann's procedure. There were two instances of open conversion (11%). The median duration of surgery was 178 minutes. The median time to bowel function recovery and median postoperative stay were 3 days and 10 days, respectively. The postoperative complication rate associated with the operation was 33% (6/18). There was one postoperative mortality. CONCLUSION: For the experienced surgeon, HAL can be a reasonable option for emergency colorectal surgery.
Abscess ; Colectomy ; Colorectal Surgery ; Decompression ; Demography ; Emergencies* ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Mortality ; Postoperative Complications ; Recovery of Function ; Retrospective Studies

PURPOSE: Laparoscopic gastrectomy in early gastric cancer patients is accepted as standard, but it is sometimes challenging for patients who refuse blood transfusions such as Jehovah's Witness (JW) patients, because of the risk of bleeding related to radical lymph node dissection. This study aimed to confirm the adequacy and safety of laparoscopic gastrectomy with D1+ lymphadenectomy in JW patients. METHODS: From January 2009 to December 2015, 265 gastric cancer patients underwent laparoscopic gastrectomy in our institute. Among them, there were 25 JW, and they were statistically matched with 75 patients from the control groups depending on age, sex, and body mass index (BMI). In a retrospective review, patient laboratory values and their pathology results were analysed. RESULTS: There was no significant difference when comparing the clinical characteristics of JW and control groups. There was no statistically significant difference in blood loss or operation time between the two groups. Mean blood loss was 202.4±172.6 ml in the JW group and 179.7±163.8 ml in the control group (p=0.556). The number of retrieved lymph nodes was 27.8±13.9 in the JW group and 29.3±12.1 in the control group (p=0.607). Haemoglobin and haematocrit were measured after surgery and there was no statistically significant difference between the two groups. CONCLUSION: Laparoscopic D1+ gastrectomy in a JW may be performed with an equivalent risk to the control group. Laparoscopic gastrectomy can be applied to Jehovah's Witnesses if the specialied cancer center has sufficient experience in stomach cancer surgery, even if there is not enough experience in bloodless surgery.
Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Body Mass Index ; Case-Control Studies* ; Gastrectomy ; Hemorrhage ; Humans ; Jehovah's Witnesses ; Lymph Node Excision* ; Lymph Nodes* ; Pathology ; Retrospective Studies ; Stomach Neoplasms*

PURPOSE: Periappendiceal abscess (PAA) is a severe complicated appendicitis with high morbidity. Non-surgical treatment followed by interval appendectomy (IA) is associated with lower complication rate compared with emergency surgery (ES) and minimally invasive surgery (MIS) can be done more often. The purpose of this study is to assess the incidence and factors predictive of complications of surgery for PAA and to evaluate the clinical effectiveness of IA as a treatment policy to increase MIS. METHODS: Retrospectively, we reviewed 171 patients undergoing surgery for PAA between 2011 and 2016 at Ulsan University Hospital. The incidence and influence of different factors were assessed by univariate and multivariate analyses. RESULTS: In 171 patients, 28 (16.4%) developed postoperative complications, which included; wound complications (7.6%), intra-abdominal abscess (4.1%) and ileus (2.9%). In both analyses, only ES was independently associated with postoperative complications; (Relative risk, 15.0; 95% Confidence interval, 2.4~92.5). Comparing the IA and ES groups revealed that operative time, complication rate, laparoscopic approach, postoperative hospitalization, postoperative antibiotic use and bowel resection rate were significantly different. The postoperative complication rate of patients with PAA in ES group was 28.7%, which was statistically higher than that of IA group (3.6%). Especially, MIS rate was more than 9-times greater in the IA group (98.8% vs. 10.3%, p<0.001). Although the IA group required additional hospitalization, there was no statistical difference between the two groups in total length of hospital stay. CONCLUSION: Morbidity was high for patients who had emergency surgery for PAA. ES was the only factor associated with postoperative morbidity. IA can reduce the postoperative complication rate and allowed MIS to be used more often as a useful treatment policy for PAA.
Abdominal Abscess ; Abscess* ; Appendectomy* ; Appendicitis ; Emergencies ; Hospitalization ; Humans ; Ileus ; Incidence ; Length of Stay ; Minimally Invasive Surgical Procedures ; Multivariate Analysis ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Ulsan ; Wounds and Injuries

Laparoscopic liver resection has been widely accepted nowadays for selective cases of liver diseases. Laparoscopic left lateral sectionectomy and minor LLR are considered standard practice worldwide and cautious introduction of major laparoscopic liver resections like hemihepatectomies, central sectionectomy etc.. in institutions having experienced liver surgeons. Because of increasing young liver donor, laparoscopic donor hepatectomy is becoming popular, which gives better cosmetic outcomes. Many clinical trials compared laparoscopic liver resection safety, long term outcomes with open procedures. More recently, advances in laparoscopic instruments and techniques encouraged Korean surgeons to choose a laparoscopic procedure as one of the treatment options for benign or malignant diseases of liver.
Hepatectomy ; Humans ; Liver Diseases ; Liver* ; Mastectomy, Segmental ; Surgeons ; Tissue Donors

No abstract available.
Emergencies* ; Hand-Assisted Laparoscopy*

A 70-year-old female patient was diagnosed with low rectal adenocarcinoma (cT3N2) based on the initial CT and MRI. The patient underwent neoadjuvant chemoradiotherapy consisting of short course radiotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) chemotherapy. Three additional cycles of simplified infusional 5-FU/LV were given every 2 weeks to the patient during the resting period (8 weeks) before surgery. For transanal TME, a purse-string suture of the distal rectum was performed just above the dentate line. Transanal circumferential dissection including the mesorectum was performed from the dentate line until the peritoneal reflection. Thereafter, laparoscopic dissection was conducted using the medial to lateral approach and the inferior mesenteric artery was ligated at the pedicle. Lateral detachment and splenic flexure mobilization were completed. After full mobilization of the distal transverse colon and rectum, the specimen was retrieved through the anus and resected. Colo-anal anastomosis was performed by the hand-sewn method. A closed suction drain was inserted into the pelvis. We also demonstrate our procedure for transanal TME using a short video clip.
Adenocarcinoma ; Aged ; Anal Canal ; Chemoradiotherapy ; Colon, Transverse ; Drug Therapy ; Female ; Fluorouracil ; Humans ; Leucovorin ; Magnetic Resonance Imaging ; Mesenteric Artery, Inferior ; Methods ; Pelvis ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Suction ; Sutures