PURPOSE: Adrenalectomy is a very rare operation and its associated learning curve has not yet been studied. The objective of this study was to determine whether the operation time decreases with experience and to evaluate the safety and feasibility of laparoscopic adrenalectomy performed by a surgeon who is new to laparoscopic and open-surgical adrenalectomy. METHODS: This study is a retrospective analysis of laparoscopic adrenalectomies performed between April 2007 and September 2012. All surgeries were performed by a single young surgeon who had no experience in performance of open or laparoscopic adrenalectomy. All surgeries were performed using the transperitoneal approach. RESULTS: In total, 42 cases were included. The average tumor size was 4.7 cm. The mean operating time was 125 min. Mean duration of hospital stay was 8.7 days. None of the cases showed conversion to open surgery or perioperative mortality. The operator achieved mastery after performance of left laparoscopic adrenalectomy in 12 cases and right laparoscopic adrenalectomy in 11 cases. CONCLUSIONS: A new surgeon can perform laparoscopic transperitoneal adrenalectomy successfully, independently, and safely after having performed the surgery in 12 cases.
Adrenalectomy* ; Conversion to Open Surgery ; Learning Curve* ; Learning* ; Length of Stay ; Mortality ; Retrospective Studies

PURPOSE: Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons. MATERIALS AND METHODS: Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher. RESULTS: During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (20~80 minutes). Median day of commencement of a soft diet was day 6 (4~17 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management. CONCLUSIONS: Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.
Conversion to Open Surgery ; Diet ; Duodenal Ulcer ; Emergencies ; Humans ; Laparoscopy ; Length of Stay ; Peritoneal Lavage ; Postoperative Complications ; Sutures

PURPOSE: Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons. MATERIALS AND METHODS: Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher. RESULTS: During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (20~80 minutes). Median day of commencement of a soft diet was day 6 (4~17 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management. CONCLUSIONS: Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.
Conversion to Open Surgery ; Diet ; Duodenal Ulcer ; Emergencies ; Humans ; Laparoscopy ; Length of Stay ; Peritoneal Lavage ; Postoperative Complications ; Sutures

PURPOSE: Application of a laparoscopic technique to common bile duct explorations has been limited due to technical difficulty. With increased experience and technique, laparoscopic surgery has become a possible option for the treatment of common bile duct stones. The purpose of this study was to assess the usefulness of laparoscopic surgery in the treatment of common bile duct stones. METHODS: Between March 1997 and August 1999, 35 patients with choledocholithiasis were treated with laparoscopic common bile duct exploration (4 had a previous biliary operative history). Intraoperative choledochoscopy was used to remove common bile duct stones. The stones were retrieved by using a saline flush, a basket, or a Fogarty catheter. The impacted stones were destroyed using electrohydraulic lithotripsy. RESULTS: Successful laparoscopic stone clearance was achieved in 33 cases (94.3%), and conversion to open surgery occurred in one case (2.9%). The morbidity was 5.7% without mortality. Two cases of retained stone were treated with postoperative choledochoscopic removal via fistula tract and postoperative endoscopic extraction. CONCLUSION: Laparoscopic common bile duct exploration is feasible and safe in most patients. With increased of experience, laparoscopic common bile duct exploration could be used widely.
Catheters ; Choledocholithiasis ; Common Bile Duct* ; Conversion to Open Surgery ; Fistula ; Humans ; Laparoscopy* ; Lithotripsy ; Mortality

PURPOSE: The objective of this study was to evaluate the advantages of a laparoscopic technique for the treatment of intussusception in children with repeated hydrostatic reduction failure. METHODS: Between April 2001 and March 2002, twenty one children with intussusception were treated. Eleven patients, with repeated barium reduction failure, underwent a laparoscopic reduction. The type of intussusception, operative time, postoperative hospital stay, and conversion rate, were prospectively examined. RESULTS: The laparoscopic reduction was successful in 8 patients (72.7%), with a conversion to an open procedure occurring in 3 (27.3%). In the 8 successful laparoscopic reduction cases, the average operative time and postoperative hospital stay were 66 minutes and 3 days, respectively. Seven cases were of the ileo-colic type of intussusception and remaining one was of the ileo-ileo-colic type. There were no mortalities or intraoperative complications. CONCLUSION: Intussusception in number of children with hydrostatic reduction failure could be reduced with the laparoscopic technique. The laparoscopic procedure for intussusception was safe and resulted in the avoidance of open surgery.
Barium ; Child* ; Conversion to Open Surgery ; Humans ; Intraoperative Complications ; Intussusception* ; Length of Stay ; Mortality ; Operative Time ; Prospective Studies

PURPOSE: Laparoscopic adrenalectomy has become the procedure of choice to remove a wide variety of adrenal tumors. The laparoscopic approaches to the adrenal gland include a lateral (transperitoneal) approach and the posterior (retroperitoneal) approach. The aim of the present study is to compare the clinical outcomes from both methods. METHODS: Between January 2000 and October 2008, we performed 60 laparoscopic adrenalectomies, including 29 posterior retroperitoneal approaches (RLA) and 31 lateral transperitoneal approaches (TLA). RESULTS: Sixty patients were treated for the following conditions: adrenocortical adenoma: 35 patients, pheochromocytoma: 19 patients, organizing hematoma: 2 patients, ganglioneuroma: 2 patients, myelolipoma: 1 patient and adrenal oncocytoma: 1 patient. The average tumor size was 3.2+/-1.4 cm in the TLA patient group and 2.9+/-1.4 cm in the RLA patient group. In the TLA group, the procedures were performed with the patients in the lateral position, and the patients were in the prone position in the RLA group. The average operation time of the RLA group was significantly shorter than that of the TLA group. The RLA group had a shorter postoperative hospital stay, they required less postoperative pain control and they resumed a full diet earlier. Conversion to open surgery was required in five patients (16%) in the TLA group. Complications occurred in five patients of the TLA group and in five patients of the RLA group. No mortality was observed in both groups. CONCLUSION: For experienced surgeons, if the adrenal tumor is less than 6 cm in size, posterior retroperitoneal adrenalectomy may be a safer and faster procedure, so it should be considered as the first choice of operation of benign adrenal tumors.
Adrenal Glands ; Adrenalectomy ; Conversion to Open Surgery ; Diet ; Humans ; Length of Stay ; Pain, Postoperative ; Prone Position

PURPOSE: The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection. METHODS: Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage. RESULTS: The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage. CONCLUSION: The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.
Anastomotic Leak ; Conversion to Open Surgery ; Humans ; Ileostomy ; Laparoscopy ; Male ; Multivariate Analysis ; Prospective Studies ; Risk Factors

We report here on our technique and outcomes of the first case of robot-assisted laparoscopic distal ureterectomy with a bladder cuff excision and ureteroneocystostomy. A 74-year-old male patient who had a distal ureter tumor underwent robot-assisted transperitoneal distal ureterectomy. After distal ureterectomy with bladder cuff excision was performed, direct ureteroneocystostomy was performed. The whole procedure was successfully performed by using the robot without conversion to open surgery. The total operative time was 207 minutes, and the estimated blood loss was 30 ml. The final pathological examination showed stage T2 invasive transitional cell carcinoma of the distal ureter. The patient's postoperative recovery was uneventful and the bladder cuff was free of tumor. Robot-assisted laparoscopic distal ureterectomy with ureteroneocystostomy is safe and feasible and offers patients the advantages of minimally invasive surgery.
Aged ; Carcinoma, Transitional Cell ; Conversion to Open Surgery ; Humans ; Male ; Operative Time ; Replantation ; Robotics ; Ureter ; Urinary Bladder

PURPOSE: Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease. MATERIALS AND METHODS: Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18(group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients(group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups. RESULTS: Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney(n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis(n=2) and renal abscess(n=2). Group 2 included chronic pyelonephritis(n=12), ureteropelvic junction obstruction(UPJ) stricture(n=6), and cystic disease(n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups(p<0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.
Conversion to Open Surgery ; Hospitalization ; Humans ; Inflammation ; Kidney ; Laparoscopy ; Nephrectomy ; Pyelonephritis, Xanthogranulomatous ; Walking

PURPOSE: Acute gangrenous and perforated appendicitis are associated with an increased risk for intraoperative conversion, postoperative complications and have been considered a relative contraindication for laparoscopic appendectomy. The objective of this study was to analyze the feasibility of the laparoscopic approach in all forms of appendicitis. METHODS: A retrospective review of 101 patients who underwent laparoscopic appendectomy for uncomplicated and complicated appendicitis (perforated appendicitis and periappendiceal abscess) between June 2000 and May 2001 was performed. RESULTS: There were 84 patients with uncomplicated appendicitis (group A), 11 patients with perforated appendicitis (group B) and 16 patients with periappendiceal abscess (group C). The mean age of the patients was 42 (12~79) years and there were 47 men and 54 women. The mean operation time was 43, 67 and 105 minutes in groups A, B and C, respectively. Oral intake commenced at 1.4, 2.2 and 2.9 days and the hospital stay was 2.5, 2.9 and 5.2 days in groups A, B and C, respectively. There was no conversion to open surgery in groups A and B; however 4 patients in group C were converted. Complications were noted in 3 patients, one for each group. The overall complication rate was 2.9% and conversion rate, 0.9%. CONCLUSION: Although our experience is limited, the laparoscopic appendectomy seems to be a feasible and safe procedure for all forms of apppendicitis, including periappendiceal abscess.
Abscess ; Appendectomy* ; Appendicitis* ; Conversion to Open Surgery ; Female ; Humans ; Length of Stay ; Male ; Postoperative Complications ; Retrospective Studies