"Big Incision, Big Surgeon !!" At the beginning of surgery, excellence was associated with big incisions and rapidity of the operation because of the anesthesia. But, nowadays there has been a big change after the development of laparoscopic surgery. It is not a discipline unto itself, but more a philosophy of surgery, a way of thinking. " Small Incision, Best Surgeon!!" So-called Minimally invasive surgery (MIS) is a means of performing major operations through small incisions, often using miniaturized, high-tech imaging systems, to minimize the trauma of surgical exposure. Laparoscopic cholecystectomy became the stepping stone of the present status of MIS and is opening the dawn of the least invasive and eventually to non-invasive surgery, for exemple, Natural Orifice Transluminal Endoscopic Surgery (NOTES). I review the history of laparoscopic cholecystectomy cholecystectomy and introduce what procedures the surgeons are performing in the field of hepatopancreato biliary diseases.
Anesthesia ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Philosophy ; Thinking

No abstract available.

Kimura's disease is a rare benign disease characterized by subcutaneous or dermal tumors occurring predominantly on the head and the neck. It usually occurs in young adults without constitutional symptoms, except for peripheral blood eosinophilia. The histopathologic features of the tumor are characterized by dense lymphoid aggregates containing a prominent germinal center and by the proliferation of endothelial cells associated with varying degrees of lymphocytic, histiocytic, and eosinophilic infiltration. We report a case of Kimura's disease without peripheral blood eosinophilia in a 24-year-old male who had had a painless and slowly growing tumor-like swelling on his right groin for one year. The mass was excised, and the specimen was confirmed as Kimura's disease. After surgical excision, the lesion recurred, so 30 mg of oral prednisone was given daily for one month and then decreased gradually for another one month. Now, the lesion is completely healed.
Endothelial Cells ; Eosinophilia ; Eosinophils ; Germinal Center ; Groin* ; Head ; Humans ; Male ; Neck ; Prednisone ; Young Adult

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors since it has many advantages; a more rapid and comfortable recovery, shorted hospitalization, and fewer complications. The purpose of this study was to report the initial 4 years experiences of LA and describe the unusual findings encountered during the operations. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Several techniques of LA have been described already. We prefer the transabdominal approach in the lateral decubitus position using 3 or 4 trocars. RESULTS: 20 patients had all unilateral tumor. The pathological findings were 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. 18 cases of 20 patients were successfully operated by laparoscopic procedure and 2 cases were converted to open adrenalectomy. The reasons of conversion were sudden cardiac arrest due to unknown origin and intraoperative bleeding due to periadrenal massive fat. During the laparoscopic operation, 2 patients showed abnormal EKG findings. The pathologies of those patients were non-catecholamine-secreting cortical adenomas. After operation, they have been completely normal in EKG. The average operating time for the complete laparoscopic adrenalectomies was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There was no postoperative complication and no operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: The LA is relatively fast and safe method and is accepted as the preferred procedure for the adrenal tumors but it should be well prepared perioperatively. Surgeons and anesthesiologists should be aware of those possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Death, Sudden, Cardiac ; Electrocardiography ; Hemorrhage ; Hospitalization ; Humans ; Length of Stay ; Methods ; Mortality ; Pathology ; Pheochromocytoma ; Postoperative Complications ; Surgeons ; Surgical Instruments

Pancreatic heterotopia and adenomyoma are variants of the same process. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and/or ductular elements, usually associated with smooth muscle proliferation, outside the topographic boundaries of the pancreas. Adenomyoma differs from pancreatic heterotopia in that acinar and islet-like tissue are not present. The common sites are stomach, duodenum, and jejunum, but ectopic pancreatic tissue may also be encountered in Meckel's diverticulum, the ampulla of Vater, gallbladder, umbilicus, fallopian tube, and mediastinum. Most examples are encountered incidentally during surgery, and on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been attributable directly to the presence of the heterotopic pancreas. But intestinal obstruction of small bowel by pancreatic adenomyoma has not been reported as of yet. The authors have experienced one case of intestinal obstruction by pancreatic adenomyoma requiring operation in a 28-year-old female. We found the 3-fold distened proximal jejunal loop, about 1 meter length, and abrupted narrowed point, and a normal sized distal loop. We treated this case by performing longitudinal incision and transverse suture of the narrowed point, so that the diameter of narrowed point was enlarged. At that time we found the 0.7Cm sized intraluminal mass at the narrowed point. We concluded that intestinal obstruction in this case was made by contraction of circular muscle due to pancreatic adenomyoma, not by a mass effect.
Adenomyoma* ; Adult ; Ampulla of Vater ; Duodenum ; Fallopian Tubes ; Female ; Gallbladder ; Gastric Outlet Obstruction ; Hemorrhage ; Humans ; Intestinal Obstruction* ; Intussusception ; Jejunum* ; Meckel Diverticulum ; Mediastinum ; Muscle, Smooth ; Pancreas ; Stomach ; Sutures ; Umbilicus ; Weight Loss

Acute aortic occlusion is rare but poses a high mortality and morbidity. Prompt diagnosis and treatment is essential. Typical presentation is rest pain with bilateral absent femoral pulse. When the non-typical symptoms predominate such as paraplegia, acute abdomen or sudden-onset hypertension, diagnosis may be difficult. We experienced a case of acute aortic thrombosis who suddenly developed paraplegia and rapidly deteriorated within several hours. When the paraplegia developed, he was under treatment with heparin and urokinase, was thrombocytopenic, and the femoral arteries were pulsatile. Spinal cord compression due to bleeding complication had to be ruled out. Duplex sonography and lumbar CT scan were not diagnostic. Aortic thrombosis was diagnosed by abdominal CT scan. This case illustrates the need for high suspicion of acute aortic occlusion presenting with paraplegia especially in patients with associated atherosclerotic disease.
Abdomen, Acute ; Aorta ; Diagnosis ; Femoral Artery ; Hemorrhage ; Heparin ; Humans ; Hypertension ; Mortality ; Paraplegia* ; Spinal Cord Compression ; Thrombosis* ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

Injuries of the inferior vena cava (IVC) might be caused by a blunt trauma, which usually affects the retrohepatic portion. Injuries of the infrahepatic IVC are usually caused by penetrating injuries and rarely occur in Korea. We report a case of a penetrating injury of the IVC at the infrahepatic suprarenal portion with a review of other reported cases.
Korea ; Vena Cava, Inferior* ; Wounds, Stab*

A primary hepatic sarcoma is a rare tumor, that most frequently arises from hepatic connective tissue or vascular channels, and is usually located in the intrahepatic area. Pedunculated, or bulging, lesions have also been reported. We encountered a pedunculated primary hepatic leiomyosarcoma occurring in a 61-year-old woman. A giant exophytic hepatic mass measuring 15x10cm in size, was located in the left lateral segment of the liver, which was compressing the stomach. A left lateral segmentectomy was performed. Microscopically, the tumor was composed of spindle cells reactive to muscle specific actin. The mitotic figures were 5/10 high power fields indicating the tumor was malignant. No other primary sites were recognized from clinical studies.
Actins ; Connective Tissue ; Female ; Humans ; Leiomyosarcoma* ; Liver ; Mastectomy, Segmental ; Middle Aged ; Sarcoma ; Stomach

Bacteroides fragilis and Escherichia coli, normal colonic inhabitants, are the most frequently isolated bacteria in infected tissues, particularly in intraabdominal abscesses. This study was designed to determine whether enteric bacteria may alter the B. fragilis-induced expression of proinflammatory cytokines in mouse peritoneal tissue (MPT). After C57BL/6 mice were inoculated with abscess-forming mixture containing B. fragilis in the presence or absence of E. coli, RNA was extracted from MPT. Expression of interleukin (IL)-1alpha and tumor necrosis factor (TNF)alpha mRNA was assessed using RT-PCR and standard RNA. Each cytokine protein was also measured by ELISA. The co-inoculation of E. coli into mouse peritoneal cavity advanced the onset of abscess development by B. fragilis infection. When mouse was co-infected with E. coli and B. fragilis intraperitoneally, there was a synergistic increase in the expression of IL-1alpha and TNFalpha mRNA in MPT and this was paralleled by increased cytokine protein secretion. Mixed inoculation of heat-killed E. coli and B. fragilis did not cause a synergistic increase in those cytokine mRNA expression. These results suggest that enteric bacteria may significantly affect proinflammatory cytokine signal produced by host peritoneal cavity in response to B. fragilis infection.
Abscess ; Animals ; Bacteria ; Bacteroides fragilis* ; Bacteroides* ; Coinfection* ; Colon ; Cytokines ; Enterobacteriaceae ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli* ; Escherichia* ; Gene Expression* ; Interleukins ; Mice ; Peritoneal Cavity ; RNA ; RNA, Messenger ; Tumor Necrosis Factor-alpha

Hepatoid adenocarcinoma (HAC) is a tumor with aberrant hepatocellular differentiation that occurs in extrahepatic organs. HAC of the gallbladder is rare, and cases of alpha-fetoprotein production are extremely rare. A 61-year-old man was diagnosed with gallbladder adenocarcinoma after laparoscopic cholecystectomy. A radical operation including resection of liver bed and lymph node dissection was performed, and no tumor cell was found. However, at postoperative 19 months, he showed lymphadenopathy of the portocaval area and tumor thrombi in the right portal vein with high levels of serum alpha-fetoprotein. After right hemihepatectomy and portahepatis lymph node dissection was performed, he was diagnosed with metastatic HAC. On reviewing the gallbladder specimen, the tumor finally demonstrated HAC as the primary origin. Despite adjuvant therapy, the patient died from multiple liver metastasis 26 months after cholecystectomy. Although HAC of the gallbladder is a very rare malignancy, awareness of its existence is critical to avoid misdiagnosis.
Adenocarcinoma ; alpha-Fetoproteins ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Diagnostic Errors ; Gallbladder ; Humans ; Liver ; Lymph Node Excision ; Lymphatic Diseases ; Middle Aged ; Neoplasm Metastasis ; Portal Vein