Retroperitoneal paraganglioma is located prim arily at the para-aortic area and functioning tumor, however, non-functioning and retrocaval located tumors are rare. Laparoscopic retrocaval paraganglioma resection is technically challenging due to vena cava close relation. A 49-year-old male was referred for a retroperitoneal tumor, detected by FDG-PET scan. He had undergone right thyroidectomy for papillary carcinoma one year ago. Abdominal computed tomography (CT) scan showed a mass measuring 2 cm in size located behind the inferior vena cava (IVC), which deviate IVC anteriorly. I123-metaiodobenzylguanidine (MIBG) scan also demonstrated abnormal focal activity. Result of preoperative adrenal function test was normal. A laparoscopic retrocaval tumor excision was performed successfully. The operative time was 160 minutes. The patient's postoperative recovery was uneventful and he was discharged on the fourth postoperative day. Pathologic examination was consistent with the diagnosis of paraganglioma. To the best of our knowledge, this is the first report on laparoscopic resection of a retrocaval non-functioning paraganglioma. In conclusion, laparoscopic retrocaval paraganglioma resection is safe and feasible.
Carcinoma, Papillary ; Diagnosis ; Humans ; Male ; Middle Aged ; Operative Time ; Paraganglioma* ; Thyroidectomy ; Vena Cava, Inferior

PURPOSE: The conventional treatment for ingested foreign bodies (IFB) is removal, which is successful in most cases. However, it can be associated with severe complications, such as gastrointestinal tract perforation, and require emergency surgery. The aim of this study is to analyze clinical data relating to IFB and to develop a proper management plan to reduce the incidence of severe complications. METHODS: Between September 2001 and September 2009, 117 patients visited the emergency room complaining of IFB. Among these patients, 29 were diagnosed with bezoar and were excluded from the study. Medical data for the remaining 88 patients was reviewed retrospectively. For statistical analysis, the foreign bodies (FB) were classified into three subgroups according to their shape (round, sharp, and amorphous). RESULTS: The median age of patients with IFB was seven years, and the male-to-female ratio was 1.3:1. Many of these patients were preschool children under the age of seven who had accidentally sw allowed FB (56 cases, 63.6%). The most common symptom presented among the patients was FB sensation (18 cases, 21%). The results of subgroup analysis showed no significant relation between the shape of the FB and the treatm ent m odality. Spontaneous passage was observed in 21 cases (23.9%). Otherwise, endoscopic removal was performed successfully in 61.4% of cases, and 13 patients required emergency operations (14.8%). CONCLUSION: Early diagnosis and a prompt approach are significant in the successful treatment of IFB. Endoscopic or surgical procedures are sometimes required, particularly in cases where complications are suspected.
Bezoars ; Child, Preschool ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Incidence ; Retrospective Studies ; Sensation

PURPOSE: Laparoscopy is being widely utilized beyond the field of surgery. We report on the early experience of laparoscopic CAPD catheter placement in adult ESRD patients. In addition, we investigate the question of whether laparoscopic CAPD catheter insertion can be used as a feasible long-term procedure. METHODS: Laparoscopic CAPD catheter placement was performed in 28 patients by one surgeon, between June, 2010 and October, 2013, and observed. A retrospective outcome study was conducted based on review of medical records. RESULTS: A total of 28 laparoscopic procedures were performed. The mean age of patients who underwent laparoscopic placement of a catheter was 60.3 years old. The most common cause of ESRD was uncontrolled hypertension combined with diabetes. The procedure took 45.7 minutes. Peritoneal dialysis was introduced on postoperative day eight, after one week of daily washing and no dialysate leaks were observed. Two incidences of catheter-related complications were observed: one incidence of catheter obstruction (due to its m igration and omental w rapping, w hich was m anaged with surgical removal) and one incidence of peritonitis (which was controlled with antibiotics). CONCLUSION: Laparoscopic CAPD catheter placement using tw o ports is a simple procedure with minimal complication. Laparoscopic CAPD catheter placement will gain greater acceptance as an alternative to the traditional method of CAPD catheter placement.
Adult* ; Catheter Obstruction ; Catheters* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Laparoscopy ; Medical Records ; Outcome Assessment (Health Care) ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Retrospective Studies

PURPOSE: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. METHODS: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using removed appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel(R) (Ethicon). We analyzed the success rate. RESULTS: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. CONCLUSION: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.
Appendectomy* ; Appendix* ; Body Mass Index ; Humans ; Laparoscopy ; Recycling ; Surgical Instruments*

PURPOSE: Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that causes severe projectile non-bilious vomiting in the first few months of life. Although open pyloromyotomy is the standard treatment for HPS, recently, the laparoscopic approach has rapidly been adopted by pediatric surgeons. The aim of this study is to determine the efficacy and safety of laparoscopic pyloromyotomy by comparing the clinical results of laparoscopic and open pyloromyotomy. METHODS: Between January 2007 and September 2012, a cohort of 69 children who underwent pyloromyotomy at Seoul National University Children's Hospital were followed; open pyloromyotomy (OP, n=56) and laparoscopic pyloromyotomy (LP, n=13). A retrospective analysis of patient's characteristics and clinical outcomes in patients with open or laparoscopic pyloromyotomy for HPS was performed. The evaluated characteristics included gestational age, sex, birth weight, age and weight at operation. Clinical outcomes included operation time, length of hospital stay, time to postoperative full feeds without vomiting, number of postoperative vomiting and complications. RESULTS: There were no significant differences in characteristics, length of hospital stay and time to postoperative full feeds without vomiting between the two groups. Incidence of postoperative vomiting in the LP group was significantly lower than that in the OP group (OP: 5.07+/-4.60 vs. LP: 2.00+/-2.16, p=0.035). In contrast, the operation time was longer, following the LP group (OP: 26.30+/-9.95 vs. LP: 44.15+/-19.56, p<0.001). Complications such as perforation of mucosal layer (OP: 2 vs. LP 1, p>0.999) and wound problems (OP: 4 vs. LP 1, p>0.999) were found to be similar in both groups. CONCLUSION: Both open and laparoscopic pyloromyotomy are safe procedures for the management of hypertrophic pyloric stenosis. Incidence of vomiting was statistically superior in the laparoscopic group. In addition, postoperative complications were fewer in this group. However, an improvement in the operation time will be needed for the future development of laparoscopic pyloromyotomy.
Birth Weight ; Child ; Cohort Studies ; Gestational Age ; Humans ; Incidence ; Infant ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic ; Retrospective Studies ; Vomiting

PURPOSE: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis. METHODS: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness. RESULTS: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group. CONCLUSION: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.
Appendectomy ; Appendicitis ; Appendix ; Hospital Costs ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

PURPOSE: Laparoscopic surgery is a minimally invasive surgery which has been widely used in abdominal surgery, such as appendectomy and cholecystectomy. There were several strong points in single incision laparoscopic cholecystectomy (SILC). However, no definite study comparing SILC with three port laparoscopic cholecystectomy (TPLC) has been reported. Therefore, this study focused on feasibility and safety of SILC in comparison with conventional TPLC. METHODS: This study included 86 cases of SILC and 230 cases of TPLC from April, 2010 to February, 2011. The patients were divided into two groups according to the surgical procedure, group 1 was SILC and group 2 was TPLC. All operations were performed by a single surgeon, and the retrograde approach was the fundamental surgical procedure used in both groups. RESULTS: Eighty five patients in group 1 underwent SILC and 229 patients in group 2 underwent TPLC. In comparison of preoperative data, statistical significance regarding age, gender, and preoperative PTGBD insertion was observed between the two groups. In comparison of intraoperative data, the average operation time and average hospital day did not show any statistical significance. Intraoperative multiple port conversion was performed in group 1 to TPLC due to cystic artery bleeding, and in group 2, TPLC was changed into a four port operation due to the same reason. CONCLUSION: In this study, no significant difference in operation result, time, and acute complication was observed between SILC and conventional TPLC. Besides the cancers, SILC could definitely be applied without exclusion criteria mentioned above if improvement of instruments and accumulation of surgeon's experience were satisfied.
Appendectomy ; Arteries ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Hemorrhage ; Humans ; Laparoscopy

PURPOSE: We reviewed our data compiled prospectively for evaluation of post-operative complications and recurrence of laparoscopic inguinal hernia repair. METHODS: Among the 1000 patients (age, > or =20 years old) who were undergone laparoscopic inguinal hernia surgery from January 2007 to July 2011, the age, sex, location, hernia type, operation time, postoperative morbidity, and conversion of 992 patients were analyzed. RESULTS: Among 992 patients, 919 (92.6%) were male and the mean age was 54.2 years (range, 20~90). Operation times (m inutes) for unilateral and bilateral hernia were 40.0 and 53.4, respectively. Mean operation time (minutes) showed a decrease over time, as that for the first half of all cases was 43.5 and that for the second half was 39.7 (p<0.001). Seven cases of conversion (post-radical prostatectomy hernia=7) were recorded to TAPP (n=3) or IPOM (n=4) from TEP. Eleven cases of postoperative catheterization (1.1%), five cases of port site seroma (0.5%), one case of mesh removal due to infection, 24 cases of seroma/hematoma (2.4%), 26 cases of neuralgia (2.6%), and four cases of bleeding with a drop in hemoglobin of more than 3 mg% (0.4%) were also recorded. There were three cases of recurrence (0.35%) at the median follow-up of 46 months (range, 20 to 70 months). CONCLUSION: Laparoscopic inguinal hernia repair can be performed safely, with low rates of complication and recurrence. This technique achieves good results combined with the benefits of minimally invasive surgery. We should be cautious in order to avoid postoperative bleeding, especially in cases of TEP.
Amidines ; Catheterization ; Catheters ; Follow-Up Studies ; Hemoglobins ; Hemorrhage ; Hernia ; Hernia, Inguinal ; Humans ; Male ; Neuralgia ; Prospective Studies ; Prostatectomy ; Pyrazines ; Recurrence ; Seroma

PURPOSE: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery. METHODS: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively. RESULTS: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024). CONCLUSION: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.
Body Height ; Carcinoma, Hepatocellular ; Child ; Cicatrix ; Disease-Free Survival ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Pain, Postoperative ; Postoperative Complications ; Quality of Life ; Recurrence

Authors requested to change the name of the hospital to proper name.