PURPOSE: Laparoscopic cholecystectomy has been the standard of care for gallbladder diseases since the late 1980s. Many surgeons have rapidly adopted single-port laparoscopic cholecystectomy for gallbladder pathologies. The aim of the current study was to analyze clinical outcome in initial single-port laparoscopic cholecystectomy. METHODS: Analysis of data from 206 consecutive single-port laparoscopic cholecystectomies performed between May 2008 and Jun 2012 was conducted retrospectively. We divided the patients into four groups according to surgery period - period I (n=56), II (n=50), III (n=50), and IV (n=50), consecutively. During each procedure only one longitudinal transumbilical incision, 1.5 to 2.0 cm in length, was made in order to access the abdominal cavity. One of the various single-port trocars was used for the procedure. Standard laparoscopic instruments were used in performance of cholecystectomy. RESULTS: Patients' demographics did not differ among the groups. Of the 14 cases that were converted to conventional laparoscopic surgery, seven were part of period I, one of II, five of III, and one of IV. Mean operation time for single-port laparoscopic cholecystectomy in each group was 71.6, 58.2, 69.1, and 53.3 minutes, in order. There were two operative complications in period I, which were managed successfully with laparoscopic surgery. No statistical difference in hospital stay was observed among the groups. CONCLUSION: Single-port laparoscopic cholecystectomy can be performed safely for various gallbladder lesions in selected cases, and the operation time improved with accumulation of cases.
Abdominal Cavity ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Demography ; Gallbladder ; Gallbladder Diseases ; Humans ; Laparoscopy ; Length of Stay ; Pathology ; Retrospective Studies ; Standard of Care ; Surgical Instruments

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure in South Korea, and the majority of female patients who receive LAGB are of childbearing age. Due to possible band-related complications, careful evaluation is required for those who become pregnant after LAGB procedures. A 28-year-old female, gravida 1, para 0, who had undergone LAGB two years earlier presented to the clinic at the 31st week of gestation. She had experienced acute epigastric pain and vomiting for one week. She was diagnosed with gastric band slippage. She underwent cesarean section and laparoscopic gastric band removal at the 35th week of gestation. Management of gastric band slippage during the third trimester is difficult, especially before the 34th week of gestation. We report on a case of medical and surgical treatment of gastric band slippage during the third trimester.
Adult ; Bariatric Surgery ; Cesarean Section ; Female ; Humans ; Korea ; Laparoscopy ; Pregnancy Trimester, Third ; Pregnancy* ; Vomiting

PURPOSE: Under the proper program, day-case laparoscopic cholecystectomy is feasible in the aspect of postoperative recovery consisting of patient's satisfaction and postoperative complication. In this study, we plan a new protocol for laparoscopic cholecystectomy by analyzing factors that can reduce hospital days. METHODS: A total of 175 patients who underwent three-day laparoscopic cholecystectomy were initially selected. Out of 175 patients, secondary selection was executed using inclusion criteria. The selected patients were scheduled for new two-day laparoscopic cholecystectomy, and 89 patients were included in the data analysis. This study elucidated the comparative analysis between the discharged in the postoperative day 0 group and the postoperative day 1 group. RESULTS: The clinical characteristics were not significantly different between discharged in the postoperative day 0 group and the postoperative day 1 group. The combined diseases were not significantly different between the two groups. Post-operative complications in both groups were analyzed on the seventh day after the operation. No significant difference was observed between the two groups. Members of the patient group who were discharged on postoperative day 0 were given a survey regarding post-operative pain, desirability of discharge, and the level of satisfaction with patient education. The average score was 8.3 out of 10 points. In comparison of the total hospital cost between the two groups, the group discharged on postoperative day 0 had lower cost in all factors. CONCLUSION: We conclude that day-case laparoscopic cholecystectomy is as safe and effective as routine clinical pathway applied laparoscopic cholecystectomy in stable cardiovascular disease, uncomplicated pulmonary disease, and controlled DM patients.
Cardiovascular Diseases ; Cholecystectomy, Laparoscopic* ; Critical Pathways ; Hospital Costs ; Humans ; Lung Diseases ; Patient Education as Topic ; Postoperative Complications ; Statistics as Topic

PURPOSE: Recent studies have shown that the procedure of laparoscopic appendectomy requires a learning curve before mastering. The aim of this study was to investigate the question of whether a surgeon who has been working as a first assistant for training in laparoscopic colorectal surgery can perform laparoscopic appendectomy without previous experience as an operator in laparoscopic appendectomy. METHODS: Ninety consecutive patients who underwent laparoscopic appendectomy by a single surgeon were retrospectively enrolled in this study. The operating surgeon completed fellowship training of the colorectal cancer division as a first assistant for two years. The patients were divided into two groups by consecutive order: Group (A) included the initial 45 patients and Group (B) included the next 45 patients. The clinical patient demographics, histological diagnosis, and outcome variables including operation time, conversion to open surgery, complications, and length of hospital stay were compared between the two groups. RESULTS: No difference in operation time was observed between the groups (mean: 58.22 min vs 66.6 min, p=0.097). Open conversion rate and drain insertion rate were similar between the two groups. There was no difference in length of hospital stay. Overall complication rate did not differ between the two groups. Moving average curve showed no specific time shortening point within these 90 enrolled patients. CONCLUSION: This study demonstrates that laparoscopic appendectomies performed by a surgeon who had achieved a training course as an assistant in laparoscopic colorectal surgery were performed safely without any difficulties during the learning period. This finding needs further validation in additional large-scale studies.
Appendectomy* ; Colorectal Neoplasms ; Colorectal Surgery ; Conversion to Open Surgery ; Demography ; Diagnosis ; Fellowships and Scholarships* ; Humans ; Laparoscopy ; Learning ; Learning Curve* ; Length of Stay ; Retrospective Studies

PURPOSE: Although laparoscopic surgery in children has expanded in recent years. laparoscopic hernia repair in children is still debatable. We aimed to summarize and describe our results of laparoscopic inguinal hernia repair and techniques among children. METHODS: Between March 2011 and August 2013, 117 children (81 male, 36 female) underwent laparoscopic inguinal hernia repair at the department of surgery. The clinical outcomes were collected retrospectively. RESULTS: The mean follow-up period was 26.2 months. Thirteen patients were ex-premature infants and a contralateral patent processus vaginalis (PPV) was present in 44 of the 110 unilateral inguinal hernia patients. There were two postoperative complications (transient hydrocele, umbilical port site infection). The mean operative time was 47 minutes. Recurrence, metachronous hernia, and testicular atrophy were not observed during the follow-up period. CONCLUSION: Our preliminary experiences suggest that the laparoscopic purse-string suture of internal inguinal opening of the hernia sac could be an effective and reliable alternative for management of pediatric inguinal hernia.
Atrophy ; Child ; Follow-Up Studies ; Hernia* ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Infant ; Laparoscopy ; Ligation* ; Male ; Operative Time ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Sutures

PURPOSE: The aim of this study is to analyze our initial experiences with laparoscopic hepatectomy for treatment of intrahepatic duct (IHD) stones and to compare the outcomes of laparoscopic hepatectomy and open hepatectomy. METHODS: From March 2010 to December 2012, for treatment of IHD stones we performed laparoscopic hepatectomy in seven cases (LH group), which consisted of four cases of left lateral sectionectomy and three cases of left hepatectomy, and open hepatectomy was performed in nine cases (OH group), which consisted of seven cases of left lateral sectionectomy and two cases of left hepatectomy. Because there was no case of right hepatectomy in the LH group, we excluded a case of right hepatectomy in the OH group. Retrospective analysis of the clinical outcomes was performed with exclusion of one case of right hepatectomy. RESULTS: There was no significant difference in male to female ratio, mean age, and mean operation time. The mean postoperative hospital stay of the LH group was significantly shorter than that of the OH group (10.9+/-4.7 vs. 22.0+/-9.0 days, p=0.007). There were two cases of intra-abdominal fluid collection in the OH group, but no case in the LH group. Remnant stones were detected in one patient of the LH group and two patients of the OH group. The initial success rate of stone clearance was 85.7% in the LH group and 77.8% in the OH group. During a mean follow-up period of 13 months (range, four to 25 months), recurrent stone was detected in one case of the OH group. CONCLUSION: Laparoscopic surgery could be an effective treatment modality for management of IHD stones in select patients.
Bile Ducts ; Calculi ; Female ; Follow-Up Studies ; Hepatectomy* ; Humans ; Laparoscopy ; Length of Stay ; Male ; Retrospective Studies

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.
Hernia, Inguinal* ; Humans ; Postoperative Complications ; Retrospective Studies ; Video Recording

Since the first clinical application of "the da Vinci system" in 2005 in Korea, robotic surgery, an emerging technology in minimally invasive surgery (MIS), has been rapidly adopted in a variety of surgical fields, and approximately 7,000 robotic surgeries have been performed annually in recent years. In past years, Korean surgeons have played a pivotal role in development of robotic surgery, particularly in the general surgery field. A major advantage of robotic surgery is to make a more precise procedure possible, especially in a confined area with magnified three-dimensional vision, enhanced dexterity by endowrist and stable camera control, and better ergonomics, thus adds the benefits of MIS, such as improvement of oncologic surgery quality and better functional preservation. For these reasons, it has been used prominently in prostate, thyroid, and rectal surgery. However, it is also true that several controversies such as less evidence for efficacy and cost-effectiveness, a longer operation time, and absence of haptic sensation have continued. In this article, we reviewed the current status of robotic surgery mainly based on a report from National Evidence-based Healthcare Collaborating Agency (NECA) and discussed the future prospects on the basis of recent literature and our clinical experiences.
Delivery of Health Care ; Human Engineering ; Korea ; Prostate ; Sensation ; Surgical Procedures, Minimally Invasive ; Thyroid Gland

This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.
Cholecystectomy* ; Compensation and Redress* ; Gallbladder ; Hepatic Veins* ; Humans ; Intraoperative Complications ; Liver ; Male ; Middle Aged ; Needles ; Polypropylenes ; Robotic Surgical Procedures ; Sutures

Factor VII deficiency is a rare congenital bleeding disorder characterized by episodes of spontaneous bleeding in severely affected individuals. It is rare intussusception due to submucosal hematoma in coagulation factor deficiency patient. We recently experienced an adult small bowel intussusception in a patient with factor VII deficiency. A 36-yr old female patient with coagulation factor VII deficiency who was referred to our hospital underwent emergency surgery for treatment of the small bowel intussusceptions. Emergency laparoscopy-assisted small bowel resection was performed for treatment of small bowel intussusception caused by submucosal hematoma. The patient was successfully treated with close laboratory monitoring and laparoscopy-assisted small bowel resection.
Adult ; Blood Coagulation Factors ; Emergencies ; Factor VII ; Factor VII Deficiency ; Female ; Hematoma ; Hemorrhage ; Humans ; Intussusception