PURPOSE: A laparoscopic approach, rather than conventional laparotomy, is the well-accepted first choice for excision of an adrenal or perinephric retroperitoneal mass. The purpose of this study was to investigate the factors that affect surgical outcomes and analyze the clinical effectiveness of this surgical treatment modality. METHODS: We conducted a retrospective analysis of 62 patients who underwent laparoscopic adrenalectomies from September 2007 to February 2013. These operations were performed by a single surgeon. Demographic characteristics, operative data, tumor characteristics, and surgical outcomes were analyzed. RESULTS: Of 62 patients, 21 were men and 41 were women. The mean operative time was 151.16+/-48.58 minutes and the mean amount of blood loss was 179.51+/-161.66 ml. There were two cases of metastatic adrenal tumors that were resected completely with prolonged survival. There was one case of recurrence during the postoperative period. Preoperatively, it was only a tumor measuring 3.5 cm without evidence of malignancy. Postoperative complications occurred in three patients. However, there was no case of conversion to laparotomy. Previous history of open abdominal operation did not affect post-operative outcomes. CONCLUSION: Laparoscopic approach for adrenal tumors is indicated regardless of its type or past history of abdominal surgery. Unless greater than 10 cm, relatively large tumors can be safely removed using this method. In particular, due to the possibility of malignant potential, aggressive surgical intervention is recommended for tumors measuring between 3 and 5 cm. Use of a laparoscopic approach is associated with low risk of surgical complication and the benefits outweigh the disadvantages.
Adrenal Gland Neoplasms ; Adrenalectomy ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Operative Time ; Postoperative Complications ; Postoperative Period ; Recurrence ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.
Abdominal Abscess ; Appendectomy ; Appendicitis ; Child ; Humans ; Ileus ; Incidence ; Length of Stay ; Wound Infection

PURPOSE: Acute appendicitis is a type of abdominal disease that requires emergency surgery. Over the past three decades, laparoscopic appendectomy has become the standard operation for acute appendicitis. The aim of this paper is to compare the methods of single port appendectomy and conventional appendectomy and to illustrate the advantages of single port appendectomy. METHODS: The first group of patients underwent single port appendectomy using a surgical glove (Group 1), and those in the second group underwent surgery using the TriPort system (Group 2). The third group of patients underwent conventional three port surgery (Group 3). Questionnaires regarding patient satisfaction with scars were administered via telephone interview. Patient characteristics, histopathological data, postoperative data, and satisfaction score were analyzed by t-test and Pearson chi2 test. RESULTS: A statistically significant difference in satisfaction scores was observed among the three groups. Overall, patients in the single port group using a surgical glove would be more likely to recommend the procedure to friends and family than would patients in the other two groups. Better cosmetic results were achieved for both groups of patients who underwent laparoscopic single port appendectomy, compared to those who underwent conventional three port laparoscopic appendectomy, with statistically significant difference. CONCLUSION: Laparoscopic single port appendectomy using a surgical glove is a feasible and safe procedure and shows no differences in terms of risk, such as postoperative complication, compared to a conventional three-trocar technique. Use of this method resulted in better satisfaction compared with the other two groups, illustrating its cosmetic improvement.
Appendectomy ; Appendicitis ; Cicatrix ; Cosmetics ; Emergencies ; Friends ; Gloves, Surgical ; Humans ; Interviews as Topic ; Patient Satisfaction ; Postoperative Complications ; Surveys and Questionnaires

PURPOSE: There are various techniques for securing the base of the appendix during performance of laparoscopic appendectomy. Many studies have reported that Endo-GIA is useful for securing the base of the appendix; however, it is costly. Many hospitals now use Endoloop ligature (ELL) for securing the base of the appendix. Many studies have demonstrated the many advantages of the Hem-o-lok clip (HLC) for securing the base of the appendix. The aim of this study is to compare the surgical outcomes of securing the base of the appendix between HLC and ELL during performance of laparoscopic appendectomy. METHODS: A retrospective cohort study was conducted for comparison between HLC and ELL for securing the base during performance of laparoscopic appendectomy. From May 2008 to October 2011, 102 patients underwent laparoscopic appendectomy performed by a single surgeon. Thirty one patients were excluded for various reasons. In 38 patients, the base of the appendix was secured by HLC, and in 33 patients, ELL was applied. Data included age, sex, body mass index (BMI), cost of materials, preoperative white blood count (preoperative WBC), preoperative c-reactive protein (preoperative CRP), preoperative fever, operation time, hospital days, diameter of the appendiceal base, number of perforated appendicitis, and intraoperative or postoperative complication. RESULTS: HLC was used in 38 patients, with a meanage of 36.4 years old. ELL was applied in 33 patients, with a meanage of 19.3 years old. Significant difference in age of patients was observed between the groups (p<0.001). The groups were comparable with regard to sex, BMI, preoperative WBC, preoperative CRP, preoperative fever, operation time, hospital stay, diameter of the appendiceal base, perforated appendicitis, and intraoperative or postoperative complication. The cost of six HLCs was 32,940 won, and that for one ELL was 29,610 won, therefore, there was no significant difference in the cost of material between the tw o groups of patients. CONCLUSION: Except for age, no difference was observed between the two groups. If a single HLC set is available for securing the base of the appendix, there will be a significant difference of the material cost between the two groups. ELL is more useful for securing the appendiceal base, with a larger diameter, which is inappropriate for use of HLC.
Appendectomy ; Appendicitis ; Appendix ; Body Mass Index ; C-Reactive Protein ; Cohort Studies ; Fever ; Humans ; Length of Stay ; Ligation ; Postoperative Complications ; Retrospective Studies

PURPOSE: Conventional laparoscopic appendectomy (LA) is a widely used treatment for appendicitis. Nowadays, single incision laparoscopic appendectomy (SILA) is increasingly used as an alternative treatment for appendicitis. The purpose of this study is to evaluate the clinical significance and differences between LA and SILA. METHODS: A total of 519 patients undergoing LA or SILA between January 2011 and December 2012 were identified in a retrospectively collected database. Patients' characteristics and peri-operative variables were analyzed. RESULTS: LA was performed in 485 patients and SILA was performed in 34 patients. Mean operation time for the LA group was 62.7 minutes (range 23.3~68.1) and that for the SILA group was 62.7 minutes (range 50.9~74.5). This difference of operation time was statistically significant. In the learning curve of SILA, operation time was gradually decreased. No significant differences in hospital stay and peri-operative complications were observed between groups. CONCLUSION: Although operation time for SILA was longer than that for LA, SILA was safe. Therefore, a prospective study should be conducted in order to confirm the possibility of application to most appendicitis patients.
Appendectomy ; Appendicitis ; Humans ; Laparoscopy ; Learning Curve ; Length of Stay ; Retrospective Studies

PURPOSE: Colorectal surgeries by single port laparoscopic surgery (SPLS) are increasing. While recent studies have reported results that are similar with the idea of conventional laparoscopy, SPLS is considered superior to conventional laparoscopy with regard to cosmetic aspects. We investigated the question of whether length of incision and postoperative recovery are different depending on the method of anastomosis in patients who underw ent SPLS right hemicolectomy (RHC). METHODS: Data on patients who underwent SPLS RHC from May 2011 to April 2012 at Samsung Medical Center were retrospectively collected. Among 117 patients, 31 received functional end-to-end anastomosis (FEEA) while 86 received isoperistaltic side-to-side anastomosis (ISSA). RESULTS: Operation time was shorter in FEEA compared to ISSA (152+/-42 vs 172+/-35 min, p=0.01). Neither group required an additional port. Although wound extension for specimen delivery tended to be frequent in loop type specimen after FEEA, the result was statistically insignificant (58.1 vs 43.0%, p=0.15). No difference in wound length was observed (4.4+/-1.0 vs 4.5+/-1.5 cm). Length of stay was longer in ISSA compared to FEEA (6.3+/-2.1 vs 7.9+/-4.3 days, p=0.01), and there was no difference in first gas passage (2.5+/-0.9 vs 2.8+/-0.9 days, p=0.26). Although three patients (9.7%) with FEEA and 19 patients (22.1%) with ISSA had postoperative complications, the difference was insignificant. CONCLUSION: Theoretically, delivery of a tube shaped specimen after ISSA is expected to reduce unnecessary wound extension and possible tumor dissemination compared to loop shape specimen after FEEA. However, results of our study showed no advantage in recovery period and wound length. We suggest that future prospective study might reveal more valuable conclusions on the subject.
Cosmetics ; Humans ; Imidazoles ; Laparoscopy ; Length of Stay ; Nitro Compounds ; Postoperative Complications ; Retrospective Studies

PURPOSE: Use of bipolar electocoagulation devices becomes popular in the laparoscopic surgical field. However, several studies comparing energy-based devices for use in performance of mechanical sealing and cutting techniques have reported various results. The aim of this study was to evaluate feasibility and efficacy of new commercially available bipolar electocoagulation devices: EnSeal(TM) device (Ethicon Endo-Surgery, Cincinnati, OH, USA) by comparison with LigaSure(TM) atlas 5 mm (COVIDIEN, Boulder, CO, USA), for use in performance of coagulation and cutting techniques during performance of laparoscopic colorectal cancer surgery. METHODS: Between June 2010 and February 2011, 50 consecutive patients who underwent curative laparoscopic surgery for right colon cancer or rectal cancer were enrolled. Time and number of device activations were compared during omentectomy in cases of right colectomy and mesorectal trimming procedure in cases of anterior resection. Pathologic data and short-term clinical outcomes were also compared. RESULTS: No significant differences in terms of clinicopathologic comparison were observed between the EnSeal and LigaSure groups. No significant difference in mean operative time (207.6+/-45.3 vs. 198.9+/-57.2; p=0.558), mean time of omentectomy (11.0+/-4.5 vs. 12.6+/-8.6; p=0.293), mean time of m esorectal trimming (18.6+/-10.0 vs. 16.1+/-6.9; p=0.418), mean number of device activations during omentectomy (43.5+/-10.2 vs. 51.6+/-39.2; p=0.586), and mean number of device activations during performance of mesorectal trimming (44.8+/-22.3 vs. 49.1+/-23.7; p=0.597) were observed between the two groups. CONCLUSION: Bipolar electocoagulation devices were adapted for use in laparoscopic surgery, resulting in reduced operative time and blood loss. EnSeal(TM) Device and LigaSure(TM) atlas 5 mm were useful during performance of sealing and cutting techniques in laparoscopic colorectal cancer surgery.
Colectomy ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Laparoscopy ; Operative Time ; Rectal Neoplasms ; Surgical Instruments

PURPOSE: Limited traction has been an obstacle in the advancement of single incision laparoscopic cholecystectomy (SILC). Adequate retraction is necessary for safe performance of a cholecystectomy. In this study, we introduce our method for securing CVS for prevention of bile duct injury during performance of SILC and evaluated the effectiveness of the snake liver retractor. METHODS: A total of 148 patients who underwent needlescopic assisted SILC (nSILC) from February 2011 to February 2012 at Uijeongbu St. Mary's Hospital, Uijeongbu, Korea were analyzed. Patients were categorized into two groups: G roup I consisted of patients who underwent nSILC without use of a snake liver retractor from February 2011 to October 2011 (n=51) and group II consisted of patients who underwent nSILC using a snake liver retractor from October 2011 to February 2012 (n=97). Patient characteristics and operative outcomes were compared between groups in order to evaluate the effectiveness of use of a snake liver retractor during performance of SILC. RESULTS: There were no differences in age, sex, BMI, and history of previous abdominal surgery. However, more difficult surgeries for acute cholecystitis were performed in group II. Nevertheless, no differences in operative outcomes, such as operative time, rate of bile spillage, open conversion rate, intraoperative complication, and postoperative hospital stay were observed between groups. In addition, CVS identification time was rather shorter in group II, compared with group I. CONCLUSION: Results of this study showed that nSILC using a snake liver retractor can allow for achievement of CVS safely and for expansion of indication for SILC through improvement of exposure and obtaining adequate traction.
Achievement ; Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Humans ; Intraoperative Complications ; Korea ; Length of Stay ; Liver ; Operative Time ; Snakes ; Traction

PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has been the alternative treatment in patients who have failed endoscopic removal. Until now, biliary drainage has been performed as a customary practice after LCBDE in order to prevent complication or to prevent remnant stones from draining out; however, the drainage was often caused by other complications. For this reason, we have been performing LCBDE with primary closure. The aim of this study was to report on the efficacy and safety of primary closure. METHODS: Of 207 cases of common bile duct stones with performance of LCBDE from March 2001 to January 2013, 199 cases were included. Eight cases were excluded due to the open conversion. The 199 patients were subdivided into the primary closure group (P-group) and the drainage group (D-group). RESULTS: Of 199 patients, there were 36 (18.1%) with primary closure, and 163 (81.9%) with drainage. No significant difference in characteristics was observed between the two groups, except for smaller stones in the P-group (11.4+/-6.0 mm, 16.2+/-8.0 mm, p<0.01). Mean number of postoperative hospital days was significantly shorter in the P-group (6.0+/-3.1 days, 7.6+/-3.8 days, p=0.019). The rate of postoperative complications was higher in the D-group, but showed no statistical significance. There were six cases of bile leakage in the D-group, and two cases in the P-group, but without statistical significance (p=0.638). The recurrence rate was significantly lower in the P-group (5.6%, 22.1%, p=0.02). CONCLUSION: In the P-group, the number of mean postoperative hospital days was lower, and a lower rate of recurrence was observed. Compared with other types of drainage after LCBDE, the primary closure would be a sufficient method. Therefore, it can be regarded as safe enough and feasible.
Bile ; Common Bile Duct ; Drainage ; Humans ; Postoperative Complications ; Recurrence

PURPOSE: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair. METHODS: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS(TM) port and conventional instruments were used for the procedure. RESULTS: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high. CONCLUSION: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.
Cicatrix ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Patient Satisfaction ; Recurrence ; Seroma ; Skin ; Urinary Retention ; Wounds and Injuries