PURPOSE: Single-port laparoscopic surgery (SPLS) has recently emerged as a method to improve the morbidity and cosmetic benefit of conventional laparoscopic surgery. We describe our experience of SPLS for an anterior resection (AR). The results of a prospective series of single-port laparoscopic anterior resection procedures are presented. METHODS: Anterior resections were performed on 16 cases using a single-port laparoscopic technique between March 2009 and March 2010. The surgical and oncologic outcomes were recorded on a prospective database. RESULTS: Sixteen (8 women) unselected patients (eight males, eight females), aged 43~82 years (median 66.5 years), underwent a SPLS anterior resection for sigmoid colon cancers (median 16 cm above AV, range 13~27). All patients were alive at 30 days. The surgery time ranged from 150~415 min (median 242 min) and the median wound incision length was 2.4 cm (range 1.5~4.0 cm). The median hospital stay was 7.5 days. Pathological reports from the resected specimens revealed adenocarcinoma in 15 patients and mucinous carcinoma in one. There was one case of an anastomotic leak that required reanastomosis. The median number of lymph nodes harvested was 27.5 (range 10~56). CONCLUSION: SPLS is a possible approach to an anterior resection with the potential for minimal access. A SPLS anterior resection is feasible and safe when performed by an experienced laparoscopic surgeon and team. On the other hand, the technique and oncologic safety warrants further prospective randomized studies.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Anastomotic Leak ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Cosmetics ; Hand ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Male ; Prospective Studies

PURPOSE: Several techniques and devices have recently been introduced for single-incision laparoscopic cholecystectomy. We describe our technique using standard laparoscopic instruments and ports, and report the initial results. METHODS: Between March 2009 and June 2010, 60 consecutive patients underwent single-fulcrum laparoscopic cholecystectomy for benign gallbladder disease. The general patient characteristics and perioperative results, including the operation time, conversion rate and complications, were assessed retrospectively. RESULTS: Seventeen (28.3%) patients were male and 43 (71.7%) patients were female. The mean age was 47.4+/-12.4 years, and the mean total operation time was 57.5+/-13.9 min. The operation time became stable after 30 cases. There was no conversion to conventional laparoscopic cholecystectomy or open surgery. Additional trocars were required in three patients due to intraoperative complications, which were managed successfully with additional trocars. The intraoperative complications included loosening of the clips on the cystic duct, vertical laceration of the cystic duct, and burn injuries to the duodenal wall. There was no postoperative morbidity. CONCLUSION: Despite the limited sample size in this series, the results suggest that single-fulcrum laparoscopic cholecystectomy is safe and feasible for the treatment of benign gallbladder disease. Nevertheless, a further prospective randomized controlled trial comparing this technique with conventional techniques will be needed to confirm its true clinical value.
Burns ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Female ; Gallbladder Diseases ; Humans ; Intraoperative Complications ; Lacerations ; Male ; Sample Size ; Surgical Instruments

PURPOSE: To assess the technical feasibility of laparoscopic distal pancreatectomy (LDP) focusing on the development of postoperative complications including pancreatic fistula (POPF). METHODS: From March 2001 to April 2010, 57 patients underwent a distal pancreatectomy. The patients were divided into two groups, LDP group (L group, n=15) and open distal pancreatectomy group (O group, n=42). The clinicopathological characteristics, surgical variables and postoperative outcomes of these 2 groups were compared retrospectively. RESULTS: Patients with a malignancy constituted 7% of the L group and 31% of the O group (p=0.084). The tumor size was significantly larger in the O group (2.6 vs. 5.3 cm). The body mass index (BMI) was significantly higher in the L group (24.9 vs. 22.9 kg/m2). One case of a pancreas pseudocyst in the L group was converted to open surgery due to intraoperative bleeding. The L group showed significantly less intraoperative bleeding, earlier start of solid meals and shorter hospital stay. There was no significant difference in the incidence of postoperative complications and POPF between the 2 groups. POPF of ISGPF grade B developed in 0 and 2 patients in the L group and O group, respectively. One intestinal obstruction and 1 fluid collection that required intervention was encountered in the O group. One patient with adenocarcinoma who underwent LDP was alive 25 months after surgery without recurrence. CONCLUSION: LDP provides the advantages of minimal access surgery with a comparable rate of POPF to ODP. LDP is considered suitable for benign and borderline-malignant pancreatic lesions.
Adenocarcinoma ; Body Mass Index ; Hemorrhage ; Humans ; Incidence ; Intestinal Obstruction ; Length of Stay ; Meals ; Pancreas ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms ; Postoperative Complications

PURPOSE: Polypoid lesions of the gallbladder have a range of causes. A problem exists in the selection of patients for surgery. This study examined the usefulness of laparoscopic cholecystectomy, suspected risk factors and plan of patients with gallbladder polyps. METHODS: This study examined 57 patients who underwent laparoscopy cholecystectomy with gallbladder polyps. All patients had been diagnosed preoperatively by ultrasound and abdominal computed tomography between October 2001 and October 2010. Preoperative radiologic diagnosis, age, gender, symptoms, size of polyps, number, concurrent gallstones and histological diagnosis of the polyps as well as the postoperative complications were reviewed retrospectively. The operation indications were polyps >10 mm, age above 55 years, symptomatic polyps, coincidence of a stone, focal thickening of gallbladder wall and detection during other operations. RESULTS: The number of each type of polyp lesion of the gallbladder was as follows: 26 cases (45.6%) had cholesterol polyps, 2 cases (3.6%) inflammatory polyps, 1 case (1.7%) mucosal lymphoid follicles, 12 cases (21.1%) adenomatous polyps, 1 case (1.7%) adenocarcinoma. Non-neoplastic and neoplastic polyps accounted for 50.9% and 22.8%, respectively. Forty-eight cases had an accepted operative indication and underwent surgery. The nine other cases also underwent surgery. Among those with operative indications, 27.1% had neoplastic polyps. Of the patients who had non-indication operative surgery or polyps <5 mm in size, there were non neoplastic polyps in any cases. Two of the patients developed complications; wound infection (1 case), and common bile duct obstruction (1 case). CONCLUSION: Observation and careful surgery is necessary for patients with polyps <5 mm in size, and who do not have accepted operative indications. Laparoscopic cholecystectomy can be considered an adequate treatment for patients with accepted operative indications.
Adenocarcinoma ; Adenomatous Polyps ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholesterol ; Common Bile Duct ; Gallbladder ; Gallstones ; Humans ; Laparoscopy ; Polyps ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Wound Infection

Inadvertent vaginal insertion of barium sulfate is an uncommon complication of a barium enema examination. In the few reported cases, venous embolizaton of barium occurred and this usually resulted in death. We present here a case of vaginal insertion of the enema catheter in a young woman, resulting in barium in the uterus, fallopian tubes and abdominal cavity, but not in the veins. After an emergency laparoscopic operation, the patient had been doing well for 6 months without evidence of complication.
Abdominal Cavity ; Barium ; Barium Sulfate ; Catheters ; Colon ; Emergencies ; Enema ; Fallopian Tubes ; Female ; Humans ; Peritonitis ; Uterus ; Veins

Acute appendicitis is the most common cause of an acute abdomen. But torsion of the appendix is a rare disorder that causes abdominal symptoms that are indistinguishable from acute appendicitis. So, making the preoperative diagnosis of torsion of the appendix is difficult. In 1918, Payne et al. reported the first case of torsion of the appendix in a 37 years old woman. Since then, more than thirty cases have been reported. Torsion of the appendix can occur at any age & gender. Here, we report on a case of secondary torsion of appendix with mucinous cystadenoma in a 52 year-old woman, which was initially thought to be a right adnexal mass. Abdomen CT showed an 11x5 cm sized intra-abdominal mass growing along the right fallopian tube. On the small bowel series, an extra-luminal mass was found and this was pushing aside the small intestine. We performed diagnostic laparoscopic exploration and found inflammation of appendix with torsion. It was twisted 720degrees in a clockwise direction with ischemic change. The histological result was mucinous cystadenoma.
Abdomen ; Abdomen, Acute ; Appendicitis ; Appendix ; Cystadenoma, Mucinous ; Fallopian Tubes ; Female ; Humans ; Inflammation ; Intestine, Small

PURPOSE: Laparoscopic instruments have been remarkably developed through many trials. Various studies and experiments on laparoscopic instruments are underway in other countries. Laparoscopic surgery is also very actively applied in Korea. However, research on the use and safety of the instruments is stagnant. Furthermore, reuse of some disposable laparoscopic instruments is frequently observed, but there are only rare studies on the safety of this. Thus, we tried to provide study cases on the safety of repeated use of disposable laparoscopic instruments. METHODS: To investigate the effectiveness of sterilization and a re-package procedure, we divided the laparoscopic instruments that are commonly used in our institution into 10 types. Among all the available instruments, 32 instruments were selected for the simulation experiment. Each instrument was sterilized using ethylene oxide gas or glutaraldehyde 2%, and then packaged. Then, each was observed grossly and microscopically under aseptic conditions and we looked for any remnant foreign body or contaminant. When remnant foreign body or contaminant was found, they were collected and separately cultured. RESULTS: Residual contaminants were found in 15 instruments (46.9%) out of a total of 32 and microorganisms, including coagulase-negative staphylococcus and gamma-hemolytic streptococcus, were cultured from (9.38%), and each had different types of microorganisms. CONCLUSION: It is remarkable that the bacteria were cultured from recycled laparoscopic instruments after sterilization. The reuse of laparoscopic instruments might be cost-effective, but further studies on its safety are required. Moreover, careful inspection on the method of surgical instrument sterilization in each institution will be necessary.
Bacteria ; Ethylene Oxide ; Ethylenes ; Foreign Bodies ; Glutaral ; Korea ; Laparoscopy ; Staphylococcus ; Sterilization ; Streptococcus ; Surgical Instruments

PURPOSE: The aim of this study was to determine the advantage of adequate PTGBD in acute complicated cholecystitis patients. METHODS: We performed a retrospective review of a collected database from September 2001 to July 2008. Acute cholecystitis with gangrene or perforation was defined as acute complicated cholecystitis. A PTGBD was performed for these patients immediately after the diagnosis using US or CT and then a tubogram was performed after 5~7 days. After evaluating the gallbladder (GB) and common bile duct (CBD) with a tubogram, we removed the drainage tube and the patients underwent a LC after readmission. RESULTS: Three hundred seventy four of the 893 patients who were diagnosed with acute cholecystitis underwent PTGBD. While 19 (3.2%) of the total acute cholecystitis patients were converted to open cholecystectomy due to severe inflammation, 14 (3.7%) of the acute complicated patients were converted to open cholecystectomy. In 79 patients, the pre-operative tubogram showed the presence of CBD stone and so ERCP was performed. There were no post-operative deaths. CONCLUSION: PTBGD in acute complicated cholecystitis patients allows the early relief of acute cholecystitis symptoms. This allows sufficient evaluation and treatment for CBD during the PTGBD state. Furthermore, this decreases the mortality and morbidity in the high-risk patients due to sufficient evaluation and management of the underlying critical disease, which allows elective cholecystectomy when the patients is in better condition for surgery. Therefore, PTGBD can be useful for acute complicated cholecystitis.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Common Bile Duct ; Drainage ; Gallbladder ; Gangrene ; Humans ; Imidazoles ; Inflammation ; Nitro Compounds ; Retrospective Studies

PURPOSE: Due to coverage by the nationwide medical insurance system for laparoscopic appendectomy, the laparoscopic approach for complicated appendicitis has been widely performed in Korea. The aim of this study is to evaluate the surgical outcomes and cost effectiveness of laparoscopic appendectomy for complicated appendicitis. METHODS: This study included 33 patients who underwent the laparoscopic approach (LA) and 26 patients who underwent the open approach (OA) for the complicated appendicitis between March, 2005 and February, 2010. We compared the outcomes of the length of stay, the complications and the costs. RESULTS: The hospital stay was 4.9 days for LA and 6.2 days for OA. (p>0.05) The overall complication rates were 21% (7/33) for LA and 27% (7/26) for OA. (p>0.05) All the complications were managed conservatively and there was no mortality in either group. The total cost and the patient's charge was Won 3,390,421 and Won 1,574,093 for LA and Won 3,260,523 and Won 1,493,510 for OA, respectively (p>0.05). CONCLUSION: The laparoscopic approach is safe, efficacious and cost effective. It should be the initial procedure of choice for most cases of complicated appendicitis.
Appendectomy ; Appendicitis ; Cost-Benefit Analysis ; Fees and Charges ; Humans ; Insurance ; Korea ; Length of Stay ; Retrospective Studies

PURPOSE: Compared to traditionally used abdominoperineal resection and low anterior resection for the treatment of rectal neoplasm, transanal excision (TAE) has several benefits such as a lower complication rate, a shorter average hospital stay and improved quality of life. Transanal endoscopic microsurgery (TEM) was recently introduced for resecting rectal neoplasm. The aim of this study was to compare the therapeutic results between TAE and TEM in patients with rectal neoplasm. METHODS: From October 2000 to December 2008, 115 patients underwent TEM or TAE at the NCC. Among the patient with rectal neoplasm, the patients with recurred rectal cancer and pathologic T2 or T3 stage were excluded. Thirty four and 33 patients were included for this study in the TAE and TEM groups, respectively. The locations of the lesion, the average number of fragmented specimens, the resection margin, postoperative complications and recurrence were retrospectively compared between the TEM and TAE groups. For the patients with T1 cancer, the disease-free survival rates were compared between the TAE and TEM groups. RESULTS: The median distance of lesions from the anal verge in the TEM group was higher than that in the TAE group: (mean distance: 6.75 cm, range: 3~15 cm) for TEM group and (mean distance: 3.13 (range: 1~8 cm) for the TAE group, p<0.001). The TAE group had more fragmented specimens than the TEM group (mean for the TAE: 1.44 (range: 1~4), mean for the TEM group: 1.06 (range: 1~2), p=0.031). For the patients with T1 cancer, the 3 year disease-free survival rate was not significantly different between the two groups (83.9% for the TAE group and 91.7% for the TEM group p=0.734). CONCLUSION: TEM can remove higher located rectal neoplasm and a less fragmented specimen was aquired that that in TAE. TEM seems to have similar oncologic outcomes as compared with TAE.
Disease-Free Survival ; Humans ; Length of Stay ; Microsurgery ; Postoperative Complications ; Quality of Life ; Rectal Neoplasms ; Recurrence ; Retrospective Studies