PURPOSE: This study evaluated the safety and feasibility of gasless laparoscopic assisted transumbilical appendectomy (GLATUA). METHODS: Data for 62 GLATUA and 84 laparoscopic appendectomies (LA) for uncomplicated appendicitis, which had been performed over a 12 month period in a single institution, were compared retrospectively. The GLATUAs were carried out through an umbilical incision. The abdominal wall was retracted upward using an "L"-shaped retractor and the inflamed appendix was found by gasless laparoscopic vision. A transumbilical extracorporeal appendectomy was then performed. The LAs were performed using a three-port system. RESULTS: The GLATUA group had a shorter mean operative time (44.1+/-22.1 vs. 51.5+/-24.7 min, p=0.06), mean time for resuming a soft diet (29.0+/-9.2 vs. 41.3+/-20.7 hrs, p<0.01) and hospital stay (3.0+/-0.9 vs. 3.6+/-1.7, p<0.01) than the LA group. There was no significant difference in complication rates (6.5% vs. 3.6%, p=0.44). The mean medical costs of the GLATUA group were 66.7% of the LA group. CONCLUSION: GLATUA is a safe, feasible and more cost-effective alternative technique for surgery in uncomplicated acute appendicitis than LA.
Abdominal Wall ; Appendectomy ; Appendicitis ; Appendix ; Diet ; Length of Stay ; Operative Time ; Retrospective Studies ; Vision, Ocular

PURPOSE: Laparoscopic surgery is used in elderly patients to maximize the benefits of improved postoperative recovery but this supposition lacks proper evidence. The aims of this study were to assess the safety and feasibility of laparoscopic colorectal surgery in elderly patients (group A, age > or =70 years, n=77) by a comparison with those in younger patients (group B, age < or =65 years, n=142), and to define the factors contributing to postoperative complications. METHODS: A retrospective analysis of 219 patients, who underwent elective laparoscopic colorectal cancer surgery between June 2006 and November 2010 at Kyung Hee University Hospital at Gangdong, was performed. The data included the patient's demographics, surgical and postoperative outcomes, including complications and recovery parameters. RESULTS: The mean ages of group A and B were 76 years and 56 years, respectively. Group A had more comorbid conditions than group B, as assessed by the Charlson comorbidity index score (group A 4.09 vs. group B 3.06, p<0.001). The postoperative recovery times were similar in the two groups. Intensive care unit (ICU) stays were more frequent in group A than group B (group A 44.2% vs. group B 6.3%, p<0.001). Postoperative complications were independently related to the long operation time (>200 minutes), ICU stay and rectal surgery. CONCLUSION: Laparoscopic colorectal surgery in elderly patients is safe and does not compromise the postoperative outcomes despite the comorbid conditions of the elderly patients.
Aged ; Colorectal Neoplasms ; Colorectal Surgery ; Comorbidity ; Demography ; Humans ; Intensive Care Units ; Laparoscopy ; Postoperative Complications ; Retrospective Studies

PURPOSE: Although some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of a robotic system, few studies have reported the use of robotic surgery for rectal cancer. This study analyzed prospectively the safety, morbidity, mortality and operation time of a robotic rectal resection for rectal cancer. METHODS: The data of 185 consecutive patients, who had undergone robotic rectal resection for rectal cancer at Korea University Aanam Hospital from July 2007 to April 2011, was analyzed prospectively. The postoperative outcomes and operative times were evaluated. RESULTS: Robotic rectal resection using a da Vinci surgical system was performed on 185 patients. There were 115 low anterior resections, 5 anterior resections, 1 Hartmann's operation, 10 ultra-low anterior resections, 43 intersphincteric resections and 11 abdominoperineal resections. The median hospital stay was 9 days. The overall morbidity rate was 33.4%. There was one conversion to open surgery. The mean passage of flatus was noted on postoperative day 2.0, diet was started on postoperative day 2.3 and the mean postoperative hospital stay was 13.7 days. The mean number of retrieved lymph nodes was 16. The total operation time decreased with increasing operator experience (306 min vs 285 min vs 268 min, p=0.009). CONCLUSION: A robotic rectal resection is feasible and safe for rectal cancer patients. The data showed an acceptable morbidity and mortality rate compared to the short term results of conventional laparoscopic and open surgery reported previously. Nevertheless, the oncologic and functional benefits of robotic colorectal surgery should be evaluated through a large scale study.
Colorectal Surgery ; Conversion to Open Surgery ; Diet ; Flatulence ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies ; Rectal Neoplasms

Obesity is associated with high mortality. Bariatric surgery is considered the only evidence-based approach to sustainable weight loss. The most popular bariatric surgeries are Roux-en-Y gastric bypass, gastric banding and sleeve gastrectomy. The laparoscopic approach is favored over the open method for its good recovery. Recently, the robotic system was applied to bariatric surgery, and was reported to have strengths during suturing and anastomosis. On the other hand, there is no report of robotic bariatric surgery in Korea. In the present study, robotic Roux-en Y gastric bypass and robotic sleeve gastrectomy was performed successfully on morbidly obese patients.
Bariatric Surgery ; Gastrectomy ; Gastric Bypass ; Hand ; Humans ; Korea ; Obesity ; Weight Loss

An intra-abdominal cystic lymphangioma is a benign neoplasm that rarely occurs within the abdominal cavity. Intra-abdominal cystic lymphangioma is treated by a resection performed through a radical procedure. We report a case of a 37-year-old woman who had an asymptomatic mesenteric cyst that was discovered incidentally during a routine physical check-up. Treatment was completed without complications using a laparoscope.
Abdominal Cavity ; Adult ; Female ; Humans ; Laparoscopes ; Lymphangioma ; Lymphangioma, Cystic ; Mesenteric Cyst

PURPOSE: Laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter insertion is used instead of open CAPD insertion because additional measures to prevent complications can be made without a conventional laparotomy. This study compared the early experience of laparoscopic CAPD catheter insertion with open CAPD insertion in children. METHODS: Between January 2006 and May 2011, 52, 16 and 36 patients who underwent CAPD insertion, laparoscopic CAPD insertion and open CAPD insertion, respectively, for end stage renal disease at Seoul National University Children's Hospital were enrolled in this study. The clinicopathological factors, operative factors and outcomes were analyzed by a retrospective medical record review. RESULTS: The mean operative time of the laparoscopic group was longer than that of the open groups (78 minutes vs 60 minutesm, p value=0.079). In the laparoscopic group, 3 patients underwent closure of the processus vaginalis and the occurrence of an inguinal hernia was prevented, whereas 3 patients in the open group underwent herniorrhaphy for an inguinal hernia. The mean period of catheter use in the laparoscopic and open group was 201 and 984 days, respectively. Complications occurred more frequently in the open group than in the laparoscopic group (14 patients (38.9%) vs. 2 patients (12.5%), p value=0.059). Peritonitis (19.4%) was the most common complication, which occurred only in the open group, followed by catheter obstruction due to omental wrapping. Catheter migration occurred more frequently in the open group (20%) than the laparoscopic group (12.5%). CONCLUSION: These results suggest that laparoscopic CAPD catheter insertion can be a suitable method for CAPD catheter insertion in children.
Catheter Obstruction ; Catheters ; Child ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Kidney Failure, Chronic ; Laparoscopy ; Laparotomy ; Medical Records ; Operative Time ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Retrospective Studies

PURPOSE: Laparoscopic appendectomy is a popular surgical treatment of choice for children with appendicitis. This study compared laparoscopic appendectomy (LA) with an open appendectomy (OA) in children with simple appendicitis (SA) and perforated appendicitis (PA) to confirm the safety and effectiveness of the laparoscopic procedure. METHODS: A retrospective medical record review was performed on 193 patients who underwent an appendectomy at our institution from January, 2008 to August, 2011. The demographic properties and postoperative factors including complications were assessed. RESULTS: Among 140 SA, there were 81 and 59 cases of OA and LA, respectively. In SA, the time to bowel movement in LA was shorter than OA (0.9 vs. 1.2 days, p=0.0005) and the number of times analgesics were used in LA were significantly lower than OA (1.8 vs. 2.5, p=0.027). Of 53 PA, 30 cases received OA whereas 23 cases underwent LA. In patients with PA, the LA group were older (124.0 vs. 98.8 months, p=0.027) with a longer operative time (93.5 vs. 68.2 minutes, p=0.02). On the other hand, the time to diet was faster in LA (1.8 vs. 3.2 days, p=0.02). In both SA and PA, there were no significant differences between OA and LA with respect to gender, hospital stay, drain insertion, duration of antibiotics usage, and complications. In SA, the LA group had fewer complications than the OA group with borderline significance. CONCLUSION: LA is a safe and effective way to treat SA and PA in children.
Analgesics ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Child ; Diet ; Hand ; Humans ; Length of Stay ; Medical Records ; Operative Time ; Retrospective Studies

PURPOSE: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. METHODS: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients' characteristics, operation time, hospital stay, analgesic use and related complications. RESULTS: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2~9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. CONCLUSION: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
Female ; Granuloma ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pyrazines ; Retrospective Studies ; Seroma ; Urinary Retention

PURPOSE: Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has established itself as a safe and effective treatment for inguinal hernia. Nevertheless, there are difficulties in learning the technique. In particular, patients with a medical history of having undergone lower abdominal surgery are generally excluded from laparoscopic hernia repair due to the technical difficulty of the procedure. This study evaluated the early surgical outcome and examined the feasibility of techniques for laparoscopic TEP inguinal hernia repair in patients who had previously undergone lower abdominal surgery. METHODS: Ten cases of laparoscopic TEP inguinal hernia repair in patients with a prior history of lower abdominal surgery between November 2006 and January 2010 were reviewed. All cases were treated by a single highly experienced laparoscopic surgeon. RESULTS: Previous operations included 5 cases of radical prostatectomies for prostate cancer, 2 cases of open suprapubic prostatectomies for benign prostate hypertrophy, 2 cases of radical cystectomies for bladder cancer and 1 case of laparoscopic low anterior resection for rectal cancer. In all 10 cases, the patients were male with 9 cases involving an indirect hernia and 1 case involving a direct hernia. The mean operation time was 136.5+/-33.7 minutes, and in 1 case, the surgical method was converted to the transabdominal preperitoneal approach. Postoperatively, there were 3 cases of urinary retention, and the administration of analgesics were required 1.0+/-0.6 times on average. The mean length of hospitalization was 1.2+/-0.8 days. During the mean 18 month (1~36 months) follow-up period, there was no recurrence and chronic pain but 1 case of mesh infection was encountered 6 months after TEP repair. CONCLUSION: Although the laparoscopic TEP inguinal hernia repair can be carried out safely on patients with previous lower abdominal surgery, it needs to be carried out by fully trained surgeons with sufficient experience in the TEP technique. Nevertheless, more extensive experience and a longer follow-up period will be needed to evaluate the feasibility and efficiency of the TEP approach.
Analgesics ; Chronic Pain ; Cystectomy ; Follow-Up Studies ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Hospitalization ; Humans ; Hypertrophy ; Laparoscopy ; Learning ; Male ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Pyrazines ; Rectal Neoplasms ; Recurrence ; Urinary Bladder Neoplasms ; Urinary Retention

PURPOSE: Laparoscopy is being used increasingly for the management of small bowel obstructions (SBOs), but only a few studies have examined the indications and utility of laparoscopic surgery in SBO. This study investigated the feasibility, effectiveness and safety of laparoscopic surgery in SBO, as well as the predictors of the success or failure of laparoscopic surgery. METHODS: From June 2006 to March 2010, 73 patients underwent surgery for SBO at the Department of Surgery, Kyung Hee University Medical Center. The patients treated by laparoscopy were compared with those treated by laparotomy in terms of the differences in operative time, postoperative hospital stay and return of bowel function, as evidenced by the toleration of a liquid diet, surgical site infection and recurrence rate. A Chi-square test, student's t-test and ANOVA test were performed to identify the predictors of success or failure of laparoscopic surgery, particularly the preoperative laboratory findings, vital signs, previous abdominal surgery, duration of illness, bowel diameter on abdomen plain film and location of the transition zone on computerized tomography. RESULTS: Of the 73 cases, 30 cases were in the laparoscopic group (41.1%) and 43 cases were in the laparotomy group (58.9%). The postoperative hospital stay was significantly shorter in the laparoscopic group than in the laparotomy group (8.1+/-5.8 vs. 15.2+/-14.9 days, p=0.04), and the period until the return of bowel function was significantly shorter in the laparoscopic group than laparotomy group (4.3+/-3.1 vs. 6.6+/-3.6 days, p=0.02). The surgical site infection rate tended to be lower in the laparoscopic group than in the laparotomy group (4.5% vs. 23.3%, p=0.07) and the mean surgery time tended to be shorter in the laparoscopic group than in the laparotomy group (76.3+/-28.1 vs. 96.3+/-55.9 minutes, p=0.06). There were no differences in the incidence of intraoperative bowel injury between the two groups (0/22 (0%) in the laparoscopic group vs. 2/43 (4.7%) in the laparotomy group, p=0.30), recurrence rate (0/22 (0%) vs. 3/43 (7.1%), p=0.34) and mortality rate (1/22 (4.5%) vs 0/43 (0%), p=0.30 respectively). The rate of conversion to open surgery was 26.7% (8/30). The causes of conversion to open surgery were severe bowel distension (2 cases), severe adhesion (2 cases), no visible cause of obstruction (1 case), iatrogenic bowel injury (1 case), bowel ischemia and perforation (1 case) and hemodynamic instability (1 case). There were no significant differences in the preoperative WBC count, CRP, pulse rate, number of past abdominal surgeries, duration of illness, bowel diameter on plain abdominal film and obstruction site between the successful group and conversion group, except for the significant differences in body temperature and marginal differences in the type of previous surgery. CONCLUSION: The laparoscopic approach has been shown to be safe and feasible in the management of SBO for selected patients. There were no pre-operative predictive factors for successful laparoscopy, except for factors such as afebrility and previous gynecological surgery. Nevertheless, larger, randomized prospective trials will be needed to determine the predictors of success or failure of laparoscopic surgery.
Abdomen ; Academic Medical Centers ; Body Temperature ; Conversion to Open Surgery ; Diet ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Ischemia ; Laparoscopy ; Laparotomy ; Length of Stay ; Operative Time ; Recurrence ; Vital Signs