Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.
Appendectomy ; Child ; Conversion to Open Surgery ; Demography ; Education ; Electronic Health Records ; Granulation Tissue ; Humans ; Inflammation ; Laparoscopy* ; Learning Curve ; Length of Stay ; Pain, Postoperative ; Pediatrics* ; Postoperative Complications ; Retrospective Studies ; Sample Size ; Traction ; Wounds and Injuries

PURPOSE: Management of appendicitis in children has always been an issue in pediatric surgery. Both diagnostic methods and treatment vary significantly among medical centers, and little consensus exists in many aspects of the care for patients with appendicitis. Here, we assessed the value of drain insertion after appendectomy in children. METHODS: This study is a retrospective review of pediatric patients who underwent appendectomy for perforated appendicitis at a tertiary medical center between 2003 and 2012. Patients who had a peritoneal drain inserted after appendectomy were compared with patients without drains regarding preoperative features and postoperative outcomes. Statistical analyses included a 2-tailed Student t-test and a chi-square or Fisher exact test. RESULTS: In total, 958 patients were reviewed. Of 342 patients with perforated appendicitis, 108 (31.6%) had Jackson-Pratt (JP) drains inserted. The JP group had a longer hospital stay compared with the non-JP group (6.38 +/- 3.59 days vs. 3.87 +/- 2.38 days, P < 0.001). The JP group also had higher complication rates (22.2% vs. 6.8%, P = 0.003), including the formation of intra-abdominal abscesses. CONCLUSION: According to our results, there seems to be little evidence to support peritoneal drain insertion after appendectomy, even in perforated appendicitis cases.
Abdominal Abscess ; Appendectomy* ; Appendicitis* ; Child* ; Consensus ; Drainage ; Humans ; Length of Stay ; Retrospective Studies

Purpose: Thyroid hormone is an important hormone in maintaining metabolism and homeostasis in the body. There exists a common perception among patients that thyroid surgery will cause weight gain. Prevention of any undesired weight gain could be important for the maintenance of well-being in most patients. Our study compares changes in body mass index (BMI) and weight after total thyroidectomy or lobectomy in thyroid cancer patients. Methods: A total of 967 patients with differentiated thyroid carcinoma were enrolled in the study, from March 2011 to July 2016 at Chung-Ang University Hospital. Exclusion criteria were less than lobectomy, modified radical neck dissection, recurred operation, and combined operation for other causes. Primary endpoints were change in body weight and BMI at 2 years after surgery. A subgroup analysis was performed for patients with significant weight change. Results: There were no differences between both groups in BMI after 2 years of thyroid operation. Thyroid stimulating hormone (TSH) levels were not significantly different. Fifteen percent of patients showed significant change in body weight after 2 years of operation. The subgroup analysis of these patients showed no significant differences in gender, age, or extent of operation between those who had gained weight compared to those who had lost weight. There were also no differences in postoperative TSH levels, levothyroxine supplementation, or radioactive iodine treatment. Conclusion There was a minimal postoperative increase in mean BMI over the years in patients undergoing thyroidectomy for differentiated thyroid cancer. However, weight change did not differ in those undergoing thyroid lobectomy or total thyroidectomy.

PURPOSE: The purpose of this study was to determine the extent of safety of medial dissection of the thyroid gland along the trachea. Medial to lateral dissection of the thyroid gland along the trachea after early division of the isthmus has been known to be a useful technique in thyroid surgery, especially for difficult cases, but the risk of injury of the recurrent laryngeal nerve (RLN) has constrained thyroid surgeons from utilizing this technique to its full extent. METHODS: Distances of the laryngeal entry point (LEP) of 134 RLNs of 71 patients from the midline of the trachea, and some other anatomical distances, were measured intraoperatively. The relationships of the intraoperatively measured data with circumferences of the cartilaginous portion of the trachea (CCT) around LEP measured preoperatively by CT scan were evaluated. RESULTS: LEP was always located within 2 mm vertically from the horizontally extended line of the inferior border of the cricoid cartilage and was the closest point from the midline in the whole course of the RLN. The distance between LEP and the midline was very closely correlated with CCT measured on preoperative CT scan, and it can be accurately calculated with a regression equation; Distance between LEP and the midline = (0.42 × CCT) + (1.2 × sex) + 3.2 (mm) (sex: female=0, male=1; R2 = 0.85). CONCLUSION: Early division of the isthmus and dissecting the thyroid off the trachea to the calculated extent is a safe and effective procedure.
Cricoid Cartilage ; Humans ; Recurrent Laryngeal Nerve* ; Surgeons ; Thyroid Gland* ; Thyroidectomy ; Tomography, X-Ray Computed ; Trachea*

Purpose: The aim of this study was to examine the rate of expression of estrogen receptor α (ERα) and β1 (ERβ1), progesterone receptor (PR), and rate of overexpression of epidermal growth factor receptor (EGFR) in a relatively large cohort of patients with papillary thyroid carcinoma (PTC). We also aimed to examine whether each receptor influenced clinicopathological characteristics and prognosis of PTC. Materials and Methods: We made a microarray of paraffin-embedded PTC surgical tissues from 436 patients. We compared the results of the immunohistochemical staining for each hormone receptor with clinicopathological characteristics. Results: The positive expression rate of hormonal receptors was 40.4% for ERα, 83.7% for ERβ1, and 71.3% for PR in patients with PTC. Overexpression of EGFR was shown in 19.3% of patients with PTC. The age was lower (44.6±12.1 years vs. 47.1±12.5 years, p=0.040) and tumor smaller (0.96±0.69 cm vs. 1.13±0.82 cm, p=0.020) in the ERα positive group, which also showed higher PR positivity (80.7% vs. 65.0%, p < 0.001) and overexpression of EGFR (27.3% vs. 13.8%, p < 0.001). However, neither the positivity of hormone receptors nor overexpression of EGFR affected the recurrence of PTC. Conclusion In conclusion, most (94.6%) patients with PTC were found to exhibit positive expression for ERs or PR. We also found that neither the positive expression of hormone receptors nor overexpression of EGFR were associated with the recurrence of PTC.

Purpose: Thyroid hormone is an important hormone in maintaining metabolism and homeostasis in the body. There exists a common perception among patients that thyroid surgery will cause weight gain. Prevention of any undesired weight gain could be important for the maintenance of well-being in most patients. Our study compares changes in body mass index (BMI) and weight after total thyroidectomy or lobectomy in thyroid cancer patients. Methods: A total of 967 patients with differentiated thyroid carcinoma were enrolled in the study, from March 2011 to July 2016 at Chung-Ang University Hospital. Exclusion criteria were less than lobectomy, modified radical neck dissection, recurred operation, and combined operation for other causes. Primary endpoints were change in body weight and BMI at 2 years after surgery. A subgroup analysis was performed for patients with significant weight change. Results: There were no differences between both groups in BMI after 2 years of thyroid operation. Thyroid stimulating hormone (TSH) levels were not significantly different. Fifteen percent of patients showed significant change in body weight after 2 years of operation. The subgroup analysis of these patients showed no significant differences in gender, age, or extent of operation between those who had gained weight compared to those who had lost weight. There were also no differences in postoperative TSH levels, levothyroxine supplementation, or radioactive iodine treatment. Conclusion There was a minimal postoperative increase in mean BMI over the years in patients undergoing thyroidectomy for differentiated thyroid cancer. However, weight change did not differ in those undergoing thyroid lobectomy or total thyroidectomy.

PURPOSE: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. METHODS: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. RESULTS: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. CONCLUSION: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.
Female ; Humans ; Neck ; Pain, Postoperative* ; Pharynx ; Postoperative Complications ; Prospective Studies ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

BACKGROUND: High-fat diet is known to be implicated in the pathogenesis of various metabolic disorders related to an inflammatory response. The aim of this study was to investigate the influence of high-fat diet for intestinal acetic acid and butyric acid concentrations which are related to inflammation-associated colon cancer risk. METHODS: Both male and female rats of 6, 31, 74 and 104-week of age were fed chow diet or high-fat diet for 8 weeks. Body weight and food intake were measured weekly during the feeding period. Intestinal acetic acid and butyric acid levels were measured by high-performance liquid chromatography from luminal contents of ileum and cecum. RESULTS: Male rats showed greater weight change than female rats in every age. Calorie-adjusted food intake was also higher in male rats compared to female rats. Male rats showed similar intake of food in every age while 31-week old female rats showed increased intake, which was decreased at 74-week and 104-week of age. The ileal acetic acid concentration was increased in male rats fed high-fat diet, while female rats fed high-fat diet showed no significant change in the ileal acetic acid level. On the other hand, butyric acid almost disappeared in high-fat diet fed rats regardless of sex. CONCLUSIONS: High-fat diet increases the intestinal acetic acid concentration while reducing the butyric acid concentration which may account for increased risk of inflammation-associated colon cancer.
Acetic Acid ; Animals ; Body Weight ; Butyric Acid ; Cecum ; Chromatography, Liquid ; Colonic Neoplasms ; Diet ; Diet, High-Fat ; Eating ; Female ; Hand ; Humans ; Ileum ; Male ; Phenobarbital ; Rats

OBJECTIVE: To investigate adverse pregnancy outcomes in non-obese women with polycystic ovary syndrome (PCOS) compared with obese-PCOS and control groups. METHODS: Women with PCOS who underwent assisted reproductive technology (ART) from August, 2003 to December, 2007, were considered. A total of 336 women with PCOS were included in the study group and 1,003 infertile women who had tubal factor as an indication for ART were collected as controls. They were divided into four groups: a non-obese PCOS group, obese-PCOS group, non-obese tubal factor group, and obese tubal factor group, with obesity defined by a body mass index over 25 kg/m2, and reviewed focusing on the basal characteristics, ART outcomes, and adverse pregnancy outcomes. RESULTS: There was no difference among the groups' the clinical pregnancy rate or live birth rate. Regarding adverse pregnancy outcomes, the miscarriage rate, multiple pregnancy rate, and prevalence of preterm delivery and pregnancy induced hypertension were not different among the four groups. The incidence of small for gestational age infant was higher in the PCOS groups than the tubal factor groups (p<0.02). On the other hand, the morbidity of gestational diabetes mellitus (GDM) was not high in the non-obese PCOS group but was in the obese groups. And in the obese PCOS group, the newborns were heavier than in the other groups (p<0.02). CONCLUSION: Non-obese PCOS presents many differences compared with obese PCOS, not only in the IVF-parameters but also in the morbidity of adverse pregnancy outcomes, especially in GDM and fetal macrosomia.
Abortion, Spontaneous ; Body Mass Index ; Case-Control Studies ; Diabetes, Gestational ; Female ; Fetal Macrosomia ; Gestational Age ; Hand ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Infant ; Infant, Newborn ; Live Birth ; Obesity ; Ovary ; Polycystic Ovary Syndrome ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Pregnancy, Multiple ; Prevalence ; Reproductive Techniques, Assisted