Minimally invasive surgery (MIS) has been applied to nearly all fields of surgery due to its advantages like reduced morbidity, a better cosmetic outcome and early recovery. The recent advances in its technique have allowed us to use modified MIS technique in the field of kidney transplantation. From January 2004 to Mar 2006, minimally invasive kidney transplantation was carried out in 20 patients. Many clinical variables were compared to the conventional method. The operative procedure began with 7~8 cm skin incision. A laparoscopic balloon dissector was used to create the retroperitoneal space for the placement of the grafted kidney. Vascular anastomosis and ureteroneocystostomy were performed under direct vision and with video-assisted TV monitoring. The average length of the wound was 7.8 cm and it was placed below the belt line. The average operating time was 186 minutes. Less analgesic was given compared to conventional methods. There was one postoperative complication, a mild lymphocele. All patients showed normalized serum creatinine levels within 4 days. All grafted kidneys showed normal findings on the postoperative ultrasound and renal scans. Minimally invasive video-assisted kidney transplantation is technically feasible and may offer benefits in terms of better cosmetic outcomes, less pain and quicker recuperation than conventional kidney transplantation.
Creatinine ; Humans ; Kidney Transplantation* ; Kidney* ; Lymphocele ; Postoperative Complications ; Retroperitoneal Space ; Skin ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Transplants ; Ultrasonography ; Wounds and Injuries

No abstract available.
Aneurysm, False* ; Blood Pressure Monitors* ; Blood Pressure* ; Compression Bandages* ; Humans ; Radial Artery*

No abstract available.
Diospyros* ; Intussusception*

Purpose: This study aimed to compare outcomes of opioid patients-controlled anesthesia (PCA) and intraoperative local anesthesia in terms of postoperative pain, lab results, patient surveys, and discharge scores to evaluate the feasibility of ambulatory laparoscopic cholecystectomy (LC). Methods: Patients who underwent LC for acute cholecystitis were assigned to the outpatient surgery (OPS) group or inpatient surgery (IPS) group according to the surgeon. In the OPS group, a mixture of bupivacaine and epinephrine was injected into trocar sites and sprayed on the surgical dissection field. Oral opioid and analgesics were given twice a day. In the IPS group, patients received opioid PCA. Numeric rating scale (NRS) for walking, erythrocyte sedimentation rate (ESR), CRP, self-assessed survey on general physical condition and discharge, and discharge score of ambulatory surgery were assessed postoperatively. Results: NRS was significantly lower in the OPS group. There were no significant differences in ESR and CRP between the groups. Self-assessed survey on general conditions and the possibility of discharge were significantly better in the OPS group. The discharge scores at 3, 6, and 9 hours were significantly higher in the OPS group. Conclusion Intraoperative instillation of bupivacaine at port sites and dissection fields had a better effect on short-term postoperative pain, patient surveys, and discharge criteria of ambulatory surgery than opioid PCA.

Purpose: Surgery is prioritized for a splenic injury when the patient is hemodynamically unstable or the injury is severe and there is an increased risk of bleeding. This study aimed to examine the outcomes of splenectomies where a surgical stapling device was used to reduce operation time and rapidly control bleeding. Methods: This retrospective study included 53 patients who underwent a splenectomy for traumatic splenic injury at Chosun University Hospital between 2012 and 2017. Clinical outcomes including operation time (duration), blood transfusion amount (number of units), length of hospital stay, length of intensive care unit stay, and mortality rate were compared between patients who received conventional ligation [conventional group (CG)] and patients who received a splenectomy where a surgical stapling device was used [stapling group (SG)]. Results: The SG showed an average operation time of 17 minutes less than the CG, although the reduction was not statistically significant. No significant differences in estimated blood loss and blood transfusion amount were determined between the 2 groups, although the SG received 1 more unit of red blood cells for transfusion in the 48-hour post-operative period compared with the CG. One case of pancreatic fistula as a postoperative complication was reported in the SG. Conclusion The use of a surgical stapling device in a splenectomy may be considered for a hemodynamically unstable patient with splenic injury which caused severe anatomical damage.

Purpose: Surgery is prioritized for a splenic injury when the patient is hemodynamically unstable or the injury is severe and there is an increased risk of bleeding. This study aimed to examine the outcomes of splenectomies where a surgical stapling device was used to reduce operation time and rapidly control bleeding. Methods: This retrospective study included 53 patients who underwent a splenectomy for traumatic splenic injury at Chosun University Hospital between 2012 and 2017. Clinical outcomes including operation time (duration), blood transfusion amount (number of units), length of hospital stay, length of intensive care unit stay, and mortality rate were compared between patients who received conventional ligation [conventional group (CG)] and patients who received a splenectomy where a surgical stapling device was used [stapling group (SG)]. Results: The SG showed an average operation time of 17 minutes less than the CG, although the reduction was not statistically significant. No significant differences in estimated blood loss and blood transfusion amount were determined between the 2 groups, although the SG received 1 more unit of red blood cells for transfusion in the 48-hour post-operative period compared with the CG. One case of pancreatic fistula as a postoperative complication was reported in the SG. Conclusion The use of a surgical stapling device in a splenectomy may be considered for a hemodynamically unstable patient with splenic injury which caused severe anatomical damage.

PURPOSE: Hepatic resection is the treatment of choice for small malignant tumor, intrahepatic cholelithiasis having normal liver function and so on. Partial hepatectomy for liver disease has been performing more commonly than the past. Postoperative mortality and morbidity are decreasing as the operative technique is developed. This report describes a review of our experience for hepatic resection and an analysis of potential risk factors affecting the morbidity and the mortality in a hepatectomy. METHODS: Between Jan. 1997 and Mar. 2001, we performed 112 cases of partial hepatectomy and retrospectively analyzed the clinicopathological features of the cases. RESULTS: The most common disease needing hepatic resection was intrahepatic duct stone (46). The mean operative time was 377 minutes. The overall in-hopital mortality and morbidity rates were 6.8% (6/112) and 25% (59/112), respectively. Various postoperative complications developed; 16 wound infections (14.2%), 6 Bile leakage (5.3%), 6 intraabdominal abscess (5.3%), 5 cardiopulmonary complications (4.4%), 2 hepatic failure (1.7%), 2 postoperative bleeding (1.7%). The old had more cardiopulmonary complications. The significant risk factors for perioperative mortality were preoperative serum bilirubin level, alkaline phosphatase, prothrombin time, partial prothrombin time, perioperative transfusion and bleeding. CONCLUSION: This paper presents risk factors of hepatectomy in our hospital. The results state importance of selection of patients and perioperative bleeding managements to reduce of morbidity and mortality of hepatectomy.
Abscess ; Alkaline Phosphatase ; Bile ; Bilirubin ; Cholelithiasis ; Hemorrhage ; Hepatectomy ; Humans ; Liver ; Liver Diseases ; Liver Failure ; Mortality ; Operative Time ; Postoperative Complications ; Prothrombin Time ; Retrospective Studies ; Risk Factors* ; Wound Infection

No abstract available.
Asian Continental Ancestry Group* ; Humans

No abstract available.
Aneurysm, False ; Blood Pressure Monitors ; Blood Pressure ; Compression Bandages ; Humans ; Radial Artery

PURPOSE: Papillary thyroid microcarcinomas (PTMC), which are not palpable and have no clinical symptoms are 1.0 cm or less in diameter. The optimal extent of thyroid tumor resection has been controversial. We investigated clinicopathological findings of PTMC of 5 mm or less in diameter for reasonable therapeutic approach. METHODS: From, Jan. 2002 to Dec. 2006, 366 patients underwent thyroidectomy for thyroid papillary carcinoma at our institution. Among these patients, 62 patients with a mass measuring less than 5 mm and 103 patients with a mass 5 mm to 1.0 cm were selected. We retrospectively reviewed their medical records. RESULTS: There was no significant difference on the clinical characteristics except multifocality. We performed more unilateral lobectomy, near total thyroidectomy with or without neck node dissection in patients with PTMC of less than 5 mm (P=0.13). In permanent biopsy, lymph node metastasis more frequently occurred in patients with PTMC of less than 5 mm (P=0.03). There were no differences in capsular invasion, distant metastasis or recurrence. CONCLUSION: In papillary thyroid microcarcinoma less than 0.5 cm, it is very uncommon for capsular invasion, distant metastasis and locoregional metastasis to exist. The extent of tumor resection may be limited less than near total thyroidectomy for suitable cases, because there was no locoregional metastasis or distant metastasis in the follow-up period. Longer follow-up periods would be required to confirm that limited surgery is sufficient for tumors less than 0.5 cm in size.
Biopsy ; Carcinoma ; Carcinoma, Papillary ; Follow-Up Studies ; Humans ; Lymph Nodes ; Medical Records ; Neck ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy