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Laparoscopic Removal of a Vertebral Foreign Body.

Hee Chul SHIN ; Ju Hee LEE ; Ye Seob JEE ; Do Joong PARK ; Hyung Ho KIM ; Ho Seong HAN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):54-56.

We report a case of laparoscopic removal of a retained foreign body, a broken surgical instrument, after posterior lumbar decompression and interbody fusion (PLIF) for infection control of the vertebrae. The surgical instrument was broken during PLIF surgery. However, the orthopedic surgeon could not remove the broken instrument because of bleeding and a poor operative view; the surgeon finished the operation leaving the broken surgical instrument in the vertebral body. Plain films revealed a metallic pin-like material at the anterior side of the lumbar vertebral body. Six days later, through a laparoscopic approach, the broken surgical instrument was removed without complication, and the orthopedic surgeon completed the planned operation successfully.
Decompression ; Foreign Bodies ; Hemorrhage ; Infection Control ; Laparoscopy ; Orthopedics ; Spine ; Surgical Instruments

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The Incidence of the Occult Contralateral Hernia in Patients Undergoing Total Extraperitoneal (TEP) Repair of a Left Inguinal Hernia.

Choon Sik CHUNG ; Jeong Eun LEE ; Yong Geul JOH ; Sang Hwa YU ; Gyu Young JEONG ; Seung Han KIM ; Dong Keun LEE

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):50-53.

PURPOSE: Laparoscopic herniorrhaphy (LH) can be used to examine the asymptomatic contralateral side and repair occult contralateral hernias coincidentally with reduced morbidity. In this prospective study, we evaluated the results of diagnostic exploration of the right side during total extraperitoneal (TEP) laparoscopic repair of left side inguinal hernias. METHODS: A prospective study of 100 consecutive male patients undergoing TEP repair by a single surgeon (C.S) between January and June 2008 was conducted. Two cases that had transabdominal preperitoneal (TAPP) prosthetic repair and one intraperitoneal onlay mesh (IPOM) were excluded. We routinely explored the contralateral side to determine the incidence of right side occult hernia. RESULTS: The mean age was 52 (range; 18~82 years). Among the 100 patients, 17 had bilateral, 52 right and 31 left hernias on physical examination prior to surgery. Three of 31 diagnosed preoperatively as left inguinal hernia were confirmed to have occult right hernias (3/31, 9.7%). Among the three patients, two patients with a direct type had the same type of hernia as on the contralateral side (2/10, 20%). Another one patient with an indirect type had direct type of hernia on the contralateral side (1/21, 4.8%). CONCLUSION: Given the low incidence of contralateral side occult hernia with indirect types of hernias, routine exploration may not be indicated during TEP repair. However, it might be, reasonable to explore the contralateral side in patients with a direct type of hernia because of the higher incidence of contralateral occult hernias.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Incidence ; Inlays ; Male ; Physical Examination ; Prospective Studies ; Pyrazines

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Laparoscopic Totally Extraperitoneal Herniorrhaphy: Is it Feasible for Recurrent Inguinal Hernias?.

Zisun KIM ; Sung Woo CHO ; Yong Jin KIM ; Dongho CHOI ; Gil Ho KANG ; Dan SONG ; Jae Joon KIM ; Kyung Yul HUR

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):44-49.

PURPOSE: Laparoscopic totally extraperitoneal (TEP) herniorrhaphy is an effective surgical technique for recurrent inguinal hernia. The recent introduction of various types of prosthetic mesh and the technical improvements in laparoscopic herniorrhaphy have allowed this modality to be used for various types of recurrent inguinal hernias, although careful selection of surgical techniques is required according to the patient's condition and the type of previous surgery. METHODS: One thousand and thirty cases were scheduled to undergo laparoscopic TEP herniorrhaphies from December of 2000 to August of 2008. We retrospectively collected and analyzed the data on the patient characteristics, the types of hernia, the number of previous recurrences, the operating technique, the operating time, the postoperative hospital stay and the postoperative complications. RESULTS: A total of 86 herniorrhaphies were performed in 83 patients with recurrent inguinal hernias. The mean patient age was 50.4 years. The total number of recurrences among the 83 patients was 118 cases and the number of recurrences was as follows: 1st in 65 patients, 2nd in 12 patients, 3rd in 7 patients and 4th in 2 patients. Eighty one laparoscopic TEP herniorrhaphies were performed, and 5 cases were performed by laparoscopic transabdominal preperitoneal repair or laparoscopic intraperitoneal onlay mesh repair. The mean operative time was 29.9 minutes, and there was no statistical correlation between the type of prior herniorrhaphy and the operative time. The mean postoperative hospital stay was 0.9 days and no major complications occurred. CONCLUSION: Selecting the type of surgery to perform for treating recurrent inguinal hernia has become complicated due to many recent diversified techniques of herniorrhaphy. Although laparoscopic TEP herniorhaphy is effective for treating recurrent inguinal hernia, a meticulous approach and various surgical techniques are required when prosthetic mesh has been previously placed on the preperitoneal space.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Inlays ; Length of Stay ; Operative Time ; Postoperative Complications ; Pyrazines ; Recurrence ; Retrospective Studies

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Laparoscopic Colectomy: Technical Considerations.

Yu Gene OH ; Yeong Cheol IM ; Dae Hwa CHOI ; Hee Jeong CHA

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):37-43.

PURPOSE: Laparoscopic colectomy is technically demanding. Here we share of experience with laparoscopic procedures with focusing on (1) preoperative localization by a colonoscopic tattoo and (2) comparing the laparoscopic total mesorectal excision (lapaTME) with the conventional TME (openTME) according to microscopic examination. METHODS: We retrospectively collected 112 cases of laparoscopic colectomy that was performed for treating colorectal cancer during the past 6 years. Preoperative colonoscopic tattoo was done by using india ink. The tattoo cases were compared with the non-tattoo cases. Comparison between 13 cases of lapaTME and 15 cases of openTME was assessed by both gross and microscopic examination in the 28 cases for 9 months. The lapaTME and openTME were applied to mid-rectal cancer and mid&low rectal cancer, respectively. RESULTS: Tattoo was carried out for the Tis (100%), T1 (92%), T2 (72%), T3 (36%) cases. Of the significant cases, T3 lesion was not identified at laparoscopic colectomy. LapaTME grossly showed a greater incidence of defect than that of openTME, but there was no difference microscopically between lapaTME and openTME. CONCLUSION: A tattoo was useful for early lesion and it should be considered for advanced lesion. LapaTME for mid-rectal cancer can be done without compromising the principles of TME.
Carbon ; Colectomy ; Colorectal Neoplasms ; Incidence ; India ; Ink ; Laparoscopy ; Rectal Neoplasms ; Retrospective Studies

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Clinical Analysis and Laparoscopic Surgical Experience for an Appendiceal Mucocele.

Eun Young CHANG ; Jong Hoon PARK ; Jung Ahn RHEE ; Hae Chang CHO ; Mi Jin GU

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(1):31-36.

PURPOSE: A mucocele of the appendix is an infrequent entity of appendiceal pathology. A preoperative diagnosis is important to determine for appropriate treatment and to avoid unintended rupture of the mucocele during surgery. The purpose of our study was to identify the clinical features of an appendiceal mucocele (AM) and to describe the experience of the use of the laparoscopic approach for an AM. METHODS: Between July 1998 and July 2008, 32 cases of AM were diagnosed. We reviewed the clinicopathological characteristics and surgical experience for an AM. RESULTS: The incidence of an AM was 0.66% for 4825 performed appendectomies. Most cases manifested with symptoms of abdominal pain (84.4%), but two cases were determined based on CT incidental findings. A preoperative diagnosis of a mucocele was determined for 34.4% of the cases. The use of ultrasonography, CT and colonoscopy helped to achieve a correct diagnosis. Open surgery was performed in 15 cases and laparoscopic surgery was performed in 17 cases. For patients that underwent an appendectomy, the mean operation time and diet-start date were significantly shorter for patients that underwent laparoscopic surgery as compared to patients that underwent open surgery (p=0.030, p=0.007, respectively). Pathology identified mucosal hyperplasia (25%), mucinous cystadenoma (59.4%) and a simple mucocele (15.6%). The mean duration of follow-up was 46 months. Recurrence or development of pseudomyxoma peritonei and complications after laparoscopic surgery were not seen. CONCLUSION: Laparoscopic resection of an AM was feasible when there was no mucinous spillage. Close follow-up is recommended in all patients due to the risk of recurrence in the form of pseudomyxoma peritonei or a gastrointestinal neoplasm.
Abdominal Pain ; Appendectomy ; Appendix ; Colonoscopy ; Cystadenoma, Mucinous ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Humans ; Hyperplasia ; Incidence ; Incidental Findings ; Laparoscopy ; Mucins ; Mucocele ; Pseudomyxoma Peritonei ; Recurrence ; Rupture

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Laparoscopic versus Open Appendectomy in Pregnancy.

Hong Kyu JUNG ; Jun Chul CHUNG ; Gyu Seok CHO ; Eung Jin SHIN ; Chul Wan LIM ; Hyung Chul KIM ; Ok Pyung SONG

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2010;13(2):54-58.

PURPOSE: Although laparoscopic appendectomy is a safe and effective procedure for the management of acute appendicitis, laparoscopic appendectomy in pregnancy has not been considered the preferred procedure until recently. The aim of this study was to evaluate the safety of laparoscopic appendectomy (LA) during pregnancy as compared with the control group that underwent open appendectomy (OA) during pregnancy. METHODS: The clinical data of all the patients who underwent appendectomy during pregnancy at our hospital between 2006 and 2009 was collected and retrospectively analyzed. Nineteen patients underwent LA and 11 patients underwent OA. The general features of the cases, the outcomes and the fetal status were evaluated. RESULTS: There were no significant differences in the length of the procedure, the hospital stay and the complication rate between the LA and OA groups. All the laparoscopic procedures were completed without conversion to an open operation. There were no significant differences between the two groups for premature delivery, the delivery type and the birth weight. There were no fetal losses or abortions. CONCLUSION: Our results demonstrate that LA was not inferior to OA in terms of the operative outcomes, the complication and both the fetal and maternal safety during 1st and 2nd trimesters of pregnancy. LA could be safely performed even in the 1st and 2nd trimesters of pregnancy using careful patient selection, safe operative techniques and the appropriate application of instruments.
Appendectomy ; Appendicitis ; Birth Weight ; Humans ; Length of Stay ; Patient Selection ; Pregnancy ; Retrospective Studies

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Laparoscopic Repair with Omental Patch for Perforated Duodenal Ulcer.

Youngjoo SEO ; Junhyun LEE ; Wook KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2010;13(2):49-53.

PURPOSE: Laparoscopic surgery is now being applied to most abdominal surgeries. We evaluated the surgical outcomes of laparoscopic primary repair with an omental patch for treating perforated duodenal ulcer as compared to that of open surgery. METHODS: A total of 124 consecutive patients who underwent repair of perforated peptic ulcer from January 2000 to February 2009 were included in the study. The surgical outcomes that were evaluated were the operation time, the use of intravenous/intramuscular analgesics, the complication rate, the hospital stay and the postoperative endoscopic findings. RESULTS: 124 patients underwent surgical repair for perforated peptic ulcer disease (81 open repairs and 43 laparoscopic repairs). The mean age was 43.7+/-16.6 in the laparoscopic group and 45.7+/-18.3 in the open group, respectively (p=0.55). Laparoscopic repair had a similar operation time as open repair (110.4+/-37.5 minutes vs 101.2+/-30.8 minutes p=0.149, respectively). There were statistical differences for the hospital stay (7.8+/-3.0 days laparoscopy vs 9.9+/-4.0 days open; p=0.004) and the need for analgesics (range; 0~17 open vs 0~16 laparoscopic; p=0.026). But the complication rate was not significant different in both group (2.3% open vs 12.3% laparoscopic; p=0.062). CONCLUSION: Laparoscopic repair is a feasible and safe surgical option for patients with perforated peptic ulcer and it is an excellent alternative to open procedure when performed by experienced hands.
Analgesics ; Duodenal Ulcer ; Hand ; Humans ; Laparoscopy ; Length of Stay ; Peptic Ulcer

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Role of First Assistant on Laparoscopy-assisted Distal Gastrectomy for Gastric Cancer Patients.

Song I YANG ; Kyung Won SEO ; Ki Young YOON ; Seung Ho CHOI

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2010;13(2):43-48.

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has become a feasible and acceptable surgical technique for treating early gastric cancer. However, there are no reports about the role of the first assistant on LADG. The aim of this study is to compare between an experienced first assistant and an inexperienced first assistant surgeon for conducting LADG to treat early gastric cancer. METHODS: The data from 32 consecutive patients with early gastric cancer and who underwent LADG by one surgeon between May 2008 and December 2008 was reviewed. The operation times of 32 consecutive patients were reviewed. Other indicators such as the transfusion requirements, the time to first flatus, and the postoperative hospital stay were also evaluated between an experienced first assistant and an inexperienced first assistant surgeon. RESULTS: No significant differences between an experienced first assistant and an inexperienced first assistant surgeon in terms of the patients' clinicopathologic characteristics and surgical outcomes were found, but there was a statistically significant difference in the operation times between the two groups. CONCLUSION: After the operator has overcome the learning curve and standardization has been established, LADGs are minimally affected by the role of the first assistant.
Flatulence ; Gastrectomy ; Humans ; Learning Curve ; Length of Stay ; Stomach Neoplasms

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Robotic Roux-en-Y Gastric Bypass and Robotic Sleeve Gastrectomy for Morbid Obesity: Case Reports.

Do Joong PARK ; Sang Hoon AHN ; Ju Hee LEE ; Hyung Ho KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2011;14(2):114-117.

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

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Laparoscopic Resection of an Asymptomatic Intra-Abdominal Lymphangioma.

Kee Hoon HYUN ; Jun Ho PARK ; Su Yun CHOI ; Won Hyuk CHOI ; Jin Cheol JEONG ; Doo Jin KIM ; Joo Seop KIM ; Samuel LEE

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2011;14(2):111-113.

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

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