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Clinical Usefulness of the Methods of Gallbladder Bed Dissection for Treating Acute Cholecystitis.

Seung Jin LEE ; So Young JUNG ; Jae Pil JUNG ; Ji Woong CHO ; Byung Chun KIM

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):118-122.

PURPOSE: Laparoscopic cholecystectomy (LC) for treating acute cholecystitis (AC) is a technically demanding procedure even for experienced surgeons. The purpose of this study is to evaluate the clinical usefulness of the methods of gallbladder bed dissection for patients with acute cholecystitis. METHODS: We reviewed the medical records of 74 patients who were admitted for AC and they underwent early LC with ultrasonic shears dissection (UD) (n=40) or monopolar electrocautery dissection (MD) (n=34) at Kangnam Sacred Heart Hospital from August 2006 to December 2008. We compared many variables between the two methods. RESULTS: The mean operative time in the LC group with UD was 48.3 minutes versus 42.8 minutes for the MD group (p=0.163). The conversion rate was 5.0%, and the postoperative morbidity rate was 12.5% in the UD group, versus an 8.8% conversion rate and an 8.8% morbidity rate in the MD group (p=0.426 and 0.254). CONCLUSION: The use of UD in the dissection of the gallbladder bed has no specific advantage over MD for treating patients with acute cholecystitis, but further investigations are required to confirm this.
Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Electrocoagulation ; Gallbladder ; Heart ; Humans ; Imidazoles ; Medical Records ; Nitro Compounds ; Operative Time ; Ultrasonics

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A Prospective Comparison Study of the Two-port and Three Port Techniques for Performing Laparoscopic Cholecystectomy.

Young KIM ; Tae Wan WON ; Dong Eun PARK ; Kwon Mook CHAE

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):113-117.

PURPOSE: Various methods have evolved for laparoscopic cholecystectomy: the four-port, three-port or two-port methods. Some authors have recently recommended 2 port laparoscopic cholecystectomy as a useful method. We compared the clinical characteristics of the two-port method and the three-port method, and we estimated the usefulness of each method. METHODS: We performed a prospective analysis of 40 patients who underwent laparoscopic cholecystectomy by a single surgeon from September 2008 to January 2009. The two port and 3 port techniques were alternatively done during the study period by one surgeon who had adequate experience with laparoscopic surgery at Wonkwang university hospital. We compared the two groups according to the parameters of the operation time, the intraoperative complications, the conversion rate, the postoperative complications, the postoperative hospital stay, the pain at the trocar sites and the patients' satisfaction. RESULTS: There were significant differences between the two and three port groups in terms of the mean operation time, the conversion rate and the intraoperative events. The mean operation time (2 port; 38.95+/-10 min., 3 port; 23.25+/-5 min.: p<0.01), conversion rate (2 port; 5 cases, 3 port; 0 case: p=0.016) and there were fewer intraoperative events using the three port technique that that of the two port technique (2 port; 14 events, 3 port; 2 events: p<0.01). There were no significant differences of the trocar site pain, the hospital stay and the patients' satisfaction. CONCLUSION: Considering our results, the tree port technique could be regarded as the optimal surgical technique compared to the 2 port technique for performing laparoscopic cholecystectomy, or at least until new instruments for gall bladder traction and new port were not developed.
Cholecystectomy, Laparoscopic ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments ; Traction ; Urinary Bladder

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Laparoscopic Cholecystectomy in Patients with a History of Upper Abdominal Surgery.

Young Sik BAE ; Sang Mok LEE ; Joo Hyun KIM ; Bum Soo KIM ; Sun Hyung JOO

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):108-112.

PURPOSE: Laparoscopic cholecystectomy is currently the treatment of choice for gallbladder disease. Previous abdominal surgery was considered as a relative contraindication for laparoscopic cholecystectomy due to the presence of intraabdominal adhesion and the difficulty in visualization. Several recent studies have suggested that previous abdominal surgery is no longer a contraindication for laparoscopic surgery by virtue of the accumulation of surgeons' experience and the evolution of laparoscopic instruments. In this study, we evaluated the impact of previous upper abdominal surgery on laparoscopic cholecystectomy. METHODS: The data of 706 consecutive patients who underwent laparoscopic cholecystectomy from September 2004 to December 2007 was retrospectively analyzed. Thirty-three patients had undergone pervious upper abdominal surgery and 673 patients had not. We compared the operative time, the type of trocar that was used, the postoperative complications, the frequency of open conversion and the length of the postoperative hospital stay between the two groups RESULTS: The operative time was longer (141.8+/-88.7 min vs. 74.1+/-37.4 min, p<0.001) and larger trocars were used more often (p<0.001) in the previous upper abdominal surgery group. There was no significant difference in the open conversion rate, the major postoperative complication rate and the length of the postoperative hospital stay. CONCLUSION: Laparoscopic cholecystectomy might be an optimal treatment for patients with a history of previous upper abdominal surgery. Previous upper abdominal surgery is not a contraindication for laparoscopic cholecystectomy when it is performed by experienced laparoscopic surgeons.
Cholecystectomy, Laparoscopic ; Gallbladder Diseases ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments ; Virtues

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621 Cases of Laparoscopic Cholecystectomy by a Single Surgeon.

Ha Kyoung PARK ; Yun Sik LEE ; Jin Hyun PARK

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):102-107.

PURPOSE: Laparoscopic cholecystectomy (LC) has been the treatment of choice for acute and chronic disease of the gallbladder. We have performed 621 cases of LC from January 02 2001 to April 30 2008. This study aims to clinically analyze 621 cases of LC that were performed by a single surgeon over a 7 year period and to evaluate the effectiveness and safety of laparoscopic treatment for gallbladder disease. METHODS: From January 02 2001 to April 30 2008, 621 patients underwent LC at the Department of Surgery by a single surgeon. We retrospectively analyzed the patients' ages, gender distribution and chief complaints, the operation times, the duration of hospitalization, the conversion rate to open cholecystectomy and the causes, the diagnostic methods and the postoperative complications through a review of the patients' charts. RESULTS: The mean age was 46 years and the ratio of males to females was 1:1.4. The most common chief complaint was right upper quadrant pain (52.97%). The mean operative time was 67.37 minutes and the duration of hospitalization was 5.12 days and the duration of postoperative hospitalization was 3.86 days. The conversion rate was 3.29% and the most common cause of conversion was anatomic uncertainty due to inflammatory adhesion. Abdominal sonography was the most common diagnostic method and this was performed in 73.27% of the patients. The postoperative complication rate was 1.93%. CONCLUSION: LC has become the gold standard for the treatment of benign gallbladder diseases. We think that LC is effective and safe, and even at a secondary care hospital, if the surgeon has accumulated operative experience and improved operative skill.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Chronic Disease ; Female ; Gallbladder ; Gallbladder Diseases ; Hospitalization ; Humans ; Male ; Operative Time ; Polyenes ; Postoperative Complications ; Retrospective Studies ; Secondary Care ; Uncertainty

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A Comparison of the Oncologic Results after Laparoscopic Abdominoperineal Resection and Ultra-low Anterior Resection with Hand-sewn Coloanal Anastomosis for Treating Distal Rectal Cancer.

Jae Beom SEO ; Gyu Seog CHOI ; Kyoung Hoon LIM ; Min Jung JO ; You Seok JANG ; Jun Seok PARK ; Soo Han JUN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):96-101.

PURPOSE: Abdominoperineal resection (APR) has been regarded as the standard procedure for the treatment of distal rectal cancer since Miles first described it in 1908. But because of the better understanding of the patterns of spreading tumor, the pelvic physiology, the development of stapling devices and introduction of total mesorectal excision (TME), the rate of sphincter preserving surgery has been increasing. The aim of this study is to compare the oncologic outcomes after laparoscopic APR and ultra-low anterior resection with handsewn coloanal anastomosis (CAA) for treating distal rectal cancer. METHODS: Between January 2003 and October 2007, 95 patients who were followed up for more than 2 years after curative laparoscopic APR or CAA for distal rectal cancer were included in this study. The clinical characteristics, pathologic findings, postoperative complications and oncologic results were retrospectively analyzed. RESULTS: There were 31 APRs and 64 CAAs. The median follow-up period was 43 (5~79) months. The mean distance between the lower margin of the tumor and the anal verge was 2.1+/-1.2 cm in APR and 3.7+/-1.4 cm in CAA (p<0.001). There were 2 (6.5%) local recurrences and 8 (25.8%) systemic recurrences after APR and 3 (4.7%) local recurrences and 10 (15.6%) systemic recurrences after CAA, respectively (p=0.641, p=0.161). The 3-year disease-specific survival rate was 86.7% in APR and 93.5% in CAA (p=0.407). The 3-year disease free survival rate was 73.7% in APR and 80.1% in CAA (p=0.161) but there were no significant differences in the oncologic results according to the stages between the two groups. CONCLUSION: The operative procedures are changing toward sphincter preservation. Laparoscopic ultra-low anterior resection and hand-sewn coloanal anastomosis is oncologically as safe as laparoscopic APR for treating lower rectal cancer. However, APR should be considered the standard treatment for distal rectal cancer when it invades the anal sphincter or the levator ani.
Anal Canal ; Congenital Abnormalities ; Disease-Free Survival ; Ear ; Follow-Up Studies ; Humans ; Laparoscopy ; Postoperative Complications ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Survival Rate

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Is Laparoscopic Multivisceral Resection Applicable to Colorectal Cancer Adherent to Adjacent Organs?.

Young Kwang PARK ; Ho Suk LEE ; Ho Geun YOUN ; Chang Kyun PARK ; Duk Won HWANG ; Sang Ik NOH

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):88-95.

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic multivisceral resection of colorectal cancer adherent to adjacent organs. METHODS: We reviewed retrospectively 32 patients undergoing elective laparoscopic multivisceral resection for colorectal cancer adherent to adjacent organs between June 2003 and May 2009. Survival curves were generated by Kaplan-Meier method. RESULTS: The median age of 32 patients was 73 years. In 10 of 17 rectal cancer patients (59%), neoadjuvant chemoradiation was performed. All the surgeries were completed laparoscopically. The postoperative complications occurred in 21.9% and there was no operative mortality. The median length of hospital stay was 15.5 days. In 23 of 32 patients (72%), the resection was considered curative. Median follow-up period of all patients and curatively resected patients was 22 (range, 2~65) months, 34 (range, 4~65) months respectively. Local recurrence rate, the 3-year overall survival rate and the 3-year disease free survival rate of 23 curatively resected patients was 4.3%, 92.9% and 84.4%, respectively. CONCLUSION: Laparoscopic multivisceral resection is feasible and safe in highly selected patients with colorectal cancer adherent to adjacent organs. Further validation is needed.
Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate

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Single Incision Three Ports Laparoscopic Appendectomy.

In Chul MIN ; Dong Ju KIM ; Lee Chan JANG ; Jae Woon CHOI ; Woo Young SUN ; Jun Soo JEONG ; Han Lim CHOI ; Dong Hee RYU

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):84-87.

PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute appendicitis. The laparoscopic appendectomy has the advantages of a more rapid recovery, better cosmetic outcome and reduced postoperative pain compared to the open appendectomy. Several laparoscopic procedures have been described that used two or more trocars. We present the results of a new LA technique that performed through three ports in a single incision. METHODS: A single incision three-port LA was performed in 10 patients. Under general anesthesia, a 5 mm scope (0degrees), 2 mm working port and 5 mm working port were inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a grasper or dissector. The base of the appendix was ligated with an endo-loop two times and cut by scissors. The appendix was then withdrawn through the umbilicus. RESULTS: The average operating time in our series was 69.5+/-23.3 minutes and the median time to discharge 4.5+/-1.9 days. Wound infection developed in two patients. There was no conversion to traditional LA or laparotomy. CONCLUSION: A single incision three port LA was safe and effective for LA. The availability of laparoscopic procedures has expanded the range of options available from which to choose a suitable procedure for individual cases.
Anesthesia, General ; Appendectomy ; Appendicitis ; Appendix ; Cosmetics ; Hand Strength ; Humans ; Pain, Postoperative ; Surgical Instruments ; Umbilicus ; Wound Infection

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Laparoscopic Gastrectomy for Gastric Cancer Patients with Chronic Obstructive Pulmonary Disease.

Jong Jin KIM ; Moon Su LEE ; Ju Hee LEE ; Do Joong PARK ; Hyuk Joon LEE ; Hyung Ho KIM ; Han Kwang YANG

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):78-83.

PURPOSE: The aim of this study was to evaluate the safety of laparoscopic gastrectomy for gastric cancer patients with chronic obstructive pulmonary disease (COPD). METHODS: The medical records of 863 patients who underwent gastrectomy for gastric cancer from January 2007 to December 2008 at Seoul National University Bundang Hospital were retrospectively reviewed. One hundred forty five patients with COPD were divided into the laparoscopic gastrectomy or open gastrectomy groups. The 362 patients who underwent laparoscopic gastrectomy were divided into the COPD or the non-CODP groups. Comparative analysis between each of the two groups was done. RESULTS: Out of 145 patients with COPD, eighty seven patients (60.0%) underwent laparoscopic gastrectomy and 58 patients (40.0%) underwent open gastrectomy. Comparing the laparoscopic gastrectomy group with the open gastrectomy group, there was no significant differences in age, gender, the body mass index, the smoking history, the preoperative general condition, the operation time, the estimated blood loss and the preoperative pulmonary function tests (p>0.05). The postoperative hospital stay was longer in the open gastrectomy group than that in the laparoscopic gastrectomy group (9.1 days vs. 6.8 days, respectively, p<0.001). One patient in the laparoscopic gastrectomy group (1/87, 1.1%) had postoperative pulmonary complications and 6 patients in the open gastrectomy group (6/58, 10.3%) had pulmonary complications (p=0.017). On comparing the COPD with the non-COPD groups for the 363 patients who underwent laparoscopic gastrectomy, there were significant differences in gender, age, a history of tuberculosis, a smoking history, the American Society of Anesthesiologists (ASA) class and the cancer stage. Yet there was no significant difference of the postoperative pulmonary complications (p=1.000) between the groups. CONCLUSION: Laparoscopic gastrectomy can be performed safety for gastric cancer patients with mild COPD and it should be considered as a primary treatment method.
Body Mass Index ; Gastrectomy ; Humans ; Length of Stay ; Medical Records ; Postoperative Complications ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Retrospective Studies ; Smoke ; Smoking ; Stomach Neoplasms ; Tuberculosis

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Laparoscopic versus Open Primary Repair for Perforated Peptic Ulcer.

Kun Moo CHOI ; Ji Hoon KIM ; Jin Ho KWAK ; Hyuk Jai JANG ; Myoung Sik HAN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):74-77.

PURPOSE: Simple closure, regardless of using an omental patch, continues to be the preferred option for many surgeons. It is a easy, quick and safe operation, and it can be applied to all situations by every surgeon. The purpose of this study was to investigate the feasibility of routinely using laparoscopic repair for treating perforated peptic ulcer. METHODS: A retrospective review was carried out on 68 consecutive patients who underwent patch repair for a perforated peptic ulcer; 11 underwent laparoscopic repair and 57 underwent open repair. Laparoscopic repair was performed by one surgeon at the same hospital between March, 2006 and February, 2009. Both groups were compared according to the Mann-Whitney U-test. A p value <0.05 was considered to be significant. RESULTS: Statistical significance (p<0.05) between two groups (laparoscopic vs. open) was present regarding to the postoperative morbidity (0 vs. 16 cases, respectively), the hospital stay (4.8 vs. 12.7 days, respectively), the postoperative day of resuming an oral diet (3 vs. 5.7 days, respectively). The mean operative time of laparoscopic repair (78 minutes) was shorter than that of open repair (82 minutes) but this was not statistically significant (p=0.81). We excluded using a pain scale or assessing the use of analgesics in this study because of the popularity of IV PCA (intravenous patient-controlled analgesia). CONCLUSION: Laparoscopic primary repair is a safe emergency procedure for treating perforated peptic ulcer patients.
Analgesics ; Diet ; Emergencies ; Humans ; Length of Stay ; Operative Time ; Passive Cutaneous Anaphylaxis ; Peptic Ulcer ; Retrospective Studies

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Initial Experience with Laparoscopic Surgery for Treating Upper Gastrointestinal Disease.

Jin Bong YE ; Sung Jin OH ; Boo Hwan HONG ; Dong Hee KIM ; Yeon Soo CHANG ; Jae Hee KANG ; Tae Seok LEE ; Joon Kil HAN

Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons.2009;12(2):68-73.

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.
Constriction, Pathologic ; Deglutition Disorders ; Duodenal Ulcer ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Laparoscopy ; Parkinsonian Disorders ; Retrospective Studies ; Stomach Neoplasms ; Superior Mesenteric Artery Syndrome

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