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Transanal Total Mesorectal Excision for Low Rectal Cancer.

Chang Woo KIM ; Yoona CHUNG ; Sun Jin PARK ; Kil Yeon LEE ; Suk Hwan LEE

Journal of Minimally Invasive Surgery.2016;19(2):79-80. doi:10.7602/jmis.2016.19.2.79

A 70-year-old female patient was diagnosed with low rectal adenocarcinoma (cT3N2) based on the initial CT and MRI. The patient underwent neoadjuvant chemoradiotherapy consisting of short course radiotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) chemotherapy. Three additional cycles of simplified infusional 5-FU/LV were given every 2 weeks to the patient during the resting period (8 weeks) before surgery. For transanal TME, a purse-string suture of the distal rectum was performed just above the dentate line. Transanal circumferential dissection including the mesorectum was performed from the dentate line until the peritoneal reflection. Thereafter, laparoscopic dissection was conducted using the medial to lateral approach and the inferior mesenteric artery was ligated at the pedicle. Lateral detachment and splenic flexure mobilization were completed. After full mobilization of the distal transverse colon and rectum, the specimen was retrieved through the anus and resected. Colo-anal anastomosis was performed by the hand-sewn method. A closed suction drain was inserted into the pelvis. We also demonstrate our procedure for transanal TME using a short video clip.
Adenocarcinoma ; Aged ; Anal Canal ; Chemoradiotherapy ; Colon, Transverse ; Drug Therapy ; Female ; Fluorouracil ; Humans ; Leucovorin ; Magnetic Resonance Imaging ; Mesenteric Artery, Inferior ; Methods ; Pelvis ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Suction ; Sutures

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Three Dimensional Laparoscopy Improves Surgical Performance: Comparative Study in a Cadaver.

Jin Kwon LEE ; Suk Hwan LEE ; Jun Gi KIM ; Yoon Suk LEE ; Kil Yeon LEE ; Sun Jin PARK ; Bong Hyeon KYE ; Sang Chul LEE ; Sang Woo LIM

Journal of Minimally Invasive Surgery.2016;19(2):75-78. doi:10.7602/jmis.2016.19.2.75

PURPOSE: Conventional laparoscopy using a two-dimensional (2D) has limited performance because of insufficient representation of the stereoscopic effect. Development of three-dimensional (3D) imaging technology has improved depth perception, shortened the execution time and reduced error number. This study was designed to identify the effects of 3D imaging on surgical performance for skilled professionals and surgical residents. METHODS: Two laparoscopic skills tasks, each with three repetitions, were performed by seven experienced laparoscopic surgeons, two minimally experienced laparoscopic surgeons, and three inexperienced surgical residents under both 2D and 3D conditions with two cadavers. Outcome measures were time for task completion and subjective assessment of performance. RESULTS: Suturing was completed by all participants and anchoring with V-Loc was performed by 10 participants. Suturing and anchoring time were significantly shorter with 3D laparoscopic in all participants (suturing time, p=0.011; anchoring time, p=0.005). Significant differences were observed between experienced and minimally experienced surgeons (suture time, p=0.021; anchoring time, p=0.018). There was no significant difference among inexperienced surgical residents, but they preferred 3D imaging over 2D. CONCLUSION: 3D laparoscopy is associated with a significantly shorter time for performance by experienced surgeons. Our results suggest that 3D laparoscopy will be helpful for surgeons conducting laparoscopic procedures.
Cadaver* ; Depth Perception ; Imaging, Three-Dimensional ; Laparoscopy* ; Outcome Assessment (Health Care) ; Surgeons

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What is the Safe Training to Educate the Laparoscopic Cholecystectomy for Surgical Residents in Early Learning Curve?.

Yun Kyung JUNG ; Yong Jin KWON ; Dongho CHOI ; Kyeong Geun LEE

Journal of Minimally Invasive Surgery.2016;19(2):70-74. doi:10.7602/jmis.2015.19.2.70

PURPOSE: This study was conducted to investigate the safety of laparoscopic cholecystectomy (LC) performed by surgical residents. METHODS: We reviewed the records of patients who underwent LC for chronic cholecystitis and gallbladder polyps between February 2010 and July 2012. All diagnoses were confirmed by biopsy. All procedures performed by surgical residents were conducted under the close supervision of an experienced laparoscopic surgeon. A standard four-port method was used, and we achieved the critical view of safety in almost all patients. RESULTS: Of 219 LC procedures, 136 were performed by an experienced laparoscopic surgeon, and 83 by surgical residents. There was no significant difference in postoperative hospital stay (1.1 vs. 1.2 days, p=0.337) or complication rates (3.7% vs. 2.4%, p=0.712) between groups. However, the patients operated on by surgical residents had significantly longer operation times (40.7 vs. 63.7 min, p<0.05). CONCLUSION: LC performed by inexperienced surgical residents under the supervision of an experienced surgeon is safe and feasible for chronic cholecystitis and gallbladder polyps. Major bile duct injury is strongly correlated with having performed fewer than 20 LC procedures, so surgical residents must secure the critical view of safety, and the supervising surgeon must confirm it before the cystic duct and cystic artery are ligated.
Arteries ; Bile Ducts ; Biopsy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cystic Duct ; Diagnosis ; Gallbladder ; Humans ; Learning Curve* ; Learning* ; Length of Stay ; Methods ; Organization and Administration ; Polyps

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The Benefits of Percutaneous Transhepatic Gallbladder Drainage prior to Laparoscopic Cholecystectomy for Acute Cholecystitis.

Byeonghun OH ; Eunyoung KIM ; Eun Jeong AHN ; Jong Min PARK ; Sei Hyeog PARK

Journal of Minimally Invasive Surgery.2016;19(2):63-69. doi:10.7602/jmis.2016.19.2.63

PURPOSE: Several studies have reported that laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) is associated with a reduced duration of surgery and a lower rate of conversion to open laparotomy compared with laparoscopic cholecystectomy without PTGBD and delayed laparoscopic cholecystectomy after conservative therapy. However, these results are contradictory. This retrospective study investigated the safety and usefulness of laparoscopic cholecystectomy combined with pre-operative PTGBD in patients with acute cholecystitis. METHODS: The clinicopathologic data and surgical outcomes of 101 patients who underwent laparoscopic cholecystectomy between January 2010 and September 2015 were reviewed retrospectively. RESULTS: Patients in the PTGBD group vs. the non-PTGBD group were significantly older (mean age: 65.47±12.2 vs. 56.32±13.7; p=0.001). Underlying diseases were also significantly more common in the PTGBD group (75.4% vs. 45.5%; p=0.002). There were no significant differences between the two groups in terms of operative time, blood loss, rate of open conversion, postoperative oral intake, and postoperative hospital stay. Total hospital day was significantly longer in the PTGBD group (11.14±7.22 vs. 6.23±5.17; p=0.049). There was no significant difference in the postoperative complications between the two groups, and all patients in this study lived. CONCLUSION: This study suggested that satisfactory results can be achieved with selective preoperative PTGBD in older and sicker patients with acute cholecystitis.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Drainage* ; Gallbladder* ; Humans ; Laparotomy ; Length of Stay ; Operative Time ; Postoperative Complications ; Retrospective Studies

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The Usefulness of Critical Pathway in Laparoscopic Cholecystectomy.

Jae Uk CHONG ; Jung Bum CHOI ; Mi Ae SEO ; Su Ji LEE ; Ja Hye CHEON ; Kyung Sik KIM

Journal of Minimally Invasive Surgery.2016;19(2):57-62. doi:10.7602/jmis.2016.19.2.57

PURPOSE: Under the rising demand of health services, the critical pathway (CP) which standardizes the practice guideline was introduced as a means to provide quality healthcare service. CP may increase the patient's satisfaction rate by providing systematic and consistent service. We aimed to evaluate the significance of CP by development and application of CP to patients undergoing laparoscopic cholecystectomy. METHODS: From June 2010 to July 2011, 148 patients underwent elective laparoscopic cholecystectomy. Patients were divided into two groups, including 57 patients in the CP group and 91 patients in the non-CP group. In a retrospective review, related hospital costs were analyzed and compared for both groups. Survey results on satisfaction for the CP group were also analyzed. RESULTS: The mean age was 22.7 years in the CP group and 37.9 years in the non-CP group. Number of hospitalized days was one day for the CP group and 2.51 days for the Non-CP group with p<0.001. In cost analysis all variables showed a significant reduction in the CP group compared to the Non-CP group. The satisfaction rate in the CP group scored 8 points out of 10. CONCLUSION: Results have shown benefit from the financial point of the view for the CP group. Current inclusion criteria for CP are limited and still in development for a solid protocol. Further efforts with a large-scale comparative study to broaden the indication for CP are desired.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Costs and Cost Analysis ; Critical Pathways* ; Delivery of Health Care ; Health Services ; Hospital Costs ; Humans ; Retrospective Studies

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Natural Orifice Transluminal Endoscopic Surgery in Korea.

Dae Kyung SOHN

Journal of Minimally Invasive Surgery.2016;19(2):52-56. doi:10.7602/jmis.2016.19.2.52

Natural orifice transluminal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgical techniques with flexible endoscopy technology. Surgical treatment has been in constant evolution in the search for minimizing incisions, regardless of the complexity of the operation. NOTES represents another step in this ongoing progression toward less invasive procedures. The advantages of such an approach include reduced incisional pain, decreased wound complications, such as infections and hernias, improved cosmetic results, and potentially faster recovery and return to work. Until substantial improvement in NOTES instrumentation are made to optimize this approach, these procedures are likely to require laparoscopic assistance. Critics challenge the safety and advantages of this technique in the face of effective minimally invasive surgical options such as laparoscopic surgery. Here, we discuss the current NOTES status and techniques.
Endoscopy ; Hernia ; Korea* ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Natural Orifice Endoscopic Surgery* ; Return to Work ; Wounds and Injuries

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Single Port Gastrectomy for Gastric Cancer.

Sang Hoon AHN ; Do Joong PARK ; Hyung Ho KIM

Journal of Minimally Invasive Surgery.2016;19(2):45-51. doi:10.7602/jmis.2016.19.2.45

Laparoscopic gastrectomy for gastric cancer has been used for more than 20 years, and gastric cancer treatment is now shifting to a new era because of innovations in surgical instruments and technical advances. Single port gastrectomy (SPG) for gastric cancer has recently been introduced in Korea and Japan. SPG is the ultimate reduced port technique in the view of surgical approaches because the operation is performed through a single incision in the abdominal wall. The first case of SPG was reported in 2010 by Omori and the first case in Korea was reported in 2011 by Park. Because of its short history, the benefits of laparoscopic gastrectomy have not yet been fully evaluated. This review describes the current situation, challenges and the future perspectives of single port laparoscopic gastrectomy for gastric cancer.
Abdominal Wall ; Gastrectomy* ; Japan ; Korea ; Laparoscopy ; Stomach Neoplasms* ; Surgical Instruments

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To Minimize Post-operative Pain in Inguinal Hernia Repair: Single-port Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair without Fixation of the Mesh.

Ji Hoon KIM

Journal of Minimally Invasive Surgery.2016;19(2):43-44. doi:10.7602/jmis.2016.19.2.43

No abstract available.
Hernia, Inguinal*

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Laparoscopic Versus Open Pyloromyotomy for Hypertrophic Pyloric Stenosis.

Heonjin JUNG ; Ji Hoon JANG ; A Hae JO ; Soo Hong KIM ; Sung Eun JUNG ; Kwi Won PARK ; Hyun Young KIM

Journal of Minimally Invasive Surgery.2013;16(1):11-14. doi:10.7602/jmis.2013.16.1.11

PURPOSE: Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that causes severe projectile non-bilious vomiting in the first few months of life. Although open pyloromyotomy is the standard treatment for HPS, recently, the laparoscopic approach has rapidly been adopted by pediatric surgeons. The aim of this study is to determine the efficacy and safety of laparoscopic pyloromyotomy by comparing the clinical results of laparoscopic and open pyloromyotomy. METHODS: Between January 2007 and September 2012, a cohort of 69 children who underwent pyloromyotomy at Seoul National University Children's Hospital were followed; open pyloromyotomy (OP, n=56) and laparoscopic pyloromyotomy (LP, n=13). A retrospective analysis of patient's characteristics and clinical outcomes in patients with open or laparoscopic pyloromyotomy for HPS was performed. The evaluated characteristics included gestational age, sex, birth weight, age and weight at operation. Clinical outcomes included operation time, length of hospital stay, time to postoperative full feeds without vomiting, number of postoperative vomiting and complications. RESULTS: There were no significant differences in characteristics, length of hospital stay and time to postoperative full feeds without vomiting between the two groups. Incidence of postoperative vomiting in the LP group was significantly lower than that in the OP group (OP: 5.07+/-4.60 vs. LP: 2.00+/-2.16, p=0.035). In contrast, the operation time was longer, following the LP group (OP: 26.30+/-9.95 vs. LP: 44.15+/-19.56, p<0.001). Complications such as perforation of mucosal layer (OP: 2 vs. LP 1, p>0.999) and wound problems (OP: 4 vs. LP 1, p>0.999) were found to be similar in both groups. CONCLUSION: Both open and laparoscopic pyloromyotomy are safe procedures for the management of hypertrophic pyloric stenosis. Incidence of vomiting was statistically superior in the laparoscopic group. In addition, postoperative complications were fewer in this group. However, an improvement in the operation time will be needed for the future development of laparoscopic pyloromyotomy.
Birth Weight ; Child ; Cohort Studies ; Gestational Age ; Humans ; Incidence ; Infant ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Postoperative Nausea and Vomiting ; Pyloric Stenosis, Hypertrophic ; Retrospective Studies ; Vomiting

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Study on the Feasibility and the Safety of Hem-o-lok Clipping for Complicated Acute Appendicitis during Laparoscopic Appendectomy.

Ki Hyun KIM ; Si Hak LEE ; Kwang Ho YANG ; Sun Hwi HWANG

Journal of Minimally Invasive Surgery.2013;16(1):6-10. doi:10.7602/jmis.2013.16.1.6

PURPOSE: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis. METHODS: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness. RESULTS: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group. CONCLUSION: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.
Appendectomy ; Appendicitis ; Appendix ; Hospital Costs ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

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