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Robotic Central Pancreatectomy with Pancreaticojejunostomy for Solid Pseudopapillary Neoplasm.

Jin Woo LEE ; Juno YOO ; Ji Wool KO ; Sung Hoon CHOI

Journal of Minimally Invasive Surgery.2017;20(2):74-76. doi:10.7602/jmis.2017.20.2.74

PURPOSE: Minimally invasive central pancreatectomy has rarely performed because of its technical difficulty. Robot system enhances surgical dexterity to perform such complex procedures. METHODS: A 29-year-old woman was admitted with acute cholecystitis and an 1.4 cm enhancing mass was incidentally found at the pancreatic proximal body on computed tomography. Preoperative image studies suggested a neuroendocrine tumor or solid pseudopapillary neoplasm. The patient underwent robotic cholecystectomy and central pancreatectomy with pancreaticojejunostomy. RESULTS: The total operation time was 280 minutes and the estimated amount of intraoperative bleeding was 100 ml. The postoperative recovery was uneventful and she was discharged on the 7(th) postoperative day. Pathologic examination reported a solid pseudopapillary neoplasm. CONCLUSION: The technical difficulties associated with the procedure can be overcome with the help of the wrist-like movement of the robotic instruments, especially for the preservation of splenic vessels and for creating precise anastomoses in narrow spaces.
Adult ; Cholecystectomy ; Cholecystitis, Acute ; Female ; Hemorrhage ; Humans ; Neuroendocrine Tumors ; Pancreatectomy* ; Pancreatic Neoplasms ; Pancreaticojejunostomy* ; Robotic Surgical Procedures

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Laparoscopic Approach for Pancreatic Leiomyosarcoma with Metachronous Liver Metastasis.

Woohyung LEE ; Jae Yool JANG ; Soon Chan HONG ; Chi Young JEONG

Journal of Minimally Invasive Surgery.2017;20(2):69-73. doi:10.7602/jmis.2017.20.2.69

Although pancreatic leiomyosarcoma (PLM) is a rare malignant pancreatic cancer, it usually shows aggressive biological features such as invasion to an adjacent organ or distant metastasis at the time of diagnosis. Radical resection is the best treatment modality but effective chemotherapies have not been identified. A 58-year-old female was referred to us complaining of intermittent left upper quadrant abdominal discomfort. Imaging studies revealed a 10-cm mass in the pancreatic tail. The patient underwent laparoscopic distal pancreatectomy with splenectomy, and the pathological findings were consistent with PLM. Imaging studies 14 months after surgery revealed multiple liver metastases. Because the patient was young with a sufficient remnant liver, we performed laparoscopic metastatectomy without any postoperative complications. Patients with PLM need frequent check-ups, even after curative resection. The role of laparoscopic resection should be confirmed in the future.
Diagnosis ; Drug Therapy ; Female ; Humans ; Laparoscopy ; Leiomyosarcoma* ; Liver* ; Middle Aged ; Neoplasm Metastasis* ; Pancreatectomy ; Pancreatic Neoplasms ; Postoperative Complications ; Splenectomy ; Tail

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Single Incision Laparoscopic Cholecystectomy without a Camera Operator.

YoungRok CHOI ; Ho Seong HAN ; Yoo Seok YOON ; Jae Young CHO ; Jae Yool JANG ; Han Lim CHOI ; Jae Seong JANG ; Seong Uk KWON ; Sungho KIM ; Jangkyu CHOI

Journal of Minimally Invasive Surgery.2017;20(2):63-68. doi:10.7602/jmis.2017.20.2.63

PURPOSE: This study aimed to evaluate the implementation of solo surgery using a laparoscopic scope holder for single incision laparoscopic cholecystectomy (SILC). METHODS: With a glove port and a flexible high-definition scope, SILC was performed through a single trans-umbilical incisional site with CO2 pneumoperitoneum at a pressure of 12 mmHg. Fifty-eight patients who underwent solo SILC using a scope holder (Solo-SILC) were compared to 15 patients who underwent camera operator-assisted SILC (Ca-SILC) in terms of intraoperative and postoperative outcomes. RESULTS: The mean BMI and operation time were 23.0±3.6 kg/m² and 64.4±16.6 min in Ca-SILC and 25.0±3.8 kg/m² and 58.2±27.1 min in Solo-SILC, respectively (p=0.067 and p=0.410). Estimated blood loss was negligible and an additional assistant port was not required in either groups. A case of gallbladder perforation and bile leak was noted in the Ca-SILC group, and 13 cases of bile leak in the Solo-SILC group, with no significant differences (p=0.167) during the surgery. Postoperative outcomes including surgical complications, diet restriction, diarrhea and hospital stay were not significantly different except for shoulder pain (p<0.001). CONCLUSION: Even with the limitations of a small number of patients, Solo-SILC proved to be a feasible technique. To confirm the safety of solo-SILC, further studies with a larger sample size are required.
Bile ; Cholecystectomy, Laparoscopic* ; Diarrhea ; Diet ; Gallbladder ; Humans ; Length of Stay ; Minimally Invasive Surgical Procedures ; Pneumoperitoneum ; Sample Size ; Shoulder Pain

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Laparoscopic Choledochal Cyst Excision and Hepaticojejunostomy: A Case Series.

Eun jung KOO ; Eunyoung JUNG ; Soon Ok CHOI

Journal of Minimally Invasive Surgery.2017;20(2):58-62. doi:10.7602/jmis.2017.20.2.58

PURPOSE: Choledochal cysts are congenital dilatations of the biliary tract and are generally surgically excised. Laparoscopic total excision of choledochal cysts and hepaticojejunal biliary tract reconstruction has gained acceptance among pediatric surgeons. We report our early experience with this procedure. METHODS: From May 2013 to April 2016, 10 consecutive patients (7 females and 3 males) underwent laparoscopic choledochal cyst excision and hepaticojejunostomy at our center. We retrospectively reviewed their medical records for age, sex, clinical symptoms, Todani classification, anomalous pancreaticobiliary duct union, operative time, starting day for enteral feeding, complications, and hospital stay. RESULTS: The median patient age was 22 months. Four patients were aged less than 6months, 3 of whom received prenatal diagnosis using ultrasonography. Patients presented with abdominal pain, jaundice, vomiting and fever. No abdominal mass was palpated in any patient. One patient was classified as Todani type Ia, 4 as Ic, and 5as IVa. Six patients had an anomalous pancreaticobiliary duct union. The mean operative time was 319.4 minutes. There were no surgery-related complications. Sips of water were allowed from mean postoperative day 2.4 and regular diet from mean postoperative day 3.4. The mean hospital stay was 6.5 days. CONCLUSION: Laparoscopic excision of choledochal cyst and hepaticojejunostomy in children is feasible with favorable cosmesis.
Abdominal Pain ; Biliary Tract ; Child ; Choledochal Cyst* ; Classification ; Diet ; Dilatation ; Enteral Nutrition ; Female ; Fever ; Humans ; Jaundice ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Prenatal Diagnosis ; Retrospective Studies ; Surgeons ; Ultrasonography ; Vomiting ; Water

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Oncoplastic Thyroid Surgery Using A Bilateral Axillo-Breast Approach.

Chan Yong SEONG ; Hyeong Won YU ; Young Jun CHAI ; Kyu Eun LEE

Journal of Minimally Invasive Surgery.2017;20(2):51-57. doi:10.7602/jmis.2017.20.2.51

Since the first use of the robot da Vinci system for thyroid surgery in 2007, robotic thyroidectomy (RT) via a bilateral axillo-breast approach (BABA) has become a popular surgical alternative for patients who wish to avoid scars on the neck. BABA RT provides excellent cosmetic satisfaction with surgical safety and oncologic completeness. Recently, the use of BABA RT has expanded beyond benign thyroid nodules and small-sized papillary thyroid carcinoma (PTC) to Graves' disease, relatively large PTCs, and PTC with lateral neck metastasis. Unfortunately, there are concerns about the use of this procedure for these additional indications. This review article summarizes postoperative outcomes of BABA RT for thyroid carcinoma, including quality of life, as well as expanding indications for BABA RT.
Cicatrix ; Graves Disease ; Humans ; Laryngeal Nerves ; Neck ; Neoplasm Metastasis ; Quality of Life ; Robotic Surgical Procedures ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

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Outcomes of Laparoscopic Versus Open Left Lateral Sectionectomy; Single Center Experience; A Initiative to Be the Ground for Evidence.

YoungRok CHOI ; Yoo Seok YOON

Journal of Minimally Invasive Surgery.2017;20(2):49-50. doi:10.7602/jmis.2017.20.2.49

No abstract available.
Humans ; Hepatectomy ; Retrospective Studies ; Prospective Studies ; Length of Stay ; Living Donors ; Patient Selection ; Abdominal Wall ; Tissue and Organ Harvesting ; Neoplasms ; Liver Cirrhosis

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Technical Compensation for Hepatic Vein Injury during Robotic Single Site Cholecystectomy.

Jae Uk CHONG ; Myung Jae JUNG ; Chang Moo KANG

Journal of Minimally Invasive Surgery.2016;19(3):115-116. doi:10.7602/jmis.2016.19.3.115

This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.
Cholecystectomy* ; Compensation and Redress* ; Gallbladder ; Hepatic Veins* ; Humans ; Intraoperative Complications ; Liver ; Male ; Middle Aged ; Needles ; Polypropylenes ; Robotic Surgical Procedures ; Sutures

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What Are the Risk Factors for Complication in Transumbilical Single-Port Appendectomy?.

Hee Sung LEE ; Yong Hae BAIK ; In Woong HAN ; Won Yong CHOI ; Beom Seok KWAK ; Young Jin PARK ; Min Gu OH ; Hong Yong KIM

Journal of Minimally Invasive Surgery.2012;15(4):138-144. doi:10.7602/jmis.2012.15.4.138

PURPOSE: Along with the development of minimally invasive surgery, laparoscopic surgery has recently been adopted worldwide. In cases of laparoscopic appendectomy, single port appendectomy is increasingly being adopted due to its cosmetic advantages and reduced pain. This study was conducted to evaluate the risk factors associated with post-operative complications in single port appendectomy. METHODS: Forty-nine consecutive patients who underwent transumbilical single port appendectomy (TUSPLA) were enrolled in this study. We reviewed the initial WBC count, hsCRP, position of the appendix, and intra operative findings and then analyzed the data by univariate and multivariate analysis. RESULTS: Complications were observed in five of the 49 patients (10.2%). Specifically, wound complications were observed in three patients (6.1%), and periappendiceal fluid collection occurred in two patients (4.1%). Univariate analysis revealed a retrocecal type appendix (p=0.046) and overweight (BMI> or =23, p=0.034) as risk factors significantly correlated with the occurrence of complications. Conversely, retrocecal type appendix (p=0.121) and overweight (BMI> or =23, p=0.329) were not significantly correlated with complications upon multivariate analysis. CONCLUSION: For patients with a high risk of postoperative complications, including those with retrocecal appendix undergoing TUSPLA and obese patients, sufficient informed consent is necessary, and intensive monitoring for the incidence of complications must be considered postoperatively. However, further studies enrolling larger groups of patients should be conducted to confirm these findings.
Appendectomy ; Appendix ; Cosmetics ; Humans ; Incidence ; Informed Consent ; Laparoscopy ; Overweight ; Postoperative Complications ; Risk Factors

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Single-center Comparative Study of Laparoscopic Versus Open Colon Surgery.

Kyoung Hwan KONG ; Il Dong KIM ; Ki Ho KIM ; Jin Soo PARK ; Byung Sun SUH ; Sang Wook KIM ; Hye In LIM

Journal of Minimally Invasive Surgery.2012;15(4):133-137. doi:10.7602/jmis.2012.15.4.133

PURPOSE: To examine the change in practice from open to laparoscopic practice in our local trust and compare the benefits with those of an open surgery group. METHODS: This retrospective comprehensive review analyzed 225 patients who underwent resection of colon cancers at the Dae Jin Medical Center, including 182 who underwent laparoscopic surgery (LAC) and 43 who underwent conventional open surgery (OC), conducted by a single surgeon from August 2002 to August 2010. The LAC group was divided into two groups, 50 patients during the early period and 132 patients during the late period, and short-term and oncologic outcomes were recorded. Patients identified through clinical coding and data were analyzed using the Statistical Package for Social Sciences, version 18.0 (2009. SPSS Inc. USA). RESULTS: Comparisons of 43 open versus 50 early and 132 late laparoscopic colon surgeries for various indications and outcomes were made. The operative time was longer in the LAC group (early and late LAC group) than in the OC group. However, post operative recovery time (hospital stay, days to sips of water and days to soft diet) was significantly shorter in the early and late LAC group than in the OC group. There was no significant difference between the LAC groups and open group with respect to age, sex, American Society of Anesthesiologists, tumor-node stage, morbidity, mortality, overall survival rates, disease free survival rates and recurrence rates. CONCLUSION: In our experience, laparoscopic surgery resulted in acceptable short term outcomes and our results support those of other studies with respect to clinical outcomes of laparoscopic surgery.
Clinical Coding ; Colectomy ; Colon ; Colonic Neoplasms ; Disease-Free Survival ; Humans ; Laparoscopy ; Operative Time ; Recurrence ; Retrospective Studies ; Social Sciences ; Survival Rate ; Water

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Can Elderly Patients Older than 75 Years with Colorectal Cancer Tolerate Planned Laparoscopic Surgery?.

Kang San LEE ; Young Wan KIM ; Joo Hee KIM ; Hyun Jun KWON ; Ik Yong KIM

Journal of Minimally Invasive Surgery.2012;15(4):126-132. doi:10.7602/jmis.2012.15.4.126

PURPOSE: Colorectal resection for elderly patients is associated with significant morbidity and mortality. It is still unclear whether or not laparoscopic colorectal resection (Lap CR) is indicated in elderly patients. The aim of this study is to evaluate the outcome of colonic surgery in elderly patients and to assess the feasibility and safety of laparoscopic colorectal surgery in elderly patients. METHODS: Patient characteristics and perioperative and pathologic data on 295 patients who underwent Lap CR for cancer from Jan. 2004 to Aug. 2011 were prospectively collected. Exclusion criteria were emergency and palliative by-pass surgery. Outcomes for elderly patients (> or =75 years) were compared with those of younger patients (<75 years). RESULTS: In comparison of 257 younger patients (<75 years, median age 61 years), 38 elderly patients (> or =75 years, median age 79 years) showed a greater proportion off emale gender (52.6% vs. 37.0%, p=0.065) and American Society of Anesthesiologists score 2~3 (97.3% vs.42.0%, p<0.001). No differences in tumor location, median operative time, conversion rate, duration of hospital stay, and perioperative complications (23.7% vs. 30.0%, p=0.427) were observed between the two groups. Distributions of American Joint Committee on Cancer stages and number of harvested lymph nodes were comparable between groups. CONCLUSION: Although elderly patients are more likely to be affected by co morbidities, postoperative outcome in this group after Lap CR is comparable with that of younger patients. Use of Lap CR in elderly patients is safe, and is associated with a low morbidity. It should be also regarded as the optimal approach for very elderly patients.
Aged ; Colon ; Colorectal Neoplasms ; Colorectal Surgery ; Emergencies ; Humans ; Joints ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies

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