Robotic surgery systems, including the Korean-developed Revo-i surgical robotic system (Meerecompany Inc.), have expanded from routine cholecystectomies to complex hepatobiliary and pancreatic (HBP) procedures. We report two cases: one of choledochal cyst excision with Roux-en-Y hepaticojejunostomy, and another of extended cholecystectomy for gallbladder cancer, both performed entirely robotically using Revo-i. Both patients recovered without immediate postoperative complications and were discharged on postoperative day 7.These cases are the first to demonstrate the technical feasibility of fully robotic complex HBP surgeries with Revo-i, including the first reported choledochal cyst excision and extended cholecystectomy. Further experience and research are needed to confirm the safety and broader applicability of this system in HBP surgery.

Biliary stent migration is one of the late complications of endoscopic retrograde cholangiopancreatography. Most of the biliary stent migration is asymptomatic and successfully managed by stent removal. A 66-year-old man with unresectable pancreatic cancer, common bile duct obstruction, and duodenal third portion obstruction underwent endoscopic plastic biliary stent placement and duodenal uncovered metallic stent placement in two separate sessions. After 3 weeks from the duodenal stenting, he presented with hematemesis. Urgent esophagogastroduodenoscopy and magnetic resonance imaging showed hemobilia. The patient recovered with conservative managements. Cross-sectional imagings done 2 months later demonstrated the penetration of the biliary stent into portal vein. Here, we present a case of delayed hemobilia caused by penetration of biliary plastic stent into the portal vein.

Background: /Aim: In gallbladder cancer (GBC), gender differences in incidence and mortality rates have been reported with geographic variation. However, there is little known about sex-related difference in GBC prognosis. This study compares prognostic factors according to gender for GBC. Methods: We searched clinicopathological factors in all stages of 952 GBC patients from seven medical centers in Korea. A total of 927 patients were enrolled and surgery with curative resection was performed in 499 patients. Results: Carbohydrate antigen (≥37 U/mL) was a significant prognostic factor in both females and males (odd ratio [OR], 4.30; 95% confidence interval [CI], 3.13-5.89; p<0.001). Age was a significant factor only in female patients, elderly patients were associated with low resectability and the likelihood of T-stage >2; an independent predictor of poor prognosis via multivariate analysis (OR, 1.03; 95% CI, 1.01-1.05; p=0.005, OR, 1.05; 95% CI, 1.02-1.08; p=0.002). Body mass index (BMI) also showed gender difference, and lower BMI (≤25 kg/m2) was the significant good indicator of multivariate analysis for lymph node metastasis in female patients (OR, 0.42; 95% CI, 0.23-0.77; p=0.005) but, the significant poor indicator of univariate analysis for advanced T-stage in male (OR, 2.79; 95% CI, 1.40-5.54; p=0.003). Conclusions These results suggest that there is a possibility of gender difference in GBC prognosis. Age and high BMI were poor prognostic factors for curative resection for female GBC patients.

A 62-year-old farmer was admitted to our department because of second degree chemical burns of both buttocks ten days following accidental contact with Gramoxone, a weed killer. He was treated with oral antibiotics and cold compresses and discharged after the burned area were reepithelialized. Laboratory findings were within normal limits for three weeks. Although lung fibrosis, hepatic and renal failure can be caused by repeated absorption of paraquat (Gramoxone) through injuried skin, systemic absorption through normal skin has not been reported. During the four month follow up period there were no systemic problems nor recurrence of skin lesions. We report herein a case of chemical burns induced by Gramoxone, which is probably an occupational dermatosis of farmers handling weed killers.
Absorption ; Anti-Bacterial Agents ; Burns ; Burns, Chemical* ; Buttocks ; Fibrosis ; Follow-Up Studies ; Humans ; Lung ; Middle Aged ; Paraquat ; Recurrence ; Renal Insufficiency ; Skin ; Skin Diseases