• Journal of Minimally Invasive Surgery
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• v.21 no.4
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• pp.139-140
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• 2018

• Journal of Gastric Cancer
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• v.12 no.4
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• pp.237-242
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• 2012

Purpose: Despite the great advances in laparoscopic techniques, most active general surgeons do not apply laparoscopic surgery in the treatment of duodenal ulcer perforation when facing a real-life emergency. Therefore, our study was designed to evaluate the feasibility of laparoscopic surgery in duodenal ulcer perforation, and provide a step-by-step protocol with tips and recommendations for less experienced surgeons. Materials and Methods: Between March, 2011 and May, 2012, 21 patients presenting with duodenal ulcer perforation underwent laparoscopic primary repair with omentopexy. There were no contraindications to perform laparoscopic surgery, and the choice of primary repair was decided according to the size of the perforation. The procedure for laparoscopic primary repair with omentopexy consisted of peritoneal lavage, primary suture, and omentopexy using a knot pusher. Results: During the operation, no conversion to open surgery or intra-operative events occurred. The median operation time was 45.0 minutes (20~80 minutes). Median day of commencement of a soft diet was day 6 (4~17 days). After surgery, the median hospital stay was 8.0 days (5~27 days). Postoperative complications occurred in one patient, which included a minor leakage. This complication was resolved by conservative management. Conclusions: Although our study was carried out on a small number of patients at a single institution, we conclude that laparoscopic primary repair can be an effective surgical method in the treatment of duodenal ulcer perforation. We believe that the detailed explanation of our procedure will help beginners to perform laparoscopic primary repair more easily.

• Journal of Gastric Cancer
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• v.15 no.4
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• pp.278-285
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• 2015

Purpose: Gastric submucosal tumors (SMTs) located very close to the esophagogastric junction (EGJ) are a challenge for gastric surgeons. Therefore, this study reports on the experience of using endoscopic and laparoscopic full-thickness resection (ELFR) with laparoscopic two-layer suturing in such tumors. Materials and Methods: Six patients with gastric SMTs very close to the EGJ underwent ELFR with laparoscopic two-layer suturing at Kyungpook National University Medical Center. With the patient under general anesthesia, the lesser curvature and posterior aspect adjacent to the EGJ were meticulously dissected and visualized using a laparoscopic approach. A partially circumferential full-thickness incision at the distal margin of the tumor was then made using an endoscopic approach under laparoscopic guidance. The SMT was resected using laparoscopic ultrasonic shears, and the gastric wall was closed using two-layer suturing. Thereafter, the patency and any leakage were checked through endoscopy. Results: All the ELFR procedures with laparoscopic two-layer suturing were performed successfully without an open conversion. The mean operation time was $139.2{\pm}30.9$ minutes and the blood loss was too minimal to be measured. The tumors from four patients were leiomyomas, while the tumors from the other two patients were gastrointestinal stromal tumors with clear resection margins. All the patients started oral intake on the third postoperative day. There was no morbidity or mortality. The mean hospital stay was $7.7{\pm}0.8$ days. Conclusions: ELFR with laparoscopic two-layer suturing is a safe treatment option for patients with an SMT close to the EGJ, as major resection of the stomach is avoided.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.125-132
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• 2011

The aim of this study was to compare peritoneal dialysis catheter insertion by the open method to the laparoscopic method. Twenty four laparoscopic and 10 open peritoneal dialysis catheter placements were performed in children between 2001 and 2008. Patient characteristics, operation related data, procedural complications and clinical outcome were compared. Although there were no cases of catheter obstruction, exit site infection or bleeding in the laparoscopic group, compared to the open method, there was no statistically significant difference between the two groups. Catheter removal rate due to complication was high in the open group and catheter survival rate was high in the laparoscopic group. We concluded that laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups with at least equivalent functional results compared to the open method. An advantage of laparoscopic catheter insertion is removal of the great omentum and easy fixation of the catheter to the abdominal wall.

• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.37-43
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• 2017

Laparoscopic cholecystectomy is of one the most common general surgical operations performed today. Concomitant choledocholithiasis occurs in roughly 10-20% of patients with symptomatic gallstones. Laparoscopic bile duct exploration (LBDE) offers a single-stage minimally-invasive solution to the management of choledocholithiasis. LBDE may be performed either via the transcystic route or via laparoscopic choledochotomy. A number of strategies to improve success are available to the surgeon to help in the problem of complicated choledocholithiasis, these range from simple maneuvers to the use of laser or mechanical lithotriptors. With the advances in laparoscopic surgery, it is also possible to handle complex surgical conditions such as Mirizzi syndrome or recurrent pyogenic cholangitis laparoscopically, even though these have yet to be accepted as standard of care. Following laparoscopic choledochotomy, options for closure include: primary closure, closure over a T-tube, and closure over an endobiliary stent. T-tube placement has been associated with increased operating time and hospital length of stay compared to primary closure, with no significant differences in morbidity. Based on the available literature, LBDE appears comparable to ERCP with regards to procedural efficacy and morbidity. LBDE remains relevant to the general surgeon and is best viewed as being complementary to endoscopic therapy in the management of choledocholithiasis.

• Journal of Gastric Cancer
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• v.24 no.1
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• pp.57-68
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• 2024

Reduced-port gastrectomy (RPG) includes all procedures derived from various efforts to minimize surgical invasiveness, with single-incision laparoscopic gastrectomy (SILG) being the ultimate reduced-port technique. However, there are challenges related to its feasibility, oncological validity, training, and education. This review describes the current issues and challenges, as well as the future prospects of RPG for gastric cancer. Gastrectomy, which started as an open surgery, has evolved into a laparoscopic surgery. With the advancements in laparoscopic technology, SILG has been used to minimize surgical scarring. However, owing to the technical difficulties of SILG, cases involving the addition of 1 trocar or needle grasper alongside the multichannel port have also been reported. Additionally, 3-port laparoscopic gastrectomy (3PLG) using only 3 trocars is also being performed. RPG, as a concept, includes a range of approaches such as SILG, 2-port laparoscopic gastrectomy, and 3PLG. These techniques aimed to reduce the number of ports or incisions required for laparoscopic gastrectomy. Despite technical difficulties, RPGs offer numerous advantages, including minimal invasiveness, excellent cosmetic outcomes, and the potential for improved postoperative recovery, such as reduced length of hospital stay and post-operative pain. It could be considered similar to conventional laparoscopic gastrectomy, and may not be oncologically inferior. Ongoing studies, such as the KLASS 12, are required to gain further insights.

• Journal of Veterinary Science
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• v.19 no.6
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• pp.862-864
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• 2018

An elective laparoscopic ovariectomy on a healthy dog revealed a cystic structure in the left ovary. The surgical procedure was successful. Histopathological examination showed the presence of a teratoma adjacent to the ovary. To the best of the authors' knowledge, this is the first reported case of an ovarian teratoma removed by laparoscopic ovariectomy in a dog by using a multiport laparoscopic ovariectomy technique.

• Journal of Gastric Cancer
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• v.13 no.1
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• pp.26-33
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• 2013

Purpose: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8221-8224
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• 2014

Gastric cancer continues to be a leading cause of cancer death. The majority of patients with gastric adenocarcinoma in China present with advanced disease. Ruling out unresectable cancers from an unnecessary "open" exploration is very important. The aim of this study was to assess the value of five-port anatomical laparoscopic exploration in T4 gastric cancer in comparison with three-port laparoscopic exploration and laparotomy exploration. We conducted a retrospective study on 126 patients with T4 stage scheduled for D2 curative gastrectomy based on computed tomography (CT) staging at Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, from Apr. 2011 to Apr. 2013. Laparotomy exploration (Group I), three-port laparoscopic exploration (Group II) or five-port anatomical laparoscopic exploration (Group III) were performed prior to radical gastrectomy. Accuracy rate for feasibility of D2 curative gastrectomy in laparotomy exploration and five-port anatomical laparoscopic exploration groups was higher than that in the three-port laparoscopic exploration group. Five-port anatomical laparoscopic exploration group had the highest accuracy resection rate (Group I vs Group II vs Group III,92.6% vs78.6% vs 97.7%; p<0.05) and shorter length of hospitalization (Group I vs Group II vs Group III, $9.58{\pm}4.17$ vs $6.13{\pm}2.85$ vs $5.00{\pm}1.81$; p<0.001). Three-port laparoscopic exploration has low accuracy rate for assessing feasibility of D2 curative gastrectomy and five-port anatomical laparoscopic exploration should be performed on patients with T4 gastric cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9985-9996
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• 2014

Background and Aim: Laparoscopic and open rectum surgery for rectal cancer remains controversial. This systematic review compared the short-term and long-term efficiency and complications associated with laparoscopic and open resection for rectal cancer. Materials and Methods: We searched PubMed, Embase, Cochrane Library, ISI Web of Knowledge and the China Biology Medicine Database to identify potential randomized controlled trials from their inception to March 31, 2014 without language restriction. Additional articles were identified from searching bibliographies of retrieved articles. Two reviewers independently assessed the full-text articles according to the pre-specified inclusion and exclusion criteria as well as the methodological quality of included trials. The meta-analysis was performed using RevMan 5.2. Results: A total of 16 randomized controlled trials involving 3,045 participants (laparoscopic group, 1,804 cases; open group, 1,241 cases) were reviewed. Laparoscopic surgery was associated with significantly lower intraoperative blood loss, earlier return of bowel movement and reduced length of hospital stay as compared to open surgery, although with increased operative time. It also showed an obvious advantage for minimizing late complications of adhesion-related bowel obstruction. Importantly, there were no significant differences in other postoperative complications, oncological clearance, 3-year and 5-year or 10 year recurrence and survival rates between two procedures. Conclusions: On the basis of this meta-analysis we conclude that laparoscopic surgery has advantages of earlier postoperative recovery, less blood loss and lower rates of adhesion-related bowel obstruction. In addition, oncological outcome is comparable after laparoscopic and open resection for rectal cancer.