• Advances in pediatric surgery
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• v.19 no.2
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• pp.90-97
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• 2013

Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.192-195
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• 2010

Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury.

• Journal of Gastric Cancer
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• v.11 no.4
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• pp.239-242
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• 2011

A debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a $10{\times}8$ cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.

• Journal of Gastric Cancer
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• v.10 no.3
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• pp.133-136
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• 2010

Purpose: The aim of this study was to evaluate the effectiveness of our retraction method for achieving a good operative field for the adequate lymph node dissection during laparoscopic gastrectomy in view of short term surgical outcome. Materials and Methods: This study prospectively enrolled 19 patients who underwent laparoscopic gastrectomy for early gastric cancer. The procedure was simply performed by putting the laparoscopic sigle suture in the phrenoesophageal ligament, and then the string was pulling and tying over the sternum. Surgical outcomes of these patients were evaluated. Results: Under V-shaped liver retraction, the mean operating time and mean number of retrieved lymph nodes was 166.3 minute and 31.37, respectively. And the results were satisfactory compared to open or conventional laparoscopic gastric surgery. Conclusions: V-shaped liver retraction requires no extra port or assistant's hands, and prevents additional injury to any intra-abdominal organ. And this method can easily, efficiently and safely enable to achieve a good operative field for the lymph node dissection near the lesser curvature of the stomach.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.12
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• pp.5077-5081
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• 2014

To clarify whether gastric cancer patients can benefit from laparoscopy-assisted surgery completed by junior surgeons under supervision of expert surgeons, data of 232 patients with gastric cancer underwent operation performed by inexperienced junior surgeons were reviewed. Of the 232 patients, 137 underwent laparoscopy-assisted resection and in 118 cases this approach was successful. All of these 118 patients were assigned to laparoscopic group in this study, 19 patients who were switched to open resection were excluded. All laparoscopic operations were performed under the supervision of expert laparoscopic surgeons. Some 95 patients receiving open resection were assigned to the open group. All open operations were completed independently by the same surgeons. Short-term outcomes including oncologic outcomes, operative time intra-operative blood loss, time to first flatus, time to first defecation, postoperative hospital stay and perioperative complication were compared between the two groups. The numbers of lymph nodes harvested in the laparoscopic and open groups were $21.1{\pm}9.6$ and $18.2{\pm}9.7$ (p=0.029). There was no significant difference in the length of margins. The mean operative time was $215.9{\pm}32.2$ min in laparoscopic group and $220.1{\pm}34.6min$ in the open group (p=0.866), and the mean blood loss in laparoscopic group was obviously less than that in open group ($200.9{\pm}197.0ml$ vs $291.1{\pm}191.4ml$; p=0.001). Time to first flatus in laparoscopic and open groups was $4.0{\pm}1.0$ days and $4.3{\pm}1.2$ days respectively and the difference was not significant (p=0.135). Similarly no statically significant difference was noted for time to first defecation ($4.7{\pm}1.6$ vs $4.8{\pm}1.6$, p=0.586). Eleven patients in the laparoscopic group and 19 in the open group suffered from peri-operative complications and the difference between the two groups was significant (9.3% vs 20.0%, p=0.026). The conversion rate for laparoscopic surgery was 13.9%. Patients with gastric cancer can benefit from laparoscopy-assisted operations completed by inexperienced junior surgeons under supervision of expert laparoscopic surgeons.

• Journal of Gastric Cancer
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• v.13 no.1
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• pp.51-57
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• 2013

Purpose: Additional gastrectomy is needed after endoscopic resection for early gastric cancer when pathology confirms any possibility of lymph node metastasis or margin involvement. No studies depicted the optimal type of surgery to apply in these patients. We compared the short-term and long-term outcomes of laparoscopic gastrectomy with those of open gastrectomy after endoscopic resection to identify the optimal type of surgery. Materials and Methods: From 2003 to 2010, 110 consecutive patients who underwent gastrectomy with lymphadenectomy either by laparoscopic (n=74) or by open (n=36) for gastric cancer after endoscopic resection were retrospectively analyzed. Postoperative and oncological outcomes were compared according to types of surgical approach. Results: Clinicopathological characteristics were comparable between the two groups. Laparoscopic group showed significantly shorter time to gas passing and soft diet and hospital day than open group while operation time and rate of postoperative complications were comparable between the two groups. All specimens had negative margins regardless of types of approach. Mean number of retrieved lymph nodes did not differ significantly between the two groups. During the median follow-up of 47 months, there were no statistical differences in recurrence rate (1.4% for laparoscopic and 5.6% for open, P=0.25) and in overall (P=0.22) and disease-free survival (P=0.19) between the two groups. Type of approach was not an independent risk factor for recurrence and survival. Conclusions: Laparoscopic gastrectomy after endoscopic resection showed comparable oncologic outcomes to open approach while maintaining benefits of minimally invasive surgery. Thus, laparoscopic gastrectomy can be a treatment of choice for patients previously treated by endoscopic resection.

• Journal of Korean Academy of Nursing Administration
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• v.8 no.1
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• pp.123-135
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• 2002

Purpose: In this study, the critical pathway for laparoscopic cholecystectomy patients was developed and applied for clinical study. The effectiveness of the critical pathway was analyzed. Method: The subjects with no critical pathway services of this study were 30 laparoscopic cholecystectomy operation patients, who were hospitalized in B General Hospital in Busan from Nov. 28. 2000 to May 2. 2001. The subjects with critical pathway services of this study were 30 laparoscopic cholecystectomy operation patients, who were hospitalized in B General Hospital in Busan from June. 11. 2001 to Oct. 31. 2001. Results: 1. Development for critical pathway Preliminary critical pathway for the laparoscopic cholecystectomy patients was developed though analysis of the reference and 34 case of medical record. The items on the y-axis were assessment, test, treatment, diet, fluid, consult, medication, activity and education and the items on the x-axis were till 3days after operation. The developed critical pathway was applied in clinical field. 2.　Effectiveness of application on developed critical pathwayPost operational complication was not found in neither the critical pathway using Group nor Non-using Group. Hospitalization period mean was 4.63 days for the using Group and 5.93 days for the Non-using Group(P=.001). The mean cost for medical examination and treatment for the using Group was 786,270 won, 117,454 won(12.9%) less than that of the Non-using Group, 903,724 won(P=.000). The degree of satisfaction for the using group was 3.7 points, for the Non-using Group, 3.15 points. The degree of satisfaction for the used Group was 0.55 points higher than that for the Non-using Group and there was a statistically significant difference(P=.000). Concousion: From results of this study, Using the critical pathway in the laparoscopic cholecystectomy operational patients was effective in decreasing the hospitalization period and cost, and increasing the satisfaction about the medical service.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5395-5399
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• 2014

Purpose: This study was designed to evaluate the outcomes of laparoscopic colorectal resection in a period of learning curve completed by surgeons with different experience and aptitudes with a view to making clear whether seniors had a better learning curve compared with juniors. Methods: From May 2010 to August 2012, the first twenty patients underwent laparoscopic colorectal resection completed by each surgeon were selected for analysis retrospectively. A total of 240 patients treated by 5 seniors and 7 juniors were divided into the senior group (n=100) and the junior group (n=140). The short-term outcomes of laparoscopic surgery of the two groups were compared. Results: The mean numbers of lymph nodes harvested were $21.2{\pm}11.0$ in the senior group and $17.3{\pm}11.5$ in the junior group (p=0.010); The mean operative times were $187.9{\pm}60.0min$ as compared to $231.3{\pm}55.7min$ (p=0.006), and blood loss values were $177.0{\pm}100.7ml$ and $234.0{\pm}185ml$, respectively (p=0.001); Conversion rate in the senior group was obviously lower than in the junior group (10.0% vs 20.7%, p=0.027) and the mean time to passing of first flatus were $3.3{\pm}0.9$ and $3.8{\pm}0.9$ days (p=0.001). For low rectal cancer, the sphincter preserving rates were 68.7% and 35.3% (p=0.027). Conclusions: Seniors could perform laparoscopic colorectal resection with relatively better oncological outcomes and quicker recovery, and seniors could master the laparoscopic skill more easily and quickly. Seniors had a better learning curve for laparoscopic colorectal cancer resection compared to juniors.

• Journal of Gastric Cancer
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• v.4 no.2
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• pp.75-81
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• 2004

Recently detection of early gastric cancer (EGC) has been increasing and the treatment strategies for gastric cancer have been changing. The purpose of this study was to compare clinical outcomes between laparoscopically assisted (LADG) and hand-assisted laparoscopic gastrectomy (HALDG) and open distal gastrectomy for early gastric cancer. This review is directed toward providing gastric surgeons with recent advances in the treatment of EGC. We investigated the English language literature for the past 12 years through computer searches which focused on : 1) Patient demographics, 2) Operation time, 3) Intra-operative blood loss, 4) Depth of invasion, 5) CBC, 6)Weight loss, 7) Analgesic requirement, 8)Time NPO, 9) Length of hospital stay, 10) Tumor stage, 11) Lymph node (LN) dissection, 12) Position of LN resected, 13) Complications. Improved operative techniques and surgical instrumentation have facilitated the development of minimally invasive gastric cancer surgery. The short-term benefits of laparoscopic gastrectomy included less surgical trauma, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no change in operative outcome. Laparoscopic gastrectomy was better accepted by the patients as a good procedure and promptly brought the patients back to their previous lifestyle and activities of daily living. But the advantages of HALDG for gastric cancer, extended lymph node dissection and intracorporeal anastomosis are feasible and easier with the presence of the internal hand. The hand-assisted laparoscopic (HALDG) method reported the best results in lymph node dissection.This method is an alternative to total laparoscopic radical gastrectomy. LADG and HALDG, when compared with conventional open gastrectomy, have several advantages. When performed by a skilled surgeon, LADG and HALDG are safe and useful techniques for patients with early-stage gastric cancer. Their appropriateness for gastric cancer surgery require further study.

• Journal of Minimally Invasive Surgery
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• v.21 no.4
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• pp.148-153
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• 2018

Purpose: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). Methods: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. Results: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time ($58.97{\pm}18.53$ (SILA) vs. $57.57{\pm}21.48$ (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay ($2.76{\pm}1.41$ vs. $3.97{\pm}2.97$, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). Conclusion: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.