• The Korean Journal of Medicine
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• v.93 no.6
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• pp.556-559
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• 2018

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications.

• Journal of Gastric Cancer
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• v.19 no.1
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• pp.132-137
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• 2019

The occurrence of hiatal hernia after total gastrectomy with Roux-en-Y reconstruction is rare. We report the case of a 76-year-old man who presented with dyspnea, vomiting, and fever around 8 days after total gastrectomy with Roux-en-Y reconstruction. Abdominal computed tomography revealed a hiatal hernia containing part of the small intestine in the left thoracic cavity. Emergent reduction and repair of the hiatal hernia were performed later. Operative findings revealed that the Roux limb was incarcerated in the left pleural cavity. Esophagojejunostomy leakage, perforation of the small intestine with transient ischemic change, and pyothorax were also found. Thus, feeding jejunostomy, thoracoscopic decortication, and diversion T-tube esophagostomy were performed. Considering that the main cause of hiatal hernia is blunt dissection with division of the phrenoesophageal membrane, approximating the crus with 1 or 2 figure-8 sutures, according to the size of the defect, to prevent the incidence of hiatal hernia after total gastrectomy may be performed.

• Clinical Endoscopy
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• v.51 no.6
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• pp.587-590
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• 2018

Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health checkup endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.

• The Korean journal of helicobacter and upper gastrointestinal research
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• v.18 no.3
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• pp.209-212
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• 2018

We report a rare case of systemic amyloidosis with gastrointestinal and lymph node involvement. A 64-year-old woman was admitted to our hospital with dyspepsia and weight loss. Initial esophagogastroduodenoscopy (EGD) revealed nonspecific findings, and abdominal computed tomography showed necrotizing lymphadenopathy at the porta hepatis. Laparoscopic lymph node biopsy was performed under suspicion of tuberculous lymphadenopathy, but a definite diagnosis was not established. Follow-up EGD performed 6 months later revealed multiple telangiectasia-like lesions at the gastric body, and endoscopic biopsy revealed amyloid deposition. Through additional blood and urine protein electrophoresis, the patient was finally diagnosed with systemic amyloidosis associated with multiple myeloma. She was treated with dexamethasone, thalidomide, and bortezomib; however, she died 3 months after diagnosis because of pneumonia and multiple organ failure.

• Journal of Medicine and Life Science
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• v.16 no.1
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• pp.13-16
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• 2019

In a patient with blunt abdominal trauma with small bowel injury, early diagnosis is clinically challenging due to unclear clinical symptoms and signs in the early stage of an injury. On the other hand, a delay of diagnosis of bowel disruption may lead to increased complication and mortality. The diagnostic laparoscopy is very useful for the evaluation of the small bowel injury. Laparoscopy can reduce unnecessary open surgery in a patient with blunt abdominal trauma with subtle symptoms and imprecise findings on abdominal computed tomography. Also it can prevent delay of treatment and be converted immediately to open surgery as soon as bowel damage is revealed. Furthermore, extracorporeal repair of small bowel via mini-laparotomy after a single incision diagnostic laparoscopy in a patient with traumatic small bowel perforation was a feasible and safe alternative to conventional laparoscopy. We are pleased to introduce successfully treated cases by extracorporeal repair of small bowel via mini-laparotomy after a single incision diagnostic laparoscopy in a patient with small bowel perforation after blunt trauma.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.175-178
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• 2021

The umbilicus is an important aesthetic component of the abdomen; therefore, its absence is both cosmetically and psychologically distressing to the patient. However, loss of the umbilicus during abdominal surgical procedures is often unavoidable. Umbilical reconstruction is aimed at obtaining a natural, three-dimensional appearance. We propose a simple method for immediate umbilical reconstruction with good long-term results. This technique was used successfully on a patient who underwent tumor excision. A 49-year-old woman presented with a large mass, measuring 5.8×4.0 cm, on her umbilicus. The mass, an epidermal cyst, developed after laparoscopic uterine myomectomy 5 years earlier. Complete excision of the mass resulted in a large defect, and immediate umbilical reconstruction was planned. Our procedure involved apposing and anchoring two opposing flaps onto the abdominal wall, so that the umbilicus would retain its depth over a long period of time. Negative-pressure wound therapy was applied for 72 hours as a mild compressive dressing. No complications were encountered. The healing process was uneventful and the aesthetic outcome was pleasing; a natural-appearing navel was created. The patient was satisfied with the end result. This technique provides a permanent and sufficient depression for the umbilicus.

• The Journal of Korea Robotics Society
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• v.16 no.2
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• pp.172-178
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• 2021

The COVID-19 pandemic has been reshaping the world by accelerating non-contact services and technologies in various domains. Hospitals as a healthcare system lie at the center of the dramatic change because of their fundamental roles: medical diagnosis and treatments. Leading experts in health, science, and technologies have predicted that robotics and artificial intelligence (AI) can drive such a hospital transformation. Accordingly, several government-led projects have been developed and started toward smarter hospitals, where robots and AI replace or support healthcare personnel, particularly in the diagnosis and non-surgical treatment procedures. This article inspects the remaining element of healthcare services, i.e., surgical treatment, focusing on evaluating whether or not currently available laparoscopic surgical robotic systems are sufficiently preparing for the era of post-COVID-19 when contactless is the new normal. Challenges and future directions towards an effective, fully non-contact surgery are identified and summarized, including remote surgery assistance, domain-expansion of robotic surgery, and seamless integration with smart operating rooms, followed by emphasis on robot tranining for surgical staff.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.99-106
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• 2016

Minimally invasive surgery for gastric cancer has increased in popularity during the last two decades mainly in the Asia for patients with early-stage cancer. Nevertheless, the development of laparoscopic surgery for gastric cancers in the Western world has been slow because of the advanced stage at diagnosis for which LG is not yet considered an acceptable alternative to standard open surgery. RAG has been reported as a safe alternative to conventional surgery for treating of early gastric carcinoma. We assess the current status of robotic surgery in the treatment of gastric cancer focusing on the technical details, postoperative outcome, oncological considerations and future perspectives. In gastrectomy the biggest advantage of the robotic approach is the ease and reproducibility of lymphadenectomy. Reports also show that even the intra corporeal digestive restoration is facilitated by use of the robotic approach, particularly following TG. Additionally, the accuracy of robotic dissection is confirmed by decreased blood loss in comparison to conventional laparoscopy. The learning curve and technical reproducibility also appear to be shorter with robotic surgery and, consequently, robotics can help to standardize and diffuse minimally invasive surgery in the treatment of gastric cancer. While published reports have shown no significant differences in surgical morbidity, mortality, or oncological adequacy between robot-assisted and conventional gastrectomy. There are some advantages in terms of postoperative recovery of patients after robotic surgery. More studies are needed to assess the true indications and oncological effectiveness of robotic use in the treatment of gastric carcinoma.

• Clinical Pain
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• v.18 no.1
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• pp.36-39
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• 2019

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.114-119
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• 2023

A 51-year-old male patient had four times of massive hematochezia episode three days before arrival. Carbohydrate antigen (CA) 19-9 level was extremely elevated. Computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography identified 5.7 cm sized periampullary duodenal cancer with regional metastatic lymph nodes and vascular invasion to aberrant right hepatic artery, main portal vein, and superior mesenteric vein. Diagnosed as duodenal adenocarcinoma through endoscopic biopsy, 16 times of FOLFIRI (5-fluorouracil, leucovorin, irinotecan) was conducted. The regimen changed to XELOX (capecitabine, oxaliplatine), four times of administration was done, and the CA19-9 level dramatically decreased. The tumor decreased to 2.1 cm. After R0 laparoscopic pylorus preserving pancreatoduodenectomy, no adjuvant therapy was given. No sign of recurrence or metastasis was reported, and the patient reached complete remission after five years. We reported a case where neoadjuvant chemotherapy for locally advanced duodenal adenocarcinoma was shown to be effective.