• Journal of Gastric Cancer
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• 제15권2호
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• pp.132-138
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• 2015

Single-incision laparoscopic total gastrectomy for gastric cancer has recently been reported by Seoul National University Bundang Hospital. However, this is not a popular procedure primarily because of the technical difficulties involved in achieving consistent intracorporeal esophagojejunostomy. At Seoul National University Bundang Hospital, we recently introduced a simple, easy-to-use, low-profile laparoscopic manual scope holder that enables the maintenance of a stable field of view, the most demanding condition in single-port gastrectomy. In this technical report, we describe in detail the world's first solo single-incision laparoscopic total gastrectomy with D1+ lymph node dissection and intracorporeal esophagojejunostomy for proximal early gastric cancer.

• Advances in pediatric surgery
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• 제20권2호
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• pp.23-27
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• 2014

Purpose: Laparoscopic hernia repair in children is still controversial. The aim of this study was to report our long-term results of the laparoscopic hernia technique, which is based on the same surgical principles as conventional open herniotomy. Methods: Five hundred fourteen pediatric patients with inguinal hernia were included in this study under informed consent. All patients underwent a laparoscopic technique of sac transection and intracorporeal ligation. The asymptomatic contralateral inguinal ring was routinely explored and repaired if a patient had patent processus vaginalis on the contralateral side. Patients were prospectively followed for 5 years. Those who were lost to follow-up were excluded from the study. Perioperative complications and recurrences were evaluated. Results: The mean follow-up period was 29 months. Mean operation time was 27.5 minutes. Forty one percent of the patients had contralateral patent processus vaginalis. Only one hernia recurred (0.19%). We had one case of contralateral metachronous hernia (0.21%) during follow-up period. Conclusion: The long-term follow-up results of our study revealed that laparoscopic hernia sac transection and ligation can be a safe and effective alternative for conventional herniorraphy.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.206-211
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• 2011

Purpose: Laparoscopic total gastrectomy (LTG) for gastric cancer is still uncommon because of technical difficulties, especially in esophagojejunostomy (EJ). There are many reports for various laparoscopic procedures of EJ using linear or circular staplers. On the other hands, there has been no report for hand-sewn anastomosis. We report successfully performed intracorporeally hand-sewn EJ after LTG. Materials and Methods: The clinicopathologic data and short-term surgical outcomes of 6 patients who underwent totally laparoscopic total gastrectomy for upper gastric cancer from December 2010 and July 2011 were retrospectively reviewed. Results: The mean age was 66.5 years and mean body mass index (kg/$m^2$) was 24.6. All patients had medical comorbidities. The mean patient ASA score was 2.17. Among the 6 patients, previous abdominal operation was performed for 2 patients and combined operation was performed for 3 patients. The mean blood loss, operation time, and EJ anastomosis time was 130 ml, 379.7 minutes, and 81.5 minutes, respectively. The mean time to first flatus, first oral intake, and postoperative hospital stay was 3.0, 3.0, and 12.5 days, respectively. There was no 30-day mortality case. Postoperative aspiration pneumonia and multiple periventricular lacunar infarctions developed in 1 patient. There were no anastomosis-related complications and other major surgical complications. Conclusions: When the intracorporeal anastomotic technique becomes popular in LTG the intracorporeally hand-sewn EJ may be accepted as one method among the various laparoscopic procedures of EJ.

• Journal of Gastric Cancer
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• 제17권3호
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• pp.193-203
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• 2017

The implementation of national cancer screening has increased the detection rates of early gastric cancer (EGC) in Korea. Since the successful introduction of laparoscopic gastrectomy for gastric cancer in the early 1990s, this technique has demonstrated improved short-term outcomes without compromising long-term oncologic results. It is associated with reduced pain, shorter hospitalization, reduced morbidity rates, better cosmetic outcomes, and equivalent mortality rates as those for open surgery. Laparoscopic gastrectomy improves patients' quality of life (QOL) and provides favorable prognosis. Single-incision laparoscopic gastrectomy (SILG) is one extremely minimally invasive method, theoretically offering improved cosmetic results, less postoperative pain, and earlier recovery after surgery than conventional multiport laparoscopic gastrectomy. In this context, SILG is thought to be an optimal method to promote and maximize patients' QOL in the acute postoperative phase. However, the technical difficulties of this procedure have limited its use. Since the first report describing single-incision distal gastrectomy in 2011, only 16 studies to date have evaluated SILG. Most of these studies have focused on the technical feasibility and safety of SILG because its long-term outcomes have not been reported. This article reviews the advantages and limitations of SILG.

• Advances in pediatric surgery
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• 제8권2호
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• pp.156-160
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• 2002

When jaundice persists for more than 14 days postnatally, the early diagnosis of surgical jaundice is important for the prognosis in extrahepatic biliary atresia after draining procedure. The role of diagnostic laparoscopy to differenctiate medical causes of jaundice from biliary atresia is evaluated in this report. Four patients with prolonged jaundice have been included in this study. When the gallbladder was not visualized we proceeded to laparotomy. In patients with enlarged gallbladder visualized at laparoscopy, laparoscopic guided cholangiogram was performed, and laparoscopic liver biopsy was done for those who had a patent biliary tree. Two patients had small atretic gallbladder and underwent a Kasai hepato-portoenterostomy. One patients showed a patent gallbladder and common bile duct with atresia of the common hepatic and intrahepatic ducts, and they underwent a Kasai hepatic-portoenterostomy. One patient showed an enlarged gallbladder and laparoscopic-guided cholangiogram were normal. Laparoscopic liver biopsy was performed. There were no complications. Laparoscopy with laparoscopic-guided cholangiogram may be a valuable method in accurate and earlier diagnosis in an infant with prolonged jaundice.

• 임상간호연구
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• 제15권3호
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• pp.17-26
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• 2009

Purpose: The purpose of this study was to compare the recovery outcomes between a normal weight group (BMI<25) and an overweight group ($$BMI{\geq_-}25$$), who received laparoscopic surgery for rectal cancer, to provide information for effective decision making. Methods: Data from 76 patients who received laparoscopic surgery for rectal cancer in a university hospital were reviewed retrospectively from September 2004 to March 2007. Collected data were analyzed using Win SPSS 12.0. The recovery outcomes related to the operation were the length of the operation, the amount of bleeding during the operation, the length of stay in the recovery room, first bowel movement, the length of hospital stay, and complications. Results: There was no statistical difference between the two groups with regard to the recovery outcomes. Conclusion: From the above results, nursing information can be offered to help make effective decisions before the operation for overweight patients with rectal cancer who prefer laparoscopic surgery.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.230-234
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• 2004

목적: 최근 위 질환에서 복강경 사용이 증가하고 있는 추세이다. 그러나, 조기위암의 경우 그 적응증과 표준 술식에 대해서는 논란이 있어 왔다. 본 연구의 목적은 handassisted laparoscopic distal gastrectomy (HALDG), laparos-copy-assisted distal gastrectomy (LADG), 그리고 개복하 원위 위 절제술간의 임상적 결과의 비교를 통해 조기 위암에서 복강경 술기의 유용성을 알아보고자 하였다. 대상 및 방법: 2001년 8월부터 2004년 7월까지 본원에서 조기위암으로 진단받아 HALDG (=18)와 LADG (=7)를 시행한 25명의 환자들을 대상으로 하였으며, 같은 시기에 개복하 원위 위 절제술을 시행한 40명의 환자와 수술시간, 재원 기간, 식이 시작 시기, 절제된 림프절 수 등의 임상적 결과를 비교 분석하였다. 또한 수술 시기에 따라 HALDG와 LADG을 각각 전기와 후기로 분류하여 임상적 결과를 비교하였다. 결과: 복강경 군과 개복술 군 간의 절제된 림프절 수에는 차이가 없었으며, 수술 시간은 복강경 군에서 유의하게 길었다(P<0.05). 또한, 그 외 임상적 결과들에서도 두 군 간에 차이가 없었다. 전기와 후기의 비교에서 후기의 HALDG 군에서 비록 수술 시간의 증가는 있었으나 절제된 림프절 수는 $22.31\pm4.29$에서 $29.40\pm3.21$로 후기에서 유의하게 증가하였다(P<0.05). 결론: 복강경하 위절제술의 경험을 통해 D1+$\beta$ 이상의 림프절 절제가 가능하였고 술식의 안정성 등 조기위암에서도 복강경 술식이 적용될 수 있음을 알 수 있었다. 하지만, 술식의 표준화가 필요하며, 대규모 전향적 연구를 통해 복강경 술식에서도 개복술에서 보인 종양학적 근치성이 입증되어야 할 것이다.

• Journal of Gastric Cancer
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• 제5권4호
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• pp.295-303
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• 2005

대한복강경위장관연구회가 2004년 전국에서 시행된 복강경 위 수술의 현황을 조사하였다. 모두 36개의 기관으로부터 38명의 외과의가 설문에 응답하였다. 2004년 한 해 동안 시행된 복강경 위 수술은 총 1,089예였고 1995년부터 2004년까지 시행된 복강경 위 수술을 누적하면 모두 2,386예였다. 2004년에 위선암 환자에서 시행된 복강경 위 수술은 2003년보다 약 2배 많은 754예였다. 위선암에 대한 근치적 위절제술인 복강경보조위아전절제술 및 복강경보조위전절제술은 2001년도를 전환점으로 급속히 증가하였다(2001년 55예, 2002년 150예, 2003년 364예, 2004년 738예). 특히 복강경보조위전절제술은 작년에 폭발적 인 증가를 보였다. (2003년 20예, 2004년 112예). 그러나 복강경보조유문부보존위절제술 및 복강경보조근위부위절제술과 같은 복강경보조기능보존위절제술은 작년 각각 1예씩 시행되어 아직 보편화되지 않았다. 위 점막하종양에 시행된 복강경위쐐기절제술은 142예였다. Hand-assisted laparoscopic surgery는 2001년 39예, 2002년 55예, 2003년 49예가 시행되었으나 2004년에는 단 5예만 시행되어 급격한 감소를 보였다. 고도비만수술은 2003년도에 시작되어 2004년에는 49예로 증가하였다. 위선 암에서 복강경위수술의 적응증에 대한 견해로서 19명이 조기위암에서 시행한다고 하였고 7명은 적응증을 T2N0까지 넓히고 있었다. 앞으로 보험문제가 해결이 되고 장기 성적이 나온다면 위선암에 대한 복강경 위 수술은 널리 보편화될 것이다.

• Advances in pediatric surgery
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• 제4권2호
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• pp.172-175
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• 1998

With the recent advances in instruments and techniques, laparoscopic procedure have extended to neonates with congenital anomalies. The author reports a 6-day-old boy with Hirschsprung's disease, treated successfully by the laparoscopic endorectall pull-through procedure. The technique and its potential role in the treatment of Hirschsprung's disease are described. One camera port and three working ports were used for access to the peritoneal cavity. The descending and sigmoid colon were mobilized laparoscopically. The submucosal dissection was done transanally. The colon was then pulled down in continuity, divided above the transition zone, and secured to the anal mucosa about 10 mm above the pectinate line. Author concluded that endorectal pull-through can be performed safety with the laparoscope.

• Advances in pediatric surgery
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• 제19권2호
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• pp.66-72
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• 2013

Intussusception is common cause of intestinal obstruction in children. Most of intussusceptions can be treated with non-operative reduction using air or barium. However, about 10% patients need operative treatment due to failure of reduction, peritonitis, and recurrence after reduction. We introduce our experience of laparoscopic surgery for intussusception. From April 2010 to March 2013, we reviewed 57 children who diagnosed intussusception. Twelve patients underwent an operation. The cause of operation was 7 of failure of air reduction and 5 of recurrence after air reduction. Median age was 21.5 months (range: 5.0~57.7 months) and 11 children (91.7%) underwent successful laparoscopic reduction. Median operating time was 50 minutes (range: 30~20 minutes) and median hospital days was 4.5 days (range: 3~8 days). One patient had a leading point as a heterotopic pancreas and underwent bowel resection through conversion. There was neither intra-operative nor postoperative complication. Laparoscopic reduction for intussusception can bring an excellent cosmetic effect with high success rate.