• Journal of Gastric Cancer
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• v.13 no.3
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• pp.136-148
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• 2013

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

• Journal of Gastric Cancer
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• v.18 no.2
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• pp.109-117
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• 2018

Purpose: This study aimed to investigate the outcomes of laparoscopic gastrectomy in very elderly patients with gastric cancer, who have outlived the average lifespan of the Korean population (men: ${\geq}77years$, women: ${\geq}84years$). Materials and Methods: Between 2004 and 2015, 836 patients with gastric cancer underwent a laparoscopic gastrectomy. They were divided into the elderly group (EldG) and non-elderly group (nEldG). Propensity score matching for covariates of sex, tumor depth, node status, and extent of resection was performed. Clinicopathologic characteristics, and surgical and survival outcomes were compared between the 2 groups. Results: The EldG had a higher American Society of Anesthesiologists (ASA) score and a higher number of comorbidities. There was no significant difference in the post-operative complications, except for pulmonary complications, which were more frequent in the EldG (5/56, 8.9%) than in the nEldG (0/56, 0%). The EldG had a shorter overall survival (OS), but cancer-specific survival was similar for both groups. Among deceased patients, 2 (25%) and 8 patients (50%) died within a year of surgery in the nEldG and EldG, respectively. Univariate and multivariate risk factor analyses for OS showed that age, ASA score, tumor, node, metastasis (TNM) stage, and occurrence of complications were significantly related to deterioration in OS. Conclusions: Laparoscopic gastrectomy can be safely performed in very elderly patients with gastric cancer who have outlived the average lifespan of the Korean population. However, impact of laparoscopic gastrectomy on improving survival is not clear, and careful patient selection is recommended.

• Journal of Gastric Cancer
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• v.18 no.2
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• pp.172-181
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• 2018

Purpose: This study aimed to evaluate the surgical outcomes and investigate the feasibility of reduced-port laparoscopic gastrectomy using learning curve analysis in a small-volume center. Materials and Methods: We reviewed 269 patients who underwent laparoscopic distal gastrectomy (LDG) for gastric carcinoma between 2012 and 2017. Among them, 159 patients underwent reduced-port laparoscopic gastrectomy. The cumulative sum technique was used for quantitative assessment of the learning curve. Results: There were no statistically significant differences in the baseline characteristics of patients who underwent conventional and reduced-port LDG, and the operative time did not significantly differ between the groups. However, the amount of intraoperative bleeding was significantly lower in the reduced-port laparoscopic gastrectomy group (56.3 vs. 48.2 mL; P<0.001). There were no significant differences between the groups in terms of the first flatus time or length of hospital stay. Neither the incidence nor the severity of the complications significantly differed between the groups. The slope of the cumulative sum curve indicates the trend of learning performance. After 33 operations, the slope gently stabilized, which was regarded as the breakpoint of the learning curve. Conclusions: The surgical outcomes of reduced-port laparoscopic gastrectomy were comparable to those of conventional laparoscopic gastrectomy, suggesting that transition from conventional to reduced-port laparoscopic gastrectomy is feasible and safe, with a relatively short learning curve, in a small-volume center.

• Journal of Gastric Cancer
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• v.18 no.2
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• pp.182-188
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• 2018

Purpose: Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG. Materials and Methods: A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group. Results: Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases ($157.8{\pm}38.4$ minutes vs. $118.1{\pm}34.5$ minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases ($160.8{\pm}51.6$ minutes vs. $173.3{\pm}35.2$ minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of <$25kg/m^2$ (<$25kg/m^2$:${\geq}25kg/m^2$, $159.3{\pm}41.7$ minutes: $194.25{\pm}81.1$ minutes; P=0.001). Conclusions: Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of <$25kg/m^2$ was found to be a favorable factor for SPDG.

• Asian-Australasian Journal of Animal Sciences
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• v.13 no.5
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• pp.595-599
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• 2000

Fine wool sheep (n=18) maintained in a tropical environment were allocated to three treatment groups. Estrus was induced with two injections of $PGF_{2{\alpha}}$ (10 mg. im) at 10 days interval. Superovulation treatment started 2 days prior to the second injection of $PGF_{2{\alpha}}$. Each ewe was treated with a total dose of 25 units FSH (Super-OV) i.m. every 12 hover 3 days; Group 2 were also injected i.m. with 200 IU PMSG at the first injection of FSH; Group 3 was treated as in Group 2 and also with GnRH ($4{\mu}g$ Buserelin) at the onset of estrus. The ewes in estrus were mated with a fertile ram. Ovarian examination and recovery of embryo and ova were performed at laparoscopy and laparotomy on day 3 or 4 after mating. Data for onset of estrus, duration of estrus, number of corpora lutea (CL), number of unnovulated large follicle (LF), embryo recovery rate, embryo quality and fertilization recorded for the 3 groups. Ewes in the Group 1 set in estrus later (p<0.05; $50.0{\pm}7.29h$) than the ewes in Group 2 ($24.5{\pm}3.58$) and 3 ($32.5{\pm}3.58h$). The duration of estrus, ovarian size and ovarian response (number of CL and LF) did not differ significantly (p>0.05) among the 3 groups. The proportion of ewes with a superovulatory response (${\geq}2$ CL) was the lowest (50%) in Group 1 treated with FSH alone but ova/embryo recovery (100%) and fertilization (100%) was significantly (p<0.05) higher than Group 2 (58.3 and 85.7%, respectively) and Group 3 (48.6 and 50%, respectively). It is concluded that in tropical fine wool sheep, there is no difference in the 3 treatments for yield of good quality embryos but ovarian response and ovulation rate increased on additional use of PMSG and GnRH respectively to FSH alone.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4327-4333
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• 2016

Purpose: To systematically review efficacyand safety of robotic gastrectomy (RG) compared with conventional laparoscopic gastrectomy (LG) for gastric carcinoma. Materials and Methods: A systematic literature search was carried out using PubMed, Cochrane Library, CBM, CNKI, WanFang, VIP and other sources like relevant references to obtain comparative studies assessing the effectiveness and safety between RG and LG published between 2013 and 2016. Then the literature was screened and the data were extracted by 2 independent reviewers. The quality of the literature was assessed, and the data analyzed using Stata/SE 14 software. Fixed effects or random effects models wereapplied according to heterogeneity. Results: A total of 12 non-randomized observational clinical studies involving 3,580 patients were included, of which 1,096 had undergone RG and 2,484 had received LG. The results of the meta-analysis showed in terms of effectiveness, RG was associated with less blood loss, less time to first flatus and greater number of harvested lymph nodes, but there were no significant differences in proximal and distal resection margins, compared with LG. In terms of efficiency, RG was associated with shorter hospital stay, but longer operative time. In terms of safety, there were no statistically significant differences in complications, mortality and conversions between RG and LG. Conclusions: RG can achieve comparable or better short-term and radical effects than LG, with respect to effectiveness, efficiency and safety in treatment of gastric carcinoma. Future studies involving RG should focus on decreasing operative time and reducing cost. Moreover, there is a need for randomized controlled trials comparing the two techniques with long-term follow-up.

• Journal of Gastric Cancer
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• v.16 no.4
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• pp.240-246
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• 2016

Purpose: It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). Materials and Methods: From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. Results: The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). Conclusions: In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique.

• 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.

• The Korean Journal of Nuclear Medicine
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• v.14 no.1
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• pp.37-44
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• 1980

The usefulness of single, random measurements of serum FSH and LH in the diagnosis of primary amenorrhea by radioimmunoassay was investigated. The 16 patients were divided into 3 groups by the level of serum FSH and LH. The first group with increased level of serum FSH and LH is five patients, all of these are related to the acquired or congenital abnormality of the ovary. Further studies indicated include buccal smear, chromosome analysis, gynecography and laparosocopy. The second group with normal serum FSH and LH is nine patients, four patients of these are related to the developmental anomaly of the Mullerian duct and five patients are undo etermined origin. Further studies indicated include laparoscopy and gynecography. The third group with decreased serum FSH and normal or decreased serum LH is two patients, one of these is related to the pituitary function, isolated FSH deficiency, the other is undetermined origin. Further studies indicated include the pituitary function test, LH-RH stimulation test, skull radiography. Determination of serum FSH and LH levels does not permit a specific etiologic diagnosis of primary amenorrhea. However the serum levels of FSH and LH can be used to differentiate the principal area of the investigation and can be of assistance in choosing more specific testing procedures.

• Korean Journal of Adult Nursing
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• v.27 no.5
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• pp.481-492
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• 2015

Purpose: The purpose of this study was to examine the effects of the evidence-based clinical practice guidelines on Postoperative Nausea and Vomiting (PONV). Methods: The research design was a non-equivalent control group with a non-synchronized design. The participants were the patients undergoing gynecologic laparoscopy. Data were collected from July, 2014 through January, 2015. The participants in the experimental group (n=35) received an assessment of risk factors of PONV, aroma therapy, and P6 acupressure method as recommended in the guidelines. Those in the control group (n=35) received usual nursing care. Data were analyzed by mean, standard deviation, t-test, ${\chi}^2$-test using SPSS/WIN 19.0 program. Results: The occurrence of nausea and vomiting, the level of nausea and vomiting, and the need for antiemetic medicine in the experimental group were significantly less than those in the control group after surgery. The levels of postoperative pain and the amounts of time for nursing activities in the experimental group were significantly reduced than those in the control group after surgery. The levels of satisfaction were significantly higher in the experiment group than that of the control group. Conclusion: The evidence-based guidelines is recommended for nursing practice as a guidance for managing PONV and helping the recovery of patients after laparoscopic surgery.