• Journal of Gastric Cancer
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• 제15권3호
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• pp.209-213
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• 2015

A 78-year-old man underwent laparoscopy-assisted total gastrectomy for gastric cancer (pT3N0M0). Multiple port sites were used, including a 10 mm port for a videoscope at the umbilical point and three other working ports. During the six-month follow-up evaluation, a 2 cm enhancing mass confined to the muscle layer was found 12 mm from the right lower quadrant port site, suggesting a metastatic or desmoid tumor. Follow-up computed tomography imaging two months later showed that the mass had increased in size to 3.5 cm. We confirmed that there was no intra-abdominal metastasis by diagnostic laparoscopy and then performed a wide resection of the recurrent mass. The histologic findings revealed poorly differentiated adenocarcinoma, suggesting a metastatic mass from the stomach cancer. The postoperative course was uneventful, and the patient completed adjuvant chemotherapy with TS-1 (tegafur, gimeracil, and oteracil potassium). There was no evidence of tumor recurrence during the 50-month follow-up period.

• Clinical and Experimental Reproductive Medicine
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• 제40권1호
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• pp.29-32
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• 2013

Objective: To investigate the influence of laparoscopic surgery on the natural conception rate in infertile women with endometriosis during the first year after the operation. Methods: We retrospectively studied 43 infertile women with surgically proven endometriosis. The natural conception rate was investigated for the 12 months after the laparoscopy. Results: The overall pregnancy rate was 41.9% (18/43). 66.7% (12/18) and 94.4% (17/18) of the patients conceived within postoperative 3 months and 6 months, respectively. The spontaneous pregnancy rate was not associated with the severity of endometriosis or laparoscopic findings or the type of surgery. The pregnancy rate for stage IV was relatively low (20.0%) compared to stage I, II, and III (35.7%, 44.4%, and 53.3%, respectively), although it did not reach statistical significance. Conclusion: Conservative surgical treatment with laparoscopy and a prompt attempt at natural conception may be effective for infertile patients with endometriosis.

• Journal of Gastric Cancer
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• 제12권1호
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• pp.49-52
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• 2012

Through the advent of surgical techniques and the improvement of laparoscopic tools including the ultrasonic activated scissor, laparoscopic gastrectomy has been increasingly used in far more cases of benign or malignant gastric lesions for the benefit of patients without compromising therapeutic outcomes. Even though possible complications provoked by the ultrasonic activated scissor can be prevented during the procedure with increasing advanced laparoscopic experience and supervision, unexpected late complications after the operations rarely occur. An extremely rare case of left incarcerated diaphragmatic hernia of the transverse colon developed in an 81-year-old female patient as a late complication, 8 months after laparoscopy-assisted total gastrectomy for gastric cancer, with laparoscopy successfully resumed and without the need to sacrifice any portion of the bowel.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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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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• 제7권2호
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• pp.97-101
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• 2007

저자들은 조기위암 환자에서 복강경보조 위전절제술 및 췌장보존식 비장절제술을 경험하였기에 이를 보고 하고자 한다. 62세 남자 환자로 내시경 조직검사에서 위상부와 위하부에 2개의 병변을 가진 조기위암으로 진단되어 복강경보조 위전절제술을 계획하고 수술을 진행하였다. 기복을 형성 후 5개의 투관을 삽입하여 위의 대만을 초음파 소작기로 박리 후 비장의 하단으로 박리를 진행하던 중 비장문부의 림프절 종대가 관찰되어 동결절편검사를 시행한 결과 암전이가 확인되어 위전절제술과 함께 췌장보존식 비장절제술을 시행하였다. 검상돌기 직하부에 수직으로 4 cm의 절개창을 형성 후 위장과 비장을 꺼낸 후 Roux-en-Y 식도공장문합술을 시행하였다. 환자는 수술 후 3일째 첫 번째 가스배출과 함께 유동식을 시작하였으며 별다른 문제없이 수술 후 9일째 퇴원하였다. 저자들은 비장문부의 림프절 암전이가 발견된 근위부 조기위암의 경우에도 복강경을 통한 제2군 림프절 절제가 가능함을 알 수 있었으며 복강경 보조 위전절제술 및 췌장보존식 비장절제술을 안전하게 시행할 수 있다고 생각한다.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.732-736
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• 2006

목 적 : 정류고환은 소아비뇨기영역에서 가장 흔한 기형으로 여러 합병증을 일으키며, 그 중 비촉지성 정류고환은 전체 정류고환 중 약 20%를 차지한다. 비촉지성 정류고환의 진단방법은 여러 가지가 있으나 아직 확립되지 않아 임상에서 통상적으로 적용될 수 있는 비촉지성 정류고환의 진단방법을 알아보고자 하였다. 방 법 : 2000년 3월부터 2005년 2월까지 본원에서 수술한 정류고환 129례 중 비촉지성 정류고환 31례를 대상으로 초음파검사, 전신마취하 신체검사, 복강경검사를 실시한 후 각 검사의 효과와 필요성을 분석하였다. 결 과 : 비촉지성 정류고환 31례에서 초음파검사상 13례(41.9%)에서 고환을 발견하였고 18례(58.1%)에서 고환을 발견할 수 없었고, 전신마취하 신체검사상 15례(48.4%)에서 고환을 촉지하였고 16례(51.6%)에서 고환을 촉지할 수 없었다. 초음파 검사와 전신마취하 신체검사에서 고환을 발견 못한 16례를 대상으로 복강경 검사를 실시하여 16례 고환 모두의 위치와 상태를 알 수 있었다. 결 론 : 신체검사상 고환을 촉지할 수 없는 비촉지성 정류고환에서 초음파검사, 전신마취하 신체검사, 복강경검사 순으로 진행하는 것이 비용과 효과 면에서 가장 좋은 진단과정으로 생각한다.

• Clinical and Experimental Reproductive Medicine
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• 제7권1_2호
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• pp.11-20
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• 1980

Hysterosalpingograms (H.S.G.) have been done for several decades to determine causative factors in female infertility. However, the H.S.G. only reverals uterine cavity and tubal patency or inpatency. The author prefers to find more details in regard to the status and condition of the female reproductive organs and their surrounding tissue as they pertain to infertility. H.S.G. in combination with laparoscopic examination reveals the following results. Preparation and method of performance of H.S.G. during laparoscopy in a healthy reproductive age women are as follows. When laparoscopy is not contraindicated, NPO is ordered with routine bowel preparation. Analgesics administered by injection prior to procedure are valium 10mgs and pethidine 50-100mgs. The radiographic procedure is the same as for any HSG technique. During laparoscopy a solution of 3 to 10 ccs. of 60% hypaque sodium is used. Fluroscopic scout films are obtained A-P and oblique views as well as a delayed check film. 1. Age distribution of primary and secondary infertility in this studies involving tubal factors was as follows: 20-29 age group showed 46% incidence and in the 30-39 age group, 50% incidence. Duration of infertility in this study group was the following: 1-2 years showed 26.7%, 3-5 years 53.8%, and 6-9 years 13.3%. 2. Indications of laparoscopic examination were as follows: Secondary infertility in 35% of the cases, obscure tubal occlusion on previous H.S.G. in 25%, unknown origin in 11.7%, and the remaining cases included pelvic pain, small masses, dysmenorrhea, and uterine anomaly. The laparoscopic examination showed clearly the reproductive organs and the surrounding tissues in the pelvic cavity. The abnormal tubal findings there revealed were tuberculous salpingitis and hydrosalpinx in 10% each, endometriosis and peritubabl adhesions in 6.7% each, biconuate uterus in 3.3%. The remaining 58.3% of the cases showed normal findings. Laparoscopic observation for possible myoma nodules, streak ovary, and peritubal adhesions was also done at this time. 3. Comparative tubal findings in combined H.S.G. and laparoscopic examination revealed the following. Bilateral tubal occlusion was present in 14% (7cases) on laparoscopic examination but on H.S.G. 38% (19 cases) were noted. However, tubal occlusion and peritubal adhesions were found in 26% (13 cases) upon laparoscopy and only 8% (4 cases) on H.S.G. examination alone. Normal pelvic findings were present in 60% (27 cases).

• Journal of Gastric Cancer
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• 제9권2호
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• pp.51-56
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• 2009

목적: 위암의 복막재발 또는 암종증을 확진하기 위해서는 개복 수술 및 생검이 필요하다. 최근 시험적 개복술 대신 진단적 복강경 검사가 많이 시행되고 있으나 위암 환자에서 복막재발을 진단하기 위해 시험적 개복술 대신 진단적 복강경 검사로 대체한 것에 관한 연구는 아직 보고된 바가 적다. 이에 복막전이가 의심되는 위암환자에서 시행된 진단적 복강경 검사를 분석하여 그 역할과 유용성에 대해 검토하고자 한다. 대상 및 방법: 2004년 2월부터 2009년 3월까지 복막전이가 의심되어 진단적 복강경 검사를 시행 받은 총 45명의 위암 환자들에 대해 안전성과 정확도를 평가하였다. 결과: 총 45명의 연구 대상 환자들에서 남자는 26명(57.8%), 여자는 19명(42.2%)이었고 전체 평균 연령은 49.3세(25~74세)였다. 총 검사시간은 평균 $44.1\pm26.9$분, 술 후 재원기간은 평균 $2.7\pm2.8$일이었다. 45명 중 검사상 양성으로 나온 사람은 35명이었으며, 음성으로 나온 10명 중 위음성은 3명이었다. 검사 관련 합병증은 1건이었으며, 검사 관련 사망자는 없었다. 민감도는 진단적 복강경 검사의 경우 92.1%, 이학적 검사 29.7%, 복부 CT 86.5%, PET CT 69.2%. CEA 검사는 18.8%였다. 결론: 진단적 복강경 검사는 비교적 짧은 시술 시간과 재원기간, 낮은 합병증 발생율을 보여 시험적 개복술에 비해 안전한 검사이다. 또한 다른 검사에 비해 민감도가 높아 위암환자에서 복막 재발 및 암종증 여부를 확인하는데 효과적인 검사 방법으로 사료된다.

• 대한위암학회:학술대회논문집
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• 대한위암학회 2003년도 제16회 추계학술대회
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• pp.3-3
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• 2003

• Journal of Gastric Cancer
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• 제12권4호
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• pp.249-253
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• 2012

Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.