• Journal of Gastric Cancer
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• 제13권4호
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• pp.199-206
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• 2013

Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2007년도 추계국제학술대회 및 컨퍼런스
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• pp.567-567
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• 2007

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2008년도 춘계학술대회
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• pp.96-96
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• 2008

• 한국간담췌외과학회지
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• 제26권4호
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• pp.318-324
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• 2022

Backgrounds/Aims: Gallstone disease is a recognized complication of bariatric surgery. Subsequent management of choledocholithiasis may be challenging due to altered anatomy which may include Roux-en-Y gastric bypass (RYGB). We conducted a retrospective service evaluation study to assess the safety and efficacy of endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in patients with RYGB anatomy. Methods: All the patients who underwent EDGE for endoscopic retrograde cholangiopancreatography after RYGB at two tertiary care centers in the United Kingdom between January 2020 and October 2021 were included in the study. Clinical and demographic details were recorded for all patients. The primary outcome measures were technical and clinical success. Adverse events were recorded. Hot Axios lumen apposing metal stents measuring 20 mm in diameter and 10 mm in length were used in all the patients for creation of a gastro-gastric or gastro-jejunal fistula. Results: A total of 14 patients underwent EDGE during the study period. The majority of the patients were female (85.7%) and the mean age of patients was 65.8 ± 9.8 years. Technical success was achieved in all but one patient at the first attempt (92.8%) and clinical success was achieved in 100% of the patients. Complications arose in 3 patients with 1 patient experiencing persistent fistula and weight gain. Conclusions: In patients with RYGB anatomy, EDGE facilitated biliary access has a high rate of clinical success with an acceptable safety profile. Adverse events are uncommon and can be managed endoscopically.

• Journal of Gastric Cancer
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• 제21권2호
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• pp.111-121
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• 2021

Laparoscopic endoscopic cooperative surgery (LECS) refers to the endoscopic dissection of the mucosal or submucosal layers with laparoscopic seromuscular resection. We recommend a treatment algorithm for the LECS procedure for gastric benign tumors according to the protruding type. In the exophytic type, endoscopic-assisted wedge resection can be performed. In the endophytic type, endoscopic-assisted wedge resection of the anterior wall is relatively easy to perform, and endoscopic-assisted transgastric resection, laparoscopic-assisted intragastric surgery, or single-incision intragastric resection in the posterior wall and esophagogastric junction (EG Jx) can be attempted. We propose an algorithm for the LECS procedure for early gastric cancer according to the tumor location. The endoscopic submucosal dissection (ESD) procedure can be adapted for all areas of the stomach, and single-incision ESD can be performed in the mid to high body and the EG Jx. In full-thickness gastric resection, laparoscopy-assisted endoscopic full-thickness resection can be adapted for the entire area of the stomach, but it cannot be applied to the pyloric and EG Jx. In conclusion, surgeons need to select the LECS procedure according to tumor type, tumor location, the surgeon's individual experience, and the situation of the institution while also considering the advantages and disadvantages of each procedure.

• 한국임상수의학회지
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• 제24권3호
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• pp.315-319
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• 2007

1년령, 암컷, 15 kg의 잡종견에서 위내시경을 이용한 경위장관 담낭절제술을 최소한의 복강경 도움아래에서 성공적으로 수행하였다. 내시경용 바늘 절개도를 이용하여 배쪽 유문부에서 위절개를 실시하였다. 위절개부를 통하여 내시경을 복강내로 진입한 다음 뒤쪽으로 돌려서 담낭쪽 시야를 확보하였다. 술야의 확보를 위해 복강경용 겸자를 이용하여 담낭의 바닥부위를 부드럽게 들어올렸다. 담낭관과 동맥을 내시경용 endoclip을 이용하여 3중 결찰하였다. 담낭관과 동맥을 절단한 후 내시경용 소작겸자와 바늘 절개도를 이용하여 담낭을 간으로부터 분리하였다. 분리된 담낭은 내시경을 이용해 입을 통하여 제거하고, 위절개부위는 내시경용 endoclip을 이용하여 봉합하였다. 술후 3일째 방사선검사 및 혈청화학검사를 통해 위봉합부위의 천공이 없음과 담즙의 누출이 없음을 확인하였다. 술후 16일째 위내시경과 복강경 검사를 실시하였다. 위내시경검사 결과 봉합부위가 완전히 유합 되었음을 확인하였고 복강경 검사를 통해 담낭절제부위와 위절개부의 장막에 대망막이 유착되어있음을 확인하였다. 본 연구는 개에서 자연개구부 내시경수술(NOTES)을 이용한 담낭절제술의 최초 보고로써 새로운 방법에 의한 담낭절제술에 대한 가능성을 제시한다.

• 한국임상수의학회지
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• 제28권5호
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• pp.497-505
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• 2011

자연개구부를 통한 내시경적 수술 (NOTES)은 최근 많은 잠재적인 장점들로 인해 새롭게 주목받고 있는 수술방법이다. 하지만 국내에서 대부분 사용되어지고 있는 내시경은 기구가 삽입되는 포트가 한 개인 것이 대부분으로 순수 NOTES를 시행하기에는 다소 어려움이 있을 수 있다. 이에 본 실험에서는 복강경과 순수 NOTES의 중간 단계 인 하이브리드 NOTES를 통해 담낭절제술을 실시하였다. 이 방법은 한 개의 복강경 포트를 삽입함으로써 이를 통해 복강경용 겸자를 사용하여 담낭의 견인 역할을 할 수 있다는 장점을 지닌다. 내시경은 경위장관, 경결장 및 경질을 통 해 외부 피부 절개 없이 복강 내로 삽입되어 수술이 진행되었으며 복강 내압은 $CO_2$를 이용하여 4 mmHg로 유지하였다. 위 세 경로를 통한 접근으로 담낭절제술은 모두 성공적으로 이루어졌으며 모든 실험견들은 실험기간동안 임상적인 유의성 없이 좋은 회복을 나타내었다. 본 연구를 통해 개에서 최소 침습적 수술로 담낭절제술을 실시할 수 있는 방법을 확립하고 시술 시에 발생할 수 있는 부작용 등을 확인함으로써 소동물 수의 임상영역에서 최소 침습적 수술이 보급될 수 있는 기초가 되며, 복강경과 내시경의 임상 활용도를 높일 수 있을 것으로 생각된다. 하지만 경결장의 경우 내시경 접근 시 복강 내에서 소수의 세균 감염이 확인되었으며 경결장 접근의 경우 접근 방법에 대한 다른 연구가 필요할 것으로 생각된다.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.355-362
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• 2022

Backgrounds/Aims: Postoperative fluid collection is a common complication of pancreatic resection without clear management guidelines. This study aimed to compare outcomes of endoscopic ultrasound (EUS)-guided trans-gastric drainage and percutaneous catheter drainage (PCD) in patients who experienced this adverse event after pancreaticoduodenectomy (PD). Methods: Demographic and clinical data and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for fluid collection after PD between January 2015 and June 2019 in our tertiary referral center were retrospectively analyzed. Results: Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (69.8%), and nausea/vomiting (17.0%). Within 8 weeks of drainage, 77.4% showed a diameter decrease of more than 50% (87.5% in EUS vs. 66.7% in PCD, p = 0.09). Post-procedural intravenous antibiotics were used for an average of 8.1 ± 4.3 days and 12.4 ± 7.4 days for EUS group and PCD group, respectively (p = 0.01). The EUS group had a shorter post-procedural hospital stay than the PCD group (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p < 0.01). However, the two groups showed no statistically significant difference in technical or clinical success rate, reintervention rate, or adverse event rate. Conclusions: EUS-guided drainage and PCD are both safe and effective methods for managing fluid collection after PD. However, EUS-guided drainage can shorten hospital stay and duration of intravenous antibiotics use.