J Minim Invasive Surg 2017; 20(3): 79-83  https://doi.org/10.7602/jmis.2017.20.3.79
28 Years of the Journey for Laparoscopic Surgery and Memories of People Who Gave so much of Themselves to Support Me During the Time
Jun-Gi Kim
President of KSELS, Department of Surgery, Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea
Correspondence to: Jun-Gi Kim Department of Surgery, Seoul St. Mary Hospital, The Catholic University of Korea, 222 Banpo-dearo, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-2876, Fax: +82-2-595-2822, E-mail: jgkim@catholic.ac.kr
Published online: September 15, 2017.
© Journal of Minimally Invasive Surgery. All rights reserved.

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LIFE CHANGING EXPERIENCE AND A FRIENDSHIP

I joined St. Vincent’s Hospital, the Catholic University of Korea in May 1984, and I have operated a lot of laparotomies. I then had a chance to work abroad at the University of Colorado Health Science Center in the U.S from September 1989 to February 1991. I learned the pelvic exenteration from Prof. Nathan Pearlmann and laparoscopic surgery from Prof. Gregory V. Stiegmann during my stay at the University of Colorado. It was a great opportunity to learn laparoscopic surgery at this time as it changed my life as a surgeon. I was fortunate to observe the whole process of implementing laparoscopic surgery to the University setting with Prof. Gregory V. Stiegmann leadership. I participated in animal testing, fresh cadaver testing and clinical applications. The experience would later be an excellent reference when I introduced laparoscopic surgery to South Korea. My time at the University of Colorado Health Science Center provided both technical experience and networking opportunities as I still keep in touch with Prof. Manabu Yamamoto and Prof. Seigo Kitano.

DAWN OF LAPAROSCOPIC SURGERY IN THE 1990s – A KEEN INTEREST AND AMBITION FOR NEW SURGICAL TECHNIQUES

I returned to South Korea in March 1991, I had performed the laparoscopic cholecystectomy successfully in October.1 I had attempted various laparoscopic surgeries including benign gastric surgeries (June, 1992), colon resection (April, 1994, Fig. 1), splenectomy (June, 1994),2 adrenalectomy (Nov. 1995),3 laparoscopic abdominal transanal proctosigmoidectomy with coloanal anastomosis (Feb. 1996),4 Duhamel’s operation (Mar. 1997),5 and lumbar sympathectomy (Nov. 1998). It was a remarkable progress because laparoscoic splenectomy, laparoscopic abdominal transanal proctosigmoidectomy with coloanal anastomosis (LATA), and laparoscopic Duhamel’s procedure were never performed in South Korea before.

Fig. 1.

Medical record of my first laparoscopic abdominoperineal resection patient.



LATA was co-developed with Prof. Jong-Seo Lee who learned Transanal Transabdominal Transanal Proctosgmoidectomy with coloanal anastomosis (TATA) from Prof. Gerald Marks at the Thomas Jefferson University in the U.S.6 Prof. Lee and I worked together and performed three cases of the laparoscopic version of TATA. We named those surgeries as “LATA”. However, after performing the 5th surgery, Prof. Lee passed away. I felt deeply sorry for his death. It brings me much grief when thinking about it to this day.

As I gained more experiences in laparoscopic colorectal cancer surgery, I had a chance to give a presentation on “Preliminary Experience with Laparoscopic Colectomy: Comparison with Conventional Colectomy” at the Spring Congress of Korean Surgical Society in Kyung-ju, Korea in 1996.7 I never expected to be welcomed as it was a very new technique brought in to the country but the audience’s response was harsher than I had imagined. However, it could not stop my ambition and interests towards this new technique. There were about 109 surgeons who were interested in laparoscopic technique other than myself, therefore, we decided to establish the Korean Society of Endoscopic & Laparoscopic Surgeons (KSELS) and finally organized it on April 20, 1996. Like it or not, laparoscopic surgery was gradually performed on both benign and malignant diseases, and expanding its influence in Korea.

LAPAROSCOPIC SURGERY BECAME A COMMON SURGICAL TECHNIQUE IN THE 2000s

Many surgeons still had concerns about laparoscopic surgery until the 90s but a new era began in 2000. On November 24, 2000, the Korean Laparoscopic Colorectal Surgery Study Group was launched with 12 surgeons interested in laparoscopic colorectal surgery. I was appointed as the first chairman of this group. The goals of study group were to standardize the laparoscopic surgery technique, to plan and organize the randomized controlled trial (RCT), and also to educate those interested in learning the technique. Later, the group was included in the Korean Society of Coloproctology (KSCP) in August 2002. The members of the group increased to 183 after seven years. Today, almost all of the members of the KSCP belongs to the member of this group thus it is meaningless to mention the number of its member.

The nine and a half years that I worked as a chairman for Korean Laparoscopic Colorectal Surgery Study Group were blessed years. We held 20 live surgery symposiums and 22 video symposiums during my term. Members were very eager to participate in the symposium. They learned and taught each other through sharing their edited videos, live surgery demonstrations and lectures. The white paper of the Korean laparoscopic colorectal surgery study group was published in the supplement section of the journal, Annals of Coloproctology in November, 2005. It contained the beginning stage of the group and its history.8 To standardize laparoscopic colorectal surgery skills, I organized laparoscopic experts groups to publish an atlas of laparoscopic colorectal surgery in 2006. Photos and videos of members performing laparoscopic surgeries were collected for three years from 2006 to 2008 to publish the Atlas of Laparoscopic Colorectal Surgery.9 It has been quite a long time since the atlas was published on April 10, 2009 but I cannot forget the ambition we had back then. I am glad to hear the atlas is on a great reference to those who want to learn and are interested in the laparoscopic colorectal surgery. The publication ceremony was held at the Catholic University of Korea with the 22nd video symposium of Korean laparoscopic colorectal surgery study group on June 12, 2009. I resigned from the group as chairman and my longtime friend, Prof. Seon Hahn Kim from Korea University succeeded me as 2nd chairman.

Laparoscopic surgery was at the initial stage of its expansion when I started as a chairman of Korean Laparoscopic Colorectal Surgery Study Group but it became the major surgical technique when my term was almost finished. Robotic surgery also came to the forefront at this time. Since then, the group has had numerous live surgery symposium, video symposium, and international conferences, and has led the laparoscopic surgery field with the support from 2nd chairman, Seon Hahn Kim, 3rd chariman, Gyu-Seog Choi, 4th chairman, Hyeong-Rok Kim, and 5th chairman, Byung Chun Kim. I would like to thank them once again for their role.

I served as the first editor-in-chief of the official journal of the Korean Society of Endoscopic & Laparoscopic Surgeons (KSELS) (Daehan Naesigyeong Bokganggyeong Weigua Hakhoeji, now its name has been changed as Journal of Minimally Invasive Surgery) from 2006 to 2008.

SERVING AS A CHAIRMAN AT THE KOREAN SOCIETY OF ENDOSCOPIC & LAPAROSCOPIC SURGEONS FOR TWO YEARS AND FOUR AGENDAS THAT WERE FOCUSED

I focused on four things while I was a chairman of the board of directors of the Korean Society of Endoscopic & Laparoscopic Surgeons from 2010 to 2012. First was to launch the prospective randomized controlled trial named ‘SIMPLE’. SIMPLE is the abbreviation of SIngle port versus Multiport Laparoscopic Surgery (SIMPLE) in Colon Cancer. The last case was enrolled in June, 2017 and it is still being followed-up. Prof. Chang Woo Kim analyzed the learning curve of Single Port Colectomy for all participants and published on the Surgical Endoscopy.10 Prof. Byung Mo Kang is in the process of publishing interim results. I believe this trial could be an internationally renowned research in the field of comparison study between single port and multiport colectomy.

Second was a co-operation with the Korean laparoscopic surgery study group of community hospital. Chairman, Bong Soo Chung, of the Korean laparoscopic surgery study group of community hospital requested for this co-operation and I approved their proposal. KSELS was actively involved in meetings with the study group starting from the 3rd symposium held at Hanmaeum Changwon Hospital in March 7, 2010. This co-work would be meaningful, because many community-hospital affiliated surgeons are general surgeons rather than specialist, they would like to learn general laparoscopic principles as well as specialized laparoscopic techniques in gastric, colorectal and hepatobiliary surgeries.

Third was to hold the congress on a regular basis. During my term, total four major congresses were held. Two major Fall congresses were held with congress of Korean Surgical Society (KSS) and other two congresses were held as Spring Congress of KSELS in Gwangju on April 29, 2011, and 2012 International Congress of the Korean Society of Endoscopic & Laparoscopic Surgeons with the slogan “Global Lead in Minimal Invasive Surgery” in Seoul on March 30th and 31st of 2012. Congresses were successful with the support of the current Chairman of the Board of Director, Prof. Ho-Seong Han from the Seoul National University who was the director of the Scientific Committee back then.

Fourth was to publish the KSELS white paper. I decided to publish the white paper to look back at the 15 years of the history of KSELS and to look forward to the future potential. Prof. Byung Chun Kim was appointed as a director of the Planning Committee and asked to publish the white paper. Dr. Seung Kyu Jeong was selected as an assistant administrator to manage the project and assisted the director Prof. Byung Chun Kim with previous secretory generals. The planning committee met monthly for seven months to collect, review, and edit the data. The white paper was finally published in December, 2011.11

WONDERFUL YEARS AS A CHAIRMAN, A PRESIDENT AND A PROFESSOR – MY DEEPEST GRADITUDE TO PEOPLE WHO SHOWED UNFLAGGING SUPPORT DURING THESE YEARS

After finishing two grateful years term as a chairman of the board of directors, I was appointed as the president of the KSELS in 2016 and the year of 2016 was meaningful for us because we had celebrated our 20th anniversary meeting.

It was my honor to observe the growth of the KSELS until 2017 spring conference with Prof. Ho-Seong Han, chairman of the board of directors. It was such a fruitful years for me as a professor and a member of the society. Once again, I would like to express my gratitude to those who supported me during the time.

Lastly, I would like to introduce the Korean Natural Orifice Transluminal Endoscopic Surgery Society (K-NOTES). This society was established in February, 2011. Members are surgeons, gastroenterologists and engineers. I represent the society with Prof. Chang Duck Kim from the division of gastroenterology in Korea University as a co-president. Laparoscopic surgery has been improving through present day and I am certain that it will lead the no-scar surgery area in near future. In order to achieve this goal, the invention of new surgical instrument is inevitable thus the co-operation with the surgery, internal medicine, and engineering department is required. Prof. Dong Soo Kwon from Korea Advanced Institute of Science and Technology (KAIST) represents the engineers and has led the K-NOTES. I believe that K-NOTES will be the leading society in the future with a help of many professors who want to explore the new area.

TEACHING AND COMMUNICATING ARE THE BEST WAY TO GROW ALONG WITH LEARNING – FRIENDS WHO TAUGHT AND LEARNED FROM EACH OTHER

Forty surgeons from medical schools and general hospitals in South Korea have visited me to learn laparoscopic surgery from October of 1997 until the day I retired. They came to the hospitals where I worked and trained for more than two weeks. I have spent quite hard time due to facing many practical problems when I translating open surgery to laparoscopic surgery back in the early 90s. During this hardship, those visit encouraged me and reminded me why I was doing this. I was pleased to share my knowledge and techniques with colleagues, and open to all discussions. I would not be where I am without them. Prof. Sang Mok Lee from Kyung Hee University was the first surgeon visited me and I shared the skills of laparoscopic cholecystectomy and laparoscopic splenectomy with him. Prof. Suk-Hwan Lee is the first surgeon among many colorectal surgeons who came to learn laparoscopic colorectal surgery, and he is from Kyung Hee University as well.

Since April, 2004 until I retire Seoul St. Mary’s Hospital, the Catholic University of Korea, 52 foreign surgeons visited St. Vincent hospital (nine surgeons) and Seoul St. Mary’s hospital (43 surgeons) from two weeks to two years to study laparoscopic surgery (Fig. 2). My first foreign student was Prof. Chucheep Sahakitrungruang from King Chulalongkorn Memorial Hospital in Thailand. He referred and introduced me to surgeons in Thailand. I believe that because of his referral, as many as 31 surgeons from Thailand visited me to learn laparoscopic colorectal surgery. I am honored to have students abroad with the help from my colleagues, development of Korea’s medical industry, and alma mater. Also, I would like to thank my senior colleague, Prof. Chung-Soo Chun and Prof. Yong Gul Lim, an anesthesiologist from St. Vincent Hospital and Hospital’s administration.

Fig. 2.

Laparoscopic colon surgery was performed with international fellows who visited me at Seoul St. Mary’s hospital, The Catholic University of Korea.



I enjoy demonstrating the live surgery, because I do not have to spend much time to prepare the presentation. Also, words used during the live surgery are relatively simple thus I feel comfortable as a non-native English speaker. When I perform the difficult operation case, the audience bears with me and understands rather than criticizes. I performed 30 cases of live demonstration from March 3, 2006 to April 4, 2017 in 11 countries. The most performed country was Korea which was nine times, followed by Thailand (five times), India (four times), China (three times), Singapore (twice), and Myanmar (twice). I remember the 15th live demonstration held at Chiangmai, Thailand on February 3, 2012 and 17th at Coimbatore, Tamilnadu India on July 19, 2012. The two surgeries were successful and there was a special ceremony held after. I was appointed as a fellow of the association of minimal access surgeons of India, and a traditional ceremony was held in Thailand. Students put the flower necklace on me and I splashed the water on their heads and gave them good words. It was a entertaining yet devotional experience for me.

I should mention the Asia Endosurgery Task Force(AETF) as well. AETF was established during the ELSA Bali 2004 meeting in September 28, 2004. I participated in the meeting as a founding member along with Prof. Woo Jung Lee from Yonsei University and represented South Korea. The purpose of AETF was to educate endosurgery for more surgeons in Asia region. There has been 27 workshops during the past 12 years from December 2005 to April, 2017. I held three of those workshops as a course director (Shanghai, China in March, 2008, and in Osong, Korea in August, 2013 and in October, 2016).

I want to let beloved mentees know that treating patients and working with colleagues should be like offering a Buddhist mass. Treat them as if they are Buddha. If there is anything to learn from students and colleagues, treat them like a teacher and learn. I tried my best to teach them and learn from those who visited me regardless of their background and the nationality. People were commenting that surgeons with laparoscopic surgery experience would easily and quickly learn robotic surgery. However, in order to minimize any errors I visited my mentees who have more robotic surgery experiences than myself and learned from them. My deepest thanks go to Prof. Kang Young Lee from Yonsei University, Kil Yeon Lee from Kyung Hee University, and Prof. Yoonah Park from Samsung Medical Center who came to my operation theater and taught me the robotic surgery technique.

I would like to end my speech with the words from my mentor, Prof. Yong Kak Lee’s. ‘The surgery should follow an embryologic plane. The surgery should follow principles of vascular surgery.’ I have been keeping these words since I was young staff surgeon. I believe this idea implies to all matters related to the surgery. And finally I want to thank again truly amazing Prof. Chung-Soo Chun. He supported me every step of the way for me to focus on the laparoscopic surgery.

References
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  2. Kim JG, Jin SH, and Seo YJ et al. Laparoscopic Splenectomy. J Korean Surg Soc 1995;48:573-586.
  3. Seo IY, Kye BH, and Kim JG et al. The Comparison of Laparoscopic Adrenalectomy with Open Adrenalectomy. J Korean Surg Soc 2006;70:363-369.
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  5. Kim JG, Won YS, and Chin HM et al. Laparoscopic Duhamel Procedure for Hirschsprung's Disease: The first two cases in Korea. J Korean Surg Soc 1999;57:458-463.
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  8. The Korean Laparoscopic Colorectal Surgery Study Group. White paper of the Korean Laparoscopic Colorectal Surgery Study Group in the Journal of the Korean Society of Coloproctology. Seoul: MEDrang Inc; 2005.
  9. The Korean Laparoscopic Colorectal Surgery Study Group. Atlas of Laparoscopic Colorectal Surgery. Seoul: Biomedbook; 2009.
  10. Kim CW, Lee KY, and Lee SC et al. Learning curve for single-port laparoscopic colon cancer resection: a multicenter observational study. Surg Endosc 2017;31:1828-1835.
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  11. The Korean Society of Endoscopic & Laparoscopic Surgeons. White paper of the Korean Society of Endoscopic & Laparoscopic Surgeons. Seoul: MEDrang Inc; 2011.


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