Vol.26 No.2, June 15, 2023 Article TypeCase ReportEditorialOriginal ArticlePresidential AddressVideo/Multimedia Article

• Presidential Address 2023-06-15

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  What is the role of surgical oncologist in the treatment of gastric cancer?

  Jeong Ho Song , Sang-Yong Son , Sang-Uk Han

  Journal of Minimally Invasive Surgery 2023; 26(2): 47-50 https://doi.org/10.7602/jmis.2023.26.2.47

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  Surgical oncologist plays a pivotal role in treating patients with cancer in the era of precision medicine. In this article, we summarized traditional roles of surgical oncologists and suggested further additional ones for the modern day in the multidisciplinary approach to gastric cancer treatment.

• Editorial 2023-06-15

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  Feasibility of laparoscopic Witzel feeding jejunostomy

  Geum Jong Song

  Journal of Minimally Invasive Surgery 2023; 26(2): 51-52 https://doi.org/10.7602/jmis.2023.26.2.51

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• Editorial 2023-06-15

  0 83 72

  Safe and convenient intrathoracic anastomosis in minimally invasive Ivor Lewis esophagectomy

  Sang Hyun Kim

  Journal of Minimally Invasive Surgery 2023; 26(2): 53-54 https://doi.org/10.7602/jmis.2023.26.2.53

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• Original Article 2023-06-15

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  A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis

  Kyeong Eui Kim , In Soo Cho , Sung Uk Bae , Woon Kyung Jeong , Hyung Jin Kim , Seong Kyu Baek

  Journal of Minimally Invasive Surgery 2023; 26(2): 55-63 https://doi.org/10.7602/jmis.2023.26.2.55

  Abstract

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  Purpose: This study aimed to compare the postoperative outcomes and patient-surveyed scar assessments of single-port laparoscopic appendectomy (SPLA) with the outcomes of multiport laparoscopic appendectomy (MPLA).
  Methods: Between August 2014 and November 2017, the prospective randomized study comprised 98 patients diagnosed with acute appendicitis and indicated for surgery. Fifty-one patients had MPLA and 47 patients received SPLA. The primary endpoint was the total score of Patient Scar Assessment Questionnaire (PSAQ) administered to patients 6 weeks after surgery.
  Results: SPLA involved a shorter median operative time than MPLA (47.5 minutes vs. 60.0 minutes, p = 0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, and postoperative complication. SPLA patients had shorter total incision length (2.0 cm vs. 2.5 cm, p < 0.01) and required fewer analgesics on the day of surgery than MPLA patients (p = 0.011). The PSAQ favored the SPLA approach, revealing significant differences in total score (48 vs. 55, p = 0.026), appearance (15 vs. 18, p = 0.002), and consciousness (8 vs. 10, p = 0.005), while satisfaction with appearance and symptoms scale did not (p = 0.162 and p = 0.690, respectively).
  Conclusion: The postoperative scar evaluated by the patient was better with SPLA than with MPLA, and patient satisfaction with the scar was comparable between the two techniques.

• Original Article 2023-06-15

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  Intrathoracic anastomosis using handsewn purse-string suturing by the double-ligation method in laparo-thoracoscopic esophagectomy

  Takamasa Takahashi , Yuji Kaneoka , Atsuyuki Maeda , Yuichi Takayama , Hiroki Aoyama , Takahiro Hosoi , Kazuaki Seita

  Journal of Minimally Invasive Surgery 2023; 26(2): 64-71 https://doi.org/10.7602/jmis.2023.26.2.64

  Abstract

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  Purpose: In minimally invasive esophagectomy (MIE), it is important to reduce the rate of anastomotic leakage to ensure its safety. At our institute, the double-ligation method (DLM) has been introduced to insert and fix the anvil of the circular stapler for intracorporeal circular esophagojejunostomy in gastric surgery. We adopted this method for intrathoracic anastomosis (IA) in MIE. The aim of this study was to investigate the safety of IA with DLM in MIE.
  Methods: In this study, 48 patients diagnosed with primary middle or lower third segment thoracic esophageal carcinoma with clinical stage I, II, III or IV disease were retrospectively evaluated. Postoperative outcomes were assessed.
  Results: Among the 48 patients, 42 patients underwent laparo-thoracoscopic esophagectomy and IA using a circular stapler with the DLM. The average total operation time and thoracoscopic operation time were 433 and 229 minutes, respectively. The average purse-string suturing time was 4.7 minutes. The rates of anastomotic leakage and stenosis were 2.4% and 14.3%, respectively. The overall incidence of postoperative complications (Clavien-Dindo grade of ≥III) was 16.7%. The average postoperative stay was 16 days.
  Conclusion: The procedure of IA using a circular stapler with the DLM in MIE was safe and provided a low rate of anastomotic leakage.

• Original Article 2023-06-15

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  Laparoscopic pancreaticoduodenectomy and laparoscopic pancreaticoduodenectomy with robotic reconstruction: single-surgeon experience and technical notes

  Jae Young Jang , Eui Hyuk Chong , Incheon Kang , Seok Jeon Yang , Sung Hwan Lee , Sung Hoon Choi

  Journal of Minimally Invasive Surgery 2023; 26(2): 72-82 https://doi.org/10.7602/jmis.2023.26.2.72

  Abstract

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  Purpose: Despite the increasing number of robotic pancreaticoduodenectomies, laparoscopic pancreaticoduodenectomy (LPD) and LPD with robotic reconstruction (LPD-RR) are still valuable surgical options for minimally invasive pancreaticoduodenectomy (MIPD). This study introduces the surgical techniques, tips, and outcomes of our experience with LPD and LPD-RR.
  Methods: Between March 2014 and July 2021, 122 and 48 patients underwent LPD and LPD-RR respectively, at CHA Bundang Medical Center in Korea. The operative settings, procedures, and trocar placements were identical in both approaches; however, different trocars were used. We introduced our techniques of retraction methods for Kocherization and uncinate process dissection, pancreatic reconstruction, pancreatic division, and protection using the round ligament. The perioperative surgical outcomes of LPD and LPD-RR were compared.
  Results: Baseline demographics of patients in the LPD and LPD-RR groups were comparable, but the LPD group had older age (65.5 ± 11.6 years vs. 60.0 ± 14.1 years, p = 0.009) and lesser preoperative chemotherapy (15.6% vs. 35.4%, p = 0.008). The proportion of malignant disease was similar (LPD group, 86.1% vs. LPD-RR group, 83.3%; p = 0.759). Perioperative outcomes were also comparable, including operative time, estimated blood loss, clinically relevant postoperative pancreatic fistula (LPD group, 9.0% vs. LPD-RR group, 10.4%; p = 0.684), and major postoperative complication rates (LPD group, 14.8% vs. LPD-RR group, 6.2%; p = 0.082).
  Conclusion: Both LPD and LPR-RR can be safely performed by experienced surgeons with acceptable surgical outcomes. Further investigations are required to evaluate the objective benefits of robotic surgical systems in MIPD and establish widely acceptable standardized MIPD techniques.

• Case Report 2023-06-15

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  Laparoscopic pancreas-preserving near total duodenectomy for large villous adenoma in patients with total colectomy for familial adenomatous polyposis

  Dawn Jung, Ji Eun Jung, Chang Moo Kang

  Journal of Minimally Invasive Surgery 2023; 26(2): 83-87 https://doi.org/10.7602/jmis.2023.26.2.83

  Abstract

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  Most familial adenomatous polyposis (FAP) patients undergo total colectomy, but duodenal polyposis develops in up to 90% of patients with FAP and a 4% to 18% risk of duodenal and ampullary cancer remains. Laparoscopic pancreas-preserving near total duodenectomy is thought to be a potential option and can be an effective approach to preserve the pancreas. A 48-year-old male patient, who underwent laparoscopic total colectomy with end ileostomy because of FAP with colorectal cancer, was diagnosed with a 20 mm-sized duodenal adenoma in the second to the third portion. The operation was performed on December 27, 2021. Near total duodenectomy was done and type II Billroth gastrojejunostomy was done. Laparoscopic pancreas-sparing duodenectomy is shown to be safe, with favorable short-term oncologic outcome compared to laparoscopic pancreatoduodenectomy in terms of less blood loss, faster recovery time, and much less total cost.

• Video/Multimedia Article 2023-06-15

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  Robotic approach in complex ventral hernias: anterior component separation technique

  Raquel Nogueira , Diego Laurentino Lima , Eduardo ParraDavila , Flavio Malcher

  Journal of Minimally Invasive Surgery 2023; 26(2): 88-92 https://doi.org/10.7602/jmis.2023.26.2.88

  Abstract

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  Open onlay ventral hernia repair is still one of the most-used surgical techniques for the repair of hernias worldwide. The robotic anterior component separation technique uses the surgeon’s usual anatomical expertise on onlay mesh placement with the manipulation and advantages of minimally invasive surgery. It maintains the precepts of reestablishment the midline integrity and insertion of mesh in the preaponeurotic space, without contact with the viscera. The use of this technique is simple and quite reproducible if you compare it with other techniques. Also, the time spent in surgery does not last long.

• Video/Multimedia Article 2023-06-15

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  Laparoscopic double mesh repair of a large Morgagni hernia: a video vignette

  Matteo Rivelli , Giulia Turri , Cristian Conti , Alessandro Valdegamberi , Corrado Pedrazzani

  Journal of Minimally Invasive Surgery 2023; 26(2): 93-95 https://doi.org/10.7602/jmis.2023.26.2.93

  Abstract

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  Morgagni hernia (MH) is a rare congenital diaphragmatic hernia (CDH) that accounts for less than 2% of surgically repaired CDH in adulthood. Even if this condition is often asymptomatic, surgery is advised due to the risk of life-threatening complications such as volvulus or bowel strangulation. Surgery for MH repair can be performed by transthoracic, transabdominal, laparoscopic, or thoracoscopic approaches. Though laparoscopy has recently improved surgical outcomes, the use of prosthetic meshes and the need for reduction of the hernia sac are still the most debated issues. We present the video of a laparoscopic repair of a large MH with the use of a double mesh technique and no resection of the hernia sac.