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  • Review ArticleSeptember 15, 2012

    0 115 1223

    Laparoscopic Pediatric Surgery

    Jong Hoon Park, M.D., Ph.D.

    J Minim Invasive Surg 2012; 15(3): 57-62

    Although laparoscopic surgery in children was once considered controversial, it has since been recognized for producing safe, feasible, adequate, and good cosmetic outcomes, compared to open surgery. In addition, like laparoscopic surgery in adults, some pediatric laparoscopic surgery has developed into standard operations for treatment of some diseases. In performance of pediatric laparoscopic surgery, some difficulties in securing sufficient space in a narrow visual field and surmounting the learning curve have been encountered due to a lack of pediatric diseases, resulting in insufficient laparoscopic surgical experience. However, development of pediatric laparoscopic instruments and improved laparoscopic surgical techniques have enabled pediatric surgeons to overcome such difficulties and to perform single port laparoscopic surgery and robot surgery. However, conduct of randomized prospective studies in children is difficult, and few meta-analyses have been conducted; therefore, it is still too early for pediatric surgeons to reach a consensus. In particular, in Korea, only a small number of pediatric surgeons have attempted performance of advanced high-tech pediatric laparoscopic surgery and built up such experiences. The purpose of this review is to explore current trends in laparoscopic surgery performed in domestic and foreign pediatric surgical patients on the basis of recent literature and my personal experiences.

  • Review ArticleSeptember 15, 2012

    0 149 840

    Analysis of Factors Which Reduce Operation Time in Performance of Single Incision Laparoscopic Cholecystectomy

    Yu Ni Lee, M.D., Woo Young Kim, M.D., Eun Hye Choi, M.D.

    J Minim Invasive Surg 2012; 15(3): 63-67

    Purpose: Single-incision laparoscopic surgery (SILS) is a rapidly evolving technique which bridges traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). We previously published a study comparing single port laparoscopic cholecystectomy (SPLC) and three port laparoscopic cholecystectomy (TPLC). We concluded that age, sex, diagnosis, body mass index (BMI), length of hospital stay, and mobilization between SPLC and TPLC produced no effect on the surgical requirements or outcomes between the two techniques. However, there were significant differences in operating time and pain scale. Thus, in this study we aimed to analyze those factors which reduced operating time.
    Methods: This retrospective medical record review enrolled 49 patients who had received SPLC at Presbyterian Medical Center from April 2009 to November 2010. Patient age, sex, BMI, length of hospital stay, operating time, pathological reports, and incidents of iatrogenic gallbladder (GB) perforation and complications were assessed and analyzed. For determining those factors which necessitated long operating times, we assessed the operating times relative to incidents of iatrogenic GB perforation, pathologic report results, surgeon experience and patient BMI.
    Results: The ratio of men to women in the study population was 1 : 6. The average patient age was 46 years (range of 21 to 93 years). The average BMI was 24.1 (range of 18.5 to 31.5). The mean duration of hospital stay was 5.12 days (range of 2 to 15 days). The average operating time was 118 minutes (range of 75 minutes to 185 minutes). The pathologic report assessments revealed cases of acute calculous cholecystitis (n=4, 8.2%), chronic calculous cholecystitis (n=37, 76.1%) and GB polyp (n=8, 16.3%). Iatrogenic perforation of the GB occurred in 5 cases. Minor complications such as surgical site infection and umbilical skin burn occurred in 6 cases. Longer operating times were required in the GB perforation cases than in the non-perforation cases (155±21.21 minutes versus 113.9±30.71 minutes, p=0.008). Of the cases of acute and chronic calculous cholecystitis and GB polyp, those including acute calculous cholecystitits required the longest operation times. The average operating time for the first 25 cases was 134.6±33.16 minutes and the average operating time for the remainder was 100.8±20.41 minutes (p=0.001). There was no significant difference in operating time between the BMI>24 and BMI<24 groups (125.9±35.17 minutes versus 111.2±27.65 minutes, respectively, p=0.112).
    Conclusion: We found 3 factors related to a reduction in operation time: (i) avoidance of iatrogenic perforation of the GB, (ii) application of treatment to case of chronic calculous cholecystitis and GB polyp, and (iii) accumulation of case experience by the attending surgeon.

  • Original ArticleSeptember 15, 2012

    1 111 1068

    The Value of Preoperative Magnetic Resonance Cholangiopancreatography (MRCP) in Patients Who will be Performed Laparoscopic Cholecystectomy

    Jin O Baek, M.D., Yong Hoon Kim, M.D., Keun Soo Ahn, M.D., Tae Jun Park, M.D., Koo Jeong Kang, M.D., Tae Jin Lim, M.D.

    J Minim Invasive Surg 2012; 15(3): 68-74

    Purpose: The aim of this study is to evaluate the value of preoperative MRCP prior to laparoscopic cholecystectomy by analysis of postoperative outcomes.
    Methods: Between 2009.12∼2010.12, 283 patients underwent laparoscopic cholecystectomy for treatment of benign biliary disease. Among these patients, 125 underwent preoperative MRCP and were classified as the MRCP group. The remaining 158 patients who did not undergo MRCP were classified as the non MRCP group. We compared perioperative data, including the rate of bile duct injury, operative complication, conversion rate, hospital stay, and hospital cost between the two groups. In addition, we analyzed preoperative MRCP findings, including common bile duct (CBD) stones and bile duct anomaly.
    Results: Findings on pre-operative MRCP scan revealed silent CBD stones in five patients (4.0%) and bile duct anomalies were identified in 17 patients (13.6%). Three cases of bile duct injury occurred in the non MRCP group, whereas, no bile duct injury occurred in the MRCP group. No significant statistical difference in postoperative complication was observed in either group. Mean duration of operation was 50.5 (±30.4) minutes in the MRCP group, and 52.2 (±29.9) minutes in the non MRCP group (p=0.630). Post operative hospital stay was 2.1 (±1.4) days (mean) in the MRCP group, and 2.5 (±2.5) days in the non MRCP group. No statistical difference was observed between the two groups (p=0.110).
    Conclusion: MRCP may be useful for evaluation of bile duct anomaly and identification of hidden bile duct stones. However, this modality did not show statistical benefits for postoperative outcomes in patients who underwent laparoscopic cholecystectomy.

  • Original ArticleSeptember 15, 2012

    0 124 514

    Comparative Analysis Between Totally Extraperitoneal Repair and Prolene Hernia System at a Single Institute

    Jeong Mo Ku, M.D., Il Dong Kim, M.D., Ki Ho Kim, M.D., Dong Woo Shin, M.D., Byung Sun Suh, M.D., Sang Wook Kim, M.D., Hye In Lim, M.D., Jin Soo Park, M.D.

    J Minim Invasive Surg 2012; 15(3): 75-78

    Purpose: Laparoscopic hernioplasty is a standard procedure used for the repair of inguinal hernia. However, due to the technical and anatomical complexities associated with this treatment and the requirement for long surgery time as compared to other methods, the use of laparoscopic hernioplasty remains questionable. This study compared the results of two surgical repair methods: totally extraperitoneal (TEP) hernia repair and the Prolene hernia system (PHS).
    Methods: A retrospective review was conducted of all patients who underwent TEP (154 cases) and PHS (126 cases) from January 2008 to December 2010 as performed by a surgeon at our hospital. Operating time, length of hospital stay, recurrence rate, surgical site infection rate, wound hematoma rate and scrotum swelling rate were all compared.
    Results: For the TEP treatment cases the mean operating time was 59.5 min, mean hospital stay was 4.9 days, there were 2 cases (1.3%) of recurrence, one case (0.6%) of surgical site infection, 20 cases (12.9%) of wound hematoma and 8 cases (5.2%) of scrotum swelling. In the case including treatment by PHS the mean operating time was 39.6 min, mean hospital stay was 5.4 days, there were no cases of recurrence, there were 2 cases (1.7%) of surgical site infection, 11 cases (9.5%) of wound hematoma and 12 cases (10.3%) of scrotum swelling. There were no cases involving neurogenic pain or chronic pain.
    Conclusion: Both PHS and TEP are safe and effective procedures for repairing inguinal hernia. Thus, with consideration of variable patient conditions and other factors, either PHS or TEP are recommended as viable procedures for treating inguinal hernia.

  • Case ReportSeptember 15, 2012

    2 107 700

    Synchronous Cholecystectomy and Totally Extraperitoneal (TEP) Herniorrhaphy Using an Umbilical Incision

    Hae-Hyeon Suh, M.D., Ph.D., Yong Kwon Cho, M.D., Hye Gyung Rheu, M.D., Ph.D.

    J Minim Invasive Surg 2012; 15(3): 79-82

    Two or more procedures maybe combined into a single surgical event using an abdominal laparoscopic surgery technique. Synchronous operations can provide patients with the advantage of a single hospital stay, single anesthetic exposure and single recovery period. Cholecystectomy and totally extraperitoneal (TEP) herniorrhaphy should be performed in both extremities and in different spaces of the abdomen. As described in this report, laparoendoscopic single site surgery (LESS), synchronous cholecystectomy and TEP herniorrhaphy were successfully performed using an umbilical incision in a single surgical event.

Mar 15, 2024 Vol.27 No.1
pp. 1~54


Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248