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Laparoscopic distal gastrectomy for gastric cancer has rapidly gained popularity because of its shortterm benefits, including less blood loss, less postoperative pain, earlier postoperative recovery, and shorter hospital stay, compared to the conventional open method. Although the long-term results of phase III trials have yet to be published, laparoscopic distal gastrectomy is now considered to be accepted for early-stage gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic distal gastrectomy is being used for advanced gastric cancer. However, due to the technical difficulty of performing D2 lymphadenectomy, this application remains controversial. Well-designed clinical trials will clarify the surgical feasibility and oncological safety of laparoscopic distal gastrectomy for advanced gastric cancer in the near future.

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Purpose: Owing to the accumulation of surgical experience, the indications of single port laparoscopic cholecystectomy (SLC) have increased. To overcome the difficulties and limitations of SLC, we included an additional instrument for use in retracting the gallbladder fundus. The aim of this study was to investigate the feasibility of 4-instrument fundal retraction SLC. Methods: We retrospectively analyzed 134 patients who had undergone SLC for benign gallbladder disease. We compared the clinical outcome between patients who had undergone SLC without fundal retraction (3-instrument SLC, n=102) and those who had undergone SLC with fundal retraction (4-instrument fundal retraction SLC, n=32). Results: Of 134 patients, 47 were male and 87 were female. A significantly higher proportion of patients in the 4-instrument fundal retraction group had gallbladder distention and wall thickening than patients in the 3-instrument SLC group. No statistically significant difference in the incidence of pericholecystic inflammation, adhesion, and gallbladder perforation; duration of operation, the incidence of complications, and duration of postoperative hospital stay was observed between the two groups. In univariate analysis to perform 4-instrument fundal retraction SLC, higher BMI, the presence of gallbladder distension, and wall thickening were significant factors. In multivariate analysis, gallbladder distention and the presence of concurrent operation during SLC were independently significant factors for performing 4-instrument fundal retraction SLC. Conclusion: Four-instrument fundal retraction SLC is a feasible and safe surgical procedure, particularly in patients with a high BMI, gallbladder distention, wall thickening, inflammation, or adhesions. If difficulties are encountered during 3-instrument SLC, simple fundal retraction using an additional instrument may be the preferred option prior to converting the operation to conventional laparoscopic cholecystectomy.

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Purpose: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. Methods: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. Results: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. Conclusion: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

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Purpose: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. Methods: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. Results: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8±3.2 in stent group vs. 16.3±10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5±138.7 in stent group vs. 381.8± 411.9 in emergency group, p=0.010) and duration for resuming diet (3.2±2.2 in stent group vs. 6.6±7.0 days in emergency group, p=0.017) were significantly better in the stent group. Conclusion: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome

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Purpose: Single port laparoscopic inguinal hernia repair has been performed to further reduce port related morbidities and to improve the cosmetic outcome. However, the cosmetic result of single port laparoscopic totally extraperitoneal inguinal hernia repair (TEP) has not been superior to that of transabdominal preperitoneal hernia repair (TAPP). The aim of this study is to introduce and assess the Single Umbilical Tangential Incision (SUTI) for Lap-TEP repair.Methods: Forty one hernia repairs of 34 patients were performed using SUTI-TEP method. SUTI was made all along the inferolateral skin of the umbilical pit and a vertical incision of less than one centimeter was made in the supra- or infraumbilical skin if needed; the total length of the incision was 2~2.5 cm. SILS^TM port and conventional instruments were used for the procedure.Results: All procedures were completed without conversion to the conventional TEP procedure. Mean operation time was 73 minutes for unilateral primary hernia, 119 minutes for bilateral primary hernia, 88.5 minutes for unilateral recurrent hernia, and 120 minutes for bilateral recurrent hernia. There were two cases of wound seroma and four cases of urinary retention postoperatively. Other significant complications were not noted. There was no recurrence of hernia during the follow-up period of one to 24 months. At routine follow-up visit at three months postoperative, the scar was barely visible and overall level of patient satisfaction was very high.Conclusion: The SUTI-TEP inguinal hernia repair is safe and shows superior cosmetic results. Further studies are required in order to assess the long-term outcome.