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Repair of lower abdominal incisional hernia is always a surgical challenge. TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Its indication can be extended for treatment of non-midline lower abdominal hernia. Peritoneal incision is created just below the hernia defect with pre-peritoneal dissection to expose supra-pubic preperitoneal space with Cooper’s ligament exposed. Non-adhesive mesh then placed over pre-peritoneal space and partially intra-peritoneally, and cover the whole extra-peritoneal space prepared to ensure enough overlapping. Mesh is fixed by tackers for intra-peritoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes is fixed at the safety zone and covered up by the peritoneal flap to avoid mesh migration. Fixation of the meshes at the lateral aspects were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures in cases of lateral lower abdominal hernia. Repair of midline and lateral lower abdominal incisional hernia with this novel modified technique with prosthetic mesh is safe and effective. A larger case series and longer follow-up is required for validation of this technique.

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Laparoscopic ventral hernia repair is performed less frequently than open repair because some ventral hernias are unsuitable for laparoscopic repair and the complications are more severe than those of open repair. However, currently, the incidence of laparoscopic hernia surgery has been gradually increasing. The technique for laparoscopic ventral hernia repair depends on the shape, size, location, number, recurrence, and symptoms of the hernia. Computed tomography (CT) is the most accurate method for identifying these factors. Ventral hernia repair begins with an approach to the peritoneal space. Having adequate space to place the mesh is the most important step in surgery. Cosmetic and medical results of primary closure of the hernia margin are superior to those of the bridging technique in laparoscopic ventral hernia repair. However, if primary closure is not possible, the component separation technique can be used to narrow the defect for primary repair of a ventral hernia. Making the abdominal skin flap during the conventional component separation technique can injure the perforator vessels in the abdominal wall, and an injured perforator shuts down the blood supply to the subcutaneous tissue of the abdomen, which then becomes necrotic. To prevent such complications, a perforator-preserving technique can be performed, such as the laparoscopic and posterior component separation techniques. Complications of laparoscopic ventral hernia repair include seroma, hemorrhage, intestinal injury, mesh infection, and recurrence. Mesh infection is one of the most severe complications that sometimes requires reoperation. To prevent infection, it is necessary to minimize contact between the mesh and skin during the surgical procedure.

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Purpose: In this study, we explored the safety of laparoscopic gastrectomy in obese gastric cancer patients compared with conventional open gastrectomy based on early surgical outcomes.
Methods: A total of 462 patients who underwent curative gastrectomy for early gastric adenocarcinoma from January 2000 to December 2014 were enrolled. Two obesity cohorts were defined according to a body mass index (BMI) of ≥25 kg/m² versus ≥30 kg/m². Those cohorts were further divided into the laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) groups, and clinicopathologic characteristics were compared with early surgical results.
Results: There were no significant differences in clinicopathologic characteristics between the LDG and ODG groups in the BMI ≥25 or BMI ≥30 cohorts. For the overall complication rate, fewer complications were observed in the LDG than ODG group in both cohorts. Among the overall complications, significant differences were observed in the minor complication rates (Clavien-Dindo I or II), but no significant difference was observed in the rate of Clavien-Dindo III or higher complications. For risk factor analysis of postoperative complications, open distal gastrectomy, age >60 years, and BMI ≥30 were independent risk factors for postoperative morbidity among all obese patients.
Conclusion: LDG may be a better procedure to improve surgical outcomes in patients with obesity undergoing surgery for early gastric cancer in terms of less excessive blood loss, shorter operation time, and lower complication rates.

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Purpose: Laparoscopic surgery has been accepted as a standard procedure for colorectal cancer. Preoperative chemoradiation for rectal cancer has some advantages, such as decreased tumor size and lower stage, and lower local recurrence. However, preoperative chemoradiation has the disadvantage of increasing postoperative complication risks. The aim of this study was to evaluate the safety of laparoscopic surgery for rectal cancer after preoperative chemoradiation in elderly patients.
Methods: 46 patients underwent laparoscopic surgery for rectal cancer after preoperative chemoradiation. Patients were divided into younger (<70 years, n=35) and older groups (≥70 years, n=11).
Results: In the younger group, men were more predominant (80% vs. 54.5%, p=0.124). In the older group, more patients had high American Society of Anesthesiologists scores (score 3 was 2.9% vs. 36.4%, p=0.005) than in the younger group. Sphincter-preserving surgery was performed more frequently in the younger group (77.2% vs. 45.5%, p=0.065). Operation time (195.8 min. vs. 212.5 min, p=0.553) and intraoperative blood loss (200.6 cc vs. 209.1 cc, p=0.952) were not significantly different. Significant anastomotic leakage was absent in both groups. Postoperative hospital stay was 9.7 and 10.9 days (p=0.669). Complete remission rates were similar in the both groups (8.8% vs. 18.2%, p=0.824).
Conclusion: Postoperative outcomes are comparable between older group and younger group. Laparoscopic surgery could be considered as safe, feasible therapeutic options in elderly patients after preoperative chemoradiation for rectal cancer. However, large randomized trials with comparative methodologies are needed.

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Idiopathic portal hypertension (IPH) is a rare disorder which is clinically characterized by portal hypertension, splenomegaly, hypersplenism and the absence of liver cirrhosis. Patients with IPH have massive splenomegaly leading to increased portal venous flow and subsequent portal hypertension. In selected IPH patients with splenomegaly and hypersplenism, splenectomy can be regarded as an effective treatment protocol for decreasing portal hypertension. We report a case of a 44-year-old woman who was diagnosed with IPH accompanied by splenomegaly and hypersplenism. She underwent laparoscopic splenectomy and clinical symptoms and hypersplenism resolved. Our study shows that laparoscopic splenectomy can be considered as a procedure for treating patients with splenomegaly and hypersplenism due to IPH.

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In the bilateral axillo-breast approach (BABA), the camera is inserted through the areolar incision, and this raises the concern it might be difficult to identify the lymph nodes (LN). The purpose of this study is to evaluate the feasibility of the Firefly for central lymph node dissection (CLND) in robotic thyroidectomy using the BABA. This study evaluated 18 patients who underwent robotic surgery using Firefly between December 2015 and March 2016. For LN mapping, 0.05 ml of ICG was injected into the thyroid 3~4 minutes before CLND. Green-stained LN could be detected easily through a near-infrared camera. The number of retrieved LNs was 7.83.0 after CLND using the Firefly, which was higher than the 6.7±0.2 reported in previous surgeries. In addition, it helped to distinguish between the parathyroid and the LNs. The Firefly technology was helpful in identifying the LNs, guiding the CLND and performing a complete CLND.

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In rectal cancer surgery, gentle opening of the plane by continuous traction and optimized visualization is essential. Recently, a wristed robotic suction-irrigation device was developed for efficient traction of the rectum and good surgical visualization. This video shows a technique of robotic total mesorectal excision using a wristed robotic suction-irrigation device. A 74-year-old woman with rectal cancer had a biopsy-proven adenocarcinoma within 9 cm of the anal verge. She underwent totally robotic total mesorectal excision using a dual-docking technique. Total procedure time was 445 minutes. The patient was discharged on postoperative day 8 without any complications. Total number of lymph nodes harvested was 12, and proximal and distal resection margins were 11.2 and 4.7 cm, respectively. Totally robotic total mesorectal excision using a wristed robotic suction-irrigation device was an efficient and useful procedure for rectal cancer.