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  • Review ArticleDecember 15, 2020

    1 276 591

    Gynecological Surgery and Its Five Steps Towards Resilience: Minimally Invasive Approach in the COVID-19 Era

    Inés Gil Prados , M.D. , Mónica Bellón del Amo , M.D. , Rebeca Ruiz Román , M.D. , Francisco Javier García Santos , M.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 153-158

    After the declaration of the coronavirus disease 2019 (COVID-19) pandemic, gynecological surgery joins the readjustment process that this great global health crisis implies. In the light of current literature, the five steps towards its resilience are described as below; (1) Dynamic prioritization of surgical indications and reintroduction of elective surgeries: Diverse surgical prioritization lists are published including the most common gynecological pathologies. (2) Minimally invasive surgery through laparoscopy and robotic assistance: Some authors suggest a theoretical but unproven risk of viral transmission during these approaches because of the aerosol generation. These theories are opposed to the well-proven advantages of these approaches compared to open surgery. (3) Optimization of surgical procedures, according to the recommendations of different societies aimed at reducing the dispersion of aerosols and surgical smoke. (4) Clinical, epidemiological and microbiological screening of all patients awaiting prompt surgery: This screening should be adapted to the local alert state. (5) Protection through the reduction of number of persons present in the operating room, and the use of adapted personal protective equipment according to physical proximity to the patient.

  • EditorialDecember 15, 2020

    1 209 420

    The importance of tumor localization is increasing because the application of laparoscopic surgery in colon cancer surgery is on the rise and the incidence of early cancer is also rising. There are several methods of tumor localization, but the most popular method is preoperative colonoscopic tattooing. Various tattooing agents are used, and among them, India ink is the most widely used agent. However, it is impossible to use India ink in Korea. Therefore, research on other alternative agents is needed.

  • EditorialDecember 15, 2020

    1 214 473

    Clinicopathological Features and Prognosis of Gastric Cancer in Young Patients

    Ki Bum Park , M.D., Kyong Hwa Jun , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 161-162

    Gastric cancer mainly occurs in middle-aged and older people after their 50s, and the incidence of gastric cancer in younger people is rare. The frequency of gastric cancer that occurred before 40 years of age is 6-8% of all gastric cancer patients, and most of them are over 35 years of age. The prognosis of gastric cancer in young patients is believed to be poor because of more aggressive tumor behaviors and delayed diagnosis, however, there is controversy.

  • Original ArticleDecember 15, 2020

    2 201 547

    Clinicopathologic Characteristics of Young Gastric Cancer Patients: Diagnostic Staging Accuracy and Survival

    Woochul Kim , M.D., Sangil Youn , M.D., Yongjoon Won , M.D., Sahong Min , M.D., Young Suk Park , M.D., Sang-Hoon Ahn , M.D., Do Joong Park , M.D., Ph.D., Hyung-Ho Kim , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 163-171

    Purpose: The purpose of this study was to investigate the clinicopathologic characteristics of young gastric cancer patients and analyze the risk factors for stage underestimation and survival.
    Methods: Relevant data of 5029 patients who underwent surgery for gastric cancer at Seoul National University Bundang Hospital between 2003 to 2014 were collected. Patients were divided based on age (younger group and older group). Clinical stages were compared to pathologic stages for accuracy, and risk factors for underestimation were analyzed using univariate and multivariate analysis regression. Overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method.
    Results: A total of 4396 patients were eligible for inclusion. The younger group was an independent risk factor for nodal metastasis (RR=1.44, 95% CI 1.06~1.95) and an independent risk factor for clinical N-stage underestimation (RR=1.50, 95% CI=1.14~1.98). However, there was no significant difference in 5-year cancer-specific survival for both age groups (92.2% vs 90.2%, p=0.306).
    Conclusion: In conclusion, intra-operative investigation of T-stage with standard operation should be done in young gastric cancer patients as they have a higher incidence of lymph node metastasis, with greater frequency of stage underestimation.

  • Original ArticleDecember 15, 2020

    0 303 445

    Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction

    In-Kyeong Kim , M.D., Ji-Ho Park , M.D., Young-Joon Lee , M.D., Ph.D., Sang-Ho Jeong , M.D., Ph.D., Tae Han Kim , M.D., Ph.D., Dong-Hwan Kim , M.D., Han-Gil Kim , M.D., Jin-Kyu Cho , M.D., Jae-Myung Kim , M.D., Seung-Jin Kwag , M.D., Ph.D., Ju-Yeon Kim , M.D., Ph.D., Chi-Young Jeong , M.D., Ph.D., Young-tae Ju , M.D., Ph.D., Eun-Jung Jung , M.D., Ph.D., Soon-Chan Hong , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 172-178

    Purpose: A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection.
    Methods: A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed.
    Results: All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication.
    Conclusion: LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.

  • Original ArticleDecember 15, 2020

    2 284 400

    A Comparison of Short-Term Outcomes between Laparoscopic and Open Liver Resection in Elderly Patients

    Su Yong Lee , M.D., Ph.D., Dong-Shik Lee , M.D., Ph.D., Sung Su Yun , M.D., Ph.D., Chan Woo Cho , M.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 179-185

    Purpose: The aim of this study was to compare the short-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) in elderly patients with hepatic tumors.
    Methods: From January 2013 to December 2019, a retrospective study was conducted for a total of 143 patients with over 70 years of age, who underwent liver resection for hepatic tumors. Forty-five patients who received biliary reconstruction at the same time were excluded. According to surgical approaches, 98 patients were classified into LLR and OLR groups. All postoperative complications were classified according to the Clavien-Dindo grading system and the Comprehensive Complication Index (CCI).
    Results: Incidence of the postoperative complications was not statistically different between LLR and OLR groups. The CCI was significantly lower in the LLR group, with a median of 8.556, and a median of 19.698 in the OLR group (p=0.042). The length of hospital stay in the LLR group was significantly shorter than in the OLR group (p=0.008).
    Conclusion: LLR is safe and feasible as a treatment for hepatic tumor in elderly patients with potentially less postoperative complications compared to OLR.

  • Original ArticleDecember 15, 2020

    3 276 486

    Preoperative Colonoscopic Tattooing Using a Direct Injection Method with Indocyanine Green for Localization of Colorectal Tumors: An Efficacy and Safety Comparison Study

    Young Jin Kim , M.D., Ji Won Park , M.D., Ph.D., Han-Ki Lim , M.D., Yoon-Hye Kwon , M.D., Min Jung Kim , M.D., Eun Kyung Choe , M.D., Ph.D., Sang Hui Moon , M.D., Ph.D., Seung-Bum Ryoo , M.D., Ph.D., Seung-Yong Jeong , M.D., Ph.D., Kyu Joo Park , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 186-190

    Purpose: Endoscopic tattooing is used to mark colorectal lesions for subsequent surgery. As a tattooing agent, India ink has been widely used but is not currently available in Korea. Indocyanine green (ICG) can be applied as an alternative agent. However, studies on colonoscopic tattooing by the direct injection of indocyanine green are lacking. This study aimed to compare the efficacy and safety between an ICG direct injection method and an India ink saline test injection method.
    Methods: A total of 227 patients who underwent preoperative endoscopic tattooing for colorectal neoplasm (149 patients in the ICG direct injection group and 78 patients in the India ink saline test injection group) were included in the study. The efficacy of the two methods was compared by visualization and safety was compared by evaluating the perioperative tattooing complications.
    Results: The visualization of lesions in the ICG group was not different from that of the India ink group (p=0.42, 96.0% vs 98.7%, respectively). Only one patient in the ICG group had abdominal pain related to tattooing, but no complications developed in the India ink group.
    Conclusion: Considering the good visualization and low complication rate, the direct injection of ICG can be used as an alternative tattooing method.

  • Original ArticleDecember 15, 2020

    0 277 396

    Clinical Outcome of Novel Reconstruction of Double Shouldering Technique after Proximal Gastrectomy

    Min Chul Kim , M.S., M.D., Amir Ben Yehuda , M.D., Young-Woo Kim , M.D., Ph.D., Hong Man Yoon , M.S., M.D., Harbi Khalayleh , M.D., Won Ho Han , M.D., Hirokazu Noshiro , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 191-196

    Purpose: Various reconstruction methods have been proposed to reduce reflux after proximal gastrectomy, and we report here a double shouldering technique. The purpose of this study is to compare the novel double shouldering technique with conventional esophagogastrostomy in terms of short term and 3-year clinical outcome.
    Methods: A retrospective observational case control study was performed on 63 patients for cT1N0 upper third gastric cancer who underwent proximal gastrectomy from January 2012 to November 2016 at the National Cancer Center, Korea. There were 26 patients with conventional esophagogastrostomy, and 37 patients with novel double shouldering technique. The primary outcome was endoscopic reflux esophagitis findings one and three year after surgery according to Los Angeles classification. Secondary outcomes were short term surgical outcome and reflux symptom.
    Results: There was no significant difference in reflux esophagitis on endoscopic findings at 1 and 3 years after surgery between the two group. The double shouldering (DS) technique group showed significantly better postoperative outcomes with bile reflux at one and three years via endoscopic findings versus conventional esophagogastrostomy (CEG). Operative time and hospital stay were significantly shorter in the CEG group than the DS group. There was no significant difference in terms of reflux symptoms and complications.
    Conclusion: This novel DS technique is a reconstruction method for use after proximal gastrectomy. It did not show a significant clinical benefit. Development of surgical techniques and further study is needed to identify the optimal reconstruction method after proximal gastrectomy.

  • Case ReportDecember 15, 2020

    0 218 436

    Diaphragmatic Hernia with Gastric Volvulus and Complete Gastric Outlet Obstruction

    Hayder Al-Masari , M.D., Heba Nofal , M.D., Rawan Majdalawi , M.D., Reham Ainawi , M.D., Abdulwahid Alwahedi , M.D., Tarek Mahdi , M.D., Ph.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 197-200

    A combination of Cytoreductive surgery (CRS) along with hyperthermic intraperitoneal chemotherapy (HIPEC) considers a crucial approach in treating designated patients with alimentary and gynecological malignancies with the involvement of the peritoneal cavity. The foremost frequent surgical complications are leakage, digestive perforations, fistulas, intestinal obstruction, abscess, and peripancreatitis. This report presents a case of a patient with a late acquired herniation of guts through the diaphragm after CRS and HIPEC that were already done 6 months back. A 26 -year- old male previously treated with CRS and HIPEC for testicular mesothelioma with peritoneal involvement, was admitted to our unit with the diagnosis of gastric outlet obstruction. His CT scan illustrated a left diaphragmatic hernia involving the stomach and splenocolic flexure. Each denudation of the diaphragmatic serosa throughout CRS which typically occurs during the surgical operation in a combination of the HIPEC heat can explain such complication. The herniation is extremely uncommonly diagnosed after CRS and HIPEC. Surgical techniques for hernia repair can be done by direct suturing of the defect or closure with artificial or biological tissue, each technique is a potential surgical technique for repair with reliable long-run results.

  • Video/Multimedia ArticleDecember 15, 2020

    5 318 553

    Natural Orifice Specimen Extraction (NOSE) with Single-Stapling Anastomosis for Left Colon Cancer

    Ming-Yin Shen , M.D., Ph.D., William Tzu-Liang Chen , M.D.

    Journal of Minimally Invasive Surgery 2020; 23(4): 201-203

    One of the major criticisms of laparoscopic colectomy is the requirement of an additional mini laparotomy to remove the resected specimen. This may be associated with postoperative pain and wound complications. Therefore, the use of a natural orifice as a delivery route for the specimen extraction without a laparotomy incision can subsequently reduce the risk of wound complications. In this video, we demonstrate the natural orifice specimen extraction procedure with a side-to-end single-stapling colorectal anastomosis.

Jun 15, 2024 Vol.27 No.2
pp. 55~127


Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248