Single Incision Laparoscopic Cholecystectomy without a Camera Operator

PURPOSE: This study aimed to evaluate the implementation of solo surgery using a laparoscopic scope holder for single incision laparoscopic cholecystectomy (SILC). METHODS: With a glove port and a flexible high-definition scope, SILC was performed through a single trans-umbilical incisional site with CO2 pneumoperitoneum at a pressure of 12 mmHg. Fifty-eight patients who underwent solo SILC using a scope holder (Solo-SILC) were compared to 15 patients who underwent camera operator-assisted SILC (Ca-SILC) in terms of intraoperative and postoperative outcomes. RESULTS: The mean BMI and operation time were 23.0±3.6 kg/m² and 64.4±16.6 min in Ca-SILC and 25.0±3.8 kg/m² and 58.2±27.1 min in Solo-SILC, respectively (p=0.067 and p=0.410). Estimated blood loss was negligible and an additional assistant port was not required in either groups. A case of gallbladder perforation and bile leak was noted in the Ca-SILC group, and 13 cases of bile leak in the Solo-SILC group, with no significant differences (p=0.167) during the surgery. Postoperative outcomes including surgical complications, diet restriction, diarrhea and hospital stay were not significantly different except for shoulder pain (p<0.001). CONCLUSION: Even with the limitations of a small number of patients, Solo-SILC proved to be a feasible technique. To confirm the safety of solo-SILC, further studies with a larger sample size are required.

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

The Prevalence of Abdominal Aortoiliac Artery Aneurysm in the Hospital Patient Group and Treatment Status / 대한혈관외과학회지

PURPOSE: Abdominal aortoiliac artery aneurysm (AIAA) is a common disease in the elderly. The prevalence of AIAA was well known in western countries. However, in Korea, there are a few studies regarding the prevalence. This study was carried out to determine the prevalence of AIAA by reviewing the radiological reports of abdominal computed tomography (CT). METHODS: We searched the words like "aneu" or "rysm" in radiological reports of 22,520 abdominal CT (11,974 patients) between January 1, 2005 and March 31, 2010 in patients over 50 years old. We found 121 patients who had AIAA of more than 3 cm or more than 1.8 cm isolated iliac artery aneurysm. We analyzed the characteristics of these patients with aneurysm. RESULTS: The prevalence of aneurysms was 1.01% (121 patients). The aneurysms in men were more prevalent than women (1.39% vs. 0.51%). In the octogenarian, the aneurysms were found to be most frequent (2.75%). Among the 121 aneurysms, aortic, aortoiliac, and isolated iliac artery aneurysms were 66 (54.6%), 28 (23.1%), and 27 (22.3%). In terms of aneurysmal size, greater than 6 cm, 5 to 6 cm, and less than 5 cm were 19 (20%), 13 (14%), and 62 (66%), respectively. The rupture rate was 18% (6 patients) in more than 5 cm abdominal aortic aneurysm. CONCLUSION: The prevalence of AIAA is lower than Western countries. This is not a national-wide survey, but results are similar to the other Korean reports. Reviewing radiologic reports of abdominal CT is another way to study the prevalence of aneurysms.

Bowel infarction due to intestinal mucormycosis in an immunocompetent patient / 대한외과학회지

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.

Successful Removal of a Migrated Catheter of Chemoport in Right Atrium

The use of totally implantable central venous access devices (chemoport) has increased with the development of chemotherapeutic agents in oncologic patients, especially with no venous access site. However, there can be various complications such as port site infection, thromboembolism, injury of central vein, fracture of catheter, and migration of catheter. We report a rare case of migration of catheter to right atrium due to the separation of the catheter from the chemoport.

Can Review of Sonographic Findings Spare Diagnostic Thyroidectomy in Patients with Thyroid Nodules Suspicious of Follicular Neoplasm Cytologically?

PURPOSE: Follicular neoplasms (FNs) such as follicular adenoma and carcinoma (FTC), nodular hyperplasia (NH) and follicular variant of papillary carcinoma (FVPC) share cytological features. In the present study, we investigate whether review of sonographic findings in patients with thyroid nodules suspicious of FN spares diagnostic thyroidectomies (DTs) by excluding benign diseases such as NH or not. METHODS: From June 1999 to May 2007, DTs were performed on 98 patients who had nodules suspicious of FN. High resolution sonographic findings are available for 53 patients. According to the final histologic diagnosis: Group I (23 patients) consisted of 20 FNs (11 FTCs), 1 Hurthle cell adenoma, 2 FVPC; Group II (30 patients) consisted of all others (23 NHs, 4 Hashimoto's thyroiditis, 3 papillary carcinomas (PTCs). Sonographic features were compared between the two groups. RESULTS: Three differential sonographic findings (DSF) i.e. irregular margin, absence of peripheral halo or marked inhomogeniety were identified more often in Group II than Group I (P<0.05). If we spared DTs for patients who have at least one DSF, 18 patients (34.0%) would have been selected for clinical follow-up whose final diagnoses were 14 NHs and 4 PTCs (including 1 FVPC). Sparing DTs by DSFs shows sensitivity, 56.7%; specificity, 95.7%; positive predictive value, 94.4%; negative predictive value, 62.9%; and accuracy, 73.6%, respectively. CONCLUSION: In patients with thyroid nodules suspicious of FN, sonographic findings such as irregular margin, absence of peripheral halo or marked inhomogeneity might spare DTs with the help of other diagnostic modalities such as cytogenetic or immunohistochemical studies.

Single Incision Three Ports Laparoscopic Appendectomy / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute appendicitis. The laparoscopic appendectomy has the advantages of a more rapid recovery, better cosmetic outcome and reduced postoperative pain compared to the open appendectomy. Several laparoscopic procedures have been described that used two or more trocars. We present the results of a new LA technique that performed through three ports in a single incision. METHODS: A single incision three-port LA was performed in 10 patients. Under general anesthesia, a 5 mm scope (0degrees), 2 mm working port and 5 mm working port were inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a grasper or dissector. The base of the appendix was ligated with an endo-loop two times and cut by scissors. The appendix was then withdrawn through the umbilicus. RESULTS: The average operating time in our series was 69.5+/-23.3 minutes and the median time to discharge 4.5+/-1.9 days. Wound infection developed in two patients. There was no conversion to traditional LA or laparotomy. CONCLUSION: A single incision three port LA was safe and effective for LA. The availability of laparoscopic procedures has expanded the range of options available from which to choose a suitable procedure for individual cases.

Patterns of Recurrent Hernias according to the Types of Previous Hernioplasties

PURPOSE: Recently, conventional tissue repairs are gradually being replaced by tension-free hernioplasties using meshes (mesh repairs) in hernia surgery. The aim of the present study was to evaluate patterns of recurrent hernias according to the types of previous hernioplasties. METHODS: From August 2005 to July 2008, 18 hernioplasties were performed in recurrent cases at Chungbuk National University Hospital. All previous hernioplasties were performed at local hospitals except one case of ventral hernia. We reviewed the medical records and compared clinical features according to the types of previous hernioplasties. RESULTS: Among the 18 recurrent hernias, there were 15 inguinal including 2 pediatric cases, an umbilical, and 2 incisional hernias. Among 13 adult inguinal recurrent cases, 5 occurred after tissue repair (3 indirect, 1 direct, and 1 pantaloon type) and 8 after mesh repairs (direct type in all). Recurrence developed earlier after mesh repairs than tissue repairs (median [min~max]; 24 [0.1~164] vs. 243 [60~360] months, P=0.005). Other types of recurrence developed between 6 to 48 months after previous operations. Recurrent hernias after mesh repairs occurred preferentially along the margin of previous meshes. All cases were treated by mesh repairs except in pediatric cases. Median operation time and hospital stay for recurrent inguinal hernias were not different significantly by previous operations. Postoperative complications were minimal without recurrence during a median 5.5-(1.5~25.5)-month follow-up. CONCLUSION: Recurrent hernias develop both after tissue repairs and mesh repairs. After mesh repairs, recurrences develop earlier and are more often associated with technical failure compared to tissue repairs.