Robot-assisted distal gastrectomy for gastric cancer in a situs inversus totalis patient / 대한외과학회지

A 47-year-old man was referred to Seoul National University Bundang Hospital with an ulcerative lesion in the midbody of the stomach. Computed tomography revealed that he was a situs inversus totalis (SIT) patient. Robot-assisted distal gastrectomy with D1+beta lymph node dissection and Billroth II anastomosis were performed. With the aid of robotic surgery, the surgeon didn't need to change his position and could perform the surgery without any confusion resulting from the patient's reversed anatomy. The operation took 300 minutes, with no intraoperative complications. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The final pathologic report was pT3N3a by American Joint Committee on Cancer 7th tumor-node-metastasis staging. We successfully performed robot-assisted distal gastrectomy for gastric cancer in a SIT patient. We believe that this is the first case of robotic surgery reported in a SIT patient with gastric cancer.

Comparison of Conventional Transanal Resection with Transanal Endoscopic Microsurgery in Patients with Rectal Neoplasm / 대한내시경복강경외과학회지

PURPOSE: Compared to traditionally used abdominoperineal resection and low anterior resection for the treatment of rectal neoplasm, transanal excision (TAE) has several benefits such as a lower complication rate, a shorter average hospital stay and improved quality of life. Transanal endoscopic microsurgery (TEM) was recently introduced for resecting rectal neoplasm. The aim of this study was to compare the therapeutic results between TAE and TEM in patients with rectal neoplasm. METHODS: From October 2000 to December 2008, 115 patients underwent TEM or TAE at the NCC. Among the patient with rectal neoplasm, the patients with recurred rectal cancer and pathologic T2 or T3 stage were excluded. Thirty four and 33 patients were included for this study in the TAE and TEM groups, respectively. The locations of the lesion, the average number of fragmented specimens, the resection margin, postoperative complications and recurrence were retrospectively compared between the TEM and TAE groups. For the patients with T1 cancer, the disease-free survival rates were compared between the TAE and TEM groups. RESULTS: The median distance of lesions from the anal verge in the TEM group was higher than that in the TAE group: (mean distance: 6.75 cm, range: 3~15 cm) for TEM group and (mean distance: 3.13 (range: 1~8 cm) for the TAE group, p<0.001). The TAE group had more fragmented specimens than the TEM group (mean for the TAE: 1.44 (range: 1~4), mean for the TEM group: 1.06 (range: 1~2), p=0.031). For the patients with T1 cancer, the 3 year disease-free survival rate was not significantly different between the two groups (83.9% for the TAE group and 91.7% for the TEM group p=0.734). CONCLUSION: TEM can remove higher located rectal neoplasm and a less fragmented specimen was aquired that that in TAE. TEM seems to have similar oncologic outcomes as compared with TAE.

Validation of POSSUM-physiological Score as Predictors of Post-operative Morbidity and Mortality after Emergency Operation for Peptic Ulcer Complications

PURPOSE: The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications. METHODS: We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients' characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality. RESULTS: One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P<0.001) and between patients with and without morbidity (26.7 vs. 17.3, P<0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively). CONCLUSION: The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.

Adequate Dose Reqirements of Propofol by Injection during Anesthesia Induction / 대한마취과학회지

BACKGROUND: Propofol is a short-acting intravenous sedative-hynotic agent that can be used for induction and maintenance of general anesthesia. This study was perfomed to evaluate adequate dose requirements of propofol by injection during anesthesia induction, and to evaluate the induction technique by assessing induction dose, induction time, success rate of induction and hemodynamic effects. METHODS: Ninety healthy adult patients(ASA class I or II), scheduled for elective surgery under general anesthesia, were randomly assigned to receive propofol 1 mg/kg(group I), 2 mg/kg(group II), and 3 mg/kg(group III) respectively as an induction agent. Mean arterial pressure(MAP) and heart rate(HR) were measured before the administration of propofol and just after successful induction. We determined the speed of injection as lasting 40 seconds. RESULTS: Success rate of induction in group I(30%) was lower than group II(100%) and III(100%). The induction time in group I(81s) was longer than group II(51s) and III(47s). The MAP were statistically significant difference among three groups(p<0.05 compared with before induction). In group III, the MAP was more decreased than group I and II and HR was more increased than group I and II. CONCLUSIONS: We concluded that propofol in group II(2 mg/kg) is more desireable dose than group I(1 mg/kg) and group III(3 mg/kg) for induction of general anesthesia.