ABSTRACT
Purpose@#Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center. @*Methods@#A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone. @*Results@#There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%). @*Conclusion@#A working ACS department has been implemented in a Korean medical center.
ABSTRACT
Purpose@#Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center. @*Methods@#A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone. @*Results@#There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%). @*Conclusion@#A working ACS department has been implemented in a Korean medical center.
ABSTRACT
This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.
Subject(s)
Humans , Male , Middle Aged , Cholecystectomy , Compensation and Redress , Gallbladder , Hepatic Veins , Intraoperative Complications , Liver , Needles , Polypropylenes , Robotic Surgical Procedures , SuturesABSTRACT
PURPOSE: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. MATERIALS AND METHODS: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). RESULTS: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. CONCLUSION: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.