50 Cases of Laparoscopic Appendectomy by One Surgical Resident: The Learning Curve and Safety / 대한내시경복강경외과학회지

PURPOSE: The frequency of performing laparoscopic appendectomy (LA) has increased compared to that of open appendectomy because of its advantages such as decreased postoperative pain, shorter hospitalization and quicker recovery. The advantages of minimally invasive surgery are well known to the general public, so we recognized the importance of a laparoscopic training course. We analyzed the results of LA performed by one resident and we determined the learning curve and the safety. METHODS: We retrospectively studied 50 consecutive patients with a preoperative diagnosis of acute appendectomy and who underwent LA by one surgical resident. We used the medical and video records and compared the patients' age, gender, BMI, the location of the appendix tip, the pathologic findings, the state of drainage insertion, intraoperative bleeding, conversion to open surgery, the operation time and the complicating factor affecting the operating time. RESULTS: The mean operation time was 79.9 minutes and the operation time was effectively shortened when the surgeon had many experiences, the patients had a low BMI and there was no perforation, periappendiceal abscess or insertion of drains. After 25 cases of surgery experience (LA), the surgeon had enough expertise for the operations. Two cases of wound infection around the umbilical area and 1 case of intraperitoneal fluid collection occurred after the surgery. Yet this was all soon cured by wound dressing and the use of antibiotics. CONCLUSION: Fifty cases of LA were safely performed by one surgical resident. Thus, LA is a suitable procedure for surgical residents and it helpful for learning the basic technique of other advanced laparoscopic surgeries.

Subarachnoid Hemorrhage Due to a Ruptured Middle Cerebral Artery Bifurcation Aneurysm Superimposed by an Idiopathic Intracerebral Hematoma

A rare case of idiopathic subcortical intracerebral hematoma superimposed on the subarachnoid hemorrhage due to the rupture of an ipsilateral middle cerebral artery bifurcation aneurysm is reported and pertinent literatures are reviewed.

A Case of Appendiceal Carcinoid Tumor

Carcinoid is the most common tumor in the appendix and most often occurs in young patient. A case of mesoappendiceal invasion of carcinoid of appendix in presented and the literature review for indications for right hemicolectomy. A 38-year-old man was admitted to hospital after 3 day with right lower quadrant pain. The appendectomy was performed. At gross pathologic examination the appendix measured 7.5 cm in length and 1.6 cm in diameter. The serosal surface is congested and covered with yellow white fibrinoid material. The cut surface revealed a focal thickening of wall, measured 0.7 x 0.5 cm at 2 cm from tip of the appendix. Light microscopy revealed a typical carcinoid tumors infiltrating periappendiceal fat tissue. The patient was readmitted 4 weeks postoperatively for an elective right hemicolectomy. At exploratory laparotomy, there were no palpable lymph nodes. Exploration of the distal ileum, small bowel, and remaining abdomen did reveal any other carcinoid tumors.

Appendiceal Intussusception Caused by Mucinous Cystadenocarcinoma

An intussusception was first reported by Barbette in 1674, but an intussusception of the appendix was first reported in London, in 1858. Of all intussusceptions, 5% occur in adults, and of these 90% are as a result of a primary cause. Therefore, treatment is usually based on the primary cause. An intussusception of the appendix can be treated by barium or air reduction, or by an appendectomy, with manual reduction in pediatrics, but these are very uncommon in adult, and can be treated by various methods, according to the underlying cause. A 74 years old woman was preoperatively diagnosed, by radiological examination, to have an intussusception of the appendix. An exploratory laparotomy was performed, and the lesion confirmed as an intussusception caused by an appendix mass, which was cystic and filled with mucin. Therefore, a right hemicolectomy was performed, with the pathological results confirming a mucinous cystadenocarcinoma of the appendix. Here, we report a case of an adult intussusception of the appendix in a 74 years old woman.

Congenital Hypoplasia of the Bilateral Internal Carotid Artery: A Case Report

Congenital agenesis, aplasia or hypoplasia of the internal carotid artery is rare vascular disease and usually combine with intracranial aneurysm, subarachnoid hemorrhage, or intracerebral hemorrhage. We report a case of bilateral congenital hypoplasia of internal carotid artery in a 36 year-old woman presented with semicomatose mentality. The brain computed tomography(CT) revealed intracerebral hemorrhage with intraventricular hemorrhage, and cerebral angiography showed hypoplasia of bilateral internal carotid artery without narrowing of the bony carotid canal on the temporal bone CT.

Comparison of Laparoscopic Cholecystectomy and Minilaparotomy Cholecystectomy

BACKGROUND: Cholecystectomy is the standard treatment for gallbladder stones and at present is performed in minimally invasive procedures. There are several advantages to a laparoscopic cholecystectomy, so now it is a popular procedure for use in a cholecystectomy. Also, a minilaparotomy cholecystectomy is an alternative method to a traditional open cholecystectomy and results in a smaller incision than a traditional open cholecystectomy. METHODS: We analyzed outcomes following laparoscopic and minilaparotomy cholecystectomy. 74 patients with gallstones were included. 45 patients were treated by a laparoscopic cholecystectomy and 29 patients were treated by a minilaparotomy cholecystectomy. RESULTS: Compared to the minilaparotomy cholecystectomy, the laparoscopic cholecystectomy resulted in a shorter mean hospital stay, a faster mean time to diet, and a longer mean operating time. During the first postoperative 24 hours more analgesics were used in the minilaparotomy cholecystectomy than in the laparoscopic cholecystectomy, and the laparoscopic cholecystectomy was more expensive than the minilaparotomy cholecystectomy. Postoperative complications occurred in 3 patients receiving a lapaaroscopic cholecystectomy and 1 patient receiving a minilaparotomy cholecystectomy. Conversion from a laparoscopic cholecystectomy to a traditional open cholecystectomy was necessary in 2 patients; no conversion to a traditional cholecystectomy was necessary in the minilaparotomy cholecystectomy. CONCLUSIONS: This study has proven the advantages of a laparoscopic cholecystectomy to be shorter hospitalization, less pain, and better cosmetic effect. Also, a minilaparotomy cholecystectomy has the advantages of a laparoscopic cholecystectomy and can be performed more safely.