Laparoscopic fluorescence imaging technique for visualizing biliary structures using sodium fluorescein: the result of a preclinical study in a porcine model

Purpose@#Near-infrared fluorescence imaging has been recently applied in the field of hepatobiliary surgery. Our objective was to apply blue-light fluorescence cholangiography during laparoscopic surgery. Therefore, we designed a preclinical study to evaluate the feasibility of using blue-light fluorescence for cholangiography in a porcine model. @*Methods@#Five millimeters of sodium fluorescein (SF) solution was administered into the gallbladder of 20 male 3-way crossbred (Landrace × Yorkshire × Duroc) pigs in laparoscopic approach. The biliary tree was observed under blue light (a peak wavelength of 450 nm) emitted from a commercialized light-emitting diode (LED) light source (XLS1 extreme, Chammed). @*Results@#In 18 of 20 porcine models, immediately after SF solution was administered into the gallbladder, it was possible to visualize the biliary tree under blue light emitted from the LED light source. @*Conclusion@#This study provided a preclinical basis for using blue-light fluorescence cholangiography using SF in laparoscopic surgery. The clinical feasibility of blue-light fluorescence imaging techniques for laparoscopic cholecystectomy remained to be demonstrated.

Therapeutic Effect of Teriparatide for Osteoporotic Thoracolumbar Burst Fracture in Elderly Female Patients

Objective@#: Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture. @*Methods@#: This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61–88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC). @*Results@#: There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05). @*Conclusion@#: Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

Solo Reduced Port Laparoscopic Left Lateral Sectionectomy

Laparoscopic approach for left lateral sectionectomy became the standard procedure. With increasing demand for minimizing of the access ports and with the advancement in surgical technique, reduced port laparoscopic surgery is introducing itself to the fields of hepatic surgery. We report a case of solo reduced port laparoscopic left lateral sectionectomy for a 25-year-old patient with a 1.7 cm sized tumor implant of growing teratoma syndrome. She underwent salpingo-oophorectomy and 3 cycles of chemotherapy with bleomycin, etoposide and cisplatin 2 prior to the operation. Her BMI was 18.3 kg/m². The total operation time was 85 minutes and estimated blood loss was scanty. The patient was discharged without a significant complication on postoperative day 5. In the video, we demonstrate the surgical procedure of the solo reduced port laparoscopic left lateral sectionectomy using a laparoscopic scope holder.

Fatigue and weakness hinder patient social reintegration after liver transplantation

BACKGROUND/AIMS: With improvements in the survival of liver transplantation (LT) recipients, the focus is shifting to patient quality of life (QOL), and employment is an important factor in aiding the social reintegration of LT patients. This study aims to evaluate the current employment status of liver graft recipients and various factors that may hinder reemployment. METHODS: Fifty patients above age 18 who underwent either living or deceased donor LT at a single center from March 2009 to July 2016 were interviewed during their visit to the outpatient clinic. The internally developed questionnaire consisted of 10 items. The Karnofsky Performance Scale and EQ-5D were used to evaluate patient function and QOL. RESULTS: A total of 25 (50%) patients returned to work after transplantation (the working group), and 21 (84%) patients in the working group returned to work within the first year after transplantation. In the non-working group (n=25), 17 (68%) answered that their health was the reason for unemployment. Fatigue and weakness were the most frequent symptoms. CONCLUSIONS: The data shows that as many as 50% of total patients returned to work after receiving LT. Fatigue and weakness were the most common complaints of the unemployed group, and resolving the causes of these symptoms may help to increase the employment rate.

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.

Current Status of Laparoscopic Liver Resection: Experiences from Tertiary Center

Laparoscopic liver resection has been widely accepted nowadays for selective cases of liver diseases. Laparoscopic left lateral sectionectomy and minor LLR are considered standard practice worldwide and cautious introduction of major laparoscopic liver resections like hemihepatectomies, central sectionectomy etc.. in institutions having experienced liver surgeons. Because of increasing young liver donor, laparoscopic donor hepatectomy is becoming popular, which gives better cosmetic outcomes. Many clinical trials compared laparoscopic liver resection safety, long term outcomes with open procedures. More recently, advances in laparoscopic instruments and techniques encouraged Korean surgeons to choose a laparoscopic procedure as one of the treatment options for benign or malignant diseases of liver.

Solo Three-incision Laparoscopic Cholecystectomy Using a Laparoscopic Scope Holder for Acute Cholecystitis

PURPOSE: L aparoscopic cholecystectomy (LC) i s a c ommonly p erformed procedure for t he management of acute cholecystitis. The presence of an inexperienced scopist or a shortage of manpower could be problematic in emergency surgical cases. To overcome these potential problems while ensuring a stable surgical view during LC, we performed solo surgery. METHODS: We retrospectively reviewed the results of 22 patients who underwent solo three-incision LC (S-TILC) and 31 patients who underwent the conventional three-incision LC (C-TILC) from March 1, 2015, to August 31, 2015. We compared the two groups with respect to the patients' clinical characteristics, and intraoperative and postoperative results; and severity grade as defined by the updated Tokyo guidelines 2013 (TG13) criteria. RESULTS: No significant differences in baseline characteristics were found between the two groups. The intraoperative perforation rates were higher in the C-TILC group than in the S-TILC group (p=0.016). Two cases were converted to human-assisted LC in the S-TILC group because of severe adhesions and the scope holder breaking down. No significant differences were found between the groups with respect to length of hospital stay; postoperative diet habit; or rates of post-cholecystectomy diarrhea, abdominal pain, wound complication, or complication according to the Clavien-Dindo grade. CONCLUSION: S-TILC and C-TILC were comparable in terms of results, and this solo surgery in LC could be performed for cases of acute cholecystitis during shortage of skilled manpower.

DialysisNet: Application for Integrating and Management Data Sources of Hemodialysis Information by Continuity of Care Record / 대한의료정보학회지

OBJECTIVES: Health Avatar Beans was for the management of chronic kidney disease and end-stage renal disease (ESRD). This article is about the DialysisNet system in Health Avatar Beans for the seamless management of ESRD based on the personal health record. METHODS: For hemodialysis data modeling, we identified common data elements for hemodialysis information (CDEHI). We used ASTM continuity of care record (CCR) and ISO/IEC 11179 for the compliance method with a standard model for the CDEHI. According to the contents of the ASTM CCR, we mapped the CDHEI to the contents and created the metadata from that. It was transformed and parsed into the database and verified according to the ASTM CCR/XML schema definition (XSD). DialysisNet was created as an iPad application. The contents of the CDEHI were categorized for effective management. For the evaluation of information transfer, we used CarePlatform, which was developed for data access. The metadata of CDEHI in DialysisNet was exchanged by the CarePlatform with semantic interoperability. RESULTS: The CDEHI was separated into a content list for individual patient data, a contents list for hemodialysis center data, consultation and transfer form, and clinical decision support data. After matching to the CCR, the CDEHI was transformed to metadata, and it was transformed to XML and proven according to the ASTM CCR/XSD. DialysisNet has specific consideration of visualization, graphics, images, statistics, and database. CONCLUSIONS: We created the DialysisNet application, which can integrate and manage data sources for hemodialysis information based on CCR standards.