Hybrid Single-Incision Laparoscopic Colon Cancer Surgery Using One Additional 5 mm Trocar.

BACKGROUND: Single-incision laparoscopic surgery (SILS) is a feasible and safe procedure for colorectal cancer. However, SILS has some technical limitations such as collision between instruments and inadequate countertraction. We present a hybrid single-incision laparoscopic surgery (hybrid SILS) technique for colon cancer that involves use of one additional 5 mm trocar. METHODS: Hybrid SILS for colon cancer was attempted in 70 consecutive patients by a single surgeon between August 2014 and July 2016 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Using prospectively collected data, an observational study was performed on an intention-to-treat basis. RESULTS: Hybrid SILS was technically completed in 66 patients, with a failure rate of 5.7% (4/70). One patient was converted to open surgery for para-aortic lymph node dissection. Another was converted to open surgery due to severe peritoneal adhesion. An additional trocar was inserted for adhesiolysis in the other two cases. Median lengths of proximal and distal margins were 12.8 cm (interquartile range [IQR], 10.0-18.6), and 8.2 cm (IQR, 5.5-18.3), respectively. Median total number of lymph nodes harvested was 24 (IQR, 18-33). Overall rate of postoperative morbidity was 12.9%, but there were no Clavien-Dindo grade III or IV complications. There was no postoperative mortality or reoperation. Median postoperative hospital stay was 6 days (IQR, 5-7). CONCLUSIONS: Hybrid SILS using one additional 5 mm trocar is a safe and effective minimally invasive surgical technique for colon cancer. Experienced laparoscopic surgeons can perform hybrid SILS without a learning curve based on the formulaic surgical techniques presented in this article.

Degradation characteristics of metoprolol during UV/chlorination reaction and a factorial design optimization.

Metoprolol (MTP), a hypertension depressor, has been increasingly detected even after conventional water treatment processes. In this study, the removal of MTP was compared using chlorination (Cl2), UV-C photolysis, and UV/chlorination (Cl2/UV) reactions. The results showed that the UV/chlorination reaction was most effective for MTP removal. MTP removal during UV/chlorination reaction was optimized under various conditions of UV intensity (1.1-4.4 mW/cm(2)), chlorine dose (1-5 mg/L as Cl2), pH (2-9), and dissolved organic matter (DOM, 1-4 mgC/L) using a two-level factorial design with 16 experimental combinations of the four factors. Among the factors examined, DOM scavenging by OH radicals was the most dominant in terms of MTP removal during UV/chlorination reaction. The established model fit well with the experimental results using to various water samples including surface waters, filtered and tap water samples. The optimized conditions (UV intensity=4.4 mW/cm(2), [Cl2]=5 mg/L, pH 7, and [DOM]=0.8-1.1 mgC/L) of the model removed more than 78.9% of MTP for filtered water samples during UV/chlorination reaction. Using LC-MS/MS, five byproducts of MTP (molecular weight: 171, 211, 309, 313, and 341, respectively) were identified during UV/chlorination reaction. Based on this information, the MTP transformation mechanism during UV/chlorination was suggested. Our results imply that applying UV/chlorination process after filtration stage in the water treatment plant (WTP) would be the most appropriate for effective removal of MTP.

Adsorption characteristics of selected hydrophilic and hydrophobic micropollutants in water using activated carbon.

In this study, we investigated adsorption characteristics of nine selected micropollutants (six pharmaceuticals, two pesticides, and one endocrine disruptor) in water using an activated carbon. The effects of carbon dosage, contact time, pH, DOM (dissolved organic matter), and temperature on the adsorption removal of micropollutants were examined. Increasing carbon dosage and contact time enhanced the removal of micropollutants. Sorption coefficients of hydrophilic compounds (caffeine, acetaminophen, sulfamethoxazole, and sulfamethazine) fit a linear isotherm and hydrophobic compounds (naproxen, diclofenac, 2, 4-D, triclocarban, and atrazine) fit a Freundlich isotherm. The removal of hydrophobic pollutants and caffeine were independent of pH changes, but acetaminophen, sulfamethazine, and sulfamethoxazole were adsorbed by mainly electrostatic interaction with activated carbon and so were affected by pH. The decrease in adsorption removal in surface water samples was observed and this decrease was more significant for hydrophobic than hydrophilic compounds. The decline in the adsorption capacity in surface water samples is caused by the competitive inhibition of DOM with micropollutants onto activated carbon. Low temperature (5°C) also decreased the adsorption removal of micropollutants, and affected hydrophobic compounds more than hydrophilic compounds. The results obtained in this study can be applied to optimize the adsorption capacities of micropollutants using activated carbon in water treatment process.