Solo Reduced Port Laparoscopic Left Lateral Sectionectomy

YoungRok Choi,Ho-Seong Han,Yoo Seok Yoon,Jai Young Cho,Sungho Kim,In Gun Hyun,Kil Hwan Kim 대한내시경복강경외과학회 2018 Journal of Minimally Invasive Surgery Vol.21 No.3

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.

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

Soyeon Choi,YoungRok Choi,Ho-seong Han,Yoo-Seok Yoon,Jai Young Cho,Seonguk Kwon,Jae Seong Jang,Jangkyu Choi,Sungho Kim 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.4

Purpose: Laparoscopic cholecystectomy (LC) is a commonly performed procedure for the 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.

Implication of Fast Track after Pancreaticoduodenectomy

Woohyung Lee,Yoo-Seok Yoon,Ho-Seong Han,Jai Young Cho,YoungRok Choi,Hong Kyung Shin,Jae Yool Jang,Hanlim Choi 대한종양외과학회 2015 대한임상종양학회 학술대회지 Vol.2015 No.2

Outcomes of Laparoscopic Major Liver Resection for Hepatocellular Carcinoma

( Hanisah Guro ),( Jai Young Cho ),( Ho-seong Han ),( Yoo-seok Yoon ),( Youngrok Choi ),( Jae Seong Jang ),( Seong Uk Kwon ),( Sungho Kim ),( Jang Kyu Choi ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: To compare the surgical outcomes of laparoscopic and open major liver resection (LR) for hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed 165 patients who underwent major LR for HCC between January 2004 to June 2015. We divided the patients into two groups as to the type of procedure, laparoscopic major LR (group L; n=62) and open major LR (group O; n=90). Results: Open conversion occurred in 13 patients and these were excluded. In group L, there were 30 right hepatectomy, 28 right posterior sectionectomy, 11 left hepatectomy, 6 right anterior sectionectomy, 6 extended right hepatectomy, and 2 central bisectionectomy. Tumor size was greater in Group O (6.3±3.8cm) than in group L (4.1±2.4cm; P=0.016). There were no differences in the mean ICG-R15% (P=0.698) and presence of histologic cirrhosis (P=0.295). The mean operation time was longer in group L (416.6±166.9min) than group O (332.5±105.4min; P=0.002), but there were no differences in blood loss (P=0.319), transfusion rate (P=0.260), and R0 rate (P=0.255) between two groups. However, hospital stay was shorter (11.3±8.3 vs. 18±21.4; P=0.007) and complication rate was lower (20.5% vs. 38.7%; P=0.005) in group L than group O. There was no statistical difference in 5-year overall patient survival rate (77.3% vs 60.2%; P=0.087) and the 5-year disease-free survival rate (50.8% vs 40.1%; P=0.139) between the two groups. Conclusions: Laparoscopic major LR for hepatocellular carcinoma is feasible and oncologically safe when performed by experienced surgeons, but further refinements of the surgical technique are needed to reduce operation time.

Current status of laparoscopic liver resection for hepa-tocellular carcinoma

( Hanisah Guro ),( Jai Young Cho ),( Ho Seong Han ),( Yoo Seok Yoon ),( Youngrok Choi ),( Mohan Periyasamy ) 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.2

Laparoscopic liver resection (LLR) is becoming widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic left lateral sectionectomy and minor laparoscopic liver resection are now considered standard approaches, especially for tumors located in the anterolateral segments of the liver. Laparoscopic left lateral sectionectomy in adult donors is also gaining acceptance for child liver transplantation in many centers. Major LLRs, including left hepatectomy and right hepatectomy, have been recently attempted. Laparoscopic donor hepatectomy is becoming more popular owing to increasing demand from young living donors who appreciate its minimal invasiveness and excellent cosmetic outcomes. Several centers have performed total laparoscopic donor right hepatectomy in adult-to-adult living donor liver transplantation. Many meta-analyses have shown that LLR is better than open liver resection in terms of short-term outcomes, principally cosmetic outcomes. Although no randomized control trials have compared LLR with open liver resection, the long-term oncologic outcomes were similar for both procedures in recent case-matched studies. (Clin Mol Hepatol 2016;22:212-218)

Laparoscopic resection of hilar cholangiocarcinoma

Woohyung Lee,Ho-Seong Han,Yoo-Seok Yoon,Jai Young Cho,YoungRok Choi,Hong Kyung Shin,Jae Yool Jang,Hanlim Choi 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.4

Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43?76 years), 610 minutes (410?665 minutes), 650 mL (450?1,300 mL), and 12 days (9?21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma.

Neutrophil-to-lymphocyte ratio predicts early acute cellular rejection in living donor liver transplantation

Boram Lee,YoungRok Choi,Jai Young Cho,Yoo-Seok Yoon,Ho-Seong Han 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.6

Purpose: The aim of this study was to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in acute cellular rejection (ACR) after living donor liver transplantation (LDLT). Methods: All consecutive patients who underwent ABO-compatible (ABOc) LDLT from September 2014 to December 2017 were retrospectively reviewed. NLR was calculated on 3 occasions; (1) 4 weeks prior to liver transplantation (LT), (2) the day of LT, and (3) the day before liver biopsy. Results: Among 66 patients who underwent ABOc LDLT, ACR was identified in 15 patients (22.7%) on protocol liver biopsy performed routinely on the postoperative day 7. There was no significant difference in NLR at 4 weeks prior to LT and the day of LT between no-ACR and ACR group (2.98 ± 1.92 vs. 2.54 ± 1.15, P = 0.433; 17.9 ± 8.31 vs. 20.5 ± 13.4, P = 0.393). However, NLR was significantly lower in ACR group compared to non-ACR group just prior to liver biopsy (5.82 ± 3.42 vs. 18.4 ± 17.2, P = 0.035). NLR tends to decrease 3.5 days before the onset of ACR. The area under the receiver operating characteristic curve for optimal cut-off value of NLR was 6.49, with sensitivity and specificity of 80.4% and 73.3% respectively. Conclusion: NLR has a potential as a noninvasive predictor of early ACR in ABOc LDLT.

Long-term outcomes of emergency ABO-incompatible living donor liver transplantation using a modified desensitization protocol for highly sensitized patients with acute liver failure: A case report

Boram Lee,Jai Young Cho,Ho-Seong Han,Yoo-Seok Yoon,Hae Won Lee,Jun Suh Lee,Moonhwan Kim,YoungRok Choi 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4

Although there is no established desensitization protocol for liver transplantation (LT), desensitization usually entails treatment with rituximab, plasmapheresis, splenectomy, and intravenous immunoglobulin (IVIG) infusion together with a local graft. The desensitization protocol is usually initiated 2 to 3 weeks before transplantation. Therefore, patients with acute liver failure warranting urgent LT are usually ineligible for ABO-incompatible (ABOi) LT. For these reasons, several attempts have been made to abridge the desensitization protocol and extend the indication for ABOi living donor LT (LDLT). Here we report a 40-year-old female diagnosed with chronic hepatitis B and acute-on-chronic liver failure (model for end-stage liver disease score, 31). In the absence of a suitable compatible liver donor, emergency ABOi LT was planned using a modified desensitization protocol. The preoperative isoagglutinin (IA) titer was 1 : 1,024 and the preoperative T- and B-cell cross-matches were positive. The patient received a single dose of rituximab (375 mg/㎡) and IVIG (0.8 g/kg) was administered from the anhepatic phase until three days after transplantation. Although the patient developed acute cellular rejection in the early stages after LT, she has maintained a stable graft function, even after 5 years. In summary, a modified desensitization protocol consisting of rituximab and IVIG is a feasible strategy for highly sensitized patients with elevated IA titers indicated for urgent LDLT.

ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer

Boram Lee,YoungRok Choi,Ho-Seong Han,Yoo-Seok Yoon,Jai Young Cho,Sook-Hyang Jeong,Jin-Wook Kim,Eun Sun Jang,Soomin Ahn 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.3

Backgrounds/Aims: Graft survival after ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has increased due to advances in desensitization methods. We analyzed early outcomes following ABOi LDLT using only rituximab without any additional desensitization methods in recipients with low anti-ABO antibody titers (≤1:32). Methods: Ten adult patients underwent ABOi LDLT between September 2014 and December 2016. All patients were administered a single dose of rituximab (300 mg/㎡) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 underwent multiple sessions of plasmapheresis to reduce titers to <1:32 (rituximab+plasmapheresis, RP). Seven patients with low anti-ABO titer (≤1:32) did not undergo plasmapheresis (rituximab-only, RO). ABO-compatible LDLT patients during the same period were included for comparison (n=22). Results: Post-transplantation titers were significantly lower in the RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p=0.04), (POD30 1.26±0.45 vs 108±107, p=0.02). There were no significant differences in rejection, biliary complications and infection between groups. There were no significant differences in outcome between the RO group and ABO-compatible except for infection. Conclusions: This study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABOi LDLT using conventional immunosuppression and rituximab alone.

췌장수술 후의 백혈구 수치 변화

김대환(Daehwan Kim),한호성(Ho-Seong Han),윤유석(Yoo-Seok Yoon),조재영(Jai Young Cho),최영록(Youngrok Choi),장재율(Jae Yool Jang),최한림(Hanlim Choi) 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.2

Purpose: Pancreatic surgery is challenging and associated with high morbidity. Therefore, it is important to detect it early before it becomes clinically apparent. The white blood cell (WBC) count useful as a predictive marker of postoperative pancreatic fistula. The aim of this study was to evaluate the diagnostic accuracy of WBC in predicting pancreatic fistula. Methods: Between September 2003 and December 2013, 405 patients underwent elective pancreaticoduodenectomy or pylorus preserving pancreaticoduodenectomy for periampullary malignancy. Among them, 372 patients with no preoperative leukocytosis were enrolled in this study. The serum WBC count was monitored daily until postoperative day 8. The clinic and pathological data of these patients were analyzed by reviewing medical records retrospectively. Results: Thirty patients (8%) developed pancreatic fistula grade B and C. The WBC count, measured every other day, was significantly higher every other day during the first 7 postoperative days in patients who developed pancreatic fistula grade B and C, compared with those patients who did not develop pancreatic fistula. The WBC count cutoff value of 13.07x10<SUP>9</SUP>/L, 10.37 x10<SUP>9</SUP>/L on postoperative day 1,7 yielded a sensitivity of 57%, 70%, specificity of 53%, 67% for the detection of pancreatic fistula. Conclusion: Patients with postoperative fistula grades B and C showed WBC counts that did not decrease on subsequent measurements during the early postoperative period. The measurement of WBC counts after pancreaticoduodenectomy can play a clinically important role in the early detection of pancreatic fistula development even from postoperative one day.