Optimal indication of single-incision laparoscopic cholecystectomy using Konyang Standard Method in benign gallbladder diseases

Seung Jae Lee,In Seok Choi,Ju Ik Moon,Dae Sung Yoon,Won Jun Choi,Sang Eok Lee,Nak Song Sung,Seong Uk Kwon,In Eui Bae,Seung Jae Roh,Sung Gon Kim 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.3

Purpose: The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established. Methods: This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Dif f icult surger y (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were def ined to comprehensively evaluate surgical diff iculty and postoperative outcomes, respectively. Results: Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m 2 were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, p < 0.001) and PPO (5.0% vs. 15.9%, p = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC. Conclusion: SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and metanalysis

Karim Ataya,Hussein El Bourji,Ayman Bsat,Amir Al Ayoubi,Al Moutuz Al Jaafreh,George Abi Saad 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.4

Purpose: In recent years, the need for revisional bariatric surgery (RBS) procedures has experienced a noteworthy surge to confront complexities and weight recidivism. Despite being a subject of controversy for many, the utilization of the Da Vinci robotic platform (Intuitive Surgical, Inc.) may present benefits in RBS. This study aimed to evaluate the outcomes of robotic RBS in comparison to Laparoscopic RBS. Methods: A meticulous and thorough analysis was ensured through a comprehensive exploration of the literature, which included PubMed, Medline, Scopus, and Cochrane. This exploration was conducted in adherence to the directives outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle- Ottawa scale was used for quality assessment. Results: A total of 11 studies were included in this meta-analysis, comprising 55,889 in the laparoscopic group and 5,809 in the robotic group. No significant differences were observed in the leak, bleeding, operative time, or length of stay across both groups. However, the robotic group showed higher rates of conversion to open surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53–0.79; p < 0.0001; I2 = 0%), reoperation (OR, 0.70; 95% CI, 0.57– 0.87; p = 0.0009; I2 = 6%), and readmission (higher rate of readmission in the robotic group; OR, 0.76; 95% CI, 0.62–0.92; p = 0.005; I2 = 30%) Conclusion: Robotic-assisted bariatric surgery has no significant advantage over conventional laparoscopic surgery. Further research is warranted to explore and evaluate surgeons’ methodology and proficiency differences.

Laparoscopic cholecystectomy and common bile duct exploration for gallstone and common bile duct stone in a patient with a left-sided gallbladder: a case report

Takeshi Ueda,Tetsuya Tanaka,Yuki Kirihataya,Chisato Hara,Atsushi Yoshimura 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.4

Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case in which laparoscopic cholecystectomy and common bile duct exploration were achieved for an 89-year-old female patient with left-sided gallbladder. Surgery was carried out using our usual trocar position. Calot triangle was covered by the body of the gallbladder and could not be detected. We dissected the gallbladder from the fundus towards the neck. The cystic duct joined the common bile duct from the right side, and common bile duct exploration was performed routinely without perioperative comorbidities. Although the preoperative diagnosis rate is low and the risk of intraoperative bile duct injuries in patients with left-sided gallbladder is high, laparoscopic cholecystectomy and common bile duct exploration can be safely performed by understanding the location and bifurcation of the cystic duct.

Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea

Sungwoo Jung,Jin Ho Lee,이형순 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

Purpose: Robotic hernia repair has increased in popularity since the introduction of da Vinci robots (Intuitive Surgical). However, we lack quantitative analyses of its potential benefits. Herein, we report our initial experience with robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. Methods: We retrospectively reviewed the data from patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the da Vinci platform. Data on patient characteristics and surgical outcomes were also collected. Results: Twenty-one patients (including 20 male patients [95.2%]) with a mean age of 54.1 ±16.4 years and body mass index of 23.8 ± 1.9 kg/m2 underwent R-TAPP inguinal hernia repair. Bilateral hernia repair was performed in two patients (9.5%), and six patients (28.5%) with scrotal hernia underwent R-TAPP hernia repair. A sigmoid colon sliding hernia was present in three patients (14.3%). The mean operation and console times were 91.8 ± 20.4 minutes and 154.5 ± 26.2 minutes, and 61.4 ± 16.9 minutes and 128.0 ± 25.5 minutes for unilateral and bilateral inguinal hernia, respectively. Spermatic vessel injury was identified intraoperatively in one patient. Two minor postoperative complications, postoperative ileus, and wound seroma were reported. The mean duration of hospitalization was 3.8 ± 0.9 days. No recurrence or conversion to open surgery was required. Conclusion: Our findings suggest that R-TAPP inguinal hernia repair is safe and feasible. Its cost-effectiveness, optimal procedural steps, and indications for a robotic approach require further investigation.

What is the role of surgical oncologist in the treatment of gastric cancer?

Jeong Ho Song,Sang-Yong Son,한상욱 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.2

Surgical oncologist plays a pivotal role in treating patients with cancer in the era of precision medicine. In this article, we summarized traditional roles of surgical oncologists and suggested further additional ones for the modern day in the multidisciplinary approach to gastric cancer treatment.

The Journal of Minimally Invasive Surgery is indexed by PubMed Central in 2022

박선진 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.3

The Journal of Minimally Invasive Surgery (JMIS) is the official journal of the Korean Society of EndoLaparoscopic & Robotic Surgery (formerly the Korean Society of Endoscopic and Laparoscopic Surgeons). The editorial board of JMIS has been trying steadily for several years to be indexed by the international literature databases. As a first step, JMIS has been deposited into PubMed Central in 2022. Here I would like to show you the path that JMIS has been following over the years.

Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand

Chalerm Eurboonyanun,Potchavit Aphinives,Jakrapan Wittayapairoch,Kulyada Eurboonyanun,Tharatip Srisuk,Suriya Punchai,Somchai Ruangwannasak,Kriangsak Jenwitheesuk,Emil Petrusa,Denise Gee,Roy Phitayakor 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

Purpose: Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. Methods: A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007–2010, 2011–2014, and 2015–2018, and analyzed to explore changes in the operative trends. Results: For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. Conclusion: The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents’ technical skills in open and laparoscopic surgery to remain competitive with their global partners.

Robotic-assisted versus laparoscopic paraesophageal hernia repair: a systematic review and meta-analysis

Symeonidou Elissavet,Gkoutziotis Ioannis,Petras Panagiotis,Mpallas Konstantinos,Kamparoudis Apostolos 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

surgeons. This systematic review aims to compare the outcomes of robotic-assisted and conventional laparoscopic approaches for paraesophageal hernia repair, specifically examining postoperative complications, operative time, hospital stay, and recurrence. Methods: A systematic review including thorough research through PubMed, Scopus, and Cochrane, was performed and only comparative studies were included. Studies concerning other types of hiatal hernias or children were excluded. A meta-analysis was conducted to compare overall postoperative complications, hospital stay, and operation time. Results: Ten comparative studies, with 186,259 participants in total, were included in the meta-analysis, but unfortunately, not all of them reported all the outcomes under question. It appeared that there is no statistically significant difference between the conventional laparoscopic and the robotic-assisted approach, regarding the overall postoperative complication rate (odds ratio [OR], 0.56, 95% confidence interval [CI], 0.28–1.11), the mean operation time (t = 1.41; 95% CI, –0.15–0.52; p = 0.22), and the hospital length of stay (t = –1.54; degree of freedom = 8; 95% CI, –0.53–0.11; p = 0.16). Only two studies reported evidence concerning the recurrence rates. Conclusion: Overall, the robotic-assisted method did not demonstrate superiority over conventional laparoscopic paraesophageal hiatal hernia repair in terms of postoperative complications, operation time, or hospital stay. However, some studies focused on cost and patient characteristics of each group. Further comparative and randomized control studies with longer follow-up periods are needed for more accurate conclusions on short- and long-term outcomes.

Do we all agree that the future of pancreaticoduodenectomy lies in how effectively we use robots?

Jae Hoon Lee 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

Current status of laparoscopic emergency surgery in Korea: multicenter restrospective cohort study

Jung-Min Bae,Chang-Yeon Jung,Keesang Yoo,Hak-Jae Lee,Suk-Kyung Hong,Sungyeon Yoo,Yun Tae Jung,Eun Young Kim,Min Jung Ko,Ho-Gyun Shin 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

Purpose: Laparoscopic surgery is a choice in several emergency settings. However, there has been no nationwide study or survey that has compared the clinical use of laparoscopic emergency surgery (LES) versus open abdominal emergency surgery (OES) in Korea. Therefore, we examined the state of LES across multiple centers in Korea and further compared this data with the global state based on published reports. Methods: Data of 2,122 patients who received abdominal emergency surgery between 2014 and 2019 in three hospitals in Korea were collected and retrospectively analyzed. Several clinical factors were investigated and analyzed. Results: Of the patients, 1,280 (60.3%) were in the OES group and 842 (39.7%) were in the LES group. The most commonly operated organ in OES was the small bowel (25.8%), whereas that for LES was the appendix. In appendectomy and cholecystectomy, 93.7% and 88.0% were in the LES group. In small bowel surgery, gastric surgery, and large bowel surgery, 89.4%, 92.0%, and 79.1% were in the OES group. The severity-related factors of patient status demonstrated statistically significant limiting factors of selection between LES and OES. Conclusion: Although our study has several limitations, compared to the LES data from other countries, the general LES state was similar in appendectomies, cholecystectomies, and small bowel surgeries. However, in gastric and colorectal surgeries, the LES state was different from those of other countries. This study demonstrated the LES state and limiting factors of selection between LES and OES in various operated organs. Further studies are required to analyze these differences and the various limiting factors.