Ileal long-segment ischemia after the unintended ligation of variant ileal branch during laparoscopic right hemicolectomy

손경모,김태언,신동훈,나주영,In Young Lee,Shin Hoo Park 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.3

The variant terminal trunk of the superior mesenteric artery (SMA) could be confused with the ileocolic artery (ICA) as it runs on the right side of the superior mesenteric vein. If the variant ileal branch of SMA is mistaken for the ICA, unintentional ligation could cause long-segment ischemia in the ileum. We encountered a rare case of ileal ischemia caused by unintentional ligation of the variant ileal branch of the SMA during laparoscopic right hemicolectomy, which was confirmed by indocyanine green (ICG) angiography and hyperspectral imaging (HSI). Intraoperative real-time perfusion monitoring using ICG angiography and tissue oxygen saturation monitoring using HSI could help detect segments of hypoperfusion and prevent hypoperfusion-related anastomotic complications.

Multifunctional Indocyanine Green Applications for Fluorescence-Guided Laparoscopic Colorectal Surgery

손경모,Ahn Hong-min,In Young Lee,하기원 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.3

Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applica- tions for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluores- cence-guided colorectal surgery.

외과의의 산학연병 협력 경험 - 형광 조영 수술

손경모 대한외과학회 2021 대한외과학회 학술대회 초록집 Vol.2021 No.5

Colonic hypoperfusion following ligation of the inferior mesenteric artery in rectosigmoid colon cancer patients

손경모,Tae Un Kim,Byung-Soo Park,Hyuk Jae Jung,Sang Su Lee,윤지욱,이준우 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.97 No.2

Purpose: Colon perfusion status is one of the most important factors for the determination of postoperative anastomotic complications. Colonic hypoperfusion can be induced by inferior mesenteric artery (IMA) ligation in some patients. This study aimed to evaluate atherosclerotic risk assessment and vascular parameters of CT angiography as predictors of colonic hypoperfusion. Methods: This prospective study was conducted at a tertiary referral hospital and included 46 rectosigmoid colon cancer patients undergoing laparoscopic anterior resection between August 2013 to July 2014. Atherosclerotic risk scores were assessed using the Framingham cardiovascular risk score system. The IMA length, branching pattern, atherosclerotic calcification, and intermesenteric artery and mesenteric vascular diameters were evaluated using CT angiography. Mesenteric marginal artery pressures were measured before and after IMA clamping. The mean arterial pressure (MAP) index was calculated by dividing the mesenteric marginal MAP into the systemic MAP to determine the mesenteric hypoperfusion status after IMA clamping. A critically low MAP index was defined as <0.4. Results: Critically low MAP index (<0.4) was observed in 6 cases (13.0%) after IMA clamping. Atherosclerotic calcification of the IMA and superior mesenteric artery occurred in 11 (23.9%) and 5 patients (10.9%), respectively. Low MAP index was associated with high atherosclerotic risk score and short IMA length, rather than atherosclerotic calcification and other vascular parameters of the major mesenteric arteries. Multivariate analysis indicated that high atherosclerotic risk and short IMA length were independent predictors of critically low MAP index. Conclusion: Atherosclerotic risk assessment and IMA length were useful predictors of the mesenteric hypoperfusion status following IMA ligation during laparoscopic rectosigmoid colon surgery

Hirschsprung 병에서 Transanal One-Stage Pull-Through 술식의 단기 성적

손경모,김해영,Son, Gyung-Mo,Kim, Hae-Young 대한소아외과학회 2001 소아외과 Vol.7 No.2

The aim of this study was to evaluate the short-term outcomes of the trans anal one-stage pull-through procedure(TOP) in Hirschsprung's disease. Eight patients aged 3 weeks to 8 months with Hirschsprung's disease underwent this procedure. A rectal mucosectomy was performed from just proximal to dentate line to the level of peritoneal reflexion, where muscle layer was incised circumferentially. Rectosigmoid was mobilized out through the anus, and full-thickness frozen biopsy was taken for confirmation of ganglionic cells. After the rectal muscular cuff was divided longitudinally in the posterior aspect, aganglionic bowel was removed and ganglionic colon was anastomozed to the anus. The mean operating time was 161 minutes, and the mean hospital stay after operation was 3.8 days. Five patients had three to four bowel movement per day without other therapy at mean postoperative 39.2 days. Although long-term follow-up will be required, the TOP might be the new alternative surgical procedure for Hirschsprung's disease.

Is the oncological impact of vascular invasion more important in right colon cancer?

손경모 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.2

Vascular invasion is an unfavorable prognostic factor for the recurrence and systemic metastasis of colon cancer. An interesting study in this issue evaluate the difference in the oncological impact of vascular invasion according to tumor side in colon cancer. The authors suggest that the oncological impact of vascular invasion could be worse in nonmetastatic right colon cancer than in nonmetastatic left colon cancer. Herein, hematoxylin-eosin staining was used to detect vascular invasion. In a recent study, elastin staining could detect more venous invasion. It is expected that the molecular pathologic characteristics of colon cancer can be identified precisely and the oncological outcomes of colon cancer can be improved in the future.

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

손경모,이인영,이윤석,계봉현,Cho Hyeon Min,장제호,김창남,이길연,이석환,김준기,The Korean Laparoscopic Colorectal Surgery Study Group 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.6

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

Organ preservation for early rectal cancer using preoperative chemoradiotherapy

손경모 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.3

조기 대장암의 다학제적 치료 전략

손경모,박수범,김태언,박병수,이인영,나주영,신동훈,오상보,조성환,김현성,김형욱 대한의사협회 2022 대한의사협회지 Vol.65 No.9

Background: Treatment for early colon cancer has progressed rapidly with endoscopic resection and minimally invasive surgery. Selection of patients without risk of lymph node metastasis is necessary before deciding on endoscopic resection for early colon cancer treatment. We aimed to review the optimal multidisciplinary treatment strategies for early colon cancer, including endoscopy and surgery. Current Concepts: Pathological risk factors include histologic grade of cancer cell differentiation, lymphovascular invasion, perineural invasion, tumor budding, and deep submucosal invasion. These risk factors for predicting lymph node metastasis are crucial for determining the treatment strategy of endoscopic excision and radical resection for early colon cancer. Prediction of the depth of invasion in early colon cancer using endoscopic optical assessments is vital to determine the appropriate treatment method for endoscopic or surgical resection. Furthermore, optical assessment of pit and vascular patterns is useful for estimating the depth of submucosal invasion using magnifying chromoendoscopy and narrow-band imaging endoscopy. Performing an endoscopic and pathologic evaluation of the risk factors for lymph node metastasis is imperative when selecting endoscopic or surgical resection. Endoscopic treatments include cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. In addition, appropriate surgical treatment should be recommended for patients with early colon cancer with a high risk of lymph node metastasis. Discussion and Conclusion: A multidisciplinary approach should be recommended to establish an optimized treatment strategy, minimize the risk of complications, and obtain excellent oncologic outcomes via patient tailored treatment in patients with early colon cancer.

외과 환자의 감염관리

손경모 대한외과학회 2019 대한외과학회 학술대회 초록집 Vol.2019 No.5