Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

C. William Helm,Cibi Arumugam,Mary E. Gordinier,Daniel S. Metzinger,Jianmin Pan,Shesh N. Rai 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.3

Objective: To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods: Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results: 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ≥3 complications 9.2:34.0 (p<0.01), ≥3 wound complications 3.1:22.3 (p<0.01) and ≥3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (≥36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion: For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection. Objective: To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods: Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results: 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ≥3 complications 9.2:34.0 (p<0.01), ≥3 wound complications 3.1:22.3 (p<0.01) and ≥3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (≥36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion: For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.

Diagnostic and Therapeutic Laparoscopy for Abdominal Trauma: A Single Surgeon’s Experience at a Level I Trauma Center

( Hancheol Jo ),( Dong Hun Kim ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.4

Purpose: Laparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon’s experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients. Methods: In total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages. Results: The mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups. Conclusions: Laparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.

Non-Randomized Confirmatory Trial of Laparoscopy-Assisted Total Gastrectomy and Proximal Gastrectomy with Nodal Dissection for Clinical Stage I Gastric Cancer: Japan Clinical Oncology Group Study JCOG1401

Kataoka, Kozo,Katai, Hitoshi,Mizusawa, Junki,Katayama, Hiroshi,Nakamura, Kenichi,Morita, Shinji,Yoshikawa, Takaki,Ito, Seiji,Kinoshita, Takahiro,Fukagawa, Takeo,Sasako, Mitsuru The Korean Gastric Cancer Association 2016 Journal of gastric cancer Vol.16 No.2

Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155.

Is Second Look Laparoscopy for Diagnosing Remaining Ovarian Cancer Appropriate Further Treatment?

Rama Inamdar,Ahyoung Cho,Hae Kyung Yoo,Hye-Sung Moon 이화여자대학교 의과학연구소 2019 EMJ (Ewha medical journal) Vol.42 No.2

Objectives: The aim of our study is to compare the findings of investigative modalities and second look laparoscopy in ovarian cancer and establish the safety and accuracy of second look laparoscopy for detecting ovarian cancer. Methods: We retrospectively reviewed 11 patients with ovarian cancer treated by a single surgeon from 2006 to 2013. These patients were diagnosed at the time of primary cytoreductive surgery and received six cycles of combination chemotherapy. Then, they underwent second look laparoscopy. They were followed up with tumor markers monthly and PET-CT and/or CT scans. Results: All 11 patients had undergone primary surgery followed by six cycles of consolidation chemotherapy. Eight patients had positive pathologic findings on second look laparoscopy (72.7 %). The CA 125 level was higher in one patient (12.5%). In seven patients who had positive results on second look laparoscopy, the value was well below normal limit (87.5%). Three patients had recorded increases in fluorodeoxyglucose uptake (37.5%). The increase in standardized uptake values in specific regions in the scans corresponded to positive biopsies from those regions. Seven patients who had positive findings on second look laparoscopy were treated with consolidation chemotherapy. The 5-year survival rate was 66.67%, and the 5-year recurrence rate was 33.33%. Conclusion: There are limitations to the accuracy of current investigative techniques, and we must rely on clinical correlation with these modalities for each case of second look laparoscopy. It is feasible to safely perform second look laparoscopy to detect remnant ovarian cancer.

Non-Randomized Confirmatory Trial of Laparoscopy-Assisted Total Gastrectomy and Proximal Gastrectomy with Nodal Dissection for Clinical Stage I Gastric Cancer: Japan Clinical Oncology Group Study JCOG1401

Kozo Kataoka,Hitoshi Katai,Junki Mizusawa,Hiroshi Katayama,Kenichi Nakamura,Shinji Morita,Takaki Yoshikawa,Seiji Ito,Takahiro Kinoshita,Takeo Fukagawa,Mitsuru Sasako,Stomach Cancer Study Group/Japan C 대한위암학회 2016 Journal of gastric cancer Vol.16 No.2

Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospectivestudy evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. Anon-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy andlaparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japaneseinstitutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints areoverall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assistedproximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. TheUMIN Clinical Trials Registry number is UMIN000017155.

Diagnostic Laparoscopy for the Management of Impalpable Testes

박지현,박용현,박관진,최황 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.5

Purpose: Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes. Materials and Methods: Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end. Results: The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy. Conclusions: Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative. Purpose: Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes. Materials and Methods: Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end. Results: The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy. Conclusions: Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.

복강경검사에 따른 동맥혈 산소포화도 및 심전도 변화

강동훈(Dong Hoon Kang),전훈재(Hoon Jae Chun),송치욱(Chi Wook song),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

N/A To assess t.he safety of diagnostic laparoscopy, we monitored arterial oxygen saturation (SaO ) and EKG changes using pulse oxymeter and EKG monitor in 72 patients who un- derwent laparoscopy, not suffered from cardio-pulmonary disease. The baseline SaO, was 96.0+2.4'/o dnd it decresed t,o 94.0+3.0'/o during laparoscopy and to 94.2+3.4% aft.er laparoscopy(p<0.001). The baseline heart rate was 77.7+20.0/min and it increased to H4..'I-t17.9,/min during laparoscopy(p<0.01). The Holter F.KG changes in 22 patients over ii0 ycars old v;ere transient sinus t.achycardia in 27.3% and ST segment depression in 4.5 ,I,. In patients over 65 years olcl, with high tolerance score, the baseline saturation were not significantly different between other age and tolerance groups, but SaO, were de- <reased significantly through and after the procedure. We identified old age, and well tol- vrated patients during laparoscopy as independent risk factors for arterial oxygen satura- tiori. Ke recommend cont.inuous monit.oring anc1 giving supplemental oxygen to pat.ients ivith these high risk factors from outset of laparoscopy. (Korean J Gastroenterol 1994; 2h: 561-567)

Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy -Assisted Distal Gastrectomy

김한길,정상호,이영준,하우송,최상경,홍순찬,정은정,주영태,정치영,박태진,박지호 대한위암학회 2013 Journal of gastric cancer Vol.13 No.1

Purpose: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy

Laparoscopy-Assisted Distal Gastrectomy for Early Gastric Cancer in the Elderly

Kim, Eun Ji,Seo, Kyung Won,Yoon, Ki Young The Korean Gastric Cancer Association 2012 Journal of gastric cancer Vol.12 No.4

Purpose: With an increase in life expectancy, more elderly patients are presenting with gastric cancer. As a result it is yet be resolved whether laparoscopy assisted distal gastrectomy is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes of laparoscopy assisted distal gastrectomy between elderly and nonelderly patients with gastric cancer. Materials and Methods: The study group was comprised of 316 patients who underwent laparoscopy assisted distal gastrectomy between April 2005 and December 2010. Of these patients, 93 patients whose ages were 65 years or more were compared with 223 patients who were younger. Results: There were no differences in the short term outcome or minor complication rate between the elderly patients and the nonelderly patients. The hospital stay was significantly longer and the major complication rate was significantly higher for the elderly patients compared with nonelderly patients. Conclusions: Laparoscopy assisted distal gastrectomy for early gastric cancer in the elderly patients had comparable operation time and blood loss with the nonelderly group. However, the safety and advantage of laparoscopy assisted distal gastrectomy in the elderly patients need to be further studied in higher volume trials.

Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy-Assisted Distal Gastrectomy

Kim, Han-Gil,Park, Ji-Ho,Jeong, Sang-Ho,Lee, Young-Joon,Ha, Woo-Song,Choi, Sang-Kyung,Hong, Soon-Chan,Jung, Eun-Jung,Ju, Young-Tae,Jeong, Chi-Young,Park, Taejin The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.1

Purpose: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. Materials and Methods: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. Results: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). Conclusions: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.