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RISS 인기검색어
- 검색키워드
- 저자 : ( Lip Seng Lee ) (검색결과 4 건)
- 무료
- 기관 내 무료
- 유료
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Techniques of Laparoscopic Trans-Choledochal Common Bile Duct Exploration and Its Complications
( Paramasivam Sivamayuran ),( Lip Seng Lee ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Laparoscopic common bile duct exploration (LCBDE) has been proven to be a technically demanding but cost-effective option for the management of common bile duct (CBD) stones. It can be performed trans-cystically for stones that are small (< 6mm) or trans-choledochally for bigger stones ( >10mm). Laparoscopic trans-choledochal CBD exploration requires more technical skills and it is also associated with specific complica tions e.g. bile duct stricture, bile leak and rarely injury to the posterior wall of CBD or injury to portal vein Methods: In Changi General Hospital, CBD exploration for CBD stones is usually reserved for stones failed to be removed via endoscopic retrograde cholangiopancreatography (ERCP) or stones identified on intraoperative cholangiogram (IOC). The patients who had laparoscopic trans-choledochal CBD explora tion were retrospectively reviewed. The techniques and compli cations of trans-choledochal LCBDE were described. Results: We identified 2 cases with complications. First one had bile leak from the choledochotomy site, requiring to undergo ERCP and stenting postoperatively. The second one had a very rare posterior CBD wall injury during choledochotomy, which was converted to open biliary bypass. Conclusions: Laparoscopic trans-choledochal CBD exploration is technically demanding. Care should be taken during cho ledochotmy. This technique should be reserved for cases with dilated CBD.
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A Review of the Techniques, Current Status and Learning Curves of Laparoscopic Bile Duct Exploration
Poh Benjamin Ruimin,Tan Siong San,Lee Lip Seng,Chiow Adrian Kah Heng Korean Society of Gastrointestinal Cancer 2017 Journal of digestive cancer reports Vol.5 No.1
Laparoscopic cholecystectomy is of one the most common general surgical operations performed today. Concomitant choledocholithiasis occurs in roughly 10-20% of patients with symptomatic gallstones. Laparoscopic bile duct exploration (LBDE) offers a single-stage minimally-invasive solution to the management of choledocholithiasis. LBDE may be performed either via the transcystic route or via laparoscopic choledochotomy. A number of strategies to improve success are available to the surgeon to help in the problem of complicated choledocholithiasis, these range from simple maneuvers to the use of laser or mechanical lithotriptors. With the advances in laparoscopic surgery, it is also possible to handle complex surgical conditions such as Mirizzi syndrome or recurrent pyogenic cholangitis laparoscopically, even though these have yet to be accepted as standard of care. Following laparoscopic choledochotomy, options for closure include: primary closure, closure over a T-tube, and closure over an endobiliary stent. T-tube placement has been associated with increased operating time and hospital length of stay compared to primary closure, with no significant differences in morbidity. Based on the available literature, LBDE appears comparable to ERCP with regards to procedural efficacy and morbidity. LBDE remains relevant to the general surgeon and is best viewed as being complementary to endoscopic therapy in the management of choledocholithiasis.
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Low-cost model for pancreatojejunostomy simulation in minimally invasive pancreatoduodenectomy
Hiang Jin Tan,Adrian Kah Heng Chiow,Lip Seng Lee,Suyue Liao,Ying Feng,Nita Thiruchelvam 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.4
Minimally invasive pancreatoduodenectomy (MIS PD) is a well reported technique with several advantages over conventional open pancreatoduodenectomy. In comparison to distal pancreatectomy, the adoption of MIS PD has been slow due to the technical challenges involved, particularly in the reconstruction phase of the pancreatojejunostomy (PJ) anastomosis. Hence, we introduce a lowcost model for PJ anastomosis simulation in MIS PD. We fashioned a model of a cut pancreas and limb of jejunum using economical and easily accessible materials comprising felt fabric and the modelling compound, Play-Doh. Surgeons can practice MIS PJ suturing using this model to help mount their individual learning curve for PJ creation. Our video demonstrates that this model can be utilized in simulation practice mimicking steps during live surgery. Our model is a cost-effective and easily replicable tool for surgeons looking to simulate MIS PJ creation in preparation for MIS PD.
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