Early experiences in robotic single-site plus one port platform for complex hepatobiliary and pancreatic surgery.

Background: Minimal invasive surgery in hepatobiliary and pancreatic (HBP) surgery has been accepted worldwide in recent years. However, applications of single-site laparoscopic surgery in complex HBP surgery have been limited due to difficulty in manoeuvring instruments and the limited range of motion resulting from clashing instruments.

Methods: To overcome the limitations, we have used the Da Vinci single-site surgical platform with one additional port in a Da Vinci Xi system to perform donor right hepatectomy, pancreaticoduodenectomy, and combined resection of the common bile duct and spleen vessels preserving distal pancreatectomy.

Prevention and management of intraoperative complication during single incision laparoscopic totally extraperitoneal repair.

Serious complications related to hernia surgeries have rarely been reported. One meta-analysis comparing laparoscopic and open mesh repair reported that 0.4% of potentially serious operative complications were reported.

Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique.

Background: Although laparoscopic minor liver resections (LLR) of posterosuperior (PS) segments are technically challenging, several expert centers are increasingly performing this procedure. In the present study, we introduced novel techniques, including the rubber band traction method and positional changes, and compared surgical outcomes of LLR for hepatocellular carcinoma (HCC) located in PS segments with open minor liver resection (OLR).

Methods: From January 2008 to August 2019, 113 patients underwent laparoscopic (n = 55) or open (n = 58) minor liver resections for single small HCCs (<5 cm) located in PS segments.

Role of postoperative adjuvant therapy in resected invasive intraductal papillary mucinous neoplasm of the pancreas: A multicenter external validation.

Background: Adjuvant therapy is beneficial in prolonging survival in patients with pancreatic ductal adenocarcinoma (PDAC). However, no clear guidelines are available on the oncologic effect of adjuvant therapy in resected invasive intraductal papillary mucinous neoplasms (inv-IPMN).

Methods: In total, 551 patients with PDAC and 67 patients with inv-IPMN of the pancreas were reviewed.

Outcomes of open versus single-incision laparoscopic totally extraperitoneal inguinal hernia repair using propensity score matching: A single institution experience.

Purpose: The aim of the current study was to compare the outcomes between open and single-incision laparoscopic totally extraperitoneal (SILTEP) inguinal hernia repair.

Methods: To compare the outcomes between the open and SILTEP groups, we performed propensity score matching to adjust for significant differences in patient characteristics. The outcomes were compared between the matched groups.

Laparoscopic pancreaticoduodenectomy reduces incidence of clinically relevant postoperative pancreatic fistula in soft pancreas with a smaller than 2 mm pancreatic duct.

Background: Soft pancreas with small pancreatic duct is a known risk factor for postoperative pancreatic fistula (POPF). This study demonstrated the safety and feasibility of laparoscopic duct-to-mucosa pancreaticojejunostomy (PJ) and compared perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with soft pancreas and small pancreatic duct.

Methods: From January 2014 to December 2019, 183 patients underwent LPD and 91 patients underwent OPD by a single surgeon.

Oncologic Outcomes of Extended Lymphadenectomy without Liver Resection for T1/T2 Gallbladder Cancer.

Purpose: This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladder cancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissection without liver resection in T1/T2 GBC.

Materials And Methods: From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeon at Severance Hospital.

Robotic Single-Site Plus One Port: Pancreas Enucleation.

Purpose: Laparoscopic approaches to enucleation of the pancreas have been frequently described. Here we present a case of robotic single-site plus one port pancreas enucleation. To our knowledge, this enucleation surgical technique is the first to be reported in the medical literature.

Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer.

Background: Immunologic factors such as neutrophil-lymphocyte ratio and platelet-lymphocyte ratio play an important role in predicting the oncologic outcome of patients in pancreatic ductal adenocarcinoma (PDAC). It is hypothesized that host immunity represented by total lymphocyte count at diagnostic stage would influence oncologic outcome in left-sided PDAC.

Methods: Between January 1992 and August 2017, total of 112 patients who underwent distal pancreatectomy for left-sided PDAC were included and analysed.

Rates of Serious Complications Estimated by the ACS-NSQIP Surgical Risk Calculator in Predicting Oncologic Outcomes of Patients Treated with Pancreaticoduodenectomy for Pancreatic Head Cancer.

Background: The purpose of this study was to validate the predictive value of the oncologic outcome in addition to the validation of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in patients treated with pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) for pancreatic head cancer.

Methods: From June 2005 to December 2014, 199 patients underwent PD or PPPD for pancreatic head cancer. Medical records were retrospectively reviewed for investigating general patient characteristics and any comorbid diseases.

Downstaging with Localized Concurrent Chemoradiotherapy Can Identify Optimal Surgical Candidates in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus.

Background: Locally advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) has a poor oncological outcome. This study evaluated the oncological outcomes and prognostic factors of surgical resection after downstaging with localized concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC).

Methods: From 2005 to 2014, 354 patients with locally advanced HCC underwent CCRT followed by HAIC.

Suppression of PROX1-mediated TERT expression in hepatitis B viral hepatocellular carcinoma.

Somatic mutations in the telomerase reverse transcriptase (TERT) promoter are related to telomerase activation and frequently occur at two hot spots located at -124 and -146 bp relative to the start codon in various cancers. Here, we investigated the occurrence and implications of genetic alterations in the TERT promoter in hepatitis B viral hepatocellular carcinoma (B viral HCC). TERT promoter mutations, especially -124C>T, clearly enhanced transcriptional activity in HCC cell lines.

Oncologic outcomes after radical surgery for periampullary cancer in octogenarians.

Backgrounds/aims: Interest in treatments for elderly patients has increased with life expectancy, and various studies have reported on the safety and feasibility of radical surgery in elderly patients with cancer. Here, we investigated oncologic outcomes of periampullary cancer in octogenarians.

Methods: We retrospectively reviewed medical records of 68 patients over 80 years of age who were diagnosed with periampullary cancer and were eligible for surgery; we analyzed overall survival (OS) and immediate postoperative complications and mortality.

Indocyanine Green Perfusion Imaging-Guided Laparoscopic Pancreaticoduodenectomy: Potential Application in Retroperitoneal Margin Dissection.

Background: During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD.

Role of common bile duct resection in T2 and T3 gallbladder cancer patients.

Backgrounds/aims: Routine bile duct resection as part of the typical oncological resection for patients with advanced gallbladder cancer remains controversial with regard to, ultimately, curative value. The aim of this study was to compare oncological outcomes for patients undergoing surgery for gallbladder cancer with or without bile duct resection.

Methods: We recruited, for the purpose of this study, all patients who underwent surgical resection for T2 and T3 gallbladder cancer at Severance hospital, Seoul, Korea, during the period January 2000 and December of 2011.

Yonsei criteria: a clinical reflection of stage I left-sided pancreatic cancer.

In this study, we examined associations between pancreatic cancer that met the Yonsei criteria (YC) and classifications from the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. Clinicopathological and survival data were collected from132 patients who underwent distal pancreatectomy for left-sided pancreatic ductal adenocarcinoma between January 2000 and December 2015, and the utility of the YC for selecting treatment and predicting survival was evaluated using the 8th AJCC staging manual. Of the 102 patients who ultimately qualified for the study, 45 patients were reclassified as stage I based on the 8th AJCC cancer staging system.

Robotic hepatectomy: the Korean experience and perspective.

Since the robotic surgical system was first introduced in 2005, the number of robotic surgery has been gradually increasing in Korea. The proportion of general robotic surgery is relatively higher compared to the western countries, but robotic liver resection is one of the most complex procedures among robotic general surgery. In this article, we introduce the development of robotic liver resection in Korea and describe our standardized techniques.

Robotic Cholecystectomy Using the Newly Developed Korean Robotic Surgical System, Revo-i: A Preclinical Experiment in a Porcine Model.

One Korean company recently successfully produced a robotic surgical system prototype called Revo-i (MSR-5000). We, therefore, conducted a preclinical study for robotic cholecystectomy using Revo-i, and this is a report of the first case of robotic cholecystectomy performed using the Revo-i system in a preclinical porcine model. Revo-i consists of a surgeon console (MSRC-5000), operation cart (MSRO-5000) and vision cart (MSRV-5000), and a 40 kg-healthy female porcine was prepared for robotic cholecystectomy with general anesthesia.

Clinically determined type of 18F-fluoro-2-deoxyglucose uptake as an alternative prognostic marker in resectable pancreatic cancer.

Purpose: To investigate the association between clinical PET (positron emission tomography) type and oncologic outcome in resectable pancreatic cancer.

Methods: Between January 2008 and October 2012, patients who underwent potentially curative resection for resectable pancreatic ductal adenocarcinoma without neoadjuvant treatment were retrospectively investigated. Clinical PET type was defined as follows: pancreatic cancer with similar 18FDG uptake to renal calyx was determined as kidney-type (K-type), and relatively lower 18FDG uptake than that of renal calyx was regarded as Non-K type.

Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer.

Aim: To investigate the association between postoperative pain control and oncologic outcomes in resected pancreatic ductal adenocarcinoma (PDAC).

Methods: From January 2009 to December 2014, 221 patients were diagnosed with PDAC and underwent resection with curative intent. Retrospective review of the patients was performed based on electronic medical records system.

Are Adipose-Derived Stem Cells From Liver Falciform Ligaments Another Possible Source of Mesenchymal Stem Cells?

Falciform ligaments in the liver are surrounded by adipose tissue. We investigated the capability of adipose-derived stem cells from human liver falciform ligaments (hLF-ADSCs) to differentiate into hepatic-type cells and confirmed the functional capacity of the cells. Mesenchymal stem cells (MSCs) were isolated from the liver falciform ligament and abdominal subcutaneous adipose tissue in patients undergoing partial hepatectomy for liver disease.

Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection: A Three-Center Experience with 39 Patients.

Background: Stomach cancer is the second most commonly diagnosed cancer in Korea. Although the long-term survival outcome has improved, secondary primary tumors from periampullary regions are increasing inevitably and pancreaticoduodenectomy (PD) following gastrectomy is challenging. This study evaluates the surgical outcomes of PD following gastrectomy and suggests the optimum method for reconstruction.