g-Soo Chun

Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery.

BACKGROUND The need for an initial learning experience in laparoscopic colorectal cancer surgery has been well established. However, the inherent differences in the complexity and results of laparoscopic rectal cancer surgery, as compared to colon surgery, warrant a study to analyze the learning curve exclusively for rectal cancer resections. MATERIALS AND METHODS four hundred thirty-one patients operated on between April 1994 and March 2006 were analyzed retrospectively for changes in surgical outcomes according to case sequence. A multidimensional analysis was done, based on the following parameters: conversion to laparotomy, intraoperative complications, postoperative complications, reoperations, operative time, and transfusion volumes. Multiple statistical methods were used for evaluation of the learning curve, which included the cumulative sum (CUSUM) method, risk-adjusted CUSUM, moving average method, and analysis of variance (ANOVA). RESULTS The risk factors for conversion were prior abdominal surgery (hazard ratio, 2.52; 95% CI, 1.04-6.10; P = 0.04) and tumor size > or =3.5 cm (hazard ratio, 5.05; 95% CI, 1.95-13.08; P = 0.001). Risk-adjusted CUSUM analysis showed that case 61 was the peak change point for conversion. Postoperative complications occurred in 56 patients (13.0%), and the rate was associated significantly with case sequence (P < 0.001). The turning point in the CUSUM model occurred at case 79, and the complication rates decreased thereafter. Operative time and intraoperative transfusion volumes stabilized over cases 61-75 and declined thereafter. CONCLUSIONS Multidimensional analysis considering various surgical outcomes is necessary to evaluate the learning curve for laparoscopic rectal cancer surgery. The effective surgical learning curve was approximately 60-80 procedures in this series.

Intravascular Papillary Endothelial Hyperplasia (Masson's Hemangioma) of the Liver: A New Hepatic Lesion

Intravascular papillary endothelial hyperplasia (Massons hemangioma) is a disease characterized by exuberant endothelial proliferation within the lumen of medium-sized veins. In 1923, Masson regarded this disease as a neoplasm inducing endothelial proliferation, however, now it is considered to be a reactive vascular proliferation following traumatic vascular stasis. The lesion has a propensity to occur in the head, neck, fingers, and trunk. Occurrence within the abdominal cavity is known to be very rare, and especially in the liver, there has been no reported case up to date. The authors have experienced intravascular papillary endothelial hyperplasia of the liver in a 69-yr-old woman, and report the case with a review of the literature.

Learning Curves in Laparoscopic Right-Sided Colon Cancer Surgery: A Comparison of First-Generation Colorectal Surgeon to Advance Laparoscopically Trained Surgeon

BACKGROUND We aimed to evaluate the learning curve (LC) for laparoscopic right-sided colon cancer surgery (LRCCS) by comparing the results between two surgeons (first-generation colorectal surgeon versus laparoscopically trained surgeon). METHODS The study was a retrospective analysis that evaluated 117 consecutive LRCCSs performed by two surgeons, the first-generation surgeon (Surgeon A) and laparoscopically trained surgeon (Surgeon B), from April 1995 to August 2006. Patients were divided into two groups; patients included in groups I and II received LRCCSs from surgeons A and B, respectively. RESULTS The moving average method revealed that the operation times of surgeons A and B began to shorten after the 9th case. The cumulative sum (CUSUM) analysis of group I data showed that the 24th case was the peak point of conversion. The 35th case was the peak for intraoperative complications, and the 17th case was the peak for postoperative complications. There was only one case of conversion in group II. The peak points for inadequate lymph node dissection were the 37th case in group I and the 8th case in group II. The CUSUM analysis for surgeons A and B showed that the 18th case and the 8th case, respectively, were the overall peak points in the failure of LRCCS. CONCLUSIONS We suggest that careful observation of a laparoscopic procedure, such as acting as the scope operator for a certain amount of time, may help in shortening the LC of the actual procedure.

Impact of laparoscopic surgery on the long-term outcomes for patients with rectal cancer

Background:  This 20‐year retrospective study compared the results of laparoscopic surgery with open surgery for patients with rectal cancer to evaluate the impact of laparoscopic surgery on long‐term oncological outcomes for rectal cancer.

Laparoscopic splenectomy: 3 ports are enough.

With advanced technologies and accumulating experience, a new consensus concerning the least invasive laparoscopic splenectomy should be addressed. We retrospectively analyzed 41 consecutive patients who underwent laparoscopic splenectomy from 1994 to 2007. We divided our patients into 3 groups according to the number of trocars used: group 1 (n=11, 5 trocars), group 2 (n=21, 4 trocars), and group 3 (n=9, 3 trocars). In each group, postural change was made for the operation: supine for group 1, semilateral for group 2, and true lateral for group 3. Except for the shorter operation time for group 3 compared with group 1 and group 2 (P<0.001), there were no differences in perioperative parameters. Considering the least invasive nature of laparoscopic operations, 3-port splenectomy seems to be very promising in this context. Additionally, proper modification of patients posture is an essential part of the least invasive ever 3-port laparoscopic splenectomy.

The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study

BackgroundThis retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer.MethodsFrom April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve.ResultsWhen groups I and II, and groups II and III were compared, overall survival (OS) did not differ significantly whereas disease-free survival (DFS) in groups I and III were statistically higher than in group II (P = 0.042 and P = 0.050). In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P = 0.2036) and DFS ( P = 0.2356) than open surgery. Also, the incidence of local recurrence in group III (2.6%) was significantly lower than that in groups II (7.4%) and I (12.1%) ( P = 0.013).ConclusionsInstitutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.