Dev-Aur Chou

Comparison of robot-assisted laparoscopic adrenalectomy with traditional laparoscopic adrenalectomy - 1 year follow-up

BackgroundLaparoscopic adrenalectomy offers distinct benefits to patients and has now become the gold standard for the removal of adrenal lesions. Nonetheless, the procedure poses a challenge for surgeons in regards to the maneuverability of instruments, the two-dimensional operating field and the counterintuitive movements. This study reports our experience using the Zeus robotic surgical system in laparoscopic adrenalectomy compared with traditional laparoscopic adrenalectomy.Patients and MethodsFrom January 2003 to February 2005, a total of 12 patients were prospectively enrolled to receive robot-assisted laparoscopic adrenalectomy (RALA) or traditional laparoscopic adrenalectomy (TLA). The time necessary for robotic setup and operation was recorded, as well as complications, technical problems, postoperative hospital stay, morbidity, and mortality.ResultsFive RALA procedures and seven TLA were successfully completed. There was no significant difference between the groups in terms of age, body mass index, and tumor size. Resection times were longer in the RALA group (168.0 ± 30.7 min vs. 131.4 ± 29.0 min, p = 0.05). There were no perioperative complications. There was neither postoperative mortality nor morbidity at the time of discharge and during one year follow-up.ConclusionsRALA is as safe and technically feasible as TLA, It provides a real benefit for the surgeon with the three dimensional view, a comfortable sitting position, the elimination of the surgeon’s tremor, and increased degrees of freedom of the operative instruments compared with TLA. However, patient outcomes and operative costs should be evaluated further.

Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis

BackgroundA review of the literature pertaining to percutaneous transhepatic cholangioscopic lithotomy (PTCSL) showed that more than 50% of reported patients had undergone earlier biliary surgery.MethodsA retrospective study investigated 74 patients undergoing initial PTCSL for hepatolithiasis who had undergone no prior biliary surgery or manipulation. The patients were followed for 1 to 23 years after PTCSL for effective evaluation of the procedure outcome.ResultsComplete clearance of hepatolithiasis was achieved for 61 (82%) patients. The incomplete clearance rate was higher for patients with intrahepatic duct stricture (11/37 [30%] vs 2/37 [5%]; p < 0.05), although it showed no relation to the actual lobar distribution of hepatolithiasis (left: 7/41 [17%] vs right: 2/11 [18%] vs bilateral: 4/22 [18%]; p < 0.05). The recurrence rate for hepatolithiasis also was higher for patients with intrahepatic duct stricture (18/26 [69%] vs 13/35 [37%]; p < 0.05), but the recurrence rate showed no relation to the lobar distribution of hepatolithiasis (left: 18/34 [53%] vs right: 4/9 [44%] vs bilateral: 9/18 [50%] p > 0.05) or the presence of gallbladder stones (5/12 [42%] vs 26/49 [53%]; p > 0.05). Patients showing the coexistence of retained or recurrent hepatolithiasis demonstrated a higher incidence of recurrent cholangitis (57% [13/23] vs 14% [7/51]; p < 0.01) or cholangiocarcinoma (17% [4/23]) vs 0% [0/51]; p < 0.01).ConclusionsThe findings show that PTCSL is effective for treating primary hepatolithiasis, and that complete stone clearance is mandatory to diminish the sequelae of hepatolithiasis. Intrahepatic duct stricture was the main factor contributing to incomplete clearance and stone recurrence.

A False Negative Non-Morphine-Augmented Hepatobiliary Scan in a Patient with Empyematous Calculous Cholecystitis

False-negative results of hepatobiliary scans for the diagnosis of acute calculous cholecystitis are rare. We report a 60-year-old male case in which the diagnosis was suggested by typical clinical presentation (RUQ pain, fever and leukocytosis) and abdominal sonography (distension and mild thickened wall of the gallbladder with gallbladder stone), but a false negative (superscript 99m)Tc- DISIDA non-morphine-augmented hepatobiliary scan (visualization of the gall bladder since the 30(superscript th) mm imaging). The final diagnosis was empyematous calculous cholecystitis. This case report concludes that caution has to be taken in interpreting hepatobiliary scans, although the false-negative rate is very low.

Laparoscopic Common Bile Duct Exploration: Experience of 22 Patients

Laparoscopic common bile duct exploration (LCBDE) is gaining favor for the management of common bile duct stones. This study presents our laparoscopic approach in patients with common bile duct stones. Materials and Methods: Between January 2000 and December 2002, 69 patients with CBD stones were reviewed and collected information. Thirty-six patients (52%) of these 69 patients with CBD stones were managed by open exploration. LCBDE was attempted in 22 selected patients (32%) with stable hemodynamic states. The other 11 patients (16%) were managed by robot-assisted LCBDE. LCBDE was carried out with a choledochotomy and T-tube drainage. Results: We divided the 22 patients who had undergone LCBDE into two groups for analysis. In two cases (9%), the LCBDE was converted to open common bile duct exploration. The first 17 patients were assigned to group A, and the last 5 patients to group B. There were no operative mortalities, but 2 cases of complications (9%) in group A, and 1 case of retained stones (4.5%) in group B. One patient with recurrent stones underwent hepaticojejunostomy. Conclusions: LCBDE is not yet accepted as the standard procedure for choledocholithiasis, and we need more cases to fully evaluate the safety and feasibility of LCBDE for further trials and meta-analyses.