In Taik Chang

Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments

Purpose To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). Methods Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. Results Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). Conclusion The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments.

Clinical factors for distinguishing perforated from nonperforated appendicitis: a comparison using multidetector computed tomography in 528 laparoscopic appendectomies.

The accurate and early diagnosis of perforated appendicitis (PA) is important when a surgeon is making decisions with regard to time and method of operation that are critical in reducing morbidity and mortality. A total of 528 laparoscopic appendectomies were investigated with the review of data. Clinical factors for identifying PA and a comparison using computed tomography (CT) (prominent role in detection of appendicitis despite of its high cost) were done. Among the clinical factors, total duration of the symptoms before admission (cutoff value: 24.51 h, sensitivity/specificity 0.51/0.65) and highly selective C-reactive protein levels (cutoff value: 9.52 mg/L, sensitivity/specificity 0.80/0.69) had significance on PA (P=0.001) compared with the performance of CT (sensitivity/specificity 0.28/0.99). The total duration of the symptoms before admission and highly selective C-reactive protein levels were respectable predictors of PA compared with those when using CT, showing that it could be another diagnostic tool for identifying PA.

Laparoscopic Approach to a Case of Appendicular Schwannoma

Appendicular schwannoma is a rare tumor originating from Schwanns cells in the Auerbach plexus. The preoperative diagnosis is difficult because the clinical features are nonspecific, and it is mostly found accidentally via a radiologic image as a tumor, mimicking malignancy. We report a case of an appendicular schwannoma coexisting with an adenocarcinoma in the lung. A laparoscopic appendectomy was done with a clear resection margin, and the immunohistochemical staining showed positive S-100 protein, which confirmed the schwannoma. The patient also underwent a left upper lobectomy of the lung. The patient has been free of recurrence for the 6 months since the operation. The laparoscopic approach could be available for treatment of an appendicular schwannoma, thus avoiding an unnecessary laparotomy.

Case of Small Bowel Perforation due to Enteropathy-Type T-Cell Lymphoma

Enteropathy-type T-cell lymphoma (ETTL) is a rare disease with a poor prognosis. According to the World Health Organization (WHO) classification, it is a subtype of the peripheral T-cell lymphomas. This disease is associated with gluten-sensitive enteropathy, has a high risk of intestinal perforation and obstruction, and is refractory to chemotherapeutic treatment. We report the case of a 73-year-old woman who was diagnosed with enteropathy-type T-cell lymphoma of the small intestine, which was positive for the markers of cytotoxic T cells, CD3, CD8, and CD56, on immunohistochemical staining after resection of the perforated terminal ileum.