Kwok-Kay Yau

Immediate preoperative laparoscopic staging for squamous cell carcinoma of the esophagus

BackgroundConventional preoperative staging for esophageal carcinoma could be inaccurate. Laparoscopy has been applied for the staging of various upper gastrointestinal malignancies. It can identify peritoneal and liver deposits not shown by imaging, and could reduce the number of nontherapeutic laparotomies. This study aimed to evaluate the efficacy of laparoscopic staging for the management of squamous cell carcinoma involving the mid and distal esophagus.MethodsA retrospective review was performed for all patients with esophageal cancer evaluated for surgical resection from January 1998 to January 2004. Laparoscopy was performed for all the patients with mid and distal esophageal cancer immediately before open gastric mobilization. The efficacy of laparoscopy for the management of squamous cell carcinoma of the esophagus was evaluated.ResultsAmong the 63 patients with potentially resectable disease shown on conventional imaging, 54 (84%) underwent esophagectomy with curative intent after laparoscopic staging. Seven patients (11%) underwent laparoscopy alone because of abdominal metastases (n = 5) or other medical conditions (n = 2) that precluded esophagectomy. Two patients (3%) had exploratory right thoracotomy without esophagectomy despite normal laparoscopic findings. The sensitivity and specificity of laparoscopic staging were 100% in this series of patients (100% sensitivity and specificity means no false-positives or -negatives).ConclusionLaparoscopic staging is valuable for the management of patients with mid and distal squamous cell carcinoma of the esophagus. Patients with metastatic disease and those with prohibitive surgical risk can thus avoid unnecessary laparotomy and be offered other treatment methods.

Laparoscopic sphincter-preserving total mesorectal excision: 10-year report

Aim  Total mesorectal excision (TME) is currently the gold standard for resection of mid or low rectal cancer and is associated with a low local recurrence rate. However, few studies have reported the long‐term oncological outcome following use of a laparoscopic approach. The aim of this study was to evaluate the long‐term oncological outcome after laparoscopic sphincter‐preserving TME with a median follow up of about 4 years.

Endo-Lap OR: an innovative "minimally invasive operating room" design.

BackgroundA newly constructed Endoscopic-Laparoscopic operating room (Endo-Lap OR) started to operate in our department in January 2005. A prospective study was conducted to evaluate its feasibility, efficacy, and safety, as well as the staff’s satisfaction.Patients and methodsFrom January 2005 to September 2005, all patients undergoing operation in this Endo-Lap OR were included in the study. The patient’s diagnosis, types of operating procedures, incidents of operating failure (either due to the hardware or the software of Endo-Lap OR) that led to a delay in the patient’s transfer or that extended the total operating time were recorded. In addition, questionnaires regarding staff satisfaction with the new operating room were distributed to nurses, anesthetists, and surgeons.ResultsA total of 640 cases were included in the study period, 245 cases of open surgery, 282 cases of laparoscopic surgery, 82 cases of endoscopic surgery, 17 cases of video-assisted thoracoscopic surgery, and 14 cases of combined endoscopic-laparoscopic surgery. There were no reported incidents of operating failure related to hardware or software problems. The overall staff satisfaction was excellent.ConclusionsThe integration of endoscopic and laparoscopic surgery into this newly constructed Endo-Lap OR is feasible and safe. The running of the operating room was smooth and it received a high level of acceptance and satisfaction from different staff members.

A man with recurrent lower abdominal pain: Spigelian hernia.

Recurrent abdominal pain due to spigelian hernia (SH) is rare and notoriously difficult to diagnose. This is particularly true when patient present with pain only without visible or palpable mass. Ultrasonic scanning and computed tomography is valuable in diagnosing this rare condition. However, for a small hernia with its content reduced spontaneously during examination, even computed tomography will miss the diagnosis. In the era of laparoscopic surgery, the role of laparoscopy in the management of recurrent abdominal pain of unknown origin has become more and more important. It is especially true in the management of SH as it is both diagnostic and therapeutic. We report a case of SH presented as recurrent lower abdominal pain of unknown origin and its successful diagnosis and treatment by laparoscopic approach.

Outcomes of endoluminal stenting for distal colorectal cancer: An institutional experience

Aim:  The present article aims to review the results of the use of the self‐expanding metallic stent (SEMS) in our institution for distal colorectal tumours, defined as tumours distal to the splenic flexure.

Unusual Cause of Acute Abdomen—Ruptured Retroperitoneal Paraganglioma

Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

Simultaneous laparoscopic abdominal and transanal excision for low rectal tumours

Aim:  In performing laparoscopic sphincter‐preserving total mesorectal excision, one of the technical challenges is to obtain an adequate distal mural margin of 2 cm in the case of low rectal tumours. Herein we describe a technique, known as simultaneous laparoscopic abdominal and transanal excision, where an adequate distal margin can be safely achieved at the beginning of the operation.

Minimally invasive operating suite in the 21st century: Endo‐Lap operating room

Although a number of innovative and futuristic operating room (OR) designs have been proposed, the challenge to implement the OR of the future has never been fulfilled. We believe the setting of future OR should be an integration of the entire spectrum of surgical care: from diagnostic to preoperative planning, and from intraoperative navigation to education. Besides overcoming the deficiencies of today’s OR, it should also create a platform that allows easy inclusion of upcoming innovation. The opening of the brand new, innovative operating room in the Pamela Youde Nethersole Eastern Hospital, the Endo‐Lap OR, is considered a benchmark in the territory. As minimally invasive surgery continues to flourish, we believe the concept and vision behind this Endo‐Lap OR will help to shed light on the future development of OR.

Robotic thyroidectomy using the bilateral axillo‐breast approach

Thyroidectomy is one of the common surgical operations performed in Hong Kong. The use of an endoscopic approach provides an alternative to traditional open surgery, which is widely practice in South–East Asian countries. The cosmetic outcome is excellent. Since the use of the robotic da Vinci system for thyroidectomy in 2008 in Korea, it provides a stable alternative for endoscopic thyroidectomy. We hereby present one case of robotic right hemithyroidectomy using the bilateral axillo-breast approach (BABA).

Transumbilical single incision laparoscopic appendicectomy: Tips and tricks

Single incision/port laparoscopic surgery has become one of the hot topics in the local surgical community. However, the operation involves a distinct surgical technique that is completely different from conventional laparoscopic procedure. Herein, we report a case of complicated appendicitis that was operated on by the transumbilical single incision laparoscopic approach in order to show the tips and tricks in carrying out single incision/port laparoscopic surgery. A 24-year-old woman was admitted for a 1-day history of epigastric pain and vomiting. The pain shifted to the right lower quadrant after admission. On examination, the patient was feverish with local peritonism in the right lower quadrant of her abdomen. Blood tests, including a complete blood picture, liver and renal function tests, were normal. A pregnancy test was negative. The clinical picture was compatible with the diagnosis of acute appendicitis. Laparoscopic appendicectomy by transumbilical single incision approach was then decided and agreed by patient. The patient was operated on under general anaesthesia with prophylactic antibiotics given after induction. A urinary catheter was inserted and the patient was lying in the supine position. A transumbilical incision was made and the abdominal fascia extended to approximately 2 cm in length. A Single Incision Laparoscopic Surgery device (Tyco Healthcare Group LP, Norwalk, Connecticut USA) was inserted. Initially, three 5-mm working trocars were used and a 5-mm laparoscope with a flexible tip was used. The patient was then placed in the Trendelenberg position and turned to her left side in order to expose the ilecocaecal region. Suppurative, post-ileal appendicitis was found with pus collected in the pelvis. The pus was aspirated out first before further dissection to minimize spillage of pus to other parts of the abdomen. As the tip and body of the appendix was stuck down to the mesentery, a retrograde approach was decided. The mesoappendix was cauterized and divided by a 5-mm bipolar energy device (Ligasure, Tyco Healthcare Group LP, Boulder, USA). The appendix stump was then ligated with 2-0 vicryl by an extracorporeal knot. After division of the appendix at its base, the appendix was then separated from adhesions by blunt and sharp dissection. The appendix was taken out using a plastic bag to prevent wound contamination. The pelvis, operative field and finally the subphrenic spaces were carefully cleaned by warm saline irrigation and suction. The operative site was then mopped with a small gauze until clean and dry. The umbilicus was reconstructed with interrupted PDS-1 for the fascial layer and 3-0 nylon for the skin closure. The operation time was 45 min with minimal blood lost. The patient was able to be discharged from hospital 2 days after the operation with a full course of antibiotics. No oral or parental analgesic was required by the patient after the operation. The wound had healed nicely at 2 weeks with almost no visible scar. Histological examination of the appendix confirmed acute appendicitis with gangrenous mucosal changes.