S.P.Y. Kwok

Risk factors predicting the development of complications after foreign body ingestion

The aim of this study was to determine the predictive risk factors for complications resulting from foreign body ingestion.

Sentinel lymph node dissection in papillary thyroid carcinoma.

Background:  Occult lymph node (LN) metastasis is common in papillary thyroid carcinoma. Sentinel lymph node (SLN) biopsy has been proven to be successful and accurate to predict the nodal status in melanoma and breast cancer. We investigate the use of SLN in papillary thyroid carcinoma.

Endoscopic management of submandibular sialolithiasis

BACKGROUND Transoral removal and sialoadenectomy are the two main modalities of treatment for submandibular stones. However, missed ductal stones are not uncommon, and there is a risk of lingual or hypoglossal nerve injury. We attempted to avoid these complications by using an endoscopic technique. METHODS The case notes of the patients who had undergone endoscopic removal of submandibular stones were studied retrospectively. The procedure was performed under general anesthesia. The submandibular orifice was incised by carbon dioxide laser, and a 3.1-mm rigid scope was inserted under direct vision with normal saline irrigation after dilatation. The stones were either broken down by laser or removed with a Dormia basket or forceps. RESULTS A total of 13 patients underwent the procedure. The duration of median follow-up was 15 months. In 11 patients, the stones were identified and removed. No stone was found in two patients (15.4%). There were no false negatives, since no stones were discovered subsequently in these two patients. One, two, three, and four stones were present inside the ducts in seven patients (54.6%), one patient (7.7%), two patients (15.4%), and one patient (7.7%), respectively. The symptoms subsided completely in 11 patients within 4 weeks after the procedure. Persistent swelling occurred in two patients. In one of them, no residual stone was revealed by CT scan. The other patient had a large calculus that was only partially fragmented by laser lithotripsy at the initial operation. No lingual nerve or hypoglossal nerve injury was detected in any patient. CONCLUSION Sialoendoscopy is a safe and efficacious treatment for submandibular ductal stones. It reduces the incidence of missed stones, and nerve injury, as well as the need for sialoadenectomy.

How useful is colonoscopy in locating colorectal lesions

AbstractBackground: It is important to establish the precise location of a colorectal lesion preoperatively. We used a model based on colorectal cancer to assess the efficacy of colonoscopy in locating these lesions. Methods: We retrospectively analyzed all consecutive new colorectal cancer cases at the Department of Surgery, United Christian Hospital, Hong Kong, in 1995. Results: Of the 123 cases reviewed by us, 84 cases satisfied the analysis criteria. The overall accuracy was 81%. It was especially high in the rectosigmoid region (93%) and descending colon (100%). The overall predictive power was 83%. It was especially high in the right-sided colon (100%) and the rectosigmoid region (93%). Conclusions: We conclude that colonoscopy is an accurate means for locating lesions in the upper rectum and sigmoid colon. It is also very predictive of lesions in the upper rectum, sigmoid colon, and right-sided colon.

Acupuncture anaesthesia in inguinal hernia repair

Background:  The present study was undertaken to evaluate the efficacy of acupuncture anaesthesia in inguinal hernia repair.

Ports, don't slip out!

The laparoscopic approach is now a standard alternative option in abdominal surgery. By using different types and sizes of operating ports, various laparoscopic instruments can be manipulated with ease inside the abdomen. Nevertheless, the frequent slipping of the operative ports from the abdominal wall while instruments are moved in and out the ports can cause lots of frustration. Once the port is out, pneumoperitoneum is lost, and the whole process must be reestablished to regain a view. This is time-consuming and potentially catastrophic when the forceps is holding an important structure or when profuse bleeding is encountered. There are commercially available “port grippers” to anchor the ports in the abdominal wall by a screw design. Such grippers require two hands to adjust the length of the shaft of the port inside the abdomen and are cumbersome if frequent adjustments are necessary during the course of an operation. We have found a simple, easy, and inexpensive way of anchoring the port to the abdominal wall. A strong suture (0 silk) is placed through-and-through the skin around the entry site after the port has been inserted into the abdomen. The port is then pulled back until just enough length is inside the operation field to maintain pneumoperitoneum. The suture is secured to the port by wrapping it around the insufflation tap (Fig. 1A). By doing this, the port can be pushed inside the abdomen but cannot be pulled out because of the holding suture (Fig. 1B). The surgeon can easily adjust the length of the port inside the abdomen with one hand. We found this simple technique very useful for maintaining the ports in a desirable position. It is particularly useful in operations requiring lateral positions (e.g., laparoscopic adrenalectomy, splenectomy) because of the tendency for the ports to slip out. We recommend using this inexpensive technique in every laparoscopic operation to secure the ports.