2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
stones, impacted stones or fibrin embedded stones.
Choledochoscopy was employed in all patients. Simple choledocholithiasis
cases that were resolved using trans-cystic duct
flushing, glucagon and passage of a catheter were excluded
from analysis.
Results: A total of 43 patients met study inclusion criterion.
Total bile duct clearance was achieved in 98% of these
patients. 9% of these LCBDE cases were completed via the cystic
duct and 91% using choledochotomy techniques. No cases
of pancreatitis resulted from LCBDE in this study.
Conclusion: LCBDE using the MIG, choledochoscope, stone
baskets and lithotripter is safe and effective. A 98% success
rate was achieved in this series of patients. Trans-cystic duct
techniques and choledochotomy techniques are complementary,
and laparoscopic biliary tract surgeons need to be familiar
with both of these procedural methodologies. Urologic surgery
has developed effective methods to deal with ureteral
stones that can be adapted for cases of choledocholithiasis
with great efficacy. The necessary instrumentation for LCBDE
is available, relatively inexpensive, and can be cross utilized
with urologic surgery.
P215–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC ANATOMICAL LIVER RESECTION IN A PADI-
ATRIC PATIENT WITH BENIGN CYSTIC LESION, Ho-Seong Han
MD, Yoo-Seok Yoon MD, Yoo Shin Choi MD,Sang Il Lee
MD,Jin-Young Jang MD,Sun-Whe Kim MD,Yong-Hyun Park
MD, Department of Surgery, Seoul National University College
of Medicine, Seoul, Korea
Introduction: Despite recently increasing numbers of reports
on laparoscopic liver resection, cases performed in pediatrics
have been rarely documented. We report on a totally laparoscopic
left lateral sectionectomy in a pediatric patient with
benign cystic lesion. To our knowledge, this is the first reported
case of laparoscopic anatomical liver resection in a pediatric
patient.
Methods and Procedures: A 5-year-old girl presented with a 1-
month history of right upper quadrant pain. Abdominal CT
revealed a large (10 x 10 cm), multi-septated cystic tumor presumed
to originate from the liver. At the inspection via laparoscope,
an exophytic tumor originating from the left lateral section
was identified, and so a totally laparoscopic left lateral
sectionectomy was performed. Three 10 mm and one 12 mm
trocars were placed, and a 30¡Æ laparoscope was used.
Intraabdominal pressure was maintained below 10 mmHg.
After complete mobilization of the left lateral section by dissection
of the falciform and triangular ligaments, the liver
parenchyma was superficially dissected with Harmonic scalpel.
Then the Glisson¡¯s pedicles to the lateral section and left
hepatic vein with the overlying remnant liver parenchyma
were completely divided using two Endo-vascular GIAs. The
specimen was extracted through a small incision of about 4.5
cm, created by extending the epigastric port.
Results: The operative time was 150 minutes. The estimated
blood loss was about 100 cc, and no intraoperative transfusion
was needed. The patient was discharged on postoperative day
11 without postoperative complications. Postoperative pathology
confirmed a mesenchyal hamartoma of the liver with a
free resection margin.
Conclusion: This case shows that laparoscopic liver resection
can be a safe and feasible operative procedure in the pediatric
patient with liver disease. Thus we believe that laparoscopic
liver resection can be a promising surgical technique in selected
pediatric patients.
P216–Hepatobiliary/Pancreatic
Surgery
THE USEFULNESS OF CUSA DURING LAPAROSCOPIC LIVER
RESECTION, Yoo-Seok Yoon MD, Ho-Seong Han MD,Yoo Shin
Choi MD,Sang Il Lee MD,Jin-Young Jang MD,Sun-Whe Kim
MD,Yong-Hyun Park MD, Departement of Surgery, Seoul
National University College of Medicine, Seoul, Korea
Introduction: The major problem of laparoscopic liver resection
is bleeding during liver parenchymal transection, which is
182 http://www.sages.org/
difficult to control laparoscopically and may increase postoperative
complications. Although Harmonic scalpel, Ligasure, and
endo-vascular GIA etc are being widely employed in parenchymal
dissection, these have a possibility of incomplete vascular
control due to somewhat blind application. We experienced
reduced intraoperative blood loss after adoption of CUSA
(Cavitron Ultrasonic Surgical Aspirator). In this study, we evaluated
the usefulness of CUSA in laparoscopic liver resection
by analyzing our experiences.
Methods and Procedures: Between May 2003 and August
2004, a total of 21 cases of laparoscopic liver resection (11 left
lateral sectionectomy, 5 left hepatectomy, 4 tumorectomy, 1
right posterior sectionectomy) were performed by one surgeon
(Dr. Han HS). Of total cases, we selected the cases of leftsided
liver resections (left: 5 cases, left lateral: 11 cases) and
compared the clinical results between 10 cases before use of
CUSA (Harmonica scalpel or Ligasure was used) (group A) and
6 cases after use of CUSA (group B) for of total cases.
Results: The patients comprised 8 men and 8 women, ranging
from 5 to 74 years with a mean age of 55.9 years. Indications
for this procedure included 10 cases of localized IHD stones
and 6 cases of tumor (3 benign tumor, 3 hepatocellular carcinoma).
No significant differences between two groups were
observed in sex, age, and indications between two groups.
Group B showed improved results compared to group A in
operation time (group A vs. group B: 382.3¡_175.4 vs.
250.0¡_87.5 minutes), blood transfusion amount (2.1¡_2.9 vs. 0
units), postoperative hospital stay (15.8¡_6.6 vs. 9.3¡_3.3 days),
postoperative complications (30% vs. 0%), although statistical
analysis was not done due to a small number of cases. Three
cases of postoperative complications (sepsis, biliary fistula,
intraabdominal fluid collection) were present in group A, and
postoperative mortality occurred in one patient due to sepsis.
However, there was no postoperative complication and mortality
in group B.
Conclusions: Our experiences, although limited, indicate that
CUSA enables more precise resection of the liver parenchyma
in a dry field, and eventually can lead to reduction of blood
loss, shorter operator time, and decreased postoperative complications.
P217–Hepatobiliary/Pancreatic
Surgery
CLINICAL OUTCOMES AFTER LAPAROSCOPIC CBD EXPLO-
RATION, Yoo-Seok Yoon MD, Ho-Seong Han MD,Seog Ki Min*
MD,Hyeon-Kook Lee* MD,Yoo Shin Choi MD,Sang Il Lee
MD,Jin-Young Jang MD,Sun-Whe Kim MD,Yong-Hyun Park
BA, *Department of Surgery, Ewha Women?s University
College of Medicine,
Introduction: Recently, one stage operation with laparoscopic
common bile duct exploration (LCBDE) is being widely used
for the treatment of CBD stone disease. The aim of this study
is to evaluate the long term-results of LCBDE.
Methods and Procedures: From March 1997 to February 2004,
a total of 110 cases of LCBDE for choledocholithiasis was performed
at Ewha Women University Mokdong Hospital and
Seoul National University Bundang Hospital. Excluding 19
cases with combined intrahepatic duct stones, 91 patients who
underwent the LCBDE for choledocholithiasis confined to CBD
were retrospectively analyzed by reviewing the medical
records.
Results: The patients were composed of 51 men (56%) and 40
women (44%), with a mean age of 67.4?2.7 years. Endoscopic
sphincterotomy (ES) was performed in 32 cases (35.2%) during
preoperative period. The mean operation time was 218?0 minutes,
and the open conversion rate was 2.2% (2 cases). The
mean postoperative hospital stay was 13.6?.7 days.
Postoperative complications occurred in 9 cases (11%), all of
which responded to the conservative medical management.
There was no postoperative mortality. Excluding 15 cases of
follow-up loss, recurred CBD stones were detected in 5 cases
(6.6%) after a mean follow up period of 35 months. Among the
recurred cases, 2 cases were treated with ES and lithotripsy,
and the remaining 3 cases were not managed due to asymptomatic
small stones.
Conclusions: LCBDE is a safe and effective method in clearing
of CBD stones.