총담관으로의 클립 이동은 복강경 수술의 드문 합병증이다. 저자들은 4년 전 복강경 담낭절제술과 복강경 총담관탐색술을 동시에 받은 66세 남자에서 Hem-o-lok 클립 이동으로 인한 담관 결석 1예를 문헌고찰과 함께 보고하고자 한다. 상복부 통증을 주소로 내원한 환자의 복부 전산화단층촬영에서 담관의 확장과 다량의 담관 결석 및 담관을 침범한 이물질이 의심되었다. 내시경역행담췌관조영술을 하여 다량의 담관 결석과 함께 이물질을 제거하였다. 이물질의 정체는 Hem-o-lok clip이었다. 복강경 담낭절제술과 복강경 총담관탐색술을 받은 환자가 상복부 통증을 호소한다면, 드물지만, 클립 이동에 의한 담관 결석 가능성도 염두에 두어야 한다.

As a part of the effort to improve post-transfer survival rate of embryos in Korean black goats, a technique for laparoscopic uterine transfer of blastocysts was carried out. A total of 26 transferrable embryos (morula to expanded blastocysts) were transferred to 13 recipient goats via transabdominal laparoscopic method. In consequence of our hormone protocol, 65% of the recipients (13/20) were found to have synchronized estrus. After confirmation of corpus luteum in each recipient goat, a Babcock laparoscopic forceps was inserted into the lower abdominal cavity to hold a uterine horn and fasten it near the peritoneum without causing injury. Then 7.5cm long 16G IV catheter was inserted directly into the uterine lumen through the abdominal wall. After removal of the stylet of the IV catheter, the embryo transfer tube (identical in size to the stylet and loaded with blastocysts) was inserted into the uterine lumen through the catheter to unload the embryos. Of the 13 estrus synchronized recipients, 9 were transferred blastocysts and 4 were transferred molurae (2 embryos in each recipient) in uterine ipsilateral to the ovary with corpus luteum. Four of the 9 recipients which blastocysts were transferred using this method has been confirmed pregnant (44.4% pregnancy rate).

본 증례는 복강경 담낭절제술 후 10년이 경과되어 발생한 총담관 결석의 예로, 결석 내 포함된 외과용 클립이 담관결석의 원인이 되었을 것으로 추정된다. 내시경으로 제거한 총 담관결석 내에 외과용 클립이 발견되어 수술시 사용한 외과용 클립이 총담관 내로 이동하여 총담관 내 결석의 핵으로 작용했을 가능성을 뒷받침한다. 담낭 절제술 후 발생한 우상 복부 통증으로 내원한 환자에서 외과용 클립에 의한 총담관 결석은 진단에 있어 고려해야 할 부분으로 생각된다. 진단은 단순복부촬영에서 우상복부에 금속성 물질이 관찰된다면 의심할 수 있겠으나, 내시경적 담췌관조영술에서 총담관 내에 음영결손과 결석 내부에 금속성 물질이 관찰될 때 가능하다. 치료는 일반적인 총담관 결석의 치료와 동일하며, 내시경을 이용한 유두괄약근 절개술 후 바스켓 및 풍선 카테터를 이용한 결석 제거가 유용하다.

Laparoscopic ovum pick-up (LOPU) is a convenient method for collecting oocytes in small ruminants. LOPU has the advantage of being a less invasive means of oocyte collection, thereby allowing for a repeated usage of the oocyte donor animals. A total of 25 Korean black goats were used in the winter season (December to February) and LOPU was applied to the goats which had been treated for superovulation more than two times during the last twelve months. Estrus was synchronized with an intravaginal insert containing 0.3 g progesterone for 10 to 12 days. Ovaries were hyperstimulated with eCG 1,000 IU oneshot, FSH with eCG (50 mg / 1,000 IU; 70 mg / 500 IU; 70 mg / 1,000 IU) oneshot or FSH multiple-shot with eCG oneshot (20 mg × 6 / 300 IU) given intramuscularly 72 h prior to LOPU. For these groups, the number of follicles (mean ± SEM) observed which developed to larger than 2 mm in diameter were 1.6 ± 2.5, 4.3 ± 3.1, 5.5 ± 4.2, 6.6 ± 2.1 and 8.8 ± 7.8, respectively. Oocytes were aspirated by using OPU needles and a vacuum pump. The overall oocyte retrieval rates were 41.4%. Oocytes were matured in TCM-199 supplemented with 10% (w/v) bovine serum albumin + 10 μg/ml FSH + 1 μg/ml 17β-estradiol for 27 h at 39℃ in 5% CO2 in air. Oocytes were parthenogenetically activated by ionomycin combined with 6-diethylaminopurine (6- DMAP). Total oocyte maturation and cleavage rate were 67.3% and 78.8%, respectively. In summary, LOPU is a useful oocyte collection method in Korean black goats that can provide immature oocytes for transgenesis or nuclear transfer.

Four estrus-induced Himalayan tahrs (Hemitragus jemlahicus) were inseminated with frozen-thawed semen by laparoscopic or transcervical insemination techniques with no regard to the site of ovulation in non-breeding season. In June and July, 2009, estrus was synchronized by Eazi-Breed (Controlled internal drug release; Pfizer Animal Health, New Zealand) insertion for 16 days and PG 600 (PMSG 400IU, hCG 200 IU; Intervet, Netherlands) injection (IM) a day before removing . Forty eight hours later, laparoscopic or transcervical insemination was done to each of two tahrs under anesthetic condition inducted by ketamine (1.5 mg/kg) and medetomidine (0.09 mg/kg). For examination of estradiol and progesterone, blood was collected right before insertion, PG 600 injection, removal and insemination. Estradiol levels of four tahrs (No. 1, 2, 3, 4) before insertion and insemination were 13.3, 8.8, 14.3, 12 pg/ml and 23.5, 25.5, 21.1, 11.5 pg/ml, respectively. Progesterone levels of four tahrs (No. 1, 2, 3, 4) before insertion and insemination were 1.8, 0.05, 0.63, 0.61 ng/ml and 1.03, 0.37, 1.48, 2.12 ng/ml. Except for No. 4 tahr, cervices showed cervical mucus and opened enough to penetrate with embryo transfer gun sheet usually used for cows. Therefore, No.4 was laparoscopically inseminated together with No. 1. In conclusion, none of four Himalayan tahrs was pregnant. However, we proved that estrus could be induced by CIDR and PG 600 injection in non-breeding season, and laparoscopic or transcervical insemination with frozen-thawed semen could be one of assisted reproductive techniques in Himalayan Tahr.

Laparoscopy is frequent used to assist the diagnosis and treatment of various surgical department. However, complications associated with the procedure including pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium, and air embolism have been reported. Incidence of subcutaneous emphysema during extraperitoneal laparoscopic surgery has been reported 99%. We report the case of a 76 years old female patient who had subcutaneous emphysema and hypercarbia during retroperitoneal laparoscopic nephrectomy. After developing hypercapnia, we increased the minute ventilation and lowered the CO2 gas insufflation pressure. Until the end of the operation, the patient’s vital signs did not change and end tidal CO2 was not increased any more.

The sacrocolpopexy has been the gold standard surgery for POP (pelvic organ prolapse). Though the rates of mesh-related complications after sacrocolpopexy are relatively low, the complications should be considered. This case report describes the clinical cases of removal of mesh eroding following hysterectomy, laparoscopic sacrocolpopexy and posterior vaginal repair. The surgery for complete mesh excision was performed at laparotomy or laparoscopy. Although any complications haven't been yet reported in two cases, careful follow-up management should be needed. Successful sacrocolpopexy without complications requires technically experienced pelvic surgeons, the most suitable surgical methods and the best graft material.

Uterine rupture in pregnancy is a rare event and may lead to fatal complications for both mother and fetus. It is commonly occurred in women who have a history of an operation that involves the uterine myometrium. Cornual ectopic pregnancy is quite rare, and it is usually managed by cornual resection on laparotomy or laparoscopy. Uterine rupture at third trimester following laparoscopic cornual resection is very rare. Here we report a case of uterine rupture in a pregnant woman at 35 weeks gestation with previous history of right cornual pregnancy treated with laparoscopic salpingectomy and cornual resection.

Wolff-Parkinson-White syndrome (WPW) is a common disorder of the conduction system of the heart. Patients with such disorder may be asymptomatic or present with cardiac symptoms like palpitation and dyspnea. The anesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia. We report a hemodynamic management of a 53-year-old male with WPW syndrome scheduled for laparoscopic cholecystectomy under general anesthesia. We performed total intravenous anesthesia with propofol and remifentanil, and we placed the laryngeal mask airway behind the endotracheal tube using Bailey's Maneuver before extubation of endotracheal tube.

The aim of this study was to evaluate clinical outcomes of laparoscopic surgery for colorectal cancer within a learning period. A total of 86 consecutive patients who underwent laparoscopic resection for colorectal cancer between January 2010 and December 2011 were investigated retrospectively. The patients were sorted into the early and late group; 43 patients were included in each group. Patient’s clinicopathologic features, perioperative outcomes, morbidity, and mortality were evaluated. The two groups showed similar operative results in terms of operation time, conversion rate to open surgery (16% vs 7%, p=0.313), and the rate of postoperative complication (34.9% vs 37.2%, p=0.313). The most serious complication, anastomotic leak, developed in five and four patients in the early and late group, respectively. Hemoglobin change, which means blood loss indirectly was lower in late phase and was statistically significant (2.3g/dL vs. 1.7g/dL, p=0.007). No difference in TNM stage and number of retrieved lymph nodes (19.2±11.9 vs 18.7±12.7, p=0.847) was observed between the two groups. Laparoscopic surgery for colorectal cancer can be performed safely and effectively even during a learning period, if the operation is performed carefully.

Laparoscopic appendectomy using three trocars has been widely performed. Recently, a single incision laparoscopic surgical procedure has become popular because it is less invasive. We report on our early experience in performance of single incision laparoscopic appendectomy (SIL-A). Data on the operating time, the duration to make the pneumoperitoneum, body mass index (BMI), rate of conversion to another operation, complication, hospital stay, dosage of analgesics, and pain score were collected prospectively at two centers. Twenty seven patients underwent SIL-A. The mean BMI was 23.3±3.1 kg/m2 (17.6-30.5). The mean time required to make a pneumoperitoneum was 9.9±5.0 minutes (5.0-28.0). The mean operating time was 37.6±26.7 minutes (10.0-100.0). The rate of intra-operative complication was 3.7% (1/27), and the rate of post-operative complication was 22.2% (6/27). The mean hospital stay was 4.1±1.2 days (2-6). The immediately postoperative pain score was 5.4±1.5 (3-8), however, the pain score at discharge was 0.4±0.7 (0-2). The mean dosage of analgesics was 1.5±1.3(0-4), however, none of the patients took analgesics after postoperative three days. SIL-A is feasible but requires improved instrumentation and experience.