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Purpose: This study aimed to evaluate whether laparoscopic appendectomy is suitable for training residents to become proficient in laparoscopic surgery. Materials and Methods: A total of 1574 laparoscopic appendectomies were performed at En-Chu-Kong Hospital between January 1998 and December 2003 (788 men and 786 women). These cases were divided into three groups: 543 cases (in 1998–1999) performed by 5 attending surgeons during the learning and trial stage; 536 cases (in 2000–2001) performed by 5 attending surgeons assisted by 2 senior residents with prior experience in open appendectomy; and 495 cases (in 2002–2003) done by these 2 senior residents, supervised by the attending surgeons. Demographic data, intraoperative findings, operative time, conversion rate, frequency of analgesic injection, timing of oral intake, hospital stay, morbidity, and mortality were analyzed. Results: There were no statistically significant differences in the operations performed by attending surgeons (mature stage) vs. senior residents in terms of intraoperative findings, operative time (60.1 ± 60.4 minutes vs. 56.3 ± 25.6 minutes), conversion rate (1.12% vs. 0.81%), frequency of analgesic injection (0.57 ± 1.37 times/stay vs. 0.43 ± 0.94 times/stay), timing of oral intake (23.7 ± 30.2 hours vs. 20.8 ± 27.5 hours), hospital stay (73.9 ± 61.8 hours vs. 70.3 ± 51.6 hours), morbidity, or mortality (0% vs. 0.2%). Conclusion: Laparoscopic appendectomy can be safely incorporated into the training of surgical residents under the supervision of experienced surgeons. Laparoscopic appendectomy also provides knowledge of the basics of laparoscopic technique before going on to more complex operations. [ABSTRACT FROM AUTHOR]

Gastrojejunostomy through laparotomy is a traditional procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. However, patients face pain and high rates of morbidity and mortality after this operation. We present two cases of gastrojejunostomy for unresectable and obstructing gastric antral cancer using a double scope technique. The operative time was approximately 90 minutes for each patient, and the postoperative hospital stays were 9 and 10 days, respectively. Operative results were good. Vomiting was relieved. There were no delays in gastric emptying. No recurrence of gastric outlet obstruction was noted in the first patient, who died 9 months postoperatively. The second patient survived without this problem 6 months postoperatively. Palliative gastrojejunostomy via the double scope technique is a safe and effective minimally invasive procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. It also provides accurate staging of the disease perioperatively. It should be considered the surgical choice for geriatric patients when clinically appropriate. [ABSTRACT FROM AUTHOR]

We report the case of a 51-year-old man who had abdominal distension and intermittent cramping pain for 4 months. A lower gastrointestinal double-contrast study revealed a protruding mass at the transverse colon. Endoscopic ultrasonography showed a lesion arising from the submucosal layer. Instead of a laparotomy, the lesion was removed laparoscopically with the assistance of a colonoscope. No operative morbidity was noted. With future improvements of this technique, tumors that are difficult to remove with colonoscopy can be excised laparoscopically without the aid of an endoscopic stapler. In our case, the tumor was localized intraoperatively and extracted using the intraoperative colonoscopy. This double-scope technique is safe and cost-effective for some difficult colonic lesions. [ABSTRACT FROM AUTHOR]

Mucinous cystadenoma is a rare lesion of the vermiform appendix and is seldom diagnosed before surgery, although radiologic and ultrasonographic findings have been reported. We present the case of a 65-year-old female with rheumatoid arthritis who presented with general malaise, poor appetite, fever, and right upper and lower quadrant pain of about one week's duration. Abdominal sonography and computed tomography revealed an 8 × 4 × 3 cm cystic lesion of the appendix. Laparoscopic evaluation confirmed this finding and the lesion was resected without rupturing the tumor during manipulation. Laparoscopic surgery provides the advantages of good exposure and evaluation of entire abdominal cavity, as well as more rapid recovery. It is important to avoid tumor rupture during manipulation, and formation of pseudomyxoma peritonei, in case the tumor is malignant. [ABSTRACT FROM AUTHOR]

Presents a study which attempted to evaluate the relative efficacy of a method, which provides the benefits of both conventional and minilaparoscopic cholecystectomy. Port sites for combined laparoscopic cholecystectomy; Results of the study; Conclusion.