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Laparoscopic adrenalectomy offers distinct benefits to patients and has now become the gold standard for the removal of adrenal lesions. Nonetheless, the procedure poses a challenge for surgeons in regards to the maneuverability of instruments, the two-dimensional operating field and the counterintuitive movements. This study reports our experience using the Zeus robotic surgical system in laparoscopic adrenalectomy compared with traditional laparoscopic adrenalectomy. From January 2003 to February 2005, a total of 12 patients were prospectively enrolled to receive robot-assisted laparoscopic adrenalectomy (RALA) or traditional laparoscopic adrenalectomy (TLA). The time necessary for robotic setup and operation was recorded, as well as complications, technical problems, postoperative hospital stay, morbidity, and mortality. Five RALA procedures and seven TLA were successfully completed. There was no significant difference between the groups in terms of age, body mass index, and tumor size. Resection times were longer in the RALA group (168.0 ± 30.7 min vs. 131.4 ± 29.0 min, p = 0.05). There were no perioperative complications. There was neither postoperative mortality nor morbidity at the time of discharge and during one year follow-up. RALA is as safe and technically feasible as TLA, It provides a real benefit for the surgeon with the three dimensional view, a comfortable sitting position, the elimination of the surgeon’s tremor, and increased degrees of freedom of the operative instruments compared with TLA. However, patient outcomes and operative costs should be evaluated further. [ABSTRACT FROM AUTHOR]

Background: Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer. Case presentation: A case of ruptured mucocele resulting from cystadenoma of the appendix was presented as right inguinal hernia in a 70-year-old male. The patient underwent colonoscopy, x-ray, ultrasound and computed tomography. Localized pseudomyxoma peritonei associated with adenocarcinoma of the descending colon was diagnosed. The patient underwent segmental resection of the colon, appendectomy, debridement of pseudomyxoma and closure of the internal ring of right inguinal canal. He is free of symptoms in one year follow-up. Conclusion: Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated and colonoscopy can be performed meticulously in cases of ruptured mucoceles and localized pseudomyxoma peritonei. Surgical intervention is the current choice of management. [ABSTRACT FROM AUTHOR]

Purpose: In an attempt to obviate the necessity for hospitalisation, the ablative dose of 131I in the treatment of thyroid cancer is divided into two or three fractions at weekly intervals in some hospitals with no special bed for 131I treatment. Thyroid stunning has been observed in patients receiving a 131I dose between 74 and 370 MBq (2-10 mCi). However, the influence of 131I uptake after administration of a higher dose, such as 1,110-1,850 MBq of 131I, has never been reported. In this study, we evaluated the degree of reduction in 131I uptake after patients received 1,480 MBq of 131I and evaluated the clinical value of fractionated ablative doses of 131I. Methods: Thirty-five patients with functional thyroid cancer received a total of 4,440 MBq (120 mCi) of 131I which was divided into three fractions administered at weekly intervals. In all patients two 131I whole-body scans were performed. The first scan was performed directly prior to the second dose of 131I (7 days after the first administration of 131I), and the second scan was performed 7 days after the second administration of 131I and directly prior to the third administration. Regions of interest including the neck and lungs were drawn to calculate the uptake of 131I in the thyroid remnant and possible cervical lymph node and lung metastases. Results: The mean uptake of 131I was 2.73% 7 days after the first administration, and decreased significantly to 0.26% 7 days after the second administration. The mean decrease was as high as 80.7%. The decrease in 131I uptake was significant in all patients except the two with lung metastases. In the two patients with lung metastases, no definite evidence of decreased uptake was noted; the uptake of 131I in the lung metastases even increased on the second 131I image in one of these patients. After administration of 1,480 MBq of 131I, the decreased uptake was significant in all neck lesions but not in lung metastases. Conclusion: The use of fractionated ablative doses of 131I is not to be recommended in patients without lung metastases. However, the influence of fractionated ablative doses of 131I in patients with lung metastases is worthy of further study. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common acute abdomen in general surgery. Show-Chwan Memorial Hospital began an AITS/IRCAD laparoscopic training program in late May 2008. In this retrospective analysis, we surveyed the impact of the AITS training program on surgeons’ preference for open appendectomy (OA) versus laparoscopic appendectomy (LA). Methods: From January 1, 2004 to July 31, 2009, patients diagnosed with acute appendicitis in Changhua Show-Chwan Memorial Hospital and Chang-Bing Show-Chwan Memorial Hospital were retrospectively analyzed. Demographic data, laboratory examinations, surgical methods, hospital stay, and complication rate data were collected and analyzed. The LA rate and effect of surgeons’ preference before and after AITS were compared. Results: In all, 1,267 patients (58.2% male and 41.8% female; mean age, 36.6 years) were diagnosed with acute appendicitis during this period. Among them, 78.9% of patients had uncomplicated and 21.1% complicated appendicitis; 784 patients (61.9%) underwent OA, and 465 (36.7%) received LA. In 2004, only 8.1% of patients underwent LA, but the number increased rapidly to 90.4% in 2009 ( P < 0.001). The average LA rate before AITS was 21%; however, after AITS, the LA rate increased to 84.6% ( P < 0.001). The LA rate increased for all surgeons completing the training course, ranging from 16 to 83%. The overall appendectomy complication rate was 8.4%, with no significant difference between OA (9.7%) and LA (6.5%; P = 0.174). Hospital stay was shorter in the LA group (4.05 ± 1.9 days) compared with the OA group (4.55 ± 3.6; P = 0.006). Conclusions: Attending the laparoscopic training course significantly increased surgeons’ preference for LA. [ABSTRACT FROM AUTHOR]

Background: Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy. Case presentation: A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm. Conclusions: Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery. [ABSTRACT FROM AUTHOR]

To treat secondary hyperparathyroidism with subtotal parathyroidectomy or total parathyroidectomy with autotransplantation might cause the disease to recur because of growth of the parathyroid remnant or the autografts. The aim of the present study was to determinate an alternative surgical treatment for secondary hyperparathyroidism. Of 94 uremic patients, 44 (median age: 50.5 years; 33 women/11 men) were assigned to group A, patients who were not expected to receive kidney transplantation for various reasons and had total parathyroidectomy without autotransplantation; 50 (median age 46 years; 33 women/17 men) were assigned to group B, patients who had either total parathyroidectomy with autotransplantation or subtotal total parathyroidectomy with preservation of parathyroid tissue in situ. Parameters measured included demographics, perioperative and follow-up biochemistry tests, operative time, postoperative complications, length of hospital stay, patients’ compliance with the postoperative calcium and 1,25 dihydroxy-viatmin D supplementation regimen, symptom relief, and presence of recurrence. Mean operative times were 103 and 122 min ( P = 0.007); postoperative complication rates were 18.2% and 12.0% ( P = 0.563); mean hospital stays were 6 and 9 days ( P = 0.259); adequate patient compliance with the postoperative calcium and 1,25 dihydroxy-viatmin D regimens were 84.1% and 78.0%, respectively ( P = 0.6); symptom relief rates were 88.6% and 80.0% ( P = 0.277). Recurrence rates over 60 months in group A and group B were 4.5% and 18.0%, resectively ( P = 0.028 by Kaplan-Meier analysis). Because of the lower recurrent rate and shorter operative time, total parathyroidectomy without autotransplantation may be an option for treating patients with symptomatic secondary hyperparathyroidism who are not expected to receive kidney transplantation. [ABSTRACT FROM AUTHOR]