Journal of Surgical Innovation and Education

Tips for Laparoscopic Feeding Jejunostomy Using a Barbed Suture: Sin Hye Park, Dong Jin Kim; J Surg Innov Educ. 2024;1(2):31-33. Published online December 9, 2024; DOI: https://doi.org/10.69474/jsie.2024.00108

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Abstract PDF: Feeding jejunostomy is crucial for patients with compromised oral intake, particularly after gastrointestinal surgery or esophagectomy. Traditional methods involve interrupted sutures to secure the feeding tube to the abdominal wall, but this can be cumbersome due to the need for knot tying. This paper presents the case of a 75-year-old male patient who underwent minimally invasive esophagectomy with feeding jejunostomy for esophageal cancer, and introduces the use of a knotless barbed suture, which is commonly employed in gastrointestinal operations. The laparoscopic procedure utilized four trocars for jejunostomy, employing a 3-0 silk purse string suture and a 14-Fr Foley catheter. The barbed suture was used to secure the catheter in place without knots, covering 360° around the catheter. This method aims to simplify laparoscopic feeding jejunostomy and improve clinical practice.

Laparoscopic Paraaortic Lymph Node Sampling in Gastric Cancer Patients with Suspected Paraaortic Lymph Node Metastasis: Ba Ool Seong, Ju No Yoo, Chang Seok Ko, Sa-Hong Min, Chung Sik Gong, In-Seob Lee, Moon-Won Yoo, Jeong Hwan Yook, Beom Su Kim; J Surg Innov Educ. 2024;1(2):34-38. Published online December 27, 2024; DOI: https://doi.org/10.69474/jsie.2024.00206

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Abstract PDF: D2 lymphadenectomy is the standard approach for lymph node dissection in curable gastric cancer. However, paraaortic lymph node (PALN) dissection in addition to D2 lymphadenectomy has not been shown to improve survival rates and is therefore not routinely performed. Nevertheless, PALN sampling may be indicated for diagnostic purposes because it can provide critical information for accurate staging and treatment planning. Laparoscopic PALN sampling, however, poses significant challenges due to limited accessibility and visibility in the paraaortic region. Moreover, the proximity of major blood vessels, such as the abdominal aorta and renal vein, is another difficult aspect of the procedure. In this context, we present two cases to demonstrate practical strategies for facilitating laparoscopic PALN sampling. The procedure can be effectively performed by first identifying the ligament of Treitz and then, when necessary, fixing the small bowel mesentery to the abdominal wall using a tagging suture so that there is adequate vision and enough working space. This enables careful and precise dissection of the target tissue without compromising the feasibility and safety of the operation.

Colorectal Endoscopic Submucosal Dissection Using the Double-Clips Traction Method: Dae Kyung Sohn; J Surg Innov Educ. 2024;1(2):39-41. Published online November 27, 2024; DOI: https://doi.org/10.69474/jsie.2024.00080

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Abstract PDF: Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique used to remove large adenomas or early colorectal cancers. This paper presents a step-by-step introduction of the methodology for performing colorectal ESD using the double-clips traction method. The technique is designed to enhance visualization, shorten the procedure time, and improve the safety and efficacy of colorectal ESD, especially in challenging cases involving large or fibrotic lesions. By providing reliable traction, this method helps to maintain a stable and clear field of view throughout the procedure, which is critical for the success of the dissection.

Indocyanine Green-Guided Precision in a Left Lateral Sectionectomy for Hepatocellular Carcinoma: Woohyung Lee, Kwang Pyo Hong, Mirang Lee, Minkyu Sung, Yejong Park, Ki Byung Song, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim; J Surg Innov Educ. 2024;1(2):42-45. Published online December 3, 2024; DOI: https://doi.org/10.69474/jsie.2024.00087

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Abstract PDF: Parenchyma-sparing anatomical resection is recommended in patients with hepatocellular carcinoma due to the presence of underlying liver disease. More precise hepatectomy has been enabled by recent technical advancements, including negative staining with indocyanine green following ligation of the corresponding Glissonean pedicle, which offers intraoperative guidance by delineating the resection plane in real-time. Herein, we present a case of laparoscopic left lateral sectionectomy that used this staining technique.

LuminoMark: An Alternative for Localization: Ee Jin Kim, Tae Kyung Yoo, Jisun Kim, Il Yong Chung, Beom Seok Ko, Hee Jeong Kim, Jong Won Lee, Byung Ho Son, Sae Byul Lee; J Surg Innov Educ. 2024;1(2):46-48. Published online December 13, 2024; DOI: https://doi.org/10.69474/jsie.2024.00178

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Abstract PDF: Breast cancer is the most common cancer among women in Korea. Given the increased preference for breast-conserving surgery (BCS), preoperative localization is crucial, especially for non-palpable lesions, to ensure clear resection margins. Traditional methods such as wire-guided localization have limitations, including patient discomfort and wire migration. Recently, LuminoMark, an indocyanine green–macroaggregated albumin–hyaluronic acid mixture, has emerged as a promising alternative with potential benefits over existing techniques. We present a case of a 67-year-old female with a non-palpable Breast Imaging-Reporting and Data System 5 breast lesion. Preoperative localization was performed using LuminoMark, with accurate placement verified by a Lumino-imager. The lesion was successfully excised, and the absence of residual fluorescence confirmed complete resection. LuminoMark provided effective lesion localization without skin pigmentation, reducing the risk of misdiagnosis during follow-up. The procedure demonstrated a short learning curve, similar to that of charcoal localization. However, the need for a costly near-infrared fluorescence detector and the lack of long-term follow-up data are current limitations. Despite minor drawbacks, LuminoMark offers advantages over traditional localization methods, including improved aesthetics and reduced complications. This case demonstrates its feasibility as a next-generation localization technique for BCS, emphasizing the importance of an accurate injection technique to ensure adequate dispersion and complete tumor resection. Further studies are warranted to validate its long-term efficacy.

Techniques of Creating an Arteriovenous Fistula for Hemodialysis Access: A Comprehensive Guide: Chang Sik Shin, Ji Il Kim; J Surg Innov Educ. 2024;1(2):49-52. Published online December 27, 2024; DOI: https://doi.org/10.69474/jsie.2024.00171

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Abstract PDF: Arteriovenous fistula (AVF) creation is crucial for patients with end-stage renal disease requiring long-term hemodialysis, due to its superior long-term patency and lower complication rates compared to arteriovenous grafts. This paper presents detailed techniques and a step-by-step tutorial for AVF creation—including radiocephalic, brachiocephalic, and brachiobasilic fistulas—offering valuable insights for both novice and experienced surgeons.

Hepaticojejunostomy in Minimally Invasive Surgery: A Step-by-Step Guide: Younsoo Seo, Inhyuck Lee, Go-Won Choi, Yoon Soo Chae, Won-Gun Yun, Young Jae Cho, Hye-Sol Jung, Joon Seong Park, Jin-Young Jang, Wooil Kwon; J Surg Innov Educ. 2024;1(2):53-54. Published online December 12, 2024; DOI: https://doi.org/10.69474/jsie.2024.00192

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Abstract PDF: With rapid advances in minimally invasive surgery (MIS) techniques, such as laparoscopy and robotics, their application has expanded across various surgical fields, including pancreatobiliary surgery. Numerous studies have demonstrated the feasibility and potential benefits of MIS. Hepaticojejunostomy, a procedure creating a connection between the hepatic duct and the jejunum, is primarily used to bypass biliary obstructions or during operations that involve bile duct resection, such as pancreatoduodenectomy or choledochal cyst excision. Proficiency in minimally invasive hepaticojejunostomy techniques is essential for surgeons in this evolving field. This video presents a detailed, step-by-step guide to the principles and techniques of performing hepaticojejunostomy using both laparoscopic and robotic platforms.

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