Laparoscopic Inguinal Hernia Repair in Female Pediatric Patients

Joong Kee Youn

J Surg Innov Educ. 2025;2(2):35-38.   Published online December 19, 2025

DOI: https://doi.org/10.69474/jsie.2025.00325

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Laparoscopic inguinal hernia repair (LIHR) has become a widely adopted surgical approach for pediatric inguinal hernia because it offers superior visualization and enables simultaneous assessment of the contralateral side. An 8-month-old female infant presented with a spontaneously reducing bulge in the right inguinal region, most noticeable during diaper changes. Physical examination revealed an easily reducible inguinal mass that was palpably firm and spherical, raising strong suspicion for ovarian inclusion. A positive silk glove sign was also identified on the contralateral side. Under general anesthesia, a three-port laparoscopic technique was used, consisting of a 5-mm umbilical port and two 3-mm working ports. The peritoneum and gubernaculum were carefully dissected from surrounding structures using electrocautery before sac closure, a step performed to minimize the risk of recurrence. Both the symptomatic right hernia sac and the asymptomatic contralateral patent processus vaginalis, which was visually confirmed intraoperatively, were closed using an intracorporeal purse-string high ligation with absorbable sutures. Three-port LIHR with meticulous dissection of the peritoneum and gubernaculum represents an effective and definitive technique for pediatric inguinal hernia repair. This approach allows simultaneous bilateral repair and is associated with excellent postoperative recovery, supporting its continued use as a primary surgical method.

Indocyanine Green Fluorescence-Guided Enucleation via the Serosal Approach for Benign Subepithelial Tumors of the Gastroesophageal Junction

Ji-Hyeon Park, Sojung Kim, Ho Seok Seo, Kyo Young Song, Han Hong Lee

J Surg Innov Educ. 2025;2(2):31-34.   Published online December 19, 2025

DOI: https://doi.org/10.69474/jsie.2025.00283

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Subepithelial tumors (SETs) located at the gastroesophageal (GE) junction remain technically challenging in minimally invasive surgery because the convergence of the esophageal sphincter, diaphragmatic hiatus, and gastric fundus creates a confined operative field. When a tumor is fully embedded within the muscular layer, its capsular margin is often indistinguishable from the serosal surface, making precise enucleation technically demanding. To address this limitation, we adopted a fluorescence-guided technique that enables accurate intraoperative localization of the tumor through indocyanine green (ICG) injection. After induction of anesthesia, approximately 0.1–0.2 mL (0.05–0.1 mg) of ICG diluted in normal saline is injected endoscopically into the submucosal plane at the tumor site for benign SETs. During surgery, near-infrared visualization provides a distinct fluorescent margin that guides safe serosal incision and enucleation while preserving the mucosa and the anatomy of the GE junction. This technique is particularly useful for benign, well-encapsulated lesions such as leiomyoma or ectopic pancreas, where clear dissection planes can be preserved. However, it should not be used for lesions with any suspicion of gastrointestinal stromal tumor or other malignant potential, because capsular or intratumoral injection may pose a theoretical risk of tumor cell dissemination. Careful peritumoral submucosal injection that avoids capsular disruption may be cautiously considered. In selected benign tumors, ICG-guided serosal enucleation provides clear localization, facilitates complete resection, and minimizes both functional and structural complications at the GE junction.

Laparoscopic Extended Totally Extraperitoneal Hernia Repair with Posterior Component Separation with Transversus Abdominis Release for a Recurrent Incisional Hernia

Sa-Hong Kim, Kyoyoung Park, Chungyoon Kim, Jeesun Kim, Do-Joong Park, Hyuk-Joon Lee, Seong-Ho Kong

J Surg Innov Educ. 2025;2(1):5-8.   Published online June 17, 2025

DOI: https://doi.org/10.69474/jsie.2025.00024

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A patient with multiple comorbidities, including hypertension, type 2 diabetes, hyperlipidemia, and edema, and a prior history of abdominal surgery presented to the gastrointestinal department with a recurrent incisional hernia larger than 10 cm. The patient underwent laparoscopic extended totally extraperitoneal (e-TEP) hernia repair under general anesthesia. The bilateral retrorectal spaces were accessed via three trocars, followed by midline crossover in the upper abdomen and caudal dissection along the fascial defect. Due to the large size of the defect and the anticipated tension, posterior component separation (PCS) with transversus abdominis release (TAR) was performed, with careful preservation of the neurovascular bundles running anterior to the head of the transversus abdominis muscle. After separate closure of the posterior and anterior layers using barbed sutures, a mesh was placed in the intercomponent space to avoid direct contact with intraperitoneal structures. Closed-suction drains were placed bilaterally to prevent seroma formation. The procedure was completed successfully, and the patient experienced no complications. The patient was discharged without complications. A follow-up computed tomography scan demonstrated the integrity of the hernia repair, with progressive resolution of fat infiltration and fluid collection. Laparoscopic e-TEP hernia repair with PCS and TAR provides a safe and effective approach for managing complex recurrent incisional hernias. This technique enables tension-free closure with mesh placement while minimizing intra-abdominal complications.

Gastrointestinal

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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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.

Gastrointestinal

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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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.

Colorectal

Laparoscopic Right Hemicolectomy with an Inferior Approach: How I Do It

Young Il Kim, Hayoung Lee, Min Hyun Kim

J Surg Innov Educ. 2024;1(1):6-9.   Published online June 28, 2024

DOI: https://doi.org/10.69474/jsie.2024.00038

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Since its introduction in the early 1990s, laparoscopic colorectal surgery has been extensively validated through randomized controlled trials, establishing its safety and efficacy from oncological and technical standpoints. Laparoscopic right hemicolectomy (LRHC) procedures exhibit variability in dissection extent and initiation sites. Complete mesocolic excision is essential in LRHC, involving precise dissection along embryologic planes and varying in lymph node dissection extent (D2 or D3). Other variations in LRHC include the use of the medial approach (or superior mesenteric vein [SMV]-first approach), where dissection starts along the SMV, the lateral approach (or inferior approach), starting with meso-ileal and retroperitoneal dissection, and the superior approach, initiated by separation of the omentum and transverse colon. This paper presents a case of LRHC for ascending colon cancer using an inferior approach. The procedure included trocar placement, followed by inferior, superior, and medial dissection phases, concluding with specimen extraction and extracorporeal anastomosis. With a standardized procedure, mastery of diverse approaches (inferior, medial, and superior) remains crucial, as the most appropriate method varies among cases.

Liver

Optimized Surgical Techniques in Laparoscopic Living-Donor Right Hemihepatectomy Using Indocyanine Green Fluorescence Images

YoungRok Choi, Suk Kyun Hong, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh

J Surg Innov Educ. 2024;1(1):14-17.   Published online June 26, 2024

DOI: https://doi.org/10.69474/jsie.2024.00066

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This paper outlines the surgical technique for laparoscopic living-donor right hemihepatectomy (LLDRH), a minimally invasive procedure that increases graft safety and reduces donor morbidity. The technique includes careful patient selection, precise port placement, meticulous liver mobilization, and careful parenchymal dissection, followed by secure graft extraction and effective hemostasis. LLDRH offers several advantages over open living-donor surgery, including lower costs, less postoperative pain, shorter hospital stays, and better cosmetic results. The use of advanced three-dimensional laparoscopic systems and indocyanine green fluorescence imaging has further increased the safety and effectiveness of this procedure. As laparoscopic technology continues to evolve, LLDRH is likely to become more widely adopted, offering a valuable option for liver transplantation programs. A video clip shows a 32-year-old woman with a body mass index of 25.7 kg/m2 who donated her right liver. Her remnant liver volume was 34%, and the estimated graft-to-recipient weight ratio was 1.2. The operation time was 240 minutes, with an estimated blood loss of 150 mL. She was discharged on the fifth postoperative day without any complications.

Gastrointestinal

Techniques in Jejunojejunostomy, Gastrojejunostomy, and Esophagojejunostomy in Reduced-Port Gastrectomy

Sa-Hong Min

J Surg Innov Educ. 2024;1(1):3-5.   Published online June 25, 2024

DOI: https://doi.org/10.69474/jsie.2024.00031

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Minimally invasive gastric cancer surgery aims to reduce morbidity and mortality while maintaining satisfactory oncological outcomes. Laparoscopic gastrectomy is a standard treatment, offering reduced pain, shorter hospital stays, and faster recovery. Reduced-port gastrectomy has gained popularity due to its requirement for limited assistants; however, it poses unique challenges. This paper shares the techniques used in three cases of jejunojejunostomy, gastrojejunostomy, and esophagojejunostomy during reduced-port gastrectomy. Reduced-port techniques were successfully implemented in all three cases. Key steps included proper port placement, the use of tagging sutures, and strategic stapler insertion and adjustment. The reduced-port approach demonstrated feasibility and effectiveness despite its inherent challenges. Reduced-port gastrectomy can be effectively performed with a careful technique and meticulous planning, despite the challenges of transitioning from conventional five-port techniques. Using fewer ports results in less pain, fewer complications, and shorter hospital stays without compromising oncologic outcomes. These techniques can be helpful for trainees and novice surgeons, though careful candidate selection is paramount.