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Are Routine Blood Group and Save Samples Needed for Laparoscopic Day Case Surgery? World J Surg 2016; 40:1295-8. [DOI: 10.1007/s00268-016-3463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Hamza N, Pereira M, Gilliam A. Routine ‘group and save’ is unnecessary on the day of surgery for elective laparoscopic cholecystectomy. ACTA ACUST UNITED AC 2015. [DOI: 10.1308/147363515x14272809071167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
What this means for cost savings and reserve stocks.
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Affiliation(s)
- N Hamza
- County Durham and Darlington NHS Foundation Trust
| | - M Pereira
- County Durham and Darlington NHS Foundation Trust
| | - A Gilliam
- County Durham and Darlington NHS Foundation Trust
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Khajuria A. Robotics and surgery: A sustainable relationship? World J Clin Cases 2015; 3:265-269. [PMID: 25789298 PMCID: PMC4360497 DOI: 10.12998/wjcc.v3.i3.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/24/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Robotic surgery is increasingly being employed to overcome the disadvantages associated with use of conventional techniques such as laparoscopy. However, despite significant promise, there are some clear disadvantages and robust evidence base supporting the use of robotic assistance remains lacking. In this paper, the advantages and drivers for robotics will be discussed, its drawbacks and its future role in surgery.
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Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features. Emerg Radiol 2014; 22:283-94. [PMID: 25537821 DOI: 10.1007/s10140-014-1291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/12/2014] [Indexed: 12/18/2022]
Abstract
Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.
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Shaikh I, Boshnaq M, Al-Naher A, Patel S, Tsavellas G. A pilot survey of consenting practice for laparoscopic cholecystectomy. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:9-10. [PMID: 24430999 DOI: 10.1007/s11673-013-9507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Irshad Shaikh
- Department of Surgery, QEQM Hospital, Margate, Kent, UK
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Ladic A, Petrovic I, Augustin G, Puretic H, Skegro M, Gojevic A, Nikolic I. Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone. Surg Infect (Larchmt) 2013; 14:408-11. [PMID: 23859691 DOI: 10.1089/sur.2012.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities. METHODS Case report and review of the literature. CASE REPORT A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved. CONCLUSION Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present.
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Affiliation(s)
- Agata Ladic
- Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
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Lee DY, Rehmani SS, Guend H, Park K, Ross RE, Alkhalifa M, McGinty JJ, Teixeira JA. The incidence of trocar-site hernia in minimally invasive bariatric surgery: a comparison of multi versus single-port laparoscopy. Surg Endosc 2012; 27:1287-91. [PMID: 23232997 DOI: 10.1007/s00464-012-2597-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/17/2012] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations. METHODS There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture. RESULTS Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias. CONCLUSIONS SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.
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Affiliation(s)
- David Y Lee
- St. Luke's-Roosevelt Hospital Center, Institute for Bariatric and Minimally Invasive Surgery, 1111 Amsterdam Avenue, Babcock 4W, New York, NY 10025, USA.
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Hochhegger B, Zanetti G, Marchiori E. A huge transdiaphragmatic abscess detected postcholecystectomy. Ann Thorac Surg 2012; 93:e163. [PMID: 22632537 DOI: 10.1016/j.athoracsur.2012.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 12/28/2011] [Accepted: 01/18/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Bruno Hochhegger
- Pavilhão Pereira Filho, Post graduation Program in Pulmonary Sciences, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
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Han JP, Liu B, Yang YL, Su QJ, Shi M, Qian Z, Dong L, Zhang CL, Ha YD. Relationship between characteristics of CD44 +/ki-67 - colorectal cancer stem cells and clinicopathological characteristics in patients with colorectal cancer. Shijie Huaren Xiaohua Zazhi 2011; 19:3483-3488. [DOI: 10.11569/wcjd.v19.i34.3483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the number, location, distribution and staining features of CD44+/ki-67- colorectal cancer stem cells and to analyze their relation with clinicopathological characteristics in patients with colorectal carcinoma.
METHODS: Streptavidin-HRP immunohistochemical staining, double immunohistochemical staining and hematoxylin-eosin staining were performed to detect the expression of CD44 and ki-67 in 10 cases of normal mucosal tissue, 15 cases of adenoma with atypical hyperplasia, 59 cases of colorectal carcinoma, and human colon cancer cell line SW620. The number, location, distribution and staining features of CD44+/ki-67- colorectal cancer stem cells were observed, and their relation with clinicopathological characteristics was analyzed.
RESULTS: The number of CD44+/ki-67- tumor cells accounted for 0.1%-25.0% (average 5.82%) of all tumor cells, and the cells were mainly distributed in the sides of the basal membrane or common wall of glands. These cells had round or oval nuclei that were consistent in size, and contained deep stained chromatin and less cytoplasm. These features are consistent with those of stem cells in the intestinal crypts. The number of CD44+/ki-67- tumor cells was significantly correlated with depth of cancer infiltration (χ2 = 1.851, P < 0.05) and lymph node metastasis (χ2 = -4.113, P < 0.01).
CONCLUSION: CD44+/ki-67- are suitable specific markers for tumor stem cells and can be used for tumor stem cell isolation, targeted therapy, individualized treatment, prediction of tumor metastasis, and estimation of prognosis in patients with colorectal cancer.
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Single-port versus multi-port cholecystectomy for patients with acute cholecystitis: a retrospective comparative analysis. Hepatobiliary Pancreat Dis Int 2011; 10:521-5. [PMID: 21947727 DOI: 10.1016/s1499-3872(11)60088-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Trans-umbilical single-port laparoscopic cholecystectomy for chronic gallbladder disease is becoming increasingly accepted worldwide. But so far, no reports exist about the challenging single-port surgery for acute cholecystitis. The objective of this study was to describe our experience with single-port cholecystectomy in comparison to the conventional laparoscopic technique. METHODS Between August 2008 and March 2010, 73 patients with symptomatic gallbladder disease and histopathological signs of acute cholecystitis underwent laparoscopic cholecystectomy at our institution. Thirty-six patients were operated on with the single-port technique (SP group) and the data were compared with a control group of 37 patients who were treated with the multi-port technique (MP group). RESULTS The mean age in the SP group was 61.5 (range 21-81) years and in the MP group was 60 (range 21-94) (P=0.712). Gender, ASA status and BMI were not significantly different. The number of white blood cells was different before [SP: 9.2 (range 2.8-78.4); MP: 13.2 (range 4.4-28.6); P=0.001] and after the operation [SP: 7.8 (range 3.5-184.8); MP: 11.1 (range 5-20.8); P=0.002]. Mean operating time was 88 (range 34-174) minutes in the SP group vs 94 (range 39-209) minutes in the MP group (P=0.147). Four patients (5%) required conversion to an open procedure (SP: 1; MP: 3; P=0.320). During the follow-up period of 332 (range 29-570) days in the SP group and 428 (range 111-619) days in the MP group (P=0.044), eleven (15%) patients developed postoperative complications (P=0.745) and two patients in the SP group required reoperation (P=0.154). CONCLUSIONS Trans-umbilical single-port cholecystectomy for beginning acute cholecystitis is feasible and the complication rate is comparable with the standard multi-port operation. In spite of our good results, these operations are difficult to perform and should only be done in high-volume centers for laparoscopic surgery with experience in single-port surgery.
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Single-Incision Cholecystectomy in about 200 Patients. Minim Invasive Surg 2011; 2011:915735. [PMID: 22091365 PMCID: PMC3199860 DOI: 10.1155/2011/915735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/08/2011] [Indexed: 01/07/2023] Open
Abstract
Background and Aims. We describe our experience of performing transumbilical single-incision laparoendoscopic cholecystectomy as standard procedure for acute and chronic gallbladder diseases. Methods. Between September 2008 and March 2010, 220 patients underwent laparoscopic single-incision surgery. A single port was used for 196 patients and two conventional 5 mm and one 10 mm port in 24 cases. All operations were performed with straight instruments. Results. Single-incision surgery was successfully performed in 215 patients (98%). Three patients (1.4%) required conversion to a three-port technique and two patients (0.9%) to an open procedure. Average age of 142 women (65%) and 78 men (35%) was 47 years (range: 15-89), average ASA status 2 (range: 1-3) and BMI 28 (range: 15-49). Mean operative time was 62 minutes (range: 26-174) and 57 patients (26%) had histopathological signs of acute cholecystitis. Eleven patients (5%) developed to surgery-related complications and nine (4%) of these required a reoperation. The mean followup was 331.5 (range: 11-590) days. Conclusion. Transumbilical single-incision cholecystectomy is a feasible and safe new approach for routine cholecystectomy. After a short learning curve, operation time and complication rate are comparable with standard multiport operation. In addition, most cases of acute cholecystitis can be performed with this technique.
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McGregor CGC, Sodergren MH, Aslanyan A, Wright VJ, Purkayastha S, Darzi A, Paraskeva P. Evaluating systemic stress response in single port vs. multi-port laparoscopic cholecystectomy. J Gastrointest Surg 2011; 15:614-22. [PMID: 21308488 DOI: 10.1007/s11605-011-1432-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 01/19/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Acute-phase proteins and inflammatory cytokines mediate measurable responses to surgical trauma, which are proportional to the extent of tissue injury and correlate with post-operative outcome. By comparing systemic stress following multi-port (LC) and single-incision laparoscopic cholecystectomy (SILC), we aim to determine whether reduced incision size induces a reduced stress response. METHODS Thirty-five consecutive patients were included, 11 underwent SILC (mean ± SEM; age 44.8 ± 3.88 year; BMI 27 ± 1.44 kg/m(2)) and 24 underwent LC (56.17 ± 2.80 year; 31.72 ± 1.07 kg/m(2), p < 0.05). Primary endpoint measures included levels of interleukin-6 and C-reactive protein measured pre- and post-operatively. Length-of-stay (LOS) and postoperative morbidity were secondary endpoints. RESULTS No statistically significant differences were found between SILC and LC for interleukin-6 and C-reactive protein levels, LOS and duration of surgery. There was also no correlation between systemic stress response and operative parameters. There were no intra-operative complications. CONCLUSION SILC appears to be a safe, feasible technique with potential advantages of cosmesis, reduced incisional pain, and well-being recommending its use. These data indicate no difference in systemic stress and morbidity between SILC and LC. A larger, multi-centred, randomised prospective trial is warranted to further investigate and confirm this finding.
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Affiliation(s)
- Colleen G C McGregor
- Department of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary's Hospital, Paddington, UK.
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Quinn M, Suttie S, Li A, Ravindran R. Are blood group and save samples needed for cholecystectomy? Surg Endosc 2011; 25:2505-8. [PMID: 21301881 DOI: 10.1007/s00464-011-1573-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 12/14/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cholecystectomy is a common, safe procedure. This study aimed to determine whether a blood group and save approach still is required for primary cholecystectomy. METHODS A retrospective regional analysis of all cholecystectomy patients identified from pathology records between January 1998 and February 2005 was undertaken. The study excluded from further analysis patients for whom cholecystectomy was not the primary operation or for whom the data were incomplete. RESULTS A total of 4,652 patients were identified. Of these patients, 19 were excluded due to incomplete data and 171 were excluded because the cholecystectomy was secondary to another procedure. Of the remaining 4,462 patients, 2,916 (65.4%) had a blood sample sent to the blood transfusion service. The 2,916 patients were subdivided into blood group and save samples (2461/4462, 55.2%) and blood cross-matched samples (455/4462, 10.2%). Blood transfusion was required by 48 patients (48/4462, 1.1%). Subanalysis of the transfused group showed that 27 patients received a blood transfusion due to complications of the index operation, with 18 (18/27, 66.7%) undergoing transfusion while in the operating theater. The indication for transfusion in the remaining 21 patients was secondary to a reoperation for complications of laparoscopic cholecystectomy (n = 8), related to primary hematologic malignancy (n = 6), or not documented (n = 7). CONCLUSION The use of routine blood group and save is not justified. A targeted approach will reduce the demand on blood transfusion service without detriment to those undergoing cholecystectomy. There is no substitute for adequate vigilance for bleeding as a complication with any surgical procedure.
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Affiliation(s)
- Martha Quinn
- Department of Surgery, Gartnavel General Hospital, Glasgow, G12 0XH, UK.
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Gwon DI, Ko GY, Sung KB, Kim JH, Yoon HK. Percutaneous Transhepatic Treatment of Postoperative Bile Leaks: Prospective Evaluation of Retrievable Covered Stent. J Vasc Interv Radiol 2011; 22:75-83. [DOI: 10.1016/j.jvir.2010.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/04/2010] [Accepted: 10/09/2010] [Indexed: 12/13/2022] Open
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Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2010; 15:113-21. [PMID: 21152941 DOI: 10.1007/s10029-010-0757-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 11/21/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE There is a risk of developing a trocar site hernia (TSH) after laparoscopic surgery, but data is sparse and based mostly on retrospective studies with a short and poorly defined follow-up period. Surgical approaches and patient-related co-morbidity have also been suggested as risk factors for development of TSH. The aim of the present review was to perform a qualitative systematic analysis to estimate the incidence of TSH and to discuss the surgical and patient-related risk factors for development of TSH. METHODS The literature search was until 19 May 2010. Studies with TSH, defined as either operation for TSH or a hernia found during clinical follow-up, were included. We included randomised controlled trials, prospective non-controlled studies including >200 patients, and retrospective studies including >200 patients. The review was completed according to the PRISMA guidelines. RESULTS We included 19 studies in adults and 3 studies in paediatric patients (<18 years), and a total of 30,568 adults and 1,098 children were analysed. The overall incidence of TSH was 0-5.2%. TSH occurred most often (96%) in trocar sites of a minimum of 10 mm, located mostly in the umbilicus region (82%). Data supported a higher incidence of TSH when the trocar site fascia was not sutured, and in pre-school children undergoing a laparoscopic procedure. CONCLUSIONS Current data suggests a relatively low incidence of TSH but that all trocar incisions of a minimum of 10 mm should be closed. In pre-school children undergoing laparoscopic surgery, all port sites should be closed.
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Affiliation(s)
- F Helgstrand
- Department of Surgery, Køge Sygehus, University of Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
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Abstract
Currently there is no evidence for prophylactic cholecystectomy to prevent gallstone formation (grade B). Cholecystectomy cannot be recommended for any group of patients having asymptomatic gallstones except in those undergoing major upper abdominal surgery for other pathologies (grade B). Laparoscopic cholecystectomy is the preferred treatment for all patient groups with symptomatic gallstones (grade B). Patients with gallstones along with common bile duct stones treated by endoscopic sphincterotomy should undergo cholecystectomy (grade A). Laparoscopic cholecystectomy with laparoscopic common bile duct exploration or with intraoperative endoscopic sphincterotomy is the preferred treatment for obstructive jaundice caused by common bile duct stones, when the expertise and infrastructure are available (grade B).
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Kee SK, Kim JO, Kwon OK, Nam SY. Iatrogenic Gallbladder Perforation during Gastric Endoscopic Mucosal Resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.3.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Se Kook Kee
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - Jae Oh Kim
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - Oh Kyoung Kwon
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - Soon Young Nam
- Department of Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea
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