日期:990716 9:10-9:30
主題:From Laparoscopic Surgery to SILS Surgery
主講人:WONG KIN HING SIMON
簡歷：
Current Appointments (Since 2008)
Consultant Department of Surgery, Prince of WalesHospital Shatin, Hong Kong
Honorary Consultant Department of Surgery,Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.Clinical Associate Professor (Honorary) Faculty of MedicineDepartment of SurgeryThe ChineseUniversity of Hong Kong
Past Appointments
Associate Consultant (2004-2007) Department of Surgery,Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
Honorary Clinical Assistant Professor(2004-2007) LKS Faculty of MedicineDepartment of SurgeryThe Hong KongUniversity
Honorary Consultant (2004-2008) Hong Kong Sanatorium & Hospital
大綱：
Introduction
Traditional surgery with large incision to facilitate human hand movement was applied in surgical field for many years. However, the fact that open surgery tends to associated with problems of postoperative pain, wound infection, incisional hernia, and prolonged hospitalization. Application of minimal access surgery has achieved better perioperative outcomes with less pain and faster recovery by using a series of small incisions. From these advances in minimal access surgery and endoscopy, natural orifices transluminal endoscopic surgery (NOTES) has evolved. NOTES provide a novel access to the peritoneal cavity by incising through the lumen of the gastrointestinal tract without causing transabdominal scarring. However, the main obstacle of NOTES is the security of the access site closure and as a reliable closure for transluminal access is not yet available, NOTES surgeries are still await to be perfected. On the other hand, a parallel development and attention is now focused on a procedure that can be readily be performed with similar cosmetic outcome: single-incision laparoscopic surgery.
Single-incision surgery has been given a panoply of acronyms and names such as single-incision laparoscopic surgery (SILS), single-port access (SPA) surgery, laparoscopic endoscopic single-site surgery (LESS) and embryonic natural orifice transumbilical endoscopic surgery (E-NOTES). In 2009, the Laparoendoscopic Single-Site Surgery Consortium for Assessment and Research (LESSCAR) was formed to serve as an international multidisciplinary ad hoc organization to advance the field of this single incision surgical technique. After extensive deliberations, LESSCAR unanimously concluded that the term laparoendoscopic single-site (LESS) surgery most accurately conveys the broad philosophical and practical aspects of the field.
Advantage of SinglePort Surgery / LESS
At this moment, the most accepted advantage of LESS surgery is cosmetic. Scar is hidden inside umbilicus, which make this laparoscopic surgery apparently “Scarless”. However, other advantages such as reduce wound pain, improve patents’ satisfactory or quality of life are all NOT proven. More research & studies are required to answer these questions.
Obstacle & Solutions
Since SILS procedures are relatively new and in evolution, many techniques have been described but no widely accepted standard exists. Because the primary benefit of SILS seems to be cosmetic, most agree that the umbilicus is the preferred site of entry. However, there are difficulties in performing this procedure through umbilicus. The 3 main difficulties are: 1. Close proximity of instrument; 2. Limitation of triangulation; 3. Inadequate exposure of surgical field (lack of retraction). With advance in technology and instrument designs, these obstacles will be overcome.
Future development and research
According to the LESSCAR suggestion, it is recommended that before a LESS procedure is performed, the surgeon should possess adequate standard laparoscopic experience, and preferably should have undergone a certain amount of LESS surgical training. At a minimum, this should include 1–2 dedicated days of stepwise structured training incorporating inanimate training models, ‘‘hands-on’’ animal training sessions, observation of clinical procedures, and performance of initial LESS surgeries in a mentored and proctored setting. Since the evidence of the superiority of LESS surgery is weak at the present moment, application of this new technique needs to be critical and selective. Papers and reports on this technique are encouraged, preferably with IRB based protocol and prospective database collection. Selective criteria are needed to be clearly defined and studies in comparing traditional laparoscopic technique versus LESS technique are needed.
日期:990716 9:30-10:30
主題:Live Surgery Demonstrate-SILS Sleeve Gastrectomy
主講人:Muffazal Lakadawa
簡歷：
Educational Qualifications:
Academic:
Masters in Surgery (M.S.), B.Y.L.NairHospital,University of Mumbai;Completed residencies for 3 years in general surgeryMBBS, University of Mumbai.
Professional:
Fellowship in Bariatric SurgeryWith Dr Raul Rosenthal,Cleveland Clinic, USA 2005
Fellow, Department of Bariatrics,With Dr Piet Pattyn, Head, Unit of Gastro Surgery.University of Ghent Hospital, Belgium 2005
Fellowship in Advanced LaparoscopicColorectal SurgeryWith Prof. Seon Hahn Kim, Seoul, Korea 2005
Teaching Faculty:
Lecturer at B.Y.L.NairHospital, one of the largest teaching hospitals in Mumbai.
Preceptor, Ethicon Institute of Surgical Education (EISE): conduct training for surgeonsall over the country twice a month on minimal access on solid organs.
Proctor for Covidien Asia Pacific Training Fellowships in Bariatric Surgery.
Training Yearly Fellowships in Minimal Access Surgery
Honours and Awards
'Humanitarian of the year' Awarded by the All India Human Rights Association' 2007.
Ranbaxy Award for Best Thesis at MS. Exams ‘Therapeutic Endoscopy in ObstructiveJaundice’.
Silver Medal at Shirin Mehtaji Oration – 1996 ‘Obstructive Jaundice.’Gold Medalist in Anatomy
大綱：
Live Surgery Demonstrate
日期:990716 10:30-11:30
主題:Live SurgeryDemonstrate-SILSPort Surgery
主講人:徐光漢
簡歷：
學歷：台灣大學醫學系
現職：敏盛綜合醫院一般外科主治醫師
經歷：亞東醫院台大代訓住院醫師
台大總醫師
大綱：
Live Surgery Demonstrate
日期:990716 11:30-12:30
主題:Live Surgery Demonstrate- SILS Metabolic Surgery
主講人:陳榮堅
簡歷：
學歷：中國醫藥學院醫學系
現職：敏盛綜合醫院一般外科主治醫師
經歷：恩主公醫院一般外科主治醫師
馬偕醫院一般外科總醫師
大綱：
Live Surgery Demonstrate
日期:990716 13:30-13:50
主題:Metabolic Surgery in Asia-Surgical Treatment of Diabetes.
主講人:Sayeed Ikramuddin
簡歷：
EDUCATION
Graduate:
7/86-6/90 AlbanyMedicalCollege, Albany, NY; M.D. 1990, Medicine
Undergraduate:
1984-1988 Union College, Schenectady, NY; B.S. 1988, Biology/History
POSTDOCTORAL TRAINING
7/96-6/97 Department of Surgery Fellow in Advanced Laparoscopic
OhioStateUniversity Surgery/W. Scott Melvin, MD
Columbus, Ohio
7/94-6/96 Department of Surgery Chief Resident Surgery/John Aust, MD
SUNYHealthSciencesCenter, Syracuse, NY
7/93-6/94 Department of Surgery Surgical Resident/John Halverson, MD
SUNYHealthSciencesCenter, Syracuse, NY
7/92-6/93 Department of Surgery Surgical Research Fellow/
SUNYHealthSciencesCenter, Division of Transplantation
Syracuse, NY Diane Tice, PhD
7/91-6/92 Department of Surgery Surgical Resident/John Halverson, MD
SUNYHealthSciencesCenter, Syracuse, NY
7/90-6/91 Department of Surgery Surgical Intern/John Aust, MD
SUNY Health Sciences Center, Syracuse, NY大綱：
10/01 – present Associate Professor of Surgery
Co-Director, Minimally Invasive Surgery
Director of Bariatric Surgery
University of MinnesotaMedicalSchool
Department of Surgery
7/98 – 9/01 Assistant Professor of Surgery, University of PittsburghSchool of Medicine,
Department of Surgery
2/98 – 6/98 Instructor in Surgery, Minimally Invasive Surgery
University of PittsburghSchool of Medicine, Department of Surgery
11/97 – 1/98 Visiting Instructor in Surgery, Minimally Invasive Surgery
University of PittsburghSchool of Medicine, Department of Surgery
ACADEMIC ADMINISTRATIVE APPOINTMENTS
2008 – present Medical Director, Operating Room, University of Minnesota Medical
Center, Fairview, Minneapolis, MN
2001 – present Co-Director, Minimally Invasive Surgery
Director of Bariatric Surgery
University of MinnesotaMedicalSchool, Department of Surgery
CLINICAL/HOSPITAL APPOINTMENTS
7/09-Present Medical Staff Privileges, FairviewMaple GroveMedicalCenter,
Maple Grove, MN
7/06-Present Operating Privileges, Abbott Northwestern Hospital, Minneapolis, MN
7/04-Present Operating Privileges, RegionsHospital, St. Paul, MN
11/01-Present Staff Physician
University of MinnesotaMedicalCenter, Fairview, Minneapolis, MN
3/99-2/03 Staff Physician
UPMCBeaverValley / AliquippaCommunityHospital, Aliquippa, PA
2/98-8/01 Chief of General Surgery
VA Pittsburgh Healthcare System, Pittsburgh, PA
2/98-10/01 Staff Physician
University of PittsburghMedicalCenter (UPMC), Pittsburgh, PA
大綱：
TYPE 2 DIABETES IS A SIGNIFICANT CLINICAL PROBLEM THAT HAS NO BORDERS. IT IS AN EPIDEMIC. DEVELOPMENT OF TYPE 2 DIABETES IS CLOSELY ASSOCICATED WITH WEIGHT GAIN. UNDERLYING THIS THERE MUST ALSO BE INSUFFICIENT BETA CELL RESPONSE TO GLUCOSE. PERIPERAL INSULIN RESISTANCE AND IMPAIRED GUT RESPONSE TO A MIXED MEAL ALSO CONTRIBUTE TO THE DEVELOPMENT OF TYPE 2 DIABETES. BARIATRIC SURGERY IN ANY FORM IS KNOWN TO IMPACT THE PREVALANCE OF TYPE 2 DIABETES. THE MOST PROFOUND IMPACT OCCURS IN PATIENTS THAT EXPERIENCE THE GREATEST WEIGHT LOSS. AN ADDITIONAL FACTOR THAT MUST BE CONSIDERED IS THE EFFECT OF INTESTINAL REARRANGEMENT ON INCRETIN SECRETION. IN PARTICULAR THERE IS A FOUR FOLD INCREASE IN THE INCRETIN RESPONSE TO A GLUCOSE CHALLENGE POST GASTRIC BYPASS COMPARED TO WEIGHT LOSS CONTROLS. THERE IS ALSO A CHANGE IN INTESTINAL HORMONAL RESPONSE IN PATIENTS WHO UNDERGO A BYPASS PROCEDURE COMPARED TO BANDING. THESE OBSERVATIONS HAVE MANY TO PROPOSE THAT SURGERY BE CONSIDERED FOR PATIENT WHO DO NOT MEET THE TRADITIONAL WEIGHT BASED NIH CRITERA FOR BARIATRIC SURGERY. THIS LECTURE WILL COVER THE IMPACT OF SURGERY ON MARKERS OF TYPE 2 DIABETES AND THE METABOLIC SYNDROME. MECHANISMS OF IMPROVEMENT WILL BE DISCUSSED.
日期:990716 13:50-14:10
主題:Metabolic Surgery in Asia- Experience from lndia
主講人:Muffazal Lakdawala
簡歷：
Educational Qualifications:
Academic:
Masters in Surgery (M.S.), B.Y.L.NairHospital,University of Mumbai;Completed residencies for 3 years in general surgeryMBBS, University of Mumbai.
Professional:
Fellowship in Bariatric SurgeryWith Dr Raul Rosenthal,Cleveland Clinic, USA 2005
Fellow, Department of Bariatrics,With Dr Piet Pattyn, Head, Unit of Gastro Surgery.University of Ghent Hospital, Belgium 2005
Fellowship in Advanced LaparoscopicColorectal SurgeryWith Prof. Seon Hahn Kim, Seoul, Korea 2005
Teaching Faculty:
Lecturer at B.Y.L.NairHospital, one of the largest teaching hospitals in Mumbai.
Preceptor, Ethicon Institute of Surgical Education (EISE): conduct training for surgeonsall over the country twice a month on minimal access on solid organs.
Proctor for Covidien Asia Pacific Training Fellowships in Bariatric Surgery.
Training Yearly Fellowships in Minimal Access Surgery
Honours and Awards
'Humanitarian of the year' Awarded by the All India Human Rights Association' 2007.
Ranbaxy Award for Best Thesis at MS. Exams ‘Therapeutic Endoscopy in ObstructiveJaundice’.
Silver Medal at Shirin Mehtaji Oration – 1996 ‘Obstructive Jaundice.’Gold Medalist in Anatomy
大綱：
Obesity Surgery Society of India (OSSI). It is affiliated to the International Federation for theSurgery of Obesity (IFSO). It promotes guidelines for the management of obesity and relateddiseases which are relevant to the Indian subcontinent. OSSI also lays down the guidelinesfor accreditation of centres of excellence and training of surgeons in bariatric surgery. OSSItook it up as a mission to increase awareness about obesity and its related diseases in India.The society organises regular programmes and meetings with general public as well assurgeons to further their knowledge about bariatric surgery. The society encourages a holisticapproach for the treatment of obesity.
日期:990716 14:10-14:30
主題:Metabolic Surgery in Asia- Experience from Korea
主講人:Kyung Yul Hur
簡歷：
Education :
Mar.1978 - Feb.1984 : M.D. degree from Soonchunhyang University College of Medicine
Mar.1987 - Feb.1989 : Master degree from SoonchunhyangUniversity Graduate school.
Mar.1992 - Feb.1995 : Ph.D. degree from Soonchunhyang University Graduate school.
Appointment :
Intern, SoonchunhyangUniversityHospital March, 1984
Resident, SoonchunhyangUniversityHospital March, 1985
Fellow, Dept. of Surgery, SoonchunhyangUniversityHospital March, 1992
Instructor, Dept. of Surgery, SoonchunhyangUniversityHospital March, 1995
Assistant professor, Dept. of Surgery, SoonchunhyangUniversityHospital March,1997
Associate professor, Dept. of Surgery, SoonchunhyangUniversityHospital March,2001
Head, Laproscopic bariatric and hernia center, HansolHospital September,2003
Professor, Dept. of Surgery, SoonchunhyangUniversityHospital March,2007
大綱：
Backgrounds: Laparoscopic mini-gastric bypass (MGB) in morbidly obese patients with type 2 diabetes mellitus (T2DM) was proved to be effective in numerous literatures. T2DM in eastern Asia tend to occur in patients with relatively lower body mass index(BMI) compared to patients in western countries since they are more prone to central obesity, and secretory function of pancreatic beta-cells are markedly decreased early in diabetes. Treatment outcomes of laparoscopic MGB for non-obese T2DM patients are also expected to be outstanding, but no data has been reported. This is a prospective pilot study to evaluate the efficacy and availability of laparoscopic MBG for T2DM patients with BMI<30kg/m2.
Methods and Materials: This study was approved by our institutional review board for human investigation. A total of 39 patients were scheduled for laparoscopic MGB at SoonchunhyangUniversityHospital from August of 2009 to April of 2010. All patients were diagnosed as T2DM by definition of American Diabetes Association (ADA), with plasma C-peptide level higher than 1ng/ml. Thirty-five out of 39 patients were BMI<30kg/m2 and 12 patients were BMI<25kg/m2. Preoperative data including glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour post prandial glucose (2-hr PPG), and fasting plasma C-peptide were compared with data at 1st, 3rd, and 6th postoperative months respectively. Under general anesthesia, the patient was placed in supine French position. After vertical gastroplasty along the lesser curvature, small intestine 200cm distal from ligament of Treitz was anastomosed with preformed gastric tube in Billroth II fashion, bypassing gastric antrum, duodenum, and proximal jejunum consequently. An anchoring suture was laid between middle portion of the gastric tube and afferent limb attaining acute angulation of the afferent limb, and simultaneously maintaining a parallel line between the long gastric tube and efferent limb. At the end of operation, diameter of anastomosis was evaluated through intraoperative gastroscpe, followed by air leak test and blue dye test to identify anastomosis leakage. Upper gastrointestinal (UGI) gastrografin test and blue dye test was done on 1st postoperative day, and clear liquid diet was resumed after confirmation of negative anastomosis leakage.
Results: Among 35 patients of BMI<30kg/m2, 19 patients were female (54.3%), mean age was 46.5 years-old (range, 23-67), and mean BMI was 25.4 kg/m2 (range, 19.6-29.8). Mean preoperative HbA1c was 9.8% (range 6.3-15.4), mean FPG, and 2-hr PPG was 212mg/dl (range 115-403), and 337mg/dl (range 154-533), respectively. Mean preoperative C-peptide was 2.59ng/ml (range, 1.05-5.17). Mean operative time was 103.3 minute (range, 80~120), and every patients resumed diet on 1st postoperative day with discontinuing medical treatment including oral hypoglycemic agents or insulin, and no major postoperative complications occurred. Six months follow up data were available in 10 patients – FPG, 2-hr PPG was decreased to 143.9mg/dl, and 192.7mg/, respectively. Mean HbA1c has decrease to 6.9%. All the other patients showed decreased tendency in plasma glucose.
Conclusions: This is the preliminary report focused on treatment effect of laparoscopic MGB in T2DM patients with BMI less than 30kg/m2 in Korea. HbA1c, FPG, and 2-hr PPG decreased by 6th postoperative months, without any major postoperative complications, showing promising outcomes. Further studies are required to determine late postoperative complications or cure of diabetes.
日期:990716 14:30-14:50
主題:Metabolic Surgery in Asia- Experience from Hong Kong
主講人:Mui Lik Man, Wilfred
簡歷：
學歷：Chinese University of Hong Kong, Medicine
現職：Hong Kong Bariatric, medical director
Chief, bariatric and metabolic surgery at Evangel and Union Hospital of Hong Kong
經歷：surgical fellow , laparoscopic and obesity surgery at the JohnsHopkinsHospital
大綱：
In year 2001-2002, he went overseas training on advanced laparoscopic and obesity surgery at the JohnsHopkinsHospital as surgical fellow. His main interests are advanced laparoscopic, bariatric and metabolic surgery. He pioneered the use of intragastric balloon, laparoscopic gastric banding, laparoscopic sleeve gastrectomy and bypass surgery to treat obesity and diabetes in Hong Kong and he is the official trainer of intragastric balloon in Asia-Pacific region.
日期:990716 14:50-15:10
主題:Metabolic Surgery in Asia- Experience from Japan
主講人:Kazunori Kasama
簡歷：
學歷：GunmaUniversity, School of Medicine
現職：Director of Weight Loss Surgery, Minimally Invasive SurgeryCenter, Yotsuya Medical CubeTokyo, Japan
Clinical assistant professor of Tohoku University, Department of Surgery
Clinical assistant professor of GunmaUniversity, Department of Emergency medicine
Clinical assistant professor of Shiga Medical University, Department of Surgery
經歷：1990 Dept of Anesthesiology, Gunma University
1993 Dept of Traumatology and Emergency medicine, OsakaUniversity
1994 Senior Resident, Dept of Surgery, KamedaMedicalCenter
1997 Staff , Dept of surgery, KamedaMedicalCenter
2000 Assistant Director, Dept of Surgery, KamedaMedicalCenter
2001 Director, Dept of Surgery, HorieHospital
2006 Director of Weight Loss Surgery, Minimally Invasive SurgeryCenter, Yotsuya Medical Cube
大綱：
Result of bariatric surgery is well known in western countries. But bariatric surgery is still immature in Asia and effect to Asian population is unclear. We studied deference between Japanese and non- Japanese on results of bariatric surgery under the same protocol. It reveals that the liver dysfunction and diabetes among Japanese patients with morbid obesity tends to be worse than in non-Japanese patients when the BMI is similar. LRYGB have a same effect to both Japanese and non-Japanese patients. From this study, bariatric surgery for Japanese can be expected to have same results with western population
Gastric cancer is one of the frequent diseases on which to perform treatments in some countries in Asia as Korea, China and Japan. One of the problems of LRYGB is bypassed stomach which is not easy to be examined by common methods.
Laparoscopic Sleeve Gastrectomy (LSG) is emerging procedure, without bypassed stomach, and thought be one of good options as single procedure for Asian population. Confining group to BMI less than 50, %EWL of LSG is good enough as LRYGB in my Japanese series. But regarding anti-diabetic effect, cure rate after LRYGBP was better than that of LSG for Japanese. There is a particularity of Asian T2DM. It is suggested that impaired early-phase insulin secretion may be the initial abnormality in the development of glucose intolerance in Japanese people
We introduced Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG/DJB) for patients with severe T2DM since 2007. Data regarding weight loss were similar to our results for laparoscopic Roux-en-Y gastric bypasses. There was no mortality. No dumping, stenosis or marginal ulcer was observed during postoperative follow-up. Postoperative 75g OGTT reveals that LSG/DJB can improve not only Insulin resistance but also early-phase insulin secretion.
For Asian, LSG would be a good bariatric surgery. But for the patients with severe T2DM, adding DJB can achieve extremely good result of T2DM resolution. We suggest making a careful choice of candidate for these procedures.
日期:990717 9:10-9:35
主題:Section I Medical Aspect-Gut hormone update
主講人: Chih-Yen Chen
簡歷：
Education:
1992 M.D. / School of Medicine, TaipeiMedicalUniversity, Taipei, Taiwan2006 Ph.D. / Institute of Clinical Medicine, School of Medicine, NationalYang-MingUniversity, Taipei, Taiwan
Postdoctoral Training:
1999-2001 / The Brain-Gut Interaction Laboratory, CURE / DDRC & UCLA, Los Angeles, California, USAAcademic Appointment
1998 / Lecture of Medicine, NationalYang-MingUniversitySchool of Medicine, Taipei, Taiwan2003 / Assistant Professor of Medicine, NationalYang-MingUniversitySchool of Medicine, Taipei, Taiwan
2008 / Associate Professor of Medicine, NationalYang-MingUniversitySchool of Medicine, Taipei, Taiwan
Medical Association