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Introduction: Twelve years have elapsed since the introduction of laparoscopic colorectal surgery in Korea. It would be a meaningful work to remind the past of laparoscopic colorectal surgery in Korea, discuss the current status and plan its future. First of all, we want to review related journals published in Korea during the past 12 years and secondly, analyze the results of a survey research from the members of the Korean Society of Coloproctology and the Korean Laparoscopic Colorectal Surgery Study Group. Finally, we would like to present current activities carried out by the Korean Laparoscopic Colorectal Surgery Study Group and discuss the future of laparoscopic colorectal surgeons. Related Journals: The first Korean surgeon who performed laparoscopic colon resection was Prof. Jae-Gahb Park from the Seoul National University in March 1992, reported in the Journal of the Korean Society of Coloproctology in March of 1993. A comparative study between open and laparoscopic colorectal resections was published in May of 1997 by Drs. Won-Kyung Kang, Jun-Gi Kim et al.. Since then, 21 papers were published, being 7 of them, case reports. The remainder papers analyzed less than 30 patients in average, with the exception of three papers which analyzed more than 50. Three papers were comparative studies and the remainder, simple analytic studies. Seven papers included benign and malignant conditions; two, only benign diseases; and five, only malignant ones. Types of surgery ranged from abdominal-perineal resection to right hemicolectomies, including almost all colorectal procedures, being the most frequent ones low anterior resection, anterior resection and right hemicolectomies. Extended right hemicolectomies and transverse colectomies were rarer. Resections of cancer were performed in all pathological stages; however, stages II and III were more common. Operative time was longer for the laparoscopic group in all 3 papers. Conversion rates were less than 10% for most of the papers. Most frequent reasons for conversion were adjacent organ invasions and severe adhesions.Advantages of the laparoscopic surgery such as reduced postoperative pain, less incidence of ileus, and shortened length of hospital stay were numerically better for the laparoscopic group, but no statistical significance reached. This might be owing to the small patient number. Reported morbidity rate was from 5 to 19.2%, similar to the open group and also similar to the international reports. Postoperative mortality rate was 0%. The appropriateness of laparoscopic surgery for colorectal cancers was discussed in 6 papers, being the surgical margin and the number of collected lymph nodes, the criteria for the decision. In this sense, there was no difference between the two groups. After a follow-up period of 14 to 45 months, local recurrence rate was 5∼10% and systemic recurrence rate, 5∼13.3%. No report of port site recurrence was observed. None has mentioned the survival rate; however, it is expected to be published soon. Results of the Survey Research: Two surveys were conducted. The first one was conducted between April and May of 2003, which was mailed to 824 members of the Korean Society of Coloproctology. Among those, 161 replies returned. 34.8% of the responders said that they had experience with laparoscopic colorectal surgery. And among those, 17 surgeons have had more than 30 laparoscopic colorectal surgeries. The second one, directed to the members of the Korean Laparoscopic Colorectal Surgery Study Group, was conducted in March of 2004. Forty-two colorectal surgeons were involved and among those, 26 surgeons had personal experience as operator. Total number of patients operated was 2,526. Twenty-one surgeons (80.8%) had experienced more than 20 cases. Current Status of the The Korean Laparoscopic Colorectal Surgery Study Group: This study group was founded in Nov. 24, 2000 with the following purposes 1) interchange surgical skills and pertinent information, 2) standardize surgical techniques, 3) conduct prospective multicenter studies, and 4) divulging laparoscopic colorectal surgery. Ten founding members started with this project, and in August of 2002, this group was recognized as one of the study groups dependent of the Korean Society of Coloproctology. Currently, 42 surgeons from 27 different hospitals were involved with this study group. The first meeting was carried out in January of 2001 at the St. Vincent´s Hospital, The Catholic University of Korea. There were 9 meetings until the end of 2003, being quatrimestral in character. Main activities of this meeting had been video presentation of laparoscopic cases, special lectures and discussions. These meetings were a place of interchange of surgical skills and knowledge. In July of 2003, protocol was made for a prospective multicenter conjoined study. And in April of 2004, the homepage was opened and the protocol was released online. Since 2004, live surgery symposium is organized bimonthly in order to standardize surgical skills. Future of Laparoscopic Colorectal Surgery in Korea: Since 1993, a reduced group of Korean surgeons strove to divulge laparoscopic colorectal surgery in our difficult medical environment and to date of this writing there are 21 surgeons who performed more than 20 laparoscopic colorectal resections and 17 surgeons, more than 30. If we strive to standardize surgical skills through live surgery symposium during this current year, there will be more and more surgeons who overcome the learning curve of 20 to 30 laparoscopic colorectal resections. The release of online protocol will provide the opportunity to conduct a well-designed prospective randomized multi-center trial which would produce a great impact in the laparoscopic society, stimulating the widespread of this advantageous technique.
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