Surgery In Korea Research Articles

Analysis of the Legal Effect of Settlement Agreements Prepared in Medical Litigation Following Plastic Surgery in Korea.

BackgroundSettlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements.MethodsData from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed.ResultsAmong the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount.ConclusionsWhen preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.

Trends of thromboprophylaxis and complications after major lower limb orthopaedic surgeries in Korea: National Health Insurance Claim Data

BackgroundIn Western countries, prophylaxis for venous thromboembolism (VTE) following major lower limb orthopaedic surgeries is recommended. However, that has not been the case in Asian countries, where the reported incidence of postoperative VTE has been low. The present study examined trends in VTE prophylaxis prescriptions and related complications following major lower limb orthopaedic surgeries in South Korea. Design/ParticipantsUsing claim data from the National Health Insurance Corporation, 263,664 patients aged 65years or older who underwent major orthopaedic surgeries (total hip arthroplasty [THA], total knee arthroplasty [TKA], or hip fracture surgery [HFS]) between 2008 and 2012 were included. ResultThe prescription rate for VTE prophylaxis has increased from 62.4% in 2008 to 75.4% in 2012 (P<0.001). The prescription rate for new oral anticoagulants following THA and TKA has increased drastically since 2010, while that following HFS has not. Instead, prophylactic use of aspirin or low molecular weight heparin has increased in HFS cases. The rate of postoperative complications has significantly increased annually only in HFS: VTE (P=0.018) and brain haemorrhage or gastrointestinal bleeding (P=0.019). ConclusionThis result could suggest the need for more studies about the use of VTE prophylactic medicines following HFS.

Postoperative Helicobacter pylori Infection as a Prognostic Factor for Gastric Cancer Patients after Curative Resection.

Background/AimsFew studies have evaluated the effect of Helicobacter pylori infection on the prognosis of patients diagnosed with gastric cancer (GC) after curative surgery. We investigated the association between the H. pylori infection status and clinical outcome after surgery.MethodsWe assessed the H. pylori status of 314 patients who underwent curative resection for GC. The H. pylori status was examined using a rapid urease test 2 months after resection. Patients were followed for 10 years after surgery.ResultsAn H. pylori infection was observed in 128 of 314 patients. The median follow-up period was 93.5 months. A Kaplan-Meier analysis indicated that patients with H. pylori had a higher cumulative survival rate than those who were negative for H. pylori. Patients with stage II cancer who tested negative for H. pylori were associated with a poor outcome. In a multivariate analysis, H. pylori-negative status was a significant independent prognostic factor for poor overall survival.ConclusionsHaving a negative H. pylori infection status seems to indicate poor prognosis for patients with GC who have undergone curative resection. Further prospective controlled studies are needed to evaluate the mechanism by which H. pylori affects GC patients after curative surgery in Korea.

Minimally Invasive Surgery for Rectal Cancer: Current Status and Future Perspectives.

Although laparoscopic resection for colon cancer has been proven safe and feasible when compared with open resection, currently no clear evidence is available regarding minimally invasive surgery for rectal cancer. This type of surgery may benefit patients by allowing fast recovery of normal dietary intake and bowel function, reduced postoperative pain, and shorter hospitalization. Therefore, minimally invasive surgeries such as laparoscopic or robot surgery have become the predominant treatment option for colon cancer. Specifically, the proportion of laparoscopic colorectal cancer surgery in Korea increased from 42.6 to 64.7% until 2013. However, laparoscopic surgery for rectal cancer is more difficult and technically demanding. In addition, the procedure requires a prolonged learning curve to achieve equivalent outcomes relative to open surgery. It is very challenging to approach the deep and narrow pelvis using laparoscopic instruments. However, robotic surgery provides better vision with a high definition three-dimensional view, exceptional ergonomics, Endowrist technology, enhanced dexterity of movement, and a lack of physiologic tremor, facilitated by the use of an assistant in the narrow and deep pelvis. Recently, an increasing number of reports have compared the outcomes of laparoscopic and open surgery for colon cancer. Such reports have prompted a discussion of the outcomes of minimally invasive surgery, including robotic surgery, for rectal cancer. The aim of this review is to summarize current data regarding the clinical outcomes, including oncologic outcomes, of minimally invasive surgery for rectal cancer.

Metabolic Surgery in Korea: What to Consider before Surgery.

Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m2), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m2) and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.

National Trends in Surgery for Rotator Cuff Disease in Korea.

The objective of this study was to investigate the national trends in rotator cuff surgery in Korea and analyze hospital type-specific trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2007 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes, procedure codes, and arthroscopic device code were used to identify patients who underwent surgical treatment for rotator cuff disease. A total of 383,719 cases of rotator cuff surgeries were performed from 2007 to 2015. The mean annual percentage change in the age-adjusted rate of rotator cuff surgery per population of 100,000 persons rapidly increased from 2007 to 2012 (53.3%, P < 0.001), while that between 2012 to 2015 remained steady (2.3%, P = 0.34). The proportion of arthroscopic surgery among all rotator cuff surgeries steadily rose from 89.9% in 2007 to 96.8% in 2015 (P < 0.001). In terms of hospital types, the rate of rotator cuff surgery increased to the greatest degree in hospitals with 30–100 inpatient beds, and isolated acromioplasty procedure accounted for a larger proportion of the rotator cuff surgeries in small hospitals and clinics compared to large hospitals. Overall, our findings indicate that cases of rotator cuff surgery have increased rapidly recently in Korea, of which arthroscopic surgeries account for the greatest proportion. While rotator cuff surgery is a popular procedure that is commonly performed even in small hospitals, there was a difference in the component ratio of the procedure code in accordance with hospital type.

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013.

BackgroundThe purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery.MethodsData analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013.ResultsThere is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high.ConclusionPolicies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea

BackgroundCoronary angioplasty has been replacing coronary artery bypass grafting (CABG) because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD) countries, Korea has experienced a rapid increase in coronary angioplasty volumes.MethodsWe analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI) from three sources: the OECD Health Data, the National Health Insurance Service (NHIS) surgery statistics, and the National Health Insurance claims data.ResultsWe found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013.ConclusionWe found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

Effects of Changing Gloves, Forceps and Normal Saline during Colon Cancer Surgery in Korea

Objectives: This study was conducted to investigate the effects of exchanging surgical gloves, forceps and the normal saline during surgeries in lowering the level of the contamination. Methods/Statistical Analysis: 92 colon cancer surgeries were randomly allotted into one of four groups. Three different methods were tried: changing gloves in the experimental Group 1, changing forceps in the Experimental Group 2, changing normal saline used for operation in the Experimental Group 3 and no changing any materials with the standard operation method in the control group. After each operation finished, samples were taken and cultured for obtaining the contamination rate. Findings: Study results were as follow: the level of contamination in the experimental group 1 with exchanging gloves after extraction of the lesions of colon was significantly lower than that of the Control Group-Gloves. The method of exchanging the normal saline also demonstrated the effectiveness in lowering the level of contamination of the normal saline. The effectiveness of exchanging forceps was proved as the level of contamination in the experimental group 3 used the method of exchanging the forceps was significantly lower than the control group. Applications: These findings can be utilized as the evidenced foundation to establish the theoretical guidelines or the standards of practice for the surgical instruments to control the surgical site infection effectively.

Minimally Invasive Spine Surgery in Korea - A Neurosurgeon’s View -

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921–1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book.

A Thoracic Surgical Case Presented at the First Academic Meeting of the Chosun (Korean) Medical Association Held in 1947.

The late Prof. Kyeok Boo Han (1913–2005) was one of the pioneers in the early stages of the establishment of thoracic surgery in Korea. He was in charge of thoracic surgery at Seoul National University Hospital from 1948 to the outbreak of the Korean War in 1950. He presented a thoracic surgical case entitled “Adhesive (constrictive) pericarditis: one surgical case” at the first academic meeting of the Chosun (an old name for Korea) Medical Association, held in 1947. This presentation is considered to be the first thoracic surgical case presented by a Korean surgeon at a domestic medical meeting after the National Liberation from Japanese colonial rule in 1945. In this regard, this study was intended to analyze the content and the meaning of the case, published in a journal in 1948.

Clinical innovations in minimally invasive surgery in Korea.

Over the past decade, the surgical approach to treating thoracic disease has shifted to minimally invasive surgery. Without compromising the outcomes, this approach may lead to fewer resections and fewer incisions for those resections. Video-assisted thoracoscopic surgery (VATS) is a recent but major advancement that has become an established approach for major thoracic surgery. More recently, robotic surgery has been gaining recognition because it can overcome the limitations of VATS and encourage a minimally invasive approach. Indications and applications of many other innovative surgical techniques and strategies to improve overall survival have expanded rapidly. In this article, we do not represent all thoracic surgeries occurring in Korea and do not reflect the large active centers in the country. However, as one of the most innovative and active Korean centers for thoracic surgery and research, we reviewed our procedures and programs for thoracic surgery.

Natural Orifice Transluminal Endoscopic Surgery in Korea

Natural orifice transluminal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgical techniques with flexible endoscopy technology. Surgical treatment has been in constant evolution in the search for minimizing incisions, regardless of the complexity of the operation. NOTES represents another step in this ongoing progression toward less invasive procedures. The advantages of such an approach include reduced incisional pain, decreased wound complications, such as infections and hernias, improved cosmetic results, and potentially faster recovery and return to work. Until substantial improvement in NOTES instrumentation are made to optimize this approach, these procedures are likely to require laparoscopic assistance. Critics challenge the safety and advantages of this technique in the face of effective minimally invasive surgical options such as laparoscopic surgery. Here, we discuss the current NOTES status and techniques.

MP42-01 ANALYSIS OF PRESENT STATUS FOR SURGERY OF BENIGN PROSTATIC HYPERPLASIA IN KOREA, 2010 TO 2014

INTRODUCTION AND OBJECTIVES: There are no established evidence of comparing efficacy and safety between surgical methods of benign prostatic hyperplasia (BPH). This study investigated the present status related BPH surgery in Korea during five years. METHODS: County level data from the National Health Insurance Service and National Statistical Office was analyzed in this ecological study. The trend of number of BPH related surgery was analyzed and age, geographic distribution and assortclassification of hospital were also reviewed. RESULTS: There are not much change of total number of BPH related surgery during five years. Although, there is not much alteration in the number of conventional transurethral resection of prostate (TURP), the number of holmium laser prostate surgery (HOLEP) is dramatically increased. The number of HOLEP overtake the number of KTP laser after 2011 and it is anticipated that the gap will be arise. In the analysis of age, BPH related surgery is increased according to years in seventy while it is decreased in fifty and sixty. Meanwhile, after 2012, the number of BPH related surgery is decreased in local clinics, but it is increased in large hospital in metropolitan and it may be related with the increased number of HOLEP. In the analysis of geographical distribution, an uneven distribution according to country characteristics (metropolitan cities vs. nonmetropolitan cities) was showed. CONCLUSIONS: Through the data of the National Health Insurance Service, we could apprehend the present status of BPH related surgery in Korea. Then, we could know about the trend according to several factors and we think it is valuable results as academic references as well. Source of Funding: none

Cataract and Cataract Surgery: Nationwide Prevalence and Clinical Determinants.

This study aimed to investigate the prevalence and clinical determinants of cataract and cataract surgery in Korean population. The 2008–2012 Korean National Health and Nutrition Examination Survey was analyzed, which included 20,419 participants aged ≥ 40 years. The survey is a multistage, probability-cluster survey, which can produce nationally representative estimates. Prevalence of cataract and cataract surgery was estimated. Clinical determinants for those were investigated using logistic regression analyses (LRAs). The prevalence of cataract was 42.28% (95% confidence interval [CI], 40.67–43.89); 40.82% (95% CI, 38.97–42.66) for men and 43.62% (95% CI, 41.91–45.33) for women (P = 0.606). The prevalence of cataract surgery was 7.75% (95% CI, 7.30–8.20); 6.38% (95% CI, 5.80–6.96) for men and 9.01% (95% CI, 8.41–9.61) for women (P < 0.001). Cataract was associated with older age (P < 0.001), men (P = 0.032), lower household income (P = 0.031), lower education (P < 0.001), hypertension (P < 0.001), and diabetes mellitus (DM) (P < 0.001). Cataract surgery was consistently associated with older age, occupation, DM, asthma, and anemia in two LRAs, which compared participants with cataract surgery to those without cataract surgery and those having a cataract but without any cataract surgery, respectively. Hypertension, arthritis, and dyslipidemia were associated with cataract surgery at least in one of these LRAs. These results suggest that there are 9.4 million individuals with cataract and 1.7 million individuals with cataract surgery in Korea. Further studies are warranted to reveal the causality and its possible mechanism of developing/exacerbating cataract in novel determinants (i.e., anemia, asthma, and arthritic conditions) as well as well-known determinants.

Tradition and Future of the Korean Society of Plastic and Reconstructive Surgeons.

Current day Hallyu (Korean wave) culture is rapidly spreading throughout Asia and the world, moving from the periphery of global culture towards the center. 'Plastic Surgery Hallyu' has joined K-pop, TV dramas, dancing, and food as one of the pillars of the Hallyu craze, and the Korean Society of Plastic and Reconstructive Surgeons (KSPRS) is showing the its outstanding results in both surgery and research. In 2015, The Washington Post published a portrayal of plastic surgery in Korea, saying that Korea is the plastic surgery capital of the world [1]. In 2016, KSPRS will welcome the 50th anniversary of its founding. The inaugural assembly of the Korean Society of Plastic and Reconstructive Surgeons was held on May 15, 1966, initiated by around thirty professional doctors interested in the field of plastic surgery, including general surgeons, orthopedic surgeons, otorhinolaryngologists, and ophthalmologists, with Yonsei University's School of Medicine playing a key role. After this, a specialized training system was implemented in 1973, and Korea produced its first plastic surgeon specialist in 1975 [2]. Developing during the 60's and 70's into the 'Miracle on the Han River', South Korea's economy grew with dazzling speed, and this was accompanied with similarly dazzling developments in Korea's plastic surgery field. In just the short period since its founding, KSPRS has developed dynamically, growing into a large professional organization with over two thousand members. We have become the third largest such organization for plastic surgeons in the after those in the United States and Brazil [3]. In addition, we have entered into a formal partnership with the American Society of Plastic Surgeons (ASPS), and in 2013, we participated in the ASPS's annual scientific meeting as a guest nation. The official journal of KSPRS is the Archives of Plastic Surgery (Arch Plast Surg, APS). A Korean-language journal with the title Journal of the Korean Society of Plastic and Reconstructive Surgeons began being published in 1974, and in 2012, after the name change that accompanied its transition to being produced in English, it started being published six times yearly. A peer-reviewed journal, APS is currently indexed and tracked in the PubMed, PubMed Central, CrossRef, Scopus, Embase, and Google Scholar databases. There have been tangible results achieved during the four years since this transition to English, and we are devoted to striving to become more than just the representative journal of Korea, but the highest quality journal for plastic surgery in the Asia-Pacific region. As part of this effort, we continue to work hard to achieve indexing in the Science Citation Index Expanded (SCIE). APS will play a central role in the development of KSPRS's clinical scholarship [4,5]. Since its founding, KSPRS has held an annual conference. The 20th anniversary of its founding in 1986 saw the invigoration of scholarly activity, which resulted in an additional spring conference held every year, and as of the 30th anniversary, an integrated scholarly conference has been held in tandem with affiliated conferences of the Korean Society for Surgery of the Hand and the Korean Society for Aesthetic Plastic Surgery. Through these many years of dedicated work, the scholarly conference has become an international event, providing a steady foundation for advancing Korea's practice of plastic surgery onto the world's stage. In commemoration of the 50th anniversary of KSPRS's founding, PRS Korea 2016 is scheduled to take place November 17–20. Under the slogan '50 Years: Beginning of a New Era', we will invite many distinguished foreign scholars to the meeting and share recent advances and techniques. Looking back at the history of KSPRS, we can understand our present position and can prepare for tomorrow's work. KSPRS will begin the work needed to plan its vision and put forward its future core values in order to become an organization that can continue in the footsteps of its 50-year tradition. Moving forward, KSPRS will expand its international footing and revitalize international exchange. We will take steps to further expand our participation and exchange with leading international societies through meetings such as the Global Leadership Forum. We will work hard to further raise the international status of KSPRS by expanding opportunities for presenting at international conferences and by finding and fostering outstanding members. Through continued dedication, we will do everything possible to become the vanguard, taking the lead in the global era of plastic and reconstructive surgery, as we continue with our contribution to the development of the field of medicine.

Nationwide Survey on Bariatric and Metabolic Surgery in Korea: 2003-2013 Results.

A survey to evaluate the current status of bariatric and metabolic operations in Korea was conducted. Data from 5467 cases (32 hospitals) were collected. The annual numbers of bariatric and metabolic operations increased each year, from 139 in 2003 to 1686 in 2013. Adjustable gastric band (AGB, 67.2 %) was the most common operation, followed by sleeve gastrectomy (SG, 14.2 %), and Roux-en-Y gastric bypass (RYGB, 12.7 %). Mean patient age and body mass index (BMI) were 35.4 years and 35.9 kg/m2, respectively. In-hospital morbidity and mortality rates were 6 % (114/2305) and 0.25 % (5/2176), respectively. In Korea, AGB was the most common operation because of the availability and activity of specialized bariatric clinics. These national survey results established a baseline for future data collection.

Current Trend of Robotic Thoracic and Cardiovascular Surgeries in Korea: Analysis of Seven-Year National Data.

BackgroundRobotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea.MethodsData from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study.ResultsOf the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery.ConclusionTrend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed.

Current Status of Laparoscopic Metabolic/Bariatric Surgery in Korea

Bariatric surgery is considered the most effective treatment modality for treatment of obesity and related comorbid conditions. Bariatric surgery was introduced in the early 1950s. However, the bariatric “revolution” occurred during the late 1990s and early 2000s, which led to an exponential increase of bariatric procedures performed. This phenomenon occurred because of three events: the rapid increase of obesity rate, the introduction of laparoscopic technique, and the role of the mass media, including the internet. In Korea, surgery for obesity started in Jan. 2003 when the first laparoscopic sleeve gastrectomy was performed by Won Woo Kim (from The Catholic University of Korea). During the same year, laparoscopic gastric bypass was performed by several surgeons at 3 different institutions. Seung Ho Choi from Yonsei University, Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea, and Kyung Yul Hur (mini-gastric bypass) from Hansol Hospital performed gastric bypass laparoscopically. The next year, LAP-BAND ® device was approved by KFDA and the first laparoscopic adjustable gastric banding was performed by Eung Kook Kim and Sang Kuon Lee from The Catholic University of Korea in Aug. 2004. In 2009, a new procedure, the duodenojejunal bypass, was first introduced in Korea, mainly for metabolic purpose. This procedure was performed by three surgeons in three different institutions, Eung Kook Kim from The Catholic University of Korea, Seung Ho Choi from Yonsei University, and Yoon Seok Heo from Inha University. In 2011, the first robotic-assisted gastric bypass was performed by Do Joong Park from Seoul National University. In 2009, the Korean Society for Metabolic and Bariatric Surgery (KSMBS) was founded and in 2012, it became an official member of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).