Objective:To investigate the hidden blood loss (HBL) and risk factors of uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) for patients with lumbar spinal stenosis (LSS).Methods:Patients with single-segment LSS who underwent UFE-ULBD from a single orthopedic center were retrospectively analyzed between Aug.2021 and Jun.2023. The general data of patients such as age, gender, body mass index, history of smoking and drinking, medical comorbidities, preoperative anemia, American Society of Anesthesiologists physical status classification; surgical data such as surgical segment, Schizas classification of spinal stenosis, anesthesia method, operation time, intraoperative crystal fluid/colloid infusion volume; and radiological parameters such as paraspinal muscle ratio, angle of facetectomy, decompression ratio of disc-flava ligament space, decompression ratio of osseous lateral recess, superior articular process interval enlargement ratio, lamina interval enlargement ratio, dural sac cross-sectional area and enlargement ratio were also measured.Results:Fifty-six patients (26 males and 30 females) were retrospectively enrolled in this study. The mean operation time was 97.2±45.2 minutes, the mean total blood loss was 235.0±188.5 ml, and the mean HBL was 190.7±184.3 ml, accounting for 66.1% of total blood loss. These patients were divided into HBL positive group (HBL≥470 ml) and HBL negative group (HBL<470 ml). There were significant differences between the two groups in preoperative bilateral lamina interval (P=0.002), postoperative bilateral lamina interval enlargement ratio (P=0.021), preoperative dural sac cross-sectional area (P=0.009) and postoperative dural sac cross-sectional area enlargement ratio (P=0.013) at the surgical level. Logistic regression analysis suggested postoperative dural sac cross-sectional area enlargement ratio at the surgical level (OR=3.889, P=0.042) was the potential risk of HBL.Conclusions:HBL was significant in LSS patients who underwent UFE-ULBD. And postoperative dural sac cross-sectional area enlargement ratio at the surgical level might be potential risk of HBL.
Objective:To summarize the preliminary experience and key points of the application of completely visualized cavity construction technique in the posterior sheath approach single incision laparoscopic totally extraperitoneal hernia repair (SIL-TEP).Methods:Retrospective analysis of the clinical data of 30 cases of posterior sheath approach SIL-TEP from Jan. 2023 to Apr. 2023.Results:The peritoneum injury occurred in 1 patient (3.3%) when establishing the cavity. The bleeding volume was (9.50±2.40) ml. The operation time was (61.04±15.11) min on one side and (80.83±16.25) min on two sides. The time from skin cutting to device insertion was (120.77 ± 17.16) sec. The time to enter the space behind the posterior sheath was (249.67 ± 66.71) sec. The postoperative pain visual analogue score was (2.57 ± 0.73) at 24 hours and (1.97 ± 0.56) at 48 hours. Postoperative umbilical incision infection occurred in 1 patient (3.3%), Urinary retention in 1 patient (3.3%), seroma in 3 patients (10%), and ecchymosis in 1 patient (3.3%). No Chronic pain, patch infection, or recurrence was found in the follow-up.Conclusions:The completely visualized cavity construction technology has a clear field of vision, clear anatomical hierarchy, low peritoneum injury rate, and effectively reduces surgical difficulty. It can be routinely applied to the posterior sheath SIL-TEP.
Objective:To explore the advantages of single-direction three-port thoracoscopic surgery(ST-VATS)lobectomy in the treatment of early-stage lung cancer.Methods:Clinical data of consecutive VATS lobectomy and systematic lymph nodes dissection with lung malignant tumor confirmed in the First Medical Center, Chinese PLA General Hospital between Jul. 2020 and May 2022. The data of 200 patients were selected for analysis and were divided into a ST-VATS group with 100 patients and a conventional T-VATS (CT-VATS) group; The operation time, intraoperative blood loss, number of dissected lymph nodes, 3d postoperative drainage volume, postoperative chest drainage time and postoperative complications were compared respectively between the groups.Results:There was no perioperative mortality and tumor-negative surgical margin in groups. The two groups were no statistically difference in intraoperative blood loss, number of dissected lymph nodes and 3 d postoperative drainage volume. As compared with the CT-VATS group, patients in the ST-VATS group demonstrated shorter operation time [(56.29±13.35) min vs. (63.78±14.91) min, P=0.001] and shorter postoperative chest drainage time [3(3) d vs. 5(4) d, P<0.0001], with statistical differences (P<0.05).Conclusion:Compared with CT-VATS lobectomy, the ST-VATS lobectomy has the advantages of shorter operation time and postoperative chest drainage time. Additionally, it achieves the same surgical outcomes, making it a safe, effective, and promotable surgical approach.
Objective:To proove the advantage of Laennec membrane-based guidance in the separation of perihepatic adhesions after multiple liver operation.Methods:The adhesions were isolated from the subphrenic, subhepatic and naked areas through Laennec approach in patients with multiple liver surgery.Results:The adhesions were separated by Laennec membrane after several liver operations. The layers of adhesions were clear, the bleeding was less and the side injury was less.Conclusions:Laennec membrane is a safe and feasible approach for the separation of perihepatic adhesions after multiple liver operations.
The concept of day-case surgery was first proposed by British surgeon Nicoll, referring to the surgery or procedure in which a patient completes admission and discharge within one day (24 h). In recent years, China has gradually implemented the day-case mode of laparoscopic cholecystectomy.Day-case laparoscopic cholecystectomy could significantly shorten hospital stay, reduce hospital infections, accelerate patient recovery, improve the efficiency of medical resource utilization, and reduce medical costs.In order to provide reference for exploring and developing standardized day-case laparoscopic cholecystectomy and promote the standardized application and promotion of day-case laparoscopic cholecystectomy, the Minimally Invasive Surgery Committee of the Chinese Research Hospital Association organized experts from surgery, anesthesia, and nursing to develop this expert consensus.
With the widespread application of single-site laparoscopic technology in the diagnosis and treatment of gynecological diseases, problems such as high operational difficulty and long learning curve are gradually becoming prominent. In order to effectively solve these problems and reduce the operational difficulty of gynecological laparoendoscopic single-site surgery, experts have proposed a new technology and mode of single-site laparoscopic combined extracorporeal operation. This combined operation mode combines the advantages of traditional open surgery and laparoscopic technology, reducing the difficulty of surgery while improving the effectiveness of surgical treatment. The National Research Collaboration Group for Gynaecological Laparoendoscopic Single-site Surgery of Obstetricians and Gynaecologists Branch of Chinese Medical Doctor Association organized relevant experts in the field of gynecological single-site laparoscopic surgery in China and formulated this expert consensus. This expert consensus provides a detailed introduction to the background, indications and contraindications for clinical application, technical operation points, and corresponding precautions of the single-site laparoscopy combined extracorporeal operation mode, in order to further standardise and improve this combined operation mode, and better promote the clinical application and promotion of the gynaecological single-site laparoscopic technology.
Objective:To summarize the clinical efficacy and advantages of laparoscopic hepatectomy for solitary liver metastases after radical esophageal cancer resection.Methods:A retrospective analysis was performed for a patient with isolated liver metastases in the Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, in Feb. 2023. Whose right liver lesion was slowly enlarged during 4 cycles of chemotherapy by DCF (docetaxel, cisplatin and 5-fluorouracil) regimen, and then the anatomical laparoscopic right posterior lobectomy were performed.Results:The patient successfully underwent laparoscopic anatomical right posterior lobe resection of the liver, with less intraoperative bleeding, no postoperative complications such as infection, bleeding, and biliary fistula, and recovered smoothly. The postoperative pathological examination was consistent with the liver metastasis of esophageal cancer. The patient recovered well 6 months after surgery, no recurrence or progression, and continued systematic chemotherapy in the local hospital for 3 cycles.Conclusion:The laparoscopic minimally invasive resection of solitary liver metastases after oesophageal cancer resection, combined with systemic chemotherapy, improves prognosis and progression-free survival.
Objective:To summarize the clinical effect and advantage of single-port laparoscopic UGF two-wings para-aortic lymphadenectomy on the treatment of endometrial carcinoma.Methods:A retrospective analysis was conducted of 1 patients with endometrial carcinoma in stage IB (G3) from the Zhongnan Hospital of Wuhan University on Jul. 2023.The patient was diagnosed as endometrioid adenocarcinoma stage IB (G3), uterine fibroids, type 2 diabetes mellitus and anemia (mild). Single-port laparoscopic para-aortic lymphadenectomy, pelvic lymphadenectomy, epifascial hysterectomy, and bilateral salpingo-oophorectomy were performed.Results:The surgery went well. Intraoperative bleeding was low during surgery and no postoperative complications such as infection, bleeding, and celiac leakage. Patient recovering well after surgery.Conclusion:For the reason that good surgical field exposure, single-port laparoscopic UGF two-wings para-aortic lymphadenectomy can not only greatly reduce the difficulty of para-aortic lymphadenectomy, but also reduce both the collateral damage to peripheral organs during surgery and reduce postoperative complications.
Objective:The creation method of the gastric conduit holds paramount significance in esophagectomy procedures. This study aims to investigate the safety and feasibility of a novel improved technique, the Tension Gastroplasty Approach (TGA), for constructing a gastric conduit.Methods:A retrospective analysis of data from patients who underwent surgical resection for esophageal cancer at Sichuan Cancer Hospital in Jul. 2021 was conducted. The Tension Gastroplasty Approach and its key aspects were presented. Additionally, a technical assessment was performed comparing the integrity of staple lines at the cut edge of tension-free and tension gastroplasty of gastric conduit, the integrity of mucosal surface stapling, and the presence of exposed metal staples.Results:The surgical procedures proceeded smoothly, and clinical practice revealed that the TGA technique achieved superior outcomes in terms of complete staple line integrity, full mucosal surface stapling, and absence of exposed metal staples.Conclusion:The TGA technique enhances the more complete apposition of the gastric mucosal surface, thereby achieving a superior "two-sided" molding effect of the serosal and mucosal surfaces of the gastric conduit. It holds the potential to offer a safer and more dependable approach for the construction of a gastric conduit and surgery-related treatments in esophageal cancer patients. Moreover, it lays the technical foundation for further refining and optimizing clinical research on the TGA approach.
In 1997, Danish doctor Kehlet H proposed the concept of Enhanced Recovery After Surgery, which aims to reduce postoperative complications, shorten hospital days, and improve patients′ negative emotions by optimizing perioperative measures, further accelerating the postoperative recovery speed of patients. ERAS optimization measures involve preoperative, intraoperative, and postoperative. However, preoperative evaluation, management, and optimization of patients′ physical, nutritional, and psychological aspects are often overlooked by us. Clinicians usually pay more attention to the disease and the surgery itself. At the same time, For some patients, it is necessary to evaluate and intervene in their physical and mental health while waiting for surgery outside the hospital. With the proposal of the bio-medical-social psychological model, " prerehabilitation" has received attention from medical staff [1,2]. The measures proposed by ERAS are the details of the implementation of "prerehabilitation" measures and the standardization of ERAS preoperative preparation. This article reviews the current research status of prerehabilitation and explores the future development of prerehabilitation gynecology.
淋巴结在妇科恶性肿瘤诊治中一直扮演着重要的角色。从诊断价值考虑，淋巴结切除是评估淋巴结是否转移的一种方法；从治疗价值考虑，切除转移的淋巴结是减瘤手术的一部分。但这是否可以转化成生存获益？随之而来的副损伤、并发症与临床获益又如何？妇科恶性肿瘤治疗中淋巴结的去与留这一话题一直争议不断。本文对妇科三大常见恶性肿瘤：卵巢癌、宫颈癌及子宫内膜癌治疗中淋巴结处理的相关研究进行综述并阐述笔者团队的观点。
Objective:To compare the application of in-bag integrated power morcellation and contained manual scalpel morcellation in transumbilical single-port laparoscopic myomectomy.Methods:The medical records of patients who underwent transumbilical single-port laparoscopic myomectomy at the Department of Gynecology, Zhongnan Hospital of Wuhan University from Jul. 2021 to Jun. 2023 were retrospectively analyzed. There were 52 patients who underwent in-bag integrated power morcellation and 61 patients who underwent contained manual scalpel morcellation. Compare and analyze the hospitalization time, operation time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative complications, visual analogue scale (VAS) pain score of 24 h after surgery, the rate of bag breakage, postoperative drainage tube removal time, postoperative urinary catheter removal time, postoperative intestinal ventilation time, hemoglobin difference between preoperative and postoperative (1 d and 3 d) and postoperative pathology.Results:Compared with the contained manual scalpel morcellation group, the in-bag integrated power morcellation group had shorter operation time [(152.88±43.37)min vs. (176.23±59.45)min, P=0.021] and lower rate of bag breakage [0 (0.0%) vs. 8 (13.1%), P=0.019]. The difference was statistically significant (P<0.05). Compared the in-bag integrated power morcellation group with the contained manual scalpel morcellation group, there was no significantly statistical difference (P>0.05) in the hospitalization time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative complications rate, VAS pain score of 24 h after surgery, postoperative drainage tube removal time, postoperative catheter removal time, postoperative intestinal ventilation time, hemoglobin difference between preoperative and postoperative (1 d and 3 d), and postoperative pathology.Conclusion:In transumbilical single-port laparoscopic myomectomy, in-bag integrated power morcellation is a safe and feasible solution. It can be used with single-port laparoscope and electric rotator. Compared with contained manual scalpel morcellation, in-bag integrated power morcellation has shorter operation time and lower bag breakage rate, but it still needs further verification in large-sample prospective studies.
2021年12月，解放军总医院第一医学中心肝胆胰外科医学部成功完成了世界首例SP单孔机器人胰腺手术及世界第2、第3例SP单孔机器人肝脏手术[1,2]。经过一年多的探索与发展，目前的手术方式由简入繁，可实施单通道机器人胰十二指肠切除术、半肝切除术等复杂术式[3,4,5,6,7]。本文将总结前期经验并结合单通道机器人的特点，对单通道机器人肝胆胰手术的布孔策略进行分析。
Objective:To explore the safety and effectiveness of laparoscopy combined with choledochoscope in the treatment of pancreatic duct stones.Methods:Retrospective analysis of clinical data of 8 cases of chronic pancreatitis with pancreatic duct stones treated by laparoscopy combined with choledochoscope in the Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Soochow University from June 2018 to March 2023, including operation time, postoperative hospital stay, intraoperative bleeding, postoperative complications, residual stones, pain relief, blood sugar status, etc.Results:Among the 8 cases, one case of pancreatic cancer with liver metastasis was found during operation, and the operation was terminated. The other 7 cases successfully completed laparoscopy combined with choledochoscopy+ holmium laser lithotripsy+ Roux-en-Y pancreatojejunostomy. The diameter of pancreatic duct stones (7.64±2.17) mmand pancreatic duct diameters (8.8 ± 2.80) mm were counted. The average surgical time (222±67.5)minutes and the average postoperative hospital stay (16 ± 7.8) days. During the follow-up period (3-64) months, the symptoms of 6 patients were significantly relieved, and no significant abdominal pain occurred; One patient had a history of acute pancreatitis, with a significantly lower frequency of episodes compared to before surgery; All patients showed no obvious recurrence of stones on abdominal CT.Conclusion:Laparoscopy combined with choledochoscopy is a safe and effective method for the treatment of chronic pancreatitis with pancreatic duct stones.
Objective:To investigate the short-term clinical effect of robotic radical pancreatosplenectomy for high-risk recurrent resectable pancreatic cancer after neoadjuvant therapy, summarize the technical aspects and key points, and discuss the recent clinical effects.Methods:The data of a patient treated in the Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army(PLA)General Hospital were retrospectively analyzed. A 52-year-old female was diagnosed with pancreatic tail tumor. CA19-9 level was 1902 U/ml. MRI showed a hypovascular tumor in the pancreatic tail with the maximum diameter of 41mm. PET-CT showed a hypermetabolic mass in the pancreatic tail with SUVmax: 7.1, and pancreatic cancer was considered. Small lymph nodes in the pancreaticogastric space with mild metabolism were suspected to metastasize. The patient was diagnosed with pancreatic tail cancer (cT2N1M0, resectable, high risk of recurrence). The patient was received 4 cycles of neoadjuvant therapy with gemcitabine, albumin-bound paclitaxel and PD-1 inhibitor. After treatment, CA19-9 level decreased to 272.6 U/ml, the maximum diameter of tumor decreased to 26 mm, SUVmax level decreased to 2.8, and the metabolism of lymph nodes in the pancreaticogastric space disappeared. RECIST criteria assessed a partial response. Robotic radical pancreatosplenectomy combined with partial gastric wall resection was performed.Results:The operation was completed successfully, and the operation time was 265 min and the blood loss was 100 ml. The pathological diagnosis was moderately differentiated adenocarcinoma (pT2N0M0). The patient was discharged 11 days after operation. After 2 cycles of treatment, there was no tumor recurrence or metastasis during the follow-up of 18 months.Conclusion:Robotic radical pancreatosplenectomy is safe and feasible in the treatment of high-risk recurrent pancreatic cancer after neoadjuvant therapy.
Objective:To investigate the long-term efficacy and safety of gastric bypass(Roux-en-Y gastric bypass, RYGB)on patients with type 2 diabetes mellitus(T2DM).Methods:T2DM patients who received RYGB in Beijing Tiantan Hospital Affiliated to Capital Medical University were retrieved from Bariatric and Metabolic Surgery Database. Cases with complete data after 5 years of postoperative follow-up were selected to analyze the preoperative and postoperative weight, blood glucose, and combined changes in indicators such as disease and nutrition, as well as the occurrence of long-term complications of surgery.Results:Thirty-seven patients with T2DM undergoing RYGB were enrolled. The mean follow-up was 6.2(5.0-9.0)years. Five years after operation, body weight and glycosylated hemoglobin(HbA1c) of all were significantly lower than those before operation, and the differences were statistically significant (all P values were less than 0.05). Only 29.7% of the patients used hypoglycemic drugs 5 years after operation, which was significantly lower than that before operation, and the difference was statistically significant(P<0.01). The complete remission rate of T2DM after 5 years was 29.7%. Compared with before operation, triglyceride(TG)was significantly reduced, high-density lipoprotein(HDL)was significantly increased, and the number of abnormal lipid metabolism and abnormal liver function were significantly reduced at 5 years after operation, and the differences were statistically significant(P value are less than 0.05). In terms of nutrition, the level of ferritin at 5 years after operation was significantly lower than that before operation, and the difference was statistically significant(P<0.05). Hemoglobin, albumin, folic acid, and vitamin B12 were all lower than those before operation, but the differences was not statistically significant(all P values were greater than 0.05). Five years after operation, 1 case(3.0%)was accompanied by symptoms of recurrent incomplete intestinal obstruction, 2 cases(6.0%)developed new gallbladder stones, and 6 cases(18.2%)developed iron deficiency anemia.Conclusion:In the long run, RYGB is safe and effective for T2DM patients. After RYGB, there are risks such as weight, blood sugar rebound, and nutritional disorders. Postoperative follow-up, diet and medication guidance should be paid attention to. Patients after RYGB should be supplemented with iron, vitamins and various trace elements preventively.
Objective:To investigate the feasibility and safety of robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction.Methods:The clinical date of 10 patients diagnosed with colorectal tumor who were treated with robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction from May 2020 to July 2022 at the Division of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital were retrospectively studied.Results:There were 4 males and 6 females, with the age range from 33 to 82 years, received robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction. The surgical specimen is removed through the rectum. The median operative time was 120(ranged 100 to 190)minutes. The intraoperative blood loss was 40(ranged 10 to 100)ml and there was no intraoperative blood transfusion. The median postoperative hospital stay was 10(ranged 8 to 18)days. There were no transit open surgery, re-operation and mortality. Perioperative complications (Clavien-Dindo grade): 1 case of grade Ⅲ, 2 cases of grade Ⅱ, 1 case of grade Ⅰ; 1 case developed anastomotic leakage, successful through conservative treatment.Conclusion:Robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction was effective and safe to treat colorectal tumor with the improvement of intra-abdominal anastomosis technology.
Objective:To investigate the safety and feasibility of Laennec approach for laparoscopic cholecystectomy in the treatment of type II Mirrizi syndrome.Methods:A patient with type II Mirrizi syndrome underwent laparoscopic cholecystectomy.Result:The patient was discharged on postoperative day 7 without complications. The tomogram was performed 6 weeks after surgery to assess the anatomy and exclude stones in the CBD prior to its removal.Conclusions:It is safe and feasible to treat type II Mirrizi syndrome with laparoscopic cholecystectomy via Laennec approach, more evidence is needed in large-scale clinical studies.
The fluorescence imaging system under laparoscopic surgeries can provide a fused vision of fluorescence and conventional white light. Surgeons can have a more intuitive and three-dimensional image perception of the intraoperative anatomy. Indocyanine green (ICG) is the most common used clinical fluorescence imaging agent used in the field of general surgery. It has accurately marked tumors and surgical margins, demonstrated sentinel and lymph nodes in tumor drainage area, and identified metastases. Thus, ICG has the ability to improve surgical efficiency, increase perioperative benefits, reduce postoperative complications, and to provide protection and guidance for surgery. This review summarized the application of ICG fluorescence imaging in laparoscopic surgeries, including gallbladder and biliary tract surgeries, gastrointestinal surgeries, pancreatic surgeries, and thyroid/parathyroid surgeries. Recent advances are reviewed to provide future perspectives for laparoscopy fluorescence imaging, including 3D stereoscopic imaging, multicolor gradient fluorescence, and new fluorescent agents.
Objective:To summarize the feasibility and advantages of robot assisted right hemihepatectomy in a patient with advanced hepatocellular carcinoma underwent conversion therapy.Methods:A retrospective analysis of the clinical data about a patient underwent this novel procedure in the Department of General Surgery, Gulou Hospital Affiliated to the School of Medicine of Nanjing University in Aug. 2022.Results:The patient with advanced hepatocellular carcinoma underwent conversion therapy, whose tumor was successfully downstaged, and received radical surgery. Less intraoperative bleeding, no postoperative infection, bleeding, biliary fistula and so on. Tumor markers and related imaging examinations showed no abnormalities 6 months after the surgery.Conclusions:It is expected to improve the long-term prognosis of patients with advanced hepatocellular carcinoma by applying the concept of conversion therapy combined with Laennec approach minimally invasive endoscopy to enhance the pathological remission rate and surgical resection rate.
