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.
