Single-incision laparoscopic surgery with self-made port for totally extraperitoneal hernioplasty: a report of 7 cases / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the feasibility of single-incision laparoscopic totally extraperitoneal hernioplasty (SILS-TEP) with self-made port for repairing of inguinal hernia.</p><p><b>METHODS</b>SILS-TEP was performed in 7 inguinal hernia patients (9 sides) with conventional laparoscopic instruments and self-made port, which composed of a wound retractor, surgical gloves and 3 ordinary trocars. The clinical data and follow-up results of 7 cases were retrospectively collected and analyzed.</p><p><b>RESULTS</b>The self-made port was applied for SILS-TEP uneventfully without the need of additional ports in all 7 patients (9 inguinal hernias). The median operating time was 90. 0 (70-125) min, intraoperative blood loss was 10. 0 (5. 0-20. 0) mL and postoperative hospital stay was 2.0 (2. 0-4. 0) d. The median pain scores of visual analog scale (VAS) at 6 h,12 h, 24 h and 14 d were 3(2~4), 2(1~2), 1(0~2) and 0(0~1), respectively. There were no intraoperative complications reported, and all patients were satisfied with wound healing. No hernia recurrence was observed during the 3-months of follow-up.</p><p><b>CONCLUSION</b>Our initial experiences show that SILS-TEP with self-made port is a safe and feasible surgery, which can simplify the procedure with available equipments and reduce the cost, therefore can be applied in grass-root hospitals.</p>

The clinical comparison of totally laparoscopic versus open total gastrectomy for gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility, safety and oncological effect of totally laparoscopic total gastrectomy (TLTG).</p><p><b>METHODS</b>The clinical data of TLTG cases and open total gastrectomy (OTG) patients between November 2007 and October 2011 were analyzed. Also compared the feasibility, safety and short-term outcomes of TLTG with OTG.</p><p><b>RESULTS</b>Ninty cases were analyzed. There were 18 cases in the TLTG group and 72 cases in the OTG group. Operation time was significantly longer in the TLTG group ((310 ± 86) minutes) than in the OTG group ((256 ± 57) min, t = 4.963, P = 0.002), However, the blood loss were significantly lower in the TLTG group ((136 ± 84) ml vs. (359 ± 141) ml, t = -11.734, P = 0.000). The post operative morbidity was similar between the TLTG and OTG group. First flatus time (t = -7.020), first diet time (t = -6.166 and -5.698), and post operative hospital stay (t = -4.610) were significantly shorter in the TLTG group than in the OTG group (P < 0.05).</p><p><b>CONCLUSIONS</b>LTG is a safe and feasible procedure with quick post-operation recovery. The laparoscopic side-to-side esophagojejunal anastomosis is a safe and feasible method of alimentary reconstruction after laparoscopic total gastrectomy.</p>

The diagnosis and treatment of pancreatic neuroendocrine neoplasms / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors of pancreatic neuroendocrine neoplasms (PNEN).</p><p><b>METHODS</b>Clinical data of 61 patients with PNEN from March 1992 to December 2012 was retrospectively analyzed. There were 23 male and 38 female patients, with a median age of 52 years (ranged from 22 to 68 years). Forty-one patients were non-functional tumors, and 20 patients were functional tumors. Fifty-nine patients received operation, 13 (22.0%) patients underwent laparoscopic operation, 2 patients underwent puncture biopsy under CT guidance. Survival was analyzed with the Kaplan-Meier method.</p><p><b>RESULTS</b>Among these patients, 53 (86.9%) patients underwent curative resection. The cases of grade G1, G2, G3 were 41 (67.2%), 9 (14.8%), 11 (18.0%), respectively. The cases of stageI, II, III, IV were 47 (77.0%), 7 (11.5%), 2 (3.3%), 5 (8.2%), respectively. Liver metastasis, neural invasion were found in 5 cases (8.2%), 5 cases (8.2%), respectively. The median follow-up period was 40 months (ranged from 3 to 209 months). The overall 1-, 3-, 5-year survival rates were 92.0%, 89.7%, 86.3%, respectively. Univariate analysis showed WHO classification (χ(2) = 18.503), TNM staging system (χ(2) = 23.401), liver metastasis (χ(2) = 18.606), neural invasion (χ(2) = 10.091), resection status (χ(2) = 25.514) were prognostic factors of PNEN (all P = 0.000).</p><p><b>CONCLUSIONS</b>Surgical resection in PNEN results in long-term survival. WHO classification, TNM staging, resection status are effective in predicting the prognosis of PNEN. Liver metastasis, neural invasion predicted poor prognosis.</p>

Laparoscopic distal pancreatectomy: the experience of 68 cases in a single centre / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of laparoscopic distal pancreatectomy.</p><p><b>METHODS</b>Totally 68 patients (male 23, female 45) aged 17 to 77 years, with distal pancreatic lesions, underwent laparoscopic distal pancreatectomy from November 2003 to December 2010. The clinical data were collected. Safety, feasibility and crucial technique manipulation were analyzed retrospectively.</p><p><b>RESULTS</b>All 68 operations were successful with two cases conversion to open, including 48 cases combined with splenectomy, and 18 cases with preservation of spleen. Fourteen cases received with combination resection of multi-organs, including 4 cases with cholecystectomy, 1 case resection of right adrenal adenoma and cholecystectomy, 1 case with myomectomy and left ovarian teratomectomy; 1 case with right ovarian teratomectomy, 1 case with resection of left adrenal adenoma, 1 case with resection of both adrenal adenoma, 1 case with resection of liver metastasis, 1 case with cholecystectomy and resection of liver metastasis, 1 case with resection of left adrenal adenoma and liver metastasis, 1 case with resection of left adrenal adenoma and colon and spleen, 1 case with biopsy of liver nodule. The mean operative time was (209 ± 58) minutes, the mean intraoperative blood loss was (191 ± 123) ml, and the mean postoperative hospital stay was (8 ± 4) days. The rate of overall postoperative complications was 18.1%, including an 12.1% rate of clinical pancreatic fistula. Only one case needed a reoperation, and there was no postoperative mortality.</p><p><b>CONCLUSION</b>Laparoscopic distal pancreatectomy with or without splenectomy is safe and feasible in the treatment of most distal pancreatic tumors.</p>

Clinical evaluation of laparoscopic radical resection of colon cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of laparoscopic radical resection of colon cancer.</p><p><b>METHODS</b>Patients with colon cancer who underwent radical resection during January 2000 to January 2004 in Sir Run Run Shaw Hospital (Medical College of Zhejiang University) were divided into open and laparoscopic groups for a non-randomized case-control study. All the patients were followed up and their clinical and pathological results were compared.</p><p><b>RESULTS</b>No difference was seen between the two groups on the patients' age, gender, lymph node numbers and Dukes staging. The laparoscopic group had a longer mean operation time [(182 +/- 62) min vs (141 +/- 37) min] and shorter hospital stay [(5.3 +/- 1.9) d vs (8.2 +/- 1.2) d] than the open group. All surgical margins were pathological negative. Post-operation follow up was 12-18 months (mean 21 months). No incision recurrence was found in neither group. As far the local recurrence and distal metastasis rate were similar in both groups.</p><p><b>CONCLUSIONS</b>Laparoscopic radical resection of colon cancer has minimal invasion and shorter recuperation than open procedure, the radicalness and either local recurrence or distal metastasis rate after surgery are similar when compared with open group.</p>

Laparoscopic spleen-preserving distal pancreatectomy for pancreatic lesions / 中国普通外科杂志

Objective To summarize the experience in laparoscopic spleen-preserving distal panereatectomy.Methods From Nov 2003 to July 2006,six patients with distal pancreatic cystic lesions underwent laparoscopic spleen-preserving distal pancreatectomy with splenic vessels preservation. Results All operations were successful with the operative time ranging from 140～265 min and the intraoperative blood loss ranged from 350～600 ml.One case received combination resection of right adrenal adenoma,1 case with combined laparoscopic myomectomy and left ovarian teratomeetamy,1 case with combined laparoscopic myomectomy,1 case with combined laparoscopic cholecysteetomy.All patients were discharged 4 to 9 days postoperatively.The pathologic diagnosis was retained cyst in 2 cases,serous cystadenoma in 2 cases,mucious cystadenoma in 2 cases.Symptoms disappeared in all cases after operations and there was no recurrence during a follow-up period that ranged from 1 month to 31 months.Conclusions Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels preservation is the most suitable procedure for the distal pancreatic benign lesions,and in experienced hands this procedure is safe and effective.