Laparoscopic circular stapled gastrointestinal anastomosis using novel device of sealed cap access after total laparoscopic gastrectomy / 中华胃肠外科杂志

Intracorporeal classic gastrointestinal anastomosis using circular stapler in totally laparoscopic gastrectomy (TLG) for gastric cancer requires intracorporeal anvil placement and suitable access for introduction of the circular stapler to the abdominal cavity without gas leak. The novel techniques for anvil placement have been updated, but there is no progress for proper access for circular stapler. In the study, intracorporeal circular-stapled gastrointestinal anastomosis were successfully accomplished using a novel device of sealed cap access with a central hole (WLB-60/70-60/100, Wuhan Widerep Medical Instrument Co.,Ltd, China) customized to the incision protection retractor for the simple and accessible introduction of the circular stapler and anvil under the optimal maintenance of pneumoperitoneum pressure in TLG. In these 3 cases, there was no gas leakage and the pneumoperitoneum was well maintained when performing the gastrointestinal anastomosis, and there was no transition to laparotomy or other anastomosis techniques. The result suggests that the sealed cap access could be a novel choice for introduction of the circular stapler to the abdominal cavity in order to obtain laparoscopic circular-stapled gastroin-testinal anastomosis in TLG.

Technique of intracorporeal gastrointestinal anastomosis after total laparoscopic gastrectomy / 中华胃肠外科杂志

Malignant or benign diseases of stomach are very common in China. The application of laparoscopy surgery in gastric diseases is a remarkable symbol of current gastric surgery. Laparoscopic assisted radical gastrectomy has gained widespread acceptance for the treatment of gastric cancer. Total laparoscopic radical gastrectomy, which means the gastric resection, lymph nodes dissection and gastrointestinal anastomosis are entirely performed in intracorporeally, is the inheritance and progression of laparoscopic assisted radical gastrectomy. However, controversy still exists regarding the risk and difficulty of intracorporeal anastomosis. In Asian countries including China, total laparoscopic radical gastrectomy has not been extensively performed yet. This review focuses on the issues related to intracorporeal gastrointestinal reconstruction in laparoscopic procedure, such as its history and current status, as well as the surgical technique and risk.

Totally laparoscopic Billroth II( gastrectomy without intracorporeal hand-sewn sutures / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of a novel totally laparoscopic Billroth II gastrectomy.</p><p><b>METHODS</b>Twelve gastric cancer patients underwent totally laparoscopic D2 dissection without intracorporeal hand-sewn sutures in the Xijing Hospital of Fourth Military Medical University between May 2011 and July 2011. In this technique, circular stapling device was used for gastrojejunostomy, and an Endo GIA was used to close the incision at the greater curvature of the stomach. After the completion of the anastomosis, a side-to-side anastomosis (jejunum-afferent loop or jejunum-efferent loop) was performed using an Endo-GIA.</p><p><b>RESULTS</b>No patients required conversion to laparoscopy-assisted or open surgery. The operative time was 196.0±19.3 min, and the blood loss was 169.5±28.8 ml. The number of lymph node harvested was 25.1±3.3. The proximal resection margin and distal resection margin were 8.8±2.4 cm and 6.9±5.5 cm, respectively. The mean time to the first postoperative flatus was 3.1±1.3 days. The length of hospital stay was 4.5±1.9 days.</p><p><b>CONCLUSION</b>This technique is simple and quick. There is no need for laparoscopic hand-sewn suturing. It is safe to perform for totally laparoscopic gastrectomy and reconstruction.</p>

Intracorporeal hand-sewn technique used in totally laparoscopic colectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of hand-sewn anastomosis in totally laparoscopic colectomy.</p><p><b>METHODS</b>Clinical data of 19 consecutive patients with benign(n=5) or malignant colonic diseases(n=14, 4 ascending colon cancers, 2 transverse colon cancers, and 8 sigmoid colon cancers) treated with totally laparoscopic colectomy with a hand-sewn anastomosis were reviewed. All the procedures were performed by the same surgeon team including totally laparoscopic resection and hand-sewn anastomosis, ileocolic anastomosis after right hemicolectomy, and hand-sewn purse-string sutures in the colon.</p><p><b>RESULTS</b>Hand-sewn anastomosis was performed for 11 patients and circular-stapled anastomosis with hand-sewn purse-string sutures was performed for other 8 patients. The mean hand-sewn anastomosis time was (49.5 ± 29.4) min, and the mean hand-sewn purse-string sutures time was (13.3 ± 5.5) min. No patients required conversion to laparoscopy-assisted or open surgery, and there were no postoperative complications related to anastomosis. One patient with transverse colon lipoma developed mild intra-abdominal infection after surgery and recovered after conservative treatment.</p><p><b>CONCLUSION</b>Totally laparoscopic intracorporeal hand-sewn anastomosis or hand-sewn purse-string sutures for colectomy is feasible and safe when performed by experienced laparoscopic surgeons.</p>

Construction of rat bowel transforming growth factor beta1 recombinant adenovirus vector / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To construct a recombinant adenovirus vector which regulates the expression of rat transforming growth factor beta (TGF-beta1).</p><p><b>METHODS</b>Total RNA was extracted from F344/N rat small intestine pre-treated with Con A to clone TGF-beta1. pTRE-shuttle vector was used as mediator to ligate TGF-beta1 gene and backbone of replication-incompetent adenoviral vector. The constructed recombinant adenovirus contained tetracycline-responsive element which could regulate the expression of inserted genes. After identification, the desired recombinant adenovirus was packaged in HEK 293 cells. Supernatant of high titer adenovirus was collected to detect the TGF-beta1 gene expression by green fluorescent protein(GFP).</p><p><b>RESULTS</b>The constructed recombinant adenovirus was identified by restriction endonucleases cutting, sequencing, PCR and GFP examination.</p><p><b>CONCLUSION</b>Rat TGF-beta1 recombinant adenovirus is established successfully, which provides material and evidence for further research of dendritic cell (DC) modified by TGF-beta1 to induce immune tolerance in rat heterotopic small bowel transplantation.</p>

Laparoscopy-assisted D2 total gastrectomy in advanced gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and advantages of laparoscopy-assisted total gastrectomy (LATG) with D2 dissection of lymph nodes versus conventional open D2 total gastrectomy (OTG) in advanced gastric cancer.</p><p><b>METHODS</b>One hundred and twenty-five patients with advanced gastric cancer in the middle or upper third of the stomach were operated on from July 2005 to March 2007. Of the patients, 59 cases received LATG and 66 OTG with D2 lymph nodes dissection. Clinical data were recorded and compared between the two groups.</p><p><b>RESULTS</b>No patient in the LATG group converted to conventional operation with laparotomy. No operation mortality and no severe morbidity occurred in LATG group. As compared with OTG group, in LATG group operation time was longer [(330 +/- 71) min vs. (261 +/- 54) min, P =0.005] in LATG group, but with similar number of lymph node retrieval (36 +/- 13 vs. 34 +/- 16, P =0.450), less operation blood loss [(175 +/- 101) ml vs. (359 +/- 210) ml, P =0.003], earlier recovery of bowel activity (P = 0.015), and a shorter duration of fever after operation (P = 0.024).</p><p><b>CONCLUSIONS</b>LATG with D2 lymph node dissection in advanced gastric cancer is safe and technically feasible with better operative access and visual field, less operation blood loss and earlier recovery.</p>

Isolation of a down-regulated novel gene with lower abundance in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To clone novel gene from suppression subtraction library established for screening down-regulated genes in gastric carcinoma, and the effects of novel gene on gastric tumorigenicity were analyzed.</p><p><b>METHODS</b>Sequencing results of 860 positive colonies chosen randomly were compared by Blast program in GenBank. Novel gene fragment was amplified by rapid amplification of cDNA ends (RACE). The mRNA expression of novel gene was detected by Northern blot and semi-quantitative PCR in 25 cases of gastric carcinoma tissue and counterpart normal gastric mucosa. The structure and chromosomal location of novel gene were investigated by Bio-message technique.</p><p><b>RESULTS</b>A 233 bp novel gene fragment was screened out from 860 clones and a 802 bp novel gene was obtained by RACE. The novel gene was named as GDDM, registered in the number of AF494508 by GenBank. The mRNA expression of GDDM in gastric carcinoma tissue (4.496+/-0.637) was significantly lower than that in the counterpart normal gastric mucosa (36.919+/-6.290)(P<0.01). Chromosomal location of GDDM gene was at 4q31.</p><p><b>CONCLUSION</b>The cloned novel gene, GDDM, is down-regulated in gastric carcinoma, and it is likely to be involved in gastric tumorigenicity.</p>

The significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility of developing a tunnel between inferior vena cava (IVC) and caudate lobe before passing a tape through it, and to explore the significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy.</p><p><b>METHODS</b>Blunt dissection was used to develop the tunnel before a tape was passed through. A hemostatic plate was placed on the surface of liver parenchyma if needed. In the procedure of hepatectomy, the tape was pulled up to create an interspace between liver parenchyma and IVC so that the IVC can be protected during transection.</p><p><b>RESULTS</b>Liver hanging maneuver was performed successfully in 47 cases. There were no severe complications related to the procedure in these cases. The procedure was terminated in 1 case because of severe bleeding.</p><p><b>CONCLUSIONS</b>1. Liver hanging maneuver is feasible in terms of anatomy and technique. 2. With liver hanging maneuver, IVC can be protected safely and the intrahepatic vessels and ductal system at the transaction line can be exposed clearly. It also makes anterior approach for hepatectomy safer and easier.</p>

Study on novel gene GDDR related to gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To confirm the GDDR cDNA property of novel down-regulated full-length gene in gastric cancer, structure of genomic GDDR DNA and its promotor region. To predict its transcription factors and transcription factor binding sites. To explore function of GDDR gene in vitro.</p><p><b>METHODS</b>GDDR mRNA was located by in situ mRNA hybridization of gastric mucous membranes, and was amplified in 13 human organs and tissues. The structure and location of GDDR on chromosome, property of protein encoded by full-length GDDR were investigated by Bio-message technique. Promotor region of GDDR was confirmed, and transcription factors or their binding sites were predicted in software Gene2promoter and Matinspector of Genomatix. Both of vector pcDNA3.1/Myc-His(-)A inserted by GDDR ORF and control vector pcDNA3.1/Myc-His(-)A were respectively transfected into gastric cell lines 7901 by lipofectamin. Growth curve, MTT test and a morphological analysis were respectively performed.</p><p><b>RESULTS</b>GDDR mRNA was located in gastric mucous epithelial cells, and only was expressed in gastric tissue. 7739 bp genomic GDDR DNA located on chromosome 2p13.3, 21701 bp away from CA11-one stomach-specific gene related to gastric cancer. 618 bp promotor region of GDDR located at position +96 bp,and -419 bp of transcription start site of GDDR. The structure of genomic DNA or cDNA between gene GDDR and CA11 was mostly similar. Sequences of their promotor region were different, transcription factors and their binding sites also varied between gene GDDR and CA11. GDDR encoded protein including a trans-membrane peptide homologed to CA11 that have been proven to encode secrete protein. GDDR was another new member of BRCHOS family just was found. Gastric cell lines 7901 transfected by GDDR showed a marked decrease in growth rate by growth curve and MTT test (72 h, 0.341 +/- 0.014 vs 0.488 +/- 0.015 A, P < 0.01).</p><p><b>CONCLUSIONS</b>Stamoch-specific, novel down-regulated gene GDDR in gastric cancer locates in gastric mucous epithelial cells can markedly inhibit growth of gastric cancer cell lines 7901, GDDR is another new member of BRICHOS family related to gastric cancer except CA11.</p>

Surgical treatment of hepatocellular carcinoma originating from caudate lobe / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the significance of surgical treatment of HCC originating from caudate lobe.</p><p><b>METHODS</b>From 1995 to 2003, caudate lobectomy, including 19 cases of isolated lobectomy and 20 cases of combined lobectomy, were performed in 39 patients with HCC originating from caudate lobe, and the factors that might influence postoperative liver function were compared between the two groups.</p><p><b>RESULTS</b>All tumors were resected successfully. One patient died of postoperative renal failure. Hydrothorax occurred in 3 patients, ascites in 4 patients, and bile leakage in 1 patient. The survival rates of 1, 3, 5 year were 53%, 50%, 39% respectively.</p><p><b>CONCLUSIONS</b>Caudate lobectomy is a effective method for HCC originating from caudate lobe.</p>