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Objective To investigate the clinical feasibility and effectiveness of 3-D printing (3DP) combined with 3-D laparoscopic nephron-sparing surgery (LNSS) for partial endogenous renal cell carcinoma.Methods A retrospective analysis was made of the clinical data of 79 patients with partial endogenous renal cell carcinoma who were admitted to our department from July 2015 to October 2018.There were 46 males and 33 females.Their average age was (50.9 ± 7.9) years old,ranged from 33 to 68 years old.Tumor stages were T1aN0M0 in 53 cases and T1bN0M0 in 26 cases.The preoperative serum creatinine ranged from 40 to 107 μmol/L,with an average of (72.4 ± 14.2) μmol/L.The preoperative GFR ranged from 19 to 54 ml/min,with an average of (40.2 ± 6.2) ml/min.Thirty-four patients underwent 2-D laparoscopic nephron-sparing surgery (2DLNSS) based on preoperative enhanced CT scans.Forty-five patients underwent 3-D printing (3DP) based on three-dimensional reconstruction of renal CT scans.Seventeen patients underwent 2-D laparoscopic nephron-sparing surgery guided by 3-D printing model(3DP-2DLNSS),and 28 patients underwent 3-D laparoscopic nephron-sparing surgery guided by 3-D printing (3DP-3DLNSS).Serum creatinine levels ranged from 42 to 122 μmol/L with an average of (86.3 ± 14.8) μmol/L,and creatinine levels ranged from 8 to 66 μmol/L with an average of (19.1 ± 14.1) μmol/L.Six months after operation,the GFR of the kidney was 9-36 ml/min with an average of (21.4 ± 6.4)ml/min,and the fluctuation range was 6-40 ml/min with an average of (19.2 ± 8.8) ml/min.There was no statistical difference in the incidence of complications and pathological types after operation.Results There was no statistical difference in general data of preoperative patients.In intraoperative and post-operative statistics,the time of exploring renal artery was shorter than that of 2DLNSS (33.7 ± 7.5) min in 3DP-2DLNSS (28.3 ± 8.2,P =0.015) min and 3DP-3DLNSS (27.8 ± 6.5,P =0.002) min.In tumor detection time,3 DP-2DLNSS was shorter than 2DLNSS group (41.2 ± 6.6 vs.46.5 ± 6.9 min,P =0.012),and 3 DP-3DLNSS was shorter than 3DP-2DLNSS (35.4 ± 7.3 vs.41.2 ± 6.6 min,P =0.009).In warm ischemia time,3DP-2DLNSS min was shorter than 2DLNSS (23.5 ±9.7 vs.33.9 ±7.5 min P ＜0.001),and 3DP-3DLNSS was shorter than 3DP-2DLNSS (18.3 ± 4.6 vs.23.5 ± 9.7,P =0.023).In surgical time,3DP-2DLNSS (115.7 ± 23.0) min and 3DP-3DLNSS (103.3 ± 22.8) min were shorter than 2DLNSS (132.4 ± 28.9) min (P =0.031,P ＜ 0.001).In intraoperative bleeding volume,3 DP-3 DLNSS was less than 2DLNSS (117.9 ± 17.9 vs.130.6 ± 16.8,P =0.009) ml.Fasting for 1 to 4 days after operation,with an average of (1.7 ± 0.8) days.The indwelling catheterization ranged from 1 to 8 days after operation,with an average of (3.9 ± 1.3) days.Negative pressure drainage was removed 2-9 days after operation,with an average of (4.9 ± 1.4) days.And the hospitalization 5-11 days after operation,with an average of (7.3 ± 1.5) days.Conclusions Preoperative 3D printing combined with intraoperative 3D laparoscopic nephron sparing surgery for partial endogenous renal tumors is safe and effective,which is superior to the previous CT scan alone and intraoperative 2D laparoscopic treatment.
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OBJECTIVE: To compare the subjective perception of surgeons with 4K-resolution(4K) and three-dimensional(3D) systems in the laparoscopic colorectal surgery.METHODS: A self-filling questionnaire survey wasdeveloped in the surgeons between August 2018 and February 2019 in Department of Gastrointestinal Surgery,RuijinHospital Affiliated to Shanghai Jiao Tong University School of Medicine. The data of questionnaires from surgeons indifferent position( major surgeons,first assistants,scopists) who performed laparoscopic colorectal surgeries with 4K,3D and 2D systems were collected. The questionnaires concerning asthenopia,motion sickness,topographical orientation,control coordination of visual angle,visual acuity,radiance,resolution ratio,depth description,color resolution,sense ofcontrols,optimum viewing distance,frames and refresh rate and contrast.RESULTS: There were 124 questionnairesscreened eligibility in the survey. Among them,there were 38 questionnaires for 2D group,43 questionnaires for 3D group and 43 questionnaires for 4 K group.(1)Overall comparison of the subjective scores:In the three groups,therewere significant difference in control coordination of visual angle,visual acuity,resolution ratio,depth description,color resolution,optimum viewing distance,frames andrefresh rate(P<0.05).(2)Subjective scores betweenmajor surgeons:In the three groups,there weresignificant difference in resolution ratio,depth description,color resolution and sense of controls(P<0.05);the most advantages could be found on resolution ratio andcolor resolution in 4 K group,and also could be found on depth description and sense of controls in 3 D group.(3)Subjective scores between first assistants: In the three groups,there were significant difference in asthenopia,controlcoordination of visual angle,resolution ratio,depth description,sense of controls,frames and refresh rate(P<0.05);In 4K group,it showed advantages on control coordination of visual angle and resolution ratio. Motion sickness was morepronounced in 3D group,but the most advantages could be found on depth description and sense of controls.(4)Subjective scores between scopists: In the three groups,there were significant difference in visual acuity,resolution ratio,depth description,sense of controls,optimum viewing distance and contrast(P<0.05). The most advantages could befound on visual acuity,resolution ratio and contrast in 4 K group,and also could be found on depth description and senseof controls in 3D group.CONCLUSION: Comparing with the traditional two-dimensional system during laparoscopiccolorectal surgery,4 K system could apply better resolution ratio,control coordination of visual angle,visual acuity andcolor resolution. 3D system could apply better depth description and sense of controls.
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Objective To summarize the etiology,diagnosis and treatment of three cases of duodenal perforation. Methods The data of 3 cases of children with duodenal perforation in our hospital from September 14,2016 to June 20,2017 were retrospectively analyzed. The causes,clinical features and treatment of children's duodenal perforation were summarized. Results A total of 2 males and 1 females aged 2 years,3 years and 5 years were included in the 3 cases. All 3 cases had fever history of upper respiratory tract infection before onset. Acute abdominal pain occurred after oral administration of ibuprofen several times,and all the abdominal plain films prompted pneumoperitoneum. Three cases of perforation sites were duodenal anterior wall,diameter were 0. 5-1 cm. Two cases of small amount of pneumoperitoneum were explored and repaired the duodenal perforation by 3D laparoscopic,1 case underwent laparotomy to repair the duodenal perforation due to a large number of liquid pneumoperitoneum and severe shock. Repair of 3 cases were covered with omentum. Three cases were all cured without anastomotic fistula, ulcer, adhesive intestinal obstruction or other complications. Followed-up in the department of gastroenterology,3 cases had no Helico-bacter pylori infection. Conclusion Repeatedly oral administration of ibuprofen can cause duodenal perfora-tion in children in the short term. Once the digestive tract perforation confirmed,emergency surgical explora-tion is needed. Laparoscopic repair of duodenum perforation is safe and effective and may have a faster recov-ery. We can choose exploratory laparotomy if conditions are not allowed.
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Objective To compare the effects of 3D laparoscopic hepatectomy (3D-LH) and open hepatectomy(OH)in glissonian access for hepatocellular carcinoma(HCC)on postoperative immunosuppression by analyzing cellular immune function. Methods During January 2014 to December 2017,sixty patients randomly scheduled to undergo hepatectomy were divided into 3D-LH group and OH group,with 30 patients in each group. All patients' peripheral blood was sampled to measure cell-mediated-immunologic markers(CD4+,CD8+T cell) before operation and in the mornings of the 1st,7thday after surgery. The effects of different operative methods on cellular immune function in patients organism were investigated. Results The decreased level in 3D-LH group was less than that in OH group in postoperative 1stday. The improvement in the 3D-LH group was more faster than that in the OH group on postoperative 7thday. There was statistical significance between the two groups(P<0.05), respectively. Conclusion When compared to open hepatectomy ,3D laparoscopy liver resection in glissonian approach for HCC,less effects in cellular immune function.
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Objective To explore the clinical significance of Nano-Carbon particles and 3D laparoscopy in central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer. Methods We conduct a retrospective analysis of sixty-five patients with cN0 thyroid cancer who were received 3D laparoscopic thyroidectomy in the last 3 years. All patients were received total resection of thyroid plus the affected side and (or) contralateral side central compartment lymph node dissection. All patients were allocated to control group (n = 32) and carbon nano-particles trace group (tracer group, n = 33). The lymph node-related indexes (including number of dissected lymph node at Ⅵ area, number of Metastatic lymph node and Frozen lymph node-positive rate at Ⅵ area), serum calcium (24 h after surgery) and PTH (48 h after surgery) were collected and compared between the 2 groups. Results Number of dissected lymph node at Ⅵ area, positive rates of intraoperative frozen-section examination of parathyroid glands and PTH (48 h after surgery) were found statistical higher in nanoparticles group than control (P < 0.05). No statistical difference were found in Number of Metastatic lymph node and serum calcium (24 h after surgery) (P < 0.05). Conclusion The clinical significance of carbon nanoparticles and 3D laparoscopy is effective and feasible for central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer.
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Objective To explore the clinical significance of Nano-Carbon particles and 3D laparoscopy in central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer. Methods We conduct a retrospective analysis of sixty-five patients with cN0 thyroid cancer who were received 3D laparoscopic thyroidectomy in the last 3 years. All patients were received total resection of thyroid plus the affected side and (or) contralateral side central compartment lymph node dissection. All patients were allocated to control group (n = 32) and carbon nano-particles trace group (tracer group, n = 33). The lymph node-related indexes (including number of dissected lymph node at Ⅵ area, number of Metastatic lymph node and Frozen lymph node-positive rate at Ⅵ area), serum calcium (24 h after surgery) and PTH (48 h after surgery) were collected and compared between the 2 groups. Results Number of dissected lymph node at Ⅵ area, positive rates of intraoperative frozen-section examination of parathyroid glands and PTH (48 h after surgery) were found statistical higher in nanoparticles group than control (P < 0.05). No statistical difference were found in Number of Metastatic lymph node and serum calcium (24 h after surgery) (P < 0.05). Conclusion The clinical significance of carbon nanoparticles and 3D laparoscopy is effective and feasible for central compartment lymph node dissection and parathyroid glands protection in treatment of cN0 thyroid cancer.
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Objective To investigate the clinical effects and advantages of flexible 3D laparoscopic surgery on rectal cancer after neoadjuvant chemoradiotherapy (nCRT). Methods The data of 152 patients who received laparoscopic rectal cancer resection after nCRT excluding the cases of high rectal cancer, cardiac and pulmonary dysfunction were analyzed from January 2015 to January 2016 in the Department of Colorectal Surgery of Liaoning Cancer Hospital. The distances from the annal edge to the inferior tumor margin were within 8 cm in these patients. Among these patients, 76 cases received the 3D laparoscopic surgery after nCRT (3D-nCRT), and 76 cases undergone the 2D laparoscopic surgery after nCRT (2D-nCRT). Results Between two groups, the number of lymph node harvest (14.8±2.1 vs. 14.3±1.7), positive rate of the distal margin [1.3 % (1/76) vs. 2.6 % (2/76)], reserving anus rate [92.1 % (70/76) vs. 81.2 % (67/76)], local recurrence rate [1.3 % (1/76) vs. 3.9 % (3/76)] and anastomotic leakage rate [2.6 % (2/76) vs. 3.9 % (3/76)] had no statistical differences (all P>0.05), while the operative time [(125.3±10.2) min vs. (136.6±12.0) min], intraoperative bleeding [(54.1±23.2) ml vs. (61.9±19.5) ml], anus exhaust time [(43.5±5.0) h vs. (45.4±5.6) h] and positive rate of circumferential resection margin (CRM) [1.3 % (1/76) vs. 9.2 % (7/76)] had statistical differences (all P< 0.05). Conclusion Flexible 3D laparoscopic surgery on rectal cancer after nCRT can shorten operative time, reduce intraoperative bleeding, alleviate the influence of intestinal peristalsis function, and improve operative quality.
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Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group's mean age was (64.2 ± 6.0)years,mean of preoperative PSA was (14.5±7.6)ng/ml,Gleason score (13 cases≤6,17 cases =7,8 cases ≥8),the mean prostate volume (41.4 ±9.1) ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was (22.8 ± 2.2) kg/m2,mean of MUL (membranous urethral length) was (15.6 ±2.6) mm;34 cases in the 2D group,3D group's mean age was (61.9 ±6.6)years,mean of preoperative PSA was (16.7 ±6.8) ng/ml,Gleason score (10 cases≤6,18 cases =7,6 cases ≥8),the mean prostate volume (42.1 ± 10.6) ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was (21.7 ± 1.9) kg/m2,mean of MUL(membranous urethral length) was (15.5 ± 2.5) mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI).Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI (body mass index)and other relevant aspects of the clinical data showed no significant difference (P ＞ 0.05).The time of bladder neck-urethral anastomosis is less than the 2D group [(12.9 ± 1.7) min and (15.7 ±2.6) min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5 ±0.1) ml vs.(0.6±0.2) ml,P =0.044],the two groups in operative time [(162.7 ± 17.1) min vs.(175.7 ± 15.7) min,P =0.802],intraoperative blood loss[(191.1 ± 31.6) ml vs.(211.8 ±43.2) ml,P =0.021],intraoperative blood transfusion rate [5.2％ (2/38) vs.8.8％ (3/34),P =0.662],postoperative incidence of urine leakage [7.9％ (3/38) vs.14.7％ (5/34),P =0.463],postoperative the MUL [(15.1 ± 2.6) mm vs.(15.0 ± 2.6) mm,P =0.767),there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks (60.5％ vs.35.3％),12 weeks (73.7％ vs.47.1％) got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.
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New technologies and ideas are constantly emerging recently. With the arrival of the era of minimally invasive surgery, most of the colorectal cancer surgeries can be conducted through minimally invasive techniques. In this study, we discuss the status, characteristics, controversy, and consensus of minimally invasive techniques in colorectal cancer surgery.
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Objective: To use transperitoneal laparoendoscopic single-site (LESS) partial nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs, and to introduce our experience on LESS training in a pig model for partial nephrectomy. Methods: A male pig was given general anesthesia and was put in a supine position. A 3.5 cm incision was made through the right abdominal rectus. A multi-channel QuadPort(Olympus™) was established. Artificial pneumoperitoneum was created by 14 mmHg(1 mmHg=0.133 kPa); the lower pole and the kidney pedicle of the right kidney were isolated. The lower pole of the right kidney was resected after the renal artery was blocked. Figure-8 sutures were used to close the wound, with no notable bleeding noticed after opening the blood. The specimen was enclosed in an endoscopic pouch and pulled out from the incision. Results: The procedure was smoothly completed without any extra incision. The operating time was 47 min; the period of renal artery occlusion was 21 min (5 min for resection, 16 min for stitching); and the intraoperative blood loss was 20 mL. There was no complication during the operation. Conclusion: Our initial experience shows that 3D-LESS partial nephrectomy procedure is technically difficult, but it is safe, feasible and effective. Flexible 3D laparoscopy can provide clear 3D visualization, improving the operating accuracy and reducing the fighting of instruments. The pig model used in this study can help surgeons to obtain experience on 3D-LESS partial nephrectomy.