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Objective:To explore the efficacy and safety of posterior retroperitoneoscopic adrenalectomy (PRA) in the prone position.Methods:The clinical data of 74 patients who underwent PRA in the prone position in our hospital from January 2019 to February 2021 were reviewed. There were 36 males and 38 females, with an average age was (54.4±12.5) years old. The body mass index was (24.03±3.5) kg/m 2. CT scans of the adrenal glands were performed before operation. There were 39 cases of adrenal tumors on the left side, 33 cases on the right side, and 2 cases on both sides. The diameter of adrenal tumors shown on CT was (2.4±1.3) cm. Among them, 22 cases were diagnosed of non-functional adrenal tumors, 21 cases were primary aldosteronism, 8 cases were Cushing syndrome, and 23 cases were pheochromocytoma . The PRA in the prone position were performed in all 74 patients(76 sides). Results:The operation was performed successfully in all 74 patients(76 sides), of which 42 cases underwent unilateral adrenalectomy, 30 cases underwent unilateral partial adrenalectomy and 2 cases underwent bilateral adrenalectomy. The operation time was (53.2±16.1) min for 76 sides, and the time of two bilateral cases was 70 min and 115 min respectively. The median time of rainage tube indwelling was 3(0, 4) d, and the hospital stay was (4.2±0.9) d. The pathological diagnosis: there were 32 cases of adrenal cortical adenoma, 8 cases of adrenal cortical hyperplasia nodule, 5 cases of adrenal cyst, 7 cases of adrenal medullary lipoma, and 22 cases of adrenal pheochromocytoma. No adverse complications occurred during the perioperative period. The patients were followed-up for (12.5±2.7) months, and no tumor recurrence or long-term complications occurred.Conclusions:Posterior retroperitoneoscopic adrenalectomy in the prone position has the advantages of reducing bleeding and exudation, and rapid recovery after surgery, which provides a safe and effective surgical method for the treatment of adrenal tumors.
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Objectives: In this study our main aim is to evaluate the sociodemographic characteristics of non-palpable testes in childrenundergo laparoscopy surgery in Bangladesh.Methods: This cross-sectional observational study was donein the department Pediatric Surgery, Dhaka Shisu (Children)Hospital (DSH), Dhaka, from March 2010 to September 2011.The study included 30 children with nonpalpable testis eitherunilateral or bilateral.Result: During the study, 37% patients belong to 2-5-year agegroup. Followed by 26% in 5-10 years age group, 20% 1-2years age group. (50%) cases, diagnosed by laparoscopy asvas and vessel entered into deep ring underwent plannedinguinal exploration. 40% belong to full term whereas 60%belong to pre-term.Conclusion: From our study we can conclude that,Laparoscopic orchiopexy were done by either single stage ortwo staged Fowler - Stephens method, needs to be evaluatedon large group of patients with longer follow- up.
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RESUMEN Introducción: son múltiples las complicaciones de la derivación ventrículo peritoneal, entre ellas la infección de la derivación, obstrucción y desconexión, son las más frecuentes. Por otro lado, el pseudoquiste de líquido cefalorraquídeo, hernia inguinal, hidrocele y perforación intestinal, son ocasionales. Objetivo: describir la cirugía laparoscópica como método de tratamiento de la extrusión anal del catéter como complicación de la derivación ventrículo peritoneal. Presentación del caso: se presenta un caso de un paciente neurointervenido a causa de un colesteatoma del clivus, al cual se le realiza una derivación ventrículo peritoneal debido a una hidrocefalia secundaria a compresión del suelo del tercer ventrículo, por el crecimiento supraselar de la lesión. Acude al servicio de Neurocirugía a causa de extrusión del extremo distal del catéter a través del ano. Después de confirmar esta complicación a través de colonoscopia, se realizó cirugía laparoscópica para retirar el extremo extruido. Conclusiones: el paciente evolucionó sin complicaciones posquirúrgicas y dado de alta hospitalaria. La cirugía por mínimo acceso ofrece ventajas con respecto a la laparotomía en la resolución de esta complicación.
ABSTRACT Introduction: there are multiple complications of peritoneal ventricle shunt, including infection of the shunt, obstruction and disconnection, are the most frequent. On the other hand, cerebrospinal fluid pseudo cyst, inguinal hernia, hydrocele and intestinal perforation are rare. Objective: to describe a laparoscopic surgery as a method of treatment of anal catheter extrusion as a complication of peritoneal ventricular bypass. Case report: a patient with a neurosurgery because of a cholesteatoma of the clivus, to which a peritoneal ventricle derivation is made due to a hydrocephalus secondary to the compression of the floor of the third ventricle, by the suprasellar growth of the lesion. The patient came to the Neurosurgery Service because of extrusion of the distal end of the catheter through the anus. After confirming this complication through colonoscopy, laparoscopic surgery was performed to remove the extruded end. Conclusions: the patient evolved without post-surgical complications and was discharged from the hospital. Minimal access surgery offers advantages over laparotomy in the resolution this complication.
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Objective@#To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure.@*Methods@#A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized.@*Results@#All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV.@*Conclusion@#The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.
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OBJECTIVE:To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS:Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st,2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS:Among 5 288 patients underwent laparoscopy surgery,1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach,duodenum and small intestine operation was the highest(69.4%);the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%;prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone(83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium(63.9%),metronidazole(13.5%)and cefotaxime sodium(11.85). There were irrational medical orders in 151 cases(8.0%)of perioperative prophylactic use of antibiotics;among prescriptions of irrational drug use,the majority was unsuitable drug selection(50.3%),followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS:The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery,and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital,strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery,relevant rational drug use education.
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Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.
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Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.
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OBJECTIVE: To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. METHODS: Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. RESULTS: Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). CONCLUSION: Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety.
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Humans , Disease-Free Survival , Follow-Up Studies , Hysterectomy , Laparoscopy , Laparotomy , Lymph Node Excision , Ovarian Neoplasms , Postoperative Complications , Recurrence , Retrospective StudiesABSTRACT
Objective: To assess the feasibility of the single-port laparoscopic transvesical prostatectomy in pigs, and to summarize the technique difficulties, so as to lay a foundation for future clinical application. Methods: Six uncastrated male pigs were used in this study. The skin stomas were made through bladder exstrophy and the TriPort system was inserted into the bladder. Radical prostatectomy was performed as did in human using laparoscopic instruments through the TriPort system after inflating the bladder. The bladder and abdomen were closed after vesicourethral anastomosis, and the prostate specimens were removed through the skin stoma. Results: The first three procedures failed due to inappropriate positioning of TriPort system, limited space of bladder, and the high tension of vesicourethral anastomosis. The other 3 procedures were successful, with the periods used being 190 min,160 min, and 110 min. The whole prostates were resected completely, and the completeness of the urinary tract was recovered using interrupted suture (6 sutures). Conclusion: The single-port laparoscopic transvesical prostatectomy is a feasible procedure, but there are technical difficulties. Further experiments are needed on human cadavers before clinical application.
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Objective To investigate the different clinical efficacy of traditional Chinese medicine and laparoscopy surgery treatment for endometriosis infertility.Methods The 45 cases of endometriosis infertility were randomly divided into two groups, for the control group,22 patients were treated by laparoscopy surgery treatment;for the experimental group, 23 patients combined with traditional Chinese medicine treatment after laparoscopy surgery.Results The efficiency of the two groups are as follows:the effective rate of the experimental group 913%, the control group 727%；the two groups were significantly different（p<0.05），the pregnancy rate of the experimental group is 696%, and the control group is 454%, the two groups were significantly different（p<0.05）.Conclusion After laparoscopy surgery combined with traditional Chinese medicine treatment for endometriosis infertility is significantly effective, and it is worthy of clinical application.