Research progress of single-incision laparoscopic radical gastrectomy / 中华胃肠外科杂志

Gastric cancer is one of the most common malignant diseases in the world, which has a high incidence in our country and threatens people's health seriously. Laparoscopic radical gastrectomy is one of the main methods of surgical treatment for gastric cancer, whose clinical application has a history of near 30 years. With the in-depth understanding of minimally invasive surgery and the improvement of patients' cosmetic demand, single-incision laparoscopic surgery has emerged. Since the first report of single-incision laparoscopic radical gastrectomy in 2010, its safety has been preliminarily confirmed. While this result still needs to be further verified by more prospective randomized controlled studies. Compared with traditional laparoscopic radical gastrectomy, single-incision laparoscopic radical gastrectomy has the advantages of less trauma, less postoperative pain and faster postoperative recovery. So it has been favored by surgeons. However, the steeper learning curve and difficult operation of single-incision laparoscopic radical gastrectomy limit its promotion in clinical applications. At present, there are still controversies and confusions in the single-incision laparoscopic radical gastrectomy. This article elucidates the advances and existing problems of single-incision laparoscopic radical gastrectomy.

Single incision multiport laparoscopic appendectomy using a 2 mm alligator forceps: our experience of 60 cases

Single incision laparoscopic surgery is an emerging branch of minimally assess surgery to reduce scar and post-operative pain. Appendicitis is a common general surgical problem encountered in day to day practice. Different methods of appendectomy have been described by different surgeons from open to laparoscopic and now single incision laparoscopic surgery has been practised. This is a prospective study carried out in our Department of General Surgery SCB Medical College, Cuttack from February 2019 to March 2020; 60 patients had undergone the procedure and the results are published noted under headings of post-operative pain at (6 hours, 12 hours, 24 hours and 48 hours), post-operative requirement of analgesia (diclofenac) at (6 hours, 12 hours, 24 hours and 48 hours), operative time, days to resume bowel activity, days of hospital stay, post-operative complication in accordance to Clavien-Dindo classification.

Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of  25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and  complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

Tratamiento de la apendicitis aguda / Acute Appendicitis Management

RESUMEN El objetivo del trabajo es profundizar en los diferentes aspectos cognoscitivos sobre las nuevas evidencias concernientes al tratamiento de la apendicitis aguda y comparar los resultados obtenidos con las diferentes técnicas quirúrgicas empleadas actualmente y el tratamiento conservador. Se realizó una revisión bibliográfica y se seleccionaron artículos en las fuentes electrónicas: Web of Science, Scielo, Elsevier, PubMed, Medline y Google, publicadas en la presente centuria en idiomas español e inglés. La apendicetomía mediante laparotomía ha sido siempre la regla de oro para el tratamiento de la apendicitis aguda. En 1982, se introdujo el acceso laparoscópico que ha demostrado ser tan seguro y eficiente como el convencional. En 2004, la cirugía endoscópica a través de orificios naturales; en 2007 por un solo puerto y en 2015 mediante endoscopia retrógrada. La evolución del cuadro clínico es variable por lo que se han propuesto estrategias como la cirugía ambulatoria, el tratamiento conservador seguido o no de cirugía de intervalo, a fin de evitar intervenciones innecesarias con morbilidad y mortalidad similares a las realizadas con urgencia. La apendicetomía mediante laparotomía o laparoscopia aun es la regla de oro del tratamiento de la apendicitis aguda, aunque se impone el acceso laparoscópico, han surgido nuevas técnicas invasivas y la cirugía ambulatoria. La antibioticoterapia es esencial y como tratamiento único tiene como objetivo disminuir los costos y la morbilidad asociada a la cirugía; por tanto, actualmente el tratamiento adecuado de esta enfermedad es controversial y dependerá de los protocolos de actuación establecidos, el estado del paciente y los recursos disponibles(AU)

ABSTRACT The objective of this work is to study in depth the different cognitive aspects about the new evidences concerning the treatment of acute appendicitis and to compare the results obtained with the different surgical techniques currently used and the conservative treatment. A bibliographic review was carried out and articles were chosen from the electronic sources Web of Science, Scielo, Elsevier, PubMed, Medline, and Google, published in this century in Spanish and in English. Appendectomy by laparotomy has always been the gold standard for the treatment of acute appendicitis. In 1982, laparoscopic access was introduced, which has proven safe and efficient as conventional access. In 2004, endoscopic surgery through natural orifices was used; in 2007, it was performed by a single port, and in 2015, through retrograde endoscopy. The evolution of the clinical picture is variable so strategies have been proposed such as ambulatory surgery, conservative treatment followed or not by interval surgery, in order to avoid unnecessary interventions with morbidity and mortality similar to those performed with urgency. Appendectomy by laparotomy or laparoscopy is still the golden standard of the treatment of acute appendicitis, although laparoscopic access is required, new invasive techniques and outpatient surgery have emerged. Antibiotic therapy is essential and, as a single treatment, aims to reduce costs and morbidity associated with surgery; therefore, the adequate treatment of this disease is currently controversial and will depend on the established protocols of action, patient condition, and the available resources(AU)

Trocar-site hernia after gynecological laparoscopic surgery: a 20-year, single-center experience / 中华医学杂志(英文版)

Background@#Trocar-site hernia (TSH) is a serious complication after laparoscopic procedures. Although it is a rare entity, it can have life-threatening consequences. This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.@*Methods@#We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital (PUMCH) from August 1998 to July 2018 and further sifted through the results for cases involving TSH. All included patients were divided into different groups according to patient characteristics, and the rate of TSH was compared among groups. Moreover, the detailed information of all patients with TSH was recorded and analyzed. Statistical analyses were performed with GraphPad Prism 6.@*Results@#The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016% (9/55,244). The rate of TSH was significant higher in elder patients (≥60 years old; 3/2686, 0.112%) than in younger patients (<60 years old, 6/52,558; 0.011%, P = 0.008). Moreover, the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery (SILS, 2/534, 0.357%) than conventional laparoscopic surgery (7/54,710, 0.013%, P = 0.003). The average age of patients with TSH was 53.4 years (range, 35.0-79.0 years). Two of the nine patients had late-onset TSH following SILS; the other seven had early-onset TSH following conventional laparoscopy. Five TSH cases occurred at right lateral port sites, and the remaining three occurred at the umbilical port site. All patients underwent repair surgery, and one required small bowel resection.@*Conclusion@#Older age and SILS are potential associated factors for TSH development, while reducing excessive manipulation and improving suturing skills, especially at the umbilical trocar site following SILS and the right lateral trocar site, can avoid herniation.

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

PURPOSE: Single-incision laparoscopic surgery (SILS) for colorectal surgery is widely performed for many disease entities. However, there are few reports about the role of repeat single-incision laparoscopic surgery (R-SILS). The aim of this study is to analyze R-SILS data to evaluate the feasibility and safety of the occurrence and review its outcomes. METHODS: This is a retrospective review of the prospectively collected SILS database in Samsung Medical Center, Seoul, Korea, between April 2009 and December 2015. A retrospective review of 38 patients who underwent R-SILS from 2,207 patients who underwent primary SILS for colorectal surgery was performed. RESULTS: The indications of R-SILS were 23 primary SILS-related complications, 10 cancer-related, and 5 other surgical indications. Of the 38 repeat surgeries, 24 were emergent operations, and 14 were elective operations. Fecal diversion for anastomotic leakage after rectal surgery was the most common reason for reoperation. There were 2 cases of conversions: one case was converted to conventional multi-port, and the other case was converted to open surgery. Mean operative time was 137.9±64.1 min, estimated blood loss (EBL) was 105±98 ml, and length of hospital stay was 10.1±8.1 days. Post-operative complication was noted in 5 (13.2%) of 38 R-SILS cases, and there was no 30-day postoperative mortality. CONCLUSION: Repeat single-incision laparoscopy surgery is feasible and safe in select patients when performed by an experienced surgeon.

Initial Experience with Single Incision Laparoscopic Appendectomy by Surgical Resident

PURPOSE: Laparoscopic appendectomy (LA) is a popular procedure for acute appendicitis. Its minimally invasive nature has made LA a commonly performed surgical technique for surgical residents. However, single incision laparoscopic surgery (SILS) poses a challenge to inexperienced surgical residents. We described our initial experience in teaching SILS for appendectomy in our medical center. METHODS: Twenty nine cases of SILA were performed by single surgical resident and 110 cases of LA were performed by four surgical residents and five board-certified surgeons. Data were reviewed retrospectively. RESULTS: The mean SILA and multi-port laparoscopic appendectomy (MLA) operative time was 44.5±14 min (range 25~85 min) and 74.8±26 min (range 20~125 min), respectively. The shorter time for SILA was significant (p<0.05). Postoperative hospital stay was 3.3±1.6 days (range 2~6 days) following SILA and 4.0±2.9 days (range 2~12 days) following MLA (p<0.05). Three cases of wound infection developed following SILA. Complications in the MLA patients included one cases each of operative bladder injury and postoperative ileus. CONCLUSION: SILA is a considerable training method for laparoscopic surgery for a surgical resident learning SILS.

Modified method for umbilical reconstruction after single-incision laparoscopic surgery / 中国现代普通外科进展

Objective:To introduce a modified method for umbilical reconstruction after single-incision laparoscopic surgery.Methods:Between June 2012 and June 2015,173 patients underwent single-incision laparoscopic cholecystectomy at our institution.All the patients adopted our modified method for umbilical reconstruction.Results:All the surgeries were successful.The umbilical incision healed well with good cosmetic result.Conclusion:The modified method for umbilical reconstruction can improve cosmesis and decrease the possibility of incision hernia after single-incision laparoscopic surgery.More studies are needed to evaluate definitive clinical advantages of this technique.

Hernioplasta inguinal laparoscópica totalmente extraperitoneal por incisión única / Single - incision totally extraperitoneal inguinal hernia repair

Antecedentes: el tratamiento laparoscópico de la hernia inguinal ha ido ganando mayor aceptación en virtud de las ventajas del abordaje mininvasivo. Para mejorarlas más aún se plantea la incorporación de otras variantes técnicas. La hernioplasta inguinal totalmente extraperitoneal (TEP) por incisión única constituye una nueva opción, pero no existen en la actualidad series de casos que confirmen su factbilidad y seguridad. Objetivo: verificar la factbilidad y seguridad de dicho método en el tratamiento de la hernia inguinal reductble. Material y métodos: en pacientes sometidos a hernioplasta inguinal laparoscópica TEP por incisión única entre agosto de 2014 y agosto de 2015 se analizaron datos demográficos, tipo y tamaño de hernia, tipo y tamaño de la malla, número de agrafes, tempo operatorio, estadía hospitalaria y complicaciones. Se valoró la intensidad del dolor posoperatorio mediante una escala visual análoga, y grado de satisfacción. Se realizó ecografa de región periumbilical (sito de acceso) y de región inguinocrural tratada, con el objeto de evaluar el grado de morbilidad asociada y recidiva. Resultados: se realizaron 43 hernioplastas TEP por incisión única en 29 pacientes. En 14 pacientes fueron bilaterales (48,2%), 88,4% hombres, de edad promedio 40 años (16-72). Fueron hernias T2 e indirectas en el 72% de los casos. El tempo promedio de estadía fue de 0,56 días (0,5-1,5). La intensidad del dolor a las 12 horas y al 7° día posoperatorio, 4,1 puntos en promedio. El grado promedio de satisfacción con el resultado cosmético fue de 9,5 (rango 8-10). No se registraron complicaciones mayores y 4 casos (9,3%) presentaron complicación menor. El tempo quirúrgico promedio fue 38,3 minutos. No se detectó recidiva herniaria en toda la serie, con una media de seguimiento de 7,1 meses. Conclusiones: la hernioplasta inguinal TEP-incisión única consttuye una opción factble y segura de realizar en pacientes seleccionados con hernia inguinal pequeña y reductble, sin riesgo adicional y sin exigencia técnica adicional. Estos hallazgos se suman a los beneficios de un menor traumatismo de la pared abdominal y un mejor resultado cosmético.

Background: the laparoscopic treatment of inguinal hernia has gained greater acceptance, by virtue of the advantages already demonstrated by minimally invasive approach. For further improvement, the incor-poraton of new technical variantis arises. Extraperitoneal inguinal hernia repair by single incision is a new opton, not existing at present series of cases that confrm their feasibility and safety. Objective: to evaluate the feasibility and safety of this method in the treatment of reducible inguinal hernia. Materials and methods: in patentis undergoing inguinal hernia repair by single incision laparoscopic sur-gery - TEP between August 2014 and August 2015; demographics, type and size of hernia, type and size of mesh, number of staples, operative tme, hospital stay, and complicatons were analyzed. The intensity of postoperative pain using a visual analog scale, and degree of satisfacton was valued. Ultrasound of the periumbilical region (access site) and treated inguinocrural region, to assess the degree of associated mor-bidity and recurrence was performed. Resultis: forty three single-incision TEP hernia repairs were performed in 29 patentis. They were bilateral in 14 patentis (48.2%), 88.4% were men, with mean age 40 years (16-72). T2 and indirect hernias comprised 72% of cases. The average length of stay was 0.56 days (0.5-1.5). The average intensity of pain at 12 hours and the 7th postoperative day was 4.1 pointis (range 1 to 8). The average degree of satisfacton with the cosmetic result was 9.5 (range 8-10). No major complicatons were recorded, and 4 cases (9.3%) had minor complicaton. The average operative tme was 38.3 minutes. No hernia recurrence was detected throug-hout the series with a mean follow up of 7.12 months. Conclusions: inguinal hernia repair by totally extraperitoneal single incision is feasible and safe to perform in selected small and reducible inguinal hernia, without additonal risk and no technical burden. These fin-dings add to the beneftis of lower abdominal wall trauma and improved cosmetic result.

Cost Benefit Alternative to Single Access Laparoscopic Cholecystectomy.

Introduction: Single-incision laparoscopic surgery is an attractive approach for cholecystectomy. However, its widespread application has many limitations. A significant obstacle of application in developing countries is the expensive and non affordable specialized single port systems and roticulating instruments. Objective: To assess the feasibility and effectiveness of the glove port technique of trans-umbilical single incision laparoscopic cholecystectomy (SILC) performed by a single surgeon using the conventional laparoscopic instruments. Methodology: 70 patients with symptomatic gall bladder stone disease were selected and underwent glove port laparoscopic cholecystectomy (GPLC). Patient’s demographic data, operative data, early postoperative complications, patient satisfaction score and wound measurement 3 months later, were documented and statistically analyzed. Results: The mean operative time was 47.75 min. The mean estimated blood loss was 14.5 ml. No conversion of the technique occurred. Overall intra operative complication rate was 5.7%, while post operative complication rate was 4.2%. Conclusion: On technical basis; we consider GPLC in selected cases; a safe, feasible and convenient, and cost effective method of SILC.

Method of auxiliary retraction in single incision laparoscopic surgery / 国际外科学杂志

Single incision laparoscopic surgery (SILS) has many advantages than standard multiport laparoscopic cholecystectomy (MLC),such as small trauma,less postoperative pain,shorter hospital stay,good cosmetic effect,and so on.Especially the satisfying cosmetic result of no abdominal scar is more important.But the SILS is also faced with many difficulties.The operation time of SILS were significantly longer in duration than MLC.The safety and the technical feasibility were lower for the SILS whose operation complications are more than the MLC.The main reason is that the operation field don't exposureis sufficient and the formation of surgical operation triangle is not easy.In order to overcome these difficulties,scholars have used the auxiliary methods of exposing the operative field in various operation,including the penetration of abdomen wall retraction and intraperitonealretractionand abdomen wall retraction.This paper with review the advantages and disadvantages of the above methods aiming to affer more values for clinical doctors in opperating SILS who get more knonledge abont it.

Single-incision Laparoscopic Surgery Versus Conventional Multi-port Laparoscopic Surgery for Tubal Pregnancy / 中国微创外科杂志

Objective To study the feasibility of transumbilical single-incision laparoscopic surgery ( SILS) in the treatment of tubal pregnancy, as compared with conventional multi-port laparoscopic surgery. Methods Sixty-two patients diagnosed as tubal pregnancy undergoing laparoscopic surgery at this hospital between September 2013 and June 2014 were selected for investigation. There were 29 cases of transumbilical SILS ( SILS group) and 33 cases of conventional multi-port laparoscopic surgery ( MPLS group) . We retrospectively reviewed the medical records of all patients and analyzed the surgical outcomes, including operative time, blood loss, surgical complications and hospital stay. Results In both groups, all procedures were performed without failure.No conversion to open surgery or additional skin incision was needed.There were no differences between the SILS and MPLS groups in the operation time [(51.5 ±10.8) min vs.(47.3 ±9.4) min, t=1.637, P=0.107], the mean estimated blood loss [(15.5 ±10.5) ml vs.(18.4 ±12.2) ml, t=-0.996, P=0.323], the absolute decrease of hemoglobin from preoperative to postoperative [(14 ± 5) g/L vs.(13 ±4) g/L, t=0.874, P=0.386], the postoperative hospital stay [(3.5 ±0.9) d vs.(3.8 ±0.8) d, t=-1.390, P=0.170], and the incidence of postoperative fever (2 cases vs.3 cases, χ2 =0.000, P=1.000).Follow-up for 1-3 months ( mean, 1.8 months) in all the cases showed smooth recovery and no postoperative complications. Conclusion SILS is a feasible and safe approach in the treatment of tubal pregnancy.

Single-incision Laparoscopic Surgery for Simultaneous Appendectomy and Cholecystectomy

Single-incision laparoscopic surgery (SILS) has become popular due to the advantage of minimizing surgical. We report on two cases of simultaneous appendectomy and cholecystectomy using a single-incision laparoscopic technique. The patients were 49- and 50-year old females diagnosed with acute appendicitis with concomitant cholelithiasis. Body mass indices of the patients were 22.3 and 26.0. A 3 cm abdominal incision was made via the umbilicus, and a single port platform was created using a small wound retractor (ALEXIS(R) wound retractor S, Applied Medical, Santa Margarita, CA, USA) and a surgical glove. Cholecystectomy was performed first, followed by the appendectomy. The operation times were 165 and 280 minutes, and blood loss was 50 and 150 cc, respectively. The postoperative hospital stays were five and seven days, and one patient had a wound seroma as a surgical complication. We believe that SILS for simultaneous appendectomy and cholecystectomy is a feasible and safe minimally invasive procedure.

Single-incision Laparoscopic Surgery for Simultaneous Appendectomy and Cholecystectomy

Single-incision laparoscopic surgery (SILS) has become popular due to the advantage of minimizing surgical. We report on two cases of simultaneous appendectomy and cholecystectomy using a single-incision laparoscopic technique. The patients were 49- and 50-year old females diagnosed with acute appendicitis with concomitant cholelithiasis. Body mass indices of the patients were 22.3 and 26.0. A 3 cm abdominal incision was made via the umbilicus, and a single port platform was created using a small wound retractor (ALEXIS(R) wound retractor S, Applied Medical, Santa Margarita, CA, USA) and a surgical glove. Cholecystectomy was performed first, followed by the appendectomy. The operation times were 165 and 280 minutes, and blood loss was 50 and 150 cc, respectively. The postoperative hospital stays were five and seven days, and one patient had a wound seroma as a surgical complication. We believe that SILS for simultaneous appendectomy and cholecystectomy is a feasible and safe minimally invasive procedure.

Single Port Laparoscopic Surgery,The New Evolution of Endoscopic Surgery / 中国微创外科杂志

Introduction Laparoscopic surgery through a single port is gaining great interest throughout the world.Here we describe our experience based on a model of single port laparoscopic cholecystectomy.Materials and Methods From January,2008 until August of 2009,we analyze a cohort of the initial one hundred cholecystectomies,to evaluate a proposed technique,common challenges,learning curve and potential solutions.Results Single port laparoscopic surgery was feasible in all patients from this cohort.Patients were strictly selected.Common technical challenges include clashing of instruments,deflection of laparoscope due to conflict with light source,organ retraction,etc.Excellent aesthetic results are superior to laparoscopy.Other benefits of laparoscopy are preserved and may prove to be superior on clinical trials.Conclusion Single port laparoscopic surgery is becoming popular worldwide.Once these essentials are mastered,a learning curve may be shortened especially for experienced laparoscopic surgeons.Transparency with patients and team building are essential requirements for a successful adoption.Clinical trials are ideal before universal adoption.