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Objective: To summarize surgery experience and efficiency of laparoscopic excision of choledochal cyst and reconstruction of biliary tract and to analyze the treatments administered during intra and post-operation of the biliary reconstruction. Methods: We enrolled 48 cases of video-guided laparoscopic intraoperative cholangiography, cholecystectomy, choledochocele resection, Roux-en-Y hepaticojejunostomy with an anti-reflux valve from August, 2001 to October, 2003.Their operative procedures and aims were retrospectively analyzed. Results: Forty-four out of 48 patients successfully underwent laparoscopy and recovered soon. Only 4 cases were transformed to open operation. The post-operation complications were found in 4 cases. Conclusion: Video-guided laparoscopic excision of choledochal cyst, biliary tract reconstruction and Roux-en-Y hepaticojejunostomy are an effective method of treatment with advantages of minimal injury, less bleeding, and sooner recovery.
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Objective The aim of this study was to discuss the technical details on laparoscopic total cyst excision with Roux Y hepatoenterostomy for the treatment of choledochal cyst in children.Methods Eight patients with type Ⅰ choledochal cyst (median age 3 6 years) underwent laparoscopic cyst excision with Roux Y hepatoenterostomy from July 2001 to April 2002.Under laparoscopic guidance, intraoperative cholangiogram was performed, the gallbladder and the dilated bile duct were completely excised. Roux en Y jejunojejunostomy was performed extracorporeally through umbilical incision (2 cm), and an end to side anastomosis was carried out intracorporeally.Results Median duration of operation was 4 8 hours (3 6 to 6 0 hours), intraoperative bleeding was between 10 to 50 ml. Hospital stay after the operation ranged from 3 to 8 days. There was no intra or postoperative complication.ConclusionLaparoscopic total cyst excision with Roux Y hepatoenterostomy was effective and safe procedure for children with choledochal cyst.
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Objective To discuss the mechanism and prevention of bile duct injury in laparoscopic cholecystectomy (LC). Methods Twenty-six cases with bile duct injuries in this study were evaluated retrospectively regarding their location, mechanism, time of detection, repairment and outcome, and the role of intraoperative cholangiography (IOC) in preventing bile duct injury. Results Among a total of 26 cases there are duct injury due to misidentification 15 cases,( IOC detected the misidentification of bile duct injuries intraoperatively 10 cases, clipping the common duct 3 cases, duct thermal injuries 4 cases and duct lacerations 4 cases, Conclusion Duct injury due to misidentification was the main type of bile duct injury in LC, Correct interpretation of IOC will detect the duct injury intraoperatively and prevent the severe consequence. Meticulous dissection and exposure of the junction of distal common hepatic duct, proximal common bile duct, and proximal cystic duct, and safe hemostasis in Calot triangle are the important measures to prevent bile duct injury in LC.
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Objective To present our experience with laparoscopic pyloromyotomy and laparoscopically assisted endorectal pull through for Hirschsprung's disease (HD) in newborns and infants.Methods Twenty newborns or infants with hypertrophic pyloric stenosis and HD,age ranged from 16～120 days and weight from 2.7～8 kg.Under epidural anesthesia and tracheal intubation,carbon dioxide was insufflated into abdominal cavity via a Veress needle,reaching an insufflative pressure of 12～14 mm Hg.One umbilical and two or three subcostal canulas for instrumentation were demanded.The pyloromyotomy was performed in patients with hypertrophic pyrolic stenosis and in patients with HD the affected colon and rectum were mobilized by dissecting the supplying vessels and cutting the peritoneal reflection,and pull-through procedure was carried out.Results The operation time was 25～150 minutes with rare complications.Oral feeding was resumed on the following day postoperation.The patients recovered and discharged from hospital 3～7 days after operation.Conclusions Laparoscopic pyloromyotomy and laparoscopic endorectal pull-through for HD in newborns and infants are safe and feasible.The advantages of this procedure include minimal trauma to abdomen,rapid restoration of stomach and bowel function and quick rehabilitation.
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Objective To evaluate the feasibility of transperitoneal laparoscopic adrenalectomy for 3 patients with primary aldosteronism who previously underwent ipsilateral adrenal surgery or nephrectomy. Methods From October 2003 to March 2004,transperitoneal laparoscopic adrenalectomy was performed on 3 male patients with primary aldosteronism,including 2 patients (39 and 72 years,respectively) who had previously undergone ipsilateral retroperitoneal laparoscopic partial adrenalectomy for Conn’s adenoma and 1 patient (42 years) who had previously undergone ipsilateral open nephrectomy for renal tuberculosis. Results Transperitoneal laparoscopic adrenalectomy was successfully performed on all the 3 patients; no complication occurred.The mean tumor size was average 1.7 cm in greatest dimension;the mean operative time was average 93 min;the mean estimated blood loss was average 18 ml,and no one needed blood transfusion.The postoperative food intake time was average 17 h,and postoperative hospital stay was average 5.0 d. Conclusions Although scar and adhesion of previous operation may present more difficulties in the subsequent operation,it is feasible to perform transperitoneal laparoscopic adrenalectomy through different surgical access on the patients who have previously underwent ipsilateral retroperitoneal adrenal or nephric surgery.
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Objective To evaluate the outcomes of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods From December 2003 to June 2004,6 patients underwent laparoscopic live donor nephrectomy (younger brother to elder sister in 1 case,elder brother to younger brother in 1, younger sister to elder brother in 1,elder sister to younger brother in 1,father to son in 1,mother to son in 1).For tissue matching,1 case was mismatched of 0 locus,2,of 2 loci and 3,of 3 loci.The results of PRA and lymphocytotoxicity test were negative.The patient was placed in the lateral decubitus.With 3 trocars, the left kidney was dissected via retroperitoneal approach.The arteries and veins were cut off by endoscopic articulating linear cutter. The donor's left kidney was taken out through a 6-7 cm long incision between 2 trocars.Staplers on renal arteries and veins were cut off,and the donor kidney was perfused with liquid,and then was implanted at the right iliac fossa of the recipients.Triple immunosuppressant therapy was used to prevent rejection. Results Laparoscopic donor nephrectomy was successfully performed on all the 6 cases by retroperitoneal approach.The kidney transplantations using the donor live kidneys were also successful.Postoperatively,the mean urine volume was 5036 ml(range,3500-6500 ml) on the first day;the mean serum creatinine level was 598 ?mol/L on the first day and 129 ?mol/L at 1 month.Follow-up of 3-9 months showed that the renal function was normal and no rejection occurred. Conclusions Laparoscopic donor nephrectomy via retroperitoneal approach is safe,feasible,and less invasive to the donor; however,this technique needs skilled surgeons of laparoscopy and renal transplantation.
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Objective To compare the therapeutic effect of laparoscopic radical cystectomy with orthotopic ileal neobladder (LRC-INB) vs open radical cystectomy (ORC-INB). Methods A total of 81 patients were evaluated including 33 undergoing LRC-INB (group A) and 48,ORC-INB (group B) from June 1994 to September 2004 at our institution.The parameters for analysis included operative time,surgical method,blood loss,therapeutic effect,complications and hospital stay.Statistics included t-test and chi-square analysis (P
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Objective To evaluate the therapeutic effects of functional reconstructive technique of laparoscopic radical prostatectomy (LRP) for organ confined prostate cancer. Methods From October 2000 to September 2004,54 patients with organ confined prostate cancer (TNM stage of T 1b-T 2) underwent LRP.After completion of the first group of 15 consecutive cases (group A) by Monstouris techniques, the functional reconstructive surgical technique, which is basically composed of anatomical radical prostatectomy,was introduced to LRP in the second group of 39 consecutive cases (group B).These techniques mainly consisted of preservation of urethral and bladder outlet sphincter muscles,reconstruction of bladder neck,and fine anastomosis between urethra and bladder neck with fixation of anterior wall of anastomotic stoma and retropubic vascular complex.The operative time, bleeding volume,complications,continence recovery time and PSA level were comparatively analyzed between the 2 groups. Results All the operations were successful in 54 patients.In group A and group B,the mean operative time was 390 min(range,270-660 min)vs 240 min(range,180-360 min);the mean bleeding volume was 430 ml(range,200-1100 ml) vs 160 ml(100-400 ml);the complication rate was 40% (6/15) vs 13% (5/39) and the continence recovery time was on average 6 months vs 3 months,respectively. There were statistically significant differences in these parameters between the 2 groups (P
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Objective To describe the initial experience of transperitoneal laparoscopic renal plication for giant hydronephrosis,and to evaluate the clinical feasibility of the procedure. Methods This series included 12 cases of giant hydronephrosis (5 men and 7 women;age ranged from 19 to 64 years with a mean of 42.6 years).Of them 4 cases had upper ureter calculi;2 had ureteropelvic junction(UPJ) obstruction;2,middle ureter calculi;3,nephrolithiasis and 1,middle ureter stricture. The upper urinary tract obstruction was relieved and plication was performed via laparoscope. Results All the 12 operations were completed successfully.The intraoperative blood loss was 50 to 200 ml,operative time was 75 to 210 min.The postoperative follow-up lasted 3 to 18 months.In all these cases,hydronephrosis was relieved and renal function was improved. Conclusions Laparoscopic renal plication is an effective and minimally invasive method and can be considered as an alternative for treatment of giant hydronephrosis.
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0 05); Flatus, time to resume early activity and hospital stay in laparoscopic group were 2 24?0 56、 3 94?1 64、 13 94?6 5 days respectively, which was significantly shorter than those in open group ( P 0 05) The mean follow up time of the two groups were 23 15?7 95 and 22 19?7 46 months, respectively Local recurrence rate,metachronous metastases rate and cumulative survival probability at 36 months were similar for the two groups Conclusion These results suggest that laparoscopic right hemicolectomy for colon cancer can be performed safely, effectively and economically with the advantages of minimal invasiveness
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Needlescope is a laparoscopic equipment with a diameter of only 2 mm. It has been used in treatment of some general surgery and gynecology diseases. In urology .needlescopic techniques have also been applied in some procedures including adrenalectomy and pediatric orchiopexy. Although debates still exist about the definition of needlescopic surgery and the 2-mm instruments have their limitation,needlescopic technology has obvious advantages such as smaller traumas,superior cosmetic result, shorter hospital stay, and abbreviated convalescence. Needlescopic techniques represent a natural evolution of conventional laparoscopy.
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Objective To investigate the feasibility and ways of closed establishment of pneumoperitoneum for laparoscopic procedures in patients with a history of abdominal surgery. [WT5”HZ]Methods[WT5”BZ] Between September 1991 and December 1998, 963 patients with a history of abdominal surgery received closed establishment of pneumoperitoneum. The difficulties with closed establishment were classified as false and real types. Veress needle penetrating into falciform ligament, mesentery, great omentum or retroperitoneal fat tissue caused false difficulty, while the difficulty due to Veress needle penetrating into abdominal viscera or because of extensive adhesion was known as real difficulty.[WT5”HZ] Results[WT5”BZ] 18 cases for false and real difficulty were transfered to open surgery.Two cases suffered visceral injuries for laparoscopic cholecystectomy, including jejunum and ileum injuries in one each case. The occurrence rate of visceral injuries accounted for 0 2% in this group.[WT5”HZ] Conclusion[WT5”BZ] This result demonstrates that closed establishment of pneumoperitoneum is safe and feasible in most patients with abdominal operative history. Abiding by the rule of closed establishment pneumoperitoneum and conversion to laparotomy in time in real difficulty is important to avoid visceral injuries.
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Objective To report on our experience with laparoscopic nephron-sparing surgery forthe treatment of renal tumors,and to seek the safe and effective techniques and methods. Methods FromJune 2003 to June 2005,16 patients (5 men and 11 women) with small exophytic solid renal masses weretreated by transperitoneal laparoscopic wedge resection in our hospital.The mean age was 46 years (range,29 -56 years).The mean tumor size of renal cell carcinoma (5 cases) and hamartoma (11 cases) was2.0 -3.5 cm and 3.0 -5.5 cm,respectively, in diameter. One case of hamartoma had secondary bleeding.Wedge resection of the tumors was performed quickly with scissor,and hemostasis was achieved by intra-ab-domen suturing and knotting. Results All the procedures were finished laparoscopically with no conver-sion to open surgery.The mean operative time was 104 min (range,70 -150 min);mean hot bloodless timewas 21 min(range,14 -32 min);mean blood loss was 158 ml (range,50 -700 ml).The pathologic exami-nation showed negative surgical margin in 5 cases of renal cell carcinoma.Postoperatively,no urinary leakageand secondary bleeding occurred,and the renal function was normal in all the 16 cases.The patients weredischarged 7 d after operation.Follow-up was 1 month to 1 year.Neither distant nor local recurrences wereobserved by the last follow-up date on B-ultrasound,IVUand CTat follow-up. Conclusions Laparoscopicnephron-sparing surgery for renal tumors is a minimally invasive procedure with less blood loss,less pain andfewer complications.Reliable non-traumatic kidney vessel control is the basic method of this operation.Sharpresection without smog and rapid renal incision suturing can reduce the renal hot bloodless time.
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Objective To evaluate the effectiveness of laparoscopy in anterio r lumbar interbody fusion. Methods Twenty-three laparoscopic anterior lumbar int erbody fusions were performed in the period between December 2000 and December 2 002. There were 9 males and 14 females with a mean age of 52 years (range, 46 to 66 years). In this group, there were 18 of spondylolisthesis, 3 of lumbar spina l instability and 2 of degenerative disc treated with anterior lumbar interbody fusion using Syncage and autograft with balloon-assisted endoscopic extraperiton eal gasless exposure. The main complaints were low back pain radiating to leg. 1 3 cases were fused at L4,5 and 10 at L5S1. The Oswestry Disability Index (ODI) w as recorded to evaluate the function preoperatively, and in the 2nd week, 3rd, 6 th and 12th month postoperatively. X-ray was taken to observe the fusion and the subsided cage. Results The operative time ranged from 50 to 180 min with a mean of 120 min, and the bleeding volume ranged from 50 to 300 ml with a mean of 80 ml. There were complications in 2 cases, one which was caused by laparoscopic mi sguidance, and the other was bleeding due to a small vessel injury. All the case s were followed-up from 12 to 24 months, with a mean of 16.6 months. The ODI was found with significant difference comparing preoperatively to at 2nd week, 3rd, 6th and 12th month postoperatively (P
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Objective To determine whether the pressure of continuous CO 2 pheumoperitoneum (CCP) affects port site implantation of tumor cells.Methods Male SD rats were injected intraperitoneally with gastric cancer cells (cell line SGC 7901). Continuous CO 2 pneumoperitoneum at 15*!mm*!Hg or 30*!mm*!Hg for 5*!mins,60*!mins,120*!mins and 180*!mins with different number of tumor cell injection(10 4/ml, 10 6/ml respectively) was then established. Several samples of peritoneal washing served as positive control.All collecting dishes were incubated at 37℃ for one week.Results Dishes were tumor cell positive on which the tumor cells were collected from rats undergoing continuous flows of CO 2 gas (5*!L/min) at pneumoperitoneum of 30*!mm*!Hg for 60 mins or longer and all peritoneal washing samples showed tumor growth also. Conclusion It suggests that the number of tumor cells, pneumoperitoneum pressure and the duration may affect the port site implantation.
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Objective To introduce the techniques of scanning the common bile duct(CBD) in full length with laparoscopic ultrasonography through the sonic window dorsal to the first portion of the duodenum(FPD). Methods The lower segment of the CBD in 300 cases was scanned in full length through the sonic window dorsal to the FPD. Results In our series, 97.67% of the lower segment of the CBD can be visualized with simple techniques through sonic window dorsal to the FPD. Visualization in 25 cases were improved with injection of saline into the subhepatic space and extraction of gas from the stomach and duodenum. Conclusion Through the sonic window dorsal to the FPD and with simple techniques, the lower segment of the CBD in majority of our cases can be satisfactorily imaged in full length. Visualization can be improved in some individuals with injection of saline into the subhepatic space and extraction of gas from the stomach and duodenum.
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Objective To compare the results between laparoscopic repair and surgical procedures in perforation of duodenal ulcer. Methods Fifteen p atients were operated on perforation of duodenal were by laparoscopic repair, an d thirty patients performed open repair or partial gastrectomy at the same peri od were chosen as control groups. Results The operating time in laparoscopic group and other two surgical groups were 59 min, 84 min and 204 min; postoperati ve requirement of analgesic was 7％(1/15), 73％(11/15) and 80％(12/15) in three groups respectively. The recovery time of gastrointestinal function was 25 h, 56 h, and 72 h. the mean time of hospitalization was 6 d, 8 d and 10 d. The differ ences among groups were significant (P
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Objective To evaluate the maneuvre of curettage and aspiration(LTCA) in laparoscopic hepatectomy. MethodsWe used Peng′s multifunctional operative dissector(PMOD) to perform laparoscopic liver transection by maneuvre of curettage and aspiration in 20 cases undergoing laparoscopic hepatectomy. Results Procedures were all successful. The recovery was uneventful without any complications. Mean operative time was 105 minutes, the average bleeding volume was 420 ml, the largest excised sample size was 10 cm?9 cm?7 cm. All patients were discharged within one week. ConclusionsThe new technique-LTCA can be used in laparoscopic hepatectomy, it has the advantages of clear anatomy, good exposure of canal construction, rapid liver transection, satisfactory hemostasis and clear operative field.
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0.05). Conclusions There is no difference in immune responses to rectal cancer patients undergoing laparoscopic total mesorectal excision with anal sphincter preservation and those having open surgery.
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Objectives To study the feasibility of total mesorectal excision (TME) by laparoscopy for rectal cancer.Methods The mesorectum in the resected samples and the number of lymph nodes resected were compared between laparoscopic (n=20) and open surgery group (n=20).Results ①The mesorecum of resected specimen was all complete in two groups. ②The lymph node yield (N 1) in laparoscopic and open group was 8.5?3.6 vs. 10.6?6.2(P=0.334), respectively. That in N 2 was 3.7?2.2 vs. 2.4?2.1(P=0.328). That in N 3 was 2.4?1.7 vs. 2.0?1.8(P=0.590).③The distal margin was all tumor-free in the two groups. ConclusionLaparoscopy is capable of performing TME in patients with rectal carcinoma undergoing radical resection.