Clinical study of "total laparoscopic pancreaticoduodenectomy" in low-flow hospitals / 国际生物医学工程杂志

Objective:To explore the safety, feasibility and clinical value of the "posterior colon approach, uncinate process first" of total laparoscopic pancreaticoduodenectomy in low volume hospitals.Methods:The clinical data of 3 patients who underwent complete laparoscopic pancreaticoduodenectomy were analyzed from January 2020 to August 2020.Results:All the 3 patients successfully underwent total laparoscopic pancreaticoduodenectomy. For the 3 patients, the operative time was 430, 385 and 425 min, and the blood loss was 550, 420 and 400 ml. After the operation, no pancreatic fistula, bile leakage, intestinal fistula and astric emptying disorder were found in the patients. The exhaust time of the 3 patients was 4, 5 and 5 days after the operation, respectively. On the 6th day after the operation, the gastric tube was removed. The extraction time of the abdominal drainage tube of the 3 patients was the 7th, 7th and the 9th day, and the postoperative hospital stay was 18, 15 and 16 days, respectively. Postoperative pathological diagnosis results showed that the 3 patients included 1 case of pancreatic head high-moderately differentiated ductal adenocarcinoma, 1 case of duodenal ampullary high-moderately differentiated adenocarcinoma, and 1 case of duodenal papillary well-differentiated adenocarcinoma.Conclusions:"Posterior approach of uncinate process" is safe and feasible in laparoscopic pancreaticoduodenectomy. It can be popularized in low volume hospitals.

Comparison of the mid- and long-term outcomes between natural orifice specimen extraction surgery and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer based on propensity score matching method / 中华胃肠外科杂志

Objective: To compare the mid- and long-term outcomes between natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer. Methods: A propensity score matching study was conducted. Patients with pathological diagnosis of rectal adenocarcinoma, preoperative imaging assessment of T1-3 and body mass index <28 kg/m(2) were included. Those who underwent local resection or abdominoperineal resection, had simultaneous multiple primary cancers, malignant intestinal obstruction or perforation, received neoadjuvant radiotherapy, and were unsuitable for laparoscopic surgery were excluded. From January 2017 to January 2019, 264 patients undergoing laparoscopic rectal cancer surgery at the Department of Colorectal Tumor Surgery, Shengjing Hospital of China Medical University were enrolled in this study, and divided into the NOSES group (52 cases) and the auxiliary incision group (212 cases). Propensity score matching method was used as 1:1 to match the initial data, and 46 pairs were finally obtained. SPSS 26.0 was used for data analysis, and 2-year disease-free survival, intraoperative and perioperative indicators were compared between the two groups. Results: The tumor short diameter in the NOSES group and the auxiliary incision group was (2.9±0.8) cm and (3.1±1.0) cm (t=0.842, P=0.402) respectively. Other baseline data were also comparable between the two groups(all P>0.05). There were no significant differences in operative time, intraoperative blood loss, length of hospital stay and postoperative complication rate between the two groups (all P>0.05). The time to first flatus [2 (1-6) days vs. 3 (1-6) days, Z=-3.035, P=0.002] and to liquid food intake [3 (1-6) days vs. 3 (2-7) days, Z=-2.587, P=0.010] after surgery in the NOSES group were earlier than those that in the auxiliary incision group. Compared with the auxiliary incision group, the postoperative pain score was lower [3 (2-5) vs. 4 (3-7), Z=-5.477, P<0.001], and the aesthetic score was higher [8 (6-9) vs. 7 (5-8), Z=-6.329, P<0.001] in the NOSES group. The distal resection margin in the NOSES group was longer than that in the auxiliary incised group [(3.7±1.2) cm vs. (2.9±1.4) cm, t=3.287, P<0.001]. There were no significant differences in proximal resection margin the number of harvested lymph nodes and positive rate of circumferential resection margin between the two groups (all P>0.05). The 2-year disease-free survival rate in the NOSES group and the auxiliary incision group was 93.5% and 89.1% respectively, and the difference was not statistically significant (P=0.466). Conclusions: NOSES has similar mid- and long-term outcomes to conventional laparoscopic surgery and the advantages of better cosmetic effect, less postoperative pain and faster recovery, which is more in line with the concept of minimally invasive and worthy of clinical promotion.

Application of "priority approach of uncinate process" in laparoscopic pancreaticoduodenectomy:A report of 200 cases / 中国实用外科杂志

OBJECTIVE: To explore the value of "priority approach of uncinate process" in laparoscopic pancreaticoduodenectomy. METHODS: The data of 200 patients who underwent laparoscopic pancreaticoduodenectomy in the No.2 Department of Hepatobiliarypancreatic Surgery, the First Hospital of Jilin University from April 2015 to October 2018 were analyzed retrospectively. RESULTS: All the 200 patients successfully completed laparoscopic pancreaticoduodenectomy, including 1 case of laparoscopic pancreaticoduodenectomy combined with right hemicolectomy,2 cases of laparoscopic pancreaticoduodenectomy combined with pancreaticocotailectomy,and 2 cases of laparoscopic pancreaticoduodenectomy combined with portal vein reconstruction(end-to-end anastomosis). The mean operation time was(281±49)min,including the specimen removal time(91±15)min,and the intraoperative blood loss was 50-850 mL(122±53)mL. The mean postoperative hospital stay was(16±9)days. Eight-teen cases(9.0%)had grade B pancreatic fistula and 3 cases(1.5%)had grade C pancreatic fistula. Postoperative anastomotic bleeding in 2 cases(1.0%). Intraperitoneal hemorrhage was found in 14 cases(7.0%), and delayed gastric emptying in 9 cases(4.5%).Biliary fistula was found in 11 cases(5.5%). There were 2 deaths(1.0%). Postoperative pathological diagnosis showed that ductal adenocarcinoma of the head of pancreas was in 33 cases(16.5%),the pancreas intraductal papillary mucinous tumor in 15 cases(7.5%),head of the pancreatic neuroendocrine tumors in 6 cases(3.0%),pancreatic ductal epithelial hyperplasia in 1 case(0.5%),solid pancreatic head fake papilloma in 9 cases(4.5%),pancreatic head capsule adenomas in 5 cases(2.5%),chronic pancreatitis in 1 case(0.5%),duodenal adenocarcinoma in 4 cases(2.0%), duodenal stromal tumor in 2 cases(1.0%), duodenal benign space-occupying lesions in 11 cases(5.5%),periampullary carcinoma of non pancreatic head origin in 105 cases(52.5%)and benign periampullary tumors in 9 cases(4.5%). CONCLUSION: "Priority approach of uncinate process" is safe,rapid and effective in laparoscopic pancreaticoduodenectomy,which is worthy of further promotion and application in clinic.

Clinical analysis of total laparoscopic resection for colorectal cancer by NOSES: a report of 50 cases / 中国内镜杂志

Objective?To investigate the feasibility, safety, operating essentials and the short-term therapeutic effect of total laparoscopic resection for colorectal cancer by Natural Orifice Specimen Extraction (NOSES).?Methods?The clinical data of 50 patients underwent total laparoscopic resection for colorectal cancer by NOSES from January 2016 to June 2017 were retrospectively analyzed.?Results?All of the 50 patients with colorectal cancer successfully received total laparoscopic resection by NOSES. None of the patients had serious postoperative complications and death related to the operation. The average operating time was (140.0 ± 29.0) minutes. The blood loss was (70.0 ± 23.4) ml. The number of lymph nodes harvested were (14.0 ± 2.3). There was no bacteria infection in abdominopelvic cavity post-operation and no recurrence occurred until the end of postoperative follow- up. Postoperative time of bed rest was (2.0 ± 0.5) days. The time of the first anal exhaust was (2.0 ± 0.5) days. The postoperative hospitalization stay was (8.5 ± 3.0) days. There was none case of lung infection while one case of anastomotic leakage. No cancer cells remained in resection margin. No local recurrence and metastasis was found in all patients after follow-up for 3 to 24 months.?Conclusion?Total laparoscopic resection for colorectal cancer by NOSES is safe and feasible, and has the advantage of minimally invasive, less pain, rapid rehabilitation, good cosmetic effect and less postoperative complications.

Curative effect of laparoendoscopic single-site surgery for benign ovarian tumor / 中国内镜杂志

Objective To investigate the clinical value of single hole laparoscopy in treatment of ovarian benign neoplasms. Methods The patients with benign ovarian tumors treated from February 2014 to August 2016 were divided into two groups, 41 cases in each. The observation group received laparoendoscopic single-site surgery, while the control group was treated with traditional porous laparoscopic gynecologic surgery. The operation effect, intraoperative and postoperative complications, postoperative ovarian function and cosmetic satisfaction were observed and recorded in the two groups. Results The operation of the two groups was smooth and there were no intraoperative or postoperative complications. The operation time and postoperative satisfaction degree of the observation group were significantly higher than that of the control group (P < 0.05). The postoperative exhaust time, postoperative hospital stay, postoperative 24 h and 72 h, VAS scores of the observation group were significantly lower than those of the control group (P < 0.05). The estradiol levels in the two groups were significantly lower than those before operation, and the levels of follicule-stimulating hormone and luteinizing hormone were significantly higher than those before operation (P < 0.05). There were no significant differences in the amount of bleeding between the two groups and the levels of estradiol, follicule-stimulating hormone and luteinizing hormone before and after the operation (P > 0.05). Conclusion The laparoendoscopic single-site surgery technique is better than the porous laparoscopic technique in the treatment of benign ovarian tumors, and it is worthy of popularization and application.

Preliminary application of laparoscopic technique in treatment of upper urinary calculi / 中国内镜杂志

Objective To evaluate the reasonable individual program for upper urinary tract calculi in minimally invasive treatment. Methods From January 2013 to June 2016, 147 patients (sides) with upper urinary calculi who had some characteristics received laparoscopic nehprectomy or corresponding surgical treatment. The number of cases of postoperative stagnation, the average hospitalization time and the average cost of treatment were compared with those of 147 patients (lateral) who underwent PCNL and URSL with the similarity, shape and load of stones before June 2016, respectively. Results The removal rate of stage I was 100.00％ (147/147) in laparoscopic group, which was significantly higher than that in PCNL and URSL group (91.84％, 135/147), the difference was statistically significant (P = 0.001); Laparoscopic group postoperative blood transfusion (0/147) and interventional hemostasis (0/147) were significantly lower in 6 cases (6/147) and 4 cases (4/147) in PCNL and URSL groups,the differences were statistically significant (P = 0.013, P = 0.044). There was no postoperative severe infection in laparoscopic group (0/147), which has no significant difference (P = 0.156) in postoperative severe infection between PCNL and URSL group (2/147). There were 9 cases of 134 cases of postoperative (9/134) fever at ≥ 38℃ in laparoscopic group, which was significantly lower than that in PCNL and URSL group (28/147), the difference was statistically significant (P = 0.002); Laparoscopic group of postoperative urinary tract stenosis in 3 cases (3/114), which was significantly lower than that of PCNL and URSL group (9/101), the difference was statistically significant (P = 0.045). The average length of stay in laparoscopic group was (10.12 ± 0.29) d, which was significantly lower (P = 0.011) than that in PCNL and URSL group (13.97 ± 0.38) days. The average cost of treatment in laparoscopic group (12541.84 ± 181.54) yuan was significantly lower than that in PCNL and URSL group (18124.65 ± 302.32) yuan, the difference was statistically significant (P = 0.018). Conclusion In some cases, when the upper urinary tract calcuci are suitable for 'cut out', the use of laparoscopic treatment is more secure; when there is a need for surgical treatment of complications, can be treated simultaneously. Laparoscopic technique is one of the important methods of minimally invasive treatment for upper urinary calculi.

Effect of total laparoscopic resection for colorectal cancer by NOSE / 中国内镜杂志

Objective To investigate the operation process of the technology, safety and operability of total laparoscopic resection for colorectal cancer by natural orifice specimen extraction (NOSE). Methods 40 patients with colorectal cancer who met the inclusion criteria of NOSE method from April 2015 to June 2017 were randomly divided into control group (traditional laparoscope) and experimental group (NOSE group), 20 cases in each. The intraoperative and postoperative quality of life between the two groups were statistically analyzed. Results All the patients completed the target operation, and no other operative methods were transferred. No complications occurred in either group. There were statistically difference (P < 0.05) between the two groups of patients in the two indicators (time and blood loss), there was no statistically significant difference in hospital time (P > 0.05), there was statistically difference (P < 0.05) between the two groups of quality of life score (SF-36 scale) in somatic function, role function, pain, cognitive and overall health status of five dimensions, the NOSE group was superior to the traditional laparoscopic group. Conclusion There are advantages in totally laparoscopic colorectal cancer treated with whole NOSE method. The overall health is good, few restrictions on daily work and life, quicker recovery of physical function and role function. Therefore, the application can be promoted if the condition is allowed.

A comparison of the periumbilical incision and the intraumbilical incision in laparoscopic appendectomy / 대한외과학회지

PURPOSE: The intraumbilical incision is being used more frequently, with increasing cases of single incision laparoscopic surgery. Since the umbilicus is deeper than the surrounding wall, it has abundant bacteria. No study has compared the adverse outcomes of periumbilical and intraumbilical incisions. We analyzed the wound complication rates of perforated appendicitis patients according to the types of umbilical incision. METHODS: A retrospective review was done of 280 patients with perforated appendicitis. One hundred fifty nine patients were treated with the intraumbilical incision, and 121 patients were treated with the periumbilical incision. We compared the perioperative outcomes according to each laparoscopic incision. RESULTS: There was no difference in operation time, postoperative hospital stay and analgesic requirement between the two groups. One case in the intraumbilical group (0.6%) and three cases in the periumbilical group (2.5%) developed wound infections. The umbilical complication rate showed no difference. CONCLUSION: The wound complication rate of intraumbilical and periumbilical incisions are not different. Although this retrospective study has inherent limitations, the intraumbilical incision seems to be a safe and feasible alternative for the periumbilical incision that can be easier to perform, with better cosmetic results.

Laparoscopic radiofrequency ablation for hepatic cavernous hemangioma in patients with liver cirrhosis / 中国微创外科杂志

Objective To evaluate the feasibility,safety,and efficacy of laparoscopic radiofrequency ablation(RFA) for the treatment of hepatic cavernous hemangioma(HCH) in patients with liver cirrhosis.Methods A total of 15 patients with HCH and liver cirrhosis received laparoscopic RFA under general anesthesia between March 2001 and August 2005.There were 6 men and 9 women,with a mean age of 46.2?7.0 years.All the patients had complained of obvious symptoms of abdominal discomfort,pain,or fullness. The etiologic factor of liver cirrhosis was hepatitis B in 13 patients and hepatitis C in 2 patients.The Child classification revealed grade A in 10 patients and grade B in 5 patients.A total of 20 liver lesions located on the surface of the liver or adjacent to the gallbladder,with a mean diameter of 7.2?1.4 cm,were identified preoperatively in the 15 patients by ultrasonography,helical CT scans,or MRI.The platelet count was(31.2?10.4)?10~9/L.Co-morbidities included chronic calculous cholecystitis in 3 patients and diabetes mellitus in 2 patients.Laparoscopic ultrasonography and liver biopsy were routinely performed during the operation.Results Laparoscopic RFA was successfully performed in all the 15 patients and laparoscopic cholecystectomy was conducted simultaneously in 3 patients.The ablation time per lesion was 68.8?34.0 min,and the total operative time was 120.0?28.0 min.No severe complications,such as intraperitoneal hemorrhage,gastrointestinal injury,diaphragmatic injury,bile leakage,and liver function failure,developed during and after the operation.Complete tumor necrosis was achieved in all the 20 lesions(100%,20/20) on contrast-enhanced helical CT scans 1 month after the treatment.During a follow-up period of 5~31 months,symptoms completely disappeared in 13 patients and significantly subsided in 2 patients.Conclusions Laparoscopic radiofrequency ablation is a feasible,safe,and effective treatment for hepatic cavernous hemangioma complicating liver cirrhosis.

Short-term outcome of laparoscopic versus open resections for rectal cancer in 165 unselected patients / 第三军医大学学报

Objective To compare the short-term results of rectal cancer treated either by laparoscopic or open total mesorectal excision(TME). Methods A series of 165 unselected consecutive patients with rectal cancer from August 2002 to December 2005, who decided to accept the laparoscopic or open TME, were included in this study. The following parameters were compared between the two groups: length of the surgical specimen, distance between the distal incisal edge of the rectum and the inferior margin of the tumor, the number of the lymph nodes resected, local recurrence rate, incidence of distant metastases, and 2 year survival rate. The mean follow-up period for both groups was 26.9 months (range, 6-46 months). Results Demographic data and Dukes stage were matched in two groups. The mean length of the resected specimens was 24.4 cm in the laparoscopic TEM group and 25.2 cm in the open TEM group. The distance from the distal incisal edge of the rectum to the inferior margin of the tumor was 2.9 cm in the laparoscopic TEM group and 2.7 cm in the open TEM group, and the mean number of lymph nodes scavenged was 11.5 in the laparoscopic TEM group and 10.6 in the open TEM group. The local recurrence rate after laparoscopic resection was 9.6%, as compared with 11% after open resection. Distant metastases occurred in 11.5% of the patients in the laparoscopic group, whereas it was 14.6% in the open group. Two year survival rate was 85.7% and disease free survival was 76.2% after laparoscopic resection and compared to 78.8% and 69.7% after open resection. All above parameters did not show statistically different between the two groups. Conclusion The oncologic resection and the early outcomes are comparable between the two surgical approaches.