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Objective:To investigate the clinical value of indocyanine green (ICG) staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach in the treament of liver cancer.Methods:The clinical data of 150 patients with primary liver cancer, who received treatment in Yuyao People's Hospital from January 2019 to December 2020, were retrospectively analyzed. Group A ( n = 82) and group B ( n = 68) were designated according to the surgery methods used. The group A was subject to laparoscopic hepatectomy with a Glisson pedicle approach. The group B received ICG staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach. Operation-related conditions, postoperative complications, and the change in liver function indexes after surgery relative to before surgery were compared between the two groups. Results:There were no significant differences in the time taken to first anal exhaust, extubation time, and length of hospital stay between group A and group B (all P > 0.05). Operative time and intraoperative bleeding in the group B were (205.04 ± 35.01) minutes and (230.05 ± 17.53) mL, respectively, which were significantly lower than those in the group A [(228.07 ± 28.05) minutes, (255.07 ± 19.00) mL, t = 4.47, 8.31, both P < 0.05]. R0 resection rate was significantly lower in group B than in group A [85.29% (58/68) vs. 70.73% (58/82), χ2 = 4.50, P < 0.05]. There were no significant differences in postoperative complications between the two groups ( P > 0.05). Before treatment, there were no significant differences in serum levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and total bilirubin between the two groups (all P > 0.05). At 1 day after surgery, serum ALT, AST, and TBil levels in each group were significantly increased compared with before surgery (all P < 0.05). Furthermore, serum levels of ALT, AST and TBil in the group A were (108.51 ± 30.23) U/L, (107.66 ± 26.93) U/L, and (32.16 ± 4.73) μmol/L, respectively, which were significantly higher than those in the group B [(88.38 ± 24.76) U/L, (86.85 ± 19.74) U/L, (27.95 ± 4.31) μmol/L, t = 4.40, 5.30, 5.65, all P < 0.05]. At 3 days after surgery, serum levels of ALT, AST, and TBil in each group were significantly lower than those at 1 day after surgery, but they were still higher than those before surgery. At 3 days after surgery, serum levels of ALT, AST and TBil in group A were (74.20 ± 13.83) U/L, (65.22 ± 9.68) U/L, and (28.18 ± 4.14) μmol/L, respectively, which were significantly higher than those in group B [(54.72 ± 10.31) U/L, (55.41 ± 7.63) U/L, (24.25 ± 3.98) μmol/L, t = 9.61, 6.79, 5.89, all P < 0.05]. Conclusion:Although the ICG staining technique has certain limitations, it can improve the accuracy of hepatectomy to a certain extent. ICG staining technique combined with laparoscopic hepatectomy with the Glisson pedicle approach is a safe and accurate treatment for liver cancer. The combined therapy is worthy of clinical application.
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Lateral lymph node metastasis (LLNM) is one of the major causes for post-operative local recurrence of middle and low rectal cancer. At present, there are still controversies on the diagnosis and treatment of LLNM. The radiological assessment of LLNM generally relies on morphological criteria such as the size or shape of the node or the response to therapy, in which the diagnostic accuracy of MRI is superior to that of other imaging techniques. Neoadjuvant chemoradiotherapy could not achieve good local control for suspicious LLNM. Lateral lymph node dissection (LLND) can reduce tumor local recurrence significantly, but the clinical value of LLND in survival and quality of life of patients has been questioned. 4K laparoscope can decrease the incidence of perioperative complications and urinary and sexual dysfunction to a certain extent. Thus, selective LLND should be undertaken to patients with suspicious LLNM after neoadjuvant chemoradiotherapy, in order to reduce tumor local recurrence and improve the prognosis of patients. The authors elaborate on diagnosis and treatment including surgery or chemoradiotherapy of LLNM in 4K laparoscopic surgery for middle and low rectal cancer combined with their own experiences.
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ABSTRACT Background: Laparoscopic inguinal hernia repair has been shown to be superior than open repairs with faster return to daily activities and decrease in the occurrence of chronic pain. However, higher direct costs and mandatory use of general anesthesia are arguments against their use. In addition, increased complexity of surgery resulting from an anatomy that is unusual to general surgeons prevents the widespread adoption of laparoscopic approach. Aim: To propose a technical systematization for transabdominal laparoscopic repair (TAPP) of inguinal hernias based on anatomical concepts. Method: To offer a systematization of TAPP repair based on well defined anatomic landmarks, describing the concept of "inverted Y", identification of five triangles and three zones of dissection, to achieve the "critical view of safety" for laparoscopic inguinal hernia repair. Results: Since this standardization was developed five years ago, many surgeons were trained following these precepts. Reproducibility is high, as far as, it´s rate of adoption among surgeons. Conclusion: The concept of the "inverted Y", "Five triangles" and the dissection based in "Three Zones" establish an effective and reproducible standardization of the TAPP technique.
RESUMO Racional: O reparo laparoscópico da hérnia inguinal tem se mostrado superior aos reparos abertos, com retorno mais rápido às atividades diárias e diminuição na ocorrência de dor crônica. No entanto, custos diretos mais altos e o uso obrigatório de anestesia geral são argumentos contra seu uso. Além disso, o aumento da complexidade da operação resultante de uma anatomia incomum aos cirurgiões gerais impede a ampla adoção da abordagem laparoscópica. Objetivo: Propor uma sistematização técnica para reparo laparoscópico transabdominal (TAPP) de hérnias inguinais com base em conceitos anatômicos. Método: Oferecer sistematização do reparo do TAPP baseado em pontos anatômicos bem definidos, descrevendo o conceito de "Y invertido", identificação de cinco triângulos e três zonas de dissecação, para alcançar a "visão crítica de segurança" para o reparo de hérnia inguinal laparoscópica. Resultados: Desde que essa padronização foi desenvolvida há cinco anos, muitos cirurgiões foram treinados seguindo esses preceitos. A reprodutibilidade é muito alta, assim como a taxa de adoção entre cirurgiões. Conclusão: O conceito de "Y invertido", dos "Cinco triângulos" e a dissecção baseada em "Três Zonas" estabelecem uma padronização efetiva e reprodutível da técnica TAPP.
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Humans , Male , Laparoscopy/methods , Herniorrhaphy/methods , Hernia, Inguinal/surgery , Reproducibility of Results , Treatment OutcomeABSTRACT
Objective To evaluate the impact of aderent perirenal fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN). Methods Clinical data of 52 patients who underwent RLPN for a small renal tumor from October 2013 to December 2015 was analyzed retrospectively. All the patients were divided into two groups according to the presence of APF by preoperative computed tomography imaging. Clinical data was collected including patients' age, gender, BMI, history of hypertension, history of diabetes, American Society of Anesthesiologists score (ASA), intra-abdominal fat (IAF), tumor size, RENAL Nephrometry score (RNS), operative time, warm ischaemia time (WIT), estimated blood loss (EBL), and length of hospital stay. Results Between the two groups, the BMI, tumor size, WIT, length of hospital stay were similar [(26.70 ± 3.33) kg/m2 vs (25.65 ± 4.01) kg/m2, (3.53 ± 1.21) cm vs (3.64 ± 1.05) cm, (27.17 ± 7.55) min vs (25.21 ± 5.64) min, (12.54 ± 4.06) d vs (10.61 ± 3.70) d, P > 0.05)], as well as the ASA and RNS. APF patients were older [(59.25 ± 11.03) y vs (49.71 ± 11.86) y, P = 0.004]. There were a high proportion of men (75.0% vs 46.4%, P = 0.036), patients with hypertension (62.5% vs 28.6%, P = 0.014), and patients with diabetes (41.7% vs 14.3%, P = 0.026). In the APF group, IAF was more [(2.02 ± 0.47) cm vs (1.35 ± 0.66) cm, P = 0.000], operative time was longer [(146.08 ± 45.45) min vs (119.32 ± 28.83) min, P = 0.017], and EBL was higher [(82.92 ± 45.73) ml vs (51.79 ± 25.10) ml, P = 0.005]. Conclusion The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL, but has no influences on the WIT and length of hospital stay. APF makes it difficult to expose the tumor, not to remove it.
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Objective To analyze the value of open tension -free hemiorrhaghy ( OTFH) and laparoscopic totally extraperitoneal prosthesis ( LTEP) repair in patients with bilateral inguinal hernia .Methods A retrospective method was used to compare the clinical data of 115 patients with bilateral hernias , of which 61 cases received LTEP and 54 cases underwent OTFH , from June 2011 to December 2013, in our hospital .Results The mean operative time of LTEP group (88.2 ±15.6 min) was longer than the OTFH group(75.7 ±21.6) min (p<0.05).The dura-tion of hospitalization in LTEP group(2.6 ±1.1) day was shorter than OTFH group(4.2 ±2.1) d (p<0.05).Hos-pitalization expense of LTEP group (12 012.0 ±2 325.2) yuan was higher than the OTFH group (9 291.3 ±2 010.1) yuan (p<0.05).The incision pain by VAS points was gradually decreased in 24 hours, 48 hours, 72 hours after op-eration, and LTEP group was significant lower than OTFH group in the same time point .In LTEP group 3 case had laceration of peritoneum but turn to no other prosthesis , and 2 cases had acute urinary retentions .11 acute urinary re-tentions occurred in OTFH group , and 2 cases had chronic pain in inguinal area and 1 cases of fat liquefaction .No recurrence was found during a follow -up period of 6 to 24 months in both of 2 groups .Conclusion Both LTEP and OTFH are safe and accessible techniques for patients with bilateral inguinal hernia .OTFH is feasible, and has short process and low cost which is suitable for primary hospitals to carry out .OTFH has the advantages of little trauma , faster postoperative recovery and less complications which is worth promoting in future .
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Objective To discuss the safety and effectiveness of laparoendoscopic single -site surgery (LESS)in cholecystectomy.Methods LESS and conventional laparoscopic(LC)effect were compared and analyzed in cholecystectomy.48 cases were divided into the two groups,24 cases(group LESS)were cheated by laparoendo-scopic single-site surgery;24 cases(group LC)were cheated by laparoscopic cholecystectomy.Contrasted in their operation time,intraoperative amount of bleeding,intraoperative laparotomy rate,body temperature after operation, complications,intestinal recovery time (postoperative exhaust),hospitalization time after operation,postoperative pain index,cosmetic effect,white blood cell (WBC),serum cortisol (Cortisol,Cor),immunoglobulin A (IgA)and comple-ment (C3 ).Results All cases were successful,no cases converted to laparotomy,no postoperative complications.The operation time of group LESS and group LC were (110.2 ±29.3)min and (77.8 ±31.2)min,respectively,the differ-ence was ststictically significant (t=5.07,P<0.05).The intestinal recovery time and hospitalization time after oper-ation in group LESS were less than that in gruoup LC (P<0.05 ).The cosmetic effect in group LESS (3.5 ± 0.5)was higher than that in group LC(2.1 ±0.5)(P<0.05).Cor and C3 in group LESS were higher than those in group LC(P<0.05 ).Conclusion Laparoendoscopic single -site surgery in cholecystectomy is safe and feasible, compared with traditional laparoscopic operation,operation time in LESS is long,but arapid postoperative recovery, beauty effect is obvious.
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Objective To observe the effect of laparoscopic operation( LPS) for the treatment of endometrio-sis(EMS) infertile serum matrix metalloproteinase in patients of matrix metalloproteinases-9(MMP-9),tissue inhibi-tors of metalloproteinase-1(TIMP-1) and interleukin-2 (IL-2),interleukin-10(IL-10) .Methods 80 patients with EMS in 2012 August to 2013 August to accept the choice of operation cases,according to the different operation modes for the observation group(received LPS operation therapy) and control group(received open operation treatment), 40 cases in each group.The changes of serum MMP9, TIMP-1, MMP-9/TIMP-1 and IL-2, IL-10, IL-2/IL-10 and 6 months after operation in the two groups were observed before and after treatment,the pregnancy situation were ob-served.Results The MMP-9 levels of the patients in the observation group[(51.21 ±24.01)μg/L] than before treatment[(261.88 ±190.11)μg/L] decreased significantly,and the observation group decreased more obviously than that in the control group;the observation group the level of TIMP-1[ (45.88 ±11.02)μg/L] than in the control group[(25.32 ±6.67)μg/L]increased significantly (t =4.846,P <0.05);observation group MMP-9/TIMP-1 decreased significantly compared with the control group,the difference was statistically significant ( t=3.636,P<0.05);the two group after treatment,IL-2,IL-10,IL-2/IL-10,the difference was statistically significant ( t=4.228, 4.415,3.396,all P<0.05);the observation group the pregnancy rate was 65%,the abortion rate 7.7%,30.0%and the 33.3%was better than that of the control group (χ2 =9.825,4.060,all P<0.05).Conclusion LPS is an effective method in treating EMS,which can increase the serum TIMP-1 and IL-2 levels,reduce MMP9 and IL-10 level;improve the immune index,improve the patient's fertility.
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PURPOSE: Laparoscopic radical nephrectomy (LRN) is more challenging with increases in body mass index (BMI). Several recent studies have shown, however, that LRN can be safely performed even in obese patients. The influence of obesity on the perioperative outcomes of LRN has not been well elucidated for large renal tumors (>7 cm), however. We estimated the impact of obesity on LRN for stage T1 and T2 renal cell carcinoma (RCC). MATERIALS AND METHODS: From January 2004 to March 2011, 266 patients underwent LRN (T1: 195, T2: 71). These patients were subdivided into the following two groups according to BMI: the nonobese group (BMI less than 25 kg/m2) and the obese group (BMI greater than 25 kg/m2). Perioperative outcomes were retrospectively compared between these two groups in T1 and T2 RCC patients. RESULTS: There were no significant differences in perioperative outcomes between the obese and nonobese groups of T1 RCC patients. However, in T2 RCC patients, operative time and complication rate were significantly increased in the obese group. CONCLUSIONS: Our results suggest that LRN can be safely performed in Korean patients with T1 RCC regardless of obesity. In T2 RCC patients, however, LRN may become more difficult with increasing BMI considering a longer operation time as well as a higher complication rate. We suggest that LRN for obese patients with T2 RCC be carefully considered.