Colecistectomia robótica por incisão única na doença da vesícula biliar: revisão sistemática e metanálise / Robotic single-incision cholecystectomy in gallbladder disease: systematic review and meta-analysis

Introdução: A colecistectomia por incisão única assistida por robótica é técnica cirúrgica emergente para o tratamento da doença da vesícula biliar. Objetivo: Analisar os resultados clínicos e o custo efetividade dela, com foco no tempo de permanência hospitalar, tempo de operação, custo total e taxa de conversão entre robótica e outros procedimentos. Métodos: Revisão sistemática e metanálise foram realizadas de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Os bancos de dados PubMed, Embase e Cochrane foram pesquisados desde o início até março de 2023. Análise estatística foi feita usando o R versão 6.2.1. Metanálise de efeitos aleatórios com razão de risco, diferença média e intervalo de confiança de 95% foi estimada usando a variância inversa e o método de Mantel-Haenszel para resultados binários e o estimador DerSimonian-Laird para resultados contínuos. Resultados: Um total de 452 pacientes foram envolvidos, incluindo 4 estudos randomizados. Os desfechos escolhidos para metanálise foram: permanência hospitalar (MD −0.03 dias, CI 95% −0.12 a 0.18, p=0.708), tempo de operação (MD 12.93 min, CI 95% −21.40 a 47.25, p=0.460) e taxa de conversão (RR 0.90, CI 95% 0.44 a 1.83, p=0.771). Conclusão: Não houve diferença estatisticamente significativa em relação à duração da permanência hospitalar, tempo de operação e taxa de conversão entre a colecistectomia robótica por incisão única e outras técnicas cirúrgicas para a doença da vesícula biliar.

Introduction: Robotic-assisted single-incision cholecystectomy is an emerging surgical technique for the treatment of gallbladder disease. Objective: To analyze the clinical results and its cost effectiveness, focusing on length of hospital stay, operating time, total cost and conversion rate between robotics and other procedures. Methods: Systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Cochrane databases were searched from inception through March 2023. Statistical analysis was performed using R version 6.2.1. Random effects meta-analysis with hazard ratio, mean difference and 95% confidence interval was estimated using inverse variance and the Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous results. Results: A total of 452 patients were enrolled, including 4 randomized trials. The outcomes chosen for meta-analysis were: hospital stay (MD −0.03 days, CI 95% −0.12 to 0.18, p=0.708), operating time (MD 12.93 min, CI 95% −21.40 to 47.25, p=0.460) and of conversion (RR 0.90, CI 95% 0.44 to 1.83, p=0.771). Conclusion: There was no statistically significant difference regarding length of hospital stay, operating time and conversion rate between single-incision robotic cholecystectomy and other surgical techniques for gallbladder disease.

The modified single incision robot-assisted laparoscopic radical prostatectomy: initial experience and clinical efficiency / 中华泌尿外科杂志

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

Application of Ultrasound Combined with DSA-guided Single-incision Technique via Axillary Vein Access in Implantation of Totally Implantable Venous Access Port / 肿瘤防治研究

Objective To evaluate the technical feasibility and safety of a single-incision technique via axillary vein (AV) for placement of totally implantable venous access port (TIVAP) guided by ultrasound combined with DSA in clinical application. Methods We retrospectively analyzed clinical data of 240 patients who received TIVAP by single incision technique via AV access guided by ultrasound combined with DSA. We observed and recorded operation-related information such as AV width, AV puncture success rate, implantation success rate, ultrasound-guided puncture time, operation time and intraoperative and postoperative complications, etc. Results All 240 patients were successfully implanted with TIVAP, and the success rate was 100%. In 229 cases, TIVAP was implanted through single-incision AV puncture under the guidance of ultrasound combined with DSA, and the success rate of AV puncture was 95.42% (229/240). In 11 cases, TIVAP was implanted through the ipsilateral internal jugular vein (IJV) under the guidance of ultrasound combined with DSA due to the failure of AV puncture. In the 240 patients, the average width of AV of the intended puncture segment was (7.56±1.26) mm measured by preoperative ultrasound exploration and positioning, in which 195 cases were successfully punctured once, 26 cases were successfully punctured twice, and 8 cases were successfully punctured three times, with the success rate of 81.25%, 10.83% and 3.34%, respectively. The average puncture time under ultrasound guidance was (0.85±0.52) min, and the average operation time was (25.9±4.8) min. The incidence of intraoperative complications was 1.67% (4/240). No hemothorax, hemopneumothorax or serious fatal complications occurred. The incidence of complications during TIVAP retention was 2.92% (7/240). No complication such as catheter-related bloodstream infection, catheter-related venous thrombosis, catheter rupture/displacement, clipping syndrome or drug extravasation was observed. Conclusion Ultrasound combined with DSA guided single-incision technique via AV access in the implantation of TIVAP is a feasible and safe implantation method with high technical success rate, short operation time and low risk of complications. It can be used as another choice of TIVAP implantation method.

Preliminary application and efficacy analysis of transumbilical single-incision plus one port robotic total mesorectal excision / 中华胃肠外科杂志

Objective: To investigate the feasibility of transumbilical single-incision plus one port (SIPOP) robotic total mesorectal excision. Methods: Clinical data of a 70-year-old male patient with BMI 22.1 kg/m(2) who successfully underwent transumbilical single-incision plus 1 port robotic total mesorectal resection of upper rectal cancer at the General Surgery Department of Daping Hospital of Army Military Medical University on September 18, 2019 were retrospectively analyzed. Preoperative colonoscopy revealed that the distance of upper rectal cancer to anal edge was 14 cm, and the tumor size was 2.5 cm×1.5 cm×1 cm. Pathological result confirmed rectal moderately differentiated adenocarcinoma. The preoperative abdominal CT showed thickened bowel-wall of upper rectum and the blurred perirectal fat, suggesting tumor infiltration. Results: The operation was successful. There were no conversion to laparotomy or abdominal auxiliary incision, and the mesorectum of the specimen was intact. The operation time was 165 minutes, the blood loss was about 20 ml, and there were no complications such as injury to peripheral organs. Postoperative pathology showed ulcerative moderately differentiated adenocarcinoma of the upper rectum with TNM stage IVA (T4N2b). The postoperative recovery was smooth. Patient ambulated on the 1st day, the catheter was removed on the 7th day, and discharged from the hospital on the 8th day. Conclusion: The transumbilical SIPOP robotic total mesorectal excision is safe, effective and feasible.

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.

Application of single incision plus one port laparoscopic surgery in radical right hemicolon cancer surgery / 中华胃肠外科杂志

Objective: To investigate the feasibility and advantages of the SILS+1 technique in the radical right hemicolectomy, by comparing the short-term efficacy, postoperative recovery of intestinal function, and stress and inflammatory response of patients with right-sided colon cancer undergoing the conventional 5-hole laparoscopic technique or the single incision plus one port laparoscopic surgery (SILS+1). Methods: A retrospective cohort study was performed. Thirty-five patients with right-sided colon cancer undergoing SILS+1 surgery at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from January 2018 to September 2020 were enrolled in the SILS+1 group. Then a total of 44 patients who underwent completely 5-hole laparoscopic right hemicolectomy at the same time were selected as the conventional laparoscopic surgery (CLS) group. The intraoperative observation indexes (operative time, intraoperative blood loss, and incision length) and postoperative observation indexes (time to ambulation after surgery, time to flatus, pain score in the first 3 days after surgery, hospitalization days, number of lymph node dissections, postoperative complication morbidity, and postoperative total protein, albumin and C-reaction protein) were compared between the two groups. Results: There was no conversion to laparotomy or laparoscopic-assisted surgery in both groups. All the patients successfully completed radical right hemicolectomy under total laparoscopy. There were no statistically significant differences in gender, age, body mass index or tumor stage between the two groups (all P>0.05). Compared with the CLS group, the SILS+1 group had shorter incision length [(5.1±0.6) cm vs. (8.5±4.1) cm, t=4.124, P=0.012], shorter time to the first ambulation (median: 27.6 h vs. 49.3 h, Z=4.386, P=0.026), and shorter time to the first flatus (median:42.8 h vs. 63.2 h, Z=13.086, P=0.012), lower postoperative pain score [postoperative 1-d: 2.0 ± 1.1 vs. 3.6 ± 0.9; postoperative 2-d: 1.4 ± 0.2 vs. 2.9±1.4; postoperative 3-d: 1.1 ± 0.1 vs. 2.3±0.3, F=49.128, P=0.003), shorter postoperative hospital stay [(9.1 ± 2.7) d vs. (11.2 ± 2.2) d, t=3.267,P=0.001], which were all statistically significant (all P<0.05). On the second day after surgery, as compared to CLS group, SILS+1 group had higher total protein level [(59.7±18.2) g/L vs. (43.0±12.3) g/L, t=2.214, P=0.003], higher albumin level [(33.6±7.3) g/L vs. (23.7±5.4) g/L, t=5.845, P<0.001], but lower C-reactive protein level [(16.3 ± 3.1) g/L vs. (63.3 ± 4.5) g/L, t=4.961, P<0.001], which were all statistically significant. There were no significant differences in the operative time, intraoperative blood loss, number of harvested lymph node, number of metastatic lymph node, and postoperative complication morbidity (all P>0.05). Conclusions: The SILS+1 technique has good operability and potential for popularization. Under the premise of radical resection, this technology not only reduces incision number and postoperative physical pain, but also speeds up postoperative recovery and shortens hospital stay.

Short-term outcomes of single incision plus one port laparoscopic surgery for colorectal cancer / 中华胃肠外科杂志

Objective: Although single port laparoscopic surgery has achieved good clinical results, many surgeons are discouraged by the difficulties of operation, conflict of instruments, lack of antagonistic traction, and straight-line perspective. Therefore, some surgeons have proposed a single incision plus one hole laparoscopic surgery (SILS+1) surgical method. This study explored the safety and feasibility of SILS+1 for radical resection of colorectal cancer. Methods: A descriptive cohort study was carried out. The clinical data, including the operation, pathology and recovery situation, of 178 patients with colorectal cancer undergoing SILS+1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2018 to January 2019 were prospectively collected and retrospectively analyzed. Clavien-Dindo criteria was used for postoperative complication evaluation and visual analog scale was used for pain standard. Follow-up studies were conducted through outpatient service or telephone and the follow-up period was up to May 2019. Results: A total of 178 patients with colorectal cancer underwent SILS+1, including 111 male patients (62.4%) with an average age of 59 years. Eleven (6.2%) patients received added 1-3 operation ports during operation, and 1 patient was converted to open surgery due to ileocolic artery hemorrhage. The operative time was (135.2±42.3) minutes. The intraoperative blood loss was (34.6±35.5) ml. The number of harvested lymph nodes was 33.1±17.6. The distal margin was (4.7±17.8) cm. The proximal margin was (10.2±5.3) cm. Operation-related complications were observed in 16 patients (9.0%) within 30 days after the operation, of whom 6 had Clavien-Dindo III complications (3.4%). The postoperative pain scores were lower than 3. The average postoperative hospital stay was (5.6±2.6) days. Three patients (1.7%) returned to hospital within 30 days after operation due to intestinal obstruction and infection around stoma. The cosmetic evaluation of all the patients was basically satisfied. Conclusion: SILS+1 is safe and feasible in the treatment of colorectal cancer, and can reduce the postoperative pain.

Extraperitoneal robot-assisted laparoscopic radical prostatectomy through single incision: Establishment and application of a modified channel / 中华男科学杂志

Objective@#To assess the feasibility and validity of the establishment of a modified channel for extraperitoneal robot-assisted laparoscopic radical prostatectomy (RARP) through single incision.@*METHODS@#From November 2020 to January 2021, 35 cases of localized PCa were treated by extraperitoneal RARP through single incision in our center. All the operations were performed by the same surgeon, none via the multichannel port for the establishment of the channel. We recorded and analyzed the intra- and postoperative parameters, operation cost, complications, pathological findings and follow-up data.@*RESULTS@#All the operations were successfully completed, without conversion to open surgery or additional channels, or serious postoperative complications, the time for establishing the extraperitoneal space averaging 25.4 (20.0－45.0) min, the operation time 67.3 (35.0－125.0) min, intraoperative blood loss 75.5 (60.0－150.0) ml, time to first postoperative anal exhaust 26 (8－48) h, and postoperative hospital stay 7.89 (7－10) d. Postoperative pathology showed adenocarcinoma in all the cases, with Gleason score (GS) 3+3 in 9 (25.7%), GS 3+4 in 9 (25.7%), GS 4+3 in 8 (22.9%), and GS ≥ 8 in 9 (25.7%) of the cases, 23 (65.7%) in the

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.

A study of single sight two port laparoscopic appendectomy for its feasibility, advantages and disadvantages

Minimally invasive techniques revolutionized surgery with severe reduction of access trauma, prompt mobilization, lessened hospital stays and better cosmesis.1 Laparoscopic appendectomy can be further categorized into three port and reduced port appendectomy. All the selected cases have been put in a tabulated form on the basis of their age, clinical features and signs, ultrasonography findings, intra op complications, duration of surgery, duration of post op pain, early post op complications, cosmetic outcome and trochar size. 20 patients fulfilling inclusion and exclusion criteria, who were admitted in our hospital (SMIMER Surat) from 1st December, 2019 to 1st April 2020 and were included in the study and underwent single sight two port laparoscopic appendectomy (SSTPLA) after their consent. We have covered the entire procedure of single sight two port appendectomy, its technique, feasibility, advantages, and disadvantages. From our study, we conclude that this new technique of SSTPLA is technically safe and feasible. Our experience of this innovative surgical technique is suggestive of the fact that SSTPLA has better patient satisfaction with respect to cosmesis, decreased post-operative pain, decreased hospital stay, decreased operative time, fewer intra operative and post-operative complications and surgeon satisfaction with respect to ergonomics and decreased chances of collision of laparoscope with only single working instrument.

Transumbilical single-incision plus one-port laparoscopic surgery for colorectal cancer: A feasibility study / 中国肿瘤临床

To explore the safety and feasibility of single-incision plus one-port laparoscopic surgery (SILS+1) for colorectal cancer. Methods: The clinical data of 8 patients with colorectal cancer who were admitted to hospital for transumbilical SILS+1 between October 2017 and November 2019 were retrospectively analyzed. Results: The procedure was successfully performed in all 8 cases, without needing to convert to open surgery or increase the number of punch holes. The mean operating time was 107 minutes (range: 95 to 124 minutes). Blood loss ranged from 10 to 80 mL (median: 33 mL). Two patients had a fever postoperatively. Postoperative heat absorption was considered, and the fever reduced after the third day. The other patients had no obvious surgical complications. Gastrointestinal function was restored 1 to 3 days after the operation, and the abdominal drainage tube was removed after 3 to 5 days. The average hospital stay was 9.3 days (range: 7 to 11 days). Postoperative pathology confirmed colorectal adenocarcinoma in all patients. The average number of lymph nodes detected was 13.6 (range: 11-16). No perioperative complications or deaths occurred. Patients were followed up for 3-24 months (average: 10 months), and no local recurrence or distant metastases were found. Conclusions: Although SILS+1 for colorectal cancer appears to be safe and feasible, with minimal trauma and satisfactory cosmetic effect, the long-term effects require further observation.

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.

Analysis of technical difficulties of single-port and reduced port laparoscopic radical gastrectomy for gastric cancer / 中华消化外科杂志

Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.

Initial Clinical Experience of Pure Single-Incision Robotic Right Hemicolectomy with da Vinci SP Platform

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to perform pure single-incision surgery in 2018. This new surgical platform demonstrated favorable performance compared with the positive aspect of single-incision laparoscopic surgery and robot surgery. To date, its use has mainly been in urological and gynecological procedures. We report a case of successful robotic single-incision right hemicolectomy for cecal cancer with the dVSP.

Upper eyelid levator-recession and anterior lamella repositioning through the grey-line: Avoiding a skin-crease incision

Purpose: This study aims to report a case series of upper eyelid cicatricial margin entropion with retraction, corrected through a grey-line approach only. We remind readers of the grey-line approach to levator recession (LR) and lamellar repositioning surgery. Methods: A retrospective review of clinic notes and photographs of patients who underwent grey-line split (GLS), LR, release of orbital septum, recession of levator, advancement of posterior lamella and anterior lamellar repositioning without a skin crease incision, from December 2015 to December 2016. Indications for surgery included mild-to-moderate cicatricial margin upper eyelid entropion, tarsal curling, and meibomian gland inversion. Patients requiring spacer interposition to lengthen the posterior lamella were excluded from the study. Parameters of the study included lid margin position, lid height, ocular surface health and symptom improvement. Results: Eleven eyelids of eight patients were included in the study, and underwent the procedure described. Lid margin position measured as the marginal reflex distance lowered (improved) in 72.7% of patients. Lid margin eversion was achieved in all eyes (100%). Corneal punctate epithelial erosions markedly improved, being present in 72.7% of patients preoperatively, and only 9.1% of patients postoperatively. Eight of eleven eyes showed symptomatic improvement, with six (54.5%) being completely asymptomatic and two achieving partial relief. An added observation was a pretarsal show asymmetry in some patients which improved in 36.4% of surgeries postoperatively. Conclusion: Upper eyelid LR with GLS and anterior lamella repositioning can all be performed through the plane of the split, avoiding a skin incision. Normal lid margin apposition was achieved in all eyes with 91% demonstrating a clear cornea and 72% having symptomatic improvement.

Single incision laparoscopic cholecystectomy for patients with Mirizzi syndrome

Since multiport laparoscopic cholecystectomy has become a standard treatment for gallbladder (GB) disease, a single incision laparoscopic surgical technique has been tried to decrease the surgical site pain and achieve a better cosmetic out come in selected patients. The development of devices dedicated for single incision laparoscopic cholecystectomy (SILC) is expanding the indication of this single incision laparoscopic technique to more complicated GB diseases. Mirizzi syndrome (MS) is one of the complex uncommon gallstone diseases in patients undergoing cholecystectomy. Because the laparoscopic procedure has become a routine treatment for cholecystectomy, several studies have reported their experience with the laparoscopic technique for the treatment of MS with a comparable outcome in Csendes type I or II. Because the indication for SILC cholecystectomy is expanded to more complicated GB conditions, and the desire of patients for a less painful, better cosmetic surgical outcome has increased, our medical center used this single incision laparoscopic surgical technique for MS Csendes types I and II patients. Here, we report 2 successful cases of SILC for patients with MS types I and II without significant morbidity.

Effectiveness and safety of single-incision versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery versus conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer as well as providing reference for clinical decision-making. Methods     We searched the Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP, Wanfang ect until March 2017 to collect randomized controlled trials (RCTs), cohort studies, and case-control studies comparing single-incision with conventional multiple ports video-assisted thoracic surgery for lung cancer.Two reviewers independently screened and selected literatures according to inclusion and exclusion criteria. Then data extraction and quality assessment of included studies were conducted. RevMan 5.3 software was used for meta-analysis. Results     Twenty-six cohort studies (3 053 patients) were included. The quality of the included studies was high with score more than five.Meta-analysis showed that single-incision video-assisted thoracic surgery had shorter thoracic drainage time (MD=–0.71, 95% CI –1.03 to –0.39), shorter hospitalization time (MD=–0.92, 95% CI –1.66 to –0.19), lower pain scores 1 day after surgery (MD=–0.65, 95% CI –0.90 to –0.40), lower pain scores 3 days after surgery (MD=–0.90, 95% CI –1.16 to –0.64), lower pain scores 7 days after surgery (MD=–1.24, 95% CI –1.90 to –0.57), less number of lymph node dissection (MD=–0.72, 95% CI –1.35 to –0.10), less total drainage fluid (MD=–108.60, 95% CI   –180.42 to –36.79) and shorter length of surgical incision (MD=–2.74, 95% CI –3.57 to –1.90) than conventional multiple ports video-assisted thoracic surgery. But the differences between the two groups in operation time, intraoperative blood loss, postoperative complications were not statistically significant. Conclusion     Single-incision video-assisted thoracic surgery is safer and better in patient's compliance than conventional multiple ports video-assisted thoracic surgery in the treatment of lung cancer. But there is no significant difference in operation time, intraoperative blood loss, or postoperative complications. It still needs large-scale, high-quality studies to demonstrate its effectiveness and safety.

Single Incision Laparoscopic Appendectomy for Management of Complicated Appendicitis: Comparison between Single-Incision and Conventional

PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.