Totally laparoscopic Billroth II( gastrectomy without intracorporeal hand-sewn sutures / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of a novel totally laparoscopic Billroth II gastrectomy.</p><p><b>METHODS</b>Twelve gastric cancer patients underwent totally laparoscopic D2 dissection without intracorporeal hand-sewn sutures in the Xijing Hospital of Fourth Military Medical University between May 2011 and July 2011. In this technique, circular stapling device was used for gastrojejunostomy, and an Endo GIA was used to close the incision at the greater curvature of the stomach. After the completion of the anastomosis, a side-to-side anastomosis (jejunum-afferent loop or jejunum-efferent loop) was performed using an Endo-GIA.</p><p><b>RESULTS</b>No patients required conversion to laparoscopy-assisted or open surgery. The operative time was 196.0±19.3 min, and the blood loss was 169.5±28.8 ml. The number of lymph node harvested was 25.1±3.3. The proximal resection margin and distal resection margin were 8.8±2.4 cm and 6.9±5.5 cm, respectively. The mean time to the first postoperative flatus was 3.1±1.3 days. The length of hospital stay was 4.5±1.9 days.</p><p><b>CONCLUSION</b>This technique is simple and quick. There is no need for laparoscopic hand-sewn suturing. It is safe to perform for totally laparoscopic gastrectomy and reconstruction.</p>

Intracorporeal hand-sewn technique used in totally laparoscopic colectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of hand-sewn anastomosis in totally laparoscopic colectomy.</p><p><b>METHODS</b>Clinical data of 19 consecutive patients with benign(n=5) or malignant colonic diseases(n=14, 4 ascending colon cancers, 2 transverse colon cancers, and 8 sigmoid colon cancers) treated with totally laparoscopic colectomy with a hand-sewn anastomosis were reviewed. All the procedures were performed by the same surgeon team including totally laparoscopic resection and hand-sewn anastomosis, ileocolic anastomosis after right hemicolectomy, and hand-sewn purse-string sutures in the colon.</p><p><b>RESULTS</b>Hand-sewn anastomosis was performed for 11 patients and circular-stapled anastomosis with hand-sewn purse-string sutures was performed for other 8 patients. The mean hand-sewn anastomosis time was (49.5 ± 29.4) min, and the mean hand-sewn purse-string sutures time was (13.3 ± 5.5) min. No patients required conversion to laparoscopy-assisted or open surgery, and there were no postoperative complications related to anastomosis. One patient with transverse colon lipoma developed mild intra-abdominal infection after surgery and recovered after conservative treatment.</p><p><b>CONCLUSION</b>Totally laparoscopic intracorporeal hand-sewn anastomosis or hand-sewn purse-string sutures for colectomy is feasible and safe when performed by experienced laparoscopic surgeons.</p>