Short-term outcomes of laparoscopic-assisted colectomy versus open colectomy in patients with colonic carcinoma: a prospective randomized study

Introduction: The second most common cause of cancer-related mortality is colorectal cancer, and laparoscopic-assisted colectomy (LAC) has gained popularity among surgeons as an alternative to the conventional approach, which is open colecrtomy (OC). The differences between LAC and OC in terms of short-term outcomes have not been well documented, and the aim of the present work is to compare the short-term outcomes of both procedures. Materials and Methods: The present prospective study comprised 164 participants submitted to LAC (n = 82) and OC (n = 82) at the Helwan and Zagazig University hospitals between January 2018 and January 2022. We collected and analyzed demographic data, surgical data, and the short-term outcomes. Results: The LAC group had a significantly lower estimated amount of blood loss, shorter hospital stay, lower rates of incisional surgical site infection, and fewer cases of burst abdomen postoperatively, but with a considerably longer operative time (30.3 minutes) than the OC group. Conclusions: Our findings show that LAC is favorable option to OC, with superior outcomes. (AU)

Short term efficacy of laparoscopic assisted transanal total mesorectal excision for low rectal cancer: a prospective, multicenter, case registration study / 中华消化外科杂志

Objective:To investigate the short term efficacy of laparoscopic assisted transanal total mesorectal excision (taTME) for low rectal cancer.Methods:The prospective study was conducted. The clinicopathological data of 80 patients who underwent laparoscopic assisted taTME for low rectal cancer in 8 medical centers，including 27 cases in the First Affiliated Hospital of Jilin University，16 cases in the Daping Hospital of Army Medical University，15 cases in the Beijing Friendship Hospital of Capital Medical University，10 cases in the Peking University Cancer Hospital，7 cases in the Peking Union Medical College Hospital of Chinese Academy of Medical Sciences，2 cases in the Peking University People′s Hospital，2 cases in the Liaoning Cancer Hospital Institute，1 case in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine，from August 2017 to September 2018 were collected. Observation indicators：(1) clinical data of enrolled patients；(2) surgical situations；(3) postoperative histopathological examination；(4)postoperative complications and hospitalization. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and (or) percentages. Results:(1) Clinical data of enrolled patients：a total of 80 patients were selected for eligibility. There were 59 males and 21 females，aged from 53 to 79 years，with a median age of 61 years. (2）Surgical situations：all 80 patients underwent surgery successfully，including 73 cases undergoing low anterior resection，4 cases undergoing Hartmann operation，1 case undergoing intersphincteric and abdominoperineal resection，1 case undergoing other operations and 1 case missing operation information. Nineteen of the 80 patients underwent transabdominal and transanal operations simultaneously. The operation time of 80 patients was 255 minutes (range，211?305 minutes). Of 80 patients，77 cases had the volume of intraoperative blood loss ≤500 mL，3 cases had the volume of intraoperative blood loss >500 mL，44 cases underwent instrumental anastomosis，24 cases underwent manual anastomosis，12 cases were missing anastomosis information，66 cases had specimens been taken out through anus，2 cases had specimens been taken out through Pfannens-tiel incision，10 cases had specimens been taken out through other ways，2 cases were missing the information of specimens removal ways，57 cases underwent preventive stoma，32 cases under-went anal canal indwelling，30 cases underwent free of splenic flexure and 2 cases were converted to open surgery. (3) Postoperative histopathological examination：of 80 patients，68 cases had the integrity of mesorectal specimens with complete，5 cases had the integrity of mesorectal specimens with near complete，1 case had the integrity of mesorectal specimens with not complete，6 cases were missing the information of integrity of mesorectal specimens，1 case had rectal perforation，1 case had positive circumferential margin and 1 case had positive distal margin. The number of lymph node dissected and diameter of tumor were 12(range，9?16) and 3.0 cm(range，1.9?4.0 cm) of 80 patients. Four of 80 patients achieved pathological complete remission. Cases with tumor stage as T0 stage，Tis stage，T1 stage，T2 stage，T3 stage or T4 stage of the pT staging，cases with tumor stage as N0 stage，N1 stage or N2 stage of the pN staging，cases with tumor stage as M0 stage or M1 stage of the pM staging were 4，2，11，24，35，4，55，21，4，75，5 of 80 patients. (4) Postopera-tive complications and hospitalization：8 of 80 patients underwent anastomotic leakage，including 2 cases with grade A anastomotic leakage，4 cases with grade B anastomotic leakage and 2 cases with grade C anastomotic leakage.Seven of 80 patients underwent intestinal obstruction. The 2 cases with grade A anastomotic leakage were improved after symptomatic drug treatment，the 4 cases with grade B anastomotic leakage were improved after treatment with antibiotics or catheter drainage and the 2 cases with grade C anastomotic leakage were improved after operation. The duration of hospital stay of 80 patients was 14 days(range，11?21 days). No patient died during hospitalization.Conclusion:Laparoscopic assisted taTME for low rectal cancer is safe and feasible，which has a good short term efficacy.

Effect of anal draw-out laparoscopic anterior resection of rectal cancer on gastrointestinal motility and prognosis in patients with low rectal cancer / 国际外科学杂志

Objective:To investigate the effect of rectal draw-out laparoscopic anterior resection on gastrointestinal motility and prognosis in patients with low rectal cancer.Methods:A total of 140 patients with low rectal cancer who received treatment in Chongqing Ninth People′s Hospital from May 2017 to May 2018 were selected, including 82 males and 58 females, aged from 35 to 78 years with an average age of (59.33±9.12) years.According to the operation methods, all patients were divided into observation group (transanal pullout laparoscopic anterior resection of rectal cancer, n=70) and the control group (laparoscopic assisted anterior rectal resection, n=70). Independent sample t test or χ2 test were used to compare operation-related indicators, occurrence of complications, changes of fluid gastric emptying, small intestinal transport capacity, gastrin and motilin in 2 groups. Kaplan-meier survival curve was plotted to compare tumor progression-free survival (PFS) and overall survival (OS) in two groups. The two groups of PFS and OS were compared by log-rank test. Results:The operative time, intraoperative blood loss, postoperative drainage volume, and postoperative recovery time of the observation group were lower than those of the control group, the ability of liquid gastric emptying 24 h after operation, small intestine transport function at 24 h and 48 h after operation, the capacity of liquid gastric emptation, intestinal transport function 24 h and 48 h postoperatively, gastrin and motilin levels at 24 h, 48 h and 72 h postoperatively were significantly higher than those of the control group, with statistically significant differences ( P<0.05). Two years PFS (85.71% vs. 81.43%) and OS (92.86% vs. 90.00%) after surgery between the observation group and the control group were not statistically significant ( P>0.05). Conclusion:The anterior resection of rectal cancer by draw-out laparoscope is safe and radical, without increasing postoperative complications. Moreover, the recovery of gastrointestinal function is earlier than traditional laparoscopic assisted rectal cancer resection, which is conducive to improving the postoperative quality of life of patients, and is worthy of clinical promotion.

Application of 3D-CT simulation image in the description of gastric artery variation to guide laparoscopic total gastrectomy / 中华胃肠外科杂志

Objective: Anatomic variations in the perigastric vessels during laparoscopic radical gastrectomy often affect the operator's judgment and prolong the operation time, and even cause accidental injury and surgical complications, and hence the safety and quality of the operation cannot be ensured. In this study, multiple slice CT was reconstructed by 3-dimensional CT simulation software (3D-CT), and 3D-CT images were used to describe the variation of celiac trunk and splenic artery before surgery. The guiding role of the different variation of vessels was analyzed for laparoscopic total gastrectomy+D2 lymph node dissection (LTG+D2LD). Methods: A retrospective cohort study was conducted. Case inclusion criteria: (1) Gastric cancer was at an advanced stage. All the patients were preoperatively examined by digestive endoscopy and 64-row enhanced CT scan, and were histopathologically diagnosed with gastric adenocarcinoma. (2) 3D-CT simulation images were reconstructed to guide the operation. (3) LTG+D2LD surgery was performed by the same surgical team. (4) Clinical data were complete, and all the patients had signed the informed consent. From 2014 to 2018, 98 patients with gastric cancer at the Gastrointestinal Surgery Department of Henan Provincial People's Hospital were enrolled. According to the Adachi classification, celiac trunk variation was divided into common type (Adachi type I) and rare type (Adachi type II-VI). According to the Natsume classification, splenic artery was classified into "flat type" and "curved type". Based on 3D-CT simulation images, variation of celiac trunk and splenic artery was described, and the differences in operation time, intraoperative blood loss and the number of postoperative retrieved lymph nodes were compared between groups with different types of arterial variation. Results: For celiac trunk, common type was found in 84 cases (86%) and rare type was found in 14 cases, including 6 cases (6%) of type II, 2 cases (2%) of type III, 2 cases (2%) of type IV, 3 cases (3%) of type V, 1 case (1%) of type VI. No other types were found. There were no statistically significant differences in clinical characteristics and number of retrieved lymph nodes between patients of the common type group and rare type group (all P>0.05). Compared with common type patients, those of rare type had longer operative time [(321.1±29.0) minutes vs. (295.1±46.5) minutes, t=2.081, P=0.040] and more intraoperative blood loss (median: 66.0 ml vs. 32.0 ml, Z=-4.974, P=0.001). For splenic artery, 41 patients (42%) were flat type and 57 patients (58%) were curved type. There were no statistically significant differences between the two groups in terms of clinical characteristics, intraoperative blood loss, operative time and number of retrieved lymph nodes (all P>0.05). Conclusions: The method of describing the variation in the perigastric vessels by 3D-CT simulation has certain clinical value in laparoscopic radical gastrectomy. The duration of LTG+D2LD is prolonged and the intraoperative blood loss is increased with the variation of celiac trunk, while the variation of splenic artery has no effect on LTG+D2LD.

Laparoscopic assisted vaginal hysterectomy: an experience at a Fortis Escorts hospital

Background: The objective of this study was to evaluate the laparoscopic assisted vaginal hysterectomy (LAVH) in terms of demographic data of patients, indications, uterine size, intraoperative and postoperative complications, amount of blood loss, operative time and duration of hospital stay.Methods: A retrospective study was conducted on 160 cases, who underwent laparoscopic assisted vaginal hysterectomy in the period between October 2018 to November 2019 at the Fortis Escorts Hospital, Faridabad, Haryana, India.Results: Majority of patients (58.75%) belongs to age group between 40-50 year. Only 30.62% cases had a history of one previous abdomino-pelvic surgery. Majority of cases (52.5%) in the study group had uterine size between 6-12 weeks. Most common indication of hysterectomy in this study was fibroid uterus which account for 49.37% of cases followed by dysfunctional uterine bleeding (16.87%) cases. Mean time of surgery in this study was 114.4±0.59 min and average blood loss was 135.62±47.63 ml. The mean weight of uterus was 243.75±82.94 gm. 5% cases had major intraoperative complications while minor postoperative complications were seen in 16.87% cases. Bladder injury was seen in 1.25%. Major haemorrhage occur in 1.25%. In this study conversion to laparotomy rate was 1.25%. Only one case of ureteric injury and one case of bowel injury was noted. Among minor complications fever (6.25%) and urinary tract infection (5.62%) were mainly seen. Mean duration of hospital stay was 2.82±1.17 days.Conclusions: LAVH enables the surgeon to convert most of the abdominal hysterectomies into vaginal ones and hence decreases postoperative pain, decreases complications, lesser duration of hospital stay and rapid return to normal activity.

A comparative study of laparoscopic-assisted choledochoscopic cholelithotripsy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis / 中国基层医药

Objective@#To compare the efficacy of laparoscopic choledochoscopic cholelithotripsy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis.@*Methods@#A retrospective study was conducted in 81 cases of cholecystolithiasis who admitted to the People's Hospital of Yuci District from March 2013 to March 2018.The patients were divided into control group (n=38, laparoscopic cholecystectomy) and study group (n=43, laparoscopic choledochoscope choledocholithotomy) according to the different surgical method.The perioperative indicators, liver function indicators, recurrence rate and complications were compared between the two groups.@*Results@#The operation time, hospital stay, recovery time of gastrointestinal function, recovery time of diet after operation and intraoperative bleeding volume in the study group were (43.59±4.59)min, (7.24±1.17)d, (15.51±2.09)d, (2.88±0.42)d, (15.07±1.32)mL, respectively, which were better than those in the control group [(55.23±5.47)min, (9.12±1.32)d, (26.48±3.48)d, (3.53±0.58)d, (24.65±1.48)mL] (t=10.411, 6.796, 17.426, 5.823, 6.864, all P=0.000). The levels of total bilirubin (TBIL), alanine transferase (ALT), aspartate aminotransferase (AST) and total protein (TP) at 1 day after operation in the study group were (24.39±2.21)μmol/L, (29.09±4.68)U/L, (29.02±4.41)U/L, (21.95±2.52)g/L, respectively, which were lower than those in the control group [(28.43±2.31)μmol/L, (34.39±4.28)U/L, (35.31±3.08)U/L, (25.28±2.42)g/L] (t=8.038, 5.293, 7.348, 6.046, all P=0.000). TBIL, ALT, ALT, AST, AST, TP levels at 3 days after surgery in the study group were (20.32±2.24)μmol/L, (24.61±4.26)U/L, (23.68±4.79)U/L, (18.94±2.89)g/L, respectively, which were lower than those in the control group [(24.45±2.02)μmol/L, (29.81±3.32)U/L, (27.94±4.50)U/L, (21.41±2.87)g/L] (t=8.669, 6.609, 4.109, 3.851; all P=0.000). The recurrence rates of the control group and the study group were 5.26% (2/38) and 6.98% (3/43), respectively, there was no statistically significant difference between the two groups (χ2=0.102, P=0.749). The incidence of complications in the study group was 4.65% (2/43), which was lower than 21.05% (8/38) in the control group, the difference was statistically significant (χ2=5.015, P=0.025).@*Conclusion@#Compared with laparoscopic cholecystectomy, laparoscopic assisted choledochoscopic choledocholithotomy has better curative effect, it can reduce the damage to liver function, with low incidence of complications, and it has high clinical value.

Comparison of application value of LTH and LAVH in hysterectomy / 中国内镜杂志

Objective To investigate the effect of total laparoscopic hysterectomy (LTH) and laparoscopic assisted vaginal hysterectomy (LAVH) for hysterectomy. Methods From February 2015 to February 2017, 182 patients with total hysterectomy were enrolled, among them, LTH was performed in 97 patients, and LAVH was performed in 85 patients, the operation time, intraoperative blood loss, the length of scar, postoperative anal exhaust time and so on were observed in the two groups, C reactive protein (CRP), interleukin -2 (IL-2) and IL-6 were detected before and after operation in two groups. Results In group LTH, the amount of bleeding and the length of scar were (104.33 ± 40.20) ml and (2.03 ± 0.84) cm respectively, which were significantly lower than those in group LAVH (P < 0.05); There was no significant difference between LTH group and LAVH group in postoperative anal exhaust time, hospital stay, postoperative analgesia and hospitalization costs (P > 0.05); The CRP and IL-6 in the LTH group postoperative were (26.43 ± 6.11) mg/L and (40.04 ± 11.03) ng/ml, significantly lower than those in LAVH group (P < 0.05), while IL-2 was (44.20 ± 12.29) ng/ml, was significantly higher than that of the control group (P < 0.05); The incidence of postoperative complications in LTH group was 6.19%, which was significantly lower than that of LAVH group (P < 0.05). Conclusion LTH is a safe and reliable method for hysterectomy, has the advantages of less complications, less influence on immune function and so on, is worthy of clinical application.

Colangiopancreatografía asistida por laparoscopia en bypass gástrico y fistulotomía pre-corte por cálculo impactado en papila / Colangiopancreatography Assisted by Laparoscopy in Gastric Bypass and Fistulotomy Pre-Cut by Calculation Impacted in Papila

La denominada cirugía bariátrica “Bypass Gástrico” es una de las operaciones bariátricas mayormente efectuadas a nivel mundial y en aumento en años recientes. La exclusión del estómago y duodeno, después del procedimiento, deja con gran dificultad, la ejecución vía oral, de la Colangiopancreatografía endoscópica (CPRE) y el acceso al tracto biliar y pancreático. Debido a la incrementada incidencia de litiasis biliar en pacientes luego del procedimiento “bypass gástrico”, habrá más requerimiento de la Colangiopancreatografía endoscópica. En los últimos años se ha demostrado que los pacientes con bypass gástrico que ameriten evaluar el tracto biliopancreático pueden someterse exitosamente a Colangiopancreatografía endoscópica terapéutica transgástrica asistida por laparoscopia, en forma segura y confiada. Presentamos nuestra paciente con litiasis residual: cálculo impactado en la papila, efectuando la Colangiopancreatografía endoscópica transgástrica asistida por laparoscopia e Fistulotomía con bisturí - aguja por cálculo impactado en la papila, resuelto satisfactoriamente.

The “Gastric Bypass” is one of the most performed bariatric operatio ns worldwide, and in recent years the number of former bypass patients accrues. The gastric bypass excludes the stomach and duodenum, and it makes very difficult, by oral route, the access to the biliopancreatic tract, by means the endoscopic retrograde cholangiopancreatography (ERCP). Due to the increased evidence of gallstones after bariatric operations, the ERCP could be more often required. In recent years, it has been demostrated that gastric bypass patients can be successfully evaluated endoscopically by laparoscopic transgastric ERCP, as a safe and reliable method. We describe a patient with residual billiary impacted stone in the papilla, who underwent laparoscopic transgastric ERCP and a precut “fistulotomy” technique with needle - knife, was highly successful, without add significant morbidity to the procedure.

Application of enhanced recovery after surgery in laparoscopy-assisted distal gastrectomy / 肿瘤研究与临床

Objective To evaluate the feasibility and efficacy of enhanced recovery after surgery (ERAS) combined with laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. Methods 60 patients with distal gastric cancer from April 2016 to September 2016 in Shanxi Cancer Hospital were enrolled. According to the admission time, the patients were numbered randomly by odd and even. 30 odd patients received conventional treatment (traditional group), and were even 30 incorporated into ERAS group. Record and comparison of two groups were conducted, including age, sex, weight, body mass index (BMI), 1-day preoperative serum albumin (ALB) level, operation time, anastomosis type, total intraoperative blood loss, postoperative TNM staging, bowel movement recovery time, postoperative hospital stay, total cost of hospitalization, complications, and serum ALB level after operation. Results The level of ALB in ERAS group was (36.16 ± 2.46) g/L at 4th day after operation, and (39.61±2.03) g/L at 7th day after operation, which were higher than those in traditional group [(34.38 ±2.31) g/L and (37.98 ±1.96) g/L, respectively], with stable changes and statistical difference (P= 0.006, P= 0.003). The recovery time of intestinal peristalsis in ERAS group was shorter than that in traditional group [(51.23±9.05) h vs. (58.97±9.61) h, P= 0.003], and the total hospitalization cost in ERAS group was less than that in traditional group [(7.23±0.34) × 104 yuan vs. (7.58± 0.37) × 104 yuan, P 0.05). Conclusion The combination of ERAS and laparoscopic-assisted distal gastrectomy is safe and effective compared with traditional ways, which can relieve the stress reaction, promote the recovery of gastrointestinal function, reduce the hospitalization cost, and accelerate the rehabilitation of patients.

Comparison of Short-term Outcomes of Hand-assisted Laparoscopic,Laparoscopic-assisted and Open Colorectal Cancer Surgery / 中国医科大学学报

Objective To compare the short-term clinical outcomes of hand-assisted laparoscopic surgery(HALS),laparoscopic-assisted surgery (LAS)and open surgery(OS)for colorectal cancer treatment. Methods The clinical data of 74 patients underwent HALS,LAS and OS for colorectal cancer treatment between October 2011 and December 2015 were assessed retrospectively. All the surgeries were performed by the same surgical team. The intraoperative details,postoperative recovery,postoperative complications,oncologic results and cost were compared among the three groups. Results A total of 24 patients in HALS group,25 patients in LAS group and 25 patients in OS group were finally included. The gen-eral data and oncologic baseline were comparable among the three groups. The comparative results showed that the operative time increase d and in-cision length shortened gradually in OS group,HALS group and LAS group(P0.05). In terms of post-operative recovery,postoperative complications and oncologic results,there was no statistical difference between the three groups(P>0.05). As for cost,the total cost and operative cost of OS group were lower than HALS group and LAS group(P0.05). The material cost increase gradually in OS group ,HALS group and LAS group(P0.05). Conclusion HALS,LAS and OS are compen-satory with each other,and clinicians can choose the reasonable procedure according to personal proficiency and situation of patients.

Effect comparison of minilaparotomy and laparoscopic-assisted right hemicolectomy on immune function of patients with colon cancer / 肿瘤研究与临床

Objective To explore the cell-mediated immune function in patients with colon cancer undergoing minilaparotomy or laparoscopic assisted right hemicolectomy. Methods From January 2009 to August 2014, the colon cancer patients receiving right hemicolectomy were retrospectively analyzed. According to the operation mode, the patients were divided into minilaparotomy group and laparoscopic-assisted group. The clinical and pathological data was analyzed. Cell counts of total CD3, CD4, CD8, CD19 as well as NK cells in venous blood samples were compared between 1 day before surgery and postoperative days (POD) 1 and 5. Measurement data with normal distribution was compared using the t test or Q test. Count data was analyzed usingχ2 test or Fisher exact probability. Results There were 408 patients with colon cancer undergoing right hemicolectomy, 26 patients of whom were excluded. The remaining 382 patients were recruited in the research, which were divided into minilaparotomy group (182 cases) and laparoscopic-assisted group (200 cases). There was no significant difference in the age, gender, body mass index, TNM staging, histological type, blood loss, return of bowel function, tumor location, hospital stay and postoperative complications between the two groups (all P> 0.05). The operating time in minilaparotomy group [(131.53 ± 22.57) min] was shorter than that in laparoscopic-assisted group [(167.53 ± 22.04) min], and there was significant difference (t=15.76, P= 0.00). Compared with prior to surgery, cell numbers of CD3, CD4, CD8, CD19 and NK cells were lower on POD 1 and POD 5 (all P0.05). Conclusion The minilaparotomy and laparoscopic-assisted right hemicolectomy have same effect on cellular immune function of patients with colon cancer.

Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.

Clinical Effect of Laparoscopic Assisted Vaginal Hysterectomy and Transvaginal Hysterectomy for Non Prolapse of Uterus / 昆明医科大学学报

Objective To observe and analyze the clinical effect of laparoscopic assisted vaginal hysterectomy and vaginal hysterectomy for non prolapse of uterus.Methods From March 2015 to April 2016,126 cases of uterus benign lesions received surgical treatment in our hospital were selected and divided into observation group and control group.The observation group was given laparoscopic assisted vaginal hysterectomy resection,while the control group was given routine vaginal hysterectomy.The blood loss,operative time,hospitalization time and complications incidence were compared between two groups.Results The operation time and the amount of bleeding in the observation group were significantly higher than that in the control group,the difference was statistically significant (P ＜ 0.05).The length of stay in the observation group was significantly shorter than that in the control group,the difference was statistically significant (P ＜ 0.05).There was no significant difference in the incidence of surgical complications between the two groups (P ＞ 0.05).The quality of life of the two groups was compared with the total score,the observation group was higher (230.79 + 9.54),P ＜ 0.05,the difference was statistically significant.Concltsion Laparoscopic assisted vaginal hysterectomy and vaginal hysterectomy in the treatment of non prolapse uterus has a good clinical effect,should be chosen and applied based on the actual situation of patients.

Combined Laparoscopic Cholecystectomy (LC) and Laparoscopic Assisted Vaginal Hysterectomy (LAVH) is Feasible and Safe in Selected Cases.

Aims: Laparoscopy has been practised for many years by both surgeons and gynaecologists and has made significant advances in last three decades. Laparoscopic Cholecystectomy (LC) has been the mainstay of treatment for gallstones for a long time. In recent years laparoscopy has been used more widely in gynaecology, where Laparoscopy Assisted Vaginal Hysterectomy (LAVH) has been performed with good results. The objective of this study was to evaluate the feasibility and outcome of performing both LC and LAVH in the same sitting. Methods: Between May 2006 and May 2012, 42 women underwent LC and LAVH in the same sitting. Patients were jointly seen by surgeon and gynaecologist and selected following certain strict criteria. We retrospectively recorded postoperative complications, duration of operation and hospital stay. They were followed up in outpatient clinic at four and twelve weeks after discharge. Results: Forty two women underwent both LC and LAVH in the same sitting. Mean duration of surgery was 160 minutes (range 140 - 245).Mean duration of hospitalisation was 64 hours (range 48 – 124 hrs). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 7 with a mean of 3.8. Two (4.7%) patients had umbilical port site infection. Conclusion: Both LC and LAVH can be performed together safely with minimum pain and morbidity. Appropriate selection of patients, preoperative planning and good communication between the surgical and gynaecological team is the key for success.

Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.

Repeatedly Recurrent Colon Cancer Involving the Appendiceal Orifice after Endoscopic Piecemeal Mucosal Resection: A Case Report / 대한소화기학회지

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.

Experience of laparoscopic-assisted radical vaginal trachelectomy for 2 patients with cervical cancer stage I / 대한산부인과내시경학회지

Because of the organized screening programs, incidence and mortality of cervical cancer has been decreased and cervical cancer is diagnosed in relatively young age women and early stages. Traditional treatments for early cervical cancer are radical hysterectomy or chemoradiation, which irreversibly destroy reproductive capacity. Radical vaginal trachelectomy could be an alternative option for young women with early cervical cancer wishing to preserve fertility. Here, we report 2 cases of our initial experiences with Laparoscopy-Assisted Radical Vaginal Trachelectomy (LARVT) for patients with cervical cancer stage I. Two cases of 29 and 31-year-old nulliparous women were diagnosed with cervical cancer IA1-IA2. They underwent LARVT with permanent cervicoisthmic cerclage with 3 cycles of adjuvant chemotherapy. LARVT can be the procedure of choice for women with early stage cervical cancer who desire a fertility preservation.

The comparison of laparoscopic-assisted vaginal hysterectomy by the number of ports / 대한산부인과내시경학회지

OBJECTIVE: To compare clinical features and surgical outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) by the number of ports in the treatment of uterine myoma and adenomyosis. METHODS: Between 1st January 2009 and 31th March 2010, 50 patients underwent 5 mm-2 port LAVH and 10 mm-3 port LAVH respectively by same surgeon at Chosun university hospital. We compared clinical features and surgical outcomes. RESULTS: There was no difference in weight of uterus between the 5 mm-2 port LAVH group and the 10 mm-3 port LAVH group (465.2+/-206.9 g vs. 470.8+/-148.5 g) (Mean+/-S.D.), and in amounts of blood loss during procedure between the two groups (115.0+/-179.3 mL vs. 125.0+/-211.7 mL). The duration of procedure showed a difference between the two groups(55.1+/-12.0 minutes vs. 60.4+/-19.5 minutes) (p=0.03). In the 5 mm-2 port LAVH group, 2 of 50 (4%) converted to laparotomy, and 1 of 50 (2%) in the 10 mm-3 port LAVH group. There was no difference in length of postoperative hospital day between the two groups (5.8+/-1.0 days vs. 6.3+/-1.6 days). In the comparison of postoperative complications, 1 of 50 (2%) required readmission and reoperation for both of the two groups. CONCLUSION: We conclude that 5 mm-2 port LAVH could be a available method in the treatment of uterine myoma and adenomyosis.

A case of laparoscopic assisted suture of small bowel perforation / 대한산부인과내시경학회지

The use of laparoscopic surgical techniques is now being applied to a variety of operations traditionally performed in an open fashion. The indication for surgery included polyps, obstruction, bleeding, and perforation. Small bowel perforation was usually treated with open surgery, but now, laparoscopic-guided bowel surgery is technically feasible and should translate into shorter hospitalization and less patient discomfort. Recently, we successfully treated a case of laparoscopic assisted suture of small bowel perforation. Here we report this case with a brief review of literature.