Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

Abstract Background: Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. Methods: A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. Results: One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. Conclusion: In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Effect of 3D laparoscopy versus traditional laparotomy on serum tumor markers and coagulation function in patients with early-stage endometrial cancer

Abstract Objectives To investigate the impact of Three-Dimensional (3D) laparoscopy compared to traditional laparotomy on serum tumor markers and coagulation function in patients diagnosed with early-stage Endometrial Cancer (EC). Method The authors retrospectively analyzed the clinical data of 75 patients diagnosed with early-stage EC and categorized them into two groups based on the surgical techniques employed. The 3D group consisted of 36 patients who underwent 3D laparoscopic surgery, while the Laparotomy group comprised 39 patients who underwent traditional laparotomy. The authors then compared the alterations in serum tumor markers and coagulation function between the two groups. Results Postoperatively, serum levels of CA125, CA199, and HE4 were notably reduced in both groups on the third day, with the levels being more diminished in the 3D group than in the Laparotomy Group (p < 0.05). Conversely, FIB levels escalated significantly in both groups on the third-day post-surgery, with a more pronounced increase in the 3D group. Additionally, PT and APTT durations were reduced and were more so in the 3D group than in the laparotomy group (p < 0.05). Conclusions When juxtaposed with traditional laparotomy, 3D laparoscopic surgery for early-stage EC appears to be more efficacious, characterized by reduced complications, and expedited recovery. It can effectively mitigate serum tumor marker levels, attenuate the inflammatory response and damage to immune function, foster urinary function recovery, and enhance the quality of life. However, it exerts a more significant influence on the patient's coagulation parameters, necessitating meticulous prevention and treatment strategies for thromboembolic events in clinical settings.

Lavado peritoneal laparoscópico en pacientes con diverticulitis aguda Hinchey III atendidos en una clínica privada de Lima / Laparoscopic peritoneal lavage in patients with Hinchey III acute diverticulitis attended at a private clinic in Lima

RESUMEN La diverticulosis es la presencia de divertículos en el tránsito intestinal, diverticulitis es la inflamación de los divertículos y ocurre en menos del 5% de pacientes con diverticulosis. El tratamiento quirúrgico de la diverticulitis aguda se aplica en los casos complicados. Tradicionalmente la operación de Hartmann es el procedimiento estándar en los casos de Diverticulitis aguda Hinchey III y IV, actualmente se recomienda individualizar el tratamiento quirúrgico en los casos de peritonitis purulenta no fecaloidea siendo el lavado peritoneal laparoscópico una opción factible. Objetivo : Describir los resultados del tratamiento quirúrgico de 4 pacientes con el diagnóstico de diverticulitis aguda Hinchey III sometidos al Lavado peritoneal en un centro privado. Material y métodos: Estudio descriptivo retrospectivo tipo serie de casos. Se recopiló información de historias clínicas para la descripción de los casos. Resultados: En los 4 pacientes intervenidos mediante el Lavado peritoneal laparoscópico, ninguno tuvo complicaciones postoperatorias ni mortalidad. Conclusiones: A juicio de los autores los beneficios del lavado peritoneal laparoscópico repercuten en una adecuada evolución postquirúrgica y generan calidad de vida en los pacientes intervenidos.

SUMMARY Diverticulosis is defined as the presence of diverticula in the intestine, when these diverticula become inflamed diverticulitis occurs, but this complication happens in less than 5% of these patients. Surgical treatment is indicated in complicated diverticulitis cases. Traditionally, the Hartmann procedure is carried out in patients with Hinchey III and IV acute diverticulitis. Currently, individualized surgical procedures are indicated in patients with non-fecal purulent peritonitis with laparoscopic peritoneal lavage as an optional choice. Objective: To report the results of laparoscopic peritoneal lavage in four patients with Hinchey III acute diverticulitis performed at a private clinic. Methods: Case series for which a review of patient clinical files was done. Results: No post-operative complications or mortality was found. Conclusions: based on authors judge, laparoscopic peritoneal lavage leads to an adequate post-operative evolution resulting in better quality of life.

Caracterización de las cirugías laparoscópicas en el Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí / Characterization of Laparoscopic Surgeries in the Gynecology Service at Hospital Materno-Infantil Ángel Arturo Aballí

Introducción: La cirugía laparoscópica ginecológica permite intervenir a la paciente sin tener que abrir el abdomen, pues consiste en realizar pequeñas incisiones. Actualmente se emplea en enfermedades como el cáncer o en la extracción de quistes y miomas, por lo que se puede aplicar en casi cualquier intervención de cirugía ginecológica. Objetivo: Caracterizar los procedimientos laparoscópicos del Servicio de Ginecología en el Hospital Materno-Infantil Ángel Arturo Aballí en el período comprendido entre enero del 2018 y diciembre del 2021. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal con el fin de describir la actividad asistencial laparoscópica. La muestra fue de 180 pacientes, según el criterio de selección no probabilístico de los investigadores. Resultados: La edad promedio fue 41,6 años. Según los antecedentes, predominó el tamaño del útero con 91,1 por ciento (n = 164). Dentro de las indicaciones quirúrgicas, se encontró la paridad satisfecha en un 34,4 por ciento, seguido del tumor de ovario (18,9 por ciento), las neoplasias intraepiteliales cervicales (13,4 por ciento) y el fibroma uterino sintomático. En cuanto a la cirugía mayor, se encontró la histerectomía abdominal laparoscópica en un 49,0 por ciento (n = 78), seguido de la salpingectomía con un 38,9 por ciento, resultados con significación desde el punto de vista estadístico (p = 0,004). En cuanto a la cirugía menor, el 11,6 por ciento de la muestra recibió la ablación de los focos endometriales. Las complicaciones fueron escasas. Conclusiones: Los procederes laparoscópicos del Servicio de Ginecología del Hospital Materno-Infantil Ángel Arturo Aballí se consideraron adecuados de acuerdo a los indicadores quirúrgicos(AU)

Introduction: Laparoscopic gynecological surgery allows for the patient to undergo surgery without having to open their abdomen, since it consists in making small incisions. It is currently used in diseases such as cancer or in the removal of cysts and myomas; therefore, it can be applied in almost any gynecological surgery. Objective: To characterize the laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí, in the period from January 2018 to December 2021. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in order to describe the laparoscopic assistance activity. The sample consisted of 180 patients, according to the researchers' nonprobabilistic selection criteria. Results: The mean age was 41.6 years. Concerning antecedents, uterine size predominated, with 91.1 percent (n = 164). Among surgical indications, satisfied parity was found in 34.4 percent , followed by ovarian tumor (18.9 percent ), cervical intraepithelial neoplasms (13.4 percent ) and symptomatic uterine fibroid. With respect to major surgery, laparoscopic abdominal hysterectomy was found in 49.0 percent (n = 78), followed by salpingectomy, with 38.9 percent ; such results are statistically significant (p = 0.004). Regarding minor surgery, 11.6 percent of the sample received ablation of endometrial focuses. Complications were rare. Conclusions: The laparoscopic procedures of the gynecology service at Hospital Materno-Infantil Ángel Arturo Aballí are considered adequate according to the surgical indicators(AU)

Biopsia ganglionar retroperitoneal por laparoscopia

Introducción: La biopsia ganglionar retroperitoneal es un procedimiento frecuentemente requerido en el estudio de neoplasias; resulta deseable optimizar su rendimiento con baja morbilidad. Este artículo describe la utilidad y complicaciones de biopsias ganglionares retroperitoneales por laparoscopia en una institución oncológica de Latinoamérica. Material y Métodos: Cohorte retrospectiva de pacientes con biopsia ganglionar retroperitoneal o mesentérica laparoscópica entre 2011 y 2021 en el Instituto Nacional de Cancerología, en Bogotá, Colombia. Se recogieron datos demográficos, quirúrgicos, complicaciones y mortalidad a 30 días, resultados histopatológicos y su rol en la clínica. Resultados: Se incluyeron 41 pacientes; 73% con diagnóstico de malignidad, principalmente linfoma. La indicación fue mayormente sospecha de recaída, seguida por sospecha de enfermedad hematológica de novo. Siempre se obtuvo tejido adecuado y suficiente para diagnóstico histológico. Requirieron conversión a laparotomía cinco pacientes (12%). No hubo complicaciones Clavien-Dindo III /IV ni mortalidad a 30 días. Se presentó morbilidad grado I o II en 3 casos (7%) y un incidente intraoperatorio grado III. Conclusión: La naturaleza invasiva y el carácter diagnóstico de la biopsia retroperitoneal laparoscópica, constituyen un desafío frecuente en la práctica del cirujano general. La planeación estratégica e individualizada y la técnica quirúrgica depurada son las claves para lograr el máximo rendimiento, con baja morbimortalidad.

Introduction: Retroperitoneal lymph node biopsy is a frequently required procedure in the study of neoplasms; it is desirable to optimize its performance with low morbidity. This paper describes the usefulness and complications of retroperitoneal lymph node biopsies by laparoscopy in a cancer institution in Latin America. Material and Methods: Retrospective cohort of patients with laparoscopic retroperitoneal or mesenteric lymph node biopsy between 2011 and 2021 at the National Cancer Institute, in Bogotá, Colombia. Demographic and surgical data, complications and 30-day mortality, histopathological results and their clinical role were collected. Results: 41 patients were included; 73% diagnosed with malignancy, mainly lymphoma. The indication was mostly suspected relapse, followed by suspected de novo hematologic disease. Adequate and sufficient tissue was always obtained for histological diagnosis. Five patients (12%) required conversion to laparotomy. There were no Clavien-Dindo III/IV complications or 30-day mortality. Grade I or II morbidity occurred in 3 cases (7%) and a grade III intraoperative incident. Conclusion: The invasive nature and diagnostic character of laparoscopic retroperitoneal biopsy constitute a frequent challenge in the practice of the general surgeon. Strategic and individualized planning and a refined surgical technique are the keys to achieving maximum performance, with low morbidity and mortality.

Short-term Outcomes and Long-term Survival Outcomes of Elderly Patients (Over 80 Years of Age) with Colorectal Cancer Who Received Laparoscopic Versus Open Surgery / 肿瘤防治研究

Objective To examine short-term outcomes and long-term survival of elderly patients (aged over 80 years) with colorectal cancer who received laparoscopic versus open surgery. Methods A total of 313 patients over 80 years old with colorectal cancer who underwent radical surgery were included.According to the surgical method, all patients were divided into open-surgery group (n=143) and laparoscopic surgery group (n=170).Baseline data were balanced between the two groups by using propensity score matching.Kaplan-Meier was used to draw the survival curve, and survival was compared by Log rank tests.Cox proportional risk model was used to analyze the effects of all factors on overall survival (OS) and disease-free survival (DFS). Results After matching, 93 patients were included in each group.The mean intraoperative blood loss, the incidence of overall postoperative complications and gradeⅠ-Ⅱ complications in the laparoscopic surgery group were significantly lower than those in the open surgery group (all P < 0.05).The time to first flatus, the time to oral feeding, and postoperative hospital stays in the laparoscopic surgery group were significantly shorter than those in the open surgery group (all P < 0.05).The mean number of lymph-node dissection was also significantly higher in the laparoscopic surgery group than in the open surgery group (P=0.030).Patients in both groups had similar 5-year OS (P=0.594) and DFS (P=0.295).Multivariate Cox prognostic analysis showed that CEA level > 5 ng/ml, pathological TNM stage Ⅲ, and perineural invasion were independent risk factors for poor OS and DFS. Conclusion Compared with open surgery, laparoscopic surgery can provide better short-term advantages and similar long-term outcomes for colorectal cancer patients over 80 years of age.

Clinical application of robotic-assistant living donor left lateral segmentectomy / 中华器官移植杂志

Objective:To explore the feasibility and safety of robotic-assisted living donor left lateral segmentectomy (LDLLS) in a large pediatric liver transplant program.Methods:Retrospective analysis was performed for clinical data of 45 LDLLS donors and recipients from June 2021 to September 2022.Traditional open donor liver resection (n=30) and robotic-assisted segmentectomy (n=15) were performed.Two groups were compared with regards to operative duration, intraoperative hemorrhage, postoperative healing and postoperative complications.SPSS 21.0 was utilized for statistical analysis.Independent sample T, paired sample T, Wilcoxon rank sum and Chi-square tests were performed for examining the inter-group differences.Results:Operative duration of robot-assisted surgery group was substantially longer than that of traditional open surgery group ( P<0.001). Intraoperative blood loss was less in robot-assisted surgery group was less than that in traditional open surgery group[(106.0±39.8) vs.(251.0±144.8) ml, P=0.001]. Postoperative hospital stay of robot-assisted surgery group was shorter than that of traditional open surgery group[6.0(6.0, 6.0) vs.7.0(6.0, 9.0), P<0.05]. Two cases of postoperative biliary leakage were observed in donor of traditional open surgery group.Among 2 cases of abdominal infection, one was due to biliary leakage from liver section and secondary surgery was then performed.One case of incisional infection and another case of thrombosis occurred in donor of traditional open surgery group.In robot-assisted surgery group, only one donor had amylase elevation.In traditional open surgery group, there were one case of local thrombosis in middle hepatic vein and one case of bile duct stricture.No long-term complications occurred in robot-assisted surgery group during a follow-up period of over 6 months.Finally recipient data analysis indicated that no significant inter-group differences existed in operative duration, intraoperative blood loss, postoperative hospital stay or postoperative abdominal infection ( P=0.634, P=0.180, P=0.86 and P=0.153). Conclusions:Robotic-assisted LDLLS proves to be be a safe and reliable option for living donor segmentectomy.It is superior to conventional LDLLS in terms of shorter hospital stay, less intraoperative blood loss and fewer postoperative complications.

Da-vinci robot-assisted surgery vs laparoscopic repair for the treatment of hiatal hernia repair / 中华普通外科杂志

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.

The efficacy of laparoscopic ovarian cyst aspiration in the treatment of neonatal simple ovarian cyst / 中国新生儿科杂志

Objective:To study the efficacy of laparoscopic ovarian cyst aspiration in the treatment of neonatal simple ovarian cyst.Methods:From August 2019 to December 2021, infants with neonatal simple ovarian cyst receiving laparoscopic ovarian cyst aspiration in the Department of Pediatrics of Gansu Provincial Maternity and Child-care Hospital were retrospectively studied. The clinical characteristics, age of surgery, operation duration, length of hospital stay, complications and follow-up were analyzed.Results:A total of 6 full-term infants were included. Simple ovarian cysts were located on the right side of the body in 5 cases and on the left in 1 case. The average cyst diameter was (6.1±1.4) cm, the surgery were performed at 2~5 d of age, the average duration of the surgery was (18.8±2.4) min and the average hospital stay was (5.3±1.0) d. No complications occurred before or after surgery. All the 6 infants had favorable growth and development. The ovarian cysts were all enlarged again in 1 month after surgery, then gradually shrunk at 3 to 6 months after surgery and completely resolved in 2 cases.Conclusions:Neonatal simple ovarian cysts are more common on the right side of the body and laparoscopic ovarian cyst aspiration has good and safe clinical efficacy.

Current status and pondering of minimally-invasive surgical techniques in radical resection of hilar cholangiocarcinoma / 中华消化外科杂志

Hilar cholangiocarcinoma is one difficultly-treated biliary malignancy with poor prognosis, and radical resection offers the only hope of cure for the disease. In recent years, with development and maturation of minimally-invasive techniques, laparoscopic or robotic-assisted radical resection of hilar cholangiocarcinoma has been attempted in some major medical centers. Laparoscopic and robotic-assisted radical resection of hilar cholangiocarcinoma is technically safe and feasible at present, but there is still a lack of large number of case report and evaluation of long-term survival of patients. Based on previous literatures and combined with clinical experiences, the author elaborates on the application status of laparoscopic and robot surgical system in the radical resection of hilar cholangiocarcinoma, and discusses the key issues that should be paid attention to in carrying out this technology, such as the operator′s prerequisite requirement and patients′ selec-tion, how to ensure the radicality of surgical resection and improve the long-term outcomes.

Diagnosis and treatment of internal hernia after laparoscopic surgery for gastric cancer / 中华消化外科杂志

With the development of laparoscopic surgery for gastric cancer, more and more surgeons use laparoscopic techniques and even totally laparoscopic techniques in gastric cancer surgery. However, technological progress brings not only smaller trauma, but also new problems and risks. Compared with traditional open surgery, the high incidence of internal hernia after laparoscopic gastric cancer surgery is an urgent problem to be solved. As the incidence of internal hernia often occurs after discharge, patients usually choose the nearest hospital for diagnosis and treatment due to the urgent course of disease. As a result, patients with internal hernia often have serious complications due to delayed treatment because of the difficulty in diagnosis. Sometimes, there are patients even death. The authors review the relevant research on postoperative internal hernia of gastric cancer in recent years and combine with practical experience to discuss the diagnosis and treatment strategy of internal hernia after laparoscopic surgery for gastric cancer, aiming to improve the clinicians′ attention to the disease and provide reference for its diagnosis and treatment.

Laparoscopic simple prostatectomy for large volume benign prostate hyperplasia: a report of 30 cases / 现代泌尿外科杂志

【Objective】 To investigate the feasibility of laparoscopic simple prostatectomy (LSP) in the treatment of large volume benign prostate hyperplasia (BPH). 【Methods】 Clinical and follow-up data of 30 patients with large volume BPH treated with LSP in our hospital during Feb.2019 and Dec.2021 were retrospectively analyzed. All patients underwent extraperitoneal LSP operation. The perioperative and 1-12 month postoperative follow-up data were analyzed. 【Results】 The average prostate volume was (92.4±38.9) mL, operation time (125±45) min, and weight of resected prostate (60.25±16.90) g. The hemoglobin decreased by (12.21±7.25) g/d after operation. No blood transfusion was needed. There was no need for bladder irrigation after operation in 21 cases (70%), and 9 cases (30%) had bladder irrigation time of (0.95±0.49) d. The postoperative catheter indwelling time was (6.92±2.51) d, and hospital stay (5.36±1.63) d. During the follow-up of (9.25±5.4) months, there was 1 case of postoperative intestinal obstruction (Clavien-Dindo grade II), 1 case of transient urinary incontinence (Clavien-Dindo grade I), and 1 case of delayed hematuria (Clavien-Dindo grade I). No urethral stricture occurred. The maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS) and quality of life (QoL) 3 months after operation were significantly improved compared with those before operation (P0.05). 【Conclusion】 LSP is safe and effective in the treatment of large volume BPH. It has advantages of complete resection of glands, minor bleeding and short postoperative bladder irrigation time. However, it still needs to be confirmed by a prospective control study of large samples.

Management of vena cava tumor thrombus dislodgement in robot-assisted laparoscopic surgery / 现代泌尿外科杂志

Renal cancer complicated with inferior vena cava tumor thrombus has been difficult to manage in urological surgery, because it has a complex anatomical relationship and involves vascular blockage of vital organs such as kidney, liver and heart, as well as the blockage and reconstruction of inferior vena cava. In addition, tumor thrombus dislodgement may occur intraoperatively, leading to acute pulmonary embolism, which makes the surgery extremely difficult and risky. In this paper, we report the successful treatment of thrombus dislodgement in a case of right kidney tumor with inferior vena cava thrombus during robot-assisted laparoscopic surgery and explore the treatment methods, aiming to avoid lethal pulmonary embolism caused by tumor thrombus dislodgement.

Comparison of short-term efficacy between laparoscopic surgery with natural orifice specimen extraction and laparoscopic-assisted surgery for radical resection of rectal cancer / 西安交通大学学报(医学版)

【Objective】 To explore the feasibility, safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction (NOSE) by comparing the postoperative pathological data, surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery. 【Methods】 A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022. Among them, 38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision (auxiliary incision group), and 36 cases underwent surgery with specimen extraction through a natural orifice (NOSES group). The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data, surgical variables, and postoperative recovery of the two groups. 【Results】 There were no statistically significant differences in general data and postoperative pathological data between the two groups (all P>0.05). The NOSES group exhibited significantly shorter operative time, time to first flatus, time to first oral intake postoperatively, and postoperative hospital stay compared to the auxiliary incision group (all P0.05). 【Conclusion】 Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery, which is worth promoting and applying in clinical practice.

Robot-assisted transperitoneal and retroperitoneal adrenalectomy for huge adrenal tumors in 45 cases / 现代泌尿外科杂志

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

Application of Laparoscopic Surgery in Ileostomy Reversal / 肿瘤防治研究

In colorectal cancer surgery, loop ileostomy is sometimes necessary to prevent anastomotic leakage. Although ileostomy reversal is relatively simple, postoperative complication is inevitable. In recent years, laparoscopic surgery has been gradually applied in ileostomy reversal due to its small trauma, fast recovery, and low complications, exhibiting satisfactory short-term outcomes. This review analyzes the application of the laparoscopic technique in ileostomy surgery and explores the potential of total laparoscopic surgery, aiming to provide a new perspective for the clinical application of laparoscopic ileostomy reversal.

Clinical Efficacy of Concept of Membrane Anatomy with Complete Mesangectomy in Radical Resection of Rectal Cancer / 肿瘤防治研究

Objective To compare the clinical efficacy between traditional laparoscopic surgery and laparoscopic surgery under the guidance of membrane anatomy with complete mesangectomy in the treatment of rectal cancer. Methods A retrospective cohort study was conducted on 60 patients with rectal cancer who were randomly divided into control group (n=30) and observation group (n=30) in accordance with the principle of randomization.The control group received traditional laparoscopic radical resection of rectal cancer, and the observation group received laparoscopic radical resection of rectal cancer under the guidance of membrane anatomy with complete mesangectomy.The different clinical application effects of the two groups were analyzed by comparing the general data, operation time, intraoperative blood loss, and postoperative rehabilitation. Results All the 60 patients underwent the laparoscopic radical resection of rectal cancer.No operation-related complications, conversion to laparotomy, or perioperative death cases were reported.No statistically significant differences in age, gender, operation time, postoperative exhaust time, drainage tube removal time, or postoperative complications were found between the two groups (all P > 0.05).Compared with the control group, the observation group had significantly less intraoperative blood loss and more lymph node dissected (P < 0.05). Conclusion Laparoscopic radical resection of rectal cancer guided by the membrane anatomy with complete mesangectomy can completely remove the mesorectum, enlarge and clear the surgical field, reduce intraoperative bleeding, thoroughly remove lymph nodes, and improve the quality of surgery.

Predictive model of early urinary continence recovery based on prostate gland MRI parameters after laparoscopic radical prostatectomy / 北京大学学报(医学版)

OBJECTIVE@#Constructing a predictive model for urinary incontinence after laparoscopic radical prostatectomy (LRP) based on prostatic gland related MRI parameters.@*METHODS@#In this study, 202 cases were included. All the patients were diagnosed with prostate cancer by prostate biopsy and underwent LRP surgery in Peking University Third Hospital. The preoperative MRI examination of all the patients was completed within 1 week before the prostate biopsy. Prostatic gland related parameters included prostate length, width, height, prostatic volume, intravesical prostatic protrusion length (IPPL), prostate apex shape, etc. From the first month after the operation, the recovery of urinary continence was followed up every month, and the recovery of urinary continence was based on the need not to use the urine pad all day long. Logistic multivariate regression analysis was used to analyze the influence of early postoperative recovery of urinary continence. Risk factors were used to draw the receiver operator characteristic (ROC) curves of each model to predict the recovery of postoperative urinary continence, and the difference of the area under the curve (AUC) was compared by DeLong test, and the clinical net benefit of the model was evaluated by decision curve analysis (DCA).@*RESULTS@#The average age of 202 patients was 69.0 (64.0, 75.5) years, the average prostate specific antigen (PSA) before puncture was 12.12 (7.36, 20.06) μg/L, and the Gleason score < 7 points and ≥ 7 points were 73 cases (36.2%) and 129 cases (63.9%) respectively, with 100 cases (49.5%) at T1/T2 clinical stage, and 102 cases (50.5%) at T3 stage. The prostatic volume measured by preoperative MRI was 35.4 (26.2, 51.1) mL, the ratio of the height to the width was 0.91 (0.77, 1.07), the membranous urethral length (MUL) was 15 (11, 16) mm, and the IPPL was 2 (0, 6) mm. The prostatic apex A-D subtypes were 67 cases (33.2%), 80 cases (39.6%), 24 cases (11.9%) and 31 cases (15.3%), respectively. The training set and validation set were 141 cases and 61 cases, respectively. The operations of all the patients were successfully completed, and the urinary continence rate was 59.4% (120/202) in the 3 months follow-up. The results of multivariate analysis of the training set showed that the MUL (P < 0.001), IPPL (P=0.017) and clinical stage (P=0.022) were independent risk factors for urinary incontinence in the early postoperative period (3 months). The nomogram and clinical decision curve were made according to the results of multivariate analysis. The AUC value of the training set was 0.885 (0.826, 0.944), and the AUC value of the validation set was 0.854 (0.757, 0.950). In the verification set, the Hosmer-Lemeshow goodness-of-fit test was performed on the model, and the Chi-square value was 5.426 (P=0.711).@*CONCLUSION@#Preoperative MUL, IPPL, and clinical stage are indepen-dent risk factors for incontinence after LRP. The nomogram developed based on the relevant parameters of MRI glands can effectively predict the recovery of early urinary continence after LRP. The results of this study require further large-scale clinical research to confirm.

Primary adrenal small cell neuroendocrine carcinoma complicated with renal venous carcinoma thrombus: a case report / 中华泌尿外科杂志

Primary adrenal small cell neuroendocrine carcinoma is clinically rare. This article reported a patient, who was diagnosed as primary adrenal small cell neuroendocrine carcinoma complicated with renal vein cancer thrombus, and underwent laparoscopic left adrenal + left kidney + left renal vein tumor embolectomy.The carcinoma relapsed after 19 months of follow-up after surgery. The patient and his family refused further treatment.

Impact of body mass index on perioperative efficacy and complications of robot-assisted radical cystectomy with intracorporeal urinary diversion / 中华泌尿外科杂志

Objective:To determine the impact of body mass index (BMI) on perioperative and oncological outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion in Zhejiang Provincial People's Hospital from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into three groups according to BMI, including 61 cases in normal group (<25.0 kg/m2), 52 cases in overweight group (25.0-29.9 kg/m2) and 33 cases in obese group (≥30.0 kg/m2). In the normal group, the median age was 73.6(59, 79), including 45 male(73.8%), with 51 cases(83.6%) of ASA score 0-2, 10 cases (16.4%)of 3 or higher, and 10 cases (16.4%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 34 cases (55.7%), hypertension in 19 cases (31.1%), diabetes in 10 cases (16.4%), heart disease in 12 cases (19.7%), and abdominal surgery in 6 cases (9.8%). In the overweight group, the median age was 69.7(60, 78), including 38 male (73.1%), with 25 cases (48.1%)of ASA score 0-2, 27 cases (51.9%) of 3 or higher, and 9 cases (17.3%) undergoing received neoadjuvant chemotherapy. Past medical history included smoking in 30 cases (57.7%), hypertension in 20 cases (38.5%), diabetes in 10 cases (19.2%), heart disease in 9 cases (17.3%), and abdominal surgery in 5 cases (9.6%). In the obses group, the median age was 69.9(61, 78), including 21 male(63.7%), with 20 cases (60.6%)of ASA score 0-2, 13 cases(39.4%) of 3 or higher, 9 cases (27.3%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 18 cases (54.5%), hypertension in 17 cases (51.5%), diabetes in 19 cases (57.6%), heart disease in 7 cases (21.2%), and abdominal surgery in 4 cases (12.1%). After statistical comparison among the three groups, it was found that the proportion of patients with hypertension and diabetes in the obesity group and overweight group was higher than that in the normal group (all P<0.05), but there was no significant difference in other factors (all P>0.05). During the surgical process, robot-assisted radical cystectomy and bilateral pelvic lymph node dissection were performed firstly. The scope of lymph node dissection was divided into standard range and expanded range, and the diversion was divided into orthotopic neobladder and ileal bladder. During the orthotopic neobladder process, 40-50 cm ileum at the distance of 15 cm away from ileocecum was obtained by stapler, and then the U-shaped neobladder was made, and the new bladder was anastomosed with urethra and bilateral ureter. For ileal bladder, the ileum was cut off 15cm away from the ileocecum with stapler to obtain the 15 cm ileum to prepare the ileal conduit and restore the continuity of the ileum. The bilateral ureteral spacing 3cm was implanted on the ileal conduit. In the normal group, standard range lymphatic dissection was performed in 20 cases (32.8%), enlarged dissection in 41 cases (67.2%), orthotopic neobladder in 22 cases(36.1%), and ileal conduit in 39 cases (63.9%). In the overweight group, standard range lymphatic dissection was performed in 12 cases (23.1%), enlarged dissection in 40 cases (76.9%), orthotopic neobladder in 26 cases (49.1%), and ileal conduit in 26 cases (50.9%). In the obesity group, the standard range of lymphatic dissection was performed in 7 cases (21.2%), enlarged dissection in 26 cases (78.7%), orthotopic neobladder in 7 cases (21.2%), and ileal conduit in 26 cases (78.8%). There was no significant difference among the three groups (all P>0.05). Compared the operation time, intraoperative blood loss, postoperative exhaust time, postoperative time of taking solid food, postoperative hospital stay, postoperative complications (according to the Clavien-Dindo grading system, postoperative complications are reported inⅠ-Ⅱ grade as mild complications and above Ⅲ grade as serious complications) and pathology results in three groups. Results:All cases successfully underwent robotically without conversion or major intraoperative complications. The operation time in overweight and obsess group were longer than that of normal group with RARC or orthotopic neobladder [310(250, 350) min, 370(310, 420) min, 250(230, 310) min, ( P<0.05)], but there was no significant difference in RARC and ileal conduit[270(220, 300) min, 280(230, 300) min, 240(220, 290)min, P>0.05]. The estimated blood loss in overweight and obsess group was more than that in normal group [230(150, 450)ml, 310(250, 600)ml, 190(100, 350)ml, P<0.05], but there was no difference in blood transfusion rate [4(7.7%), 2(6.1%), 5(8.2%), P>0.05]. The exhaust time [2(1, 3) days, 2(1, 4)days, 2(1, 4)days], postoperative solid food intake time [4(3, 5)days, 4(3, 6)days, 4(3, 6)days] and the hospital stay[10(5, 16)days, 10(6, 17)days, 12(6, 20)days] were not different in three groups(all P>0.05). The mild complication rates in 90 days were significant higher in overweight and obsess groups[28 (53.8%), 16(48.5%), 20(32.8%), P<0.05], but the total and severe complication rates were not significantly different. The incidences of urinary system complications and incision complications in obese and overweight patients were significantly higher than those in normal group ( P<0.05). There was no significant difference in the incidence of gastrointestinal complications and ureteral anastomosis-related complications (stricture or urinary leakage)( P>0.05). There was no significant difference in the number of dissected lymph node, positive lymph node, positive rate of incisional margin and postoperative pathological stage among three different BMI groups(all P>0.05). Conclusion:Robot-assisted radical cystectomy combined with intracorporeal urinary diversion is a safe and effective method for the treatment of overweight, obese and even morbidly obese patients with bladder cancer. The recovery of intestinal function and the oncological results are not affected by body mass index. However, laparoscopic radical cystectomy for overweight and obese patients, especially for orthotopic neobladder, has the risk of long operation time, large amount of intraoperative bleeding and increased risk of minor postoperative complications.