To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient / 中华老年医学杂志

Objective To explore the clinical effect of tension-free repair in the treatment of inguinal hernia in elderly patient.Methods A total of 124 elderly patients with inguinal hernia admitted in our hospital in 2016 were randomly divided into a study group(n=62)and a control group (n=62).The control group was treated with open tension-free inguinal hernia repair,whereas with laparoscopic tension-free inguinal hernia repair in the study group.The operation time,intraoperative blood loss,the postoperative pain relief-time,mean days of hospitalization,postoperative recurrence rate,and complications rates were compared between the two groups.Results The more significant improvements were found in study group versus control group in the intraoperative bleeding volume [(19.9±2.0)ml vs.(36.8±-2.5)ml,t=41.564,P=0.000],in the mean hours of postoperative pain [(22.1 ± 4.2) h vs.(35.3 ± 7.0) h,t =12.732,P =0.000],in mean days of hospitalization [(5.5 ± 1.0)d vs.(9.2±1.9)d,t=13.569,P=0.000],in incidence rate of postoperative recurrence(0.0％ vs.6.5％,x2 =4.133,P=0.042),and in postoperative complications rate(3.2％ vs.12.9％,x2 =3.916,P=0.048).Nevertheless,the operation time was longer in the study group than in the control group[(87.0±5.0)min vs.(55.5±4.2)min,t=-37.984,=0.000],Conclusions As compared with open tension-free repair,the clinical efficacy of laparoscopic tension-free hernia repair is exactly sure in the treatment of inguinal hernia,with shorter postoperative hospitalization time and lower incidence of complications.

Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach

The Glissonian approach, due to its simplicity of procedure, is a technical procedure widely used in open hepatectomy. However, it is not easily applicable in the setting of the total laparoscopic approach because of movement restriction. We herein propose a new and simple method of performing hemihepatectomy by Glissonian approach called temporary inflow control of the Glissonian pedicle (TICGL) technique. Dissection of the Glisson pedicle from the liver parenchyma is done until the posterior margin of the pedicle is visualized, and is clamped with bulldog clamps. Encircling the pedicle is not necessary. Resection of the liver parenchyma is performed under inflow control of the resected side liver providing less bleeding. After sufficient resection is done so that the whole Glissonian pedicle structures are visualized, the pedicle is encircled, often very easily without the fear of bleeding from the posterior side of the pedicle, which is a common problem when encircling is done before parenchymal resection. The staplers may then be applied safely without injuring the major hepatic veins since they have been already exposed. Stapling is done while the tape is retracted toward the contralateral side. This retraction prevents injury or stricture of the contralateral Glissonian pedicle branch. The remnant liver parenchyma is resected and hepatectomy finalized. The TICGL technique provides a safe and easy way of performing major hemihepatectomies, not only by expert laparoscopic surgeons but by less experienced surgeons. It can therefore become a standard method of performing hemihepatectomy by Glissonian approach.

A novel intracorporeal esophagojejunostomy and esophagogastrostomy following laparoscopic gastrectomy / 中华消化内镜杂志

Objective To evaluate the clinical value of a novel anvil insertion technique in intracorporeal esophagojejunostomy and esophagogastrostomy after laparoscopic total or proximal gastrectomy.Methods A total of 40 patients with gastric cancer underwent laparoscopy-assisted radical total or proximal gastrectomy with lymph node dissection,followed by esophagojejunostomy or esophagogastrostomy using a reverse anvil insertion technique (the observation group,n =22) or traditional open surgery technique (the control group,n =18).Data of the two groups were compared.Results In observation group,laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in 17 patients,laparoscopic proximal gastrectomy and esophagogastrostomy were successfully performed in the 5 patients,and no conversion to open surgery occurred.The mean time of operation was (272.0 ±49.8)min,including (12.9 ±4.3)min for anvil insertion and (48.1 ± 12.8)min for digestive tract reconstruction,which were significantly shorter than those in control group (P ＜ 0.05).The mean time of getting out of bed in observation group was (3.4 ± 0.8) d,the mean time of post-surgical eating was (8.0 ± 2.6) d,and the mean time of hospitalization was (10.8 ±3.3)d,which were all similar with those from the control group (P ＞0.05).Conclusion The reverse anvil insertion technique is a reliable strategy for laparoscopic esophagojejunostomy or esophagogastrostomy.

Meta-analysis of laparoscopic versus open partial nephrectomy / 中华泌尿外科杂志

Objective To provide Meta-analysis evidence of laparoscopic partial nephrectomy (LPN) vs open partial nephrectomy (OPN) in assisting clinical decision making.Methods By searching CHKD,PUBMED,Wanfang and VIP database self-built library up to June 30,2012,both Chinese and English literatures of LPN and OPN efficacy in controlled study were included with strict exclusion criteria by two independent screenings of the literature.Data extraction and quality assessment were done by using the RevMan 5.1 META analysis software.Results A total of four English and six Chinese literature were included in this Meta-analysis.There were 1636 cases of partial nephrectomies.Of these patients,794 cases were treated with LPN,842 cases were treated with OPN.Meta analysis results showed that:in terms of operative time (SMD =0.10,95％ CI-O.40-0.59,P =0.70),surgical complication (OR =1.03,95％ CI0.73-1.44,P =0.88),positive surgical margin (OR =1.64,95 ％ CI0.83-3.23,P =0.16),warm ischemia time (SMD =1.07,95％ CI-0.02-2.16,P =0.05),postoperative tumor recurrence (OR =0.58,95％ CI 0.26-1.30,P =0.18),there was no significant difference.But in terms of intraoperative blood loss (SMD=-1.08,95％CI-1.57--0.59,P＜0.01),postoperative hospital stay (SMD=-0.81,95％CI-0.97--0.65,P ＜0.01),the differences were significant in favor of LPN.Conclusion Comparing with OPN,LPN has advantages in intraoperative blood loss and post-operative hospital stay,no obvious advantages in operative time,surgical complications,positive surgical margin,warm ischemia time and tumor recurrence.

The impact of double-balloon enteroscopy on the evolution of detection and surgical treatment for small bowel stromal tumors / 中华消化内镜杂志

Objective To investigate the role of double-balloon enteroscopy (DBE) in the evolution of detection and surgical treatment of small bowel stromal tumors (SBSTs),based on nine years experience.Methods In this retrospective study,193 patients with localized SBSTs were divided into the CT-enterography (CTE) and/or DBE group (n =100) and conventional modalities group (n =93).These patients were further divided into the open surgery group (n =126) and laparoscopy-assisted resection group (n =67).The development of clinical diagnosis and surgical treatment strategies were compared before and after the introduction of DBE.Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group,respectively (age:50.9 ± 12.1 vs.56.9 ± 11.6 years; tumor size:3.6 ± 1.3 vs.6.1 ± 2.6 cm,P ＜ 0.01).Before the introduction of DBE (from January 2001 to December 2002),all patients underwent conventional modalities,and only 4 cases/year for open surgery.Afterward,from January 2003 to December 2004,84.6％ (11/13) of SBSTs were detected by DBE.From January 2005 to December 2008,50.0％ (23/46) of SBSTs were found by CTE combination with DBE.From January 2009 to December 2011,80.5％ (33/41) of SBSTs were diagnosed by CTE,and the number of patients underwent operation increased up to 25 cases/year,which was nearly 5.3 folds higher than that before the introduction of DBE.Sixty-seven patients were successfully operated by laparoscopy-assisted resection,82.1％ (55/67) of them were detected by CTE ands/or DBE,89.1％ (49/55) of whom had low-or intermediate-risk SBSTs.Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.

Retroperitoneoscopic adrenalectomy in semilateral supine position / 中华泌尿外科杂志

Objective To discuss the semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008, 36 patients (20 males and 16 females with mean age of 43 years) underwent retroperitoneoscopic adrenalectomy in 60° -70° semilateral supine position. There were adrenal cortex adenomas in 18 cases, pheochromocytoma in 6 cases, adrenal cysts in 3 cases, myelolipoma in 2 cases, gangliocytoma in 1 case, lymphangioma in 1 case, metastatic tumor in 1 case and corticohyporplasia in 4 cases. The mean diameter of the tumors was 2.6 cm( 0.5 - 7.7 cm ). The tumors were superior to the renal pole in 5 cases, anteromedial in 10 cases and superomedial in 17 cases. The three ports that were usually used in lateral position and were placed anteriorly to create retroperitoneal place: the first port was placed 2 -4 cm superior to the iliac crest along the anterior axillary line, the other two were placed just below the costal margin along the midaxillary line and at the same level along the midclavicular line, and dissected along the anterior surface of kidney to its superomedial aspect, so as to avoid the hampering of the kidney in the exposing of the diseased adrenal gland. Results The procedure was completed successfully in all of the cases with the operating time of 37 - 145 min ( mean 69 min) and intraoperative blood loss of 30 - 100 ml (mean 48 ml). Six cases had rupture of peritoneum, which were sutured and the procedure was continued to completion. The postoperative hospital stay was 3 -8 d (mean 5 d ). Thirty-five patients were available for follow-up of 3 - 28 months ( mean 14 months). The case of metastatic tumor died of the primary diseases in the 12th month postoperatively. No other complication was found. Conclusion With this alternative position and ports' location, the procedure of retroperitoneoscopic adrenalectomy could be easier and safer than the conventional position.

Retroperitoneal laparoscopic nephropexy: A report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN). Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Laparoscopic adrenalectomy: An experience with 2003 cases / 第二军医大学学报

Objective: To summarize our experience on laparoscopic adrenalectomy. Methods: From August 2001 to Jun 2007, a total of 203 patients (128 male and 75 female, aged 21-74 years, with a mean of [45±2] years old) received laparoscopic adrenalectomy. Six patients had bilateral tumors. The diameters of the adrenal tumors or nodules were 0.4-18 cm. Results: The 203 patients received a total of 209 times of laparoscopic adrenalectomy: including 34 cases via transperitoneal approach, 166 via retroperitoneal approach and 3 via hand-assisted approach. The overall successful rate of laparoscopic adrenalectomy was 97.04% (197/203). Six person-times (2.96%) were converted to open operation due to bleeding or adhesion. The mean operation time was 135±35 min and the estimated blood loss was 40-250 ml (with a mean of 75±25 ml). The patients could get down the bed for activity 1-3 days after operation. The postoperative hospital stay was 7-10 days (with a mean of 7± 2 days). The complications included vena caval injury (1 case), pleural injury (1 case), lumbar hematoma (4 cases), and fat liquefaction (1 case). Conclusion: Laparoscopic adrenalectomy has advantages for treating adrenal tumors. But different approaches should be chosen according to the size and pathological types of the tumors. Transperitoneal approach should be chosen for patients with larger tumors, for obese patients or for patients with bilateral lesions.

Retroperitoneal laparoscopic radical nephrectomy for renal carcinoma: An experience with 180 cases / 第二军医大学学报

Objective: To summarize our experience on retroperitoneal laparoscopic radical nephrectomy (RLRN) in treatment of patients with renal carcinoma. Methods: The clinical data of 180 patients with renal carcinoma, who received RLRN from Jan. 2001 to Jan. 2007, were retrospectively studied. The experience was summarized and the clinical outcomes of patients were assessed. Results: All the 180 patients were pathologically confirmed to have T1-T2 phase renal carcinomas, with 87 cases had left side lesions and 93 had right ones. The diameter of tumors was 1.5-8 cm, with a mean of (4.8±1.3)cm. All the patients were subjected to RLRN and all underwent successful operation. The operation time was 56-90 min, with a mean of (70±12) min; the blood loss was about 70-1 500 ml, with a mean of (122±36) ml. One patients had right renal venous injury (not converted to open surgery), 7 patients had pleural injury, 1 had diaphragmatic injury, 2 had subcutaneous emphysema, 1 had incision hernia, and 6 had delayed union of incision. The patients began oral intake of food 24-48 h after operation and were discharged 7-9 days after operation. Forty-one patients were lost during the follow up (4 months to 6 years); 4 patients died due to other reasons and 2 had pulmonary metastasis. There was no puncture site metastasis in this group. Conclusion: RLRN has the advantages of less trauma, rapid recovery, and slight pain. It is a safe and effective method for treatment of renal carcinoma.

Retroperitoneal laparoscopic partial nephrectomy for early malignant renal tumors: A report of 21 cases / 第二军医大学学报

Objective: To explore the procedures and clinical outcomes of retroperitoneal partial nephrectomy for early malignant renal tumors. Methods: A total of 21 patients (19 men and 2 women, with a mean age of 49 years) with early malignant renal tumors were subjected to retroperitoneal partial nephrectomy using ultrasound knife and electron microscopy. The 21 patients included 17 with clear cell renal carcinoma, 3 with granule cell renal carcinoma, and 1 with oxyphil cell renal carcinoma. The mean diameter of the tumors was (2.8±0.8) cm. Results: All the 21 cases underwent successful retroperitoneal partial nephrectomy without conversion to open operation. Mean surgical time was (105 ± 15) min and mean blood loss was (120 ± 22) ml. Four patients had a mean blood transfusion of 400 ml. One patient had urine leakage, with drainage volume of 200-300 ml; the drainage was stopped 15 days after operation when the drainage was less than 20 ml. The mean postoperative hospital stay was (9±2) days (7-17 days). No patients had local recurrence during a mean follow up of (20±4) months. Conclusion: Laparoscopic partial nephrectomy is feasible and safe.

Laparoscopic partial nephrectomy for early renal carcinoma: A discussion of related issues / 第二军医大学学报

Laparoscopic partial nephrectomy is gaining more and more popularity in treating patients with early renal carcinoma in recent years. Compared with radical nephrectomy, laparoscopic partial nephrectomy is a mini-invasive, safe method with satisfactory postoperative survival rate. However, there were still limited laboratory and clinical data about laparoscopic partial nephrectomy, and the experimental data of traditional laparoscopic surgery and open surgery were still used. Based on the existing data and the authors' experience, this article proposes three hypotheses for the problems puzzling urologic surgeons; the authors hope to verify the hypotheses through basic or clinical research.

Laparoscopic nephroureterectomy with bladder-cuff resection of upper urinary tract carcinoma: techniques and outcomes / 中华泌尿外科杂志

Objective To evaluate the feasibility of laparoscopic nephroureterectomy with bladder-cuff resection by TUR for upper urinary tract carcinoma. Methods Eighty-two patients with upper urinary tract transitional cell carcinoma(69 cases in renal pelvis and 13 in ureter)underwent retroperitoneal laparoscopic nephroureterectomy and bladder-cuff resection by TUR. This group of cases was retrospectively summarized including operative time, blood loss, drainage mounting days, catheterizing days, post-operative complications and hospital stays. Results All 82 operation procedures were successfully performed without severe complication. The mean operative time was 135 minutes.The mean length of hospital stay was 7 days postoperatively. The mean time with drainage and Foley catheter were 3 days and 6 days respectively. Follow-up time ranged from 6 to 76 months for 74 patients. The 3-year carcinoma recurrence was 10.6% (5/47). Only 1 patient was found incision tumor recurrence in 8 month after the procedure. Conclusion Retroperitoneoscopic nephroureterectomy with bladder cuff resection by TUR could be a feasible procedure to treat upper urinary tract transitional cell carcinoma.

Effects of retroperitoneal laparoscopic on thrombosis / 中华泌尿外科杂志

Objective To investigate the effect of reptroperitoneal laparoscopic operation on the parameters of platelet, D-dimer and thrombomodulin(TM). Methods Forty cases were divided into two groups according to the operative way, retroperitoneal laparoscopic operation (n= 20) and open operation (n=20). Blood samples were taken preoperatively and at the end of the surgery. The following parameters were measured and compared within each group and between groups: platelet count (PLT), mean platelet volume (MPV), platelet distributionwidth(PDW), D-dimer, TM. ResultsThere were no significant differences for the PLT, PDW, MPV, TM and D-dimer between before and after operation in each group. There was no difference between 2 groups either for all these indicators.No patients from either group suffered thrombosis or abnormal bleeding as a pastoperative complication. Conclusion Compared with the conventional operation, retroperitoneal laparoscopic operation dioesd not induce more change on parameters of platelet, D-dimer and TM.

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.

Total colectomy and proctocolectomy under laparoscopy for familial adenomatous polyposis with can-cerization / 中华消化内镜杂志

Objective To evaluate the safety, feasibility and efficacy of treating familial adenoma-tous polyposis (FAP) with cancerization by total colectomy and proctocolectomy under laparoscopv. Methods Perioperative data and surgical outcomes of 3 FAP patients who underwent laparoscopic total colectomy and proctocolectomy were analyzed retrospectively and compared with those of 8 patients performed conventional open surgery between Autumn 2001 and December 2002. Results All of the 3 patients were received laparoscopic total colectomy or proctocolectomy successfully without severe complications. The operative times were longer in the laparoscopic group when compared with the conventional group (243. 33 vs. 168. 75 minutes) , (P= 0.028). The mean operative blood loss, flatus and hospital stay in the laparoscopic group were 146. 66 ml, 1. 33 days and 14 days respectively without significant difference when compared with those of the conventional group. The incision length was significantly shorter in the laparoscopic group (4. 33 vs. 19. 38cm) , ( P

Laparoscopic partial nephrectomy for early renal carcinoma: a discussion of related issues / 第二军医大学学报

Laparoscopic partial nephrectomy is gaining more and more popularity in treating patients with early renal carcinoma in recent years.Compared with radical nephrectomy,laparoscopic partial nephrectomy is a mini-invasive,safe method with satisfactory postoperative survival rate.However, there were still limited laboratory and clinical data about laparoscopic partial nephrectomy,and the experimental data of traditional laparoscopic surgery and open surgery were still used.Based on the existing data and the authors' experience,this article proposes three hypotheses for the problems puzzling urologic surgeons;the authors hope to verify the hypotheses through basic or clinical research.