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AIM:To evaluate the clinical efficacy and safety of pneumoperitoneum-free single-hole endoscopy combined with ropivacaine local infiltra-tion anesthesia in pregnancy with ovarian tumor.METHODS:Twenty-eight pregnant women with ovarian tumor were randomly divided into two groups:observation group(n=16)and control group(n=12).The first time out of bed,ventilation time,postoperative hospital stay,non-invasive blood pressure,heart rate(HR),respiratory fre-quency(RR)and blood oxygen saturation(SpO2)were compared between the two groups.Pain score,Ramsay sedation score,SAS anxiety score,postoperative complications,patient satisfaction and recovery quality scale QoR15 were evaluated at 6,24 and 48 hours after operation.RESULTS:There was no significant difference in postopera-tive hospital stay,Ramsay score,RR,SpO2 and the incidence of complications between the two groups(P>0.05),but the time of getting out of bed and ventilation time were shortened,the scores of non-invasive blood pressure,HR,pain and anxiety in the observation group were lower than those in the control group,and the scores of patient satisfac-tion and QoR15 in the observation group were bet-ter than those in the control group(P<0.05).CON-CLUSION:The application of pneumoperitoneum-free single-hole endoscope combined with ropiva-caine local infiltration anesthesia in pregnancy with ovarian tumor can reach satisfactory clinical re-sults,including reducing postoperative pain and anxiety,which is worth popularizing.
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Objective:To explore the safety, effectiveness, economy and surgical techniques of bronchial priority treatment in single-port thoracoscopic right upper lobectomy by comparing it with conventional single-port thoracoscopic right upper lobectomy.Methods:Clinical data of 72 patients who underwent single-port thoracoscopic right upper lobectomy from Mar. 2019 to Feb. 2022 were collected. According to different surgical treatment sequences, the patients were divided into observation group (bronchial priority treatment, 36 cases) and control group (conventional surgery, 36 cases). The general clinical characteristics, operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative pain score, and number of staplers used in the two groups were compared.Results:All operations were successfully completed without conversion to thoracotomy. There was no significant difference between the two groups in clinical characteristics, intraoperative blood loss [ (25.3±12.8) ml vs 32.5±14.2) ml, P>0.05], postoperative hospital stay[ (4.7±1.6) d vs (4.9±1.5) d, P>0.05], postoperative pain score [ (3.3±1.1), (4.8±1.4), (3.7±1.1) vs (3.5±1.2), (5.5±1.4), (4.1±1.4), P>0.05], number of lymph node dissection (9.1±1.8 vs 8.3±1.7, P>0.05), or postoperative complications (16.7% vs 27.8%, P>0.05). Compared with the control group, the observation group had significant advantages in the operation time [ (87.2±6.1) vs (106.4±21.8) min, P<0.05] and the number of staplers used (3.7±0.8 vs 5.8±1.3, P<0.05) . Conclusions:Single-port video-assisted thoracoscopic right upper lobe resection with bronchial priority treatment is safe and effective. It simplifies the surgical procedure, reduces the use of disposable consumables, does not increase the risk of perioperative period, and has clinical application prospects.
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The minimally invasive surgery is the mainstream of the development of surgery, and the transformation of surgery from traditional open surgery to endoscopic surgery has brought great benefits to patients. However, surgeons have never stopped their exploration from porous laparoscopy to single hole or even endoscopic surgery via the natural cavity, and looking for a more minimally invasive way of surgery has always been the pursuit of clinicians. As a minimally invasive technique, single-hole laparoscopy is becoming more and more widely used in clinic, and achievements and difficulties will guide the development direction of further research in the future. This paper reviews the clinical application of single-hole laparoscopy in recent years and the status quo of its development.
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BACKGROUND@#Lung cancer is currently the leading malignant tumor in both domestic and foreign morbidity and mortality. Surgical treatment is the main treatment option for lung cancer. The aim of this study is to explore the effects of enhanced recovery after surgery (ERAS) combined with respiratory function exercise combined with single-hole thoracoscopic surgery on lung cancer patients with postoperative pulmonary complications, postoperative pain, time to get out of bed, time to extubation and length of hospital stay.@*METHODS@#A total of 240 patients who underwent endoscopic lung cancer surgery at the Affiliated Hospital of Yangzhou University and the Yancheng First People's Hospital from October 2017 to October 2019 were randomly divided into 4 groups, with 60 patients in each group. Patients in group A underwent single-hole thoracoscopic surgery, and preoperatively performed ERAS concept education and respiratory function training; group B used conventional 3-hole thoracoscopic surgery, and performed ERAS concept education and respiratory function training before operation; group C used conventional 3-hole thoracoscopic operation surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept education; group D used single-hole thoracoscopic surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept mission. The number of postoperative pulmonary complications, postoperative pain, time to get out of bed, extubation time, and hospital stay were recorded in the four groups.@*RESULTS@#Compared with the groups B, C, and D, the incidence of pulmonary complications was significantly reduced, and the time to get out of bed, extubation time, and hospital stay were significantly shortened in group A. Compared with groups B, C, the postoperative pain was significantly reduced in group A. Compared with group C, the pulmonary complications were significantly reduced, and the time to get out of bed, extubation time and hospital stay were significantly shortened in group B. The differences were statistically significant (P0.05).@*CONCLUSIONS@#For patients with single-hole thoracoscopic lung cancer surgery, the ERAS concept guidance can effectively reduce the incidence of pulmonary complications and postoperative pain, shorten the time to get out of bed, the time to extubate, and the length of hospital stay.
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Objective@#To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer.@*Methods@#200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups : group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A: 100 patients with 30#single thoracic drainage tube after operation. Groupe B: 100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups.@*Results@#There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage[(1 007.4±512.95)ml vs.(982.35±359.93)ml]and totaltube time[(5.71±2.61)days vs.(5.43±1.91) days] had no significant difference between the two groups. There was a significant difference in the length of 30#thoracic drainage tube [(5.71±2.61)days vs.(2.9±0.61)days]between the two groups. The difference of hospitalization time[(12.05±2.93)days vs.(13.45±4.15)days]and hospitalization expenses[(63 376.47±1 615.82)yuan vs.(64 449.82±3 650.04)yuan]was statistically significant. The rate of rethoracotomy in gruop A was 7%, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was statistically significant.@*Conclusion@#Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drainage tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of patients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus effectively reduce postoperative hospitalization costs of patients.
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Objective To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer. Methods 200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups :group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A:100 patients with 30#single thoracic drainage tube after operation. Groupe B:100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups. Results There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage [(1007.4±512.95)mlvs.(982.35±359.93)ml]andtotaltubetime[(5.71±2.61)daysvs.(5.43±1.91)days]hadno significant difference between the two groups. There was a significant difference in the length of 30 # thoracic drainage tube [(5.71±2.61)daysvs.(2.9±0.61)days]betweenthetwogroups. Thedifferenceofhospitalizationtime[(12.05±2.93) daysvs.(13.45±4.15)days]andhospitalizationexpenses[(63376.47±1615.82)yuanvs.(64449.82±3650.04)yuan] was statistically significant. The rate of rethoracotomy in gruop A was 7％, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was sta-tistically significant. Conclusion Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drain-age tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of pa-tients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus ef-fectively reduce postoperative hospitalization costs of patients.
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Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery under non-intubated anesthesia with spontaneous respiration.Methods The clinical data in 35 cases of uniportal video-assisted thoracoscopic surgery under non-intubated anesthesia with spontaneous respiration implemented by same doctor and team in the Affiliated Nanjing Chest Hospital of Medical College,Southeast University from June 2016 to January 2017 were retrospectively analyzed.Results The operations were successfully completed in 35 cases,including 23 cases of lung bullae resection,6 cases of lung wedge resection,5 cases of pulmonary lobectomy and lymph nodes clearance,and 1 case of bilateral sympathectomy.The operative time was 20-106min,average(38.79 ± 26.45) min,intraoperative bleeding volume was 20-350 mL,average(57.14 ± 56.50) mL.No perioperative serious complications or death occurred.Conclusion Uniportal video-assisted thoracoscopic surgery technique under non-intubated anesthesia with spontaneous respiration is safe and feasible,and can be selectively used in partial patients.
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Objective To explore the effect of single-hole thoracoscopic lobectomy on patients with early non-small cell lung cancer. Methods A total of 100 patients with early non-small cell lung cancer received surgeries in our hospital from Jan 2014 to Jan 2015. They were divided into observation group(single-hole thoracoscopic lobectomy, 50 cases) and control group (three thoracoscopic lobectomy, 50 cases) according to operation modes. The operation data, postoperative recovery situations and complication rate were compared between two groups. Results All patients completed operations successfully and there were no serious complications during operations. There were no significant differences in operation time, numbers of lymph node dissection, tumor recurrence rate and survival rate in one year after operations between the two groups(P＞0.05). The blood loss, length of incision, thoracic drainage, tube time, postoperative hospital stay and VAS scores at the first day after surgery in observation group were lower than those in control group(P＜ 0.05). The complication rate of observation group [ 20.0％ (10/50) ] was lower than that of control group [40.0％ (20/50) ](P＜0.05). Conclusion As for patients suffered from early non-small cell lung cancer, single-hole thoracoscopic lobectomy has advantages of less bleeding, fast recovery and low complication rate.
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Objective To discuss the feasibility of single hole thoracoscopy of pleural fibreboard endarterectomy surgical treatment on chronic tuberculous empyema. Methods Retrospective analysis of minimally invasive treatment of 52 cases of chronic tuberculous empyema form January 2013 to May 2016, 50 cases applied single hole thoracoscopy surgery, video-assisted mini-thoracoscopy for another 2 cases. Results There was no death, operation time 60 ~ 240 min, average 160 min, bleeding 150 ~ 2000 ml, average 350 ml, postoperative chest tube drainage time 3 ~ 21 d, average 7 d, postoperative persistent leakage in 3 patients, 3 cases of atelectasis, incisional infection in 1 case, pleural effusion in 1 case, 3 cases of arrhythmia. All the cured patients are received the corresponding treatment, the follow-up of 3 ~ 36 m, the chest CT scan show no atelectasis. Conclusion Under the condition of strict selection of indication, single hole thoracoscopy of pleural fibreboard endarterectomy in treatment of chronic tuberculous empyema is safe and feasible, so it is worthy of making further clinical promotion and application.
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Objective: To analyze the effect of single-hole thoracoscopic surgical treatment on elderly spontaneous pneumothorax patients’ postoperative assessment and serological markers and explore single-hole thoracoscopic surgery application. Methods:78 cases of elderly patients with spontaneous pneumothorax were retrospectively analyzed, and divided into single-hole thoracoscopy group with 35 patients and conventional thoracoscopic group with 43 patients. Then the surgery indicators, postoperative pain scores and perioperative serum target level differences were compared between the two groups. Results: The operative time, postoperative drainage time and total hospital stays of single-hole thoracoscopic surgery patients were shorter than that of conventional thoracoscopic group. The differences were statistically significant (t=7.183, t=5.294, t=6.938;P<0.05). The blood loss and postoperative drainage were less. The differences were statistically significant (t=6.883, t=8.735; P<0.05). The postoperative pain scores within one week was less than conventional thoracoscopic group. The differences were also statistically significant (t=6.882, t=5.724, t=5.284;P<0.05). The serological indicators, CRP, IL-1, TNF-α,α1-AT levels of patients in the single-hole thoracoscopy group were lower than the conventional group (t=8.293, t=7.274, t=9.284, t=7.183;P<0.05). Conclusion:VATS and conventional hole thoracoscopic surgery can be used for treatment of spontaneous pneumothorax in elderly, but single-hole thoracoscopy has more advantages in reducing surgical trauma and postoperative pain and optimize systemic inflammation associated factors.
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Objective To compare the clinical effect of the umbilical single hole laparoscopic and traditional three holes laparoscopic surgery in ovarian cyst. Methods 90 patients with ovarian cyst surgery were selected, and ran-domly divided into observation group and control group with 45 patients in each group. The control group was given traditional three holes laparoscopic surgery, and the observation group received single hole laparoscopic surgery. Clinical effect, postoperative complications, ovarian function, aesthetic satisfaction were compared between the two groups. Results The differences of operative time, blood loss, postoperative exhaust time, postoperative hospital stay between the two groups has no statistical difference ( > 0.05), the postoperative pain in 24 h, 72 h in the observa-tion group were significantly lower than that in control group, with significant difference ( 0.05). The contents of FSH and LH in the two groups were significantly improved, and the content of E2 was significantly decreased af-ter postoperative 30 days, compared with the preoperative, and the difference were statistically significant ( 0.05), and there was no significant difference in the content of LH, FSH and E2 between the two groups ( > 0.05). The total satis-faction of the observation group was significantly higher than the control group, and the difference was statistically significant ( <0.05). Conclusion Single hole laparoscopic surgery is adapted to the treatment of patients with ovari-an cyst on the basis of the same effect. Not only reduced the pain, but also improved the patients' satisfaction degree of the incision. It is worthy of clinical promotion.
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Objective To explore the feasibility and clinical value of transumbilical single port laparoscopic cholecystectomy . Methods In our hospital from 2010 October to 2013 August were selected with 120 patients were randomly divided into standard into two groups , 60 cases of transumbilical single port laparoscopic cholecystectomy ( Transumbilical Single Port Laparoscopic Cholecystec-tomy, TUSPLC) , 60 cases of the traditional four hole laparoscopic cholecystectomy ( Laparoscopic Cholecystectomy , LC) .Change rate were compared between the two groups , operation time , postoperative pain , postoperative intestinal function recovery time , postopera-tive drainage tube pulled out of time , postoperative hospitalization time , complications and wound condition index .Results The two groups in comparison , postoperative pain , postoperative drainage tube pulled out of time , postoperative hospitalization time of group TUSPLC and group LC were statistically different ( P 0.05 ) , TUSPLC group wound high sat-isfaction.During the follow-up of 1~3 months, no abdominal pain and other symptoms , TUSPLC group umbilical scar .Conclusions TUSPLC is safe and effective , more minimally invasive , beauty effect is good;the operation is relatively difficult , conditional hospi-tal can be carried out gradually and promotion .