Laparoscopic radical anterograde modular pancreatosplenectomy for pancreatic tail cancer / 中华普通外科杂志

Objective:To evaluate the safety and feasibility of laparoscopic radical anterograde modular pancreatosplenectomy (Lap-RAMPS).Methods:From Jan 2014 to Dec 2020, the clinical data of 83 patients who underwent laparoscopic radical resection for pancreatic tail cancer in LiHuili Hospital of Ningbo Medical Center were retrospectively analyzed.Results:Eighty-three cases were divided into Lap-RAMPS group (44 cases) and laparoscopic conventional distal pancreatectomy and splenectomy(Lap-CDP) group (39 cases). There were no significant differences in the duration of surgery [(245.34±70.30) min vs. (239.87±68.10) min], intraoperative blood lose [(159.32±115.60) ml vs. (208.97±161.70) ml] and intraoperative transfusions (2 cases vs. 3 cases) between the two groups ( P>0.05). There were no statistical significance in both groups in postoperative pancreatic fistula, postoperative bleeding grade, postoperative gastric emptying delay, Clavien-Dindo complication and postoperative hospital stay ( P>0.05). There were statistically significant differences in the negative margin rate (93.2% vs. 76.9%),lymph node harvest(12.91±8.24 vs. 8.49±6.85) and median survival time (25.0 months vs. 15.0 months) between the two groups ( P<0.05). Conclusion:Lap-RAMPS for pancreatic tail cancer is safe and feasible, increasing the negative rate of pancreatic margins, improving the lymph node harvest, and prolonging patients' survival time.

A comparative study on two different techniques in laparoscopic left hemihepatectomy / 中华肝胆外科杂志

Objective@#To compare the safety and efficacy of the retrograde and the antegrade techniques in laparoscopic left hemihepatectomy.@*Methods@#Of the 65 patients who underwent laparoscopic left hemihepatectomy between January 2016 to June 2018 at the Ningbo Li Huili Hospital of Medical Center, retrograde left hemihepatectomy was carried out in 31 patients, and antegrade left hemihepatectomy in 34 patients. The perioperative data, duration of operation, intraoperative blood loss, postoperative complications (including major bleeding, abdominal abscess and bile leakage), and post-operative hospital stay were retrospectively compared between the two groups.@*Results@#There were no significant differences in the perioperative general status between the two groups (P>0.05). Both the duration of operation [(121.5±22.1) min vs. (190.9±48.9) min, P<0.05] and the amount of blood loss [(118.9±84.1) ml vs. (195.2±85.4) ml, P<0.05] were significantly less in the retrograde than the antegrade group. There were no statistical differences in the incidences of major complications such as post-hepatectomy hemorrhage, abdominal abscess, or bile leakage, and in the postoperative hospital stay [(10.0±2.8) d vs. (12.2±3.4) d, P>0.05].@*Conclusions@#Occlusion of hepatic vascular inflow and outflow combined with retrograde left hemihepatectomy was safe and feasibly. The retrograde approach was superior to the antegrade approach in laparoscopic left hemihepatectomy.

Laparoscopic anatomical liver resection for 103 patients with hepatolithiasis / 中华肝胆外科杂志

Objective To study the feasibility and results of laparoscopic anatomical liver resection for hepatolithiasis.Methods A retrospective study was conducted based on the clinical data of 103 patients who underwent laparoscopic anatomical liver resection from June 2007 to July 2013.Results Total laparoscopic anatomical liver resection was successfully carried out in 97 patients.The mean operation time was 225.5 minutes,the blood loss was 50 ～ 1 000 ml and the mean postoperative hospital stay was 11.4 days.Postoperative complications included bile leakage (n =18),abdominal cavity infection (n =3),pulmonary infection (n =4),wound seroma (n =3),right hepatic duct injury (n =1).There was no perioperative death.Conclusion Laparoscopic anatomical liver resection for hepatolithiasis is a feasible,practical,and minimally invasive procedure.

Application of Layered Suture Technique in Laparoscopic Common Bile Duct Exploration with Primary Suture / 中国微创外科杂志

Objective To explore the application value of layered suture technique in laparoscopic common bile duct exploration with primary suture. Methods A total of 216 patients received laparoscopic common bile duct exploration with primary suture in our hospital from March 2007 to March 2013.Of these cases, layered suture technique was utilized in 89 patients and single-layer suture was used in 127 patients.The operation time, postoperative hospital stay, and postoperative complications were compared between the two groups. Results Two groups of patients were operated smoothly, with no conversions to laparotomy.Postoperative recovery was smooth.The operative time was not significantly different between the two groups of patients (t=-0.931, P=0.353). The postoperative hospital stay and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(5.9 ±1.7) d vs.(7.7 ±1.8) d,t =7.400, P=0.000;3.4%(3/89) vs.20.5%(26/127), χ2 =13.167, P=0.000].In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [45.4%(10/22) vs.15.2%(16/105),χ2 =8.429, P=0.004], whereas in the layered suture group, the incidence of postoperative bile leakage was insignificantly different among patients with and without acute cholangitis [7.1%(1/14) vs.2.7%(2/75),χ2 =0.002, P=0.964]. Conclusion Application of layered suture technique in laparoscopic common bile duct exploration with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

Total laparoscopic right hemi-hepatectomy for hepatolithiasis: report of 3 cases / 中华肝胆外科杂志

Objective To evaluate the safety and feasibility of laparoscopic right hemi-hepatectomy for hepatolithiasis.Methods The clinical data of 3 patients who underwent laparoscopic right hemi-hepatectomy were analyzed retrospectively.Results In 2 patients the operation was performed successfully.The operative time was 340 min and 300 min,and the intraoperative blood loss was 800 ml and 400 ml.There was no need for blood transfusion.There was a small amount of bile leakage (30-60 ml/day) in these 2 patients.The postoperative hospital stay was 9 d and 11 d.The third patient was converted to open surgery because of profuse bleeding.All the 3 patients recovered well from surgery.Conclusions Total laparoscopic right hemi-hepatectomy for hepatolithiasis was safe and feasible.