Clinical efficacy of single-incision and conventional three-port laparoscopic appendectomy: a Meta analysis / 中华消化外科杂志

Objective To compare the efficacy and safety of single-incision and conventional three-port laparoscopic appendectomy.Methods According to the Cochrane systematic review methods,literatures on the comparison of the effects of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA) were searched for in the PubMed,EMBASE,the Cochrane Controlled Trials Register,CNKI,CBM and VIP database.Data including the operation time,pain visual analogue scales scores,duration of postoperative hospital stay,incidence of postoperative complications,mean time of hospital stay and cost between the SILA and CTLA were compared by 2 reviewers.RevMan 4.2 software was used for Meta analysis,and the heterogeneity of the study was analyzed using the 12 test.Categorical variables were presented by odds ratio and 95％ confidence interval (95％ CI),and continuous variables were presented by weighted mean difference (WMD) and 95％C1.Results Eight randomized controlled trials including 1 444 patients were selected.All the patients were subdivided into the adults group (760 patients) and the children group (684 patients).A total of 721 patients received SILA (SILA group) and 723 received CTLA (CTLA group).The operation time of patients who received SILA in the adults group and the children group were significantly longer than those who received CTLA (WMD =4.40,7.39,95％ CI:2.14-6.66,2.16-12.61,P ＜0.05).There were no significant difference in the pain visual analogue scales scores,incidence of postoperative complications and duration of hospital stay between patients who received SILA and CTLA in the adults group and the children group (WMD =-0.34,95 ％ CI:-1.02-0.33,OR=0.97,95％CI:0.64-1.47; WMD=-0.19,95％CI:-1.14-0.76,P＞0.05).The cost of patients who received SILA was significantly higher than those who received CTLA in the children group (WMD =0.87,95 ％ CI:0.26-1.48,P ＜ 0.05).Conclusions There is no obvious advantages of SILA in perioperative and postoperative outcomes when compared with CTLA.Therefore,SILA is only a possible alternative to CTLA other than the preferred method.

Gasless single-incision laparoscopic cholecystectomy / 中华消化外科杂志

Laparo-endoscopic single site (LESS) surgery is in line with the development trend of minimally invasive surgery.Resolving the problems caused by the tiny single trocar is very important for the popularizing of LESS surgery.From February to September in 2012,34 patients with cholecystolithiasis or polypoid lesions of the gallbladder received gasless singleincision laparoscopic cholecystectomy at the Xuanwu Hospital.All the operations were successfully done,with no conversion to conventional laparoscopic surgery or open surgery.The mean operation time,intraoperative blood loss and duration of postoperative hospital stay were 70 minutes (range,45-135 minutes),18 ml (range,5-40 ml) and 3.4 days (range,3-4 days).There was no complication within the follow-up of 3 weeks,and all patients recovered well with satisfied cosmetic effect.Combination of gasless single-incision laparoscopic techniques could decrease the difficulty of LESS surgery and help to popularize LESS surgery.

Prospect of laparoscopic surgery for gastric cancer / 中华消化外科杂志

Laparoscopic surgery has been adopted for the treatment of gastric cancer in recent years around the world.New advances in these techniques have been achieved. This paper provides an overview of the clinical outcome of laparoscopic surgery for early gastric cancer and advanced gastric cancer,the application of laparoscopy-assisted pylorus-preserving gastrectomy,the technical characteristics of laparoscopy-assisted total gastrectomy,the values of single-incision laparoscopically assisted surgery and the application status and prospect of robotassisted laparoscopic gastrectomy for gastric cancer.

Application of single-incision laparoscopic surgery in digestive surgery / 中华消化外科杂志

With advances in surgical techniques,laparoseopic surgical instruments and constant equipment innovation,minimally invasive surgery has become the main stream of this century.Wide range of applications of endoscopy and laparoscopy as the representative of the revolutionary changes in diagnosis and treatment of digestive diseases since the second half of last century is the main symbol.Patients obtained benefits from the minimally invasive technique to reduce the trauma and pain,shorten the course of treatment,and gain rapid recovery.Singleincision laparoscopic surgery (SILS) is proposed in recent years.It differs from conventional multiports laparoscopic surgery,with only a small 2-3 cm incision at the body's natural scar-umbilicus as the approach to assist laparoscope and surgical instruments into the abdomen cavity.In this paper,the surgical experiences of SILS based on 800 cases and understanding of the SILS at home and abroad were presented to talk about the application of SILS technique in digestive surgery.