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Objective:To investigate the application value of single-port laparoscopic left lateral donor liver acquisition in pediatric living donor liver transplantation (PLDLT).Methods:The retrospective and descriptive study was conducted. The clinical data of the donor and recipient who were admitted to Beijing Friendship Hospital of Capital Medical University for PLDLT in January 2020 were collected. The donor was a male, aged 28 years with body mass as 62 kg, height as 174 cm and body mass index (BMI) as 20.5 kg/m 2. The recipient was the daughter of the donor, aged 1 year with body mass as 9 kg, height as 75 cm and BMI as 16.0 kg/m 2. The donor underwent single-port laparoscopic left lateral donor liver acquisition. The recipient underwent living donor liver trans-plantation by the same operation team. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Results:(1) Intraoperative conditions. The donor under-went single-port laparoscopic left lateral donor liver acquisition successfully, with the single-port access system being placed through a transumbilical incision. The operation time, the warm ischemia time of the donor liver and volume of intraoperative blood loss were 240 minutes, 3 minutes and 40 mL, respectively, of the donor. The weight of the donor liver was 233.6 g, and the corrected graft-to-recipient body weight ratio was 2.60%. The recipient underwent living donor liver transplantation successfully. (2) Postoperative conditions. The donor began to take liquid diet at postoperative day 1, and results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyltransferase (GGT) and total bilirubin (TBil) of the donor was 239 U/L, 116 U/L, 53 U/L and 22.57 μmol/L. The donor began to take diet with high quality proteins at postoperative day 2, and to get for out-of-bed activities moderately. The donor′s peritoneal drainage fluid was light red at postoperative day 3, and no fluid accumulation was found in the operation area after abdominal B-ultrasound examination, so the peritoneal drainage tube was removed. The donor was discharged at postoperative day 4. The liver function of the recipient recovered to normal level 2 weeks after the operation. (3) Follow-up. The donor was followed up by outpatient examination 2 weeks after discharged, and results of laboratory examination showed that the ALT, AST, GGT and TBil was 44 U/L, 25 U/L, 53 U/L and 9.22 μmol/L, respectively. Neither the donor nor the recipient had complication ≥Ⅱ grade of the Clavien-Dino classification, such as biliary fistula and vascular complication during the 6 months after operation.Conclusion:Single-port laparoscopic left lateral donor liver acquisition can be used into the PLDLT.
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Objective To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery.Methods The retrospective crosssectional study was conducted.The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected.Patients underwent single-port laparoscopic left upper abdominal surgery,and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver.Observation indicators:(1)intraoperative situations:surgical completion,surgical procedures,time of liver adhesive suspension,total operation time and intraoperative liver adhesive suspension-related complications;(2) postoperative situations:pre-and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels,hospital expenses and duration of hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,complications during follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017.Measurement data with normal distribution were represented as (x)+s.Repeated measurement data were analyzed using the repeated measures ANOVA.Results (1) Intraoperative situations:112 patients underwent successfully single-port laparoscopic left upper abdominal surgery,without conversion to multi-port surgery or open surgery.Of 112 patients,30,23,13,11,11,10,3,3,3,3,1 and 1 underwent radical resection of gastric cancer,partial gastrectomy,esophageal Heller myotomy + Dor fundoplication,subtotal gastrectomy,resection of body and tail of pancreas,paraoesophageal hiatal hernia repair + fundoplication,total gastrectomy,splenectomy,splenectomy + devascularization,pancreatic tail resection,simple fundoplication and splenic artery aneurysm resection,respectively.Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes.There was no hepatic laceration,hepatic subcapsular hematoma and other complications.(2) Postoperative situations:of 112 patients,preoperative ALT and AST levels of 6 patients were mildly elevated,postoperative ALT and AST levels in 2 of 6 patients returned to normal,that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively,and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively;preoperative ALT and AST levels of 106 patients were normal,ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively,and that in 3 patients remained mildly elevated),and that in 75 of 106 patients returned to normal.ALT and AST levels of 112 patients were (16± 11) U/L,(18±7) U/L before operation and (31 ±21) U/L,(34±26) U/L at day 1 postoperatively and (19 ± 17) U/L,(19 ± 12) U/L at week 1 postoperatively,respectively,with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353,29.792,P＜ 0.05),and no statistically significant difference in ALT and AST levels before operation and at week 1 postoperatively (F=2.905,1.284,P＞0.05).Hospital expenses,surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan,(23 511±9 609)yuan and (6.0±l.9)days,respectively.(3) Follow-up:112 patients were followed up for 1.0-3.0 months,with a median time of 1.6 months.During the follow-up,there were no obvious complications.Conclusion Adhesive suspension of left lateral lobe of liver is simple and safe,with satisfactory exposure effects,and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery.
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Objective To investigate application value of cutter stapler in transumbilical single port laparoscopic left lateral lobectomy.Methods The retrospective cohort study was adopted.The clinical data of 26 patients who underwent transumbilical single port laparoscopic left lateral lobectomy at the Shengjing Hospital of China Medical University from January 2010 to February 2016 were collected.Nine patients who received liver parenchyma using ultrasonic knife were allocated into the ultrasonic knife group,17 patients who received liver parenchyma using cutter stapler were allocated into the cutter stapler group.Observation indicators included (1) operation situations:operation time,volume of intraoperative blood loss,postoperative complications,time of postoperative bowel function recovery,time of abdominal cavity drainage tube removal,duration of postoperative hospital stay.(2) Postoperative reexamination and follow-up:ultrasound or computed tomography (CT) examination was performed when necessary for detecting local exudation or encapsulated effusion.The patients were followed up at postoperative 1 to 3 months with telephone interview for whether with abdominal distension or abdominal pain till March 2016.Measurement data with normal distribution were presented as (x) ± s and analyzed by using t test.Measurement data with skewed distribution were presented as M (range) and analyzed by ranksum text.Comparison of count data was analyzed by the Fisher' s exact probility.Results (1) Operation situations:all the 26 patients received transumbilical single port laparoscopic left lateral lobectomy with no conversion to porous laparoscopic surgery or open surgery.The operation time was (114 ± 54) minutes,the volume of intraoperative blood loss was 100 mL (range,20-800 mL),and no intraoperative blood transfusion was adopted.The operation time and volume of intraoperative blood loss were (135 ±43)minutes and 200 mL (range,20-800 mL) in the ultrasonic knife group,(103 ±57)minutes and 100 mL (range,20-300 mL) in the cutter stapler group,respectively,showing no statistically significant difference between the 2 groups (t =1.500,Z =-0.961,P ＞ 0.05).All the 26 patients recovered well after surgery,with no postoperative complications as postoperative hemorrhage,bile leakage,incision infection or death.The time of postoperative bowel function recovery,time of abdominal cavity drainage tube removal and duration of postoperative hospital stay was (1.5 ±0.4) days,(5.8 ± 2.0) days and (7.0 2.0) days in the ultrasonic knife group,(1.1 ± 0.3) days,(4.1 ±1.1) days and (4.9 ± 1.4) days in the cutter stapler group,respectively,showing statistically significant differences between the 2 groups (t =2.599,2.875,3.036,P ＜ 0.05).(2) Postoperative reexamination and follow-up:of 26 patients,11 patients received ultrasound or CT examination after surgery and detected no obvious local exudation or encapsulated effusion,with no special treatment.The other 15 patients didn't receive ultrasound or CT examination.All the 26 patients were followed up for 1-3 months,with no occurrence of upper abdominal distension or abdominal pain.Conclusion Transumbilical single port laparoscopic left lateral lobectomy is safe and feasible,the application of cutter stapler is helpful to safety and success of the operation,further accelerating the postoperative recovery of patients.
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Objective To investigate the clinical value of transumbilical single-port laparoscopic colorectal operation.Methods The clinical data of 25 patients with benign or malignant carcinoma at the upper part of the colon or rectum who were admitted to the No.4 People's Hospital of Zigong from January 2010 to December 2012 were retrospectively analyzed,and the clinical experience of transumbilical single-port laparoscopic colorectal operation was summarized.Surgical procedure was selected according to the position and nature of the lesion.Patients were followed up via out-patient examination and phone call till March 2013.Results Partial colorectal resection was done on 14 patients,radical resection of right colon on 1 patient,radical resection of transverse colon on 1 patient,radical resection of left colon on 1 patient,radical resection of sigmoid colon on 2 patients and radical rectectomy on 6 patients.The operation was successfully carried out on 22 patients,2 patients received four-port laparoscopic colorectal operation,and 1 patient was converted to open surgery.The median length of the incision of single-port laparoscopic colorectal operation was 3.8 cm (range,3.5-4.5 cm),and the operation time was (192 ± 32) minutes.The intraoperative blood loss was (61 ± 21)mL,and the median diameter of the tumor was 2.7 cm (range,1.0-5.0 cm).The median number of lymph nodes dissected was 7 (range,3-22),the mean time of postoperative anal exhaust time was 2 days (range,1-5 days),and the mean time of postoperative hospital stay was 8 days (range,6-20 days).The incidence of postoperative complications was 8.0％ (2/25),including 1 patient with wound infection and 1 patient with anastomotic leakage.The circumferential resection margins of radically resected specimens were negative in 11 patients.Twenty-two patients who received transumbilical single-port laparoscopic colorectal resection were followed up,and the median time of follow-up was 12 months.Colorectal liver metastasis was detected on 1 patient at postoperative month 10,and the other patients survived without tumor recurrence or metastases.Conclusions Transumbilical singleport laparoscopic colorectal operation is safe,micro-traumatic and feasible,and it also has less complication and good cosmetic effect.