ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.
ObjectiveTo compare the clinical efficacy of cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis and conventional tubular stomach combined with neck end-to-end mechanical side-to-side anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. MethodsThe clinical data of consecutive patients treated by thoracoscopic and laparoscopic esophagectomy for esophageal cancer in the Department of Cardiothoracic Surgery of the First People's Hospital of Neijiang from January 1, 2018 to March 25, 2021 were analyzed. The patients were divided into a cone-shaped gastric tube manual group (treated with cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis) and a conventional tubular stomach mechanical group (treated with conventional tubular stomach+end-to-end mechanical side-to-side anastomosis). The anastomotic time, intraoperative blood loss, number of lymph node dissection, anastomotic fistula, anastomotic stenosis, anastomotic cost, sternogastric dilatation, gastroesophageal reflux symptoms, and postoperative complications were compared and analyzed between the two groups. ResultsA total of 161 patients were enrolled, including 112 males and 49 females aged 40-82 years. There were 80 patients in the cone-shaped gastric tube manual group, and 81 patients in the conventional tubular stomach mechanical group. There was no statistical difference in the intraoperative blood loss, number of lymph nodes dissected, hoarseness, pulmonary infection, arrhythmia, respiratory failure or chylothorax between the two groups (P>0.05). The anastomosis time of the cone-shaped gastric tube manual group was longer than that of the conventional tubular stomach mechanical group (28.35±3.20 min vs. 14.30±1.26 min, P<0.001), but the anastomotic cost and incidence of thoracogastric dilatation in the cone-shaped gastric tube manual group were significantly lower than those of the conventional tubular stomach mechanical group [948.48±70.55 yuan vs. 4 978.76±650.29 yuan, P<0.001; 3 (3.8%) vs. 14 (17.3%), P=0.005]. The incidences of anastomotic fistula and anastomotic stenosis in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group, but the differences were not statistically significant (P>0.05). The gastroesophageal reflux scores in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group at 1 month, 3 months, 6 months and 1 year after the operation (P<0.05). Logistic regression analysis showed that digestive tract reconstruction method was the influencing factor for postoperative thoracogastric dilation, which was reduced in the cone-shaped gastric tube manual group. ConclusionCone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis can significantly reduce the incidence of thoracogastric dilatation after thoracoscopic and laparoscopic esophagectomy for esophageal cancer and save hospitalization costs, with mild gastroesophageal reflux symptoms, and it still has certain advantages in reducing postoperative anastomotic fistula and anastomotic stenosis, which is worthy of clinical promotion.
摘要:目的:探討腹腔鏡膽囊大部分切除在復雜膽囊結石手術中應用的可行性及安全性。方法:回顧性分析2003年1月至2008年10月間41例行腹腔鏡膽囊部分切除術的復雜膽囊結石病人。行腹腔鏡膽囊切除術指征為:膽囊管不能明確辨認時,諸如:膽囊積膿、Mirris綜合征、Calot三角致密粘連呈“冰凍樣”、萎縮性膽囊等。手術方法為:切除膽囊前壁,取凈結石,腹腔置管引流。結果:41例復雜膽囊結石病人中1例中轉開腹手術外,其余全部在腹腔鏡下完成,手術時間為45～145分鐘,平均(57.42±19.41)分鐘,1例術后出現膽漏,其余術后住院時間為2～7天。 結論:在膽囊三角不能安全辨認前提下,對于復雜膽囊結石行腹腔鏡膽囊部分切除術是一種安全的手術方式,不但能簡化手術、降低手術風險,而且能避免行開腹手術治療。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.
Objective To investigate the feasibility of elective laparoscopic hepatectomy in the treatment of ruptured hepatocellular carcinoma. Methods We tried to perform an elective laparoscopic hepatectomy for a middle-aged man who had a ruptured hepatocellular carcinoma without active hemorrhage. The data of this patient was summarized. Results The patient received the elective laparoscopic hepatectomy, and the liver lesions were completely removed. The operation was successful. Operative time was 300 min and intraoperative bleeding was 500 mL. Postoperative recovery of this patient was good and no complication occurred. The abdominal drainage tube was removed on 4 days after operation, and he discharged on 8 days after operation. The pathology confirmed that the hepatocellular carcinoma was moderately differentiated and ruptured. Conclusion Elective laparoscopic hepatectomy is safe and feasible in the treatment of ruptured hepatocellular carcinoma for specific patient, but this operation needs to be performed by experienced surgeons with laparoscopic skills.
ObjectiveTo compare the postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) and single-anastomosis sleeve ileal bypass (SASI), and to explore the risk factors for PONV. MethodA total of 220 patients at the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2022 were prospectively collected, and were randomly divided into the LSG group and the SASI group; the general condition of the patients was recorded. PONV was assessed on the POD0, POD1, POD2, POD30, POD60, POD90, using the Rhodes index score.ResultsThe total Rhodes index score in the LSG group was higher than that in the SASI group [(25.56±13.54) vs. (16.06±11.28), P＜0.05]. The results of multiple linear regression analysis showed that female (P=0.014), LSG (P＜0.001), young age (P=0.050), and low BMI (P=0.019) were risk factors for PONV. ConclusionsCompared with LSG, the Rhodes index score after SASI is low. For young women with low BMI, special attention should be paid to the prevention and treatment of PONV after LSG.
ObjectiveTo summarize the diagnosis and treatment of a primary gastric colon cancer, and to explore its safety and feasibility.MethodThe clinical data of a patient with gastric cancer and sigmoid colon cancer who admitted to The Affiliated Yantai Yuding Hospital of Qingdao University in October 2017 was analyzed.ResultsThe patient underwent laparoscopic radical gastrectomy plus π anastomosis and laparoscopic radical resection of colon cancer. The operation time was 330 min and the intraoperative blood loss was 120 mL. There were no complications such as stomach cramps and sputum after operation and he was successfully discharged on the 9th day after surgery. Postoperative pathological staging: gastric cancer (pT3N3M0, ⅢB) and sigmoid colon cancer (pT2N0M0, Ⅰ B).ConclusionsMultiple primary cancer of the simultaneous gastric colon should be diagnosed before operation. Laparoscopic minimally invasive treatment for gastric cancer with sigmoid colon cancer is safe and feasible, and can benefit patients.
ObjectiveTo investigate the effectiveness of axillary single-site laparoscopic subcutaneous mastectomy in treatment of gynecomastia (GYN) and the assessment method of glandular mass before operation. Methods A clinical data of 65 GYN patients admitted between August 2023 and February 2024 and matched the selection criteria was retrospectively analyzed. The patients were (30.8±7.9) years old, with a body mass index (BMI) of 27.3 (24.9, 29.8) kg/m2. According to Simon’s grading criteria, the GYN was classified as gade Ⅰ in 8 cases, grade Ⅱa in 32 cases, grade Ⅱb in 21 cases, and grade Ⅲ in 4 cases. All patients underwent bilateral axillary single-site laparoscopic subcutaneous mastectomy. The operation time, intraoperative blood loss, postoperative bilateral extubation time, total length of hospital stay, and the occurrence of related complications were recorded. The cosmetic outcome score was assessed by questionnaire at 2 months after operation. Preoperative BMI, lying/standing sternal notch to nipple (SN-N), and lying/standing nipple to nipple (N-N) were measured. The differences in SN-N between standing and lying positions (ΔSN-N) and in N-N between lying and standing positions (ΔN-N) were calculated. The intraoperative resected glandular mass was recorded. The glandular mass-related indicators (BMI, ΔSN-N, ΔN-N) were compared between Simon grades. Spearman’s correlation analysis and multiple linear regression analysis of glandular mass with BMI and ΔSN-N, ΔN-N and Simon grading (grades Ⅰ, Ⅱa, Ⅱb, and Ⅲ were assigned values of 1, 2, 3, and 4, respectively) of the corresponding side. ResultsAll operations were successfully completed with the operation time of 75.0 (60.0, 90.0) minutes, the intraoperative blood loss of 12.0 (11.0, 13.0) mL, and the bilateral extubation time of 1.5 (1.5, 1.5) days after operation. The total length of hospital stay was 3.0 (3.0, 3.0) days. Three cases of subcutaneous hematoma in the chest wall and 1 case of nipple areola numbness and discomfort occurred after operation, while the rest of the patients had no complication, such as postoperative haemorrhage, effusion, infection, and nipple areola necrosis. The subjective cosmetic scores were all 15 at 2 months after operation, which was very satisfactory. The differences in ΔSN-N of right side between Simon grade Ⅰ and grades Ⅱa, Ⅱb, Ⅲ and in ΔSN-N of left side between Simon grade Ⅰ and grades Ⅱb, Ⅲ were significant (P<0.05), while the differences between the remaining grades were not significant (P>0.05). The differences in ΔN-N between Simon grade Ⅱa and gradeⅡb and in BMI between Simon grade Ⅱb and grade Ⅲ were not significant (P>0.05), while the differences between the remaining grades were significant (P<0.05). The glandular masses of left and right breasts in 65 patients were 69.0 (52.1, 104.0) g and 73.0 (56.0, 94.0) g, respectively; and the difference between left and right breasts was not significant (Z=?0.622, P=0.534). The data of the right breast was selected for correlation analysis. Correlation analysis showed that the right glandular mass was positive correlated with BMI and Simon grading, ΔSN-N, and ΔN-N (P<0.05). Multiple linear regression analysis showed that Simon grading had a positive predictive effect on glandular mass, and the regression equation was as follows: right glandular mass=5.541+32.115×Simon grading (R2=0.354, P<0.001). ConclusionAxillary single-site laparoscopic subcutaneous mastectomy is an ideal surgical procedure for the treatment of GYN. BMI and Simon grading are closely related to GYN glandular mass, and have certain reference value for preoperative glandular mass assessment.
ObjectiveTo compare clinical outcomes between laparoscopic (LAP) and open surgery for non-metastatic colon cancer of T4a stage.MethodsWe retrospectively analyzed clinical data of non-metastatic colon cancer patients of T4a stage with confirmed pathological results who underwent curative resection in Peking Union Medical College Hospital between January 2011 and December 2017. These patients were allocated into LAP group (n=107, underwent laparoscopic radical operation) and open group (n=52, underwent open surgery).ResultsThere were no significant difference in operating time, number of lymph nodes harvested, number of positive lymph nodes, incidence of complications within 30 days, and Clavien-Dindo grading between the LAP group and open group (P>0.05), but intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay in the LAP group were less than (shorter than) those of the open group (P<0.05).ConclusionLaparoscopic approach for non-metastatic colon cancer of T4a stage is safe and feasible, and it has advantages including less intraoperative blood loss, faster recovery, and shorter hospital stay.
ObjectiveTo evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. MethodsA retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). ResultsAll 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. ConclusionsLDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.
In current domestic research on laparoscopic training, researchers usually consider instrument movement path in the hand-eye coordination relationship. However, they ignore the information contained in visual cues by which could guide and control instrument movements. Studies in other areas have shown that trainers can improve their perceptual-motor skills by gaze training. This paper was designed to examine the effectiveness of eye gaze tracking technology in laparoscopic training and to analyze gaze strategy of the subjects in different training methods. The Tobii X1 Light Eye Tracker was used to track the gaze position of subjects when they were performing the two-handed transferring task in box trainer, and to obtain parameters related to gaze strategy including the efficiency of task completion, as well as visual search, visual processing and observation transfer analysis based on Markov chain model. The results showed that the completion time during the last training in gaze training group was decreased by 101.5 s comparing to the first training. Compared with video training group, gaze strategy of gaze training group has a significant change, such as fixation and saccade duration rate was increased by 38%, fixation duration on target area was increased, and saccade amplitude increased by 0.58°, and the probability of the fixation point transferring to equipment decreased by 15%. The results demonstrated that eye gaze tracking technology can be used in laparoscopic training, and can improve the subjects’ skills and shorten the learning curve by learning gaze strategies of experts.