The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.
The minimally invasive cardiovascular surgery developed rapidly in last decades. In order to promote the development of minimally invasive cardiovascular surgery in China, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) has gradually standardized the collection and report of the data of Chinese minimally invasive cardiovascular surgery since its establishment. The total operation volume of minimally invasive cardiovascular surgery in China has achieved substantial growth with a remarkable popularization of concepts of minimally invasive medicine in 2019. The data of Chinese minimally invasive cardiovascular surgery in 2019 was reported as a paper for the first time, which may provide reference to cardiovascular surgeons and related professionals.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
ObjectiveTo compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.MethodsA total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared.ResultsThere was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1% vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively.ConclusionCompared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.
Objective To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed. Results The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up. Conclusions Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.
Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. MethodsA retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). ResultsA total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). ConclusionCardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.
ObjectiveTo compare the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches in the treatment of single-segment lumbar spinal stenosis.MethodsBetween February 2015 and January 2017, 70 cases of single-segment lumbar spinal stenosis were treated with MIS-TLIF. The bilateral decompression via unilateral approach (group U) was performed in 36 cases and bilateral decompression via bilateral approaches (group B) in 34 cases. There was no significant difference in age, gender, body mass index, disease duration, distribution of responsibility segments, preoperative visual analogue scale (VAS) score of low back pain and leg pain and Oswestry disability index (ODI) score (P>0.05). The operation time, intraoperative blood loss, hospitalization stay after operation, complications related to operation, incidence of asymptomatic lateral root symptoms, VAS scores of low back pain and leg pain, and ODI score before and after operation were compared between the two groups. X-ray film and CT scan at 12 months after operation were used to assessted the intervertebral bony fusion.ResultsThe operation time and intraoperative blood loss in group U were significantly less than those in group B (P<0.05). There was no significant difference in hospitalization stay after operation between the two groups (t=–0.311, P=0.757). During the operation, 1 case in group U and 2 cases in group B had dural tear. No screw placement related nerve injury or asymptomatic lateral root symptoms occurred after operation. The patients were followed up 24 to 38 months, with an average of 32.8 months in group U and 35.5 months in group B. The VAS scores of low back pain and leg pain at 2 days, 3, 6, and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). The ODI scores at 3, 6 and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). Radiographic examination showed interbody fusion at 12 months after operation in the two groups.ConclusionMIS-TLIF is safe and effective in the treatment of single-segment lumbar spinal stenosis with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches. Bilateral decompression via unilateral approach takes less operation time and has less intraoperative blood loss.
Objective To explore the safety of minimally invasive esophagectomy (MIE) with three-field lymphadenectomy (3-FL) for esophageal squamous cell carcinoma (ESCC) by comparing the short-term outcomes between the 3-FL and the two-field lymphadenectomy (2-FL) in MIE. Methods The clinical data of patients with ESCC who underwent minimally invasive McKeown esophagectomy in our hospital from July 2015 to March 2022 were collected retrospectively. Patients were divided into a 3-FL group and a 2-FL group according to lymph node dissection method. And the clinical outcomes and postoperative complications were compared between the two groups. Results A total of 257 patients with ESCC were included in this study. There were 211 males and 46 females with an average age of 62.2±8.1 years. There were 109 patients in the 3-FL group and 148 patients in the 2-FL group. The operation time of the 3-FL group was about 20 minutes longer than that of the 2-FL group (P<0.001). There was no statistical difference between the two groups in the intraoperatve blood loss (P=0.376). More lymph nodes (P<0.001) and also more positive lymph nodes (P=0.003) were obtained in the 3-FL group than in the 2-FL group, and there was a statistical difference in the pathological N stage between the two groups (P<0.001). But there was no statistical difference in the incidence of anastomotic leak (P=0.667), chyle leak (P=0.421), recurrent laryngeal nerve injury (P=0.081), pulmonary complications (P=0.601), pneumonia (P=0.061), cardiac complications (P=0.383), overall complications (P=0.147) or Clavien-Dindo grading (P=0.152) between the two groups. Conclusion MIE 3-FL can improve the efficiency of lymph node dissection and the accuracy of tumor lymph node staging, but it does not increase the postoperative complications, which is worthy of clinical application.
ObjectiveTo summarize the related research results of minimally invasive treatment of anterior pelvic ring fracture, and to improve the understanding of minimally invasive treatment of anterior pelvic ring fracture.MethodsThe literature of minimally invasive treatment of anterior pelvic ring fracture at domestic and overseas in recent years was reviewed, and the reduction and fixation methods of minimally invasive treatment were summarized and analyzed.ResultsThe pelvic reduction frame may be an effective auxiliary method for minimally invasive reduction of pelvis. The fixation methods of anterior pelvic ring include percutaneous screw fixation, stent fixation, and percutaneous plate fixation.ConclusionOne kind of fixation is not applicable to all types of anterior pelvic ring fracture, and the fixation method should be selected according to the type of fracture and the patient’s condition to minimize the complications.
Vitrectomy is the preferred surgical method for diabetic retinopathy, especially in the stage of proliferative diabetic retinopathy. Vitrectomy for diabetic retinopathy involves all aspects of vitrectomy, which is one of the signs of maturity of retinal surgeons. With the application of minimally invasive vitrectomy and perioperative anti-neovascularization drugs, indications and timing of surgery, perioperative medication, management of vitreous, and whether combined with cataract surgery have changed greatly, and new understanding is needed. Evidence-based clinical research on the timing of diabetic retinopathy surgery and perioperative drug use should be carried out to provide a new theoretical basis for the surgical treatment of diabetic retinopathy.