Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is ch...Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.展开更多
Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to Jul...Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to July 2007,76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies,including adnexal cyst,uterine myoma and ectopic pregnancy,were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group,the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However,the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group,except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection,the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe,effective method to treat benign gynecological diseases. Moreover,it was easy to master. As a minimally invasive treatment,gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients’ and the government’s burden significantly.展开更多
Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM wi...Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.展开更多
Transvaginal natural orifice transluminal endoscopic surgery(vNOTES),as a minimally invasive surgery technique,applies CO_(2) for creating pneumoperitoneum,and uses a closed system to through smoke evacuation from a d...Transvaginal natural orifice transluminal endoscopic surgery(vNOTES),as a minimally invasive surgery technique,applies CO_(2) for creating pneumoperitoneum,and uses a closed system to through smoke evacuation from a dedicated outlet or port.It has the potential to generate aerosol in the operation room,which can lead to an increased risk of transmission of SARS-CoV-2.This technical note introduces a new technique of gasless pure vNOTES to hysterectomy using silicone face mask as a modified vNOTES port.展开更多
Objective To evaluate gasless laparoscopy in treating gynecological conditions.Methods With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operativ...Objective To evaluate gasless laparoscopy in treating gynecological conditions.Methods With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operative field and pelvic organs with routine operative instruments under epidural anesthesia. When a dense pelvic adhesion was confronted, we used the temporarily low-pressured pneumolaparoscopy to dissect it.Results All procedures were carried out without organ injury, hematorna, or other complications. The operative field can be clearly seen with this method. The mean time for appendagectorny was one hour and for laparoscopic assisted vaginal hysterectomy 80 minutes.Conclusion Gasless laparoscopy avoids the complications which occur in the routine laparoscopy such as subcutaneous or mediastinal pneurnatoma, hypercarbonernia, air embolism, cardiopulmonary dysfunction.Our lifting method is simple, convenient, time and money saving, as well as more flexible for treating gynecological conditions.展开更多
Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcome...Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.展开更多
Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under end...Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.Methods A total of 68 patients （64 women and 4 men） underwent the surgery. Their ages ranged from 18 to 65 years,with a mean age of （34±3） years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.Results All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation.The patients were satisfied with the cosmetic results of the surgery.Conclusion The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.展开更多
目的:明确免充气腔镜下经腋窝入路单侧甲状腺全切术治疗单侧甲状腺良性肿瘤的应用价值。方法:选取92例单侧甲状腺良性肿瘤患者为研究对象,患者采用随机方法分为对照组和观察组,各46例;对照组予以传统颈前入路单侧甲状腺切除术,观察组予...目的:明确免充气腔镜下经腋窝入路单侧甲状腺全切术治疗单侧甲状腺良性肿瘤的应用价值。方法:选取92例单侧甲状腺良性肿瘤患者为研究对象,患者采用随机方法分为对照组和观察组,各46例;对照组予以传统颈前入路单侧甲状腺切除术,观察组予以免充气腔镜下经腋窝入路单侧甲状腺全切术;以患者围术期指标,术后疼痛情况、美容满意度及并发症情况为评价指标,比较两组治疗效果。结果:与对照组比较,观察组患者围术期的术中出血量和术后总引流量少,手术时间和住院时间短;术后1、3、7 d VAS评分低,美容满意度高,术后并发症发生率低;各评价指标组间差异显著(P<0.05)。结论:对单侧甲状腺良性肿瘤患者采用免充气腔镜下经腋窝入路单侧甲状腺全切术效果显著。展开更多
基金supported by a grant from the Beijing Municipal Science&Technology Commission(No.Z141107002514121)
文摘Giant hiatal hernia（GHH） comprises 5% of hiatal hernia and is associated with significant complications.The traditional operative procedure,no matter transthoracic or transabdomen repair of giant hiatal hernia,is characteristic of more invasion and more complications.Although laparoscopic repair as a minimally invasive surgery is accepted,a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation.The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia.We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution.The GHH was defined as greater than one-third of the stomach in the chest.Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients.Mean age was 67 years.The results showed that there were no conversions to open surgery and no intraoperative deaths.The mean duration of operation was 100 min（range：90–130 min）.One-side pleura was injured in 4 cases（14.8%）.The mean postoperative length of stay was 4 days（range：3–7 days）.Median follow-up was 26 months（range：6–38 months）.Transient dysphagia for solid food occurred in three patients（11.1%）,and this symptom disappeared within three months.There was one patient with recurrent hiatal hernia who was reoperated on.Two patients still complained of heartburn three months after surgery.Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient.Totally,satisfactory outcome was reported in 88.9% patients.It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible,safe,and effective for the patients who cannot tolerate the pneumoperitoneum.
文摘Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to July 2007,76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies,including adnexal cyst,uterine myoma and ectopic pregnancy,were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group,the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However,the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group,except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection,the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe,effective method to treat benign gynecological diseases. Moreover,it was easy to master. As a minimally invasive treatment,gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients’ and the government’s burden significantly.
文摘Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.
文摘Transvaginal natural orifice transluminal endoscopic surgery(vNOTES),as a minimally invasive surgery technique,applies CO_(2) for creating pneumoperitoneum,and uses a closed system to through smoke evacuation from a dedicated outlet or port.It has the potential to generate aerosol in the operation room,which can lead to an increased risk of transmission of SARS-CoV-2.This technical note introduces a new technique of gasless pure vNOTES to hysterectomy using silicone face mask as a modified vNOTES port.
文摘Objective To evaluate gasless laparoscopy in treating gynecological conditions.Methods With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operative field and pelvic organs with routine operative instruments under epidural anesthesia. When a dense pelvic adhesion was confronted, we used the temporarily low-pressured pneumolaparoscopy to dissect it.Results All procedures were carried out without organ injury, hematorna, or other complications. The operative field can be clearly seen with this method. The mean time for appendagectorny was one hour and for laparoscopic assisted vaginal hysterectomy 80 minutes.Conclusion Gasless laparoscopy avoids the complications which occur in the routine laparoscopy such as subcutaneous or mediastinal pneurnatoma, hypercarbonernia, air embolism, cardiopulmonary dysfunction.Our lifting method is simple, convenient, time and money saving, as well as more flexible for treating gynecological conditions.
文摘Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.
文摘Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.Methods A total of 68 patients （64 women and 4 men） underwent the surgery. Their ages ranged from 18 to 65 years,with a mean age of （34±3） years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.Results All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation.The patients were satisfied with the cosmetic results of the surgery.Conclusion The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.
文摘目的:明确免充气腔镜下经腋窝入路单侧甲状腺全切术治疗单侧甲状腺良性肿瘤的应用价值。方法:选取92例单侧甲状腺良性肿瘤患者为研究对象,患者采用随机方法分为对照组和观察组,各46例;对照组予以传统颈前入路单侧甲状腺切除术,观察组予以免充气腔镜下经腋窝入路单侧甲状腺全切术;以患者围术期指标,术后疼痛情况、美容满意度及并发症情况为评价指标,比较两组治疗效果。结果:与对照组比较,观察组患者围术期的术中出血量和术后总引流量少,手术时间和住院时间短;术后1、3、7 d VAS评分低,美容满意度高,术后并发症发生率低;各评价指标组间差异显著(P<0.05)。结论:对单侧甲状腺良性肿瘤患者采用免充气腔镜下经腋窝入路单侧甲状腺全切术效果显著。
