Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their m...Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.展开更多
Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and fro...Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.展开更多
AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic p...AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic patients(39 females and 11 males)with SMILE were enrolled in this prospective study.The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis,dynamic stereopsis,foveal suppression,and binocular balance point of signal to noise ratio(s/n ratio).All subjects received measurements in 1d before operation,and 1d,1wk,and 1mo postoperatively.RESULTS:Both static and dynamic stereopsis showed no significant difference after SMILE.The foveal suppression improved significantly 1wk and 1mo after SMILE(P=0.005 and P=0.007 respectively).The binocular balance point of signal to noise ratio showed a significant improvement 1d,1wk and 1mo after SMILE for both eyes(P<0.001 for each eye respectively).CONCLUSION:Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively,and SMILE can improve both foveal suppression and binocular imbalance in these patients.展开更多
1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct...1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients ...AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients who underwent SMILE were included in this retrospective,nonrandomized,comparative study.All the eyes which were with the rule astigmatism were divided into high astigmatism group(HAG;astigmatism≤-2.00 D,73 eyes)and low astigmatism group(LAG;astigmatism≥-1.00 D,84 eyes).Visual and refractive examinations were performed,HOAs of the anterior surface,posterior surface,and total cornea of the eyes were evaluated preoperatively and 6mo postoperatively.RESULTS:At the postoperative 6-month follow-up,uncorrected distance visual acuity of 20/20 or better was achieved in 97%and 100%eyes in HAG and LAG respectively and 74%and 100%eyes were within-0.50 D.Vector analysis revealed no significant differences in the correction index(P=0.066),angle of error(P=0.091)or flattening index(P=0.987)between two groups.The magnitude of error was-0.37±0.31 D in HAG and-0.04±0.19 D in LAG(P<0.001).Index of success(IOS)was 0.22±0.09 in the HAG and 0.50±0.46 in the LAG(P<0.001).HOAs of most anterior,posterior and total cornea significantly increased after SMILE,especially the spherical aberration and coma.For HAG,the SMILE procedure induced significantly higher anterior,posterior and total cornea horizontal coma and total corneal total HOAs compared with LAG(P<0.001)and these surgically induced HOAs predominantly originated from the anterior surface of the cornea.CONCLUSION:SMILE surgery induces more HOAs and a mild under-correction of astigmatism in eyes with high astigmatism.The increment in HOAs after SMILE is related to preoperative astigmatism.展开更多
AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective st...AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.展开更多
BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient como...BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.展开更多
AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospec...AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospective study was designed to evaluate 82 eyes from 82 patients,all of whom had a pre-planned RST of 280 to 300μm and normal corneal topography prior to undergoing SMILE surgery.The mean preoperative spherical equivalent(SE)was-4.82±1.30 D.A standard follow-up protocol was conducted between 1 to 6mo postoperatively.Visual outcomes were recorded using uncorrected visual acuity(UCVA)and subjective refraction.The curvature of the anterior and posterior corneal surfaces,as well as the posterior elevation at the thinnest point(PTE)were derived from the Pentacam system.RESULTS:At the final follow-up,the efficacy index was 1.14±0.15,the safety index was 1.20±0.13.The mean preoperative UDVA was 0.78±0.16 logMAR,which improved significantly to-0.07±0.06 logMAR postoperatively(P<0.001).The preoperative mean SE was-4.82±1.30 D,which decreased to-0.14±0.30 D by the last visit.The curvature of the anterior cornea at the flat meridian(AK1)were 42.62±1.02 D preoperatively,38.56±1.37 D and 38.59±1.39 D at 1 and 6mo after operation,respectively.Corresponding measurements at the steep meridian(AK2)were 43.55±1.14 D preoperatively,39.18±1.46 D and 39.22±1.50 D at 1 and 6mo after operation,respectively.Both AK1 and AK2 remained stable at 1 and 6-mo postoperative intervals(P=0.126 and 0.082,respectively).There were no observed changes in the curvature of the posterior cornea at the flat meridian or at the steep meridian,or the PTE before and after surgery.CONCLUSION:SMILE represents a safe and effective procedure for the correction of myopia and astigmatism in eyes featuring a pre-planned RST ranging from 280 to 300μm accompanied by normal corneal topography,on the premise of strict control of surgical indications.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery par...BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.展开更多
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little...BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.展开更多
BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal c...BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.展开更多
Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experienc...Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.展开更多
●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were i...●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.展开更多
Single incision laparoscopic liver resection(SILLR)is the most recent develop-ment in the laparoscopic approach to the liver.SILLR for hepatocellular carci-noma(HCC)has developed much more slowly than multiport LLR.So...Single incision laparoscopic liver resection(SILLR)is the most recent develop-ment in the laparoscopic approach to the liver.SILLR for hepatocellular carci-noma(HCC)has developed much more slowly than multiport LLR.So far,195 patients completed SILLR for HCC.In this paper,we reviewed all published papers about SILLR for HCC and discussed the feasibility of the SILLR,peri and postoperative findings,tricks of patient selection and whether SILLR compromise the oncological principles.展开更多
Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in...Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.展开更多
The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The c...The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.展开更多
●AIM:To investigate the long-term changes of corneal densitometry(CD)and its contributing elements after small incision lenticule extraction(SMILE).●METHODS:Totally 31 eyes of 31 patients with mean spherical equival...●AIM:To investigate the long-term changes of corneal densitometry(CD)and its contributing elements after small incision lenticule extraction(SMILE).●METHODS:Totally 31 eyes of 31 patients with mean spherical equivalent of-6.46±1.50 D and mean age 28.23±7.38y were enrolled.Full-scale examinations were conducted on all patients preoperatively and during followup.Visual acuity,manifest refraction,axial length,corneal thickness,corneal higher-order aberrations,and CD were evaluated.●RESULTS:All surgeries were completed successfully without complications or adverse events.Ten-year safety index was 1.17±0.20 and efficacy 1.04±0.28.CD value of 0–6 mm zones in central layer was statistically significantly lower 10y postoperatively,compared with preoperative values(0–2 mmΔ=-1.62,2–6 mmΔ=-1.24,P<0.01).There were no correlations between CD values and factors evaluated.●CONCLUSION:SMILE is a safe and efficient procedure for myopia on a long-term basis.CD values get lower 10y postoperatively,whose mechanism is to be further discussed.展开更多
文摘Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.
文摘Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.
基金Supported by Sichuan Science and Technology Program(No.23NSFSC0856).
文摘AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic patients(39 females and 11 males)with SMILE were enrolled in this prospective study.The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis,dynamic stereopsis,foveal suppression,and binocular balance point of signal to noise ratio(s/n ratio).All subjects received measurements in 1d before operation,and 1d,1wk,and 1mo postoperatively.RESULTS:Both static and dynamic stereopsis showed no significant difference after SMILE.The foveal suppression improved significantly 1wk and 1mo after SMILE(P=0.005 and P=0.007 respectively).The binocular balance point of signal to noise ratio showed a significant improvement 1d,1wk and 1mo after SMILE for both eyes(P<0.001 for each eye respectively).CONCLUSION:Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively,and SMILE can improve both foveal suppression and binocular imbalance in these patients.
文摘1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
文摘AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients who underwent SMILE were included in this retrospective,nonrandomized,comparative study.All the eyes which were with the rule astigmatism were divided into high astigmatism group(HAG;astigmatism≤-2.00 D,73 eyes)and low astigmatism group(LAG;astigmatism≥-1.00 D,84 eyes).Visual and refractive examinations were performed,HOAs of the anterior surface,posterior surface,and total cornea of the eyes were evaluated preoperatively and 6mo postoperatively.RESULTS:At the postoperative 6-month follow-up,uncorrected distance visual acuity of 20/20 or better was achieved in 97%and 100%eyes in HAG and LAG respectively and 74%and 100%eyes were within-0.50 D.Vector analysis revealed no significant differences in the correction index(P=0.066),angle of error(P=0.091)or flattening index(P=0.987)between two groups.The magnitude of error was-0.37±0.31 D in HAG and-0.04±0.19 D in LAG(P<0.001).Index of success(IOS)was 0.22±0.09 in the HAG and 0.50±0.46 in the LAG(P<0.001).HOAs of most anterior,posterior and total cornea significantly increased after SMILE,especially the spherical aberration and coma.For HAG,the SMILE procedure induced significantly higher anterior,posterior and total cornea horizontal coma and total corneal total HOAs compared with LAG(P<0.001)and these surgically induced HOAs predominantly originated from the anterior surface of the cornea.CONCLUSION:SMILE surgery induces more HOAs and a mild under-correction of astigmatism in eyes with high astigmatism.The increment in HOAs after SMILE is related to preoperative astigmatism.
文摘AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.
文摘BACKGROUND Incisional hernia(IH)is a common complication following liver transplantation(LT),contributing to significant morbidity and impaired quality of life.The interplay of transplant-specific factors,patient comorbidities,surgical complexity,and immunosuppression presents considerable challenges in hernia repair,often accompanied by substantial risks.AIM To assess the incidence,risk factors,and outcomes of IH repair in LT recipients.METHODS A systematic literature search was conducted across MEDLINE,EMBASE,Scopus,CINAHL,the Cochrane Library,Google Scholar,and PubMed,yielding 493 results.In accordance with PRISMA guidelines,39 studies reporting on IH following LT were included in the final analysis.Studies involving paediatric populations,hernias unrelated to transplant incisions,living liver donors,non-LT,and multiorgan transplants were excluded.Meta-analysis was performed using Cochrane RevMan software.The study has been registered with PROSPERO(CRD420-24563398).RESULTS A review of 39 studies revealed incidence of post-LT IH ranging from 1.7%to upto 42.8%.Pooled analysis showed comparable demographics among groups and post-LT IH incidence was higher in older age recipients[mean difference(MD)=2.39,95%CI:1.15-3.63,P<0.001],male gender(relative risk=1.42,95%CI:1.18-1.72,P<0.001),high body mass index(BMI)(MD=1.06,95%CI:0.82-1.29,P<0.001),Mercedez-Benz incision type[odds ratio(OR)=0.45,95%CI:0.21,0.96,P=0.04],and need for re-laparotomy(OR=2.49,95%CI:1.05-5.93,P=0.04).No significant differences were found in recurrence rates or wound complications between open and laparoscopic IH repairs.CONCLUSION Older recipient age,male gender,high BMI,Mercedes-Benz incision,and re-laparotomy after LT are significant risk factors for IH.In contrast,model for end-stage liver disease score,pre-LT ascites,acute rejection,and mammalian target of rapamycin inhibitor therapy do not appear to influence IH development.While open repair remains the predominant approach post-LT,no significant differences in recurrence or wound complication rates have been observed between open and laparoscopic repairs.However,open repair is associated with a shorter operative time.
文摘AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospective study was designed to evaluate 82 eyes from 82 patients,all of whom had a pre-planned RST of 280 to 300μm and normal corneal topography prior to undergoing SMILE surgery.The mean preoperative spherical equivalent(SE)was-4.82±1.30 D.A standard follow-up protocol was conducted between 1 to 6mo postoperatively.Visual outcomes were recorded using uncorrected visual acuity(UCVA)and subjective refraction.The curvature of the anterior and posterior corneal surfaces,as well as the posterior elevation at the thinnest point(PTE)were derived from the Pentacam system.RESULTS:At the final follow-up,the efficacy index was 1.14±0.15,the safety index was 1.20±0.13.The mean preoperative UDVA was 0.78±0.16 logMAR,which improved significantly to-0.07±0.06 logMAR postoperatively(P<0.001).The preoperative mean SE was-4.82±1.30 D,which decreased to-0.14±0.30 D by the last visit.The curvature of the anterior cornea at the flat meridian(AK1)were 42.62±1.02 D preoperatively,38.56±1.37 D and 38.59±1.39 D at 1 and 6mo after operation,respectively.Corresponding measurements at the steep meridian(AK2)were 43.55±1.14 D preoperatively,39.18±1.46 D and 39.22±1.50 D at 1 and 6mo after operation,respectively.Both AK1 and AK2 remained stable at 1 and 6-mo postoperative intervals(P=0.126 and 0.082,respectively).There were no observed changes in the curvature of the posterior cornea at the flat meridian or at the steep meridian,or the PTE before and after surgery.CONCLUSION:SMILE represents a safe and effective procedure for the correction of myopia and astigmatism in eyes featuring a pre-planned RST ranging from 280 to 300μm accompanied by normal corneal topography,on the premise of strict control of surgical indications.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
文摘BACKGROUND Incisional hernia is one of the known complications of renal transplant surgery,with a reported incidence between 1.1%to 3.8%.Depending on the site and extent of incisional hernia,it may require surgery particularly if it contains the trans-planted kidney either partially or completely.The current common clinical prac-tice is to repair incisional hernias using polypropylene meshes,which have their own risks and benefits.Biological meshes,which are made from human or animal-derived connective tissue,are also in use and have a less inflammatory response.Recently,hybrid meshes have been developed.These are composed of both biological and synthetic products.One such example is OviTex 1S perma-nent,which is a sterile reinforced tissue matrix composed of ovine(sheep)derived extracellular matrix and monofilament polypropylene.In this case report,we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.CASE SUMMARY We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery.The median size of the defect was 15 cm long.There was no post-operative complication.One patient required renal transplant biopsy after mesh repair,which was easily performed compared with polypropylene meshes repaired hernias in the past.CONCLUSION The OviTex 1S mesh provides benefits in hernial repairs pKTx,but cost is an issue,and their long-term viability is unclear.Continued use and reporting will help build a more informed picture.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
文摘BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.
基金This study was reviewed and approved by the Ethics Committee of Shenzhen People's Hospital.
文摘BACKGROUND Laparoscopic colorectal cancer surgery increases the risk of incisional hernia(IH)at the tumor extraction site.AIM To investigate the incidence of IH at extraction sites following laparoscopic colo-rectal cancer surgery and identify the risk factors for IH incidence.METHODS This study retrospectively analyzed the data of 1614 patients who underwent la-paroscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022.Diffe-rences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated.RESULTS Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery,303(18.8%),923(57.2%),171(10.6%),and 217(13.4%)tumors were ex-tracted through supraumbilical midline,infraumbilical midline,umbilical,and off-midline incisions.Of these,52 patients developed IH in the abdominal wall,with an incidence of 3.2%.The incidence of postoperative IH was significantly higher in the off-midline incision group(8.8%)than in the middle incision groups[the supraumbilical midline(2.6%),infraumbilical midline(2.2%),and umbilical incision(2.9%)groups](χ^(2)=24.985;P<0.05).Univariate analysis showed that IH occurrence was associated with age,obesity,sex,chronic cough,incision infection,and combined diabetes,anemia,and hypopro-teinemia(P<0.05).Similarly,multivariate analysis showed that off-midline incision,age,sex(female),obesity,incision infection,combined chronic cough,and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery(P<0.05).CONCLUSION The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery.The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.
文摘Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.
基金Supported by Shandong Provincial Natural Science Foundation(No.ZR2022QH384).
文摘●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.
文摘Single incision laparoscopic liver resection(SILLR)is the most recent develop-ment in the laparoscopic approach to the liver.SILLR for hepatocellular carci-noma(HCC)has developed much more slowly than multiport LLR.So far,195 patients completed SILLR for HCC.In this paper,we reviewed all published papers about SILLR for HCC and discussed the feasibility of the SILLR,peri and postoperative findings,tricks of patient selection and whether SILLR compromise the oncological principles.
文摘Introduction: Incisional hernia is a common medical situation and its treatment has always been a challenge for general surgeons. If laparoscopic repair has become a gold standard elsewhere, it is increasingly done in our milieu, but no data has been found. The aim of this study was to review this surgery done in our country so far, to describe the operative technique and to evaluate the postoperative outcomes. Patients and Methods: We conducted an observational descriptive study with retrospective collection of data from the 1<sup>st</sup> of July 2018 to 30<sup>th</sup> of June 2022, in three hospitals in Cameroon. Data on socio-demographic and clinical characteristics, surgical technique and postoperative outcomes of patients who had a laparoscopic repair of their incisional hernia were collected. Results: We reviewed 20 files. There were 14 women with an average age of 54.6 years. The average BMI was 32.8 kg/m<sup>2</sup>. Thirteen patients had a moderate size hernia and the hernia was localized at the midline in 18 cases. Only composite biface meshes were used with dimensions chosen to obtain at least 5 cm overlap. Spiral tacks were the only fixation means used. We registered 3 complications. One case of generalized peritonitis secondary to missed digestive perforation, one case of seroma and one case of postoperative ileus. We registered no death. Conclusion: Laparoscopic repair of incisional hernias is feasible in a resource-limited setting like ours. Compliance with the operative technique and recommendations is important to obtain short-term results closed to that put forward by literature.
文摘The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.
文摘●AIM:To investigate the long-term changes of corneal densitometry(CD)and its contributing elements after small incision lenticule extraction(SMILE).●METHODS:Totally 31 eyes of 31 patients with mean spherical equivalent of-6.46±1.50 D and mean age 28.23±7.38y were enrolled.Full-scale examinations were conducted on all patients preoperatively and during followup.Visual acuity,manifest refraction,axial length,corneal thickness,corneal higher-order aberrations,and CD were evaluated.●RESULTS:All surgeries were completed successfully without complications or adverse events.Ten-year safety index was 1.17±0.20 and efficacy 1.04±0.28.CD value of 0–6 mm zones in central layer was statistically significantly lower 10y postoperatively,compared with preoperative values(0–2 mmΔ=-1.62,2–6 mmΔ=-1.24,P<0.01).There were no correlations between CD values and factors evaluated.●CONCLUSION:SMILE is a safe and efficient procedure for myopia on a long-term basis.CD values get lower 10y postoperatively,whose mechanism is to be further discussed.
