BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intraute...BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.展开更多
To explore the clinical effect of laparoscope for patients with periappendiceal abscess. In the observation group, 30 patients were treated with laparoscopic surgery. After the completion of treatment, the operative t...To explore the clinical effect of laparoscope for patients with periappendiceal abscess. In the observation group, 30 patients were treated with laparoscopic surgery. After the completion of treatment, the operative time, the incidence of postoperative complications, the recovery time of gastrointestinal function after surgery and the occurrence of the second operation were compared between the two groups. Results: comparison of the time spent on the whole operation between the two groups. The duration of operation was (66.35 ± 5.57) min in the observation group and (121.24 ± 11.27) min in the control group. After operation, the recovery time of gastrointestinal function in two groups was (2.61 ± 0.87) d in the observation group and (3.89 ± 1.24) d in the control group. The length of stay was (6.23 ± 1.25) d in the observation group and (9.57 ± 2.05) d in the control group. All the above comparisons were P < 0.05. Conclusion: in the treatment process of periappendiceal abscess patients, the operative time, postoperative gastrointestinal function recovery time and length of stay of patients are significantly longer, which is worthy of clinical promotion.展开更多
In laparoscopic surgery, the surgeons are equipped with the suitable tools for the surgery, while the laparoscope is used to capture the operation environment and displays it on a monitor. This paper presents the math...In laparoscopic surgery, the surgeons are equipped with the suitable tools for the surgery, while the laparoscope is used to capture the operation environment and displays it on a monitor. This paper presents the mathematical kinematic position modeling of the laparoscopic tools used for autonomous positioning of a laparoscope in such operations. These models are obtained using Denavit-Hartenberg (D-H) Notations and Homogenous Transformation Matrix (HTM). The laparoscopic tools are considered as six degrees of freedom (DOF) mechanisms while the laparoscope has four DOF. The 3D loop closure equation is used to obtain the laparoscope kinematic position models in terms of those of the laparoscopic tools. These models are used to simulate and align the laparoscope camera with the surgeon’s laparoscopic Tools Center Points (TCP). The obtained results show the smooth positioning of the laparoscope camera for better visu-alization of laparoscopic surgery environments.展开更多
Objective: to analyze the specific value of humanistic care on the basis of laparoscopic surgery for clinical pediatric hernia cases. Methods: a total of 80 cases were treated by laparoscopic surgery, and were randoml...Objective: to analyze the specific value of humanistic care on the basis of laparoscopic surgery for clinical pediatric hernia cases. Methods: a total of 80 cases were treated by laparoscopic surgery, and were randomly divided into 40 cases/group, control group-routine perioperative basic care, and observation group: combined with humanistic care. Results: the data in tables 1 to 4 show that the observation group is superior to the control group (P<0.05). Conclusion: humanistic care can improve children's treatment behavior, psychological emotion and quality of life, and a good nursing atmosphere can effectively improve their nursing compliance.展开更多
BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves ...Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recover...In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.展开更多
BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comp...BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.展开更多
BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated b...BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anast...BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.展开更多
BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per y...BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.展开更多
BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)inc...BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.展开更多
BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recover...BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice be...BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.展开更多
BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation intervention...BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.展开更多
Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-ca...Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].展开更多
文摘BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.
文摘To explore the clinical effect of laparoscope for patients with periappendiceal abscess. In the observation group, 30 patients were treated with laparoscopic surgery. After the completion of treatment, the operative time, the incidence of postoperative complications, the recovery time of gastrointestinal function after surgery and the occurrence of the second operation were compared between the two groups. Results: comparison of the time spent on the whole operation between the two groups. The duration of operation was (66.35 ± 5.57) min in the observation group and (121.24 ± 11.27) min in the control group. After operation, the recovery time of gastrointestinal function in two groups was (2.61 ± 0.87) d in the observation group and (3.89 ± 1.24) d in the control group. The length of stay was (6.23 ± 1.25) d in the observation group and (9.57 ± 2.05) d in the control group. All the above comparisons were P < 0.05. Conclusion: in the treatment process of periappendiceal abscess patients, the operative time, postoperative gastrointestinal function recovery time and length of stay of patients are significantly longer, which is worthy of clinical promotion.
文摘In laparoscopic surgery, the surgeons are equipped with the suitable tools for the surgery, while the laparoscope is used to capture the operation environment and displays it on a monitor. This paper presents the mathematical kinematic position modeling of the laparoscopic tools used for autonomous positioning of a laparoscope in such operations. These models are obtained using Denavit-Hartenberg (D-H) Notations and Homogenous Transformation Matrix (HTM). The laparoscopic tools are considered as six degrees of freedom (DOF) mechanisms while the laparoscope has four DOF. The 3D loop closure equation is used to obtain the laparoscope kinematic position models in terms of those of the laparoscopic tools. These models are used to simulate and align the laparoscope camera with the surgeon’s laparoscopic Tools Center Points (TCP). The obtained results show the smooth positioning of the laparoscope camera for better visu-alization of laparoscopic surgery environments.
文摘Objective: to analyze the specific value of humanistic care on the basis of laparoscopic surgery for clinical pediatric hernia cases. Methods: a total of 80 cases were treated by laparoscopic surgery, and were randomly divided into 40 cases/group, control group-routine perioperative basic care, and observation group: combined with humanistic care. Results: the data in tables 1 to 4 show that the observation group is superior to the control group (P<0.05). Conclusion: humanistic care can improve children's treatment behavior, psychological emotion and quality of life, and a good nursing atmosphere can effectively improve their nursing compliance.
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
文摘Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘In the 2010s,laparoscopic hepatectomy(LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robotassisted hepatectomy(RAH) has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the longterm efficacy of both LH and RAH.
文摘BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.
文摘BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
基金Supported by the“521 Project”Funding Project Day of Lianyungang。
文摘BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.
文摘BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.
基金Supported by The Key Research and Development Program of Anhui Province of China,No.1804h08020273The Key Research Project of Health Commission of Anhui Province of China,No.AHWJ2022a016.
文摘BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.
文摘BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金Bethune Charitable Foundation Project,No.HZB-20190528-10Natural Science Foundation of Fujian Province,No.2020J011230.
文摘BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.
文摘BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.
文摘Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].
