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 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 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 Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated ...BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.展开更多
BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic ...BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.展开更多
Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operato...Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.展开更多
Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-...Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.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
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparosco...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.展开更多
Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which ...Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.展开更多
BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 impr...BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 improving precision and outcomes.Laparoscopic techniques,including laparoscopic-assisted right hemicolectomy(LARH)and total laparoscopic right hemicolectomy(TLRH),have further advanced colon cancer treatment by reducing trauma,blood loss,and recovery time.While TLRH offers additional benefits such as faster recovery and fewer complications,its adoption has been limited by longer operative times and technical challenges.AIM To compare the short-term outcomes of TLRH and LARH for the treatment of right-sided colon cancer and explore the advantages and feasibility of TLRH.METHODS Clinical data from 109 right-sided colon cancer patients admitted between January 2019 and May 2021 were retrospectively analyzed.Patients were divided into an observation group(TLRH,n=50)and a control group(LARH,n=59).Study variables were operation time,intraoperative bleeding volume,postoperative hospital stays,length of surgical specimen,number of lymph nodes dissected,and postoperative inflammatory factor levels of the two groups of patients.The postoperative complications were analyzed and compared,and survival,recurrence,and remote metastasis rates of the two groups were compared during a 2-year follow-up period.RESULTS The TLRH group showed the advantages of reduced intraoperative bleeding,shorter hospital stays,and quicker recovery.Lymph node dissection outcomes were comparable,and postoperative inflammatory markers were lower in the TLRH group.Complication rates were similar.Short-term follow-up(2 years)revealed no significant differences in recurrence,metastasis,or survival rates.CONCLUSION Compared to LARH,TLRH offers significant advantages in terms of reducing surgical trauma,lowering postoperative inflammatory factor levels,and mitigating the impact on intestinal function.This approach contributes to a shorter hospital stay and promotes postoperative recovery in patients.The study suggests that TLRH may offer favorable outcomes for colorectal cancer patients.展开更多
Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine v...Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.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
To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evi...To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].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
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.
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 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.
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
基金Supported by Shenzhen Science and Technology Program Project,No.JCYJ20220530145006013.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.
文摘BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.
基金Supported by Liaoning Province People's Livelihood Science and Technology(Health)Plan Joint Project,No.2021JH2/10300127the State Scholarship Funding of CSC,No.201908865001。
文摘Laparoscopic or robotic surgery accounts for an increasing proportion of liver surgery.However,the lack of haptic feedback results in a certain amount of risk.The use of laparoscopic ultrasound(LUS)enables the operator to observe internal structures of the liver in real time to easily avoid the main blood vessels.It also allows for the detection of tumor boundaries and the extent of tumor thrombi,considerably improving the success rate of the operation.Besides its advantages in detecting small lesions that are not detectable through preoperative imaging,thus assisting diagnosis and staging,the LUS can also be used to monitor ablation therapy,portal vein puncture staining,and lesion blood perfusion.Recent advances in technology like contrast-enhanced intraoperative ultrasound and realtime virtual sonography can help surgeons better perform laparoscopic surgery.For liver surgeons,LUS is an essential technique for safely performing laparoscopic surgery,making their proficiency in the use of LUS vital.This article reviews the application of LUS in laparoscopic hepatic resection of liver tumors and the new technology of LUS to help liver surgeons understand the current application status of LUS and the future research directions.
文摘Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.
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 National Natural Science Foundation of China,No.82273442.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.
文摘Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.
文摘BACKGROUND Colon cancer is a significant health issue in China,with high incidence and mortality rates.Surgical resection remains the primary treatment,with the introduction of complete mesocolic excision in 2009 improving precision and outcomes.Laparoscopic techniques,including laparoscopic-assisted right hemicolectomy(LARH)and total laparoscopic right hemicolectomy(TLRH),have further advanced colon cancer treatment by reducing trauma,blood loss,and recovery time.While TLRH offers additional benefits such as faster recovery and fewer complications,its adoption has been limited by longer operative times and technical challenges.AIM To compare the short-term outcomes of TLRH and LARH for the treatment of right-sided colon cancer and explore the advantages and feasibility of TLRH.METHODS Clinical data from 109 right-sided colon cancer patients admitted between January 2019 and May 2021 were retrospectively analyzed.Patients were divided into an observation group(TLRH,n=50)and a control group(LARH,n=59).Study variables were operation time,intraoperative bleeding volume,postoperative hospital stays,length of surgical specimen,number of lymph nodes dissected,and postoperative inflammatory factor levels of the two groups of patients.The postoperative complications were analyzed and compared,and survival,recurrence,and remote metastasis rates of the two groups were compared during a 2-year follow-up period.RESULTS The TLRH group showed the advantages of reduced intraoperative bleeding,shorter hospital stays,and quicker recovery.Lymph node dissection outcomes were comparable,and postoperative inflammatory markers were lower in the TLRH group.Complication rates were similar.Short-term follow-up(2 years)revealed no significant differences in recurrence,metastasis,or survival rates.CONCLUSION Compared to LARH,TLRH offers significant advantages in terms of reducing surgical trauma,lowering postoperative inflammatory factor levels,and mitigating the impact on intestinal function.This approach contributes to a shorter hospital stay and promotes postoperative recovery in patients.The study suggests that TLRH may offer favorable outcomes for colorectal cancer patients.
文摘Background: Intraperitoneal instillation (IPI) of local anesthesia was reported to reduce postoperative pain after laparoscopic surgeries. We aim to evaluate the effectiveness of IPI of bupivacaine + dexmedetomidine versus bupivacaine + dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy (LC). Methods: This randomized clinical trial was carried out on one hundred patients who underwent LC under general anesthesia. Patients were randomly divided into: Group (Dexa): IPI of bupivacaine with dexamethasone and Group (Dexmed): IPI of bupivacaine with dexmedetomidine. Results: The first time to request analgesia was significantly delayed in the dexmed group (P value Conclusions: Intraperitoneal Bupivacaine + Dexmedetomidine provided longer pain-free postoperative duration lower pain score over time, and lesser analgesic consumption.
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To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].
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).
