Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (...Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer. This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as prepa- ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brie?y mentioned.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
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surger...Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.展开更多
This article outlines the technical specifications of super minimally invasive stepwise full-thickness resection surgery for colorectal cancer(sft-SMIR).sft-SMIR is a super minimally invasive surgery performed through...This article outlines the technical specifications of super minimally invasive stepwise full-thickness resection surgery for colorectal cancer(sft-SMIR).sft-SMIR is a super minimally invasive surgery performed through natural orifices,combining endoscopic submucosal dissection(ESD)and full-thickness resection(EFTR)techniques,aimed at curing the disease while maximizing the preservation of the structure and function of the colorectal organs.The article specifies that this technique is suitable for early colon cancer,early rectal cancer,and locally advanced low rectal cancer after neoadjuvant therapy,detailing its indications and contraindications.It emphasizes the importance of multidisciplinary team(MDT)assessment,meticulous preoperative imaging and endoscopic evaluation,standardized intraoperative procedures(including marking,dissection,traction,full-thickness resection,and wound closure),as well as rigorous postoperative management and follow-up processes.Additionally,the expert consensus highlights the need for a strong focus on infection prevention and the establishment of standardized training and quality control systems to promote the safe and standardized application of this difficult endoscopic technique.展开更多
Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on pre...Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on previous clinical research results and combined with the ten core treatment principles of SMIS,this guideline systematically elaborates on the indications,contraindications,preoperative evaluation,surgical operation standards,postoperative management,and efficacy evaluation system of ASGS-SMIR.This surgery achieves effective repair of large-area mucosal defects and stenosis prevention in the esophagus through the technical process of“skin flap harvesting,mesh processing,sleeve suture,and stent fixation”.The purpose of this guideline is to promote the standardized and normalized application of this technique and provide guidance for clinical practice.展开更多
Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and en...Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.展开更多
Objective:This study aims to investigate the effects of pain care based on the CICARE communication model on perioperative pain control,anxiety,and nursing satisfaction in patients undergoing minimally invasive breast...Objective:This study aims to investigate the effects of pain care based on the CICARE communication model on perioperative pain control,anxiety,and nursing satisfaction in patients undergoing minimally invasive breast surgery during the day.Methods:Using a randomized controlled trial design,200 patients who underwent minimally invasive breast surgery at our hospital’s day surgery center from January 2023 to June 2024 were selected and randomly divided into the experimental group and the control group,with 100 cases in each group.The control group received routine perioperative care,while the experimental group received standardized pain care based on the CICARE communication model in addition to routine care.The Visual Analogue Scale(VAS)was used to assess pain levels at 2 hours,6 hours,and 24 hours after surgery,the State-Trait Anxiety Scale(STAI)was used to assess anxiety levels before and after the intervention,and a self-made nursing satisfaction questionnaire was used to evaluate patient satisfaction.Results:The VAS scores of the experimental group at 2 hours,6 hours,and 24 hours after surgery[(3.2±0.8)points,(2.1±0.7)points,(1.2±0.5)points]were significantly lower than those of the control group[(4.8±1.1)points,(3.6±0.9)points,(2.3±0.6)points](P<0.01).After the intervention,the state anxiety score of the experimental group(38.5±6.2)was significantly lower than that of the control group(46.8±7.1)(P<0.01).The total score of nursing satisfaction in the experimental group(94.2±4.3)was significantly higher than that in the control group(82.6±5.7)(P<0.01).Conclusion:Pain care based on the CICARE communication model can effectively relieve postoperative pain in patients undergoing minimally invasive breast surgery during the day,reduce anxiety,and improve nursing satisfaction.It is worthy of promotion and application in day surgery care.展开更多
Objective:To explore the application effect of a phased nursing guidance program in early rehabilitation training for patients after minimally invasive spinal surgery,providing references for clinical rehabilitation n...Objective:To explore the application effect of a phased nursing guidance program in early rehabilitation training for patients after minimally invasive spinal surgery,providing references for clinical rehabilitation nursing.Methods:A total of 148 patients who underwent minimally invasive spinal surgery in our hospital from July 2023 to June 2025 were selected as the study subjects.They were randomly divided into an observation group and a control group using a random number table method,with 74 cases in each group.The control group received conventional nursing guidance after minimally invasive spinal surgery,while the observation group implemented a phased nursing guidance program.The pain levels(VAS scores),spinal function(JOA scores),quality of life(SF-36 scores),rehabilitation training compliance,and complication rates of the two groups of patients at different postoperative time points were compared.Results:At 7,14,and 30 days postoperatively,the Visual Analogue Scale(VAS)scores in the observation group were significantly lower than those in the control group(all p<0.001).At 7,14,and 30 days postoperatively,the Japanese Orthopaedic Association(JOA)scores in the observation group were significantly higher than those in the control group(all p<0.0001).Moreover,the JOA scores in both groups gradually increased over time,with a more pronounced increase observed in the observation group.At 30 days postoperatively,the scores in all dimensions of the Short Form-36(SF-36)scale in the observation group were significantly higher than those in the control group(all p<0.001).The compliance rate with rehabilitation training in the observation group was 95.95%,significantly higher than the 82.43%in the control group(χ^(2)=7.008,p<0.05).The complication rate in the observation group was 4.05%,significantly lower than the 14.86%in the control group(χ^(2)=5.049,p<0.05).Conclusion:The phased nursing guidance program can effectively alleviate pain,improve spinal function and quality of life,enhance compliance with rehabilitation training,and reduce the incidence of complications in patients after minimally invasive spinal surgery,making it worthy of clinical promotion and application.展开更多
Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients...Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.展开更多
Over the last decade,with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer,there has been a significant increase in the literature regarding treatment options availabl...Over the last decade,with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer,there has been a significant increase in the literature regarding treatment options available to patients affected by this disease.That treatment related decisions should be made at a high volume multidisciplinary tumor board,after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision(TME)are accepted standard of care.More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders,which may be appropriate in 20%of patients.Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only,with transanal minimal invasive surgery(TAMIS)because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon,emerging as the leading option.Recent trials have raised concerns about the oncologic outcomes of the standard"top-down"TME hence transanal TME(Ta TME"bottom-up")approach has gained popularity as an alternative.The challenges are many,with a dearth of evidence of the oncologic superiority in the long-term for any given option.However,this review highlights recent advances in the role of chemoradiation only for complete pathologic responders,TAMIS for highly selected early rectal cancer patients and Ta TME as options to improve cure rates whilst maintaining quality of life in these patients,while we await the results of further definitive trials being currently conducted.展开更多
Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery.Over the past few decades,majority of neurosurgeons only specialize in spinal cord diseases.However,wit...Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery.Over the past few decades,majority of neurosurgeons only specialize in spinal cord diseases.However,with the advances in spine surgery,more and more neurosurgeons focus on spine diseases.As traditional surgery has been gradually replaced by precision surgery,open surgery has been gradually replaced by展开更多
AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treat...AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treatment arms:robotic gastrectomy(RG),laparoscopic gastrectomy(LG),open gastrectomy(OG).Data collection started after sharing a specific study protocol.Data were recorded through a tailored and protected web-based system.Primary outcomes:harvested lymph nodes,estimated blood loss,hospital stay,complications rate.Among the secondary outcomes,there are:operative time,R0 resections,POD of mobilization,POD of starting liquid diet and soft solid diet.The analysis includes the evaluation of type and grade of postoperative complications.Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies.To guarantee homogenous distribution of cases,patients in the RG,LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper=0.2.The successful matching resulted in a total sample of 604 patients(RG=151;LG=151;OG=302).The three groups showed no differences in all baseline patients characteristics,type of surgery(P=0.42)and stage of the disease(P=0.16).Intraoperative blood loss was significantly lower in the LG(95.93±119.22)and RG(117.91±68.11)groups compared to the OG(127.26±79.50,P=0.002).The mean number of retrieved lymph nodes was similar between the RG(27.78±11.45),LG(24.58±13.56)and OG(25.82±12.07)approach.A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P<0.0001).A similar complications rate was found(P=0.13).The leakage rate was not different(P=0.78)between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery.The main highlighted benefit is a faster postoperative functional recovery.展开更多
BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely a...BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.展开更多
There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the r...There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.展开更多
The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm...The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.展开更多
Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been...Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1)Laparoscopic surgery;(2)Robotic surgery;and(3)Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.展开更多
Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, lapa...Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short- and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.展开更多
BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopi...BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.展开更多
BACKGROUND Gastric cancer remains a leading cause of cancer-related mortality globally.Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.AIM To evaluate ...BACKGROUND Gastric cancer remains a leading cause of cancer-related mortality globally.Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.AIM To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer,focusing on its potential to reduce trauma,accelerate recovery,and achieve comparable oncological out-comes.METHODS This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023.The patients were divided into two groups:Minimally invasive surgery group(n=102),who underwent laparoscopic gastrectomy,and open surgery group(n=101),who underwent traditional open gastrectomy.We compared surgical indicators(surgical incision size,intraop-erative blood loss,surgical duration,and number of lymph nodes dissected),recovery parameters(time to first flatus,time to start eating,time to ambulation,and length of hospital stay),immune function(levels of IgA,IgG,and IgM),intestinal barrier function(levels of D-lactic acid and diamine oxidase),and stress response(levels of C-reactive protein,interleukin-6,and procalcitonin).RESULTS The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators,including smaller incisions,less blood loss,shorter surgery time,and more lymph nodes dissected(P<0.05 for all).Recovery was also faster in the minimally invasive surgery group,with earlier return of bowel function,earlier initiation of diet,quicker mobilization,and shorter hospital stays(P<0.05 for all).Furthermore,patients in the minimally invasive surgery group had better preserved immune function,superior intestinal barrier function,and a less pronounced stress response postoperatively(P<0.05 for all).CONCLUSION Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function,protecting intestinal barrier function,and mitigating the stress response compared to traditional open surgery.These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.展开更多
文摘Thoracoscopic esophagectomy is only established in some centers and a?ords a cervical anasto- mosis because intrathoracic anastomosis as a routine is technically too di?cult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer. This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as prepa- ration for transthoracic en bloc esophagectomy is described in detail and preliminary results are brie?y mentioned.
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.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.
基金National Key Research and Development Program of China(Project No.:2022YFC2503600)。
文摘This article outlines the technical specifications of super minimally invasive stepwise full-thickness resection surgery for colorectal cancer(sft-SMIR).sft-SMIR is a super minimally invasive surgery performed through natural orifices,combining endoscopic submucosal dissection(ESD)and full-thickness resection(EFTR)techniques,aimed at curing the disease while maximizing the preservation of the structure and function of the colorectal organs.The article specifies that this technique is suitable for early colon cancer,early rectal cancer,and locally advanced low rectal cancer after neoadjuvant therapy,detailing its indications and contraindications.It emphasizes the importance of multidisciplinary team(MDT)assessment,meticulous preoperative imaging and endoscopic evaluation,standardized intraoperative procedures(including marking,dissection,traction,full-thickness resection,and wound closure),as well as rigorous postoperative management and follow-up processes.Additionally,the expert consensus highlights the need for a strong focus on infection prevention and the establishment of standardized training and quality control systems to promote the safe and standardized application of this difficult endoscopic technique.
基金National Key Research and Development Program of China(2022YFC2503600)。
文摘Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on previous clinical research results and combined with the ten core treatment principles of SMIS,this guideline systematically elaborates on the indications,contraindications,preoperative evaluation,surgical operation standards,postoperative management,and efficacy evaluation system of ASGS-SMIR.This surgery achieves effective repair of large-area mucosal defects and stenosis prevention in the esophagus through the technical process of“skin flap harvesting,mesh processing,sleeve suture,and stent fixation”.The purpose of this guideline is to promote the standardized and normalized application of this technique and provide guidance for clinical practice.
基金Supported by Sichuan Provincial Administration of Traditional Chinese Medicine(No.2024MS471)。
文摘Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.
文摘Objective:This study aims to investigate the effects of pain care based on the CICARE communication model on perioperative pain control,anxiety,and nursing satisfaction in patients undergoing minimally invasive breast surgery during the day.Methods:Using a randomized controlled trial design,200 patients who underwent minimally invasive breast surgery at our hospital’s day surgery center from January 2023 to June 2024 were selected and randomly divided into the experimental group and the control group,with 100 cases in each group.The control group received routine perioperative care,while the experimental group received standardized pain care based on the CICARE communication model in addition to routine care.The Visual Analogue Scale(VAS)was used to assess pain levels at 2 hours,6 hours,and 24 hours after surgery,the State-Trait Anxiety Scale(STAI)was used to assess anxiety levels before and after the intervention,and a self-made nursing satisfaction questionnaire was used to evaluate patient satisfaction.Results:The VAS scores of the experimental group at 2 hours,6 hours,and 24 hours after surgery[(3.2±0.8)points,(2.1±0.7)points,(1.2±0.5)points]were significantly lower than those of the control group[(4.8±1.1)points,(3.6±0.9)points,(2.3±0.6)points](P<0.01).After the intervention,the state anxiety score of the experimental group(38.5±6.2)was significantly lower than that of the control group(46.8±7.1)(P<0.01).The total score of nursing satisfaction in the experimental group(94.2±4.3)was significantly higher than that in the control group(82.6±5.7)(P<0.01).Conclusion:Pain care based on the CICARE communication model can effectively relieve postoperative pain in patients undergoing minimally invasive breast surgery during the day,reduce anxiety,and improve nursing satisfaction.It is worthy of promotion and application in day surgery care.
文摘Objective:To explore the application effect of a phased nursing guidance program in early rehabilitation training for patients after minimally invasive spinal surgery,providing references for clinical rehabilitation nursing.Methods:A total of 148 patients who underwent minimally invasive spinal surgery in our hospital from July 2023 to June 2025 were selected as the study subjects.They were randomly divided into an observation group and a control group using a random number table method,with 74 cases in each group.The control group received conventional nursing guidance after minimally invasive spinal surgery,while the observation group implemented a phased nursing guidance program.The pain levels(VAS scores),spinal function(JOA scores),quality of life(SF-36 scores),rehabilitation training compliance,and complication rates of the two groups of patients at different postoperative time points were compared.Results:At 7,14,and 30 days postoperatively,the Visual Analogue Scale(VAS)scores in the observation group were significantly lower than those in the control group(all p<0.001).At 7,14,and 30 days postoperatively,the Japanese Orthopaedic Association(JOA)scores in the observation group were significantly higher than those in the control group(all p<0.0001).Moreover,the JOA scores in both groups gradually increased over time,with a more pronounced increase observed in the observation group.At 30 days postoperatively,the scores in all dimensions of the Short Form-36(SF-36)scale in the observation group were significantly higher than those in the control group(all p<0.001).The compliance rate with rehabilitation training in the observation group was 95.95%,significantly higher than the 82.43%in the control group(χ^(2)=7.008,p<0.05).The complication rate in the observation group was 4.05%,significantly lower than the 14.86%in the control group(χ^(2)=5.049,p<0.05).Conclusion:The phased nursing guidance program can effectively alleviate pain,improve spinal function and quality of life,enhance compliance with rehabilitation training,and reduce the incidence of complications in patients after minimally invasive spinal surgery,making it worthy of clinical promotion and application.
文摘Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.
文摘Over the last decade,with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer,there has been a significant increase in the literature regarding treatment options available to patients affected by this disease.That treatment related decisions should be made at a high volume multidisciplinary tumor board,after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision(TME)are accepted standard of care.More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders,which may be appropriate in 20%of patients.Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only,with transanal minimal invasive surgery(TAMIS)because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon,emerging as the leading option.Recent trials have raised concerns about the oncologic outcomes of the standard"top-down"TME hence transanal TME(Ta TME"bottom-up")approach has gained popularity as an alternative.The challenges are many,with a dearth of evidence of the oncologic superiority in the long-term for any given option.However,this review highlights recent advances in the role of chemoradiation only for complete pathologic responders,TAMIS for highly selected early rectal cancer patients and Ta TME as options to improve cure rates whilst maintaining quality of life in these patients,while we await the results of further definitive trials being currently conducted.
文摘Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery.Over the past few decades,majority of neurosurgeons only specialize in spinal cord diseases.However,with the advances in spine surgery,more and more neurosurgeons focus on spine diseases.As traditional surgery has been gradually replaced by precision surgery,open surgery has been gradually replaced by
基金Supported by CARIT Foundation(Fondazione Cassa di Risparmio di Terni e Narni),No.0024137
文摘AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical,clinical,and oncological outcomes.METHODS This is a propensity score-matched case-control study,comparing three treatment arms:robotic gastrectomy(RG),laparoscopic gastrectomy(LG),open gastrectomy(OG).Data collection started after sharing a specific study protocol.Data were recorded through a tailored and protected web-based system.Primary outcomes:harvested lymph nodes,estimated blood loss,hospital stay,complications rate.Among the secondary outcomes,there are:operative time,R0 resections,POD of mobilization,POD of starting liquid diet and soft solid diet.The analysis includes the evaluation of type and grade of postoperative complications.Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies.To guarantee homogenous distribution of cases,patients in the RG,LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper=0.2.The successful matching resulted in a total sample of 604 patients(RG=151;LG=151;OG=302).The three groups showed no differences in all baseline patients characteristics,type of surgery(P=0.42)and stage of the disease(P=0.16).Intraoperative blood loss was significantly lower in the LG(95.93±119.22)and RG(117.91±68.11)groups compared to the OG(127.26±79.50,P=0.002).The mean number of retrieved lymph nodes was similar between the RG(27.78±11.45),LG(24.58±13.56)and OG(25.82±12.07)approach.A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P<0.0001).A similar complications rate was found(P=0.13).The leakage rate was not different(P=0.78)between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery.The main highlighted benefit is a faster postoperative functional recovery.
文摘BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.
文摘There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.
基金Supported by National Key R&D Programs of China,No.2022YFC2503600.
文摘The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.
文摘Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1)Laparoscopic surgery;(2)Robotic surgery;and(3)Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.
文摘Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short- and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.
文摘BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer.Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades.Thus far,only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy.AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors.METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period.After excluding 125 patients with non-curative surgery(n=77),other synchronous cancer(n=2),remnant gastric cancer(n=25),insufficient physical function(n=13),and open gastrectomy(n=8),a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined.Accordingly,5-year overall and recurrence-free survival were analyzed using the Kaplan–Meier method with the log-rank test and Cox regression analyses,while factors associated with survival were determined using multivariate analysis.RESULTS Our analysis showed that age>65 years,American Society of Anesthesiologists(ASA)physical status 3,total or proximal gastrectomy,and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrencefree survival.Accordingly,the included patients had a 5-year overall and recurrence-free survival of 80.3%and 78.2%,respectively.Among the 814 patients,157(19.3%)underwent robotic gastrectomy,while 308(37.2%)were diagnosed with pathological stage II or III disease.Notably,our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III[hazard ratio:0.56(0.33-0.96),P=0.035].Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity(P=0.005).CONCLUSION Age,ASA status,gastrectomy type,and pathological T and N status were prognostic factors of minimally invasive gastrectomy,with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
基金Shanghai Chongming District Sustainable Development Science and Technology Innovation Action Plan,No.CKY2020-11.
文摘BACKGROUND Gastric cancer remains a leading cause of cancer-related mortality globally.Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.AIM To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer,focusing on its potential to reduce trauma,accelerate recovery,and achieve comparable oncological out-comes.METHODS This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023.The patients were divided into two groups:Minimally invasive surgery group(n=102),who underwent laparoscopic gastrectomy,and open surgery group(n=101),who underwent traditional open gastrectomy.We compared surgical indicators(surgical incision size,intraop-erative blood loss,surgical duration,and number of lymph nodes dissected),recovery parameters(time to first flatus,time to start eating,time to ambulation,and length of hospital stay),immune function(levels of IgA,IgG,and IgM),intestinal barrier function(levels of D-lactic acid and diamine oxidase),and stress response(levels of C-reactive protein,interleukin-6,and procalcitonin).RESULTS The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators,including smaller incisions,less blood loss,shorter surgery time,and more lymph nodes dissected(P<0.05 for all).Recovery was also faster in the minimally invasive surgery group,with earlier return of bowel function,earlier initiation of diet,quicker mobilization,and shorter hospital stays(P<0.05 for all).Furthermore,patients in the minimally invasive surgery group had better preserved immune function,superior intestinal barrier function,and a less pronounced stress response postoperatively(P<0.05 for all).CONCLUSION Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function,protecting intestinal barrier function,and mitigating the stress response compared to traditional open surgery.These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.
