Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparosc...Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.展开更多
BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel la...BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.展开更多
BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,sli...BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,slight postoperative pain,faster recovery.Despite the advantages mentioned above,the currently available specialized single-port laparoscopic instruments are hindered by high costs and limited applications,challenging their widespread use in medical facilities.AIM To design a two-point lifting/retracting(TPLR)technique for transumbilical single-port LC(TUSPLC)based on the anatomical features of the Calot's triangle(or cystohepatic triangle)and investigate its surgical feasibility.METHODS The clinical data of 103 patients who underwent TUSPLC utilizing the TPLR technique in the Department of Hepatobiliary Surgery at our hospital between June 2023 and June 2024 were retrospectively analyzed.The patient cohort included 82 cases of cholelithiasis,11 cases of gallbladder polyps,6 cases of concurrent gallstones and polyps,and 4 cases of gallbladder adenomyomatosis.RESULTS All the surgical procedures were conducted using standard laparoscopic instruments.Surgery was successful in 98(95.14%)patients using the TPLR method,which effectively exposed the Calot's triangle during surgery.The operative time ranged from 35 to 70 minutes,with an average of 42.4±26.8 minutes.In 3 cases,an additional operative port was required below the xiphoid process,and 2 cases were converted to conventional three-port LC.No complications such as abdominal pain,fever,bile leakage,hemorrhage,or incisional infection were noted postoperatively.No discernible surgical scars were observed at the 2-week postoperative reexamination.Additionally,a 3-month follow-up period revealed no complications.CONCLUSION The TPLR technique,developed based on the anatomical features of the Calot's triangle,facilitates exposure of the Calot's triangle during surgery.It is a simple,safe,feasible,and cost-effective method,and a promising approach for single-port LC.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
Objective:To investigate the quantitative influence of engineering parameters(diameter,bending angle)of minimally invasive surgical instruments and single-port laparoscopic surgery on biomarkers of ovarian reserve fun...Objective:To investigate the quantitative influence of engineering parameters(diameter,bending angle)of minimally invasive surgical instruments and single-port laparoscopic surgery on biomarkers of ovarian reserve function,and establish a multi-parameter coupled mathematical prediction model,providing a theoretical basis for precision instrument design and operation optimization.Methods:A total of 45 reproductive-age patients undergoing single-port laparoscopic ovarian cystectomy were selected.Through orthogonal experimental design,the instrument diameter(3/5/8 mm)and bending angle(30°/60°/90°)were divided into 9 groups,with5 cases in each group.Changes in serum AMH(anti-müllerian hormone),FSH(follicle-stimulating hormone),INHB(inhibin B)and ultrasonic AFC(antral follicle count)indexes were measured before surgery and on the 2nd to 3rd day of the first menstrual period after surgery.Enhanced CT images and laparoscopic images of ovarian force distribution were obtained.Finite element analysis(FEA)of the single-port instrument-ovarian tissue model was performed using ABAQUS software to calculate stress distribution in the ovarian cortex.Oscillatory shear experiments were used to determine the characteristics of viscoelastic property changes in the linear viscoelastic range of ovarian tissue.Results:The rate of decrease in AMH was lower in the 3 mm diameter-30°angle group(P<0.05);the peak Von Mises stress in the D3-θ30 group was lower than that in the other groups(P<0.05);the optimal parameter combination was a diameter of 3.13 mm and an angle of 21.72°,with the model calculating an AMH attenuation of 20%.Ovarian tissue changed with the frequency of the oscillatory shear test.In the low-frequency region(<1 Hz):G'>G''(elasticity-dominated);in the high-frequency region(>5 Hz):G''>G'(viscosity-dominated);the crossover point was at 5 Hz,where G'=G''=5 kPa.Before ovarian dissection:G'was relatively high and G''was relatively low,with elasticity dominating.During dissection:G'decreased and G''increased,with instrument stress causing damage.After dissection:G'further decreased and G''continued to rise,resulting in irreversible damage to the ovarian stroma.Conclusion:The engineering parameters of minimally invasive instruments significantly affect the ovarian reserve function index AMH and the peak Von Mises stress of the ovary through mechanical stress transmission.Using an instrument with a diameter of 3.13 mm and a bending angle of 21.72°can more effectively reduce the impact of single-port laparoscopic surgery on AMH decline.展开更多
A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis （VUA） in laparoscopic radical prostatectomy （LRP） was reported. A total of 42 patients were randomly selected a...A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis （VUA） in laparoscopic radical prostatectomy （LRP） was reported. A total of 42 patients were randomly selected and enrolled in this study. A standard LRP was performed in 21 patients （group 1）, whereas a novel, modified apical dissection of the prostate in LRP was performed in another 21 patients （group 2）. Surgical data, total operative time, VUA time, extravasation rate, catheterisation time, occurrence of anastomotic strictures, and the early and late continence rates were analysed statistically. No differences in clinical or pathological characteristics were determined between the two groups. The total operative time, VUA time, blood loss and catheterisation time were lower in group 2, which received the novel, modified technique compared with group 1, which received the standard technique to dissect the apex of the prostate （P〈0.01 for each variable）. Regarding the extravasation rate and the occurrence of anastomotic strictures, no significant differences were found between the two groups （P〉0.0.05 for each）. After catheter removal, a statistically significant difference in the continence rates was present at 3 and 30 days post operation in the two groups （P〈0.01, respectively）. At 90 days post operation, the difference, although still present, was no longer statistically significant （P〉0.05）. The novel, modified apical dissection of the prostate facilitates the VUA and significantly improves the efficacy of the procedure and early restoration of continence.展开更多
BACKGROUND Magnetic anchor technique(MAT)has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy,but has not been reported in laparoscopic partial hepatectomy.AIM To evaluate the feasibility of ...BACKGROUND Magnetic anchor technique(MAT)has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy,but has not been reported in laparoscopic partial hepatectomy.AIM To evaluate the feasibility of the MAT in laparoscopic left lateral segment liver resection.METHODS Retrospective analysis was conducted on the clinical data of eight patients who underwent laparoscopic left lateral segment liver resection assisted by MAT in our department from July 2020 to November 2021.The Y-Z magnetic anchor devices(Y-Z MADs)was independently designed and developed by the author of this paper,which consists of the anchor magnet and magnetic grasping apparatus.Surgical time,intraoperative blood loss,intraoperative accidents,operator experience,postoperative incision pain score,postoperative complications,and other indicators were evaluated and analyzed.RESULTS All eight patients underwent a MAT-assisted laparoscopic left lateral segment liver resection,including three patients undertaking conventional 5-port and five patients having a transumbilical single-port operation.The mean operation time was 138±34.32 min(range 95-185 min)and the mean intraoperative blood loss was 123±88.60 mL(range 20-300 mL).No adverse events occurred during the operation.The Y-Z MADs showed good workability and maneuverability in both tissue and organ exposure.In particular,the operators did not experience either a“chopstick”or“sword-fight”effect in the single-port laparoscopic operation.CONCLUSION The results show that the MAT is safe and feasible for laparoscopic left lateral segment liver resection,especially,exhibits its unique abettance for transumbilical single-port laparoscopic left lateral segment liver resection.展开更多
BACKGROUND Total laparoscopic distal gastrectomy(TLDG)is increasing due to some advantages over open surgery,which has generated interest in gastrointestinal surgeons.However,TLDG is technically demanding especially f...BACKGROUND Total laparoscopic distal gastrectomy(TLDG)is increasing due to some advantages over open surgery,which has generated interest in gastrointestinal surgeons.However,TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction.During the course of training,trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons.AIM To evaluate an appropriate,efficient and safe laparoscopic training procedures suitable for trainee surgeons.METHODS Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed.The trainees were taught a laparoscopic view of surgical anatomy,standard operative procedures and practiced essential laparoscopic skills.The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills.Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees.Learning curves were used to assess the utility of our training system.RESULTS Five trainees performed a total of 52 TLDGs(56.5%),while 40 TLDGs were conducted by two trainers(43.5%).Except for depth of invasion and pathologic stage,there were no differences in clinicopathological characteristics.Trainers performed more D2 gastrectomies than trainees.The total operation time was significantly longer in the trainee group.The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups.No difference was found in postoperative complications between the two groups.The learning curve of the trainees plateaued after five TLDG cases.CONCLUSION Preparing trainees with a laparoscopic view of surgical anatomy,standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.展开更多
Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysi...Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.展开更多
BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains contro...BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains controversial.We originally reported the augmented rectangle technique(ART)as a reconstruction option for total laparoscopic Billroth I reconstructions.Still,little is known about its effect on long-term outcomes,specifically the incidence of postgastrectomy syndrome and its impact on quality of life.AIM To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37(PGSAS-37)questionnaire.METHODS At Juntendo University,a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire.Multidimensional analysis was performed,comparing those 94 ART cases from our institution(ART group)to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database(PGSAS group).RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales(i.e.,esophageal reflux,abdominal pain,meal-related distress,indigestion,diarrhea,constipation,and dumping).The loss of body weight was marginally greater for those in the ART group than in the PGSAS group(-9.3%vs-7.9%,P=0.054).The ART group scored significantly lower in their dissatisfaction of ongoing symptoms,during meals,and with daily life.CONCLUSION ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.展开更多
Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilizatio...Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE) - i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery’s way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.展开更多
Background: Multiple studies from the last five years have demonstrated that single-incision laparoscopic surgery cholecystectomy (SILS) is not only feasible but also produces a result comparable with that of conventi...Background: Multiple studies from the last five years have demonstrated that single-incision laparoscopic surgery cholecystectomy (SILS) is not only feasible but also produces a result comparable with that of conventional laparoscopic cholecystectomy (CLC). Methods and results: In this bicentric study, we used the Short Form (36) (SF-36) and Nottingham Health Profile (NHP) surveys to estimate and compare the post-operative quality of life up to the 28th post-operative day for 66 patients who had undergone either CLC (n = 32) or SILS (n = 34). Additionally, we investigated patient satisfaction with the cosmetic results after one year. The curves summarizing the eight sections in the physical sum scale and in the mental sum scale (SF-36) were the same within the confidence interval with a confidence level of 95%. Thus, post-operative quality of life could be assumed to be equivalent for the two groups. Evaluation of the NHP survey produced similar results. The perceived cosmetic results were significantly better for the SILS group (1.3 on a scale of 1 - 5 with 1 being the best) than for the CLC group (1.9) (p = 0.016). Conclusions: This study did not demonstrate better quality of life for the single-port procedure as it had been expected. Instead, the single-port procedure produced subjectively better cosmetic results.展开更多
In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(...In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.展开更多
This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical seg...This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical segment VIII resection,a challenging procedure due to the complex liver anatomy and difficulty in accessing deep-seated lesions.Peng and colleagues’experience with caudal and cranial approaches in 34 patients underscores the feasibility of these techniques while sparking debates about the optimal approach.Their study’s strengths lie in technique standardization and comprehensive analysis,although its limitations highlight the need for further research.As minimally invasive liver surgery progresses,larger,prospective trials and integration of advanced technologies are essential for establishing best practices.展开更多
The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term out...The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term outcomes.A retrospective comparative analysis was performed on 120 patients who underwent laparoscopic radical excision for rectal cancer from June 2017 to June 2021.Patients were categorized into two groups:Group RIES(n=58),which received the novel RIES technique,and Group AIES(n=62),which underwent the conventional abdominal incision for specimen extraction.Short-term outcomes,such as postoperative pelvic sepsis,temporary ileus,anastomotic leakage,and anastomotic stricture,were meticulously recorded.Longterm efficacy was evaluated through the 3-year overall survival(OS),disease-free survival(DFS),and local recurrence rate(LRR).The RIES group demonstrated a 3-year OS,DFS,and LRR of 86.2%,77.6%,and 8.6%,respectively,with a low incidence of short-term complications.Comparatively,the AIES group showed a 3-year OS,DFS,and LRR of 83.9%,74.2%,and 19.4%,respectively,with slightly higher rates of postoperative complications.Statistical analysis using the Student's t-test,the chi-square(χ^(2))test revealed no significant differences in the primary outcomes between the two groups,and suggested the noninferiority of the RIES technique.The study suggests that the RIES technique is a safe,feasible,and potentially functional and oncological superior approach to rectal cancer treatment,without compromising clinical efficacy.Further research is warranted to validate thesefindings in a larger,multicenter,and randomized controlled trial.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
In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP hav...In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP have an important role in gastrointestinal and biliary diseases,each technique has its limitations.Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time.Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area.Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate.The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction,stenosis and bile duct injuries.For patients with simultaneous presence of stones in the gallbladder and the common bile duct,the laparoendoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP.Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction.The most common used approach to deliver the magnets is by percutaneous-peroral tract.Laparoscopicassisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.展开更多
Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical to...Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.展开更多
AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 wer...AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.展开更多
The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the y...The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.展开更多
文摘Inguinal hernia is a prevalent global surgical condition,accounting for millions of repairs annually.Tension-free mesh repair has become the gold standard for both open approaches(e.g.,Lichtenstein repair)and laparoscopic techniques(e.g.,transabdominal preperitoneal and totally extraperitoneal[TEP]repairs).1,2,3 Guidelines updated in 2018 and 2023 emphasize mesh-based repairs,providing recommendations to optimize outcomes and minimize complications.1,2 Laparoscopic hernia repair,particularly TEP,offers several advantages,such as reduced pain,quicker recovery,and improved cosmetic outcomes.
文摘BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.
文摘BACKGROUND Among the rapidly developing single-incision laparoscopic cholecystectomy(LC)techniques,transumbilical single-incision LC is increasingly replacing the traditional LC,with advantages of minimal invasion,slight postoperative pain,faster recovery.Despite the advantages mentioned above,the currently available specialized single-port laparoscopic instruments are hindered by high costs and limited applications,challenging their widespread use in medical facilities.AIM To design a two-point lifting/retracting(TPLR)technique for transumbilical single-port LC(TUSPLC)based on the anatomical features of the Calot's triangle(or cystohepatic triangle)and investigate its surgical feasibility.METHODS The clinical data of 103 patients who underwent TUSPLC utilizing the TPLR technique in the Department of Hepatobiliary Surgery at our hospital between June 2023 and June 2024 were retrospectively analyzed.The patient cohort included 82 cases of cholelithiasis,11 cases of gallbladder polyps,6 cases of concurrent gallstones and polyps,and 4 cases of gallbladder adenomyomatosis.RESULTS All the surgical procedures were conducted using standard laparoscopic instruments.Surgery was successful in 98(95.14%)patients using the TPLR method,which effectively exposed the Calot's triangle during surgery.The operative time ranged from 35 to 70 minutes,with an average of 42.4±26.8 minutes.In 3 cases,an additional operative port was required below the xiphoid process,and 2 cases were converted to conventional three-port LC.No complications such as abdominal pain,fever,bile leakage,hemorrhage,or incisional infection were noted postoperatively.No discernible surgical scars were observed at the 2-week postoperative reexamination.Additionally,a 3-month follow-up period revealed no complications.CONCLUSION The TPLR technique,developed based on the anatomical features of the Calot's triangle,facilitates exposure of the Calot's triangle during surgery.It is a simple,safe,feasible,and cost-effective method,and a promising approach for single-port LC.
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.
文摘Objective:To investigate the quantitative influence of engineering parameters(diameter,bending angle)of minimally invasive surgical instruments and single-port laparoscopic surgery on biomarkers of ovarian reserve function,and establish a multi-parameter coupled mathematical prediction model,providing a theoretical basis for precision instrument design and operation optimization.Methods:A total of 45 reproductive-age patients undergoing single-port laparoscopic ovarian cystectomy were selected.Through orthogonal experimental design,the instrument diameter(3/5/8 mm)and bending angle(30°/60°/90°)were divided into 9 groups,with5 cases in each group.Changes in serum AMH(anti-müllerian hormone),FSH(follicle-stimulating hormone),INHB(inhibin B)and ultrasonic AFC(antral follicle count)indexes were measured before surgery and on the 2nd to 3rd day of the first menstrual period after surgery.Enhanced CT images and laparoscopic images of ovarian force distribution were obtained.Finite element analysis(FEA)of the single-port instrument-ovarian tissue model was performed using ABAQUS software to calculate stress distribution in the ovarian cortex.Oscillatory shear experiments were used to determine the characteristics of viscoelastic property changes in the linear viscoelastic range of ovarian tissue.Results:The rate of decrease in AMH was lower in the 3 mm diameter-30°angle group(P<0.05);the peak Von Mises stress in the D3-θ30 group was lower than that in the other groups(P<0.05);the optimal parameter combination was a diameter of 3.13 mm and an angle of 21.72°,with the model calculating an AMH attenuation of 20%.Ovarian tissue changed with the frequency of the oscillatory shear test.In the low-frequency region(<1 Hz):G'>G''(elasticity-dominated);in the high-frequency region(>5 Hz):G''>G'(viscosity-dominated);the crossover point was at 5 Hz,where G'=G''=5 kPa.Before ovarian dissection:G'was relatively high and G''was relatively low,with elasticity dominating.During dissection:G'decreased and G''increased,with instrument stress causing damage.After dissection:G'further decreased and G''continued to rise,resulting in irreversible damage to the ovarian stroma.Conclusion:The engineering parameters of minimally invasive instruments significantly affect the ovarian reserve function index AMH and the peak Von Mises stress of the ovary through mechanical stress transmission.Using an instrument with a diameter of 3.13 mm and a bending angle of 21.72°can more effectively reduce the impact of single-port laparoscopic surgery on AMH decline.
基金This study was supported by the National Natural Science Foundation of China （No. 30973011, No. 30772178 and No. 30801147）, the Research Fund for the Doctoral Program of Higher Education of China （No. 20060558032）, the Natural Science Foundation of Guangdong Province （No. 7117362）, the Program of 5010 of Sun-Yat Sen University, China （No. 2007028） and the Fundamental Research Funds for the Central Universities of China.
文摘A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis （VUA） in laparoscopic radical prostatectomy （LRP） was reported. A total of 42 patients were randomly selected and enrolled in this study. A standard LRP was performed in 21 patients （group 1）, whereas a novel, modified apical dissection of the prostate in LRP was performed in another 21 patients （group 2）. Surgical data, total operative time, VUA time, extravasation rate, catheterisation time, occurrence of anastomotic strictures, and the early and late continence rates were analysed statistically. No differences in clinical or pathological characteristics were determined between the two groups. The total operative time, VUA time, blood loss and catheterisation time were lower in group 2, which received the novel, modified technique compared with group 1, which received the standard technique to dissect the apex of the prostate （P〈0.01 for each variable）. Regarding the extravasation rate and the occurrence of anastomotic strictures, no significant differences were found between the two groups （P〉0.0.05 for each）. After catheter removal, a statistically significant difference in the continence rates was present at 3 and 30 days post operation in the two groups （P〈0.01, respectively）. At 90 days post operation, the difference, although still present, was no longer statistically significant （P〉0.05）. The novel, modified apical dissection of the prostate facilitates the VUA and significantly improves the efficacy of the procedure and early restoration of continence.
基金the Key Research&Development Program of Shaanxi Province of China,No.2024SF-YBXM-447the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07+1 种基金the Fundamental Research Funds for the Central Universities,No.xzy022023068the Natural Science Basic Research Plan in Shaanxi Province of China,No.2020JZ-37.
文摘BACKGROUND Magnetic anchor technique(MAT)has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy,but has not been reported in laparoscopic partial hepatectomy.AIM To evaluate the feasibility of the MAT in laparoscopic left lateral segment liver resection.METHODS Retrospective analysis was conducted on the clinical data of eight patients who underwent laparoscopic left lateral segment liver resection assisted by MAT in our department from July 2020 to November 2021.The Y-Z magnetic anchor devices(Y-Z MADs)was independently designed and developed by the author of this paper,which consists of the anchor magnet and magnetic grasping apparatus.Surgical time,intraoperative blood loss,intraoperative accidents,operator experience,postoperative incision pain score,postoperative complications,and other indicators were evaluated and analyzed.RESULTS All eight patients underwent a MAT-assisted laparoscopic left lateral segment liver resection,including three patients undertaking conventional 5-port and five patients having a transumbilical single-port operation.The mean operation time was 138±34.32 min(range 95-185 min)and the mean intraoperative blood loss was 123±88.60 mL(range 20-300 mL).No adverse events occurred during the operation.The Y-Z MADs showed good workability and maneuverability in both tissue and organ exposure.In particular,the operators did not experience either a“chopstick”or“sword-fight”effect in the single-port laparoscopic operation.CONCLUSION The results show that the MAT is safe and feasible for laparoscopic left lateral segment liver resection,especially,exhibits its unique abettance for transumbilical single-port laparoscopic left lateral segment liver resection.
基金Japan China Sasakawa Medical Fellowshipthe China Scholarship Council,No.201908310012。
文摘BACKGROUND Total laparoscopic distal gastrectomy(TLDG)is increasing due to some advantages over open surgery,which has generated interest in gastrointestinal surgeons.However,TLDG is technically demanding especially for lymphadenectomy and gastrointestinal reconstruction.During the course of training,trainee surgeons have less chances to perform open gastrectomy compared with that of senior surgeons.AIM To evaluate an appropriate,efficient and safe laparoscopic training procedures suitable for trainee surgeons.METHODS Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were reviewed.The trainees were taught a laparoscopic view of surgical anatomy,standard operative procedures and practiced essential laparoscopic skills.The TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee skills.Early surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by trainees.Learning curves were used to assess the utility of our training system.RESULTS Five trainees performed a total of 52 TLDGs(56.5%),while 40 TLDGs were conducted by two trainers(43.5%).Except for depth of invasion and pathologic stage,there were no differences in clinicopathological characteristics.Trainers performed more D2 gastrectomies than trainees.The total operation time was significantly longer in the trainee group.The time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two groups.No difference was found in postoperative complications between the two groups.The learning curve of the trainees plateaued after five TLDG cases.CONCLUSION Preparing trainees with a laparoscopic view of surgical anatomy,standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG safely and feasibly.
文摘Objective: To analyze the relationship between the numbers of cases experienced and the operation time for a single surgeon aiming to master the TLH surgical technique. Material and Methods: Retrospective data analysis of women who underwent TLH for benign diseases between April, 2014 and March, 2016 was conducted by a single surgeon in a single hospital (Showa University of Fujigaoka Hospital). We divided the main procedures of the TLH operation into five sections, and measured the time required for each section. These cases were divided into three groups, group 1, 2, and 3. Results: There were 54 cases of TLH over two years for a single surgeon, and 21 cases that included essential operative procedures were divided into three groups of seven cases each. The average duration of the surgery (min.) was 178.3 ± 48.2 in the group 1, 128.3 ± 15.6 in the group 2, and 111.3 ± 15.9 in the group 3. A significant reduction in the required time was observed between group 1, 2, and 3 groups. As the number of cases increased, the operation time became statistically significantly shorter for every section except B and D. The skill growth rate was different at each section. Conclusion: For a single surgeon, as the number of surgical cases increased, we recognized the increased skill with the procedure in every section and the rate of skill growth differed for different sections. The difference of growth rate for each section implied that the number of operative cases required for a surgeon in each section was different.
文摘BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains controversial.We originally reported the augmented rectangle technique(ART)as a reconstruction option for total laparoscopic Billroth I reconstructions.Still,little is known about its effect on long-term outcomes,specifically the incidence of postgastrectomy syndrome and its impact on quality of life.AIM To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37(PGSAS-37)questionnaire.METHODS At Juntendo University,a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire.Multidimensional analysis was performed,comparing those 94 ART cases from our institution(ART group)to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database(PGSAS group).RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales(i.e.,esophageal reflux,abdominal pain,meal-related distress,indigestion,diarrhea,constipation,and dumping).The loss of body weight was marginally greater for those in the ART group than in the PGSAS group(-9.3%vs-7.9%,P=0.054).The ART group scored significantly lower in their dissatisfaction of ongoing symptoms,during meals,and with daily life.CONCLUSION ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
文摘Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE) - i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery’s way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.
文摘Background: Multiple studies from the last five years have demonstrated that single-incision laparoscopic surgery cholecystectomy (SILS) is not only feasible but also produces a result comparable with that of conventional laparoscopic cholecystectomy (CLC). Methods and results: In this bicentric study, we used the Short Form (36) (SF-36) and Nottingham Health Profile (NHP) surveys to estimate and compare the post-operative quality of life up to the 28th post-operative day for 66 patients who had undergone either CLC (n = 32) or SILS (n = 34). Additionally, we investigated patient satisfaction with the cosmetic results after one year. The curves summarizing the eight sections in the physical sum scale and in the mental sum scale (SF-36) were the same within the confidence interval with a confidence level of 95%. Thus, post-operative quality of life could be assumed to be equivalent for the two groups. Evaluation of the NHP survey produced similar results. The perceived cosmetic results were significantly better for the SILS group (1.3 on a scale of 1 - 5 with 1 being the best) than for the CLC group (1.9) (p = 0.016). Conclusions: This study did not demonstrate better quality of life for the single-port procedure as it had been expected. Instead, the single-port procedure produced subjectively better cosmetic results.
文摘In this article,we provide an important commentary on the original study Lu et al,which offers insight into the surgical efficacy of transanal total mesorectal excision(TaTME)vs laparoscopic total mesorectal excision(LapTME)in the management of low-lying locally advanced rectal cancer(LARC).We focus specifically on the rate of postoperative complications between the two using existing data from the literature.We additionally introduce robotic total mesorectal excision(RTME)and look at its postoperative complications relative to the TaTME and LapTME.LARC has been conventionally approached by open surgery.However,minimally invasive techniques have emerged over the past two decades as alternatives to open total mesorectal excision,namely robotic,laparoscopic,and transanal.Each approach has its supporters,but conflicting data on resection outcomes and complications has fueled ongoing debate over the optimal minimally invasive technique for low/mid-LARC.This article aims to extend on the data regarding the use of TaTME and RTME in the treatment of low/mid-LARC and further elaborate on their comparative efficacy relative to LapTME.
基金Supported by National Natural Science Foundation of China,No.82170406 and No.81970238.
文摘This article comments on the study by Peng et al,published in the World Journal of Gastrointestinal Surgery,representing a notable advancement in hepatobiliary surgery.This article examines laparoscopic anatomical segment VIII resection,a challenging procedure due to the complex liver anatomy and difficulty in accessing deep-seated lesions.Peng and colleagues’experience with caudal and cranial approaches in 34 patients underscores the feasibility of these techniques while sparking debates about the optimal approach.Their study’s strengths lie in technique standardization and comprehensive analysis,although its limitations highlight the need for further research.As minimally invasive liver surgery progresses,larger,prospective trials and integration of advanced technologies are essential for establishing best practices.
文摘The objective of this study is to evaluate the efficacy of laparoscopic surgery combined with the rectal inversion and specimen extraction(RIES)technique for rectal cancer,focusing on both short-term and long-term outcomes.A retrospective comparative analysis was performed on 120 patients who underwent laparoscopic radical excision for rectal cancer from June 2017 to June 2021.Patients were categorized into two groups:Group RIES(n=58),which received the novel RIES technique,and Group AIES(n=62),which underwent the conventional abdominal incision for specimen extraction.Short-term outcomes,such as postoperative pelvic sepsis,temporary ileus,anastomotic leakage,and anastomotic stricture,were meticulously recorded.Longterm efficacy was evaluated through the 3-year overall survival(OS),disease-free survival(DFS),and local recurrence rate(LRR).The RIES group demonstrated a 3-year OS,DFS,and LRR of 86.2%,77.6%,and 8.6%,respectively,with a low incidence of short-term complications.Comparatively,the AIES group showed a 3-year OS,DFS,and LRR of 83.9%,74.2%,and 19.4%,respectively,with slightly higher rates of postoperative complications.Statistical analysis using the Student's t-test,the chi-square(χ^(2))test revealed no significant differences in the primary outcomes between the two groups,and suggested the noninferiority of the RIES technique.The study suggests that the RIES technique is a safe,feasible,and potentially functional and oncological superior approach to rectal cancer treatment,without compromising clinical efficacy.Further research is warranted to validate thesefindings in a larger,multicenter,and randomized controlled trial.
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 Key Research and Development Program of Science and Technology Department of Sichuan Province,No.2018GZ0088.
文摘In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP have an important role in gastrointestinal and biliary diseases,each technique has its limitations.Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time.Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area.Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate.The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction,stenosis and bile duct injuries.For patients with simultaneous presence of stones in the gallbladder and the common bile duct,the laparoendoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP.Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction.The most common used approach to deliver the magnets is by percutaneous-peroral tract.Laparoscopicassisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.
文摘Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.
文摘AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
文摘The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.
