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
Transumbilical endoscopic surgery or laparo-endoscopic single site(LESS)surgery has become an exciting area of surgical development as innovation continues to move in the 21st century to minimally invasive surgery.The...Transumbilical endoscopic surgery or laparo-endoscopic single site(LESS)surgery has become an exciting area of surgical development as innovation continues to move in the 21st century to minimally invasive surgery.The history,present situation and perspectives are reviewed and the nomenclature of this technique is discussed in this article.The range of this technique has been applied in almost all abdominal diseases,surgeries for morbid obesity,hernia and so on,in recent years.It is estimated that 50%-80%of traditional laparoscopic surgery could be performed transumbilically in the next five years according to the LESSCAR consensus.Although the concept of transumbilical laparoscopic surgery is gaining traction rapidly and the instruments have been improved greatly, we should not advocate for slightly improved cosmetic value over safety.Multicenter,randomized and clinical trials are necessary to further elucidate the safety and efficiency of this new technique.Research that examines the efficacy of the new instruments on the market may be helpful to simplify the confusing landscape of new and novel products designed for this purpose.展开更多
BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal ...BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.展开更多
AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.
The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patient...The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.展开更多
Objective: to explore the therapeutic method and effect of gynecological transumbilical single-port laparoscopy. Methods: a total of 140 patients who received umbilical single-port laparoscopic treatment in gynecology...Objective: to explore the therapeutic method and effect of gynecological transumbilical single-port laparoscopy. Methods: a total of 140 patients who received umbilical single-port laparoscopic treatment in gynecology department of our hospital from November 2019 to January 2021 were randomly selected as the research object. They were divided into two groups according to the coin toss method. There were 70 patients in the observation group and 70 patients in the control group. The patients in the control group were treated with conventional treatment, while the patients in the observation group were treated with comprehensive treatment. The perioperative indicators of the two groups were evaluated. Results: the time of getting out of bed, duration of postoperative pain, postoperative fever time and hospital stay in the observation group were shorter than those in the control group (P 0.05). Conclusion: in the process of gynecologic transumbilical single-port laparoscopic treatment, comprehensive treatment measures can effectively improve the perioperative related indicators, which is a better therapeutic scheme.展开更多
Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left l...Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.展开更多
Laparoscopic procedure as a minimally invasive surgery had been introduced into many abdominal surgery. Smaller incisions of the abdominal wall reduce postoperative pain and the risk of wound complications, and provid...Laparoscopic procedure as a minimally invasive surgery had been introduced into many abdominal surgery. Smaller incisions of the abdominal wall reduce postoperative pain and the risk of wound complications, and provide an excellent cosmetic result compared with open surgery. Flexible endoscope-based transgastric, transcolonic, or transvaginal surgery for abdominal exploration, cholecystectomy, appendectomy, and tubal ligation may further reduce the surgical invasion.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
In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development o...In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.展开更多
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.
基金Supported by the Medical Research Program from Shanghai Health Administration(2010142)the Key Disciplines Program from Pudong New Area Government(PWZxk2010-07)
文摘Transumbilical endoscopic surgery or laparo-endoscopic single site(LESS)surgery has become an exciting area of surgical development as innovation continues to move in the 21st century to minimally invasive surgery.The history,present situation and perspectives are reviewed and the nomenclature of this technique is discussed in this article.The range of this technique has been applied in almost all abdominal diseases,surgeries for morbid obesity,hernia and so on,in recent years.It is estimated that 50%-80%of traditional laparoscopic surgery could be performed transumbilically in the next five years according to the LESSCAR consensus.Although the concept of transumbilical laparoscopic surgery is gaining traction rapidly and the instruments have been improved greatly, we should not advocate for slightly improved cosmetic value over safety.Multicenter,randomized and clinical trials are necessary to further elucidate the safety and efficiency of this new technique.Research that examines the efficacy of the new instruments on the market may be helpful to simplify the confusing landscape of new and novel products designed for this purpose.
基金Supported by the Public Welfare Research and Special Fund of the National Health and Family Planning of China,No.201402007
文摘BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.
基金Supported by Science and Technology Projects of Haizhu District of Guangzhou,China,No.2012-cg-26
文摘AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.
文摘The aim of this paper is to present and describe tran-sumbilical laparoscopic-assisted appendectomy in chil-dren, focusing on its technical aspects and clinical andsurgical outcomes. The surgical charts of all patientsaged between 0 and 14 years treated with transumbili-cal laparoscopic-assisted appendectomy admitted tothe authors' institution from January 2009 to Septem-ber 2013 with a diagnosis of suspected appendicitis fol-lowing clinical, laboratory and ultrasound findings werereviewed. Operating time, intraoperative findings, needfor conversion or for additional trocars, and surgicacomplications were reported. During the study period,120 patients aged between 6 and 14 years(mean age:9.9 years), 73 females(61%) and 47 males(39%),were treated with transumbilical laparoscopic-assistedappendectomy. There were 37 cases of hyperemicappendicitis(subserosal and retrocecal), 74 cases ofphlegmonous appendicitis and 9 cases of perforatedgangrenous appendicitis. It was not possible to estab-lish a correlation between grade of appendicitis andmean operating time(P > 0.05). Eleven cases(9%)needed the use of one additional trocar, while 8 pa-tients(6%) required conversion to the standard laparo-scopic technique with the use of two additional trocars. No patient was converted to the open technique. Tran-sumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive tech-niques.
文摘Objective: to explore the therapeutic method and effect of gynecological transumbilical single-port laparoscopy. Methods: a total of 140 patients who received umbilical single-port laparoscopic treatment in gynecology department of our hospital from November 2019 to January 2021 were randomly selected as the research object. They were divided into two groups according to the coin toss method. There were 70 patients in the observation group and 70 patients in the control group. The patients in the control group were treated with conventional treatment, while the patients in the observation group were treated with comprehensive treatment. The perioperative indicators of the two groups were evaluated. Results: the time of getting out of bed, duration of postoperative pain, postoperative fever time and hospital stay in the observation group were shorter than those in the control group (P 0.05). Conclusion: in the process of gynecologic transumbilical single-port laparoscopic treatment, comprehensive treatment measures can effectively improve the perioperative related indicators, which is a better therapeutic scheme.
文摘Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.
文摘Laparoscopic procedure as a minimally invasive surgery had been introduced into many abdominal surgery. Smaller incisions of the abdominal wall reduce postoperative pain and the risk of wound complications, and provide an excellent cosmetic result compared with open surgery. Flexible endoscope-based transgastric, transcolonic, or transvaginal surgery for abdominal exploration, cholecystectomy, appendectomy, and tubal ligation may further reduce the surgical invasion.
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.
文摘In recent years,single access laparoscopic surgery(SALS) and natural orifice translumenal endoscopic surgery(NOTES) have gained interest from both clinical and industrial point of view,with the increased development of different laparoscopic instruments,production of various access ports,and improvement of operative endoscopes.The main advantages stimulating these two approaches are the cosmetic result,the rapid recovery of the patient,and the reduced need for pain killers.SALS and NOTES are in part complementary and in part alternative techniques.Currently,SALS is much simpler and technically easier than NOTES.
