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
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
AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.
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
目的探讨肥胖患者施行经脐单孔腹腔镜手术(transumbilical laparoendoscopic single site surgery,TU-LESS)加一个操作孔的两孔腹腔镜子宫肌瘤剔除术的安全性。方法回顾性分析2020年7月~2023年7月139例两孔腹腔镜子宫肌瘤剔除术资料,其...目的探讨肥胖患者施行经脐单孔腹腔镜手术(transumbilical laparoendoscopic single site surgery,TU-LESS)加一个操作孔的两孔腹腔镜子宫肌瘤剔除术的安全性。方法回顾性分析2020年7月~2023年7月139例两孔腹腔镜子宫肌瘤剔除术资料,其中24例体重指数(BMI)≥28,115例BMI<28。TU-LESS入路基础上在左下腹增加一个5 mm辅助操作孔,使用传统腹腔镜及手术器械实施手术。比较2组围术期指标。结果1例(BMI 31.6)因手术操作困难增加第2个辅助孔,其余138例均未中转手术方式,术中、术后未出现严重并发症。2组手术时间、术中出血量、手术前后血红蛋白差值、术后首次排气时间、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后发热、术后住院时间、住院费用差异均无显著性(P>0.05)。结论肥胖患者行TU-LESS加一个操作孔的两孔腹腔镜子宫肌瘤剔除术安全、可行。展开更多
目的初步探讨经腹壁疤痕入路单孔腹腔镜下胆囊切除术的安全性和可行性。方法回顾性分析2022年01月至2025年05月在联勤保障部队第九〇一医院肝胆胰外科行单孔腹腔镜下胆囊切除术的95例胆囊结石患者的临床资料。根据手术方式分为经脐入路...目的初步探讨经腹壁疤痕入路单孔腹腔镜下胆囊切除术的安全性和可行性。方法回顾性分析2022年01月至2025年05月在联勤保障部队第九〇一医院肝胆胰外科行单孔腹腔镜下胆囊切除术的95例胆囊结石患者的临床资料。根据手术方式分为经脐入路单孔腹腔镜组50例和经腹壁疤痕入路单孔腹腔镜组45例。观察并比较两组患者的手术时间、术中出血量、术后12小时疼痛视觉模拟评分(visual analog score,VAS)、术后首次肛门排气时间、术后住院天数、并发症(包括切口感染、血肿、发热)及切口愈合不良率。结果经脐入路单孔腹腔镜组50例手术均顺利完成,术中未更改手术方式。经腹壁疤痕入路单孔腹腔镜组45例,其中1例三次剖宫产术后,因腹腔粘连严重,术中转为三孔,其余44例术中未更改手术方式。两组患者的术中出血量、术后12h VAS、术后住院天数、术后并发症(包括切口感染、血肿、发热)及伤口愈合不良率比较,差异均无统计学意义(P>0.05);两组患者手术时间和术后首次排气时间相比,差异具有统计学意义(P<0.05),经疤痕入路组手术时间短于经脐入路组,但经脐入路组术后首次排气时间短于经腹壁疤痕入路组。结论经腹壁疤痕入路单孔腹腔镜胆囊切除术安全、可行,既秉承了微创手术疼痛轻、恢复快、“无痕”的理念,又缩短了手术时间,可临床推广应用,对符合条件的患者可经剖宫产疤痕入路,仍需要更多病例和研究进一步证实。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.
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.
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.
文摘目的探讨肥胖患者施行经脐单孔腹腔镜手术(transumbilical laparoendoscopic single site surgery,TU-LESS)加一个操作孔的两孔腹腔镜子宫肌瘤剔除术的安全性。方法回顾性分析2020年7月~2023年7月139例两孔腹腔镜子宫肌瘤剔除术资料,其中24例体重指数(BMI)≥28,115例BMI<28。TU-LESS入路基础上在左下腹增加一个5 mm辅助操作孔,使用传统腹腔镜及手术器械实施手术。比较2组围术期指标。结果1例(BMI 31.6)因手术操作困难增加第2个辅助孔,其余138例均未中转手术方式,术中、术后未出现严重并发症。2组手术时间、术中出血量、手术前后血红蛋白差值、术后首次排气时间、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后发热、术后住院时间、住院费用差异均无显著性(P>0.05)。结论肥胖患者行TU-LESS加一个操作孔的两孔腹腔镜子宫肌瘤剔除术安全、可行。
文摘目的初步探讨经腹壁疤痕入路单孔腹腔镜下胆囊切除术的安全性和可行性。方法回顾性分析2022年01月至2025年05月在联勤保障部队第九〇一医院肝胆胰外科行单孔腹腔镜下胆囊切除术的95例胆囊结石患者的临床资料。根据手术方式分为经脐入路单孔腹腔镜组50例和经腹壁疤痕入路单孔腹腔镜组45例。观察并比较两组患者的手术时间、术中出血量、术后12小时疼痛视觉模拟评分(visual analog score,VAS)、术后首次肛门排气时间、术后住院天数、并发症(包括切口感染、血肿、发热)及切口愈合不良率。结果经脐入路单孔腹腔镜组50例手术均顺利完成,术中未更改手术方式。经腹壁疤痕入路单孔腹腔镜组45例,其中1例三次剖宫产术后,因腹腔粘连严重,术中转为三孔,其余44例术中未更改手术方式。两组患者的术中出血量、术后12h VAS、术后住院天数、术后并发症(包括切口感染、血肿、发热)及伤口愈合不良率比较,差异均无统计学意义(P>0.05);两组患者手术时间和术后首次排气时间相比,差异具有统计学意义(P<0.05),经疤痕入路组手术时间短于经脐入路组,但经脐入路组术后首次排气时间短于经腹壁疤痕入路组。结论经腹壁疤痕入路单孔腹腔镜胆囊切除术安全、可行,既秉承了微创手术疼痛轻、恢复快、“无痕”的理念,又缩短了手术时间,可临床推广应用,对符合条件的患者可经剖宫产疤痕入路,仍需要更多病例和研究进一步证实。
