Objective
To understand status of technical realization, present development, faced problems, and application prospects of reduced-port laparoscopic surgery for rectal cancer, and to analyze safety and feasibility so as to provide theoretical and practical basis for clinical application and promotion.
Method
By searching the databases such as Medline, Embase, and Wanfang, etc., the relevant literatures about reduced-port laparoscopic surgery for rectal cancer were collected and reviewed.
Results
At present, the most common reduced-port laparoscopic surgery was the 1-port laparoscopic surgery, 2-port laparoscopic surgery, and 3-port laparoscopic surgery. The 1-port laparoscopic surgery had the effects of minimal invasiveness and cosmesis, but it was difficult to perform. The 2-port laparoscopic surgery for rectal cancer preserved as far as possible the effect of minimal invasiveness, the difficulty of procedure was reduced greatly, which was easy to be learnt and promoted. The experience of the 3-port laparoscopic surgery for rectal cancer contributed to the technical development of the 1-port laparoscopic surgery, with no need for the assisted incision for intraoperative specimen. The reduced-port laparoscopic surgery for rectal cancer was technically feasible and safe, which possessed the equal or better short-term outcomes as compared with the conventional 5-port laparoscopic or open surgery beside the radical resection for rectal cancer. However, the stringent technique for the laparoscopic surgery was necessary and it needed to overcome the learning curve.
Conclusions
Reduced-port laparoscopic surgery has some obvious advantages in minimal invasiveness, cosmesis, and enhanced recovery. More large-sample, multi-center, randomized controlled trials are eager to further confirm safety, effectiveness, and feasibility of reduced-port laparoscopic surgery for rectal cancer.
ObjectiveTo systematically review the influence on ovarian reserve function by different hemostatic methods during laparoscopic cystectomy in treatment of ovarian endometrioma (OE).
MethodsDatabases including The Cochrane Library, PubMed, EMbase, CNKI, CBM and WanFang Data were electronically searched, to collect relevant randomized controlled trials (RCTs) about laparoscopic electro coagulation vs. microscopically suture for OE from 1990 to Mar, 2014. Meanwhile, references of included studies were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis.
ResultsA total of 16 RCTs involving 1 236 patients were finally included. The results of meta-analysis showed that the luteinizing hormone (LH) levels after 1 month, 2 months, 6 months and 12 months and estradiol (E2) levels after 2 months, 6 months had no significant differences between the two groups and the E2 level after 12 month of the suture group was significantly lower than that of the electro coagulation group. The levels of follicle stimulating hormone (FSH), LH, E2, antral follicle count (AFC), mean ovarian stromal peak systolic blood flow velocity (PSV) and anti-Mullerian hormone (AMH) in the suture group were significantly superior to those in the electro coagulation group at other follow-up time.
ConclusionCurrent evidence suggests that in treatment of ovarian endometriotic cyst by laparoscopic cystectomy, compared with electro coagulation hemostasis, suture hemostasis has less influence on ovarian reserve function. Due to limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). MethodThe data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. ResultsThe surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ2=1.675, P=0.196) and OS (χ2=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. ConclusionsSimultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.
Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing the rate of postoperative complications. Thus, this review summarizes the evolution of SILSG, further understanding and emphasizing the importance of standardized and precise surgical procedures.
ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
ObjectiveTo summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer. MethodsThe clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed. ResultsLaparoscopic distal gastrectomy was performed successfully in all patients. The operation time was (283.2±27.6) min (270-450 min) and the blood loss was (178.4±67.4) ml (80-350 ml). The time of gastrointestinal function recovery was (2.8±1.2) d (2-4 d), out of bed activity time was (1.5±0.4) d (1-3 d) and liquid diet feeding was (3.5±1.4) d (3-4 d). The hospital stay was (10.0±2.6) d (7-13 d). The number of harvested lymph nodes was 11 to 34 (17.8±7.3). The distance from proximal surgical margin to tumor was (7.0±2.1) cm (5-12 cm) and the distance from distal surgical margin to tumor was (5.5±1.8) cm (4-8 cm), thus surgical margins were negative in all samples. All patients were followed up for 3-48 months (mean 18.5 months), two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months, respectively, and other patients survived well. ConclusionsLaparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible. However, the advantage of laparoscopic technique over the conventional open surgery requires further study.
ObjectiveTo compare the clinical outcomes of laparoscopic magnetic compression cholangiojejunostomy (LMCCJ) with laparoscopic hand-sutured cholangiojejunostomy (LHSCJ). MethodsA retrospective case-control study was performed. From January 2019 to May 2022, 37 patients, who underwent laparoscopic treatment in this hospital, were enrolled in this study. There were 16 cases in the LMCCJ group and 21 cases in the LHSCJ group. The demographic information, procedure time to complete bilioenteric reconstruction, postoperative hospital stay, operative complications, magnets expulsion time, and follow-up results were collected and analyzed. ResultsThere were no statistical differences in the baseline data such as the gender, age, composition of primary diseases, preoperative total bilirubin, and preoperative common bile duct diameter between the two groups (P＞0.05). The outer diameter of the magnets was (10.50±0.97) mm, the expulsion time of the magnets was (49.69±37.58) d, and the expulsion rate of the magnets was 100% (16/16). There was no intestinal obstruction or gastrointestinal perforation caused by the retention of the magnets. The procedure time to complete bilioenteric reconstruction in the LMCCJ group was statistically shorter than that in the LHSCJ group [(11.31±3.40) min vs. (24.81±3.40) min, t=11.96, P＜0.01]. There was no statistical difference in the total bilirubin level at the first week after surgery between the two groups (U=142.0, P=0.80). The postoperative hospital stay in the LMCCJ group was longer than that in the LHSCJ group [(28.31±14.11) d vs. (16.19±7.56) d, t=3.36, P＜0.01]. During the perioperative period, there was no bleeding or biliary infection in the two groups, but one case of biliary leak in the LHSCJ group. In all 37 patients were followed-up for (548.8±259.2) d. During the follow-up period, the incidence rates of biliary intestinal anastomosis stenosis, tumor recurrence, and mortality had no statistical differences between the two groups (P＞0.05). ConclusionFrom the results of comparative analysis in this study, it can be concluded that LMCCJ is not only safe equally, but also easier and less time-consuming as compared with LHSCJ.
Objective
To investigate the learning curve of laparoscopic assisted rectal cancer radical resection of a surgeon and share the experience of laparoscopic surgery.
Methods
The date of 119 consecutive patients who were suffered operation by same team during January 2010 to December 2015 were retrospectively analyzed. The learning curve and its stages were obtained by using weighted moving average method, cumulative sum analysis(CUSUM), risk-adjusted CUSUM (RA-CUSUM)and Matlab software. The effects of each stage, such as operative time, intraoperative bold loss, harvested lymph node numbers, distal margin to the edge of tumor, complications after operation, hospital stay days, and the first time take soft food were compared, and the experience of laparoscopic assisted surgery for rectal cancer was summarized.
Results
Our learning curve was divided into three periods, the cutting point was around 36th and 80th cases, respectively. There was no significant difference between the 3 stages in general data, however when comparing the operative time, loss of blood, harvested lymph node numbers, the distal margin to the edge of tumor, hospital stay and total complications, the last period were best and the first stage were worst.
Conclusions
The learning curve can be divided into three stages, the exploration, mastery and proficient period. Our term, fixed and with rich experience in laparotomy, completed our first exploration period at about 36th patients and the second stage is around 80th cases. And the short term effect of each period’s had gradually improved with master of laparoscopic technique.
ObjectiveTo summarize the current common clinical laparoscopic gastrointestinal tumor surgical localization methods, and to provide reference for clinicians to choose reasonable localization methods. MethodThe domestic and foreign literatures related to laparoscopic gastrointestinal tumor surgical localization methods were searched and reviewed. ResultsThe common localization methods for laparoscopic gastrointestinal tumor surgery were imaging localization, preoperative endoscopic localization, intraoperative endoscopic localization and intraoperative fluorescence localization, among which abdominal enhanced CT and endoscopic-related localization methods were the most commonly used localization methods in clinical practice at present. ConclusionA variety of methods are available for surgeons to choose from, and the precise localization of tumors is better facilitated by combining multiple methods.
