ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
Objective To summarize and analyze the application value of triple stomach shaping technique in laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of patients undergoing simple LSG with triple stomach shaping technique carried out by the General Surgery Obesity and Metabolic Diseases Center of Chengdu Third People’s Hospital from January to December 2021 were retrospectively collected, recording the operative time and the occurrence of recent complications such as postoperative nausea/vomiting, gastric leakage, bleeding, obstruction/torsion within 30 days after operation. Results A total of 966 patients were collected, including 294 males and 672 females. The age was 16–65 years, average age was (32.8±8.6) years. Body mass index was 27.5–47.2 kg/m2, average was (34.2±3.5) kg/m2. All operations were successfully completed without conversion to laparotomy. The operative time was 45–170 min, average was (100.2+33.4) minutes. Postoperative nausea/vomiting occurred in 484 cases (50.10%), bleeding in 2 cases (0.21%, intraperitoneal bleeding in 1 case, intragastric bleeding in 1 case), gastric leakage in 1 case (0.10%, grade B leakage), and no perioperative death occurred. Hospitalization time was 4–24 d, average was (7.55±2.47) d. Two patients (0.21%) were hospitalized again due to nausea and vomiting within 30 days after operation, they were relieved and discharged after conservative medical treatment. Conclusion Triple gastric shaping technology is more physiological, safe and suitable for promotion.
Objective
To compare efficacy of laparoscopic and open duodenal circular drainage operation for superior mesenteric artery compressing syndrome (SMACS).
Methods
From December 2012 to December 2015, the clinical data of 23 cases of laparoscopic duodenal circular drainage operation (laparoscope group) and 28 cases of open duodenal circular drainage operation (open group) were analyzed. The operation time, intraoperative bleeding, postoperative ambulation time, postoperative analgesics usage, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time and postoperative incidence of complications were compared. The patients were followed up to confirm the effect after the operation.
Results
There were no differences of the age, sex, and body weight index between the laparoscope group and the open group (P>0.05). The operation time had no significant difference between these two groups (P>0.05). Compared with the open group, the intraoperative bleeding was less (P<0.05), the postoperative ambulation time, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time were shorter (P<0.05), the rates of postoperative analgesics usage, incision infection, pulmonary infection, and intestinal obstruction were lower (P<0.05) in the laparoscope group. The rates of anastomotic leakage and anastomotic bleeding, and total postoperative complications rate had no significant differences between these two groups (P>0.05). All the patients were followed up for 8–36 months. The clinical symptoms disappeared and the body weight increased to normal level in the two groups.
Conclusions
Preliminary results of in this study show that laparoscopic duodenal circular drainage operation in treatment of SMACS has some advantages such as less trauma, faster recovery, fewer complications and shorter hospitalization time. Laparoscopy will be an ideal choice for treatment of SMACS.
ObjectiveTo investigate the value of single incision laparoscopic cholecystectomy in the operation of benign diseases of the gallbladder in day surgery.MethodThe clinical data of 105 patients underwent the single incision laparoscopic cholecystectomy in the Day Operation Center of Zhengzhou Central Hospital of Zhengzhou University from March 2017 to December 2018 were retrospectively analyzed.ResultsThe single incision laparoscopic cholecystectomies were successfully performed in 105 patients with benign gallbladder diseases, including 65 cases of gallbladder stones, 26 cases of gallbladder polyps, 14 cases of gallbladder adenomyosis; 45 cases of men and 60 cases of women. In all cases, no incision was increased or no case was converted to laparotomy. No bile duct injury and intra-abdominal bleeding happened during the operation. All patients were discharged overnight (no more than 24 h) after the surgery and without delayed discharge and re-admission. The intraoperative blood loss was (10.3±3.5) mL, and the operation time was (55.0±25.5) min (from laparoscopy to gallbladder removal). The postoperative pain score was 1–2 and 0–1 on day 1 and on day 3 after the surgery, respectively. The postoperative incision cosmetic satisfaction score on month 6 after the operation was 4.5±0.5.ConclusionSingle incision laparoscopic cholecystectomy is safe and feasible for benign gallbladder disease during day surgery.
Objective To explore the related factors of postoperative pulmonary infection (PPI) in patients undergoing laparoscopic colorectal cancer surgery, and analyze the perioperative management strategy of pulmonary infection combined with the concept of enhanced recovery after surgery (ERAS). Methods Total of 687 patients who underwent laparoscopic colorectal cancer surgery in the colorectal cancer professional treatment group of Gastrointestinal Surgery Center of West China Hospital of Sichuan University from January 2017 to May 2019 were retrospectively included. According to the occurrence of PPI, all the included cases were divided into infection group (n=97) and non-infection group (n=590). The related factors and prevention strategies of PPI were analyzed. Results The rate of PPI among patients underwent laparoscopic resection in our study was 14.1% (97/687). Compared with the non-infection group, the proportions of patients with preoperative complications other than cardiopulmonary, receiving preoperative neoadjuvant radiotherapy and/or chemotherapy, preoperative Eastern Cooperative Oncology Group (ECOG) score 1–2, preoperative Nutrition Risk Screening 2002 (NRS2002) score 1–3, tumor located in the left colon and rectum, combined organ resection, operative time >3 h and postoperative TNM stage Ⅱ patients in the infection group were higher (P<0.05). However, the proportions of patients who used intraoperative lung protective ventilation strategy and incision infiltration anesthesia in the infection group were lower than those in the non-infection group (P<0.05). In the infection group, the proportions of patients who received regular sputum excretion, atomization therapy, balloon blowing/breathing training, stomatology nursing after operation and postoperative analgesia were all significantly lower than those of the non-infection group (P<0.05), whereas the proportions of patients receiving antibiotics and intravenous nutrition after operation were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that low preoperative NRS2002 score, intraoperative protective ventilation strategy, postoperative respiratory training, and postoperative regular sputum excretion were the protective factors of PPI, while preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor located in the left colon and rectum, late TNM staging and postoperative antibiotics were risk factors for pulmonary infection.Conclusions Preoperative cardiopulmonary complications, preoperative neoadjuvant chemotherapy, tumor location in the left colon and rectum, late TNM staging and postoperative antibiotics are risk factors for pulmonary infection in patients with laparoscopic colorectal cancer. Preoperative good nutritional status, intraoperative protective ventilation strategy, postoperative respiratory training and regular sputum excretion may reduce the incidence of PPI to a certain extent.
Objective To investigate the clinical effect of the DaVinci robot system and laparoscopic radical gastrectomy. Methods Propensity score matching and retrospective cohort study were adopted. Data of 446 patients who underwent robotic or laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery, Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University from January 2014 to April 2021 were collected. Among them, 174 cases underwent robotic and 272 cases underwent laparoscopic surgery. Using the method of propensity score matching, 133 cases were selected from robotic operation group and laparoscopic operation group respectively as the research object. The perioperative indexes of the two groups were compared. Kaplan-Meier survival analysis was used to draw the survival curve and calculate the survival rate. Cox regression model was used to analyze the risk factor of prognosis. Results There was no significant difference in baseline data between the robotic surgery group and the laparoscopic surgery group after propensity score matching (P>0.05). The operative time of the two groups [(236.47±50.32) min vs. (230.64±44.51) min, t=1.000, P=0.318], the number of lymph nodes dissected [(23.32±6.58) vs. (23.95±6.03), t=–0.826, P=0.410], the time of first anal exhaust [(3.46±0.77) days vs. (3.38±0.75) days, t=0.882, P=0.378], and the length of postoperative hospital stay [(6.98±2.84) days vs. (6.94±3.61) days, t=0.094, P=0.925] were similar, the differences were not statistically significant. Compared with the laparoscopic surgery group, the robotic surgery group had less intraoperative bleeding [(83.76±58.23) mL vs. (116.54±58.58) mL, t=–4.577, P<0.001], but the total hospitalization expenses was higher [(10.04±1.92) ten-thousand Yuan vs. (6.80±1.27) ten-thousand Yuan, t=16.211, P<0.001]. The incidence of postoperative complications between the two groups (χ2=0.057, P=0.812) and Clavien-Dindo classification of complications (Z=–0.440, P=0.965) were similar between the two groups, the differences were not statistically significant. The 3-year survival situation was similar between the two groups (P=0.356). Body mass index [RR=0.803, 95%CI (0.698, 0.924), P=0.002], TNM-staging [Ⅱ -stage vs.Ⅰ -stage, RR=4.152, 95%CI (1.121, 15.385), P=0.033; Ⅲ -stage vs.Ⅰ -stage, RR=5.476, 95%CI (1.458, 20.558), P=0.012] and postoperative complications [with vs. without, RR=3.262, 95%CI (1.283, 8.293), P=0.013] were prognostic factors for 3-year survival. Conclusion Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy has the same short-term and long-term prognosis.
ObjectiveTo investigate the clinical feasibility and value of laparoscopic precise segment Ⅳ hepatectomy by guiding of indocyanine green (ICG) fluorescence imaging via ligamenta teres hepatis. MethodThe clinicopathologic data of patients with liver cancer treated in the Department of Liver Surgery of West China Hospital of Sichuan University from January 2017 to December 2021 who underwent precise segment Ⅳ hepatectomy by the guidance of ICG fluorescence imaging through the ligamenta teres hepatis were collected retrospectively. ResultsA total of 6 patients were collected, including 5 males and 1 female. The age ranged from 42 to 78 years. All 6 patients were successfully completed using laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis. The operation time was (200±30) min, the intraoperative bleeding was (100±20) mL, and there were no intraoperative blood transfusion, postoperative liver failure, postoperative pneumonia, incision infection, bile leakage, postoperative bleeding, and other complications. The postoperative hospital stay was (7±2) d. One patient with positive microvascular invasion was found after operation and recurred at 38 months after operation, then treated by radiofrequency ablation and didn’t recur. No patient died during the follow-up period in 6 patients. ConclusionFrom results of limited cases in this study, laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis is safe, feasible, and effective.
ObjectiveTo compare the efficacy of totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through in the treatment of Hirschsprung’s disease (HD).MethodsPubMed, EMBASE, The Cochrane Library, CNKI, Wanfang, and VIP Database were searched to screen out the comparative studies published between January 1998 and May 2020 on the treatment of HD with totally transanal endorectal pull-through and laparoscopic assistance endorectal pull-through. Then two reviewers independently completed the literatures screening, data extraction, and quality evaluation. The Review Manager 5.3 software was used to combine the effect size of the postoperative effect indicators included in the literatures. Stata 14.0 software was used to perform Begg’s and Egger’s tests on the publication bias of the included literatures.ResultsA total of 8 clinical studies conforming to the standards were included and 702 cases of children undergoing HD radical resection were recorded, including 335 cases in the totally transanal endorectal pull-through group and 367 cases in the laparoscopic assistance endorectal pull-through group. Compared with the laparoscopic assistance endorectal pull-through group, the totally transanal endorectal pull-through group had an advantage in the incidence of postoperative faecal incontinence/soiling [OR=0.20, 95%CI was (0.07, 0.54), P=0.001], and the postoperative constipation recurrence rate was higher than the laparoscopic assistance endorectal pull-through group [OR=2.39, 95%CI was (1.05, 5.42), P=0.04]. There were no statistically significant differences between the two groups in terms of postoperative enterocolitis [OR=1.01, 95%CI was (0.59, 1.75), P=0.96], postoperative adhesion intestinal obstruction [OR=0.74, 95%CI was (0.28, 1.95), P=0.54], and postoperative anastomotic stenosis [OR=1.14, 95%CI was (0.51, 2.56), P=0.74].ConclusionsCompared with laparoscopic assistance endorectal pull-through, the totally transanal endorectal pull-through can reduce the incidence of postoperative faecal incontinence/soiling, but the rate of recurrence of postoperative constipation is higher. The two surgical procedures for HD have similar incidences of postoperative enterocolitis, anastomotic stenosis, and adhesive intestinal obstruction.
ObjectiveTo summarize the application status and prospect of laparoscopic pancreaticoduodenectomy (LPD).MethodThe relevant literatures about studies of LPD at home and abroad were reviewed.ResultsLPD was a difficult operation, mainly suitable for pancreatic head and periampullary benign and malignant tumors. With the development of laparoscopic techniques in recent years, LPD combined the superior mesenteric vein and portal vein resection and reconstruction, or combined multi-visceral resection was feasible, but the survival benefit of LPD with arterial resection and reconstruction and extended lymph node dissection remained to be discussed. At present, there was no clear requirement on the way to reconstruct the pancreatic fluid outflow tract, but the pancreaticojejunostomy for digestive tract reconstruction was chose by the most surgeons. The most studies had confirmed that LPD was minimally invasive and had a short-term prognosis that was not inferior to that of open pancreaticoduodenectomy. However, the results of large sample analysis about long-term survival rate and oncology results were lacking, so it was difficult to judge the advantages and disadvantages of long-term prognosis of the two methods.ConclusionsLPD is a safe, feasible, reasonable, and effective surgical method. With improvement of laparoscopic technology, LPD is expected to become a standard operation method for treatment of pancreatic head cancer and periampullary carcinoma, and oncology benefits of LPD will be further confirmed in future by large-sample clinical randomized control trials and studies of long-term prognosis follow-up.
ObjectiveTo investigate the role of 3D visualization technology in the laparoscopic precise hepatectomy. MethodsTo retrieve the literatures about the application of 3D visualization technology in laparoscopic precise hepatectomy, and summarize and analyzed them. ResultsThe application of 3D visualization in laparoscopic precise hepatectomy could effectively reduce the operative time, blood loss, blood transfusion rate, and total complication rate. The application of 3D visualization in preoperative evaluation of the resection surface and residual liver volume had been relatively mature. Although many organizations try to use 3D visualization in laparoscopic hepatectomy, such as laser registration and real-time intraoperative navigation, it had not been widely used in clinic because of technical limitations. ConclusionsExisting research results show that, the application of 3D visualization technology in laparoscopic precise hepatectomy can improve the resectability of lesions, increase perioperative safety, but intraoperative navigation is still need to be further developed before it is expected to be widely used in clinical practice. Existing evidence of increased benefit from laparoscopic precise hepatectomy with 3D reconstruction remains limited, and more rigorous randomized controlled trials of large cases are needed to confirm this.
