In current domestic research on laparoscopic training, researchers usually consider instrument movement path in the hand-eye coordination relationship. However, they ignore the information contained in visual cues by which could guide and control instrument movements. Studies in other areas have shown that trainers can improve their perceptual-motor skills by gaze training. This paper was designed to examine the effectiveness of eye gaze tracking technology in laparoscopic training and to analyze gaze strategy of the subjects in different training methods. The Tobii X1 Light Eye Tracker was used to track the gaze position of subjects when they were performing the two-handed transferring task in box trainer, and to obtain parameters related to gaze strategy including the efficiency of task completion, as well as visual search, visual processing and observation transfer analysis based on Markov chain model. The results showed that the completion time during the last training in gaze training group was decreased by 101.5 s comparing to the first training. Compared with video training group, gaze strategy of gaze training group has a significant change, such as fixation and saccade duration rate was increased by 38%, fixation duration on target area was increased, and saccade amplitude increased by 0.58°, and the probability of the fixation point transferring to equipment decreased by 15%. The results demonstrated that eye gaze tracking technology can be used in laparoscopic training, and can improve the subjects’ skills and shorten the learning curve by learning gaze strategies of experts.
ObjectiveTo investigate value of drainage fluid amylase content and other risk factors in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after laparoscopic pancreaticoduodenectomy (LPD).MethodsThe clinical data of 166 patients who underwent LPD in this hospital from January 2017 to December 2019 were retrospectively analyzed. The independent risk factors of CR-POPF after LPD were analyzed. And the sensitivity and specificity of drainage fluid amylase content obtained on postoperative day 1 and 3 (Abbreviated as DFA1 and DFA3, respectively) in predicting CR-POPF by receiver operating characteristic (ROC) curve.ResultsA total of 166 patients underwent LPD were collected in this study. The CR-POPF occurred in 16 (9.6%) patients and all of them were grade B. The DFA1 (P=0.037), DFA3 (P<0.001), and positive bacterial culture of drainage fluid after operation (P=0.020) were the independent risk factors of CR-POPF after LPD (P<0.05) by the logistic regression multivariate analysis. The area under the ROC curve of the DFA1 and DFA3 in predicting CR-POPF was 0.880 [95%CI (0.812, 0.949)] and 0.912 [95%CI (0.853, 0.971)] respectively, and the corresponding best critical value was 3 925 and 939 U/L, and the sensitivity was 100% and 100%, specificity was 64.0% and 70.7%, respectively.ConclusionFor patients with DFA1>3 925 U/L, DFA3>939 U/L, and positive bacterial culture of drainage fluid after operation, preventive measures should be made to avoid CR-POPF.
ObjectiveTo investigate the safety and feasibility of fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach. MethodWe retrospectively analyzed the clinical data of three patients who underwent fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach in Department of Hepatobiliary and Pancreas Minimally Invasive Surgery of Hunan Provincial People’s Hospital from April 2017 to April 2020.ResultsAll the three patients completed the operation pure laparoscopically. Pathology results showed one case of hepatocellular carcinoma and two cases of focal nodular hyperplasia, the tumor size range from 4–7 cm. The operation time was 240–320 min, and the blood loss was 150–500 mL. There was no intraoperative blood transfusion. The postoperative hospital stay was 10–30 days. Postoperative bile leakage occurred in one patient, which was cured by laparoscopic hepatectomy. Three patients were followed up for 8, 36, and 25 months, respectively, and all the patients survived and there was no tumor recurrence up to november 2020.ConclusionsLaparoscopic resection of central hepatic tumor is difficult and risky. Anterior transhepatic approach can maximize the preservation of liver parenchyma. In hepatobiliary and pancreatic centers with high volume of laparoscopic hepatectomy, this method is safe and feasible after strict patient selection, accurate preoperative evaluation, and fine intraoperative skills. Indocyanine green fluorescence navigation technology is helpful to accurately locate tumor during operation.
Objective
To evaluate the safety and efficacy of laparoscopic-assisted gastrectomy (LAG) comparing with conventional open gastrectomy (COG) in elderly patients with gastric cancer.
Methods
Databases included PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP were searched to collect the case-control studies about LAG versus COG for elderly patients with gastric cancer, and the searched time was from inception to May 2017. Then meta-analysis was performed by using RevMan 5.2 software.
Results
Finally, ten case-control studies included 1 522 patients were enrolled. There were 757 patients in observation group (underwent LAG) and 765 patients in control group (underwent COG). Results of meta-analysis showed that: the observation group was associated with less intraoperative blood loss ［MD=–121.12, 95% CI was (–179.93, –62.31), P<0.000 1］, more harvested lymph nodes ［MD=1.62, 95% CI was (0.60, 2.65), P=0.002］, shorter time to the first ambulation ［SMD=–2.58, 95% CI was(–4.58, –0.58), P=0.01］, shorter the postoperative intestinal function recovery time ［SMD=–0.85, 95% CI was (–1.20, –0.51), P<0.000 01］, shorter the time of oral intake ［MD=–0.90, 95% CIwas (–1.27, –0.52), P<0.000 01］, shorter hospital stay ［MD=–4.03,95% CI was (–5.62, –2.44), P<0.000 01］, lower incidences of overall postoperative complications ［OR=0.49, 95% CI was (0.38,0.64), P<0.000 01］, surgical-related complications ［OR=0.54, 95% CI was (0.39, 0.74), P=0.000 1］, incision relatedcomplications ［OR=0.42, 95% CI was (0.22, 0.81), P=0.010］, and respiratory complications ［OR=0.60, 95% CI was (0.38, 0.95), P=0.03］, but there was no significant difference on the operative time ［MD=8.36, 95% CI was (–10.97, 27.69), P=0.40］ and incidence of anastomotic fistula ［OR=0.60, 95% CI was (0.27, 1.31), P=0.20］.
Conclusions
The available evidences suggest that LAG is equally safe and feasible compared with COG, it has a significant advantages in reducing intraoperative blood loss and ensuring the number of lymph node dissected during surgery, with less trauma, shorter postoperative hospital stay, lower overall postoperative complications rate, and other short-term efficacy advantages.
ObjectiveTo explore the prevalence and adjacency of the tributaries of superior mesenteric vessel. MethodsThis study is a prospective study. The patients with right-sided colonic malignant tumor who underwent laparoscopic complete mesocolon excision at the Division of Colorectal Surgery of Peking Union Medical College Hospital from July 2016 to September 2022 were collected. The real-time observation and evaluation of vascular anatomy was performed by the operator and recorded by a resident. The continuous variables without a normal distribution were summarized as median (P25, P75). The categorical variables were presented as number (%). ResultsA total of 200 patients were enrolled, including 114 males and 86 females, with an age of 63.5 (53.5, 72.0) years. The prevalence of ileocolic artery and vein was 98.0% (196/200) and 98.5% (197/200), respectively. There were 168 (86.2%) cases of the ileocolic vein accompanied the course of the ileocolic artery at the origin in 195 patients with simultaneous presence of ileocolic artery and vein. The right colic artery and vein was present in 39.5% (79/200) and 18.5% (37/200) patients, respectively. The prevalence of the middle colic artery and vein was 96.5% (193/200) and 90.5% (181/200), respectively. And the prevalence of the middle colic vein accompanied the path of the middle colic artery at the root was 67.8% (118/174) in the 174 patients with simultaneous presence of middle colic artery and vein. The trunk length of the middle colic artery was 2.2 (1.6, 3.2) cm. The Henle trunk was present in 185 (92.5%) cases, with a trunk length of 1.00 (0.50, 1.40) cm, and its lower edge was 2.80 (2.20, 3.30) cm from the junction of the pancreatic head and the horizontal part of the duodenum.ConclusionsThe results from the data analysis of this study suggest that the ileocolic artery and vein are present most constantly with a high incidence of the ileocolic vein accompanied the course of the ileocolic artery at the origin of superior mesenteric vessels. Therefore ileocolic artery and vein are expected to serve as an optimal anatomical landmarks for the caudal-to-cranial medial approach in laparoscopic complete mesocolon excision.
Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.
Objective
To investigate safety, feasibility, and future direction of laparoscopic splenectomy.
Method
The latest progress and new achievements of laparoscopic splenectomy in the world were analyzed and summarized.
Results
At present, the laparoscopic splenectomy mainly included the completely laparoscopic splenectomy, hand assisted laparoscopic splenectomy, gasless laparoscopic splenectomy, single hole laparoscopic splenectomy, or robot assisted laparoscopic splenectomy. The completely laparoscopic total splenectomy had become the most common surgical procedure in the clinical treatment due to the reliable curative effect, less injury, and rapid recovery, the partial splenectomy was one of the precise treatments for the benign splenic lesions. The hand assisted laparoscopic splenectomy was widely used in the giant spleen, it could reduce the exposure difficulty, effectively deal with the intraoperative hemorrhage, and reduce the risk of surgery. The robot assisted laparoscopic splenectomy was one of the minimally invasive operations, the system with three-dimensional high definition vision and flexible robotic arm overcame the limitations of traditional laparoscopic two-dimensional display, could precisely complete the operation and achieve the accurate treatment.
Conclusions
Laparoscopic splenectomy has some advantages of less operative injury, less pain, and rapid recovery, it’s safety and feasibility have been proved. We should strictly grasp indications and contraindications for laparoscopic splenectomy, appropriate surgical methods should be selected for specific splenic diseases to achieve the best curative effect. Remote control and precision operation will be a direction of development in future.
Objective
To explore application value of three-dimensional (3D) laparoscopic visualization during bariatric surgery.
Methods
From January 2015 to May 2017, 64 patients underwent laparoscopic bariatric surgery in our department were included. Among these cases, 19 patients underwent 3D laparoscopic sleeve gastrectomy, and 21 patients underwent two-dimensional (2D) laparoscopic sleeve gastrectomy. Thirteen patients underwent 3D laparoscopic Roux-en-Y gastric bypass, and 11 patients underwent 2D laparoscopic Roux-en-Y gastric bypass. The total operative time, the digestive tract reconstruction time, the intraoperative blood loss, the postoperative hospitalization stay, and the operative complications were analyzed statistically.
Results
The laparoscopic bariatric surgery were performed successfully in all the 64 patients, no case was converted to the laparotomy, and no 3D laparoscopy was converted to the 2D laparoscopy. The suture time of the gastric incisal margin was shorter and the intraoperative blood loss was less with the 3D laparoscopic sleeve gastrectomy as compared with the 2D laparoscopic sleeve gastrectomy (P<0.05), but the total operative time and the postoperative hospitalization stay had no significant differences and none of postoperative complications happened between these two modes (P>0.05). The total operative time, the time to make gastric pouch, the time of the gastro-jejunal anastomosis or jejunum-jejunum anastomosis, and the intraoperative blood loss with the 3D laparoscopic Roux-en-Y gastric bypass were significantly less than those with the 2D laparoscopic Roux-en-Y gastric bypass (P<0.05), but the postoperative hospitalization stay had no significant difference between these two modes (P>0.05).
Conclusion
Pre-liminary results of limited cases in this study shows that 3D laparoscope could provide 3D stereoscopic visualization, which facilitateto clearly identify anatomical structures, and be helpful to complex operations, and then might reduce operating time, both physicians and patients could benefit from it.
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.
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor.
MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively.
ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease.
ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.
