Objective To summarize the experience of 23 cases of axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction, and to discuss its superiority and patient satisfaction. Methods The clinical data of 23 female breast cancer patients who underwent axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction from June 2021 to June 2022 in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively included. We summarized the surgical procedures, surgical safety, and postoperative patient satisfaction. Results Twenty-three patients have operated the axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction successfully without nipple reconstruction. Among them, 9 patients underwent dual-main surgeons’ surgery, and 14 patients underwent one-main surgeon surgery. The surgery time ranges from 3.5 to 7.0 h, mean of 4.76 h, and the mean operation time of 9 patients underwent dual-main surgeons’ surgery was shorter than that of patients underwent one-main surgeons’ surgery. The blood loss ranges from 20 to150 mL, mean of 45.7 mL. The postoperative hospital stay range from 0 to 24 d, mean of 10.7 d. Four people suffered from complications: 1 patient with prosthesis moving up, 2 patients with nipple-areola complications, and 1 patient with subcutaneous emphysema. All 23 women were followed for 3 months, and no one suffered from recurrence, metastasis, and death during this period. We surveyed people by BREAST-Q scale when pre-operation, 1 month after the operation, and 3 months after the operation. Compared with preoperative patients, the sexual well-being, psychosocial well-being, and chest physical well-being of 1 month postoperative patients were decreased, but obviously increased in 2 months. The satisfaction with breast of 3 months of postoperative patients were higher than preoperative patients. Conclusions Endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction can achieve good cosmetic results and improve surgical safety. The dual-main surgeons’ surgery can decrease the operation time, so as to reduce the risk of anesthesia for patients.
Objective
To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen.
Methods
The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis.
Results
① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups.
Conclusions
Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.
Objective
To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer.
Methods
One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared.
Results
There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05).
Conclusion
Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
Objective
To retrospectively analyze the analgesic effect and cost-effectiveness of combined analgesia versus intermittent analgesia for patients underwent retroperitoneal laparoscopic surgery.
Methods
We retrospectively collected clinical parameters and outcomes of analgesic effect from patients who underwent retroperitoneal laparoscopic surgery. Included patients were divided into two groups: local injection of ropivacaine combined with intermittent administration with analgesic via intravenous injection and intermittent administration with analgesic via intravenous injection only. Visual analogue scale (VAS) at different time points (2 h, 4 h, 6 h, 12 h, 24 h), usage of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), adverse events, costs and other information were collected and assessed for further analysis of analgesic effect and cost-effectiveness.
Results
A total of 80 patients were enrolled in this study, each group consists of 40 patients. The results of this study found that VAS scores at 2 h and 4 h after operation in the combined analgesic group were significantly lower than that in the intermittent intravenous analgesia group (P<0.05), while there were no significant differences between the two groups in VAS scores at 6, 12 and 24 h after operation. The usage of NSAIDs were significantly lower in the combined group than intermittent group (P<0.05). The effective rate in the combined group was significantly higher than that in the intermittent group (P<0.05). The average cost of postoperative hospitalization and postoperative analgesic of the two groups were similar (allP values >0.05), and cost-effectiveness evaluation of the combined analgesia group was better than that of intermittent group.
Conclusion
Compared to intermittent administration with analgesic via intravenous injection, subcutaneous injection of ropivacaine hydrochloride combined with intermittent intravenous injection of parecoxib in patients underwent retroperitoneal laparoscopic surgery significantly could alleviate patients' painful complaints and reduce the postoperative usage of NSAIDs without increasing adverse events. Furthermore, the combination strategy has a lower cost-effectiveness ratio than intermittent group, which represents economic advantages.
ObjectivesTo systematically review the efficacy and safety of 3D laparoscopic in the treatment of colorectal cancer.MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched online to collect clinical trials of 3D laparoscopic in the treatment of colorectal cancer from inception to September 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 26 trials, including 4 randomized controlled trials and 22 cohort studies were included. The results of meta-analysis showed that: compared with 2D laparoscopic, 3D laparoscopic had shorter operative time (MD=–16.32, 95%CI –22.61 to –10.03, P<0.000 01), less amount of blood transfusion in operation (MD=–10.80, 95%CI –19.93 to –1.66, P=0.02), more lymph node dissection (MD=0.88, 95%CI 0.30 to 1.45, P=0.003), shorter recovery time of gastrointestinal function (MD=–0.18, 95%CI –0.31 to –0.04, P=0.01), lower incidence of postoperative complication (OR=0.63, 95%CI 0.44 to 0.89, P=0.009), and fewer days in hospital (MD=–0.84, 95%CI –1.40 to –0.28, P=0.003). Additionally, there was no significant difference in hospitalization costs (MD=–0.01, 95%CI –0.23 to 0.21, P=0.94).ConclusionsCurrent evidence shows that, compared with 2D laparoscopy, 3D laparoscopy assisted colorectal cancer surgery has obvious advantages such as less bleeding during operation, shorter operation time, lower incidence of complications after operation, shorter hospitalization time and no increase in hospitalization expenses. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
The caudate lobe of the liver has always been regarded as the deepest segment, with most complicated anatomy. The surgeon’s understanding of the caudate lobe and its subsegments has undergone a complex and tortuous process. In recent years, the special view and fine anatomy of the caudate lobe in laparoscopic resection of caudate lobe of liver have been proved or challenged based on the traditional anatomical knowledge of the liver gross specimen, cast specimen and three-dimensional reconstruction. It is these validations and challenges that keep surgeons revising and restoring the caudate anatomy to its true form. This article will discuss these new ideas and describe the laparoscopic total caudate lobectomy in detail from the point of view of a laparoscopic surgeon.
ObjectiveTo investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma.MethodsRetrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ, 5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb.ResultsTotal laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190–400 min (median time of 285 min) and the amount of intraoperative blood loss was 100–500 mL (median amount of 175 mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6–15 per case (median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3–24 months (median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far.ConclusionUnder the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.
Objective To study the causes of abdominal distension in patients with hepatocellular carcinoma (HCC) after laparoscopic hepatectomy, and to explore the corresponding treatment countermeasures. Methods A total of 186 patients with HCC were treated by laparoscopic hepatectomy in our hospital from September 1, 2018 to August 31, 2020. Demographic characteristics [age, gender, body mass index (BMI), liver cirrhosis, child-Pugh classification of liver function], operative time, hilar occlusion time, intraoperative blood loss, scope of hepatectomy, postoperative visual analogue scale (VAS) score and serological indexes (hemoglobin, serum albumin, white blood cell count, platelet count, serum potassium level) were collected retrospectively. The occurrence of postoperative abdominal distension was observed, and the patients were divided into abdominal distension group and non abdominal distension group. The independent influencing factors of abdominal distension after laparoscopic hepatectomy were analyzed, and the corresponding treatment countermeasures were discussed. Results A total of 138 patients developed varying degrees of abdominal distension after operation (74.19%), including 45 cases of mild abdominal distension, 53 cases of moderate abdominal distension, and 40 cases of severe abdominal distension. They were all included in the abdominal distension group, and the occurrence time of abdominal distension was mainly 1-5 days after operation. Forty-eight patients (25.81%) had no abdominal distension after operation and were included in the non-abdominal distension group. Univariate analysis results show that: the proportion of patients with abdominal distension combined with liver cirrhosis was significantly higher than that of the non-abdominal distension group (47.10% vs. 25.00%, P=0.007), the operative time [(143.54±23.48) min vs. (129.45±24.51) min, P=0.001], hilar occlusion time [(18.02±8.12) min vs. (15.38±7.28) min, P=0.048] were significantly longer than those of the non-abdominal distension group, the postoperative VAS score was significantly higher than that of the non-abdominal distension group [5.12±1.14 vs. 4.47±1.05, P=0.004], and the serum potassium level was significantly lower than that of the non-abdominal distension group [(3.12±0.38) mmol/L vs. (3.67±0.42) mmol/L, P＜0.001]. Multivariate unconditional logistic regression analysis showed that patients with liver cirrhosis [OR=1.520, 95%CI (1.104, 2.093), P=0.010], serum potassium level ＜3.40 mmol/L [OR=1.684, 95%CI (1.203, 2.357) , P=0.002], operative time ＞136 min [OR=1.842, 95%CI (1.297, 2.616) , P=0.001], hilar occlusion time ＞16.7 min [OR=1.492, 95%CI (1.047, 2.126) , P=0.027], VAS score ＞5 [OR=1.498, 95%CI (1.021, 2.198), P=0.039] were independent risk factors of abdominal distension after laparoscopic hepatectomy. Conclusions The risk factors of abdominal distension after laparoscopic hepatectomy were liver cirrhosis, serum potassium level ＜3.40 mmol/L, operative time ＞136 min, hilar occlusion time ＞16.7 min and VAS score ＞5. More attention should be paid to high-risk patients and effective treatment measures should be taken in time to reduce the risk of abdominal distension after surgery. For patients with abdominal distension, we should take effective measures to alleviate the symptoms of abdominal distension and promote the recovery of patients with abdominal distension.
Objective
To investigate the clinical effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction (UPJO).
Methods
From November 2010 to September 2015, a total of 28 cases (21 males and 7 females) with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal laparoscopic dismembered pyeloplasty. All the 28 patients had a previous history of different degrees of lumbar pain, which was confirmed as typical UPJO by imaging examination. Operation method: following complete renal pelvis and upper ureter isolation, the renal pelvis was clipped into a trumpet-shaped mouth, 1/3 of the upper renal pelvis was temporarily kept without section. In the inferior margin of renal pelvis, longitudinal cut procedure was operated in the ureter and across the stenotic segment in about 1–2 cm; and then, anastomosis of the ureter and the renal pelvis at the lowest was performed, to maintain the continuity of the renal pelvis and ureter. Subsequently, the stenosed segment of ureter and the dilatant renal pelvis were removed, the posterior ureteropelvic anastomosis was made with an interrupted suture, and antegrade stenting of double J tube was further performed, followed by a continuous suture of the anterior wall.
Results
The procedure was successfully accomplished in all patients whithout conversion to open surgery. The operating time was 90-240 minutes with the median time of 160 minutes. The estimated blood loss was 20-70 mL with the median of 50 mL. No severe surgical complication occurred in perioperative period. The 3-24 -month follow up showed that symptoms of lumbar pain were relieved or disappeared in all the incorporated patients. Postoperative radiographic examination showed no stomal stenosis at the ureteropelvic junction, and the hydronephrosis was alleviated.
Conclusions
Retroperitoneal laparoscopic dismembered pyeloplasty for UPJO is an effective, safe, and minimally invasive surgical technique. The key to the success of the operation is to the accurate renal pelvis clipping, tension- and torsion-free anastomosis of the lowest position of the renal pelvis and the ureter, and the reconstruction of a new funnel-shaped ureteropelvic junction.
Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
