Objective To compare effectiveness between laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) in treatment of achalasia of cardia (AC) in order to provide a basis for clinical choose. Method The literatures about the treatment of AC by laparoscopic Heller myotomy or POEM were retrieved from CNKI, Embase, PubMed databases, etc., and then the contents about curative effect and complications were summarized. Results The treatment models of AC included surgical treatment such as laparoscopic Heller myotomy and endoscopy such as POEM, but there was still lack of comparing data in these two treatment models, its selection remained controversial. There was a better short-term curative effect and slighter complications for POEM as compared with the laparoscopic Heller myotomy from the trend of published literatures. However, it’s long-term effects for these two treatment models were not clarified. Conclusions Both laparoscopic Heller myotomy and POEM are medicable for AC. POEM as a new treatment of AC shows some advantages of minimal invasion and exact efficacy, but it needs to be followed-up for a long-term. Treatment model for AC is chosen on basis of typing under endoscope, physical fitness, anatomy of easophagus, previous history, tolerance of surgery and other factors.
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 explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectiveTo recognize the recent research progress in the prevention of duodenal stump leakage (DSL) after laparoscopic radical gastrectomy (LRG) for gastric cancer, so as to find a new breakthrough for reducing the occurrence of DSL. MethodA review was conducted by searching recent domestic and international literature on the prevention and management of DSL after LRG for gastric cancer. ResultsAt present, the risk factors of DSL after LRG were generally recognized in the literature, including relevant patients’ factors and surgery factors. The relevant factors of the patients themselves mainly were old age, malnutrition, and basic diseases; The factors relevant surgery mainly included surgical instruments, doctors’ operation level, etc. According to the literature, the measures taken for relevant patients’ factors mainly included preoperative improvement of nutritional status and control of the basic diseases; The preventive measures adopted for the relevant operation factors mainly included carefully intraoperative operation, improving of the anastomosis skills, and tacit cooperation of the team, which could reduce the occurrence of DSL. There was still controversy about the effect and method of routine duodenal stump reinforcement during operation. ConclusionsThe focus of reducing the occurrence of DSL is prevention. In clinical practice, patients with high-risk factors should receive special attention, with efforts to improve their condition, implement individualized decision-making, and perform meticulous intraoperative techniques to minimize complications, promote rapidly postoperative recovery, and maximize patients benefits.
ObjectiveTo compare the three-dimensional (3D) laparoscopic simulator with two-dimensional (2D) laparoscopic simulator in training of laparoscopic novices.MethodsBetween January 2018 and December 2019, surgical residents from Chinese PLA General Hospital were enrolled, which were grouped into 3D and 2D group. After receiving training program, novices in both two groups subject to performance examination, including bean-picking module, exchange module, transfer module, needle-manipulating module, and suture module. Times and errors were compared between the two groups for each module.ResultsA total of 16 novices in 3D group and 15 novices in 2D group were enrolled, and baseline characteristics including age, gender, major hand, glass wearing, laparoscopic experience, and shooting game experience were well balanced between the two groups (P>0.05). There were comparable times and errors between the two groups in terms of bean-picking module and exchange module (P>0.05). The time of transfer module and needle-manipulating module was not significant between the two groups (P>0.05), but novices in 3D group performed more precise than those in 2D group (P<0.05). In suture module, 3D group had shorter time (P=0.02) and higher accuracy (P=0.03).Conclusion3D laparoscopic simulator can shorten novice performance time in complex procedures, improve accuracy, and facilitate laparoscopic training.
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 compare the short-and mid-term outcomes of patients with esophageal cancer after subtotal esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position. MethodsThis randomized prospectively controlled study was conducted in 121 patients receiving subtotal esophagectomy via thoracoscopy between January 2010 and February 2013. The patients were randomly assigned into three groups to underwent esophagectomy in lateral prone position, prone position, or left lateral position, respectively. Forty-three patients (24 males, 19 females, 61.5±1.5 years) underwent surgery in lateral prone position, 39 patients (21 males, 18 females, 63.2±1.7 years) in prone position and other 39 patients (22 males, 17 females, 60.1±1.6 years) in left lateral position. Esophagogastric anastomosis was performed in the left neck. ResultsThe median operative time in the three groups was 232 (165-296) min, 230 (170-310) min, and 280 (190-380) min, respectively (P < 0.05). The median perioperative bleeding was 262 (185-330) ml, 275 (100-320) ml and 350 (120-560) ml, respectively (P > 0.05). The average number of harvested lymph nodes was 19.1 (9-26), 18.4 (11-23), 10.9 (6-21), respectively (P < 0.05). The postoperative medical complications occurred in 10, 9 and 11 patients in three groups, respectively, with no statistical difference. Twenty patients died in the lateral prone position group after a median follow-up period of 19.2 (6-31) months, 18 patients died in the prone position group after a median follow-up period of 20.7 (8-29) months, and 21 patients died in the left lateral position group after a median follow-up period of 18.5 (12-33) months. ConclusionThe results confirm the feasibility and safety of this minimally invasive esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position for patients with esophageal carcinoma. A possible advantage of lateral prone technique is that in case of an emergency, precious time could be saved in changing the position of the patient.
ObjectiveTo summarize the surgical experience of perineal hernia (PH) repairment after a laparoscopic abdominoperineal resection (APR) with synthetic mesh.MethodsThe clinical data of 4 cases of PH after APR from 2009 to 2015 underwent surgery were analyzed retrospectively. We applied synthetic mesh for the reconstruction of the pelvic floor.ResultsAll of the 4 cases recovered smoothly, with no complication happened. The blood loss during the operation was 50–100 mL, the operative time was 1.0–1.5 hours, the postoperative time of getting out of bed was delayed to 5–7 days after the operation and discharged after 10–14 days. Patients were advised to use transperineal bandages or rigid underpants to lift up the perineum to reduce tension after discharge. No recurrence of perineal hernia or the tumor was found on physical examination and abdominal pelvic CT scan during the 24-month follow-up.ConclusionsIt brings better effect and less trauma after the operation by using transperineal repair of PH with synthetic mesh. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
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.