AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English ...AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English and French language articles about laparoscopic and endoscopic cooperative,combined,hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer,benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients,25 studies were identified. The study design,number of cases,tumor pathology size and location,the operative technique name,the endoscopy team and surgical team role,operative time,type of closure of visceral wall defect,blood loss,complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors(GIST) in 4 studies,GIST and various benign submucosal tumors in 22 studies,early gastric cancer(p T1 a and p T1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were:laparoscopic assisted endoscopic resection,endoscopic assisted wedge resection,endoscopic assisted transgastric and intragastric surgery,laparoscopic endoscopic cooperative surgery(LECS),laparoscopic assisted endoscopic full thickness resection(LAEFR),clean non exposure technique and non-exposed endoscopic wallinversion surgery(NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications,characteristics and short term results are described.CONCLUSION: Along with the traditional cooperative techniques,new procedures like LECS,LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.展开更多
AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct visi...AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.展开更多
Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic c...Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.展开更多
Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical an...Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.展开更多
文摘AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English and French language articles about laparoscopic and endoscopic cooperative,combined,hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer,benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients,25 studies were identified. The study design,number of cases,tumor pathology size and location,the operative technique name,the endoscopy team and surgical team role,operative time,type of closure of visceral wall defect,blood loss,complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors(GIST) in 4 studies,GIST and various benign submucosal tumors in 22 studies,early gastric cancer(p T1 a and p T1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were:laparoscopic assisted endoscopic resection,endoscopic assisted wedge resection,endoscopic assisted transgastric and intragastric surgery,laparoscopic endoscopic cooperative surgery(LECS),laparoscopic assisted endoscopic full thickness resection(LAEFR),clean non exposure technique and non-exposed endoscopic wallinversion surgery(NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications,characteristics and short term results are described.CONCLUSION: Along with the traditional cooperative techniques,new procedures like LECS,LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.
文摘AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.
文摘Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.
基金Supported by National Natural Science Foundation of China,No.81372364 and No.81000189General Financial Grant from the China Postdoctoral Science Foundation,No.2014M552695
文摘Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.
