BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia ...BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.展开更多
Objective:Single-incision laparoscopic sugery has emerged as a safe and less invasive approach to conventional multi-port laparoscopy.The present meta-analysis aimed to assess the collective outcomes of single-incisio...Objective:Single-incision laparoscopic sugery has emerged as a safe and less invasive approach to conventional multi-port laparoscopy.The present meta-analysis aimed to assess the collective outcomes of single-incision laparoscopic gastrectomy(SILG)compared to multi-port laparoscopic gastrectomy(MLG)for gastric cancer.Methods:A PRISMA-compliant systematic review of randomized controlled trials(RCTs)that compared SILG and MLG for gastric cancer in PubMed and Scopus through January 2023 was conducted.The main outcomes of the review were complications,postoperative pain,conversion to open surgery,hospital stay,and recovery.Results:Three RCTs including 301 patients(61.8%male)were incuded.A total of 151 patients underwent SILG,and 150 underwent MLG.SILG was associated with a shorter operative time(WMD=-16.39,95%CI:=27.38 to=5.40,p=0.003;2=0%)and lower pain scores at postoperative day 3(WMD=-1.18,95%CI:=2.27 to=0.091,p=0.033;I^(2)=99%)than MLG.There were no statistically significant differences between the two groups in es timated blood loss(WMD=-16.95,95%CI:-35.84 to 1.95,p=0.078;I^(2)=82%),complications(OR=0.71,95%Cl:0.36 to 1.42,p=0.337;I^(2)=0%),conversion to open surgery(OR=0.33,95%C:0.01 to 8.38,p=0.504),hospital stay(WMD=0.72,95%CI:-0.92 to 2.36,p=0.056;P=84%),time to first flatus(WMD=0.06,95%CI:=0.14 to 0.26,p=0.566;I^(2)=0%),time to first defecation(WMD=-0.14,95%CI:=0.46 to 0.18,p=0.392;I^(2)=0%),or time to first oral intake(WMD=0.37,95%a:=0.75 to 1.49,p=0.520;I^(2)=94%).Conclusions:SILG is associated with shorter operative times and less early postoperative pain than MLG.The odds of complications,blood loss,hospital stay,and gastrointestinal recovery were similar between the two procedures.展开更多
Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experienc...Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.展开更多
AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patient...AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.展开更多
Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecyste...Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy(SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials(RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration(CBDE) methods have been used for more than one hundred years, laparoscopic CBDE(LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and singleincision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.展开更多
AIM: To determine the effect of single-incision laparoscopic colectomy(SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy(CLC)....AIM: To determine the effect of single-incision laparoscopic colectomy(SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy(CLC).METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision(SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected.RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC.CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.展开更多
BACKGROUND Single incision plus one port left-side approach(SILS+1/L)totally laparoscopic distal gastrectomy(TLDG)is an emerging technique for the treatment of gastric cancer.Reduced port laparoscopic gastrectomy has ...BACKGROUND Single incision plus one port left-side approach(SILS+1/L)totally laparoscopic distal gastrectomy(TLDG)is an emerging technique for the treatment of gastric cancer.Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy:relieving postoperative pain,shortening hospital stay and offering a better cosmetic outcome.Nevertheless,there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y(uncut R-Y)reconstruction.AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction(uncut R-Y reconstruction)to treat distal gastric cancer.METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled.All patients were treated at The Second Hospital of Shandong University.Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler.The clinicopathological characteristics,surgical details,postoperative short-term outcomes,postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully.The patient population included 13 men and 8 women with a mean age of 48.2 years(ranged from 40 years to 70 years)and median body mass index of 22.8 kg/m^2.There were no conversions to open laparotomy,and no other port was placed.The mean operation time was 146 min(ranged 130-180 min),and the estimated mean blood loss was 54 mL(ranged 20-110 mL).The mean duration to flatus and discharge was 2.3(ranged 1-3.5)and 7.3(ranged 6-9)d,respectively.The mean number of retrieved lymph nodes was 42(ranged 30-47).Two patients experienced mild postoperative complications,including surgical site infection(wound at the navel incision)and mild postoperative pancreatic fistula(grade A).Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively.No patients experienced moderate or severe food stasis,alkaline gastritis or bile reflux during the follow-up period.No recanalization of the biliopancreatic limb was found.CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.展开更多
AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbla...AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males(47%) and 158 females(53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology(P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery(P < 0.05).CONCLUSION: This study shows that this two singleincision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.展开更多
AIM:To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.METHODS:Between 2010 and 2012,transumbilical single-inci...AIM:To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.METHODS:Between 2010 and 2012,transumbilical single-incision endoscopic splenectomy was performed in 10 patients in our department,of whom 4 had refractory idiopathic thrombocytopenic purpura,4 had enlarged splenic cyst and 2 had splenic hematoma.A2.5-cm curved incision was made at the lower umbilicus edge,and a 10 mm laparoscope was inserted into the middle of the incision.A 5-mm harmonic scalpel was placed on the right side,and a 5-mm auxiliary instrument on the left side of the laparoscope.Splenic ligaments were incised with a harmonic scalpel,and the splenic pedicle was cut with an Endo-gastrointestinal anastomosis.The spleen was dissected and placed in a large retrieval bag,blended,and then removed.RESULTS:All transumbilical single-incision endoscopic splenectomies were performed successfully with mean operative time of 80±5 min and mean blood loss of150±20 mL.Conversion to laparotomy or multi-port laparoscopic surgery was not required in all cases.All patients were discharged on postoperative days 4-6.During the postoperative hospitalization period,no painkillers were required.No intra-abdominal complications such as infection,ascites,gastric leakage,pancreatic leakage,or wound infection occurred in any case during the 6-mo follow-up.CONCLUSION:Transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments is technically feasible and safe in selected patients.展开更多
Single-incision laparoscopic surgery(SILS),or laparoendoscopic single-site surgery,was launched to minimize incisional traumatic effects in the 1990s.Minor SILS,such as cholecystectomies,have been gaining in popularit...Single-incision laparoscopic surgery(SILS),or laparoendoscopic single-site surgery,was launched to minimize incisional traumatic effects in the 1990s.Minor SILS,such as cholecystectomies,have been gaining in popularity over the past few decades.Its application in complicated hepatopancreatobiliary(HPB)surgeries,however,has made slow progress due to instrumental and technical limitations,costs,and safety concerns.While minimally invasive abdominal surgery is pushing the boundaries,advanced laparoscopic HPB surgeries have been shown to be comparable to open operations in terms of patient and oncologic safety,including hepatectomies,distal pancreatectomies(DP),and pancreaticoduodenectomies(PD).In contrast,advanced SILS for HPB malignancy has only been reported in a few small case series.Most of the procedures involved minor liver resections and DP;major hepatectomies were rarely described.Singleincision laparoscopic PD has not yet been reported.We herein review the published SILS for HPB cancer in the literature and our three-year experience focusing on the technical aspects.展开更多
In this case report,we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer.The optimal surgical therapy for low-grade appendiceal n...In this case report,we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer.The optimal surgical therapy for low-grade appendiceal neoplasm is controversial;currently,the options include appendectomy,cecectomy,right hemicolectomy,and open or laparoscopic surgery.Due to the risk of pseudomyxoma peritonei,complete resection without rupture is necessary.We have encountered 5 cases of lowgrade appendiceal neoplasm and all 5 patients had no lymph node metastasis.We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy.In the present case,we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery(SILS),which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery.We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors,such as low-grade appendiceal neoplasms.展开更多
Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of ...Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.展开更多
More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option becau...More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.展开更多
Introduction: Single Incision Laparoscopic Surgery (SILSTM) has been developed as a less invasive laparoscopic surgery. On the other hand, robotically assisted surgical technology has offered new options for minimally...Introduction: Single Incision Laparoscopic Surgery (SILSTM) has been developed as a less invasive laparoscopic surgery. On the other hand, robotically assisted surgical technology has offered new options for minimally invasive surgery. In this study, we report a new surgical technology to perform SILS using the da Vinci S surgical system (Intuitive Surgical Inc., Sunnyvale, CA). Materials and Surgical Technique: A porcine liver with gallbladder was placed on an endoscopic surgery trainer, and a 25 mm incision was made for one robotic camera and two instruments at the umbilicus position. Both instruments were crossed while preventing them from colliding with each other, and Robot-assisted single-incision cholecyctectomy was perfumed. Discussion: This technique is expected to contribute to the development of a number of procedures in the future.展开更多
This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review c...This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review consists in highlighting the spectrum, indications, applicability, and effectiveness of single-port endosurgery in children during the first 3 postnatal months.展开更多
Single incision laparoscopic surgery(SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applicati...Single incision laparoscopic surgery(SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.展开更多
BACKGROUND The clinical manifestations of omphalomesenteric duct remnant(OMDR)can vary with the age at diagnosis,from asymptomatic incidental findings to symptoms related to gastrointestinal complications.The lifelong...BACKGROUND The clinical manifestations of omphalomesenteric duct remnant(OMDR)can vary with the age at diagnosis,from asymptomatic incidental findings to symptoms related to gastrointestinal complications.The lifelong complication rates are reported as 4%-34%,and complications are more common in patients younger than 2 years of age.The authors attempted to identify different clinical features and management for the various pediatric age groups.AIM To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.METHODS The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively.Fifteen patients diagnosed based on incidental findings during other surgeries were excluded.The patients were divided into two groups based on age:<12 mo(infants)and>12 mo(beyond infancy).We analyzed the demographic characteristics,clinical manifestations,diagnostic tools,surgical procedures,and clinical outcomes of the patients and compared them for the age groups.Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.RESULTS A total of 35 patients(7 infants,28 children beyond infancy)were finally included.In both groups,Meckel's diverticulum(MD)was the most common type of OMDR,while umbilical lesions were more common in the infant group(P=0.006).Hematochezia and abdominal pain were common in the beyond infancy group,while umbilical lesions were the most frequent symptoms in the infant group.Several diagnostic tools were used,but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding.Minimally invasive surgery was more commonly performed for children than for infants(P=0.016).Single-incision laparoscopic surgery(SILS)was performed for fifteen patients who underwent laparoscopic surgery.There were only three cases of postoperative complications,and all patients survived in good condition.CONCLUSION The clinical type of OMDR varies with age,umbilical lesions in infants,and MD beyond infancy.SILS is effective for managing children with MD regardless of age.展开更多
AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed datab...AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.展开更多
Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential as...Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.Methods:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving TSH.All included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among groups.Moreover,the detailed information of all patients with TSH was recorded and analyzed.Statistical analyses were performed with GraphPad Prism 6.Results:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(<60 years old,6/52,558;0.011%,P=0.008).Moreover,the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional laparoscopy.Five TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port site.All patients underwent repair surgery,and one required small bowel resection.Conclusion:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.展开更多
基金Supported by Wu Jieping Medical Foundation,No.320.6750.18396Nantong“14th Five-Year”Science and Education to Strengthen Health Project,General Surgery Medical Key Discipline,No.42and Nantong Municipal Commission of Health and Family Planning,No.MS2022005.
文摘BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.
文摘Objective:Single-incision laparoscopic sugery has emerged as a safe and less invasive approach to conventional multi-port laparoscopy.The present meta-analysis aimed to assess the collective outcomes of single-incision laparoscopic gastrectomy(SILG)compared to multi-port laparoscopic gastrectomy(MLG)for gastric cancer.Methods:A PRISMA-compliant systematic review of randomized controlled trials(RCTs)that compared SILG and MLG for gastric cancer in PubMed and Scopus through January 2023 was conducted.The main outcomes of the review were complications,postoperative pain,conversion to open surgery,hospital stay,and recovery.Results:Three RCTs including 301 patients(61.8%male)were incuded.A total of 151 patients underwent SILG,and 150 underwent MLG.SILG was associated with a shorter operative time(WMD=-16.39,95%CI:=27.38 to=5.40,p=0.003;2=0%)and lower pain scores at postoperative day 3(WMD=-1.18,95%CI:=2.27 to=0.091,p=0.033;I^(2)=99%)than MLG.There were no statistically significant differences between the two groups in es timated blood loss(WMD=-16.95,95%CI:-35.84 to 1.95,p=0.078;I^(2)=82%),complications(OR=0.71,95%Cl:0.36 to 1.42,p=0.337;I^(2)=0%),conversion to open surgery(OR=0.33,95%C:0.01 to 8.38,p=0.504),hospital stay(WMD=0.72,95%CI:-0.92 to 2.36,p=0.056;P=84%),time to first flatus(WMD=0.06,95%CI:=0.14 to 0.26,p=0.566;I^(2)=0%),time to first defecation(WMD=-0.14,95%CI:=0.46 to 0.18,p=0.392;I^(2)=0%),or time to first oral intake(WMD=0.37,95%a:=0.75 to 1.49,p=0.520;I^(2)=94%).Conclusions:SILG is associated with shorter operative times and less early postoperative pain than MLG.The odds of complications,blood loss,hospital stay,and gastrointestinal recovery were similar between the two procedures.
文摘Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.
文摘AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.
文摘Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy(SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials(RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration(CBDE) methods have been used for more than one hundred years, laparoscopic CBDE(LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and singleincision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.
文摘AIM: To determine the effect of single-incision laparoscopic colectomy(SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy(CLC).METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision(SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected.RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC.CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.
基金Supported by Key R&D Programs in Shandong China,No.2019GSF10822Jinan Science&Technology Bureau,No.201704125.
文摘BACKGROUND Single incision plus one port left-side approach(SILS+1/L)totally laparoscopic distal gastrectomy(TLDG)is an emerging technique for the treatment of gastric cancer.Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy:relieving postoperative pain,shortening hospital stay and offering a better cosmetic outcome.Nevertheless,there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y(uncut R-Y)reconstruction.AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction(uncut R-Y reconstruction)to treat distal gastric cancer.METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled.All patients were treated at The Second Hospital of Shandong University.Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler.The clinicopathological characteristics,surgical details,postoperative short-term outcomes,postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully.The patient population included 13 men and 8 women with a mean age of 48.2 years(ranged from 40 years to 70 years)and median body mass index of 22.8 kg/m^2.There were no conversions to open laparotomy,and no other port was placed.The mean operation time was 146 min(ranged 130-180 min),and the estimated mean blood loss was 54 mL(ranged 20-110 mL).The mean duration to flatus and discharge was 2.3(ranged 1-3.5)and 7.3(ranged 6-9)d,respectively.The mean number of retrieved lymph nodes was 42(ranged 30-47).Two patients experienced mild postoperative complications,including surgical site infection(wound at the navel incision)and mild postoperative pancreatic fistula(grade A).Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively.No patients experienced moderate or severe food stasis,alkaline gastritis or bile reflux during the follow-up period.No recanalization of the biliopancreatic limb was found.CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.
基金Supported by Hai Zhu district science and technology plans,Guang Zhou,China,No.2012-cg-26
文摘AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males(47%) and 158 females(53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology(P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery(P < 0.05).CONCLUSION: This study shows that this two singleincision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.
基金Supported by Science and Technology Projects of Haizhu District of Guangzhou,China,No.2012-cg-26
文摘AIM:To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.METHODS:Between 2010 and 2012,transumbilical single-incision endoscopic splenectomy was performed in 10 patients in our department,of whom 4 had refractory idiopathic thrombocytopenic purpura,4 had enlarged splenic cyst and 2 had splenic hematoma.A2.5-cm curved incision was made at the lower umbilicus edge,and a 10 mm laparoscope was inserted into the middle of the incision.A 5-mm harmonic scalpel was placed on the right side,and a 5-mm auxiliary instrument on the left side of the laparoscope.Splenic ligaments were incised with a harmonic scalpel,and the splenic pedicle was cut with an Endo-gastrointestinal anastomosis.The spleen was dissected and placed in a large retrieval bag,blended,and then removed.RESULTS:All transumbilical single-incision endoscopic splenectomies were performed successfully with mean operative time of 80±5 min and mean blood loss of150±20 mL.Conversion to laparotomy or multi-port laparoscopic surgery was not required in all cases.All patients were discharged on postoperative days 4-6.During the postoperative hospitalization period,no painkillers were required.No intra-abdominal complications such as infection,ascites,gastric leakage,pancreatic leakage,or wound infection occurred in any case during the 6-mo follow-up.CONCLUSION:Transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments is technically feasible and safe in selected patients.
文摘Single-incision laparoscopic surgery(SILS),or laparoendoscopic single-site surgery,was launched to minimize incisional traumatic effects in the 1990s.Minor SILS,such as cholecystectomies,have been gaining in popularity over the past few decades.Its application in complicated hepatopancreatobiliary(HPB)surgeries,however,has made slow progress due to instrumental and technical limitations,costs,and safety concerns.While minimally invasive abdominal surgery is pushing the boundaries,advanced laparoscopic HPB surgeries have been shown to be comparable to open operations in terms of patient and oncologic safety,including hepatectomies,distal pancreatectomies(DP),and pancreaticoduodenectomies(PD).In contrast,advanced SILS for HPB malignancy has only been reported in a few small case series.Most of the procedures involved minor liver resections and DP;major hepatectomies were rarely described.Singleincision laparoscopic PD has not yet been reported.We herein review the published SILS for HPB cancer in the literature and our three-year experience focusing on the technical aspects.
文摘In this case report,we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer.The optimal surgical therapy for low-grade appendiceal neoplasm is controversial;currently,the options include appendectomy,cecectomy,right hemicolectomy,and open or laparoscopic surgery.Due to the risk of pseudomyxoma peritonei,complete resection without rupture is necessary.We have encountered 5 cases of lowgrade appendiceal neoplasm and all 5 patients had no lymph node metastasis.We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy.In the present case,we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery(SILS),which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery.We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors,such as low-grade appendiceal neoplasms.
基金supported by grants from the National Natural Science Foundation of China(No.82072625)Key Research and Development Project of Zhejiang Province(No.2021C03127)+3 种基金National Natural Science Foundation of China(No.81827804)National Natural Science Foundation of China(No.81772546)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases(No.2018E50003)Key Research and Development Project of Zhejiang Province(No.2018C03083).
文摘Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.
文摘More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.
文摘Introduction: Single Incision Laparoscopic Surgery (SILSTM) has been developed as a less invasive laparoscopic surgery. On the other hand, robotically assisted surgical technology has offered new options for minimally invasive surgery. In this study, we report a new surgical technology to perform SILS using the da Vinci S surgical system (Intuitive Surgical Inc., Sunnyvale, CA). Materials and Surgical Technique: A porcine liver with gallbladder was placed on an endoscopic surgery trainer, and a 25 mm incision was made for one robotic camera and two instruments at the umbilicus position. Both instruments were crossed while preventing them from colliding with each other, and Robot-assisted single-incision cholecyctectomy was perfumed. Discussion: This technique is expected to contribute to the development of a number of procedures in the future.
文摘This study focuses on the successful application of single-incision pediatric endosurgery in the treatment of congenital anomalies and acquired diseases in neonates and infants. The purpose of this scientific review consists in highlighting the spectrum, indications, applicability, and effectiveness of single-port endosurgery in children during the first 3 postnatal months.
文摘Single incision laparoscopic surgery(SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.
文摘BACKGROUND The clinical manifestations of omphalomesenteric duct remnant(OMDR)can vary with the age at diagnosis,from asymptomatic incidental findings to symptoms related to gastrointestinal complications.The lifelong complication rates are reported as 4%-34%,and complications are more common in patients younger than 2 years of age.The authors attempted to identify different clinical features and management for the various pediatric age groups.AIM To find surgical perspectives for the pediatric age-related variants of OMDR and make recommendations for optimal management.METHODS The medical records of pediatric patients diagnosed with OMDR were reviewed retrospectively.Fifteen patients diagnosed based on incidental findings during other surgeries were excluded.The patients were divided into two groups based on age:<12 mo(infants)and>12 mo(beyond infancy).We analyzed the demographic characteristics,clinical manifestations,diagnostic tools,surgical procedures,and clinical outcomes of the patients and compared them for the age groups.Chi-squared and Fisher's exact tests were used for nominal scales and a Mann-Whitney test was used for ratio scales.RESULTS A total of 35 patients(7 infants,28 children beyond infancy)were finally included.In both groups,Meckel's diverticulum(MD)was the most common type of OMDR,while umbilical lesions were more common in the infant group(P=0.006).Hematochezia and abdominal pain were common in the beyond infancy group,while umbilical lesions were the most frequent symptoms in the infant group.Several diagnostic tools were used,but Meckel's scan was most useful in diagnosing OMDR in patients with painless rectal bleeding.Minimally invasive surgery was more commonly performed for children than for infants(P=0.016).Single-incision laparoscopic surgery(SILS)was performed for fifteen patients who underwent laparoscopic surgery.There were only three cases of postoperative complications,and all patients survived in good condition.CONCLUSION The clinical type of OMDR varies with age,umbilical lesions in infants,and MD beyond infancy.SILS is effective for managing children with MD regardless of age.
文摘AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.
文摘Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.Methods:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving TSH.All included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among groups.Moreover,the detailed information of all patients with TSH was recorded and analyzed.Statistical analyses were performed with GraphPad Prism 6.Results:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(<60 years old,6/52,558;0.011%,P=0.008).Moreover,the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional laparoscopy.Five TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port site.All patients underwent repair surgery,and one required small bowel resection.Conclusion:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.
