Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sew...Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.展开更多
Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gas...Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.展开更多
文摘Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.
基金funded by the National Facility for Translational Medicine(Shanghai,China)[grant number TMSK-2021–503 to B.F.].
文摘Background:The multi-site practice(MSP)policy has been practiced in China over 10 years.This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer(LSCRC)and gastric cancer(LSGC)under the Chinese MSP policy.Methods:We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital(n=573)and his MSP institutions(n=508)between January 2017 and December 2020.Baseline demographics,intraoperative outcomes,post-operative recovery,and pathological results were compared between the original hospital and MSP institutions,as well as between MSP institutions with and without specific competence(surgical skill,operative instrument,perioperative multi-discipline team).Results:In our study,690 patients underwent LSCRC and 391 patients underwent LSGC.The prevalence of post-operative complications was comparable for LSCRC(11.5%vs 11.1%,P=0.89)or LSGC(15.2%vs 12.6%,P=0.46)between the original hospital and MSP institutions.However,patients in MSP institutions without qualified surgical assistant(s)and adequate instruments experienced longer operative time and greater intraoperative blood loss.The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC(11.5%vs 21.2%,P<0.01)and LSGC(9.8%vs 20.5%,P<0.01).Conclusion:For an experienced gastrointestinal surgeon,performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible,but relies on the precondition that the MSP institutions are equipped with qualified surgical skills,adequate operative instruments,and complete perioperative management.
