Objective To observe the related complications of 23G pars plana vitrectomy (PPV). Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study. There were 98 patients (65.3%) with macular diseases, 46 patients (30.7%) with proliferative diabetic retinopathy, four patients (2.7%) with vitreous hemorrhage, one patient (0.7%) with rhegmatogenous retinal detachment, and lens nucleus falling off in cataract surgery in one patient (0.7%). Among 98 patients with macular diseases, 21 patients (21.4%) underwent topical anesthesia, 77 patients (78.6%) underwent retrobulbar anesthesia. DORC "twostep method" was performed in three patients, and Alcon 23G PPV "onestep method" was performed in 147 patients. The operation times ranged from 20 to 100 minutes, with a mean of (51.1±18.9) minutes. The follow-up ranged from three to 12 months. The intraoperative and postoperative complications were observed. Results Intraoperative complications was found in seven patients (4.7%), which included iatrogenic retinal breaks in one patient (0.7%), macular damage in one patient (0.7%), suprachoroidal perfusion in one patient (0.7%), puncture leakage and closure incision in two patients (1.3%), vitreous hemorrhage in one patient (0.7%) and stopper broken off in cannula in one patient (0.7%). Postoperative complications was found in 34 patients (22.7%), which including retinal detachment in one patient (0.7%), vitreous hemorrhage in three patients (2.0%), cataract in three patient (2.0%), intraocular pressure ＜10 mm Hg（1 mm Hg=0.133 kPa） in 20 patient (13.3%), and transient ocular hypertension in seven patients (4.7%). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.
Objective To evaluate the clinical characteristics of end oscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients (20 eyes) suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed. The patients (18 males and 2 females) aged from 5 to 79 years with the average age of 35.9 years. There were 16 post-trauma and 4 post-cataract endophthalmitis. The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes. During the operation, posterior vitreous detachment was induced, vitreous at the base and bands over the ciliary body was removed, and membrane at the anterior or posterior surface of the iris was also removed after lensectomy. The median of the duration of hospita lization to operation was 1.5 days, and the follow-up period was 6～42 months (mean=23 months). Results Positive cultures were obtained in 9 (45%) cases. Seven intraocular foreign bodies were extracted from 6 eyes. Ora serrata was separated at one place in 2 cases, iatrogenic retinal tear at one, two place in 1 case respectively. Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery. Ten eyes (50%) retained useful vision (ge;0.05). The visual acuity was decreased, maintained and improved in 1, 3 and 16 eyes, respectively, and 4 cases over than 0.08. Cornea was clear in 11 (55%) eyes after operation; 9 cases with silicon oil in; ocular pressure was slanting low in 2 cases , but more than 5 mm Hg（1 mm Hg=0.133 kPa）; intraocular hypertension in 1 case , controlled by medicine; local and questionable retinal detachment in 1 case respectively, without surgery again. The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers, only one eye in 11 eyes without silicon oil in was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitrectomy is useful, safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time. （Chin J Ocul Fundus Dis，2008，24：202-205）
Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
ObjectiveTo explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management.MethodsFrom January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped.ResultsThe operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications.ConclusionSince the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.
ObjectiveTo summarize our initial experience in robot-assisted left upper lobectomy for non-small cell lung cancer. MethodsFour patients with non-small cell lung cancer underwent robot-assisted left upper lobectomy with da Vinci S surgical system (Intuitive Surgical, California) in General Hospital of Shenyang Military Area Command between March and August 2013. There were 3 male and 1 female patients, and their age was 58.8 years (range:49-67 years). We used general anesthesia with double lumens trachea cannula. The patients set in right lateral decubitus position with jackknife. We used 3 arms of the robot system. A single direction lobectomy procedure or an anatomic lobectomy procedure was used according to the differentiation of fissure. Systemic lymph node dissection was performed for all patients. ResultsFour patients with left upper lobectomy were completed with total robotic procedure without conversion. Postoperative pathological examination showed all the patients were of all adenocarcinoma with 2 patients inⅠA stage and 2 patients inⅢA stage. The range of operating time was 100-150 min, intraoperative blood loss was 30-80 ml and no blood transfusion was needed for the patients. The drainage time was 6-20 days. All of the 4 patients were discharged smoothly. The patients were followed up for 10-15 months without recurrence or metastasis. ConclusionRobot-assisted left upper lobectomy is safe and feasible for non-small cell lung cancer.
Objective To explore the short-term therapeutic effect of mini-incision common vertebral pedicle screw internal fixation on thoracoclumbar fractures without neurological injury. Methods The data of 61 patients with thoracolumbar fractures without neurological injury treated with mini-incision common vertebral pedicle screw internal fixation (the mini-incision group, n=32) or percutaneous pedicle screw fixation (the percutaneous group, n=29) from February 2014 to January 2016 was retrospectively collected and analyzed. Total incision length, operation time, blood loss, fluoroscopy times, postoperative bed rest time, hospitalization costs, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), vertebral Cobb angle of correction, and accuracy rate of screw placement were compared between the two groups. Results All the patients were followed up for 6 to 24 months with a mean of 13.4 months. There were no complications such as incision infection and neurovascular injury except for 2 screws breakage in one patient in the percutaneous group. In the mini-incision group, the average total incision length was longer than that in the percutaneous group [(7.33±0.53) vs. (6.38±0.44) cm], while the average operation time was shorter than that in the percutaneous group [(62.66±4.75) vs. (72.93±5.09) minutes]; the differences were statistically significant (P<0.001). In the mini-incision group, the average frequency of fluoroscopy was fewer [(5.63±0.61)vs. (19.07±1.60) times] and the average hospitalization costs was lower [(23.3±1.5) thousand yuan vs. (39.5±1.6) thousand yuan] than those in the than that in the percutaneous group; the differences were statistically significant (P<0.001). No significant difference was found in blood loss, postoperative bed rest time, VAS score, ODI, vertebral Cobb angle of correction, and accuracy rate of screw placement between the two groups (P>0.05). Conclusions Mini-incision common vertebral pedicle screw internal fixation for thoracoclumbar fractures without neurological injury has the advantages of short operation time, less fluoroscopy times, low hospitalization costs and high fixation strength. It may obtain a good short-term effectiveness.