Objective?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）. Methods?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?Results?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups. Conclusions?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.
ObjectiveTo explore feasibility and advantages of hand-assisted laparoscopic radical resection for remnant gastric cancer. MethodsThe clinical data of 26 patients with remnant gastric cancer who underwent hand-assisted laparoscopic (hand-assisted group, n=13) or open (open group, n=13) radical resection from December 2007 to May 2016 in this hospital were retrospectively analyzed. The perioperative outcomes were compared between these two groups. ResultsThere was no conversion to open surgery in the hand-assisted group. Compared with the open group, the incision length was significantly reduced (P=0.000), the intraoperative blood loss was significantly decreased (P=0.038), postoperative the first anal exhaust time was significantly shortened (P=0.025) in the hand-assisted group. The operation time, the number of lymph nodes dissection, and the incidence of postoperative complications had no statistically significant differences between these two groups (P>0.05). ConclusionThe preliminary results of limited cases in this study show that hand-assisted laparoscopic radical resection for remnant gastric cancer is safe and feasible, it has several advantages including small incisions, mild intraoperative hemorrhage, rapid postoperative recovery, better recent clinical therapeutic outcome and so on as compared with open surgery.