Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
ObjectiveTo explore the clinical efficacy and summarize the experience of intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt). MethodThe clinical data of patients (from April 2020 to June 2024), including preoperative, intraoperative, and postoperative details who underwent LDPPHRt in Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected and analyzed. ResultsSeventy-five patients were collected in this study, including 35 males (46.7%) and 40 females (53.3%). The age was (38.3±7.9) years old, and 35 patients (46.7%) presented without symptoms. The main symptoms were abdominal pain (21 cases, 28.0%), repeated diarrhea (15 cases, 20.0%), weight loss (4 cases, 5.3%). The diameter of the pancreatic head lesions was (3.2±0.8) cm. The operative time was (210.6±23.8) min, and the blood loss was (62.4±38.1) mL. There were 18 cases (24.0%) of postoperative complications, including 6 cases (8.0%) of postoperative pancreatic fistula, 5 cases (6.7%) of haemorrhage, 4 cases (5.3%) of biliary leakage, 2 cases (2.7%) of lymphatic leakage, 4 cases (5.3%) of delayed gastric emptying, 2 cases (2.7%) of abdominal infection, 1 case (1.3%) of pulmonary infection and 2 cases (2.7%) of wound infection. The length of postoperative hospital stay was (11.7±3.3) d, and no one died within 90 d after surgery. ConclusionsThe intracapsular approach is a feasible and safe surgical procedure in LDPPHRt for patients with benign, borderline or low grade malignant tumors.
Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.
Objective To explore the risk factors of chronic postoperative inguinal pain (CPIP) after transabdominal preperitoneal hernia repair (TAPP), establish and verify the risk prediction model, and then evaluate the prediction effectiveness of the model. Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group (n=300) and validation group (n=62). The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model was established and tested. Results The incidence of CPIP at 6 months after operation was 27.9% (101/362). Univariate analysis showed that gender (χ2= 12.055, P=0.001), age (t=–4.566, P<0.01), preoperative pain (χ2=44.686, P<0.01) and early pain at 1 week after operation (χ2=150.795, P<0.01) were related to CPIP. Multivariate logistic regression analysis showed that gender, age, preoperative pain, early pain at 1 week after operation, and history of lower abdominal surgery were independent risk predictors of CPIP. The area under curve (AUC) of the receiver operating characteristic (ROC) of the risk prediction model was calculated to be 0.933 [95%CI (0.898, 0.967)], and the optimal cut-off value was 0.129, while corresponding specificity and sensitivity were 87.6% and 91.5% respectively. The prediction accuracy, specificity and sensitivity of the model were 91.9% (57/62), 90.7% and 94.7%, respectively when the validation group data were substituted into the prediction model. Conclusion Female, age≤64 years old, preoperative pain, early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP, and the risk prediction model established on this basis has good predictive efficacy, which can further guide the clinical practice.
ObjectiveTo summarize the current common clinical laparoscopic gastrointestinal tumor surgical localization methods, and to provide reference for clinicians to choose reasonable localization methods. MethodThe domestic and foreign literatures related to laparoscopic gastrointestinal tumor surgical localization methods were searched and reviewed. ResultsThe common localization methods for laparoscopic gastrointestinal tumor surgery were imaging localization, preoperative endoscopic localization, intraoperative endoscopic localization and intraoperative fluorescence localization, among which abdominal enhanced CT and endoscopic-related localization methods were the most commonly used localization methods in clinical practice at present. ConclusionA variety of methods are available for surgeons to choose from, and the precise localization of tumors is better facilitated by combining multiple methods.
ObjectiveTo explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.MethodsA total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group (43 cases) and the jaundice-free control group (control group, 61 cases) according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored.ResultsThe ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group (P<0.05). In addition, the hospital stay in the jaundice group was shorter than that of the control group (P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications (included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups (P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index (CCI), and ratio of CCI≥20 (P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications (P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications (P>0.05).ConclusionPreoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.
ObjectiveTo systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
Objective To discuss surgical skills and clinical value of laparoscopic splenectomy with behind splenic hilus tunnel-building technique. Method The clinical data of 1 patient with HBV-related hepatic cirrhosis combined splenomegaly and hypersplenism treated in the Second Affiliated Hospital of Chongqing Medical University was discussed and summarized. Results The patient underwent the laparoscopic splenectomy with surgical approach of from bottom to top, front to back, and shallow to deep. The key point of the tunnel-building technique was fully exposed the upper and lower poles of the splenic pedicle. The operative time was 70 min, the intraoperative blood loss was 50 mL, and the discharge time was 5 d after operation. Conclusion Laparoscopic splenectomy with behind splenic hilum tunnel-building technique is safe and feasible, especially for beginners.
The aim of this study is to evaluate the effect of laparoscopic simulation training with different attention. Attention was appraised using the sample entropy and θ/β value, which were calculated according to electroencephalograph (EEG) signal collected with BrainLink. The effect of laparoscopic simulation training was evaluated using the completion time, error number and fixation number, which were calculated according to eye movement signal collected with Tobii eye tracker. Twenty volunteers were recruited in this study. Those with the sample entropy lower than 0.77 were classified into group A and those higher than 0.77 into group B. The results showed that the sample entropy of group A was lower than that of group B, and fluctuations of A were more steady. However, the sample entropy of group B showed steady fluctuations in the first five trainings, and then demonstrated relatively dramatic fluctuates in the later five trainings. Compared with that of group B, the θ/β value of group A was smaller and shows steady fluctuations. Group A has a shorter completion time, less errors and faster decrease of fixation number. Therefore, this study reached the following conclusion that the attention of the trainees would affect the training effect. Members in group A, who had a higher attention were more efficient and faster training. For those in group B, although their training skills have been improved, they needed a longer time to reach a plateau.