Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases

ObjectiveTo evaluate the safety and feasibility of single-incision laparoscopic surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer.MethodsThe clinical data of 30 consecutive patients with sigmoid and upper rectal cancer who underwent SILS+1 radical resection between October 2018 and January 2020 in our hospital were retrospectively analyzed. An initial 5-cm periumbilical transverse incision was made. Then, a multiport device was placed in the umbilical incision. Two 10-mm ports were used for laparoscope insertion, and the other two ports were used for laparoscope device insertion. A 12-mm trocar was placed in the right lower abdominal quadrant under laparoscopic view and served as the surgeon’s dominant operating channel.ResultsAll operations were performed successfully without conversion to conventional laparoscopic surgery or open operation. Three patients developed postoperative complications: one patient developed ileus, one developed postoperative bleeding, and one developed wound infection. There were no perioperative deaths.ConclusionsThe safety and feasibility of SILS+1 radical resection of sigmoid and upper rectal cancer was established by experienced surgeons in our study. However, further studies are needed to demonstrate the advantages of this procedure compared with the benefits of conventional laparoscopic surgery.     

Single‐incision laparoscopic surgery for small bowel resection with an intraumbilical arcuate incision in children

Single‐incision laparoscopic surgery (SILS) has been performed on children for various procedures. However, few reports are available about SILS for small bowel resection, particularly involving conventional instruments in the pediatric population. Herein, we report four cases of small bowel resection with single umbilical incision and a three‐trocar approach. From October 2010 to September 2011, we performed small bowel resection with SILS on four cases, including a boy with an intestinal duplication cyst and three children with Meckel's diverticulum. An intraumbilical arcuate incision was made to expose the abdominal wall fascia, and one 5‐mm and two 3.5‐mm trocars were inserted. It was not necessary to extend the initial incision to exteriorize the lesion except in one case in which we applied the so‐called Y‐V closure plasty. All procedures were successful and did not require conversion, and all patients recovered smoothly without any complications. Small bowel resection using the SILS approach is suitable for these diseases.     

国内首例经阴道腹腔镜胆囊切除术

目的探讨临床开展经自然腔道内镜手术(PURE NOTES),采用经阴道腹腔镜切除胆囊的可行性、安全性和优越性。方法胃镜下针刀切开阴道后穹窿3cm,切口处安放"三通转换器"(Single Incision Laparoscopic Surgery Port,SILS PORT),三通道内分别插入3个软性器械套管建立防止漏气的通道,充气后首先于SILSPORT6点位通道进入腹腔镜探查腹盆腔情况,并监视硬质弯曲操作器械通过3点及9点位的通道到达胆囊区。分离出胆囊管及胆囊动脉,置入钛夹,分别夹闭胆囊管及胆囊动脉,常规切除胆囊,电凝胆囊床,将胆囊从阴道取出体外。结果胆囊切除时间39min,出血量2mL,未放引流,术后无阴道分泌物、无出血、胆漏等并发症,几乎无腹部疼痛,恢复快,术后第3天康复出院。结论 PURE NOTES经阴道腹腔镜胆囊切除术技术可行,操作安全,相比传统腹腔镜手术有明显优势,是目前开展PURE NOTES的较好方法 。     

Remote access laparoscopic (REAL) surgery: a novel approach for single-port surgery without a visible scar

INTRODUCTION: Single-port laparoscopic surgery usually uses the transumbilical approach. However, the transumbilical incision may be associated with a high frequency of wound-related complications, including trocar site hernia and infection. Therefore, we developed remote access laparoscopic (REAL) surgery, a new access technique for single-port surgery within the pubic hairline. This study reports on a technique developed at our institution and describes our preliminary results. MATERIALS AND SURGICAL TECHNIQUE: Ten patients with cholecystolithiasis underwent REAL surgery. A single 2.5-cm transverse incision was made medially within the pubic hairline area, and a SILS Port was inserted. A 5-mm flexible endoscope and an articulating grasper or a long laparoscopic grasper were used. Dissection of the gallbladder was achieved with laparoscopic ultrasonic shears just as in the conventional laparoscopic cholecystectomy. All procedures were successfully performed without conversion to conventional laparoscopic technique. There were no postoperative complications, and outpatient evaluation showed a clean scar within the pubic hair area in all patients. DISCUSSION: Our early experience shows that REAL surgery is feasible and safe. This novel access technique can preserve the native umbilicus and provides an invisible scar that is concealed within the pubic hair.     

自制套管单孔腹膜后镜肾上腺切除术初步经验总结

[目的]探讨采用自制套管进行单孔腹膜后镜肾上腺切除术的可行性和初步经验.[方法]2010年6月至2011年8月北京大学第一医院共有9例患者行单孔腹膜后镜肾上腺切除术.患者平均年龄59岁(32 ～80岁),男5例,女4例,平均BMI为24.1 kg/m2.所有手术均为腹膜后入路,选择腋中线与腋后线之间髂嵴上方3cm处斜行切口,切口长度3～4 cm.先以气囊扩张建立腹膜后腔,然后置入以手套自制单孔多通道套管建立手术入路,采用前端可弯曲腹腔镜器械联合常规腹腔镜器械完成手术,在术毕从切口取出标本.[结果]肿瘤长径平均3.3 cm(1.5～5.5 cm),左侧3例,右侧6例.平均手术时间62min(40～127 min),术中平均出血量为50 ml(0 ～200ml).9例手术均顺利完成,无中转开放手术或增加附加套管,无术中、术后并发症发生.平均术后住院时间为5 d(3 ～7 d).[结论]对于选择合适的病例,采用自制套管行单孔腹膜后镜肾上腺切除术是安全可行的,具有一定的美观效果,但远期疗效尚待观察,手术器械及手术技术尚待完善.     

腹腔镜下膀胱部分切除术治疗膀胱憩室

目的总结腹腔镜下膀胱部分切除术治疗膀胱憩室临床疗效并探讨其应用价值。方法回顾性分析2014年1月~2015年10月我科5例腹腔镜下膀胱部分切除术病例,4例行经尿道前列腺剜除术+腹腔镜下膀胱部分切除术,1例行经尿道膀胱颈切开术+腹腔镜下膀胱部分切除术。结果5例患者手术均成功,平均手术时间140±23.7 min,平均出血量65±15.2 mL,无需输血,术中、术后未出现严重并发症,术后2~3 d拔除引流管,平均住院时间7.4±1.1 d。结论对于膀胱出口梗阻合并膀胱憩室病例,行经尿道电切术+腹腔镜下膀胱部分切除术,具有创伤小、出血少、恢复快、并发症少、住院时间短等优点,是微创治疗膀胱憩室安全、可行的手术方法。      

A novel locally operated master-slave robot system for single-incision laparoscopic surgery

Abstract

Purpose: Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. Material and methods: A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. Results: In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. Conclusion: We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.     

肾移植后原肾盂或输尿管肿瘤患者腹腔镜肾输尿管全长切除中下腹部入路的可行性

背景:肾移植后原肾肾盂或输尿管肿瘤,不仅一侧发生,常常对侧也先后或同时发生.目的:介绍用腹腔镜先行肾切除,再用电切镜行输尿管周围膀胱袖状切除,然后取下腹部正中切口取出肾并切除下段输尿管治疗原肾肾盂或输尿管肿瘤的一种新的手术方法,并验证其可行性.设计、时间及地点:技术改进实验,于2004-07/2006-03在北京大学第三医院泌尿外科完成.对象:选择用腹腔镜和电切镜联合治疗原肾盂或输尿管肿瘤患者8例,女7例,男1例.其中4例为双侧肾盂或输尿管肿瘤,故共行12例次肾输尿管全长切除和袖状膀胱切除手术.方法:取健侧卧位用腹腔镜先行肾切除,体位由侧卧位改为截石位用电切镜做输尿管周围膀胱袖状切除,然后取下腹部正中切口取出肾并切除下段输尿管.术后常规给予膀胱灌注抗肿瘤药物治疗防止肿瘤复发.术后3,6,12个月随访,此后每年1次.主要观察指标:手术时间、出血量、病理报告、术后复发时间、术后无瘤生存时间以及并发症.结果:手术时间2.5～7h,平均3.8 h;出血量50～1200mL,平均240mL:2例需要输血,分别输血600和1000mL,病理报告:1例为输尿管低分化腺癌;11例为移行细胞癌,1～2级4例,2级4例,3级3例,其中1例突破输尿管浆膜层.突破输尿管浆膜层的肿瘤患者术后6个月肿瘤局部复发,其余患者均无瘤生存.结论:针对肾移植后原肾盂或输尿管肿瘤,用腹腔镜和电切镜联合行肾输尿管全长切除及膀胱袖状切除后,取下腹部正中切口取出标本,肿瘤复发率较低,切除效果良好.     

Single-Incision Laparoscopic Cholecystectomy after Endoscopic Nasogallbladder Drainage: A Case Report

Objective

To report a single-incision laparoscopic cholecystectomy (SILC) for a patient with cholecystitis that required endoscopic nasogallbladder drainage (ENGBD).

Clinical Presentation and Intervention

A 75-year-old man was diagnosed with moderate acute cholecystitis and underwent antiplatelet therapy for a history of brain infarction. An ENGBD was performed as an initial treatment for his cholecystitis. After recovery from the cholecystitis, a SILC was performed using a SILS Port with an additional forceps. Because neither Rouviere''s sulcus nor Calot''s triangle could be identified with a favorable laparoscopic view, the fundus-first procedure was selected. The patient''s postoperative course was uneventful, and he was discharged from the hospital on day 3 after surgery.

Conclusion

In this case of a patient who had cholecystitis that required ENGBD, a SILC was successful performed using a combination of SILS Port with additional forceps and fundus-first procedure.Key Words: Endoscopic nasogallbladder drainage, Single-incision laparoscopic cholecystectomy, Single-incision laparoscopic surgery     

Advances in reduced port laparoscopic liver resection

Reduced port surgery has been attracting attention in the field of minimally invasive surgery. Although the use of SILS is becoming widespread, technical difficulty has delayed its adoption for laparoscopic liver resection. Recently, advances in laparoscopic liver resection have been made in tandem with advances in surgical skill and devices. The main driver in conventional laparoscopic liver resection's evolution to become less surgically invasive seems to be single‐incision laparoscopic liver resection (SILLR). To date, most reports on SILLR have been single case reports or case series. Only a few cohort studies on conventional laparoscopic surgery and SILLR have been conducted. Recent reports have described the use of SILLR for well‐localized lesions and solitary tumors located in the anterolateral segments of the liver or left liver lobe, but its application remains limited to partial resection and left lateral sectionectomy. The feasibility and safety of SILLR have been demonstrated, but additional work is needed for standardization of the procedure.     

Novel procedure, SILSOID colectomy, is a bridge between conventional and single-incisional laparoscopic colectomy

Introduction: Laparoscopic colectomy (LC) is a widely accepted treatment for various diseases of the colon. Transumbilical single‐incisional laparoscopic surgery (SILS) offers excellent cosmetic results compared with standard multi‐port laparoscopic surgery. We describe a new hybrid laparoscopic procedure, SILSOID colectomy, which combines conventional LC with SILS. Methods: We performed SILSOID colectomy to treat four patients with colorectal disease. Three ports were inserted through the single transumbilical incision, and an additional port was inserted in the flank at a site that depended on the location of the lesion. Division and anastomosis of the colon were performed extracorporeally. Results: SILSOID colectomy was carried out uneventfully in all four cases. The median operation time was 220 minutes (range, 179–320 min), and the median blood loss was negligible (range, negligible–285 mL), respectively. Although one patient experienced a postoperative wound infection, no other postoperative complications occurred. Conclusion: SILSOID colectomy is safe and feasible and it can be used as an alternative to conventional LC. We consider this procedure to be a bridge between conventional LC and more advanced laparoscopic procedures, such as SILS.     

Single‐incision laparoscopic cholecystectomy for porcelain gallbladder: A case report

Single‐incision laparoscopic cholecystectomy (SILC) has been performed in patients with gallbladder stones without inflammation. Porcelain gallbladder is a rare finding of chronic cholecystitis that is characterized by extensive calcification of the gallbladder wall. Herein we describe our experience with SILC for porcelain gallbladder with a successful outcome. A 67‐old‐year woman was diagnosed with porcelain gallbladder. We performed SILC using a SILS Port and a 5‐mm forceps through the umbilical incision. Because a small amount of the omentum around the gallbladder was left to facilitate grasping the fundus, a view of both the cystic artery and the cystic duct was easily obtained. The operative time and the intraoperative blood loss were 66 min and less than 1 mL, respectively. The patient was discharged 3 days after surgery and was satisfied with the cosmetic results. Our procedure may represent an alternative to conventional laparoscopic cholecystectomy in patients with porcelain gallbladder.     

单孔后腹腔镜手术的临床应用（附102例报告）

目的探讨单孔后腹腔镜技术治疗肾脏输尿管疾病的安全性、可行性及应用价值。方法 2013年8月-2016年10月采用单孔后腹腔镜技术行肾囊肿去顶术48例、输尿管切开取石术35例和无功能肾切除术19例。使用单孔三通道套管、30°专用加长腹腔镜、预弯加长腹腔镜器械和普通腹腔镜器械配合完成操作。结果全部患者手术均获成功,单孔后腹腔镜肾囊肿去顶术手术时间(32.32±11.46)min;单孔后腹腔镜输尿管切开取石术手术时间(78.25±24.66)min;单孔后腹腔镜单纯肾切除术手术时间(87.11±32.24)min。无1例增加辅助穿刺孔,无中转常规腹腔镜手术或开放手术,无并发症发生。结论单孔后腹腔镜技术治疗肾输尿管疾病安全、可行,手术效果与传统腹腔镜等同,有临床应用价值。     

Recent advances in laparoscopic surgery

Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%–0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence‐based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined.     

Single incision laparoscopic surgery (SILS) using cross hand technique

Abstract

Single incision laparoscopic surgery (SILS) was developed as a less invasive surgical procedure, but it remains difficult because of its specific skills and left-right reversal of the instruments. Such a difference makes manipulating endoscopic instruments more challenging and increases the risk. In this study, we introduce the cross hand technique allowing the surgeon to manipulate instruments with intuitive movement.     

Sequential transurethral enucleation of the prostate and laparoscopic bladder diverticulectomy

Transurethral endoscopic technique and standard laparoscopic technique are surgical options for the management of benign prostatic hyperplasia (BPH) associated with urinary bladder diverticuli (UBD). In this article, we report laparoscopic diverticulectomy (LD) and transurethral plasmakinetic enucleation of the prostate (TUEP) in the same patient sequentially. To the best of our knowledge, this is the first case report of LD combined with TUEP. An 82-year-old patient with benign prostatic hyperplasia and two secondary large bladder diverticuli underwent sequential TUEP and LD. After completion of the TUEP procedure, the detached adenoma was pushed into the bladder as a whole. Then laparoscopic transperitoneal extravesical diverticulectomy assisted by cystoscopic transillumination was performed immediately, and the enucleated prostate was removed via the neck of the diverticulum. The enucleation time and diverticulectomy time was 18?minutes and 108?minutes, respectively. The catheter was removed on the tenth postoperative day. Transurethral endoscopic surgery combined with LD is a good choice in treating BPH and UBD in one session. But the combined procedure is time-consuming, especially for fragmentation of the prostate. TUEP can greatly reduce the operative time of the combined procedure.     

Single-incision laparoscopic surgery using an articulating monopolar for juvenile cystic adenomyoma

Abstract

We demonstrate the feasibility of single-incision laparoscopic surgery (SILS) by using a novel monopolar cautery and a technique based on conventional multiport laparoscopic surgery in a patient with Juvenile cystic adenomyoma (JCA). A 20-year-old woman with severe dysmenorrhea, and a 3-cm uterine lesion was diagnosed with JCA. 70 cm of absorbable string tied to the tumor parenchyma was used to extract the tumor. The ends of the strings were positioned extracorporeally and the intra-abdominal parts of the strings adjacent to the anchored tumor were grasped by a laparoscopic needle holder for clarifying the incision line surrounding the tumor. The lesion was completely excised using a single-use articulating hook with monopolar cautery, and the hysterotomy site was sutured using barbed string. No complications occurred intraoperatively, and dysmenorrhea had significantly improved three months after surgery. SILS for JCA is a feasible and minimally invasive surgery for women desiring esthetic benefit.     

Single‐incision laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor arising from the duodenum

We report a case involving a minimally invasive single‐incision laparoscopic and endoscopic cooperative local excision of a duodenal gastrointestinal stromal tumor. A 59‐year‐old man presented with a 35‐mm lesion located in the second portion of the duodenum. A local resection was performed via single‐incision laparoscopic and endoscopic cooperative surgery. Intraluminal endoscopic dissection of the duodenal mucosa and submucosa was performed circumferentially around the tumor. The resection was then completed by laparoscopic dissection of the seromuscular layer around the tumor. The tumor was retrieved laparoscopically. After confirming that the resection achieved clear surgical margins, we closed the duodenal wall with a laparoscopic stapling device. There were no postoperative complications, including stenosis. Single‐incision laparoscopic and endoscopic cooperative surgery can be safely and effectively performed for a duodenal submucosal tumor.     

Development and evaluation of a master-slave robot system for single-incision laparoscopic surgery

Purpose   

Single-incision laparoscopic surgery (SILS) brings cosmetic benefits for patients, but this procedure is more difficult than laparoscopic surgery. In order to reduce surgeons’ burden, we have developed a master-slave robot system which can provide robot-assisted SILS as if it were performing conventional laparoscopic surgery and confirmed the feasibility of our proposed system.     

完全腹腔镜下肾输尿管全切除术(附9例报告)

目的探讨完全腹腔镜下肾输尿管全切除的手术方法。方法该组9例。男6例，女3例。采用完全腹腔镜手术方法行肾输尿管全切除术。气管内插管全麻，侧卧位。首先采用3、4个套管经腹入路行腹腔镜下肾及肾周脂肪囊整块切除。然后将体位转成45。斜卧位，用超声刀将输尿管向下分离至膀胱壁外，提拉输尿管末段，绕其根部2cm切除膀胱壁及输尿管开口。用2-0 Dexon线缝合膀胱切口。将肾输尿管放入标本袋内取出。结果该组病例全部顺利完成手术。手术时间180-240min，平均210min。出血量150-250ml，平均180ml，无明显围手术期并发症。术后随访2-34个月，未见肿瘤种植转移及膀胱肿瘤发生。结论完全腹腔镜肾输尿管全切除术可进一步减少手术创伤，更加符合肿瘤根治原则，减少并发症。随着腹腔镜技术及设备的不断完善，该术式将越来越广泛地应用于临床。