Robot-assisted laparoscopic abdominoperineal resection for anal canal cancer associated with Crohn's disease: A case report

A 37-year-old man with Crohn's disease (CD) and a history of abdominal surgery was diagnosed with anal canal cancer. Robot-assisted laparoscopic abdominoperineal resection was performed and the patient was discharged without any postoperative complications. Recently, minimally invasive surgery for CD patients has grown in popularity. However, there have been few studies of robotic surgery for CD patients with anal canal cancer. To the best of our knowledge, we present the first report of a patient with CD-associated anal canal cancer who underwent robot-assisted laparoscopic abdominoperineal resection.     

Three‐dimensional laparoscopy‐assisted bowel resection for cavernous hemangioma of the rectum: Report of two cases

The safety and feasibility of 3‐D laparoscopy‐assisted bowel resection were demonstrated in the management of rectal cancer. However, this procedure’s role in the management of patients with diffuse cavernous hemangioma of the rectum has not been evaluated. Here, two patients were diagnosed with diffuse cavernous hemangioma of the rectum by colonoscopy and abdominal imaging. One case underwent pull‐through transection and coloanal anastomosis in 3‐D laparoscopy‐assisted surgery. In another patient, 3‐D laparoscopy‐assisted abdominoperineal resection was performed. The operations were safely performed in both cases. The two patients recovered uneventfully, and satisfactory postoperative outcomes were demonstrated. This report shows that 3‐D laparoscopy‐assisted bowel resection may be safe and feasible for patients with diffuse cavernous hemangioma of the rectum.     

Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases

Here we report a case of advanced rectal and prostate cancer with synchronous lateral lymph node (LLN) metastases that was treated with laparoscopic surgery. A 71‐year‐old man presented with fecal occult blood and was diagnosed with rectal cancer. A metastatic right LLN was suspected after CT examination of a 19‐mm lymph node (proximal internal iliac artery region) and a 13‐mm lymph node (distal internal iliac artery region) in the right lateral region. We planned neoadjuvant chemotherapy to suppress local and distant recurrence. This treatment decreased the size of the primary rectal tumor. We performed laparoscopic abdominoperineal resection and right LLN dissection. The histopathological diagnosis was LLN metastases from the rectal and prostate cancers. It is rare for synchronous metastases from rectal and prostate cancers to be observed in the LLN. It may be difficult to determine an appropriate treatment strategy in cases like this.     

Case report of perineal hernia after laparoscopic abdominoperineal resection

Perineal hernia (PH) is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present a case report of perineal hernia after laparoscopic APR and discuss its management. The patient was a 77‐year‐old man who was diagnosed with lower rectal cancer. He underwent laparoscopic APR and bilateral lateral lymph node dissection. Two months after the surgery, pain and bulging in the perineal region developed, and PH was diagnosed by CT. Repair with a polypropylene mesh was performed using a combination of laparoscopic abdominal and transperineal approaches. Reportedly, the incidence of secondary PH after APR has increased along with the rate of laparoscopic surgery. Treatment of secondary PH with transperineal repair alone may cause injuries to other organs because of adhesion of the pelvic viscera. In the present case, we safely repaired the hernia repair using a laparoscopy‐assisted perineal approach.     

Laparoscopic radical robotic prostatectomy: a case study

The management of prostate cancer includes observation, hormonal therapy, radical prostate surgery (open, laparoscopic, or laparoscopic robotic), external beam radiation, brachytherapy, or cryotherapy. Laparoscopic radical robotic prostatectomy is the newest technology in minimally invasive surgery. This is a case study of a patient who chose to undergo laparoscopic robotic prostatectomy for his prostate cancer.     

Hybrid resection of massive rectal gastrointestinal stromal tumor using laparoscopic and transanal approaches

Rectal gastrointestinal stromal tumors (GISTs) are rare, and radical surgery such as abdominoperineal resection is necessary for large rectal GISTs to obtain tumor-free resection margins. Here, we describe a 77-year-old man with a locally advanced non-metastatic GIST in the left anterolateral wall of the lower rectum. Tumor size was estimated to be 73 mm, and invasion of the left seminal vesicle and prostate was suspected. Chemotherapy with imatinib mesylate reduced the tumor size, creating a slight gap between the tumor and anterior organs. Therefore, we performed sphincter-sparing partial rectal resection using a hybrid method of laparoscopic and transanal approaches. The postoperative course was uneventful, and the patient remains disease-free on adjuvant chemotherapy 12 months after surgery. This case suggests that a hybrid method of laparoscopic and transanal surgery allows oncological and function-preserving excision of large rectal GISTs.     

腹腔镜下前列腺癌根治术结合内分泌辅助治疗高危前列腺癌的效果

目的探讨腹腔镜下前列腺癌根治术结合内分泌辅助治疗高危前列腺癌的效果。方法选取50例局部晚期高危前列腺癌患者,均行腹腔镜下前列腺癌根治术治疗,根据术后是否进行辅助内分泌治疗(AHT)将其分为观察组及对照组,比较2组手术一般情况及2年生存率。结果 50例患者均成功手术。观察组的2年总体无生化复发率为76%,对照组为52.00%,观察组中进行AHT治疗的所有患者在随访过程中均能够耐受治疗。结论腹腔镜下前列腺癌根治术结合内分泌辅助治疗高危前列腺癌,能够显著提高患者的2年无生化复发率,控制疾病进展。     

腹腔镜下前列腺癌根治术中保留尿控和性功能的临床研究

目的探讨腹腔镜下腹膜外途径改良前列腺癌根治术对患者术后尿控及性功能的影响。方法回顾性分析该院2014年1月-2017年9月收治的53例局限性前列腺癌患者的资料,其中行腹腔镜下改良前列腺癌根治术29例,行腹腔镜下常规前列腺癌根治术24例,比较两种方法的手术时间、术中失血量、术后引流量、术后尿控及性功能恢复情况等。结果两组患者在手术时间、切缘阳性率和住院时间等方面均无明显差异(P0.05),改良组术中失血量及术后引流量均较常规组少(P 0.05),改良组术后第1、3和6个月尿控及勃起功能恢复情况均优于常规组(P 0.05)。结论改良腹腔镜下腹膜外途径前列腺癌根治术可有效保留局限性前列腺癌患者的术后尿控及勃起功能。     

Incidental detection of asymptomatic migration of Hem‐o‐lok clip into the bladder after laparoscopic radical prostatectomy

Hem‐o‐lok clips have been widely used in laparoscopic or robot‐assisted surgery. We report a case of an incidentally discovered Hem‐o‐lok migration into the bladder after laparoscopic radical prostatectomy. The patient was a 75‐year‐old man with localized prostate cancer who underwent laparoscopic radical prostatectomy in July 2009. At 3 postoperative years, follow‐up ultrasonography revealed a small round mass in the bladder. No lower urinary tract symptoms were reported, and urinalysis results had never indicated hematuria or pyuria. Cystoscopy revealed a Hem‐o‐lok clip in the bladder, near the vesicourethral anastomotic site. We could not remove it with forceps in the outpatient clinic, so we performed the procedure again under general anesthesia and successfully removed the Hem‐o‐lok clip. To our knowledge, this is the first report of an asymptomatic Hem‐o‐lok migration into the bladder.     

解剖性耻骨后根治性前列腺切除术

虽然近年来腹腔镜手术及机器人辅助腹腔镜手术发展迅速,但解剖性耻骨后根治性前列腺切除术仍是治疗局限性前列腺癌的金标准。经过20多年的不断改进与创新,这项手术技术无论在安全性还是从有效性上都得到了很大的提高,同时也存在一定的并发症,如术中出血、直肠损伤、术后尿失禁、勃起功能障碍等。本文结合临床经验体会,对解剖性耻骨后前列腺癌根治术的要点进行详尽探讨,并对近年来手术技巧方面的改进作一简要阐述。     

基层医院腹腔镜直肠癌根治术20例

目的总结基层医院初期开展腹腔镜直肠癌根治术的临床经验。方法回顾分析2008年10月2009年10月收治的20例腹腔镜直肠癌手术的临床资料。结果 16例顺利完成手术,4例中转开腹,1例发生吻合口瘘。随访2～10个月,均无操作孔种植及肿瘤复发。结论采用手术者已习惯的手术路径,电刀、超声刀相结合游离直肠肠管,直视下裸化和用凯途闭合肠管,缩短了手术学习曲线,降低了手术成本,有助于在基层医院推广。     

Two‐stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report

A 75‐year‐old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.     

Laparoscopic abdominoperineal resection with lateral lymph node dissection for anorectal melanoma: A case report

Because anorectal melanoma, a rare cancer with a poor outcome, does not respond well to local radiation therapy or systemic chemotherapy, surgery is the primary treatment. Herein, we present a case of anorectal melanoma with lateral and inguinal lymph node metastases. A 61‐year‐old woman presented with rectal bleeding. Colonoscopy revealed a black tumor with ulceration in the anorectum. A CT scan revealed an anorectal tumor with left lateral lymph node swelling and right inguinal lymph node swelling. We performed a laparoscopic abdominoperineal resection with lateral lymph node dissection and right inguinal lymph node dissection. One year after the initial operation, pulmonary metastases were observed, and pulmonary resection was performed. After the pulmonary resection, brain metastases developed, and surgical resection was performed. Despite the recurrence of disease, the patient has survived for 52 months since the initial surgery and continues to receive systemic chemotherapy.     

腹腔镜下直肠切除术的器械应用与管理

目的探讨腹腔镜下直肠切除术的器械应用与管理特征。方法72例腹腔镜下直肠前切术和腹会阴联合直肠癌根治术患者,采用统一的临床路径治疗方案和整体护理。结果除5例中转开腹外,67例完成腹腔镜下直肠切除术,手术时间130～210min,平均155min;术中平均出血量190mL。结论手术室建立腹腔镜组,培养熟练掌握腹腔镜结直肠切除手术器械使用与维护、清洗、包装和灭菌的技术人才,能不断完善腹腔镜手术的操作规范,促进腹腔镜下结直肠手术的发展。     

Safe positioning for robotic-assisted laparoscopic prostatectomy

Robotic-assisted laparoscopic prostatectomy is a surgical procedure performed to eradicate prostate cancer. Use of robotic assistance technology allows smaller incisions than the traditional laparoscopic approach and results in better patient outcomes, such as less blood loss, less pain, shorter hospital stays, and better postoperative potency and continence rates. This surgical approach creates unique challenges in patient positioning for the perioperative team because the patient is placed in the lithotomy with steep Trendelenburg position. Incorrect positioning can lead to nerve damage, pressure ulcers, and other complications. Using a special beanbag positioning device made specifically for use with this severe position helps prevent these complications.     

腹腔镜低位直肠癌根治51例

目的探讨腹腔镜全直肠系膜切除（TME）治疗低位直肠癌的临床应用。方法回顾性分析51例腹腔镜低位直肠癌手术，其中Dixon术式42例，Miles手术9例。结果51例手术成功，无中转开腹，平均耗时150min，术中平均失血100mL，术后平均住院9d，无术后出血、吻合口瘘、4例排尿障碍，5例出现明显性功能障碍。随访1—39个月，随访率为80％，2例腹腔广泛转移，2例肝脏转移，1例穿刺口转移。结论腹腔镜下TME治疗低住直肠癌安全可行，且创伤小，疼痛轻，恢复快。良好的腹腔镜手术技术和手术适应证以及丰富的开腹直肠手术经验是手术成功的保证。     

Successful laparoscopic treatment of advanced rectal cancer in an extremely elderly man (101 years and 9 months)

An extremely elderly man (age, 101 years and 9 months) visited our hospital because of recurrent and worsening anal bleeding. Type 2 rectal cancer was found in his rectum during colonoscopy. He did not have any severe coexisting diseases and had not suffered any episodes of dementia. Laparoscopy‐assisted anterior resection combined with D2 lymph node dissection was performed with minimal bleeding. The operation time was 128 min. The patient suffered mild reflux pneumonia on postoperative day 6 and was administered additional antibiotics. He recovered within 2 days. He was discharged on postoperative day 17, at which point he was able to walk.     

Laparoscopic anterior resection for rectal cancer in a patient with a ventriculoperitoneal shunt

Laparoscopic surgery has been relatively contraindicated in patients with ventriculoperitoneal shunts (VPS) because of concerns about the effect of the pneumoperitoneum on shunt function. However, there have been recent reports of laparoscopic surgery on the gallbladder and cecum. This is the first report of laparoscopic high anterior resection for rectal cancer without manipulation of the VPS catheter in a patient with VPS. We made a diagnosis of advanced rectal cancer in a 77‐year‐old man who had a VPS to treat hydrocephalus after a subarachnoid hemorrhage. We performed the procedure with the patient in a 15° head‐down tilt and with 10‐mmHg pneumoperitoneum pressure. There were no postoperative complications. We concluded that laparoscopic surgery for rectal cancer can be safely performed in patients with VPS.     

Laparoscopic repair of secondary perineal hernia with coverage by the mobilized cecum

The incidence of secondary perineal hernia (SPH) has increased since the introduction of extralevator abdominoperineal resection and laparoscopic abdominoperineal resection. Currently, laparoscopic mesh repair is the usual procedure. Here, we demonstrate a repair of SPH without mesh that uses the mobilized cecum to cover the pelvic hernial orifice. An 83‐year‐old man complained of discomfort when sitting for long periods. He was status post laparoscopic abdominoperineal resection and was diagnosed with SPH. Hernia repair was performed. After transperitoneal adhesiolysis in the inferior pelvis, the right colon was laparoscopically mobilized, and the pelvic orifice was covered by suturing the cecum to the pelvic brim. The perineal skin was managed with negative pressure wound therapy. The postoperative course was uneventful. There has been no sign of recurrent herniation for 12 months. This method of SPH repair is simple to perform and avoids mesh‐related complications.     

机器人辅助腹腔镜根治性前列腺切除:经腹与腹膜外入路术后对肝肾功能的影响

目的 通过对比经腹与腹膜外入路,达芬奇机器人辅助腹腔镜根治性前列腺切除术后对肝肾功能的影响,以期为前列腺癌患者围手术期安全性提供临床依据,并为肝肾功能不全患者手术方案的制定提供参考.方法 回顾性分析2014年3月至2020年11月赤峰市医院收治的95例前列腺癌患者的临床资料,其中58例行经腹入路机器人辅助根治性前列腺切...