Precision laparoscopic sentinel node navigation surgery for femoral skin cancer

Navigation surgery using indocyanine green (ICG) fluorescence imaging has been used in thoracoabdominal surgery, and its usefulness has been reported in many cases. In this study, laparoscopic lateral lymph node dissection was performed using ICG fluorescence imaging in a patient with left femoral spinous cell carcinoma with inguinal and external iliac lymph node metastases. Spinous cell carcinoma is classified as a rare cancer in Japan, and there is a scarcity of evidence for pelvic lymph node dissection, as well as a lack of studies that mention the dissection area. We hypothesized that visualization of lymph nodes and lymph flow using intraoperative ICG fluorescence imaging would indicate the area of dissection and lead to more efficient dissection. In conclusion, intraoperative ICG fluorescence imaging may be useful in this area where there is limited evidence, although there are some limitations.     

Indocyanine green‐fluorescent imaging of hepatocellular carcinoma during laparoscopic hepatectomy: An initial experience

Introduction: Laparoscopic hepatectomy has disadvantages in intraoperative diagnosis, because it offers limited visualization and palpability of the liver surface. Recently, we developed a novel fluorescent imaging technique using indocyanine green (ICG), which would enable identification of liver cancers during open hepatectomy. However, this technique has not yet been applied to laparoscopic hepatectomy. Materials and Surgical Technique: A patient with a hepatocellular carcinoma (HCC) located in Couinaud's segment II was administered ICG (0.5 mg per kg body weight) intravenous injection 5 d before surgery, as a routine liver function test. The prototype fluorescent imaging system was composed of a xenon light source and a laparoscope with a charge‐coupled device camera that could filter out light with wavelengths below 810 nm. Intraoperatively, fluorescent imaging of the HCC was performed by changing color images to fluorescent images with a foot switch. Then, the fluorescing tumor was clearly identified on the visceral surface of segment II during mobilization of the left liver for resection of segments II and III. On the cut surface of the specimen, the tumor showed uniform fluorescence and was microscopically diagnosed as a well‐differentiated HCC. Discussion: Laparoscopic fluorescent imaging using preoperative injection of ICG enabled real‐time identification of HCC. This technique may be an easy and reliable tool to enhance the accuracy of intraoperative diagnosis during laparoscopic hepatectomy.     

内生型肾癌行后腹腔镜肾部分切除术的安全性与有效性研究

目的：探讨内生型肾癌患者行后腹腔镜下肾部分切除术（LPN）的安全性与有效性。方法回顾性分析内生型肾癌行LPN术28例患者的临床资料，从手术情况、随访结果分析其安全性与有效性。结果28例患者手术均顺利完成，无中转开放手术，术后无严重并发症。手术时间（108.2±19.3）min，术中热缺血时间（15.5±4.3）min，术中出血量〈50ml。在不借助腹腔镜超声的前提下，按照肾脏分区、肿瘤与肾脏解剖关系，将肿瘤精确定位并完整切除。术后患者住院时间（4.1±0.9） d；随访（30.3±10.6）个月，术后6个月肾小球过滤率（eGFR）较术前差异无统计学意义；1例患者eGFR下降25%，术后肾功能长期维持在CKD2期，其余患者未出现急、慢性肾功能不全，未行肾、腹膜透析等替代治疗；随访期间28例患者均未见肿瘤局部复发及远处转移。结论 LPN术治疗内生型肾癌可行、安全、有效，但尚需大样本研究及随访观察远期疗效。     

Blood flow evaluation using PINPOINT® in a case of incarcerated inguinal hernia: A case report

Indocyanine green (ICG) fluorescence for intestinal blood flow has been reported, but application during laparoscopic surgery for incarcerated inguinal hernia has not been reported. Here, we report the case of a patient with an incarcerated inguinal hernia in whom the bowel was preserved after evaluation of intestinal blood flow with ICG fluorescence using PINPOINT®, a brightfield full‐color, near‐infrared fluorescence camera. A man in his 80s was diagnosed with incarcerated inguinal hernia and underwent laparoscopic surgery. The ascending colon and mesentery showed deep red discoloration on gross evaluation. However, intravenous injection of ICG revealed uniform fluorescence of the mesentery and bowel wall, indicating the absence of irreversible ischemic changes of the bowel. As such, no resection was performed, and transabdominal preperitoneal patch plasty was completed. The patient had a good postoperative course. In this case, ICG fluorescence with the PINPOINT was useful to avoid bowel resection during laparoscopic surgery.     

Pure laparoscopic hepatectomy with augmented reality‐assisted indocyanine green fluorescence versus open hepatectomy for hepatocellular carcinoma with liver cirrhosis: A propensity analysis at a single center

Introduction

Laparoscopic hepatectomy is considered an acceptable treatment of choice in selected patients with primary hepatocellular carcinoma (HCC). Whether indocyanine green (ICG) immunofluorescence, a new technology, may improve surgery outcomes has yet to be tested. The aim of the present study was to investigate and compare the effect of ICG fluorescence imaging on the outcomes of pure laparoscopic hepatectomy and open hepatectomy for primary HCC with background cirrhosis.

Methods

From January 2015 to June 2016, 20 patients with HCC and liver cirrhosis underwent laparoscopic hepatectomy with ICG immunofluorescence. The outcomes of pure laparoscopic hepatectomy with ICG immunofluorescence were compared with those of open hepatectomy. To avoid selection bias, patients were propensity score matched in a ratio of 1 : 6, with 20 patients in the laparoscopic group and 120 in the open group.

Results

The laparoscopic group had 20 patients, and the open group had 120 patients. The laparoscopic group had less blood loss (125 vs 450 mL, P < 0.001), a shorter operation time (200 vs 250 min, P = 0.003), and a shorter hospital stay (5 vs 6 days, P < 0.001). The complication rate was 0% in the laparoscopic group compared to 15.0% in the open group (P = 0.135). All patients in the laparoscopic group had negative margin involvement. Four patients (3.3%) in the open resection group had positive margin involvement. Two patients in the ICG immunofluorescence group had additional lesions identified and resected during operation.

Conclusion

Pure laparoscopic hepatectomy with ICG immunofluorescence for primary HCC can be carried out safely with favorable short‐term outcomes even in cirrhotic patients. Better identification of the bile duct structure and better assessment of the tumor resection margin and perfusion are advantages of this new technique.     

后腹腔镜肾部分切除术治疗小肾癌42例报告

目的总结后腹腔镜技术对小肾癌(直径≤4 cm)行肾部分切除术的经验。方法 42例肾占位患者,肿瘤直径1.2~4.0 cm,经后腹腔途径施术,术后病理为40例肾脏透明细胞癌,2例乳头状肾癌。结果 41例手术均顺利完成,1例中转开放手术,手术时间60~150 min,平均105 min。肾动脉阻断时间15~37 min,平均24 min。术中出血量20~150 ml,平均60 ml。术后恢复顺利,住院7~10 d,平均8 d,随访3~24个月无肿瘤复发。结论后腹腔镜下肾部分切除术治疗小肾癌安全有效,可以作为小肾癌的首选治疗方法。     

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report

BACKGROUNDRectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARYA 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse. CONCLUSIONICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.     

后腹腔镜肾癌根治术的临床疗效评估(附67例报告)

目的评价后腹腔镜肾癌根治性切除术（retroperitoneal hparoscopic radical nephrectomy，LRN）与开放性肾癌根治性切除术（open radical nephrectomy，ORN）的临床效果。方法回顾性分析和比较后腹腔镜肾癌根治性切除术（34例，A组）与开放性肾癌根治性切除术（33例，B组）患者的临床资料，比较两种方法的手术时间、术中出血、术后引流、术后最早下床活动时间、肠功能恢复、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量、术后随访时间及手术效果。结果A组中1例因最初对解剖结构难于辨认，无法分离肾前筋膜至肾门而改开放手术，1例因损伤精索静脉出血难以控制而改开放手术，1例因肾周脂肪过多无法将肾脏掀起显露肾蒂而玫开放手术。31例手术成功；B组手术均成功，1例术后2个月因大面积脑出血死亡。余均无瘤生存。两组病例比较术中出血、术后引流、术后最早下床活动时间、肠功能恢复、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量差异有显著性（P〈0.01），而肿瘤大小、手术时间、随访时间差异无显著性（P〉0．05）。结论与传统的开放性肾癌根治性切除术相比，后腹腔镜肾癌根治性切除术虽然技术难度大，但其具有微创、痛苦小、恢复快、并发症少等优点，而对T1N0M0和T2N0M0期肿瘤控制，临床疗效相同。     

Recurrent ovarian granulosa cell tumors: clinical and imaging features

Background Granulosa cell tumor of the ovary differs from epithelial ovarian tumors in histologic appearance, clinical course and imaging findings. The purpose of this study was to evaluate clinical and imaging features of recurrent ovarian granulosa cell tumors. Methods We performed retrospective evaluation of the medical, surgicopathologic records and CT or MR images of 11 patients with pathologically proven recurrent ovarian granulosa cell tumor. Results The first recurrence of granulosa cell tumor was diagnosed at between 4 months and 18 years after the initial surgical resection of tumor (mean; 9.7 years). Six patients relapsed after 10 years after initial diagnosis. The recurrent tumors were located in the pelvic cavity alone in three patients, extrapelvic peritoneal cavity alone in two, both pelvic and extrapelvic peritoneal cavity in three, and paraaortic retroperitoneal space in three. The imaging appearances of recurrent masses were variable ranging from solid masses to completely cystic masses. Conclusion Recurrent granulosa cell tumor is characterized by late tumor recurrence manifested as a relatively small number of discrete peritoneal or retroperitoneal masses with variable imaging appearances from solid to cystic masses.     

后腹腔镜下肾癌根治术49例临床分析

[目的]评价后腹腔镜下肾癌根治术的疗效与安全性.[方法]回顾性分析2007年1月至2009年12月后腹腔镜下肾癌根治术49例患者的临床资料.[结果]49例患者平均肿瘤体积5.8 cm,手术平均时间140 min,平均出血量约120 mL,平均住院日期为9 d,6例患者有手术并发症,无中转开放手术,术后平均随访16个月,...     

经腹膜后入路小切口无气腹内腔镜辅助下上尿路肿瘤手术

目的详细介绍经腹膜后入路小切口、无气腹内腔镜辅助下上尿路肿瘤的手术方法和成功关键,以及我院初步应用的情况和体会。方法自2008年至2010年间随机选择25例上尿路肿瘤患者,其中肾上腺肿瘤12例（肾上腺皮质腺瘤8例、肾上腺嗜铬细胞瘤3例、肾上腺囊肿1例）,年龄（54.00±10.06）岁,肿瘤大小（6.91±1.70）cm;肾肿瘤T1～2N0M0期13例（肾透明细胞癌9例、肾细胞癌2例、肾腺癌2例）,年龄（53.22±13.02）岁。均采用经腹膜后入路小切口、无气腹内腔镜辅助下手术的方法施行手术。结果肾上腺肿瘤的平均手术时间为（109.30±12.84）min,根治性肾切除的平均手术时间为（121.80±13.80）min。与同期后腹腔镜手术时间相比,肾上腺肿瘤摘除少30min,根治性肾摘除少80min左右。本组病例术中均未输血,术后7d左右出院。结论小切口、无气腹内腔镜辅助下手术是微创手术方法的另一流派,适合我国国情,有应用价值。     

Usefulness of intraoperative contrast-enhanced ultrasonography in laparoscopic enucleation of small pancreatic metastases from renal cell carcinoma: A case report

Pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare. Surgical resection of the lesion is recommended if no residual tumor remains. Although there is no clear standard for surgical procedures, enucleation can be considered for small lesions. Lesion identification is important for enucleation, and contrast-enhanced ultrasound which takes advantage of the characteristics of hypervascular lesions was useful in a 68-year-old woman who underwent a left nephrectomy for RCC 11 years ago that was pathologically diagnosed as clear cell carcinoma. Recent computed tomography checkup showed a hypervascular tumor of 6 mm in the uncinated process and 10 mm in the pancreatic tail. Endoscopic ultrasonography-guided fine-needle aspiration was performed for the tail lesion, a diagnosis of clear cell carcinoma was made, and laparoscopic enucleation of the pancreatic tumors was performed aided by intraoperative contrast-enhanced ultrasound. The postoperative course was uneventful, and no pancreatic fistula occurred.     

Small bowel obstruction caused by secondary jejunal tumor from renal cell carcinoma: A case report

BACKGROUNDSecondary jejunal tumor from renal cell carcinoma (RCC) is extremely rare in clinical practice and is easily missed and misdiagnosed because of the low incidence and atypical symptoms.CASE SUMMARYA 38-year-old male patient was diagnosed pathologically with left RCC after radical nephrectomy in 2012. The patient then suffered multiple lung metastases 2 years later and was treated with oral sorafenib without progression for 6 years. In 2020, an emergency intestinal segmental resection due to intestinal obstruction was required, and postoperative pathology confirmed a jejunal secondary tumor from RCC. The patient had a smooth recovery following surgery. Three months after surgery, the patient was diagnosed with left adrenal metastasis, and subsequent sintilimab therapy has stabilized his condition.CONCLUSIONThis report is written to remind urologists and pathologists of the potential for small intestinal secondary tumors when a patient with a history of RCC seeks treatment for digestive symptoms. Enteroscopy and abdominal contrast-enhanced computed tomography are essential means of examination, but severe cases require immediate surgical intervention despite the lack of a preoperative examination to distinguish tumor attributes.     

Xpl1.2易位性肾细胞癌3例临床病理特征分析

目的探讨Xp11.2易位性肾细胞癌的临床病理学特点及其鉴别诊断、治疗和预后。方法收集3例Xp11.2易位性肾细胞癌,复习患者的临床资料,进行组织学及免疫组化观察,并结合文献复习分析。结果 3例患者中男性2例,女性1例,年龄10～40岁,平均年龄26.7岁。肿块大小分别为2.5 cm×2.5 cm×2.8 cm、4.5 cm×3.5 cm×3.2 cm和8 cm×6.7 cm×9 cm。光镜下肿瘤组织呈巢状、乳头状或假乳头状排列,肿瘤细胞有大量透明至嗜酸性胞质,细胞界限清楚;1例细胞核核仁清晰,3例肿瘤组织中均可见砂砾体。免疫组化:3例肿瘤TFE3均强(+),RCC和CD10弱(+)至强(+);1例vimentin强(+),2例CK7强(+),3例EMA(-)。本组1例失访;1例发现时已全身多处骨转移;1例随访3个月病情稳定,无复发。结论 Xp11.2易位性肾细胞癌是一种少见肿瘤,诊断主要依据病理学形态和免疫组化TFE3(+)。     

后腹腔镜肾部分切除术个体化方案在小肾癌治疗中的应用

目的探讨后腹腔镜下肾部分切除术(RLPN)个体化方案治疗小肾癌的可行性、安全性。方法回顾性分析2012年6月-2016年6月收治的98例实行RLPN治疗的小肾癌患者,男57例,女41例,年龄28~75岁,平均52岁,肿瘤位于左肾46例,右肾52例,直径0.8~4.5 cm,平均3.1 cm。87例(A组)小肾癌采用标准阻断肾动脉的状态下实施肾部分切除;7例(B组)外突性生长的小肾癌采用术中游离肾动脉,套橡皮条备用,试行不阻断肾动脉零缺血的状态下实施肾部分切除;4例(C组)影像学检查提示内生性小肾癌,采用腔内超声术中精确探查定位肾动脉阻断下实施肾部分切除。从术中情况、术后随访结果等分析其可行性、安全性。结果 A组87例中2例转开放手术,1例切缘阳性,改腹腔镜下肾根治性切除术,术中出血量30~350 ml,平均93 ml,手术时间70~245 min,平均127 min,术中热缺血时间20~42 min,平均26 min。B组7例外突性生长的肾癌,6例未阻断肾动脉,1例出血明显,切除肿瘤过程中,再阻断肾动脉15 min,完成肾部分切除术,出血量160~380 ml,平均220 ml,手术时间85~215 min,平均143 min。C组4例中内生性小肾癌全部手术过程顺利,出血量35~250 ml,平均85 ml,手术时间110~235 min,平均175 min,术中热缺血时间25~40 min,平均28 min。随访6~48个月,中位时间26个月,1例(肾门处3.0 cm透明细胞癌)术后18个月发现局部复发及肺部转移,予索拉非尼分子靶向治疗。结论 RLPN个体化方案治疗小肾癌安全、有效,但尚需增加例数和长期随访观察明确其远期疗效。     

无TriPort的单孔后腹腔镜根治性肾切除

目的 探讨使用常规腹腔镜器械行经后腹膜腔无TriPort的单孔根治性肾切除术的临床应用及疗效.方法 回顾分析北京友谊医院2011年12月至2012年9月收治的10例肾细胞癌患者,10例患者中男6例,女4例.年龄32 ～ 68岁,平均47.5岁.癌肿最大径3.5 ～6.4 cm,平均5.2 cm.癌肿位于肾上极2例,中极5例,下极3例.在腋中线髂嵴上3 ～4 cm做直径长约3 cm的半圆形切口,应用常规腹腔镜器械行无TriPort的单孔后腹腔镜根治性肾切除术.结果 10例患者均成功手术,无1例中转开放手术.手术时间120～180 min,平均146 min.出血量约100 ～200 ml,平均150 ml.术后引流管留置时间1～4d,平均住院时间7～9d,所有患者术后未使用镇痛药物.术后随访3～ 12个月,未见肿瘤复发.结论 应用常规腹腔镜器械行经后腹膜腔无TriPort的单孔腹腔镜根治性肾切除术安全有效,不仅具有传统腹腔镜手术的优点,还可以减少手术费用及手术创伤,并具有一定美容效果.     

单向免打结倒刺缝线双层连续缝合在后腹腔镜肾部分切除术中的应用

目的探讨双层连续免打结缝合,单层连续免打结缝合与单层间断缝合在肾部分切除术中的应用。方法 2011年1月-2015年1月93例肾肿瘤患者接受后腹腔镜下肾部分切除术治疗。所有手术均为同一术者完成。术中依据手术创面缝合方法分为3组。单层间断组22例,采用单层间断8字缝合,肿瘤床同时填塞止血纱布卷。单层连续组28例,采用单层可吸收缝线免打结连续缝合,应用Hem-o-loc替代打结。双层连续组共43例,为双层免打结可吸收单向倒刺缝线连续缝合。比较3组患者手术时间、围手术期结果和围手术期并发症等情况差异。结果 93例患者无中转开放,5例术中转为根治性手术。3组除肿瘤大小有差别外,性别、年龄和部位无差别。单层间断组,单层连续组,双层连续组手术时间分别为(94.00±19.00)min vs(85.00±14.00)min vs(75.00±10.00)min(P0.05),术中平均出血量分别为(131.00±57.00)ml vs(96.00±34.00)ml vs(76.00±22.00)ml(P0.05)。平均肾热缺血时间3组分别为(27.30±4.90)min vs(22.60±4.20)min vs(19.90±3.80)min(P0.05)。3组术后肠道恢复时间和术后出院时间差异无统计学意义。单层间断组、单层连续组和双层连续组术中转根治术分别为3、1和1例。术后尿瘘分别为3、1和0例。术后血肿形成分别为3、1和1例。均给予保守治疗后治愈出院。结论免打结可吸收倒刺缝线双层连续缝合可减少后腹腔镜肾部分切除术中热缺血时间,减少术中术后并发症发生。     

后腹腔镜肾上腺手术后复发原因分析

目的探讨后腹腔镜肾上腺手术术后复发的原因及预防对策。方法随诊并分析1997～2005年247例后腹腔镜肾上腺良性肿瘤切除手术中复发病例的不同特点、原因以及处理方式，总结预防的措施。结果随诊6个月～8年，247例手术中共出现术后复发6例，占2，4％。其中复发时为恶性肿瘤3例，皮质腺增生1例，醛固酮增多症1例，其他1例。结论后腹腔镜肾上腺手术后有一定的复发比例，复发的原因大部分与操作无关，通过积累经验，复发率可以控制在低水平。     

Mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient

We herein report a case of mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient. A 66‐year‐old man with a medical history of left‐sided pneumonectomy for lung cancer was diagnosed with local recurrence of lower esophageal squamous cell carcinoma (cT3N0M0 cStage II) 9 years after definitive chemoradiotherapy. The mediastinoscopic cervical approach and laparoscopic transhiatal approach were combined, and the thoracic esophagus was safely mobilized to separate the esophagus from the stump of the left bronchus and to divide dense adhesions between the esophagus and fibrotic tissue at the site of the previous left mediastinal pleural resection. The esophagectomy was uneventful and followed by reconstruction with a gastric conduit via the retrosternal route. The pathological diagnosis was esophageal squamous cell carcinoma (pT3‐AD, pN1, M0, pStage III), indicating R0 resection. Even as salvage surgery, mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who have previously undergone pneumonectomy.