Transanal Repair of Rectourethral Fistula After a Radical Retropubic Prostatectomy: Report of a Case

Rectourethral fistula occurred in a 64-year-old man after a radical prostatectomy. Despite conservative treatment the fistula did not close spontaneously. Eleven months after the original prostatectomy, an operation was performed. We chose the Latzko technique with slight modifications as follows. The patient was placed in the prone jackknife position. The fistula was found at a site about 6.0 cm from the anal verge. An elliptical area of rectal mucosa was incised about 1.5 cm from the fistulous orifice and subsequently the rectal mucosa was denuded. The submucosa was dissected above the fistula about 2.0 cm from the edge of the incision. The fistula was then closed with one layer of side-by-side absorbable 2-0 polyglactin sutures. The dissected rectal mucosal flap was brought down over the fistula and sutured in one layer to the distal edge of the rectal muscularis propria through the mucosa with 3-0 polyglactin sutures. On postoperative day 21 a retrograde urethrogram was made and it showed no leakage of urine via the rectum. This procedure is a simple, effective, and minimally morbid technique for the repair of rectourethral fistula after a radical prostatectomy, although it is only useful for the treatment of low rectourethral fistulas. Received: March 8, 2001 / Accepted: September 11, 2001     

Minimally Invasive Approach to Esophagectomy

Background:

Recent advances in laparoscopic and thoracoscopic surgery have made it possible to perform esophagectomy using minimally invasive techniques. The aim of this report was to present our preliminary experience with minimally invasive esophagectomy.

Methods:

We reviewed our experience on eight patients who underwent minimally invasive esophagectomy using either laparoscopic and/or thoracoscopic techniques from June 1996 to May 1997. Indications for esophagectomy included stage I carcinoma (5), palliative resection (1), Barrett''s with high grade dysplasia (1) and end stage achalasia (1).

Results:

The average age was 68 years (54-82). The surgical approach to esophagectomy included laparoscopic transhiatal esophagectomy with cervical anastomosis (n=4), thoracoscopic and laparoscopic esophagectomy with cervical anastomosis (n=1), and laparoscopic mobilization with right mini-thoracotomy and intra-thoracic anastomosis (n=3). Conversion to mini-laparotomy was required in two patients (25%) to complete esophageal dissection and facilitate gastric pull-up. The mean operative time was 460 minutes. The mean intensive care stay was 1.9 days (range of 0-7 days) with a mean hospital stay of 13-8 days. Minor complications included atrial fibrillation (n=1), pleural effusion (n=2) and persistent air leak (n=1). Major complications included cervical anastomotic leak (n=1), and delayed gastric emptying requiring pyloroplasty (n=1). There was no perioperative mortality.

Conclusions:

This preliminary experience suggests that minimally invasive esophagectomy is safe and feasible in centers with experience in advanced minimally invasive surgical procedures. Further studies are necessary to determine advantages over open esophagectomy.     

Transanal Minimally Invasive Surgery for Rectal Lesions

Methods:From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed.Results:TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park''s transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered.Conclusion:TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques.     

Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review

Transanal minimally invasive surgery (TAMIS) was first described in 2010 as an alternative to transanal endoscopic microsurgery (TEM). The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and early-stage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery. TAMIS has a shorter learning curve, reduced device setup time, flexibility in instrument use, and versatility in application than TEM. Also, TAMIS shows similar results in a view of the operation time, conversion rate, reoperation rate, and complication to TEM. For these reasons, TAMIS is an easily accessible, technically feasible, and cost-effective alternative to TEM. Overall, TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons. As TAMIS becomes more broadly utilized such as pelvic abscess drainage, rectal stenosis, and treatment of anastomotic dehiscence, the acquisition of appropriate training must be ensured, and the continued assessment and assurance of outcome must be maintained.     

Systematic Review of Minimally Invasive Pancreatic Resection

Background  Pancreatic resection is associated with a significant morbidity. Efforts to reduce hospital stay and enhance recovery have seen the introduction of minimally invasive surgical techniques. This article reviews the current published literature on the safety and efficacy of minimally invasive surgery of the pancreas. Methods  An electronic search of the PubMed and Embase databases was performed from 1996 to May 2008 to identify all relevant publications; studies meeting predefined inclusion criteria were retrieved and analyzed using a standardized protocol. Data on the safety and efficacy of minimally invasive surgery of the pancreas were recorded and analyzed. Results  Of 565 abstracts reviewed, 39 studies were identified as eligible for inclusion. There were 37 case series and two case control studies. Compared with open pancreatic surgery, minimally invasive pancreatic resection is similar in terms of morbidity and mortality. Blood loss and length of stay are decreased. Conclusions  Laparoscopic distal pancreatic resection and enucleation of insulinoma appear to be safe procedures with reduced hospital stay, though morbidity remains significant. The evidence for laparoscopic pancreaticoduodenectomy is in its infancy, but the authors feel it is unlikely that many centers will achieve sufficient case load to make the introduction of minimally invasive resection feasible.     

Past,Present, and Future of Minimally Invasive Abdominal Surgery

Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques.     

A Reproducible Ex Vivo Model for Transanal Minimally Invasive Surgery

Background:

Rectal tumors can be excised through a number of minimally invasive transanal techniques including transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery (TAMIS). Specialty training is often required to master the nuances of these approaches. This study aimed to create a reproducible transanal excision training model that is suited for laparoendoscopic techniques.

Methods:

Frozen porcine rectum and anus with intact perianal skin were commercially obtained. Thawed specimens were then cut to approximately 20 cm in length. The proximal end of the rectum was then everted and suction applied to the mucosa to create pseudopolyps of various sizes (sessile and pedunculated). Larger pedunculated lesions were made by tying the base of the pseudopolyps with 5–0 monofilament sutures to gather more tissue. Methylene blue dye was injected submucosally into the lesions to simulate tattoos. The proximal rectum was then closed with sutures. The model was suspended in a trainer box by clamping the distal end in a ringed clamp and the proximal end to the box. Transanal excisions using TAMIS were then performed. The procedures were done by trained community colorectal surgeons attending courses on transanal minimally invasive surgery.

Results:

Both partial- and full-thickness excisions of sessile and pedunculated rectal lesions were successfully performed during simulated TAMIS by trained community surgeons learning this laparoendoscopic technique.

Conclusion:

Transanal laparoendoscopic procedures to excise rectal tumors can be successfully and reproducibly performed in an ex vivo porcine anorectal model.     

微创重睑术在不对称双眼皮修复中的应用效果

探究在不对称双眼皮患者整形修复术中应用微创重睑术的临床效果。方法 选取2021年1月-2022年1月我院收治的100例不对称双眼皮患者为研究对象,随机分为常规组和研究组,每组50例。常规组采用常规整形修复手术,研究组采用微创重睑术,比较两组临床疗效、手术相关指标及满意度。结果研究组治疗有效率为96.00%,高于常规组的90.00%（P ＜0.05）;研究组手术愈合时间、出血次数均优于常规组（P ＜0.05）;研究组满意度评分高于常规组（P ＜0.05）。结论 微创重睑术在不对称双眼皮修复中的应用效果确切,可促进切口愈合,减少出血,有利于提高患者满意度。     

微创矫治成人漏斗胸近期临床疗效分析

目的探讨成人漏斗胸微创矫治的可行性及疗效。方法2006年6月-2008年6月,共治疗23例漏斗胸,年龄18-38岁,（24.1±6.6）岁。未做治疗21例;2例Ravitch手术后复发。Haller指数3.2-7.5,4.38±1.16。Ⅰ型14例,Ⅱ型9例。全麻,仰卧位,选择胸骨凹陷最深处两侧腋中线,分别切口3.0 cm,切开至肌层,自切口向胸廓凹陷方向游离。另选切口用CO2气体致人工气胸,进镜观察。在胸腔镜监视下经右侧切口将引导器穿过纵隔,在对侧相同水平或稍斜行位置切口穿出。成形后,将已制备好的Lorenz支撑板穿过纵隔引出,翻转后右侧置固定片,固定片和支撑板两端分别与肌肉固定。术后拍胸片观察支撑板的位置和胸腔情况。结果22例术中顺利,1例损伤心包和右心耳,扩大切口止血。术后恢复顺利,围术期未发生切口感染和支撑杆移位。术后胸闷憋气的症状缓解;胸廓外形接近于正常,非常满意率87%（20/23）。23例随访3-24个月,平均16个月,均保持良好的矫形效果。结论成人漏斗胸采用微创方法矫治是可行的,可以达到良好的矫形效果。     

B超引导下的乳腺纤维腺瘤微创旋切术

目的探讨B超引导下Mammotome微创旋切系统在乳腺纤维腺瘤微创手术中的应用价值。方法对43例53处0.6cm～2.2cm乳腺纤维腺瘤进行了B超引导下Mammotome微创旋切切除术,评价其手术效果。结果乳腺纤维腺瘤均被Mammotome微创旋切切除,平均每处旋切17次,用时31min。操作全部成功。皮肤伤口仅3mm,并发症轻微。15例(21处)经术后6～21(13.5±4.0)个月的随访,临床及B超复查均无复发迹象。结论B超引导下Mammotome微创旋切系统进行乳腺小纤维腺瘤的切除术,操作简易,切除彻底,创伤小。     

Minimally invasive surgery

Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable. This career resource guides the interested medical student and physician to opportunities for fellowship training in MIS. It includes a discussion of the specialty, training requirements, grant funding, research fellowships, and pertinent societies.     

微创胃造口术的临床应用

目的总结微创胃造口术的经验。方法 1996年1月～2011年2月,行微创胃造口术15例。2例食管癌因为食道梗阻,行免气腹腹腔镜辅助经皮穿刺胃造口术（laparoscopic assisted percutaneous gastrostomy,LAPG）,其余13例行内镜引导下经皮穿刺胃造口术（percutaneous endoscopic gastrostomy,PEG）。结果 PEG手术时间10～15 min,免气腹LAPG手术时间分别为52和43 min。术中、术后均无胃腔和腹腔出血、消化液漏入腹腔等并发症。结论 PEG和免气腹LAPG是一种创伤小、安全的胃造口方法。     

Minimally Invasive Ventricular Assist Device Surgery

The use of mechanical circulatory support to treat patients with congestive heart failure has grown enormously, recently surpassing the number of annual heart transplants worldwide. The current generation of left ventricular assist devices (LVADs), as compared with older devices, is characterized by improved technologies and reduced size. The result is that minimally invasive surgery is now possible for the implantation, explantation, and exchange of LVADs. Minimally invasive procedures improve surgical outcome; for example, they lower the rates of operative complications (such as bleeding or wound infection). The miniaturization of LVADs will continue, so that minimally invasive techniques will be used for most implantations in the future. In this article, we summarize and describe minimally invasive state‐of‐the‐art implantation techniques, with a focus on the most common LVAD systems in adults.     

肝脏肿瘤的微创治疗——从腹腔镜到机器人

目的探讨完全腹腔镜、手助式腹腔镜及机器人三种微创手术方式在肝脏切除术中的可行性、安全性及适用范围。方法回顾性分析上海交通大学医学院附属瑞金医院普外科自2004年9月至20l2年1月期间完成的微创肝脏切除术(minimally invasive liver resection,MILR)128例患者的临床资料,根据手术方式分为完全腹腔镜肝脏切除术(pure laparoscopic resection,PLR)组、手助式腹腔镜肝脏切除术(hand-assisted laparoscopicresection,HALR)组及机器人辅助肝脏切除术(robotic liver resection,RLR)组,分别观察3组患者术中与术后恢复情况并进行对比分析。结果 PLR组82例,中转开腹3例,手术时间为(145.4±54.4)min(40～290 min)、术中出血量为(249.3±255.7)ml(30～1 500 ml),术后并发腹腔感染3例,胆瘘5例,经保守治疗后痊愈,无围手术期死亡,术后住院时间为(7.1±3.8)d(2～34 d)。HALR组35例,中转开腹3例,手术时间为(182.7±59.2)min(60～300 min)、术中出血量为(754.3±785.2)ml(50～3 000 ml),术后并发腹腔感染1例,胆瘘2例,切口感染2例,经保守治疗后痊愈,无二次手术,术后住院时间为(15.4±3.7)d(12～30 d)。RLR组11例,中转开腹2例,手术时间为(129.5±33.5)min(120～200 min)、术中出血量为(424.5±657.5)ml(50～5 000 ml),术后并发腹腔感染1例,胆瘘1例,经保守治疗后痊愈,术后住院时间为(6.4±1.6)d(5～9 d)。3组中,RLR组手术时间最短(P=0.001),术后住院时间最短(P=0.000),PLR组术中出血量最少(P=0.000),其差异均有统计学意义。结论肝脏肿瘤微创切除术安全、可行,临床工作中,需要根据不同的病例选择不同的手术方式。机器人辅助肝脏切除术为肝脏肿瘤的微创治疗带来了新的突破。     

澳大利亚微创胆道外科

目的 从20世纪末期以来,澳大利亚腹腔镜手术已经快速发展进步并且逐渐扩展到各个外科手术领域.一些外科医生也完成并发表了关于腹腔镜胆总管探查技术的报道.在本文中,作者介绍了目前澳大利亚的微创外科手术治疗胆管疾病的现状,包括：常规或选择性胆管造影;胰腺胆道疾病中ERCP的作用;腹腔镜胆总管探查术的手术技巧以及胆源性胰腺炎的治疗.作者还介绍了澳大利亚目前胆总管探查的现状,并且提到他们倾向于每例腹腔镜胆囊切除术都进行术中胆道造影.如果胆总管内发现小结石而且胆囊管足够粗,则进行经胆囊管的胆总管探查术.然而,如果狭窄的胆总管内有较大的结石,则进行术后ERCP治疗.作者还进一步介绍了胆道疾病相关的其他的微创治疗手术方法.总的来说,腹腔镜手术进行胆总管取石是可行和安全的.在有足够经验的医疗中心,这种手术方法可以常规使用.同时,成功进行腹腔镜胆总管探查术也需要多种方法综合进行.ERCP也没有被腹腔镜胆总管探查术所取代,而且成为一种重要的补充性的胆总管结石治疗方法.     

腹腔镜在微创三切口食管癌根治手术中的应用

目的探讨腹腔镜胃游离术在食管癌根治术中的可行性、安全性和根治性。方法回顾性分析2006年5月-2010年12月151例微创三切口食管癌根治术的临床资料。均在胸腔镜下完成食管的游离,腹部手术早期采用开腹（57例）,后期采用腹腔镜手术（94例）。制作管状胃后在颈部行食管胃吻合术。结果 2组在年龄、性别、术前辅助治疗、术后病理分期的差异均无统计学意义（P〉0.05）。2组术后ICU时间、术后住院时间、腹部淋巴结切除数量、腹部淋巴结阳性率、围手术期死亡、吻合口漏、管状胃坏死、胃排空延迟、腹部切口感染率以及肺部感染发生率方面差异无统计学意义（P〉0.05）。与开腹组相比,腹腔镜组腹部手术时间更短[（54.3±21.0）min vs.（72.8±18.6）min,t=-5.489,P=0.000],腹部手术中出血量更少[（50.5±33.0）ml vs.（81.8±40.8）ml,t=-5.155,P=0.000]。结论腹腔镜技术已在当前食管癌手术的应用中初步显示出一定的优点和价值,不过仍然需要大样本的前瞻性的临床研究来验证。     

微创手术矫治儿童漏斗胸后胸廓骨重塑与临床疗效

目的探讨儿童漏斗胸微创手术矫治后胸廓骨的重塑及临床疗效。方法回顾性分析2009年4月至2010年9月北京军区总医院74例漏斗胸患者经微创手术矫治的临床资料,其中男63例,女11例;年龄(11.90±8.50)岁,10岁11例。74例患者于全身麻醉下在两侧腋中线做切口,在电视胸腔镜下引导穿通器经胸骨后创出通道,并抬举胸骨成形后,再将制备好的支撑板置入胸骨后。术前和术后1周行胸部CT、胸廓CT三维重建,矢状位以胸椎体中心线为切线位,测量胸骨与胸椎体前缘的距离,并观察心脏移位恢复情况和胸廓外形。结果 74例均顺利完成手术,无手术死亡。使用1根矫形板66例(89.19%),使用2根矫形板8例(10.81%)。使用1根矫形板、年龄10岁的11例患者术后7 d胸骨柄下端和胸骨体各部位与术前比较均向前移位3.76～22.92 mm,11～17岁的55例使用1根矫形板患者胸骨体中间和下端与术前比较分别向前移位2.08 mm和10.42 mm,两者胸骨体下端较术前向前移位的距离比较差异有统计学意义(t=14.24,P0.05)。术后7 d时11～17岁使用2根矫形板患者胸骨柄下端和胸骨体各部位与术前比较向前移位4.19～15.03 mm。术后7 d胸部CT显示65例(87.84%)患者心脏位置恢复正常;用2根矫形板患者胸廓外观优于用1根者。随访74例,随访率100%;随访时间6～23个月,患者术前临床症状消失,胸廓外形饱满,心脏位置完全恢复正常。结论儿童漏斗胸微创手术矫治一次性成形具有良好的重塑性;随着年龄增加,矫治支撑胸骨的力也需要增加,且疗效满意。