An innovative trainer for surgical procedures using animal organs.

Since 1990, almost 3000 surgeons have absolved the training course for minimally invasive surgery in our training center. A phantom trainer using animal organs has been used as a training device. Based on this experience, we have developed an innovative trainer for surgical procedures using animal organs. The form of this trainer was copied from a human body with gas insufflation; abdominal organs from the slaughterhouse can be integrated into this trainer. Surgeons can repeat operations such as laparoscopic cholecystectomy, appendectomy, fundoplication, colon resection and transanal endoscopic microsurgery in a realistic way and acquire a training effect in a short time.     

Laparoscopic intracorporeal bowel anastomosis by a new suturing device: A study in a laparoscopic simulator with integrated animal organs

Summary

Laparoscopic bowel anastomosis is performed with increasing frequency either extracorporeally through a small incision or intracorporeally using special endoscopic staplers. Laparoscopic intracorporeal suturing is rarely used to perform anastomosis because it is difficult and time-consuming. The aim of this study is to assess a new suturing device for performing laparoscopic intracorporeal anastomosis. In a phantom experiment, three types of end-to-end monolayer anastomoses (open [O], laparoscopic suturing device [LD] and laparoscopic hand-suture [LH]) were performed in each of 10 segments of fresh cow small intestines. The mean anastomotic time for the (O) group was shorter than that for the (LD) and (LH) groups; the time needed was 13.8, 29 and 27.3 min, respectively. The initial bursting pressure for each of the (O), (LD) and (LH) groups was 55, 35.2 and 33.3 mmHg, respectively. There was no significant difference in anastomotic circumference between the three groups. The new laparoscopic suturing device can be used to perform bowel anastomosis. It needed a longer time and had a lower bursting pressure than open anastomosis, but it proved equal to laparoscopic hand-suture anastomosis. Considering that the suturing device is still in its development phase, better results can be expected in the future.     

应用达芬奇机器人手术系统行脏器联合切除4例报告

机器人外科是一项新兴技术,拓宽了腹腔镜技术在外科领域的应用。达芬奇机器人手术系统自2000年获得FDA批准后,国外多家医疗机构陆续开展临床应用,其安全性与疗效已得到肯定与共识。沈阳军区总医院自2011年引进该设备,普外科目前共完成达芬奇机器人手术180例,其中腹腔多器官联合切除4例,占2.2％。4例中直肠前切除＋右半结肠切除1例,直肠前切除＋脾脏切除1例,直肠前切除＋阑尾切除1例,直肠前切除＋子宫全切1例。传统腹腔镜联合脏器切除手术大多是以良性病症为主,因为腹腔镜肿瘤手术要求不仅切除病灶,还要清扫其所属淋巴组织,手术难度势必较良性病变要高很多,加上传统腔镜器械在操作中存在“筷子效应”,限制了以肿瘤根治为主的传统腹腔镜多脏器联合切除的临床应用。达芬奇手术机器人因为具备了可达到7个自由度的手术器械的优势,使手术操作具有极大的灵巧性,化解了上述技术难题,在涉及肠道恶性肿瘤的联合脏器切除手术中具备很大优势。本组4例病患手术均顺利完成,术后恢复良好,未见严重并发症。笔者认为在适应证选择方面仍需谨慎,注意多学科合作并做好术前计划。     

不同模拟穿刺模型在超声引导穿刺技术教学中的比较研究

目的对比三种模拟穿刺模型(商业化的蓝胶模型、自制明胶模型及自制豆腐模型)在超声引导穿刺技术教学中的应用,比较其可行性、教学效果,为教学工作中选择合适的教具提出参考。方法招募南京医科大学二年级以上的在校学生30名,均经过超声引导下神经阻滞技术学习后,尝试在模型上实施超声引导下神经阻滞,以报数的顺序分配模拟穿刺模型,每名学生每种模型模拟练习15 min,最终完成三种模型的模拟训练。穿刺训练完成后,指导教师评估培训效果,学生需从仿真程度、耐用性、易清洁性、图像识别度及偏好程度五个方面,采用数字评分评价三种模型。结果指导教师依据学生操作过程中针道显影的清晰程度,对培训效果进行评价,三组学生间的评分比较差异无统计学意义。模型的仿真程度、耐用性、易清洁性的评分方面比较,蓝胶模型优于明胶模型和豆腐模型,差异均有统计学意义(均P0.05)。三种模型图像识别度评分比较差异无统计学意义。获知模型价格前,各有40%学员偏好蓝胶模型和明胶模型,仅20%学员偏好豆腐模型;获知模型价格后,73%学员偏好明胶模型。结论超声引导下模拟穿刺技术教学的教学模型选择需结合教学需求、费用预算及学员的偏好等多方面进行综合评估。在需要自主设计的穿刺模型中,明胶模型有较大的优势。     

培训培训者模式在护理人员艾滋病知识培训中的应用

目的探讨培训培训者模式在新疆5个艾滋病重点地区护理人员艾滋病知识、态度、行为培训中的实践效果。方法首先对培训者进行艾滋病相关知识培训,然后由这些培训者对本地区医院的护理人员进行培训。结果培训后,接受培训者及一般护理人员的艾滋病相关知识、态度、行为等得分较培训前均有显著提高,差异具有统计学意义（P〈0．01）。结论培训培训者模式可以有效提高护理人员的艾滋病知识和应对能力。     

Current experiences with robotic surgery at Severance Hospital,Yonsei University in Korea

We started performing laparoscopic cholecystectomies in 1991. Since that time, many surgeons have been trained in laparoscopic and minimally invasive surgery, and laparoscopic surgery has been used in numerous procedures, with patients benefitting as a result. We performed the first automated surgery in Korea using Automated Endoscopic System for Optimal Positioning in June 1996. Inspired by Inbae Yoon and assisted by his generous donation, our hospital started the IB Yoon Multi‐Specialty Endoscopic Research & Training Center in 1998. Subsequently in March 2005, we started the Severance Robotic and Minimally Invasive Surgery Center. The establishment of these centers has enabled us to widen the use of laparoscopic surgery and to teach many surgeons the principles of and the techniques involved in laparoscopic and robotic surgery. We performed our first robotic surgery using the da Vinci Surgical System in July 2005. In the 4 years since introducing the da Vinci Surgical System, we have successfully performed more than 2600 robotic surgical procedures. As the collaboration between medicine and robotic engineering produces more technically advanced results, we hopefully can develop our own version of the robotic system in the near future.     

腹腔镜下胆总管探查术手术护理

目的总结腹腔镜下胆总管探查术(LCBDE)的手术护理,以进一步提高手术室护理质量。方法回顾性分析14例经腹腔镜下胆总管探查术患者的手术护理资料。结果 14例手术全部成功,无1例中转开腹,手术护理配合良好,顺利出院,无并发症发生。结论经腹腔镜下胆总管探查,胆总管取石术对患者创伤小,恢复快,住院时间短,术前准备充分,术中熟练的配合技巧,术后对精密仪器的认真清洗保养是手术进行的重要保证。     

Transumbilical laparoscopic surgery using GelPort through an umbilical zigzag skin incision

INTRODUCTION: We report herein a new method of transumbilical laparoscopic surgery using a GelPort through an umbilical zigzag skin incision. The method involves collaborating with plastic surgeons to ensure the procedure was minimally invasive. MATERIALS AND SURGICAL TECHNIQUE: After marking a zigzag skin incision in the umbilical region, the skin was incised along this line. Then, a GelPort double-ring wound retractor was inserted through the incision, which enlarged the diameter of the fascial opening to 6 cm. The Gelport was latched on the wound retractor ring, following the inflation of the pneumoperitoneum by CO (2). One or more additional ports were inserted as necessary. All operations were performed in the standard fashion. The specimen was easily extracted from the abdomen through the umbilical incision, and anastomosis was performed. Using the above method, we performed the following procedures: one total gastrectomy, one distal gastrectomy, three gastric local resections, five right hemicolectomies, two high anterior resections, three cholecystectomies, and seven transabdominal preperitoneal hernioplasties. All cases were accomplished without any complications using this method. The wounds of the umbilical region were almost "scarless" in all cases. DISCUSSION: We developed an umbilical zigzag skin incision technique to perform abdominal laparoscopic operations using a GelPort, with a minimal number of skin incisions. We consider that our method reduces the technical difficulties associated with laparoscopic surgery and maintains cosmesis.     

Circular surgical stapling procedures: Design implications for MIT

Summary

As circular stapler designs evolve, they provide the means for an increasing range of surgical techniques. It appears that the long-term direction of this evolution will coincide with that of minimally invasive therapy (MIT). The range of techniques available using the current instruments is scattered throughout the literature. This range is presented as a rationalized collation. Technologists working on the development of MIT anastomotic equipment will find the core of a design specification for future development prescribed.     

简易膝关节训练器对脑卒中偏瘫患者膝关节屈曲主动运动的疗效

目的 观察简易膝关节训练器改善脑卒中偏瘫患者膝关节屈曲主动运动的临床疗效。方法 2020年3月至2021年5月,选择本院46例脑卒中后偏瘫患者,随机分为对照组和试验组各23例。两组均接受常规康复训练,试验组增加用简易膝关节训练器坐位下行膝关节屈曲主动运动训练,共8周。训练前、后测量坐位膝关节主动屈曲角度和Holden步行功能分级,采用步态分析系统测量摆动时膝关节屈曲最大角度。结果 训练后,两组膝关节主动活动度及步行中摆动期膝关节最大屈曲角度均显著提高(|t|> 6.991, P <0.001),且试验组提高更多(t> 2.185, P <0.05);两组Holden步行功能分级均明显提高(|Z|> 2.828, P <0.01),两组间无显著性差异(Z=-0.821, P=0.412)。结论 应用简易膝关节训练器训练能有效改善膝关节主动屈曲活动度,可在临床和社区康复中应用。     

腹腔镜在泌尿外科重建手术中的应用

目的 为了提高腹腔镜在泌尿外科重建手术中的应用。方法 复习近年来有关文献，阐述了腹腔镜在泌尿外科重建手术中的适应证、临床操作要点和并发症等。结果 临床上已确立的腹腔镜重建手术如肾孟成形、根治性前列腺切除术和睾丸固定术；其他操作如肾部分切除术、肾动脉瘤修补术、输尿管输尿管吻合术、回肠输尿管成形术和膀胱扩大术等是新进展性手术。结论 期望未来的腹腔镜手术将会增加，并发展成为先进和复杂的泌尿外科重建手术的选择方法。     

腹腔镜下早期卵巢癌全面分期手术的随访观察

目的随访腹腔镜治疗早期卵巢癌(EOC)的临床效果,探讨腹腔镜EOC全面分期手术的有效性和安全性。方法回顾性分析2012年5月-2015年8月在湖北省妇幼保健院手术治疗的EOC患者42例。其中,腹腔镜组19例,开腹组23例,比较两组手术时间、术中出血量、淋巴结切除数目、术后排气时间、住院时间,术后并发症发生率、分期上升率及术后化疗率。结果两组患者均顺利完成手术,未发生术中并发症。与开腹组比较,腹腔镜组术中出血量明显减少(124.7±63.5)vs(328.7±155.5)ml(P0.05),术后肛门排气时间(1.5±0.5)vs(2.7±0.9)d及术后住院时间(8.9±1.5)vs(14.3±3.8)d均明显缩短(P0.05)。两组手术时间、淋巴结切除数目、术后并发症发生率、分期上升率和术后化疗率差异均无统计学意义(P0.05)。随访7~46个月,平均24.6个月,两组复发率、死亡率差异无统计学意义(P0.05)。腹腔镜组和开腹组的无瘤生存率分别为94.7%和91.3%,总生存率分别为94.7%和100.0%。结论 EOC腹腔镜手术具有出血少、创伤小和恢复快等优势,近期疗效确切,安全可行。     

图示法健康教育在老年开胸患者围术期的应用

目的 探讨应用自制的图示对老年开胸围术期患者进行健康教育的效果,寻求一种直观、实用易懂的健康教育方法.方法 将入选的68例老年开胸患者随机分为试验组35例,采用图示法健康教育;对照组33例,采用常规健康教育.分别对健康教育掌握程度、术后遵医行为、胸腔闭式引流留置时间、肺部并发症发生率及术后住院天数进行比较.结果 试验组健康教育掌握程度和术后遵医行为优于对照组,胸腔闭式引流留置时间和术后住院天数比对照组短,肺部并发症发生率低于对照组,P均〈0.05.结论 图示法健康教育易于老年患者掌握,提高术后遵医行为,减少术后肺部并发症,缩短住院天数,促进早日康复.     

Minimally invasive surgical approach for radicalization of incidental post-cholecystectomy gallbladder carcinoma: safety,feasibility and outcomes

Background and aims: Gallbladder carcinoma is a rare but aggressive malignant neoplasm. The incidence of intra- or post-operative incidental gallbladder carcinoma diagnosis following laparoscopic cholecystectomy is estimated to be 1–2%. Aggressive re-resection is warranted as the majority of patients have residual disease either in the liver or the lymph nodes. However the use of a minimally invasive surgical approach (MISA) to perform a radicalization in these patients has not been investigated yet. We retrospectively analyzed surgical and oncologic outcome of a small selected cohort of patients with incidental gallbladder carcinoma whom underwent redo radicalization surgery by MISA.

Material and methods: From April 2012 to June 2014 at our department six patients (three females and three males) with incidental findings of gallbladder carcinoma pT1b (stage I) following laparoscopic cholecystectomy, and referred to our center from other secondary-level referral hospitals, underwent a redo surgery for radicalization by means of laparoscopic (n. 3) or robotic approach (n. 3). A retrospective analysis of prospective collected data was performed.

Results: The redo procedure consisted of a liver resection (segments IVb?+?V) and lymph nodes clearance of hepatoduodenal hilum and common hepatic artery. Conversion rate was zero. Median operative time was 290 (250–310) min. Estimate blood loss was 175 (100–350) ml. Total hospital stay was 6 (5–10) days. All liver resections were performed without inflow vascular clamping. One patient was re-operated for hemoperitoneum while peri-operative mortality was zero. Oncologically, an R0 resection was always achieved with a mean number of lymph nodes retrieved of 17,5 (14–22). The stage of the neoplasm was confirmed in all cases but one, who was found to have a pN1 status (stage IIIb). At 21 (6–32) months follow-up all patients are alive and no recurrence has been observed.

Conclusions: Our data suggest that radicalization of patients with stage I incidental postoperative gallbladder carcinoma can be done by a MISA without compromising the oncologic outcome. Larger studies are needed to validate these results.     

Combined cardiac surgical procedures in octogenarians: operative outcome

Introduction The number of patients with an indication for cardiac surgery in their ninth decade of life is increasing. This study analyses the single-center results with combined and redo cardiac surgical procedures in octogenarians retrospectively. Patients and methods Three groups were evaluated: (I) Two hundred and thirty six patients with combined cardiac surgical procedures, mean age 83.1 ± 2.5 years, 107 male (129 female). Combined aortic valve replacement (AVR) and aorto coronary bypass (ACB) was done in 215, double valve replacement (DVR) in 21. (II) AVR + ACB-group: 215 patients out of group I. (III) Control group consisting of 124 patients with a mean age of 74.1 ± 2.8 years (range 70–79.9 years) who received combined AVR and ACB. Risk stratification was done using the additive and logistic Euro-score; values are given as mean ± standard deviation and were compared using either the t-test or the Chi-square test. Results The observed mortality in group I was 9.3%. Re-intubation was observed in 10.2% and was one major risk factor for in-hospital mortality. As second risk factor, DVR could be identified. 14.8% required hemodialysis postoperatively, but this affected only the length of stay on intensive care unit (ICU) but not mortality. When comparing group II with group III, mortality was higher (10% vs. 4%), the need for hemodialysis was more frequent (16.3% vs. 4.9%), and the incidence of postoperative psycho-syndromes was also higher (26% vs. 8.1%, all: P < 0.05). The duration of ventilation (2.7 ± 7.7 vs. 1.6 ± 4.3 days) and the length of stay on ICU (8.2 ± 8.8 vs. 5.7 ± 6.4) were longer without reaching statistical significance (P > 0.05). The Euro-score overestimated the real mortality in all groups. Conclusions Octogenarians requiring combined cardiac surgical procedures required more resources and had a higher in-hospital mortality compared to younger patients. The observed in-hospital mortality was much lower than the predicted justifying the indication for surgical therapy in these patients. Patient selection, however, seems to be important but the Euro-score alone was rather ineffective in predicting poor outcome.