Laparoscopic sphincter‐preserving surgery for low rectal tumor using prolapsing technique

Introduction: With this study, we aimed to assess the feasibility and outcome of laparoscopy‐assisted low anterior resection with a prolapsing technique for low rectal tumors. Materials and Methods: We studied surgical techniques, recovery status, complications, oncological clearance and the results of short‐term follow‐up in 15 patients who had received laparoscopy‐assisted low anterior resection with a prolapsing technique for low rectal tumors between October 2005 and January 2008. Results: None of the cases was converted to open surgery. The mean operation time was 185 min (150–232 min), and the mean blood loss was 75 ml (25–105 ml). The mean time for passage of flatus, duration of urinary drainage, and postoperative hospital stay were 3 d (1–4 d), 6 d (5–10 d) and 11 d (7–20 d), respectively. The total amount of lymph nodes harvested was 15 (9–21), and the mean distal margin from the tumor was 2.5 cm (1.0–3.9 cm). No major complications were observed. The mean follow‐up time was 13 months (4–27 months). Neither local recurrence nor metastasis was observed. Acceptable anal function results were obtained in most patients. Discussion: Laparoscopy‐assisted low anterior resection with a prolapsing technique can be successfully performed.     

Bowel obstruction associated with endoscopic tattooing of the colon with India ink

During a laparoscopic resection of small colorectal lesions, preoperative endoscopic marking with India ink is useful for identifying the location of the lesion. India ink has been thought to be a safe agent with few adverse effects. We herein report a case who suffered from postoperative abdominal pain resulting in bowel obstruction, due to massive adhesion around the area with India ink. A 61‐year‐old man with early transverse colon cancer underwent a laparoscopy‐assisted transverse colon resection. Prior to the operation, endoscopic tattooing with India ink was performed. At the operation, spillage of India ink into the peritoneal cavity was observed. Many small black spots were thereafter seen on the peritoneum, mesentery and omentum, but neither severe inflammation nor any adhesion was noticed. The operation was performed without any difficulty. Though his immediate postoperative course was uneventful, a bowel obstruction gradually developed from a week postoperatively. Finally, he had to undergo a re‐operation, and was found to have diffuse and massive adhesion around areas with India ink. Especially, severe omental adhesion involved and squeezed the transverse colon. A resection of the omentum with stenotic colon and re‐anastomosis was performed. India ink can cause severe inflammation and adhesion when it accidentally leaks into the peritoneal cavity.     

Laparoscopy‐assisted distal gastrectomy in a case of gastric cancer with situs inversus totalis: a case report

Situs inversus totalis (SIT) is a rare congenital condition in which abdominal and thoracic organs are transposed from normal positions. Laparoscopy‐assisted distal gastrectomy for situs inversus totalis is technically difficult and has rarely been reported. Here, we report the case of man in his 40s with situs inversus totalis and a preoperative diagnosis of stage IA gastric cancer (cT1b, cN0, cM0). We successfully performed laparoscopy‐assisted distal gastrectomy with D1+ lymph node dissection and Billroth I reconstruction. To ensure a safe procedure, we evaluated the vessels preoperatively with 3‐D CT angiography. Furthermore, we performed the surgery by reversing our surgical positions, using a two‐monitor method, and then reconstructing under direct vision through the incision. The surgery was performed with minimal blood loss, and no severe postoperative complications were observed. Histopathological examination revealed poorly to moderately differentiated stage IA (pT1b, pN0, pM0) adenocarcinoma. No recurrence has been observed as of 2 years postoperatively.     

硬膜外入路切除巨大海绵窦海绵状血管瘤的临床分析

目的探讨硬膜外入路切除巨大海绵窦海绵状血管瘤的临床效果。方法从2008年5月至2013年5月收治的海绵窦海绵状血管瘤患者中随机选择15例进行研究。对患者实施硬膜外入路切除术,术后进行定期随访,观察记录患者的治疗效果和脑神经功能情况等。结果海绵窦海绵状血管瘤全切除的有11例,近全切除2例,次全切除1例,部分切除1例。末次随访可得:所有患者的临床症状均得到缓解或者显著改善。结论临床采用硬膜外入路切除术治疗巨大海绵窦海绵状血管瘤疗效确切,且可以一定程度保存患者的脑神经功能,值得临床推广应用。     

以癫痫发作为主的幕上海绵状血管瘤的显微手术治疗

【目的】探讨以癫痫发作为主的幕上海绵状血管瘤显微手术方法和疗效。【方法】对1999年至2009年本院收治的以癫痫发作为主的幕上海绵状血管瘤共38例,在显微镜下行切除术,术中彻底切除病灶和周围的胶质瘢痕以及含铁血黄素层。【结果】术后影像学检查显示38例海绵状血管瘤均全切除;癫痫发作得到控制,癫痫缓解率超过90％。【结论】显微手术切除海绵状血管瘤及其周围的胶质瘢痕和含铁血黄素层是控制癫痫发作的有效方法。     

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.     

Laparoscopy‐assisted distal gastrectomy for multiple adenocarcinomas in intrathoracic upside‐down stomach

Herein we report on a case of two adenocarcinomas arising from an upside‐down stomach in an elderly patient. An 83‐year‐old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy showed two superficial depressed lesions in the stomach that were confirmed on biopsy as constituting a moderately differentiated tubular adenocarcinoma. CT and an upper gastrointestinal barium study revealed that the entire stomach and parts of the duodenum were located in the mediastinum. The patient underwent laparoscopy‐assisted distal gastrectomy and regional lymph node dissection with Billroth I reconstruction, followed by reduction of the migrated stomach. The hiatal defect was closed by primary suturing of the right and left crura at the anterior space of the esophagus. The patient's postoperative course was good, and follow‐up after discharge was uneventful. To the best of our knowledge, this is the first case report of multiple adenocarcinomas in an upside‐down stomach treated by laparoscopy‐assisted distal gastrectomy.     

手术切除肝门区巨大肝海绵状血管瘤的术后护理

目的探讨手术切除肝门区巨大肝海绵状血管瘤患者术后综合护理的价值。方法选取行手术切除肝门区巨大肝海绵状血管瘤的术后患者217例,采用数字表法随机分为观察组109例和对照组108例,对照组给予常规护理,观察组在对照组的基础上,增加心理护理、并发症预防和饮食护理等综合护理。比较两组患者的住院时间、并发症发生率和满意度情况。结果观察组的住院时间为（24．5±6．4）d,短于对照组的（36．2±8．7）d,差异有统计学意义（t=3．642,P〈0．05）。观察组术后并发症发生率、患者满意度分别为8．26％,98．17％,优于对照组的27．78％,60．19％;两组比较差异均有统计学意义（X2值分别为7．945,3．015;P〈0．05）。结论实施术后综合护理,可缩短肝门区巨大肝海绵状血管瘤手术患者住院时间,降低术后并发症的发生率,提高让患者满意度,值得在临床推广应用。     

Multiple gastric gastrointestinal stromal tumors treated by laparoscopic‐endoscopic cooperative surgery: A case report

The typical treatment of choice for gastrointestinal stromal tumors (GIST) is surgical resection. Here we report a case of three GIST lesions resected safely by laparoscopic‐endoscopic cooperative surgery (LECS). A 78‐year‐old woman was referred to our hospital for further treatment of an enlarging gastric submucosal tumor. Esophagogastroduodenoscopy and endoscopic ultrasonography revealed two gastric submucosal tumors. Endoscopic ultrasonography‐guided fine needle aspiration was subsequently performed. The patient underwent LECS in accordance with therapeutic guidelines for GIST. Assisted by a laparoscope and using three trocars, a full‐thickness resection was performed endoscopically for the 3‐cm lesion and its nearby submucosal tumor, which was newly detected intraoperatively. The other lesion was also resected with an autosuture device under laparoscopy. No intraoperative or postoperative complications were observed. In LECS, endoscopic observation and resection can minimize gastric deformation and preserve gastric function. To the best of our knowledge, this is the first case of LECS performed on multiple GIST.     

Superior mesenteric artery syndrome treated with single‐incision laparoscopy‐assisted duodenojejunostomy

Superior mesenteric artery (SMA) syndrome is an uncommon disease resulting from compression and partial obstruction of the third portion of the duodenum from the SMA. A 77‐year‐old man, who did not have a history of surgery, experienced repeated vomiting and developed abdominal distension. Abdominal CT showed a narrowed third portion of the duodenum, with a distended stomach and proximal duodenum. The patient was diagnosed as having SMA syndrome and was initially treated conservatively, but his condition did not improve. Single‐incision laparoscopy‐assisted duodenojejunostomy was performed. The patient recovered well and was discharged from hospital on postoperative day 8. Laparoscopic treatment is feasible for the treatment of SMA syndrome given its safety and minimal invasiveness. This is a report of the first case of single‐incision laparoscopy‐assisted duodenojejunostomy. This procedure is safer and less invasive than a conventional laparoscopic approach in a patient with SMA syndrome.     

Comparison of perineural platelet‐rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized,single‐blind,head‐to‐head comparative trial

Recent studies demonstrated the utility of perineural injection with platelet‐rich plasma (PRP) and 5% dextrose (D5W) as novel strategies for treatment of carpal tunnel syndrome (CTS). The present study comprised a prospective, randomized, single‐blind, head‐to head comparative trial to compare the 6‐month outcome of perineural injection with PRP or D5W in patients with moderate CTS. Fifty‐two patients with unilateral moderate CTS were enrolled and randomized into two groups: The PRP group received a single 3‐cc perineural injection of PRP under ultrasound guidance, and dextrose group received a single 3‐cc perineural injection of D5W under ultrasound guidance. The Boston Carpal Tunnel Syndrome Questionnaire score was used as the primary outcome. Secondary outcomes included cross‐sectional area (CSA) of the median nerve and electrophysiological assessments. Evaluations were performed at baseline and at 1, 3, and 6 months postinjection. All patients (26 patients per group) completed the study. Compared with the dextrose group, the PRP group demonstrated significant reductions in Boston Carpal Tunnel Syndrome Questionnaire function at 3 months (p = .044), distal motor latency at 6 months (p = .028), and CSA at 3 and 6 months (p = .010 and.018, respectively). A single perineural injection of PRP reduced the CSA of the median nerve more effectively than injection of D5W at 3 and 6 months postinjection for patients with moderate CTS.     

颅内海绵状血管瘤30例显微外科治疗

目的探讨颅内海绵状血管瘤显微手术治疗方法。方法总结30例颅内海绵状血管瘤的临床表现、神经影像学特征及显微治疗方法。结果全切除22例（73．3％）,大部分切除7例（23．3％）,部分切除1例（3．4％）。结论显微手术治疗颅内海绵状血管瘤是更为安全和有效的方法,未完全切除者术后给予放射治疗,疗效满意。     

One‐stage laparoscopy‐assisted colectomy for synchronous double colorectal cancers

Synchronous multiple malignant colorectal lesions are rare, and there have been very few studies about one‐stage laparoscopic operations in these cases. Here, we evaluated the short‐term outcomes of laparoscopy‐assisted colectomy (LAC) for synchronous double colorectal cancers. Seven patients underwent one‐stage LAC that required two resections and anastomoses in our hospital from 2010 to 2014. We retrospectively examined each patient's background and subsequent surgical outcomes. The median age of patients was 78 years, and the median BMI was 19.8 kg/m². The median operative time was 190 min, and blood loss was minimal. All resected specimens were extracted through a transumbilical incision. A radical operation was performed safely without procedural accidents or postoperative complications in all cases. The median postoperative hospital stay was 12.5 days. One‐stage LAC is considered a safe and viable procedure for resecting synchronous double colorectal cancers. It involves minimal invasiveness and is similar to standard LAC.     

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.     

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.     

Combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy for synchronous double cancer of the rectum and the prostate

Here we report a combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy. A 74‐year‐old man was diagnosed with T4b low rectal and prostate cancer. The operation was performed after neoadjuvant chemotherapy for the rectal cancer. The procedure used eight ports in total, five for laparoscopic abdominoperineal resection and six for robotic‐assisted prostatectomy. First, laparoscopic total mesorectal excision including division of the inferior mesenteric artery was performed, and then, robotic dissection of the prostate was performed. The en bloc specimen was removed through the perineal wound. Then, robotic urethrovesical anastomosis was performed. An extraperitoneal end colostomy was created to finish the operation. The operating time was 545 min, and blood loss was 170 mL. The postoperative course was uneventful, and the patient discharged on postoperative day 17. The combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy were performed safely without any additional technical difficulty, as both procedures shared port settings and patient positions.     

Successful resection of cellular angiofibroma in the retroperitoneum by using laparoscopic approach

Retroperitoneal cellular angiofibroma (RCA) is very rare, and the optimal treatment for RCA has not been established. We report the case of RCA in a 58‐year‐old man who underwent curative laparoscopy‐assisted resection. Preoperative computed tomography showed heterogeneous enhancement of the 7 cm diameter tumor in the pelvis. A smaller (2.3 cm) mass was also detected in the small intestine. The preoperative diagnosis was peritoneal metastasis of the gastrointestinal tumor of the small intestine. The pelvic tumor was laparoscopically mobilized from the rectum, the left ureter, and the left internal iliac vessels. The tumor was excised by detachment from the urinary bladder in laparotomy. The pathological diagnosis was RCA. The tumor had not recurred by the 1‐year follow‐up. The laparoscopic approach thus might be useful for resection of RCA.     

First Experience Using 4‐Dimensional Hysterosalpingo‐Contrast Sonography With SonoVue for Assessing Fallopian Tube Patency

This study was conducted to describe our first experience using transvaginal 4‐dimensional (4D) hysterosalpingo‐contrast sonography with SonoVue (Bracco International BV, Amsterdam, the Netherlands) for diagnosis of fallopian tube patency. The study was prospective and conducted in a university hospital setting. The sonographic procedures included 2‐dimensional transvaginal sonography for evaluating uterine and ovarian mobility, observing intubation, and determining the initial plane and 4D hysterosalpingo‐contrast sonography for observing periovarian and pelvic diffusion. Ninety‐six outpatients visiting infertility clinics underwent 4D hysterosalpingo‐contrast sonography. All patients finished the examination successfully. A total of 192 fallopian tubes were assessed, of which 95 (49.5%) were classified as type A (the tube was patent, and the contrast agent flowed smoothly through it), 72 (37.5%) as type B (the tube was patent, but the contrast agent did not flow smoothly inside it), and 25 (13.0%) as type C (blocked). Sixteen patients underwent laparoscopy or laparoscopy combined with hysteroscopy; 28 tubes (87.5%) were concordant with laparoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for 4D hysterosalpingo‐contrast sonography versus laparoscopy were 81.8%, 90.5%, 81.8%, 90.5%, and 0.72 respectively. In total, 92.7% of patients did not require a hospital stay after 4D hysterosalpingo‐contrast sonography, and none need resuscitation. The others stayed in the hospital for clinical observation because of a severe vasovagal reaction or severe pain but received only bed rest without any medical treatment. Forty patients (41.7%) felt slight pain; 39 (40.6%) felt moderate pain; and 15 (15.6%) had a vasovagal reaction. No procedure or postprocedure complications occurred in any patient. In conclusion, 4D hysterosalpingo‐contrast sonography with SonoVue is an available screening method for assessment of tubal patency and is tolerable for most patients.     

平阳霉素碘化油乳剂选择性肝动脉栓塞治疗肝海绵状血管瘤40例

目的:评价使用平阳霉素碘化油乳剂经肝动脉栓塞治疗肝海绵状血管瘤的临床疗效。方法:对40例肝海绵状血管瘤患者,通过导管超选择插管至肝血管瘤的供血动脉,使用平阳霉素碘化油乳剂经肝动脉进行栓塞治疗。结果:所有病例均成功实施了栓塞治疗,治疗后患者症状缓解,瘤体缩小,无严重并发症,生存质量明显提高。结论:使用平阳霉素碘化油乳剂经肝动脉栓塞治疗肝海绵状血管瘤疗效肯定,安全性好。     

Reduced‐port laparoscopic surgery for rectal cancer: Feasibility based on our early experience

We report our experience of a reduced‐port laparoscopic surgery as an advanced laparoscopic surgery for rectal cancer. Twelve selected patients with clinical T1–2 and N0 rectal cancer (clinical stage I) underwent low anterior resection of the rectum. The procedures were performed with one port plus a multiple‐instrument access port with three channels. The multiple‐instrument access port was placed at the umbilicus or the site of diverting stoma, and another port was placed in the right abdomen or in the opposite abdomen of ostomy. The median operative time and intraoperative bleeding were 280 min and 15 mL, respectively. The median number of harvested lymph nodes was 20. No major perioperative morbidities occurred in this series. The median postoperative hospital stay was 10 days. Low anterior resection performed by reduced‐port laparoscopic surgery is feasible as multiport laparoscopic surgery, and it is a reliable surgical option in selected patients with rectal cancer.