腹腔镜在泌尿外科肿瘤手术中的应用进展

近年来腹腔镜在泌尿外科肿瘤手术中应用广泛。腹腔镜下已可施行肾癌根治性肾切除、肾上腺肿瘤切除、前列腺癌根治性手术、膀胱癌全膀胱切除、腹膜后淋巴结清扫术等，具有损伤小、出血少、恢复快、住院时间短和并发症少等优点，但手术时间较长，远期效果还有待临床观察。本文就其现状及研究进展作一综述。     

腹腔镜在泌尿外科肿瘤手术中的应用进展

近年来腹腔镜在泌尿外科肿瘤手术中应用广泛 ,腹腔镜下已可施行肾癌根治性肾切除、肾上腺肿瘤切除、前列腺癌根治性手术、膀胱癌全膀胱切除、腹膜后淋巴结清扫术等 ,具有损伤小、出血少、恢复快、住院时间短和并发症少等优点 ,但手术时间较长 ,远期效果还有待临床观察。本文就其现状及研究进展作一综述。     

腹腔镜技术在泌尿外科手术中的应用(附28例报告)

目的探讨泌尿外科腹腔镜手术的技术和方法，评价腹腔镜技术在泌尿外科手术中的临床价值。方法回顾性分析了28例采用腹腔镜技术诊治的泌尿外科疾病患的临床资料。行肾囊肿去除减压术16例，精索静脉高位结扎术8例，隐睾症定位术4例。结果28例手术成功26例。平均住院4d，术中均未输血，术中术后未出现严重并发症。结论通过腹腔镜能顺利进行多种泌尿外科手术，具有损伤小、痛苦轻、术后恢复快和住院时间短等优点，有良好的临床应用前景。     

腹腔镜手术在女性泌尿外科的应用

随着腹腔镜手术技术的发展，其已在女性泌尿外科得到广泛的应用。本文就腹腔镜手术治疗尿失禁、盆腔脏器脱垂、肾下垂等女性泌尿外科疾病的进展作一综述。     

腹腔镜在泌尿外科中的应用进展

腹腔镜作为微创外科的一把利剑，在泌尿外科应用越来越广泛。设备与技术日益完善。它具有创伤小。病人住院日短，恢复快，手术视野清等特点；但它设备较昂贵、病人费用较高仍是制约腹腔镜在发展中国家普遍实行的一个重要因素。     

腹膜后腹腔镜手术在泌尿外科重建手术中的应用(附258例报告)

目的：评价腹膜后腹腔镜手术用于泌尿外科重建手术的疗效、安全性,并总结治疗体会。方法：应用腹膜后腹腔镜手术行肾部分切除术54例,肾固定术26例,肾盂切开取石术12例,肾盂成形术82例,输尿管切开取石术84例。结果：254例成功,4例中转开放手术。手术时间30~150min,平均80min,术中出血20~400ml,平均150ml。术后住院4~23d,平均14d。无严重并发症发生。结论：腹膜后腹腔镜重建手术治疗泌尿外科疾病安全、有效,患者创伤小,痛苦轻,术后康复快。     

腹腔镜手术在泌尿外科中的应用进展

泌尿外科界对腹腔镜手术愈来愈重视,并广泛用于各类泌尿系疾病的诊治。随着手术方式的不断改进以及腔镜技术的日益完善,目前大部分切除和重建手术可以应用腹腔镜来完成。一些技术已经成熟并定型,一些正处于不断的完善之中,还有一些尚存在争议。本文对泌尿外科腹腔镜手术的手术方式、适应证方面的进展进行综述,对临床工作有一定的指导作用。     

腹腔镜手术在女性泌尿外科的应用

随着腹腔镜手术技术的发展,其已在女性泌尿外科得到广泛的应用。本文就腹腔镜手术治疗尿失禁、盆腔脏器脱垂、肾下垂等女性泌尿外科疾病的进展作一综述。     

手辅助腹腔镜在腹部手术中的应用(附14例报告)

目的　探讨手辅助腹腔镜在腹部手术中的应用。方法　回顾性分析我院 2 0 0 1年 5月～ 2 0 0 3年 4月间 14例腹部手术的治疗经验。结果　 14例手术时间从 30min～ 2h ,手术失血量为 2 0～ 10 0ml,中转开放手术率为 0。病人术后痛苦小 ,恢复快。结论　运用手辅助腹腔镜技术能在手术步骤上综合传统开放手术和腹腔镜手术的优势 ,达到微创的目的。     

腹腔镜泌尿外科手术326例临床经验总结

目的 探讨腹腔镜手术治疗泌尿外科疾病的临床疗效并总结经验.方法 总结2006年3月至2010年8月期间采用腹腔镜手术治疗326例泌尿外科疾病的临床资料.其中精索静脉高位结扎术148例、肾囊肿去顶减压术45例、输尿管切开取石术72例、鞘状突高位结扎术15例、肾蒂淋巴管结扎术7例、肾切除术10例、离断性肾盂成形术10例、肾上腺肿瘤切除术10例、肾癌根治术6例、隐睾下降固定术2例、巨输尿管成形术1例.结果 322例手术获成功,4例中转开放手术.手术时间12-270 min.术中出血量2~500ml,术后住院时间2~11 d.未发生严重并发症.结论 腹腔镜手术治疗泌尿外科疾病具有微创,并发症少、术后恢复快、住院时间短等优势,疗效满意,应用价值高.     

Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

Background Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands. Methods Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25–item questionnaire. Results A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines. Conclusions A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.     

经腹腔途径腹腔镜手术141例报告

目的:总结经腹腔途径泌尿外科腹腔镜手术的初期经验。方法:回顾性分析141例经腹腔途径患者的手术结果。结果:138例患者通过腹腔镜完成手术,3例转为开放手术。无需要二次手术患者,无围手术期死亡发生,无大血管及腹腔内脏器损伤等严重并发症。术后远期,1例出现不完全性肠梗阻,1例出现切口疝。结论:初学者进行经腹腔途径的泌尿外科腹腔镜手术是安全可靠的;在手术过程中,对解剖的认识和采取谨慎的态度,是避免严重并发症发生的关键。     

后腹腔镜在泌尿外科中的应用(附107例报告)

目的探讨后腹腔镜治疗泌尿外科疾病的临床疗效。方法本组自1993年3月至2006年12月采用全麻经腹膜后途径,对107例患者进行腹腔镜手术。结果本组104例手术顺利,3例中转开放手术,手术时间30-210min,术中出血20-150ml,无严重并发症。结论后腹腔镜手术治疗泌尿外科疾病具有创伤小、出血少、疗效好、并发症低等优点。     

Gasless laparoscopy in abdominal surgery

Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first experiences with laparoscopic surgery without using pneumoperitoneum. Under direct vision and digital control a fan-formed wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimited suction can be obtained without a loss of exposure. During anesthesia, neither increased ventilation nor increased ventilation pressure is necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, used in open surgery, can also be employed in gasless laparoscopy. In this way we performed gasless laparoscopic surgery on 54 patients: cholecystectomy (n=37), abdominal exploration for NSAP (n=5) or tumor staging (n=4), fenestration of liver cysts (n=5), and appendectomy (n=3). We did observe three wound infections as related complications. Six times, we had to change the surgical procedure. Compared to the traditional procedure with a CO₂ pneumoperitoneum, the results of the first gasless procedures demonstrate potential advantages.     

单孔腹腔镜技术在泌尿外科的应用进展及展望

单孔腹腔镜技术(laparo-endoscopic single-site surgery,LESS)在继承传统腹腔镜技术特点的基础上具有更好的术后美容效果和患者术后恢复更快的独特优势.然而,单孔腹腔镜手术存在暴露不佳、器械碰撞干扰、缝合难度大等难点.自2007年以来,国内外泌尿外科医师不断拓展LESS在泌尿外科领域的...     

Skill performance in open videoscopic surgery

Introduction Application of minimally invasive surgery represents the future of modern surgical care. Previous studies by our group provided a novel way for viewing open surgery using a rigid endoscope attached to charged coupled device (CCD) camera in proximity to the surgical field using a robotic arm (AESOP) and a stabilizing fulcrum (Alpha port). Materials and methods This study is a follow-up to investigate the technical feasibility, advantages, and disadvantages of relying only on video images displayed on standard monitors in performing open surgical procedures instead of direct binocular eye vision. This study used two surgeons as participants with training in basic surgical skill and previous experience in performing an intestinal anastomosis in an ordinary fashion. The standard task consisted of anastomosing porcine intestine in two layers with digital viewing of the operative field. A total of 40 anastomoses (20 by each surgeon) were compared with 10 control performances using direct vision of the field. Results All the resulting anastomoses were accurate, well coapted, and fully patent with no leakage. Time for task performance was approximately twice as long (p < 0.05) with videoscopic vision as with direct vision. Discussion These findings suggest it is technically feasible to conduct open surgeries with visualization of the open surgical field limited to video display on standard monitors.     

Cardioscopy: potential applications and benefit in cardiac surgery

Objective: Cardioscopy in open heart surgery is still not routine in most units. However, since our first report in 1996 we use this device more frequently, because we think that safety and accuracy of different surgical procedures is increased. Methods: Between 1/96 and 12/97 we performed cardioscopy in 100 patients. Indications (IND) for cardioscopy were as follows: IND (1) resection of hypertrophied septum (N=15); IND (2) evaluation of aortic valve with low grade stenosis or insufficiency (N=12); IND (3) removal of intracardiac foreign bodies/tumors (N=13); IND (4) inspection of VSD prior and after repair (N=8); IND (5) identification of paravalvular leakage (N=8); IND (6) diagnostic purposes (N=4); IND (7) education of surgeons and operating room staff (N=40).During cardioplegic arrest the 5 mm rigid or flexible cardioscope (Storz®, Tuttlingen, Germany) was inserted through ascending aorta, aortic valve or tricuspid valve depending on indication. Results: No complication occurred during cardioscopy. IND (1): there was an excellent view of all intracardiac structures. Thorough resection of hypertrophied septum was possible and there was no injury of adjacent structures or aortic valve. IND (2): all valves were inspected through a 1 cm aortic incision and the pathology of the valves was documented. In case of severe calcification, the valve was replaced although transvalvular gradient was less than 50 mm Hg. IND (3): intraventricular foreign bodies, such as felt pledges (N=2), debris (N=5), thrombi (N=4) and tumors (N=2) were entirely removed through the aortic valve with a special forceps. IND (4): anatomy of VSD was documented in all cases. It was possible to test accuracy of all patch-sutures. IND (5): all paravalvular leakages were identified eventhough there was heavy immobility of the mechanical valve. IND (6): a papillary muscle (N=2) and a thrombus formation (N=2) were diagnosed. IND (7): the surgeons and operating room staff could follow the entire procedure in all cases. Conclusions: Cardioscopy is a supporting technique to clearly identify intracardiac structures, to control several surgical procedures, to document valve pathology, and to educate surgeons and operating room staff. Handling is easy and does not increase operative risk. Some procedures will be performed with minimal invasivity in future.     

机器人单孔腹腔镜手术在泌尿外科的发展现状及展望

随着微创观念在外科手术中的进一步深入,医生和患者都期待无瘢痕手术的实现。如今,机器人单孔腹腔镜(Robotic laparoendoscopic single-site,R-LESS)手术无疑是最接近此目标的方法之一,其不仅具有单孔腹腔镜手术微创、美观、少痛、恢复快等优点,同时具有机器人独有的3D手术视野、术者震颤消除等优点。单孔腹腔镜和机器人手术系统结合而生的R-LESS使得微创手术向前迈进了一大步。本综述以R-LESS的发展历史为切入点,总结国内外发展现状,分析其优势与不足,并对未来进行展望,旨在促进R-LESS在泌尿外科领域的发展。