Successful laparoscopic extirpation of a vasoactive intestinal polypeptide-secreting neuroblastoma originating from the right adrenal gland: A report of an infantile case

We herein report a 10-month-old female infant with a 4-month history of diarrhea with electrolyte abnormalities and growth impairment. A 4-cm right adrenal tumor was detected by computed tomography. No metastasis or accumulation on I¹²³-metaiodobenzylguanidine scintigraphy was recognized in the tumor. A vasoactive intestinal peptide-secreting neuroblastic tumor was suspected, and octreotide was started, but the diarrhea persisted. Tumor extirpation was laparoscopically performed. After tumor removal, the symptoms improved immediately, and her growth caught up by 9 months after surgery. A minimally invasive approach for pediatric solid tumor is difficult, especially for neuroblastoma, but may be beneficial for the patient's recovery.     

Ergonomic comparison of laparoscopic hand instruments in a single site surgery simulator with novices

Background: Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes. Material and methods: One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires. Results: The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both). Conclusions: This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability.     

Comparison of laparoscopic and open adrenalectomy for pheochromocytoma in a single center

Introduction: Laparoscopic adrenalectomy is recognized as a safe and feasible surgical procedure for removing adrenal masses, though some reports have questioned its use because of an increased risk of cardiovascular complications. This study aims to compare laparoscopic surgery and open surgery for pheochromocytoma. Methods: We analyzed 26 patients operated on for adrenal pheochromocytoma (laparoscopic surgery: 11 patients; open surgery: 15 patients) at Kyorin University Hospital from April 1995 to July 2009. Patient records were analyzed with regards to operative time, blood loss, complications, blood pressure during surgery, amount of analgesia required in patient‐controlled analgesia, time to oral intake, length of hospital stay, and other factors. Results: Mean tumor size was greater in the open surgery patients. Blood loss was significantly less extensive in the laparoscopic surgery patients. Rates of intraoperative hypertension (defined as a sudden rise in systolic blood pressure of >200 mmHg) and hypotension (systolic blood pressure of <80 mmHg) immediately after clamping of the adrenal vein were significantly lower in the laparoscopic surgery patients. No significant differences were found between the two groups with respect to operative time, occurrence of complications, and analgesic requirements. Only one case (9.1%) required conversion from laparoscopic to open surgery because intraoperative complications, specifically uncontrollable hemorrhaging. Time to oral intake after surgery and hospital stay were significantly shorter in the laparoscopic surgery patients. During the follow‐up period, there was no mortability or recurrence of endocrinopathy in the two groups. Conclusion: We consider the safety of laparoscopic adrenalectomy for pheochromocytoma to be similar to that of open surgery.     

腹腔镜手术治疗输卵管妊娠40例临床分析

目的：探讨腹腔镜治疗输卵管妊娠的疗效。方法：选择2007年1月—2010年12月输卵管妊娠手术患者80例,腹腔镜手术者（40例）为腹腔镜手术组,开腹手术者（40例）为开腹手术组。对两组患者手术时间、术中出血量、术后排气时间、术后下床时间、术后住院天数、术后应用镇痛剂的例数、术后发热人数等进行比较分析。结果：两组在术中出血量、术后排气时间、术后平均下床时间、术后平均住院天数、术后应用镇痛剂等方面来比较,差异有显著性（P〈0.05）。结论：腹腔镜治疗输卵管妊娠创伤小、住院时间短、恢复快、疗效确切,可作为治疗输卵管妊娠的首选术式。     

后腹腔镜手术治疗肾上腺囊肿11例报告

目的 探讨后腹腔镜手术治疗肾上腺囊肿的方法 及临床意义.方法 回顾性分析2004年3月～2008年10月11例行后腹腔镜肾上腺囊肿切除术的临床资料.包括手术时间、术中出血量、止痛药使用量、术后禁食时间、下床活动时间、术后住院天数、并发症和临床疗效等.结果 11例手术均获成功,其中肾上腺部分切除术7例,肾上腺全切术4例.手术时间、术中出血量、止痛药使用例教、术后禁食时间、下床活动时间及术后住院天数分别为:(73.36±20.88)min、(40.52±25.91)mL、2例(2/11)、(1.84±0.68)d、(1.87±0.45)d和(4.86±1.27)d.除2例术后伤口皮下气肿外,无其他术后并发症.腰腹部饱胀感症状均消失(3/3),1例(1/2)高血压恢复正常.11例术后随访平均20个月(8～52个月).无1例复发.结论 后腹腔镜手术可作为肾上腺囊肿的首选治疗方法 .     

Laparo-endoscopic single-site sleeve gastrectomy: Results from a preliminary series of selected patients

Abstract

Laparoscopic sleeve gastrectomy (LSG) has received recognition in the treatment of patients with morbid obesity and BMI <40 kg/m² and high-risk patients with BMI >50 kg/m². Conventional LSG usually requires the placement of four or more trocars. Recently, newly designed access devices have allowed a single-incision laparoscopic approach; however, the clinical application of this method is still limited. We describe the operative steps of laparo-endoscopic single-site (LESS) sleeve gastrectomy and report the preliminary results: in 12 selected patients. The functional results did not differ significantly from those of standard LSG, with a median excess weight loss of 79% twelve months after surgery. Furthermore, cosmetic results seemed to be improved and postoperative pain reduced compared to standard LSG.     

后腹腔镜与开放手术行肾及肾上腺肿瘤切除临床对比研究

目的探讨经后腹腔镜行肾及肾上腺肿瘤切除术的临床疗效及安全性。方法回顾性分析2005年10月至2013年12月253例肾及肾上腺肿瘤切除术患者临床资料,其中后腹腔镜组125例,开放手术组128例,比较两组手术时间、术中出血量、术后疼痛强度、术后住院时间情况。结果后腹腔镜组122例手术获得成功,3例中转开放手术。后腹腔镜组手术时间、术中出血量、术后疼痛强度、术后住院时间与开放手术组比较差异均有统计学意义(P<0.05)。结论后腹腔镜手术治疗肾及肾上腺肿瘤具有创伤小、并发症少、术后恢复快、住院时间短等优势,疗效满意,安全性及应用价值高,值得在基层医院推广应用。     

后腹腔镜手术治疗肾上腺良性疾病55例报告

目的 介绍后腹腔镜手术治疗肾上腺良性疾病的技术要点和初步经验,评价其手术疗效.方法 总结1995年5月-2007年12月采用后腹腔镜手术治疗55例肾上腺良性疾病患者的临床资料.结果 该组55例,后腹腔镜手术全部成功,成功率100%.其中肾上腺皮质腺瘤30例(原发性醛固酮增多症20例,皮质醇腺瘤6例,非功能性皮质腺瘤4例),皮质增生症5例,肾上腺囊肿4例,嗜铬细胞瘤9例,髓脂肪瘤3例,髓质增生3例,神经节瘤1例.手术时间70-360min,平均96min.术中出血10-200mL,平均50mL,均未输血.术后住院5-11 d.平均8d.该组无并发症.术后随访1个月-5年,效果良好.结论 后腹腔镜手术治疗肾上腺良性疾病具有创伤小、出血少、术后恢复快等优点.是肾上腺良性痰病治疗的首选方法 .     

Results of a national survey on laparoscopic bariatric surgery in Japan, 2000-2009

Introduction: In Japan, laparoscopic bariatric surgery has not been popular until recently because morbidly obese patients were infrequently encountered previous and Japanese health insurance does not cover this type of surgery. In 2010, the Japan Research Society for Endoscopic and Laparoscopic Treatments of Obesity undertook the first nationwide survey on laparoscopic bariatric surgery to evaluate its current status and outcomes. Methods: A mail survey was sent to the society's 64 member institutions, which included almost all institutions in Japan actively performing laparoscopic gastrointestinal surgery. Results: From 2000 to 2009, 340 laparoscopic bariatric procedures, in total, were performed in nine of the 64 institutions (14%). The most popular procedure was laparoscopic Roux‐en‐Y gastric bypass (LRYGB, n=147), second was laparoscopic sleeve gastrectomy (LSG, n=102), and third was laparoscopic adjustable gastric banding (LAGB, n=55). However, the number of LRYGB procedures has decreased while the number of LSG procedures has rapidly increased. Total morbidity rates were 12.2% for LRYGB, 10.9% for LAGB, and 7.8% for LSG. Percent excess weight loss was 78% at 5 years after LRYGB, 52% at 4 years after LAGB, and 68% at 2 years after LSG. Although the bariatric procedures frequently resolved or improved obesity‐related comorbidities, LRYGB appears to be superior to LAGB, as was previously reported. Conclusion: The first nationwide survey of laparoscopic bariatric surgery in Japan clearly showed the current status and outcomes of this group of procedures. The Japanese results appear to be comparable to similarly undertaken surveys in Europe and the USA.     

腹腔镜结直肠切除术中转开腹风险因素分析及评分系统初步建立

目的分析腹腔镜结直肠切除术（LCS）中转开腹风险因素,根据风险因素建立预测LCS中转开腹的评分系统。方法对429例患者的临床资料进行回顾性研究。结果中转开腹68例,中转开腹率15.58%,应用Logistic回归分析确定LCS中转开腹风险因素为：年龄≥65岁（CI=2.115,P〈0.05）、体指指数BMI≥25（CI=2.907,P〈0.01）、手术例数≤25例（CI=1.900,P〈0.05）、有腹部手术史（CI=3.205,P〈0.05）、有转移（CI=30.115,P〈0.01）、肿瘤≥6cm（CI=8.954,P〈0.05）,并计算出LCS中转开腹可能性方程,根据方程建立评分系统：年龄（≥65岁为7分,〈65岁为0分）、体重（BMI≥25为11分,BMI〈25为0分）、手术是否为前25例（是为5分,不是为0分）、是否有腹部手术史（是为12分,不是0分）、肿瘤大小（≥6cm为22分,〈6cm为0分）、是否有转移（有为34分,无为0分）。计算病例得分后画出ROC曲线,预测转开腹得分为18.5分,敏感度0.765,特异度0.806。18.5分以下开腹率为5.21%,18.5分以上开腹率为42.62%（P〈0.001）。结论该评分系统预测中转开腹简便易行,稳定可靠。     

Simultaneous mesh repair of bilateral groin hernia: A comparison of laparoscopic and open techniques

Summary

The optimal management of bilateral groin hernia remains contentious. We report a prospective study of all patients undergoing simultaneous mesh repair of bilateral groin hernia during a 1 year period at a single institution. Cases managed by open surgery were compared with those undergoing laparoscopic repair; duration of hospital stay and complication rate were the main end-points. 51 patients were studied; 18 had open surgery and 33 had a laparoscopic procedure. The patients in the laparoscopic group had a shorter hospital stay (median saving of 2.5 nights). Postoperative complications (predominantly haematoma, infection and urinary retention) were more common in the open surgery group (p < 0.01). There were no recurrences over the study period. In summary, laparoscopic repair was associated with a shorter hospital stay and lower postoperative complication rate when compared with conventional open surgery. We would commend this procedure as the operation of choice for the management of bilateral groin hernia.     

后腹腔镜与开放手术行肾上腺肿瘤切除术的效果比较

目的通过比较,评价后腹腔镜与开放手术行肾上腺肿瘤切除术的临床价值。方法将46例后腹腔镜肾上腺肿瘤切除术患者与同期58例开放手术行肾上腺肿瘤切除术患者的临床效果进行比较。结果后腹腔镜手术组的术中出血量、术后止痛剂的用量、术后住院时间、术后恢复工作的时间均优于开放手术组,差异有统计学意义(P<0.01);两组在手术时间、手术费用上差异无统计学意义(P>0.05)。结论后腹腔镜肾上腺肿瘤切除术具有创伤小、术中出血少、术后恢复快等优点,已成为现代肾上腺肿瘤手术治疗的金标准。     

腹腔镜与开腹结肠癌根治手术对患者术后近期生命质量的影响

目的 对腹腔镜与开腹手术后结肠癌患者生存质量进行评估,并比较腹腔镜与开腹手术对患者生存质量的影响。方法 收集该院普外科收治的结肠癌患者125例,将其根据手术方式不同分组：腹腔镜组65例和开腹组60例,应用GLQI调查表对两组患者进行了术前及手术后1个月内生存质量的评估。结果 术前生存质量调查显示两组患者的总体生存质量和各子项目无明显差异（P >0.05）,均明显低于正常人。术后1 d,腹腔镜组患者的GLQI总分、主观症状、躯体生理功能状态、社会活动状态、心理情绪状态项目得分均较术前有所下降,但差异无显著性（P >0.05）;术后3 d起,GLQI总分和各项目得分均逐渐上升,术后30 d时,已经明显高于术前水平（P <0.05）,已达到或接近正常人水平。术后1 d,开腹组患者的GLQI总分、主观症状、躯体生理功能状态、社会活动状态、心理情绪状态项目得分均较术前明显下降（P <0.05）,术后3 d起,GLQI总分和各项目得分有所回升,但仍明显低于术前水平（P <0.05）,至30 d时基本恢复术前水平。组间比较,术后1、3、7、14及30 d腹腔镜组患者GLQI总分、主观症状、躯体生理功能状态、社会活动状态、心理情绪状态项目得分均明显高于对照组患者（P <0.05）。结论 针对结肠癌患者,腹腔镜结肠根治术不仅可取得满意的临床疗效,更能显著改善患者术后的生活质量,明显优于开腹手术。     

妇科腹腔镜手术后特发性腹水9例临床分析

目的 探讨妇科腹腔镜手术后少见并发症——特发性腹水的病因、诊断、鉴别诊断及处理。方法 回顾分析该院2004年7月～2005年10月妇科行腹腔镜手术后不明原因大量腹水的诊治情况。结果 期间共有9例患者出现不明原因腹水，年龄23-54岁；所行手术包括腹腔镜下子宫肌瘤剥除术、输卵管切除术、输卵管切开取胚术、卵巢囊肿剥除术、附件切除术以及腹腔镜辅助下阴式全子宫切除术等；出现腹水的时间多为手术后当天开始到术后5d，最晚1例在手术后2周发生；腹水总量可达1650～9200mL；多数患者无明显临床症状，少数有腹胀、恶心、呕吐等不适；腹水检查提示肌酐值与血肌酐值接近，Rivalta试验均为阳性或弱阳性，提示为渗出液；血生化检查提示血清总蛋白正常或降低；所有患者经一般支持治疗后腹水逐渐减少而痊愈。结论 妇科腹腔镜术后特发性腹水是一种少见的并发症，可能与术中腹膜受到热损伤、二氧化碳以及器械消毒液等的刺激等有关，可通过腹水检查与泌尿道、肠管等相关脏器损伤所致的腹水相鉴别，及时支持治疗有效，预后好。     

Remote access laparoscopic (REAL) surgery: a novel approach for single-port surgery without a visible scar

INTRODUCTION: Single-port laparoscopic surgery usually uses the transumbilical approach. However, the transumbilical incision may be associated with a high frequency of wound-related complications, including trocar site hernia and infection. Therefore, we developed remote access laparoscopic (REAL) surgery, a new access technique for single-port surgery within the pubic hairline. This study reports on a technique developed at our institution and describes our preliminary results. MATERIALS AND SURGICAL TECHNIQUE: Ten patients with cholecystolithiasis underwent REAL surgery. A single 2.5-cm transverse incision was made medially within the pubic hairline area, and a SILS Port was inserted. A 5-mm flexible endoscope and an articulating grasper or a long laparoscopic grasper were used. Dissection of the gallbladder was achieved with laparoscopic ultrasonic shears just as in the conventional laparoscopic cholecystectomy. All procedures were successfully performed without conversion to conventional laparoscopic technique. There were no postoperative complications, and outpatient evaluation showed a clean scar within the pubic hair area in all patients. DISCUSSION: Our early experience shows that REAL surgery is feasible and safe. This novel access technique can preserve the native umbilicus and provides an invisible scar that is concealed within the pubic hair.     

腹腔镜手术治疗宫颈癌临床预后的影响因素分析

目的分析影响腹腔镜手术治疗宫颈癌临床预后的危险因素。方法研究纳入2013年3月-2016年1月在该院行腹腔镜手术治疗宫颈癌患者80例为研究对象,术后对患者进行随访,并以宫颈癌复发和死亡为终点事件,分析患者总生存期和无病生存期,通过Cox回归模型分析影响宫颈癌手术预后的危险因素。结果 80例患者随访时间12~46个月,中位随访时间39个月。随访期间16例患者复发,6例患者死亡。无病生存期为(41.85±1.06)个月,总生存期为(44.86±0.74)个月。Cox回归分析显示肿瘤大小、临床分期、淋巴结转移和脉管浸润是影响宫颈癌手术预后的独立危险因素。结论影响腹腔镜手术治疗宫颈癌临床预后的独立危险因素为肿瘤大小、临床分期、淋巴结转移和脉管浸润。     

腹腔镜与输尿管镜双镜联合保肾手术治疗双侧输尿管癌1例报告

65岁老年患者，肉眼血尿1月余，当地医院输尿管镜检，术中见左侧输尿管口一0.5cm菜花样新生物，取活检。右侧距输尿管口7cm见菜花样新生物，取活检。CTU:右侧输尿管下段占位伴肾积水，右侧输尿管下段小结石。病理：双侧输尿管低级别乳头状尿路上皮癌。于我院行输尿管镜检辅助定位下腹腔镜下左侧输尿管下段肿瘤切除膀胱再植术+右侧输尿管膀胱肌瓣成形术。术后病理：（左侧输尿管）低级别非浸润性尿路上皮癌，部分呈乳头状，部分上皮脱落，两端切缘（-），（右侧输尿管）高级别乳头状尿路上皮癌，局部微浸润，浸润粘膜固有层，两端切缘（-）。