Migration of Hem‐o‐lok clip into the common hepatic duct after laparoscopic bile duct exploration: A case report

Hem‐o‐lok clip migration into the bile duct can lead to stone formation and granulation tissue hyperplasia. This report discusses a case wherein four clips migrated into the bile duct after laparoscopic bile duct exploration.     

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.     

Small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit: A case report

A 74‐year‐old man presented at our hospital with complaints of abdominal pain, nausea, and vomiting. He had undergone laparoscopic radical cystectomy and ileal conduit for urinary bladder cancer 1 month earlier. The patient had abdominal distention, resonant sounds on percussion, and diffuse abdominal tenderness without rebound or guarding. Abdominal CT revealed dilated jejunal loops herniated through a cord‐like structure. Based on these findings, emergency surgery was performed, and intestinal dilatation into the space between the ureter, the ileal conduit, and the sacral bone was detected. The loops were released manually and were not resected. To the best of our knowledge, this is the first case report of small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit. Retroperitonealization and the minimum required mobilization of the ureters may be necessary when urinary diversion is constructed, especially in laparoscopic or robotic surgeries.     

Endoscopy‐assisted laparoscopic submucosal dissection for a duodenal epithelial tumor

We present the case of a 46‐year‐old obese woman with a 3.5‐cm adenoma in the descending part of the duodenum who was treated with a totally laparoscopic approach. The preoperative examination revealed a pedunculated superficial tumor on the side of pancreas from the inferior duodenal angulus to 5 cm proximal to the papilla that was associated with massive blood flow. We chose not to perform endoscopic submucosal dissection, pancreaticoduodenectomy, or transduodenal tumor excision with laparotomy for this obese patient because of the poor exposure, risk of bleeding, and substantial invasiveness. We performed endoscopy‐assisted laparoscopic submucosal dissection as a novel laparoscopic‐endoscopic cooperative surgical approach in this patient. This surgery was surgically and oncologically safe.     

Laparoscopic Roux‐en‐Y duodenojejunostomy for superior mesenteric artery syndrome in a 6‐year‐old girl: A case report of a new minimally surgical technique for children

We present the first case report of laparoscopic Roux‐en‐Y duodenojejunostomy utilizing minimally invasive surgery to treat superior mesenteric artery syndrome in a child. A 6‐year‐old girl presented with a 3‐year history of intermittent postprandial epigastric pain and anorexia. An upper gastrointestinal series revealed dilatation of the first and second parts of the duodenum and an abrupt vertical cut‐off at the third portion. Despite conservative treatment for 7 weeks, there was no resolution of her symptoms, so the decision was made to proceed with a laparoscopic Roux‐en‐Y duodenojejunostomy. On follow‐up 9 months later, there had been no recurrence of her symptoms.     

Transumbilical single‐incision laparoscopic ileocecal resection for Crohn's disease in a child

We report the pediatric case of ileal Crohn's disease in which the patient underwent transumbilical single‐incision laparoscopic ileocecal resection. A 14‐year‐old boy with severe growth disturbance presented with intestinal obstruction. Transanal double‐balloon enteroscopy and contrast study during endoscopy revealed a cobble stone appearance and a severe stricture 15 cm in length located slightly proximal to the ileocecal valve. There was no evidence of fistula or abscess formation. Ileocecal resection was performed via an umbilical incision with conventional laparoscopic instruments, and the postoperative course was uneventful. Single‐incision laparoscopic ileocecal resection is a good procedure for uncomplicated Crohn's disease patients in childhood.     

腹腔镜下前列腺癌根治术的围手术期护理

目的探讨腹腔镜前列腺癌根治术的围手术期护理。方法4例采用经腹腔途经,7例采用经腹膜外途经,手术切除前列腺、精囊、输精管壶腹,行膀胱尿道吻合。采取心理护理、肠道准备、生命体征监测、引流管护理、活动训练、饮食控制等围手术期护理。结果全体患者术后恢复顺利,无并发症发生。结论该围手术期系统护理策略对腹腔镜下前列腺癌根治术是一种有效的护理方法。     

Laparoscopic resection of a dumbbell‐shaped lipoma extending through the obturator foramen: A case report

Lipomas are often lightweight and small in size with few subjective symptoms. Giant lipomas are uncommon. We herein report a case involving a giant, deep‐seated dumbbell‐shaped intermuscular lipoma in the right thigh that extended into the pelvic region through the obturator foramen and caused obturator neuropathy. A 64‐year‐old man with numbness while walking was diagnosed with a 17 × 16‐cm lipomatous tumor. He underwent radical surgery performed by a multidisciplinary team consisting of orthopedic and colorectal surgeons. High‐definition magnified laparoscopic images of the deep pelvis confirmed that tumor had infiltrated the obturator nerve. The tumor was completely resected with the obturator nerve. Six months after surgical resection, the patient had no gait disturbance or evidence of recurrence. The laparoscopic approach for this kind of complicated deep pelvic surgery was safe and feasible when performed by colorectal surgeon with ample knowledge of the pelvic anatomy.     

早期康复训练对老年高危患者腹腔镜下前列腺癌根治术后尿失禁的影响

目的：探讨早期康复训练对老年高危患者腹腔镜下前列腺癌根治术后尿失禁的影响。方法：将62例腹腔镜下老年前列腺癌术后尿失禁患者随机分为干预组和对照组各31例,干预组采用有计划系统的早期康复护理措施,对照组采用常规护理方法。比较术后3周拔除尿管后1、2、4周两组患者尿失禁改善情况。结果：干预组第1、2、4周疗效均优于对照组（P﹤0.05）。结论：对腹腔镜下老年高危前列腺癌根治术后尿失禁患者,早期行盆底肌训练结合膀胱康复训练,记录每日饮水和排尿情况,填写功能训练表等康复护理措施实用有效。     

Robotic assisted radical cystectomy: short to medium‐term oncologic and functional outcomes

Purpose: To report short‐ and medium‐term oncological and functional outcomes of the first robotic‐assisted laparoscopic radical cystectomy (RARC) series from the UK. Materials and methods: Thirty patients underwent RARC between 2004 and 2007 at our unit. We report oncological and functional outcomes of this procedure in 20 patients (17 ileal conduit and three Studer Pouches), who have completed at least 6 months of follow up. Results: There were 17 men and three women, median age 66 years (range 38–77 years). Median operating time was 330 min (range 295–510 min), and median blood loss 150 ml (range 100–1150 ml). There were two major complications (10%); a port site bleed and a rectal injury. The median follow up of this cohort is 23 months (range 7–44 months). One patient died of distant metastases at 8 months, and another developed a right ureteric tumour at 7 months. None of the patients had local pelvic or port site recurrence. The overall and disease‐free survival are 95% and 90% respectively. Functional complications included a neovesico‐urethral stricture at 3 months, a left upper ureteric stricture at 6 months and an incisional hernia at 12 months. Conclusion: Robotic‐assisted laparoscopic radical cystectomy is an emerging minimally invasive procedure which at short‐ to medium‐term follow up, in our experience, is oncologically and functionally equivalent to open radical cystectomy.     

Laparoscopic radical prostatectomy – impact of training and supervision

To define the influence of training and supervision on the quality of laparoscopic radical prostatectomy we compared our perioperative parameters, as well as the postoperative functional and oncological outcomes of four generations of surgeons with significantly different training modalities. The first two generations were trained in open retropubic radical prostatectomy, but the third and fourth generation were trained mostly laparoscopically. Overall the data of more than 1000 performed cases were compared: We could not find any significant difference concerning our complication rates. Also the data of oncological (positive margins) and functional results (data of continence with a follow‐up of more than two years) were comparable within all groups. A learning curve was observed only for the operating time, but proved to be significantly shorter for the third and fourth generations. Therefore we can conclude that the quality of laparoscopic radical prostatectomy does not depend on the individual experience in open surgery but to a considerable extent on the quality of laparoscopic education (e.g. simulation trainer, supervision).     

Laparoscopic colectomy after self‐expanding metallic stent placement through the ileocecal valve for right‐sided malignant colonic obstruction: A case report

A 78‐year‐old man with a history of open sigmoidectomy for sigmoid cancer presented with abdominal pain and vomiting. Abdominal multi‐detector CT revealed an obstructive ileocecal tumor with distended small bowel on the oral side. We performed emergency drainage using a transnasal decompression tube, and 2 days later, we conducted a colonoscopic examination, which lead to a provisional diagnosis of obstruction with a malignant tumor invading the ileocecal valve. We then placed a self‐expanding metallic stent (SEMS) through the ileocecal valve. We confirmed patency of the ileocecal valve and removed the transnasal decompression tube 2 days after SEMS placement. We then performed elective laparoscopic colectomy 8 days after SEMS placement. To the best of our knowledge, there has been only one previous report of laparoscopic colectomy after decompression with SEMS placement through the ileocecal valve for right‐sided malignant colonic obstruction.     

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。     

Laparoscopic radical prostatectomy: A European virus

The evolution of prostate cancer treatment has now incorporated the principles of minimally invasive surgery. Laparoscopic radical prostatectomy, just like a virus, infected first Europe and three years ago the United States. This European virus has nowadays a potentially widespread application. Oncological efficacy and ability to preserve and improve continence and potency are the factors that will ultimately determine the role of laparoscopic radical prostatectomy and thus the future of this virus infection. This article reviews the current published experience with minimally invasive prostatectomy and provides comparisons to published data on radical retropubic prostatectomy to increase awareness about viability. Some prospective and retrospective non‐randomized comparative studies of the two approaches are also included in the present review. The current practice patterns regarding urological laparoscopic surgery and the tendency of the urologic community in Europe and in the United States to establish minimally invasive radical prostatectomy in more urological departments are described.     

Robotic assisted laparoscopic radical prostatectomy: a review of the current state of affairs

Open retropubic radical prostatectomy is the gold standard treatment for localised prostate cancer. However, the procedure has inherent morbidity associated to it. Therefore, less invasive surgical techniques have been sought, one such alternative is robotic-assisted laparoscopic radical prostatectomy. The advantages provided by robotic technology have the potential to minimise patient morbidity while improving both functional and oncological outcomes. Although it is a recent technological advancement, robotic surgery has shown an increasing rate of adoption worldwide. Currently more than 30,000 patients have undergone this procedure worldwide. We present a review of the available literature on robotic-assisted laparoscopic radical prostatectomy.     

Laparoscopic right hemicolectomy for metachronous ascending colon cancer with preservation of an ileal conduit constructed after previous radical cystectomy for bladder cancer

A 79‐year‐old woman who had undergone laparoscopic radical cystectomy and ileal conduit construction for bladder cancer 4 years earlier presented to our hospital with anemia. We diagnosed advanced ascending colon cancer (cT4bN2M1) and documented tumor regression after six courses of folinic acid, 5‐fluorouracil, and oxaliplatin therapy. We then performed laparoscopic right hemicolectomy. Intraoperatively, we found that the right colic artery was the feeding artery of the tumor, whereas the ileocolic artery, which was the main feeder of the conduit, was not. We performed lymph node dissection along the surgical trunk with central vascular ligation of the right colic artery and the right branch of the middle colic artery while preserving the ileal conduit and its blood supply (ileocolic artery and ileal branches). The postoperative course was uneventful, and the patient remains well and cancer‐free 2 years after colonic surgery. We believe that this is the first report of laparoscopic right colectomy in a patient with an ileal conduit.     

腹腔镜前列腺癌根治术与开放术式的疗效比较Meta分析

目的利用Meta分析的方法,评价腹腔镜前列腺癌根治术(LRP)与开放前列腺癌根治术(ORP)两种手术方式治疗局限性前列腺癌的疗效。方法选取发表于1990～2011年的文献,对比LRP与ORP两种术式治疗局限性前列腺癌的随机对照试验和临床对照试验,并应用Meta分析评价手术时间、术中出血量、输血情况、切缘阳性率、术后尿道狭窄发生率、术后控尿、术后勃起功能等相关指标。结果本篇Meta分析,共分析了14篇临床同期对照试验。共纳入了9006例患者,其中行LRP3261例患者,行ORP5745例患者。对于切缘阳性的发生率,腹腔镜与ORP之间无统计学差异(OR0.88,95%CI0.77～1.01,P=0.06);LRP手术时间长于开放手术(WMD60.25min,95%CI30.83～89.68min,P<0.0001),差异具有统计学意义。LRP术中出血量小于ORP(WMD-686.61ml,95%CI-1101.49～-271.72ml,P=0.001),差异具有统计学意义。LRP患者输血率低于ORP(OR0.17,95%CI0.10～0.29,P<0.0001),差异具有统计学意义。LRP术后尿道狭窄的发生率低于ORP(OR0.32,95%CI0.14～0.71,P=0.005),差异具有统计学意义。LRP的术后一年控尿率与ORP无统计学差异(OR1.29,95%CI0.88～1.89,P=0.20)。术中保留双侧性神经的患者的术后一年勃起功能,LRP优于ORP(OR2.23,95%CI1.48～3.36,P=0.0001)。结论对于局限性前列腺癌,腹腔镜与ORP的切缘阳性发生率和术后一年控尿功能相似。LRP的手术时间长于ORP,但术中出血量少于ORP,患者输血率小于ORP,且术后尿道狭窄发生率和术后一年阳痿发生率小于ORP。     

Laparoscopic radical robotic prostatectomy: a case study

The management of prostate cancer includes observation, hormonal therapy, radical prostate surgery (open, laparoscopic, or laparoscopic robotic), external beam radiation, brachytherapy, or cryotherapy. Laparoscopic radical robotic prostatectomy is the newest technology in minimally invasive surgery. This is a case study of a patient who chose to undergo laparoscopic robotic prostatectomy for his prostate cancer.     

单孔腹腔镜和常规腹腔镜手术对前列腺癌根治患者术后康复的影响

目的探讨单孔腹腔镜与常规腹腔镜手术对前列腺癌根治患者术后康复的影响。方法对36例局限性前列腺癌患者行前列腺癌根治术,其中20例行常规腹腔镜前列腺癌根治术,16例行单孔腹腔镜前列腺癌根治术。观察两组患者的术后康复进程,比较其术后恢复情况、疼痛评分及并发症发生情况。结果两组术后引流管和尿管的拔除时间、术后住院时间、并发症发生率的差异均无统计学意义（P〉0.05）;单孔腹腔镜组的肛门排气时间、下床活动时间较常规腹腔镜组早,且疼痛评分低,差异有统计学意义（P〈0.05）。结论单孔腹腔镜前列腺癌根治患者术后疼痛轻,早活动,胃肠道功能恢复快,有利于患者术后康复。