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1.
Background Laparoendoscopic single-site (LESS) surgery for cholecystectomy and appendectomy are described in the literature. The benefits
of these procedures compared with traditional laparoscopic approaches have yet to be determined. To date, no series of LESS
surgeries for placement of an adjustable gastric band has been published or documented. This study aimed to determine the
safety and feasibility of LESS surgery for placement of an adjustable gastric band.
Methods From December 2007 to June 2008, LESS surgery to place an adjustable gastric band via a transumbilical incision was performed
for 10 patients with institutional review board approval. Essentially, multiple ports were placed through a single incision
in the umbilicus to allow for liver retraction, visualization, and working instruments. All critical steps using a standard
pars flaccida technique were performed without alteration.
Results For this study, 10 patients (9 women and 1 man) were carefully selected. These patients ranged in age from 32 to 61 years
(mean, 47 years) and had a mean body mass index (BMI) of 42 kg/m2 (range, 35–45 kg/m2). The patients were selected for absence of both hepatomegaly and central obesity. Superobese patients were not considered
for inclusion in the study. The mean operative time was 1 h and 10 min (range, 53 min to 1 h and 48 min). All the patients
were discharged home within 23 h of admission, and no perioperative complications were noted. In addition, no wound-related
complications occurred. Notably, only 2 of the 10 patients required the use of narcotic analgesia after discharge from the
recovery room. There were no intra- or postoperative complications.
Conclusions In our experience, LESS surgery for adjustable gastric banding shows this technique to be both feasible and safe for selected
patients. Although technical limitations exist that will be improved upon, further studies are needed to compare LESS surgery
for placement of an adjustable gastric band with traditional laparoscopic techniques. 相似文献
2.
Amy C. Lehman Jason Dumpert Nathan A. Wood Lee Redden Abigail Q. Visty Shane Farritor Brandon Varnell Dmitry Oleynikov 《Surgical endoscopy》2009,23(2):260-266
Background Natural orifice translumenal endoscopic surgery (NOTES) is surgically challenging. Current endoscopic tools provide an insufficient
platform for visualization and manipulation of the surgical target. This study demonstrates the feasibility of using a miniature
in vivo robot to enhance visualization and provide off-axis dexterous manipulation capabilities for NOTES.
Methods The authors developed a dexterous, miniature robot with six degrees of freedom capable of applying significant force throughout
its workspace. The robot, introduced through the esophagus, completely enters the peritoneal cavity through a transgastric
insertion. The robot design consists of a central “body” and two “arms” fitted respectively with cautery and forceps end-effectors.
The arms of the robot unfold, allowing the robot to flex freely for entry through the esophagus. Once in the peritoneal cavity,
the arms refold, and the robot is attached to the abdominal wall using the interaction of magnets housed in the robot body
with magnets in an external magnetic handle. Video feedback from the on-board cameras is provided to the surgeon throughout
a procedure.
Results The efficacy of this robot was demonstrated in three nonsurvivable procedures in a porcine model, namely, abdominal exploration,
bowel manipulation, and cholecystectomy. After insertion, the robot was attached to the interior abdominal wall. The robot
was repositioned throughout the procedure to provide optimal orientations for visualization and tissue manipulation. The surgeon
remotely controlled the actuation of the robot using an external console to assist in the procedures.
Conclusion This study has shown that a dexterous miniature in vivo robot can apply significant forces in arbitrary directions and improve
visualization to overcome many of the limitations of current endoscopic tools for performing NOTES procedures.
Presented at the 2008 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Meeting, Philadelphia, Pennsylvania,
April 9–12, 2008. 相似文献
3.
Bensaid C Le Frère Belda MA Metzger U Larousserie F Clément D Chatellier G Lécuru F 《Surgical endoscopy》2006,20(9):1410-1414
Background Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to
evaluate the performance of laparoscopy in identifying malignant ovarian cysts.
Methods Patients undergoing laparoscopy for ovarian cysts from 1998 to 2001 were enrolled prospectively. Physical findings, Doppler
ultrasonography, and serum CA 125 served to compute two risk-of-malignancy indexes (RMI-1 and RMI-2), and laparoscopy findings
served to categorize lesions as benign, possibly malignant, or malignant. Frozen sections were examined as needed. Final histology
was the reference.
Results Of 313 patients, 294 had benign cysts, six borderline lesions, and 13 malignancies. Sensitivity and specificity were respectively
84 and 93% for RMI-1, 92 and 80% for RMI-2, 100 and 99% for laparoscopy, 91 and 100% for frozen sections, and 100 and 100%
for laparoscopy plus frozen sections, which had 100% negative predictive value. Six (1.8%) adverse events occurred.
Conclusions Laparoscopy reliably identifies ovarian cancer and borderline disease. Morbidity is low compared to oncologic surgery. 相似文献
4.
Natural orifice translumenal endoscopic surgery (NOTES): dissection for the critical view of safety during transcolonic cholecystectomy 总被引:1,自引:0,他引:1
Edward D. Auyang Eric S. Hungness Khashayar Vaziri John A. Martin Nathaniel J. Soper 《Surgical endoscopy》2009,23(5):1117-1118
Background Natural orifice translumenal endoscopic surgery (NOTES), an emerging field in minimally invasive surgery, is driving the development
of new technology and techniques. The NOTES approach has several proposed benefits including potentially decreased abdominal
pain, wound infections, and hernia formation [1–4]. Cholecystectomy is one of the most commonly performed NOTES procedures to date [5–7]. To perform a safe cholecystectomy and reduce potential bile duct injuries, the cystic duct and artery must first be identified.
Establishing this critical view of safety before ligation and division has been shown to reduce bile duct injuries associated
with laparoscopic cholecystectomy [8]. This video shows that the critical view of safety can be attained with endoscopic dissection.
Methods In the porcine model, transcolonic peritoneal access is gained using an endoscopic needleknife and balloon dilator. Once orientation
is established, the gallbladder is retracted using percutaneous T-tags. The cystic duct and artery bundle are identified and
then meticulously dissected using endoscopic graspers, hook cautery, biopsy forceps, and scissors. The individual cystic duct
and artery are isolated and identified, establishing the critical view of safety. Endoscopic clip ligation and division are
then performed, and the gallbladder is dissected free.
Conclusions Dissection of the critical view of safety can be performed in a completely endoscopic fashion using appropriate instrumentation.
By achieving this critical view, the incidence of biliary injury during NOTES should be minimal and similar to the incidence
of biliary injury during laparoscopic surgery. While completing this procedure, we identified several remaining technical
limitations and deficiencies. Endoscopic retraction of tissue still is challenging with currently available instrumentation.
Hemostatic endoscopic clips are not currently available for cystic artery and duct ligation. With the development of such
instruments, cholecystectomy and other NOTES procedures will become technically more feasible.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
5.
Natural orifice translumenal endoscopic surgery (NOTES) in urology: initial experience 总被引:1,自引:0,他引:1
BACKGROUND AND PURPOSE: For years, urologists have been champions of surgery performed through natural body openings. The next frontier is intraperitoneal or retroperitoneal surgery performed via natural body openings. We reviewed the initial experience with natural orifice translumenal endoscopic surgery (NOTES) in urology. METHODS: The first experimental application of NOTES was published in 2002 when transvaginal nephrectomy was performed in the porcine model. Confirmatory experimental studies using the gastrointestinal tract for NOTES were first published in 2004. The bladder was first experimentally evaluated as a portal for NOTES in 2006. Urologists have developed and evaluated novel magnetic anchoring systems and operative platforms for NOTES. To date, clinical application of NOTES in urology is limited to transvesical peritoneoscopy. RESULTS: Analysis of the literature suggests that technologic, anatomic, physiologic, ethical, and philosophical questions must be answered before NOTES will be widely introduced or justified clinically. The premise that NOTES will be associated with a better recovery and fewer postoperative risks also remains to be evaluated. CONCLUSIONS: Largely in experimental models, urologists have show feasibility of NOTES. Ongoing evaluation and the introduction of new technologies are required for the field to advance. In addition, NOTES should be carefully embraced only after detailed evaluations prove a measured benefit in comparison to established minimally invasive techniques. 相似文献
6.
Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia 总被引:1,自引:0,他引:1
Background The standard Heller myotomy (SM) for achalasia extends 1 to 2 cm on to the stomach. The authors perform an extended myotomy
(EM) (>3 cm) with the goal of reducing postoperative dysphagia. This study examines the long-term efficacy and durability
of EM compared with SM.
Methods Patients with achalasia who underwent a laparoscopic Heller myotomy were identified from a prospective database that includes
symptom evaluation and results of esophageal functional studies. From September 1994 to August 1998, the authors performed
SM with Dor fundoplication, and from September 1998 through 2003, they performed EM with Toupet fundoplication. In 2001, they
performed a telephone survey of all available patients. This was repeated in 2005 for the EM group. The survey included scales
of symptom frequency (0 [never], 1 [once per month], 2 [once per week], 3 [once per day], 4 [more than once per day]) and
severity (0 [no symptoms] to 10 [symptoms equal to preoperative state]) as well as the need to undergo postoperative intervention
for dysphagia.
Results For this study, 52 patients underwent SM with Dor fundoplication (median follow-up period, 46 ± 24 months), and 63 patients
underwent EM with Toupet fundoplication (median follow-up period, 45 ± 17 months. Postoperative dysphagia severity was significantly
better in the EM group (4.8 ± 2.3 vs 3.1 ± 2.6; p < 0.005). There was no significant difference in postoperative heartburn frequency, esophageal acid exposure, or lower esophageal
sphincter pressure. In the SM group, 9 patients (17%) required reintervention for dysphagia: 14 endoscopic interventions for
5 patients (10%) and reoperation for 4 patients. Three patients (5%) in the EM group required reintervention for dysphagia:
one endoscopic intervention each and no reoperations (p < 0.05). A total of 30 patients in the EM group were contacted in both 2001 (median follow-up period, 19 ± 11 months) and
2005 (median follow-up period, 63 ± 10 months). There was no significant change over time in dysphagia severity (2.6 ± 1.9
vs 3.7 ± 2.0; p = 0.19).
Conclusions For the treatment of achalasia, EM with Toupet fundoplication provides excellent durable dysphagia relief that is superior
to SM with Dor fundoplication. 相似文献
7.
Transumbilical endoscopic surgery: a preliminary clinical report 总被引:6,自引:1,他引:5
Objective There has been great interest in natural orifice transluminal endoscopic surgery (NOTES) in recent years. We report another
new approach—transumbilical endoscopic surgery (TUES)—which we have performed in 40 cases for liver cysts (3), bleeding ascites
(1), chronic appendicitis (10), and gallbladder diseases (26).
Methods Transumbilical endoscopic liver cyst fenestration, abdominal cavity exploration, appendectomy, and cholecystectomy were performed
in a total of 40 patients.
Results All the operations were completed successfully except one case of intraoperative bleeding in TUES cholecystectomy which was
converted to routine laparoscopic surgery. The operating times for TUES cholecystectomy, appendectomy, and liver cyst fenestration
were 30–150 min,15–40 min, and 30–90 min, respectively. No postoperative bleeding or bile leakage occurred in this group of
patients.
Conclusions Transumbilical endoscopic surgery is feasible, and would be another option for scarless abdominal surgery. TUES cholecystectomy
is technically challenging. Careful selection of patients is important in the initial period of this technique. 相似文献
8.
目的:探讨经前胸壁入路行腔镜甲状腺手术的临床价值及手术方法。方法:回顾分析2010年1月至2012年7月为16例甲状腺腺瘤患者经前胸壁入路行腔镜甲状腺手术的临床资料。结果:16例患者均经前胸壁入路成功施行腔镜下腺叶大部或次全切除术。术中快速病理及术后常规病理提示甲状腺腺瘤,其中并囊性变3例。手术时间42~164 min,平均96 min;术中出血量5~20 ml,平均8.6 ml;术后颈部引流2~3 d;引流量16~128 ml,平均22.5 ml;术后住院4~8 d,平均5 d;术后发生皮下气肿1例,3 d后消失;无皮下淤血及积液;颈前区不适感1例,3个月后消失。无术后声音嘶哑及术后饮水呛咳,患者均对美容效果满意。结论:经前胸壁入路腔镜甲状腺手术是较成熟的术式,美容效果较好。熟练规范地应用超声刀,解剖层次清晰是避免副损伤的关键;术前标记路径,尽可能缩小前胸壁皮下游离范围是减少术后并发症的有效方法。 相似文献
9.
Mohamed El-Shazly Huang Wei Chao Ming-Huei Cheng Hung-Chi Chen 《European journal of plastic surgery》2005,28(4):272-275
Although the operating microscope was a must to perform microsurgery, we have tried to find new type equipmenlt which may be less invasive, cheaper in price, smaller in size, more portable, sterilizable, already present in many of the surgical departments, and also valid for performing microsurgery. It was the surgical endoscope by which we started to investigate the possibility to experience the skill of microsurgery. Of great importance is that the acceptance of this new technique will financially allow microsurgery to be performed in hospitals unable to afford the expensive microscopes but already having the investment in less costly and more readily available endoscopic equipment. In this project, we have tried to perform vascular microsurgical anastomoses in many of the free-flap cases. The microsurgical anastomoses were possible, easy, within a reasonable time, with good visualization. In the same terms, it is a new indication of the use of endoscopy and its interesting mode of operating, and also a new method for the microsurgical performance providing the needed clear vision without the problems of looking through the ocular pieces of a loupe or a microscope. 相似文献
10.
Lee L. Swanstrom Eric Volckmann Eric Hungness Nathaniel J. Soper 《Surgical endoscopy》2009,23(7):1519-1525
Background Natural orifice translumenal endoscopic surgery (NOTES) has theoretical patient advantages. Because public attitude toward
NOTES will influence its adoption, this study aimed to assess patients’ opinions regarding the NOTES procedure.
Methods For this study, 192 patients were surveyed. Both NOTES and laparoscopic surgery (LS) are described together with an example
case. Presurgical patients rated the importance of various aspects of surgical procedures and their preference for cholecystectomy
via NOTES or LS.
Results Complication risks, recovery time, and postoperative pain were considered more important than cosmesis, cost, length of hospital
stay, or anesthesia type (p < 0.001). In the self-reports, 56% of the respondents preferred NOTES for their cholecystectomy and 44% chose LS. The patients
perceived NOTES as having less pain, cost, risk of complications, and recovery time but requiring more surgical skill than
open surgery or LS (p < 0.04). College-educated patients were more likely to choose NOTES, whereas patients 70 years of age or older and those
who had undergone previous flexible endoscopy were less likely to select NOTES (p < 0.04). Although 80% of the patients choosing NOTES still preferred it even if it carried a slightly greater risk than LS,
their willingness to choose NOTES decreased as complications, cost, and hospital distance increased and as surgeon experience
decreased (p < 0.001). This study had a limitation in that the survey population was from surgery clinics.
Conclusion A majority of the patients surveyed (56%) would choose NOTES for their cholecystectomy. The deciding characteristics of the
patients were more education, youth, and no previous flexible endoscopy. Procedure-related risks, pain, and recovery time
were more important than cosmesis, cost, length of hospital stay, and anesthesia type in the choice of a surgical approach.
Patients were less willing to accept NOTES as risks and costs increased and as surgeon experience and availability decreased. 相似文献
11.
Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass 总被引:3,自引:0,他引:3
Background Over the past 20 years, there has been an ongoing discussion about the importance of gastric pouch size as a key factor influencing
weight loss after bariatric surgery. This analysis aimed to determine the relationship between initial gastric pouch size
and excess weight loss (EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB).
Methods Between August 2002 and March 2005, 320 LRYGB were performed at Yale New Haven Hospital. The patients’ demographics were entered
into a longitudinal, prospective database. Upper gastrointestinal series were routinely performed on postoperative day 1.
Pouch size was measured as area (cm2) on an anteroposterior radiograph at maximum pouch distention. Linear regression analysis was performed to determine the
association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustments were made for age, gender,
and preoperative body mass index (BMI).
Results The mean age of the patients was 41.2 years. Of the 320 study patients, 261 were women (81.6%) and 59 were men (18.4%). The
mean preoperative BMI was 51.1 kg/m2; the mean 6-month EWL was 50.5%; the mean 12-month EWL was 62.5%; and the mean pouch size was 63.9 cm2. A statistically significant, negative correlation between pouch size and EWL was found at 6 months (β = –0.241; p < 0.01) and at 12 months (β = –0.302; p < 0.02). The findings show that male gender (β = 0.147; p < 0.04) and preoperative BMI (β = 0.190; p < 0.01) are positively correlated with pouch size.
Conclusion The analysis demonstrates that initial gastric pouch size is not the only significant component for successful weight loss
after LRYGB. Male gender and increased preoperative BMI were identified as factors predicting pouch size. Efforts to standardize
small pouch size for all patients seems important to the success of surgical therapy for morbid obesity. 相似文献
12.
经自然腔道内镜手术是一种新型的微创手术,其发展尚面临诸多技术问题。笔者就该手术的操作平台、手术入路和切口闭合等关键问题的研究进展进行综述。 相似文献
13.
Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience 总被引:2,自引:1,他引:1
Jeffrey Cadeddu Raul Fernandez Mihir Desai Richard Bergs Chad Tracy Shou-Jiang Tang Prashanth Rao Mahesh Desai Daniel Scott 《Surgical endoscopy》2009,23(8):1894-1899
Background Magnetic anchoring guidance systems (MAGS) are composed of an internal surgical instrument controlled by an external handheld
magnet and do not require a dedicated surgical port. Therefore, this system may help to reduce internal and external collision
of instruments associated with laparoendoscopic single-site (LESS) surgery. Herein, we describe the initial clinical experience
with a magnetically anchored camera system used during laparoscopic nephrectomy and appendectomy in two human patients.
Methods Two separate cases were performed using a single-incision working port with the addition of a magnetically anchored camera
that was controlled externally with a magnet.
Results Surgery was successful in both cases. Nephrectomy was completed in 120 min with 150 ml estimated blood loss (EBL) and the
patient was discharged home on postoperative day 2. Appendectomy was successfully completed in 55 min with EBL of 10 ml and
the patient was discharged home the following morning.
Conclusions Use of a MAGS camera results in fewer instrument collisions, improves surgical working space, and provides an image comparable
to that in standard laparoscopy. 相似文献
14.
15.
Ringley C Lee YK Iqbal A Bocharev V Sasson A McBride CL Thompson JS Vitamvas ML Oleynikov D 《Surgical endoscopy》2007,21(12):2137-2141
Background Laparoscopically assisted colon resection has evolved to be a viable option for the treatment of colorectal cancer. This study
evaluates the efficacy of hand-assisted laparascopic surgery (HALS) as compared with totally laparoscopic surgery (LAP) for
segmental oncologic colon resection with regard to lymph node harvest, operative times, intraoperative blood loss, pedicle
length, incision length, and length of hospital stay in an attempt to help delineate the role of each in the treatment of
colorectal cancer.
Methods Patient charts were retrospectively reviewed to acquire data for this evaluation. Between June 2001 and July 2005, 40 patients
underwent elective oncologic segmental colon resection (22 HALS and 18 LAP). The main outcome measures included lymph node
harvest, operative times, intraoperative blood loss, pedicle length, incision length, and length of hospital stay.
Results The two groups were comparable in terms of demographics. The tumor margins were clear in all the patients. The HALS resection
resulted in a significantly higher lymph node yield than the LAP resection (HALS: 16 nodes; range, 5–35 nodes vs LAP: 8 nodes;
range, 5–22 nodes; p < 0.05) and significantly shorter operative times (HALS: 120 min; range, 78–181 min vs LAP: 156 min; range, 74–300 min; p < 0.05). Both groups were comparable with regard to length of hospital stay, pedicle length, and intraoperative blood loss.
However, the LAP group yielded a significantly smaller incision for specimen extraction (LAP: 7 cm; range, 6–8 cm vs HALS:
5.5 cm; range, 5–7 cm; p < 0.05).
Conclusion The findings suggest that hand-assisted laparoscopic oncologic segmental colonic resection is associated with shorter operative
times, more lymph nodes harvested, and equivalent hospital stays, pedicle lengths, and intraoperative blood losses as compared
with the totally laparoscopic approach. The totally laparoscopic technique was completed with a smaller incision. However,
this less than 1 cm reduction in incision length has doubtful clinical significance. 相似文献
16.
Halil Alis Osman Z. Oner Mustafa U. Kalayci Kemal Dolay Selin Kapan Aliye Soylu Ersan Aygun 《Surgical endoscopy》2009,23(7):1465-1469
Background Dieulafoy lesion is a rare but serious cause of gastrointestinal system bleeding. An aberrant submucosal artery, which was
described in 1884, causes the bleeding. The lesion can be located anywhere in the gastrointestinal tract but is most commonly
found in the proximal stomach up to 6 cm from the gastroesophageal junction. Increased experience in endoscopy has led to
an increased frequency of its proper diagnosis. Various methods are used to achieve successful hemostasis by endoscopy in
Dieulafoy lesion; however, comparative studies about the success rates of these methods are still needed. In this study, we
compared two of these endoscopic hemostatic methods: band ligation, and injection therapy in Dieulafoy lesions.
Methods In this prospective study, 18 patients admitted to the Emergency Surgical Unit between January 2002 and December 2005 with
upper gastrointestinal bleeding diagnosed as Dieulafoy lesion were included. Diagnose of Dieulafoy lesion was made at initial
or second-look endoscopy. Patients were randomized in two groups according to therapy method: injection therapy and band ligation
groups. Therapy was applied immediately after recognizing the lesion at the same endoscopic procedure. Two groups were compared
regarding demographical data, presence of comorbid diseases, history of medication and previous gastrointestinal system bleeding,
hemodynamic status, laboratory values, need for transfusion, endoscopic findings, success rate of the treatment method, mean
hospital stay, complications, and recurrence of bleeding.
Results Of 588 patients admitted with upper gastrointestinal hemorrhage, Dieulafoy lesion was recognized in 18 cases (3.1%) at initial
or second-look endoscopy. All patients were men with a mean age of 62.8 (range, 30–80) years. Band ligation was applied to
ten patients and the remaining eight were treated by injection therapy. During the follow-up period, rebleeding occurred in
six of the patients (75%) with injection therapy, whereas no rebleeding occurred for the patients in the band ligation group.
The rebleeding rate and mean hospital stay was significantly higher for the injection therapy group.
Conclusions Our study suggests that of the endoscopic treatment methods, band ligation is superior to injection therapy for the treatment
Dieulafoy lesions.
Presented at the 15th EAES Congress, July 4–7, 2008 Athens, Greece. 相似文献
17.
Fanelli G Ghisi D Berti M Troglio R Ortu A Consigli C Casati A 《Surgical endoscopy》2008,22(10):2220-2228
Background The complexity of pain from laparoscopic cholecystectomy and the need for treating incident pain provide rationale for multipharmacological
analgesia. We investigated the preoperative administration of controlled-release (CR) oxycodone as transition opioid from
remifentanil infusion for pain after laparoscopic cholecystectomy.
Methods Fifty consecutive patients undergoing laparoscopic cholecystectomy were randomly, double-blindly assigned to treatment group
(n = 25, CR oxycodone: 1 h before surgery and 12 h after the first administration) or to the control group (n = 25, placebo: administered at the same intervals). General anaesthesia was maintained with propofol and remifentanil target-controlled
infusions (TCIs). All patients received ketorolac 30 mg i.v. Tramadol i.v. was administered for patient-controlled analgesia
(PCA) postoperatively. Numerical rating scale for pain at rest and at movement (NRSr and NRSi), tramadol consumption, times
to readiness to surgery and awakening, times to modified Aldrete’s and modified Post-Anesthetic Discharge Scoring System (PADSS)
>9 and side effects were evaluated.
Results All NRSr and NRSi and tramadol consumption were significantly lower in the treatment group. The oxycodone group showed higher
modified Aldrete’s scores at each time and reached a PADSS >9 faster. Side effects and postoperative nausea and vomiting episodes
were comparable.
Conclusions We demonstrated the success of a multipharmacological treatment including opioid premedication with CR oxycodone used as transition
opioid for TCI remifentanil infusion; the treatment group showed lower pain scores and rescue analgesic consumption, shorter
time to discharge from recovery room and from surgical ward, and the same incidence of side effects, comparably to controls.
Sources of financial support for the work: University of Parma, viale Gramsci 14, 43100 Parma PR, Italy. 相似文献
18.
隐瘢痕腹腔镜胆囊切除术:一种美容效果与经自然腔道内镜手术等效的手术径路 总被引:2,自引:3,他引:2
目的:介绍一种腹部无明显手术瘢痕的腹腔镜胆囊切除术式。方法:女性胆囊良性病变25例。在脐部穿刺10mm Trocar,作为主操作孔和取出胆囊的通道。在阴毛上缘两端各穿刺5mm Trocar,一个进出5mm腹腔镜,另一个进出抓钳。术者用5mm超声刀离断胆囊管和胆囊血管,然后用电凝钩分离胆囊床,用可吸收圈套线结扎胆囊管。切下的胆囊从脐部戳孔取出。最后用可吸收线关闭脐孔,阴毛处戳孔用胶布拉拢覆盖。结果:手术全部成功,手术时间17~35min,平均25min。均未放置引流管,术后无出血、胆漏等并发症发生。术后住院1~3d。随访1~3个月,戳孔均愈合良好,脐部和阴毛处看不出手术瘢痕。患者对手术结果满意。结论:将戳孔设在脐孔和阴毛上缘行腹腔镜胆囊切除术,能达到隐藏手术瘢痕的目的。 相似文献
19.
Dean Mikami Bradley Needleman Vimal Narula Janice Durant W. Scott Melvin 《Surgical endoscopy》2010,24(1):223-228
Introduction
Weight gain after gastric bypass can occur in up to 10% of patients 5 years following and in about 20% of patients 10 years following surgery. The nadir weight is usually reached within the first 2 years after bypass surgery. However, weight may slowly be regained for numerous reasons. This phenomenon has been studied extensively, but there is often no one reason this occurs. Once psychological and dietary reasons have been investigated, revisional surgery may be the only alternative for treatment. Revisional gastric bypass surgery is associated with a much higher morbidity and mortality when compared with a primary gastric bypass procedure.Patients and methods
Thirty-nine patients underwent endoluminal gastric pouch reduction with the StomaphyXTM device after informed consent. The StomaphyXTM device is a sterile, single-use device for use in endoluminal transoral tissue approximation and ligation in the gastrointestinal (GI) tract.Results
Average age was 47.8 (29–64) years, and 36/39 (92.3%) patients were female. Average body mass index (BMI) and weight prior to the StomaphyXTM procedure were 39.8 (22.7–63.2) kg/m2 and 108.0 kg (65.90–172.2 kg). The average preprocedure excess body weight was 51.1 kg. Weight loss at 2 weeks (n = 39) was 3.8 kg (7.4% excess body weight loss, EBWL), at 1 month (n = 34) was 5.4 kg (10.6% EBWL), at 2 months (n = 26) was 6.7 kg (13.1% EBWL), at 3 months (n = 15) was 6.7 kg (13.1% EBWL), at 6 months (n = 14) was 8.7 kg (17.0% EBWL), and at 1 year (n = 6) was 10.0 kg (19.5% EBWL). No major complications were observed. The minor complications that were seen included a sore throat lasting less than 48 h in 34/39 patients (87.1%) and epigastric pain that lasted for a few days in 30/39 patients (76.9%). Three patients with chronic diarrhea had their symptoms resolved after the procedure. Eight patients with gastroesophageal reflux disease reported improvement in their symptoms post procedure.Conclusions
Endoluminal revision of gastric bypass patients with weight gain using the StomaphyXTM procedure may offer an alternative to open or laparoscopic revisional bariatric surgery. 相似文献20.
老年患者急症腹腔镜胆囊切除术55例体会 总被引:4,自引:0,他引:4
目的:总结55例老年患者行急症腹腔镜胆囊切除术(acute laparoscopic cholecystectomy,ALC)的体会。方法:回顾分析2002年1月至2007年12月55例老年患者行ALC的临床资料。结果:55例手术均获成功,手术时间40~130min;术中出血15~50ml;术后引流液为淡红色或淡黄色,30~150ml,3~5d拔除引流管;无术后出血及胆漏。仅1例剑突下戳口轻度感染,经抗感染及换药治疗5d痊愈。余者均痊愈出院,住院5~7d。结论:选择合适的手术时机,医师具备熟练的腹腔镜操作技术,老年患者行ALC是安全可行的,具有创伤小、康复快、痛苦轻的优点。 相似文献