Feasibility of single-incision laparoscopy for ruptured ectopic pregnancies with hemoperitoneum

Background: The aim of this study was to compare single-incision laparoscopic surgery (SILS) and conventional laparoscopy in ectopic pregnancies accompanied by severe hemoperitoneum.

Material and methods: The main outcome measures were duration of surgery, intraoperative bleeding quantity, complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay.

Results: A total of 53 women, 28 in the conventional laparoscopy group and 25 in the SILS group, participated in the study. There were no differences in demographic characteristics between the two groups. There were no differences in terms of variables including gestational week, beta human chorionic gonadotropin (βhCG) levels, and operation time. No intraoperative complications were observed in either group. The groups exhibited no significant differences regarding additional analgesic requirements or postoperative pain scores. However, pain at the sixth postoperative hour was lower in the SILS group. This effect was not observed at 12 and 24?hours.

Conclusion: SILS appears to be effective and safe for the treatment of ruptured ectopic pregnancies accompanied by hemoperitoneum.     

Pain,well-being,body image and cosmesis: A comparison of single-port and four-port laparoscopic cholecystectomy

Abstract

Background: This study aims to compare post-operative pain, well-being, body image and cosmesis in SILS cholecystectomy and four-port laparoscopic cholecystectomy (FPLC). Material and methods: Forty-two consecutive patients (15 SILS, 27 FPLC) undergoing elective cholecystectomy were included in the study. Peri-operative pain, well-being, body image and cosmesis were evaluated using validated assessment tools. Results: Significantly lower pain scores were reported one week post-operatively in the SILS group (5.6 vs 8.3; p = 0.035). No significant difference was found in analgesic requirements, physical or mental well-being at any time interval. Significantly higher (favourable) body image questionnaire scores were reported in the SILS group at one week (5.4 v 4.5; p < 0.01), two weeks (5.6 vs 4.8; p < 0.01) and one month (5.7 vs 5.0; p < 0.01) post-operatively. Conclusion: SILS patients have significantly reduced one-week pain scores and there was no significant difference in well-being between the two groups. Patients who underwent SILS had improved body image and cosmesis. If both techniques are found to be equivalent concerning safety, cost, learning curve and availability, SILS may play a key role in the new era of patient choice.     

The effects of music on anxiety and pain in patients during carotid endarterectomy under regional anesthesia: A randomized controlled trial

ObjectiveMusic can be used as an alternative method to decrease anxiety in awake patients during surgical procedures. The aim of this study was to test the hypothesis that listening to music during carotid endarterectomy (CEA) under regional anesthesia decreases the patient’s anxiety and pain.DesignA multicenter, prospective, randomized controlled trial.SettingPatients undergoing carotid endarterectomy under cervical plexus block.InterventionsPatients scheduled for carotid endarterectomy under cervical plexus block were randomized into two groups: Music Group and Control Group.Main Outcome MeasuresThe primary endpoint of this study was the difference in intraoperative anxiety in patients with or without music during CEA under regional anesthesia, and the secondary endpoints were intraoperative and postoperative pain, use of additional local anesthetics, use of intravenous analgesics, patient and surgeon satisfaction and complications. Anxiety was assessed using State Trait Anxiety Inventory (STAI) and numeric rating scale (NRS). Visual analog scale (VAS) was used for pain assessment.ResultsThe postoperative STAI scores were similar in both groups (p = 0.839). The NRS scores measured immediately after the end of the surgery were statistically higher in Music Group (p = 0.001). The intraoperative anxiety statistically increased in Music Group, when the scores of the intraoperative responses to the questions of “are you relaxed?” and "are you calm?" were compared. (p = 0.0001 and p = 0.0001, respectively). There were no statistical differences in terms of the amount of intraoperative and postoperative analgesic used (p = 0.801, p = 0.773, respectively). The intraoperative VAS scores, postoperative VAS scores, patient and surgeon satisfaction scores were similar in both groups (p = 0.586, p = 0.185, p = 0.302 and p = 0.599, respectively). Systolic, diastolic and mean arterial blood pressure and heart rate were no different between Music Group and Control Group at any of all time points during the intraoperative period. Surgical side and contralateral side cerebral rSO2 values are similar in both groups (p = 0.438, p = 0.397, respectively).ConclusionsMusic use in CEA under regional anesthesia increased intraoperative patient anxiety, and had no effect on intraoperative and postoperative pain or patient satisfaction.     

Reduced port laparoscopic splenectomy using a newly developed multichannel port: A pilot study

Abstract

Background: The authors introduce the dual-incision laparoscopic splenectomy (DILS) technique using a specially designed multichannel trocar and report on the surgical outcomes and operative cost of DILS compared with conventional laparoscopic splenectomy (CLS). Material and methods: The medical records of 53 patients who underwent a laparoscopic splenectomy using CLS with four trocars and DILS at our institution were analyzed. Results: There was no statistical difference in operative time between the two groups and the intraoperative transfusion rate of red blood cell substitution was not different between the two groups. In terms of postoperative pain score, hospital stay, and overall complication rate, there were no differences between the two groups. Operative cost was significantly lower in the DILS group compared with the CLS group. Conclusions: DILS is a feasible and cost-effective modality of reduced port surgery in laparoscopic splenectomy.     

A randomized controlled trial for evaluation of lower abdominal laparoscopic cholecystectomy

Background: To improve minimally invasive outcomes, we designed a new procedure, lower abdominal laparoscopic cholecystectomy (LALC). This study was conducted to evaluate the effects of LALC versus classical (CLC) and single-incision (SILC) laparoscopic cholecystectomy on reducing systemic acute inflammatory response, improving cosmesis, and postoperative pain relief.

Material and methods: Beginning from July 2014, 105 patients meeting the inclusion criteria were randomly assigned to three groups: LALC, CLC, and SILC. The primary endpoint was the determination of systemic inflammatory response to the surgery. Other outcome measures included cosmesis, postoperative pain, and perioperative indices.

Results: Each of the three groups consisted of 35 patients. The duration of the operation was significantly longer in the SILC group (p= .005). The rates of adverse events were similar. Changes in interleukin-6 (p?= .001) and tumor-necrosis factor-α (p?= .016) measured before and after surgery differed significantly; patients who underwent LALC had the smallest change in inflammatory response. Cosmesis scores at one (p?= .002) and 12 (p?= .004) weeks after surgery favored LALC and SILC. Significant differences in pain scores at four (p?= .011) and 12?h (p?= .024) postoperatively were also observed.

Conclusions: In selected patients, LALC shows more advantages in terms of lower systemic inflammatory response, improved cosmesis, and a favorable postoperative pain profile when compared with CLC and SILC.     

Effects of ropivacaine on pain after laparoscopic cholecystectomy: A prospective,randomized study

Postoperative pain after laparoscopic cholecystectomy is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. In this prospective, singleblinded, randomized study, 45 patients with ASA (American Society of Anesthesiologists) scores I and II who were about to undergo laparoscopic cholecystectomy were divided into 3 groups. After cholecystectomy, a total of 40 mL of 3.75% ropivacaine was administered preincisionally and intraperitoneally to patients in group 1 (n=14); preincisionally and intraperitoneally to patients in group 2 (n=17); and intraperitoneally and locally at incision sites to patients in group 3 (n=14). Blood levels of epinephrine and norepinephrine were examined preoperatively, 15 min after insufflation, and at the end of the operation. Visual analog pain scale scores and analgesic requirements were used for 24-h postoperative follow-up of pain levels reported by patients. No statistically significant difference was found among the 3 groups with respect to visual analog pain scale scores, total analgesic requirements, and accompanying pain, nausea, and vomiting. The earliest analgesic requirements were seen in group 2 (P < .005), and less shoulder pain was noted in group 3 (P < .005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.     

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

PurposePlacement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia.DesignRandomized controlled trial.MethodsChildren aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery.FindingsA total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both).ConclusionsAWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.     

A novel locally operated master-slave robot system for single-incision laparoscopic surgery

Abstract

Purpose: Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. Material and methods: A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. Results: In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. Conclusion: We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.     

Effectiveness and safety of endoscopic resection for gastric GISTs: a systematic review

Aims: To evaluate the effectiveness and safety of endoscopic resection for gastric gastrointestinal stromal tumors (GISTs).

Material and methods: The effectiveness and safety of endoscopic resection were mainly assessed by complete resection rate, postoperative adverse event rate, and recurrence rate. Moreover, a comparison of endoscopic with laparoscopic resection for gastric GISTs was made through weighted mean difference by STATA 12.0 with regard to operation time, blood loss, and length of stay after including patients who underwent endoscopic or laparoscopic resection for gastric GISTs in the comparative studies.

Results: Eleven studies investigating endoscopic resection for GISTs were included. For stromal tumors <2?cm in average diameters the pooled rates of complete resection, postoperative adverse events and recurrence were 0.97, 0.08, and 0.03, respectively. Only five retrospective studies directly compared endoscopic with laparoscopic resection for gastric GISTs with average diameters from 1.1?cm to 3.8?cm, and endoscopic resection had a shorter operation time than laparoscopic resection, but there were no significant differences in intraoperative blood loss, length of stay, postoperative complications, and postoperative recurrence rates between the two approaches.

Conclusions: Endoscopic resection is predominantly tried for gastric GISTs of relatively small size. It seems effective and safe for gastric GISTs <2?cm in average diameter, with relatively short operation times.     

Laparoscopic resections of colorectal cancer and synchronous liver metastases: a case controlled study

Purpose: To investigate the efficacy and safety of laparoscopic simultaneous resections of colorectal cancer and synchronous colorectal liver metastases (SCRLM), relative to open surgery.

Methods: Between 1 January 2009 and 20 April 2014, 20 of 25 patients who underwent laparoscopic simultaneous colorectal cancer and SCRLM resections were matched with 20 of 29 patients who underwent an open approach, based on prognostic propensity scores. Perioperative results and survival outcomes were compared.

Results: The laparoscopic and open groups were comparable in demographics, cancer characteristics, surgery characteristics, and chemotherapy treatment. No postoperative mortality occurred in either group. The estimated blood loss and postoperative stay were significantly greater in the open group than in the laparoscopic group (all, p?Conclusions: The postoperative complications and survival rates of patients given laparoscopic simultaneous colorectal cancer and SCRLM resections were similar to those treated with an open approach, but with greater short-term benefits. Laparoscopy in this setting by an experienced surgical team appears safe and effective, and is a feasible alternative to an open approach for selected patients.     

解剖程序化六步法后腹腔镜肾上腺切除术的临床应用*

目的探讨解剖程序化六步法在后腹腔镜肾上腺切除术中的临床应用价值。方法选择2018年7月-2019年9月在该院治疗的50例肾上腺肿瘤患者作为研究对象,按照随机数字表法将患者分为A组(25例)和B组(25例),手术方式分别采用经腹腹腔镜肾上腺切除术和解剖程序化六步法后腹腔镜肾上腺切除术。比较两组患者手术时间、术中出血量、术后下床活动时间、术后肠道功能恢复时间、疼痛视觉模拟评分(VAS)、术后引流管拔除时间、术后住院时间、术中切除肾上腺时最高收缩压(SBP)和舒张压(DBP)、术中并发症(肠管损伤、胰腺损伤、高血压危象)和术后并发症(切口感染、肺部感染、肠梗阻、高血压危象、下肢深静脉血栓)发生率的差异。结果两组患者术中出血量、术后引流管拔除时间比较,差异均无统计学意义(P 0.05);B组患者手术时间、术后下床活动时间、术后肠道功能恢复时间、术后住院时间均短于A组(P 0.05),疼痛VAS评分低于A组(P 0.05),术中切除肾上腺时最高SBP和DBP波动的幅度均小于A组(P 0.05);两组患者术后并发症发生率比较,差异无统计学意义(P 0.05);B组术中并发症发生率低于A组(P 0.05)。结论解剖程序化六步法后腹腔镜肾上腺切除术治疗直径6.00 cm肾上腺肿瘤是安全有效的,术中利用解剖标志和无血管平面,依序手术操作,解剖结构清楚,先早期处理肾上腺中央静脉,后处理肾上腺,有利于保持术中血流动力学的稳定,降低后腹腔镜手术操作难度和围术期的手术风险,从而改善患者的临床疗效。     

妇科腹腔镜手术二氧化碳气体温度和湿度对术中和术后影响的Meta分析

目的将灌注的二氧化碳CO_2气体适度的加温和加湿,以评估其对妇科腹腔镜手术的影响。方法 Pubmed和万方等数据库中搜索跟妇科腹腔镜手术CO_2气腹温度湿度相关的关键字,分析术后疼痛、镇痛药物使用、患者核心温度、术中情况和住院时间等情况。结果搜索出114篇跟妇科腹腔镜手术CO_2气腹温度湿度相关的文献,经过筛选后共17篇纳入Meta分析中。分析结果显示,与标准室温干燥气体相比,加热和加湿CO_2气腹可减轻术后当天疼痛和防止术中低体温出现,在术后吗啡每日用量、术后身体核心温度、麻醉恢复时间、住院时间、内镜镜头起雾和手术时间等差异无统计学意义。结论加热加湿后的CO_2气腹只在术后当天疼痛和术中核心温度上获益。有关加热加湿CO_2气腹对妇科腹腔镜手术的实际影响需要更多的研究来证实。     

A Double-Blind Randomized Controlled Trial of Continuous Intravenous Ketorolac vs Placebo for Adjuvant Pain Control After Renal Surgery

ObjectiveTo evaluate the efficacy and safety of a novel, continuous intravenous infusion of ketorolac, a powerful nonopioid analgesic, for postoperative pain control.Patients and MethodsA prospective, double-blind, randomized, placebo-controlled trial of a continuous infusion of ketorolac tromethamine in 1 L of normal saline vs placebo was performed in 135 patients aged 18 to 75 years after laparoscopic donor nephrectomy or percutaneous nephrolithotomy completed from October 7, 2008, through July 21, 2010. Primary study end points were the 24-hour differences in visual analog pain scores and total narcotic consumption, whereas secondary end points were differences in urine output, serum creatinine level, and hemoglobin level.ResultsThe study was stopped after randomization of 135 patients (68 in the ketorolac group and 67 in the placebo group) when interim analysis indicated that the difference in mean pain scores between the 2 groups (difference, 0.6) was smaller than the 1-point threshold set forth in the power calculations. No statistically significant change was noted in hemoglobin levels from preoperative to postoperative values (P=.13) or in postoperative serum creatinine levels (P=.13).ConclusionAlthough continuous infusion of ketorolac produced only a modest decrease in the use of narcotics, it appears to offer a safe therapeutic option for nonnarcotic pain control.Trial Registrationclinicaltrials.gov Identifiers: NCT00765128 and NCT00765232     

垂体后叶素联合宫颈套扎法在腹腔镜子宫次全切除术中的应用价值

目的探讨垂体后叶素联合宫颈套扎法在腹腔镜子宫次全切除术(LSH)中的应用价值。方法选择中国医科大学附属盛京医院2014年1月-2019年1月行LSH的患者249例,根据手术方式不同分为3组。常规组73例(A组):离断宫旁组织并打开膀胱和直肠返折腹膜后,贴宫颈旁电凝闭合子宫动静脉;宫颈套扎组83例(B组):离断宫旁组织并打开膀胱和直肠返折腹膜后,用1号可吸收线自制Roeder's线圈套扎裸化宫颈的中段,阻断子宫动静脉;垂体后叶素+宫颈套扎组93例(C组):6 u垂体后叶素加20 mL生理盐水稀释后行宫体注射,待宫体血管收缩表面变白后再按B组的方法进行操作。比较分析3组患者手术时间、术中出血量、术后排气时间、术后腹腔引流量和术后血红蛋白下降水平等。结果 B组和C组手术时间、术中出血量、术后排气时间、术后腹腔引流量和术后血红蛋白下降水平均优于A组,C组术中出血量和术后血红蛋白下降水平均优于B组,两两比较,差异均有统计学意义(P 0.05);B组与C组在手术时间、术后排气时间和术后腹腔引流量等方面比较,差异均无统计学意义(P 0.05)。术后随访3个月,3组患者均恢复良好。结论垂体后叶素联合宫颈套扎法的LSH,能缩短手术时间、明显减少术中失血量和加快患者术后康复,使复杂手术简单化、高风险手术安全化,可有效降低副损伤发生率。     

加速康复外科在腹腔镜肾上腺切除围手术期中的临床应用经验

目的 探讨加速康复外科(ERAS)在腹腔镜肾上腺切除围手术期中的临床应用经验.方法 2016年1月-2020年12月该院腹腔镜肾上腺切除术患者46例围手术期接受ERAS管理和57例接受传统管理,比较两组患者术后胃肠排气恢复时间、术后2h疼痛评分、术后住院时间、尿路感染、尿潴留发生率、呼吸道感染发生率、深静脉血栓形成和切...     

Laparoendoscopic single-site compared with conventional laparoscopic surgery for gynaecological acute abdomen in pregnant women

ObjectiveTo estimate the safety and feasibility of laparoendoscopic single-site surgery (LESS) in pregnant patients with acute abdomen.MethodsBaseline characteristics, surgical results, and obstetric and neonatal outcomes were retrospectively compared between single and multiport procedures in patients who underwent laparoscopic surgery during pregnancy between 2017 and 2021.ResultsFifty-four pregnant patients were included: 26 who underwent LESS (salpingectomy, 11 cases/cystectomy, 15 cases) and 28 who underwent conventional laparoscopic surgeries (salpingectomy, 12 cases/cystectomy, 16 cases) during pregnancy. One patient in the single-port group required additional ports. No patients converted to laparotomy. In patients undergoing salpingectomy, the single-port group showed lower 8- and 24-h postoperative pain scores, shorter hospital stays, and lower Self-rating Anxiety Scale scores prior to discharge versus conventional laparoscopy. One patient experienced postoperative vaginal bleeding and a missed abortion during follow-up. In patients receiving cystectomy, 8- and 24-h pain scores, postoperative hospital stay, and anxiety scores were lower in the single-port versus multiport group. Other outcomes were comparable between the groups.ConclusionThe feasibility and efficacy of laparoscopic surgery during pregnancy is similar between single- or multiport routes, however, the single-port route may be associated with less postoperative pain, shorter hospital stay, and lower anxiety.     

自制悬吊子宫装置在女性腹腔镜直肠癌根治术中的应用及疗效分析

目的:介绍一种自制女性腹腔镜直肠癌根治术中的悬吊子宫装置,并分析其临床应用效果。方法:回顾分析2016年1月至2019年4月在厦门大学附属成功医院普通外科接受腹腔镜直肠癌根治术的60例女性患者的临床资料,分为观察组、对照组。观察组(28例)术中为解决因子宫的下垂遮挡导致盆腔手术视野暴露困难的问题,采用了自制悬吊子宫装置悬吊子宫。对照组未悬吊子宫,行常规腹腔镜直肠癌根治手术。比较2组患者术中、术后的情况,评价该装置的效果。结果:观察组较对照组手术时间和术后肛门排气时间明显缩短(P0.05),但两组术中出血量、淋巴结清扫数量和术后并发症发生率的差异均无统计学意义。结论:自制女性腹腔镜直肠癌根治术中的悬吊子宫装置取材方便,操作安全简单,价格便宜,有利于盆腔术野暴露,降低手术操作的风险和难度,同时缩短手术时间和术后肛门排气时间,促进术后恢复。     

Clinical analysis of 52 adolescent patients with ovarian masses ≥10 cm in diameter

ObjectiveTo investigate the clinical characteristics and treatment of large ovarian masses in adolescents.MethodsAdolescents with large ovarian masses (≥10 cm in diameter) who were treated in Beijing Obstetrics and Gynecology Hospital from March 2010 to December 2018 were retrospectively assessed.ResultsFifty-two female patients (mean age: 16.17±2.04 years [11–19 years]) were included and 19 (36.5%) presented with abdominal pain. The blood flow signal rate in ultrasonography was significantly different among benign, borderline and malignant ovarian masses, unlike strong echo, dotted echo and septation rates. Carbohydrate antigen 125 positivity rates were significantly different among pathological types and the endometriotic cyst group showed the highest value (75.0%). Alpha-fetoprotein positivity rates were also different among pathological types. For ovarian cystectomy, 14 and 32 patients underwent laparotomy and laparoscopy, respectively. Mass diameters were significantly higher in the laparotomy group and the operative duration was significantly shorter in the laparoscopy group. There were no significant differences in intraoperative blood loss or postoperative recurrence rates between the two groups.ConclusionTeratomas constitute the greatest group of large ovarian masses in adolescents. Benign tumors should be treated by laparoscopic resection, while borderline or malignant tumors require individualized treatment of tumors and fertility-sparing treatments.     

Self-retaining barbed suture reduces warm ischemia time during laparoscopic partial nephrectomy

Objective: To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner.

Material and methods: From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared.

Results: The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8?±?8.2 vs. 22.9?±?7.3?min, P?=?.04; 10.4?±?3.7 vs. 13.8?±?5.6?min, P?=?.01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred.

Conclusions: The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.     

两种腹腔镜手术方案在乙状结肠癌患者中的疗效对比

目的对比传统腹腔镜乙状结肠癌根治术与腹部无切口经直肠取出标本腹腔镜手术的近期疗效。方法以2015年1月-2016年12月于该院拟实施腹腔镜辅助乙状结肠癌根治手术的患者中选出34例实施腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术的患者作为腹部无切口组。以1∶2的配对方式选择同期内年龄、性别一致,体质指数(BMI)相近的实施腹腔镜辅助乙状结肠癌根治手术的患者68例作为对照组。对比两种腹腔镜手术方案的手术时间、手术出血量、术后排气时间、术后疼痛评分、手术并发症、术后住院时间、附加镇痛处理情况、肠管切除长度、近远端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期。结果腹部无切口组乙状结肠癌患者的手术时间、手术出血量明显高于对照组,腹部无切口组乙状结肠癌患者的术后排气时间、术后清醒时疼痛评分、术后第1天的疼痛评分明显低于对照组,差异有统计学意义(P0.05);两组乙状结肠癌患者的肠管切除长度、远近端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期差异无统计学意义(P0.05)。腹部无切口组随访5~8个月,平均6个月;对照组随访6~9个月,平均7个月,均未发现肿瘤局部复发及远处转移。结论相比于传统腹腔镜手术,腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术可以明显降低患者的疼痛程度,缩短术后排气时间,肿瘤根治效果相近。