腹腔镜胆囊切除术与小切口胆囊切除术的对比分析

目的:探讨胆囊切除术适应证患者的理想术式.方法:随机选取2006年3～6月腹腔镜胆囊切除术(LC)92例,小切口胆囊切除术(MC)103例.比较两组病人的手术时间、术中出血量、术后肠功能恢复、正常活动恢复、术后住院日、并发症等指标,方差分析比较两组是否有差异.结果:LC创伤程度小,病人恢复快,但并发症高;MC创伤较大,并发症少,适应证广.结论:两种术式各有优缺点,一种术式并不适合所有胆囊切除适应证的患者,选择术式应根据患者的具体情况决定.     

Gasless laparoscopic and minilaparotomy Billroth I gastrectomy with hepatectomy for advanced gastric cancer with liver metastasis : Technique and case report

Summary

In advanced gastric cancer with solitary liver metastasis, minilaparotomy Billroth I gastrectomy and metastasectomy with laparoscopy was performed by gasless surgery. The patient was a 53-year-old female. Gastroscopic examination revealed gastric cancer (Borrman 3 type) in the antrum, and computed tomography showed a solitary liver metastasis located in segment III. On post-operative day 1, the patient was able to walk. On postoperative day 4 she was started on a clear liquid diet, and was discharged on post-operative day 14. During her post-operative recovery, the patient experienced very little pain. She did not request narcotic analgesia post-operatively.     

Absence of prophylactic antibiotics in minimum incision endoscopic urological surgery (MEUS) of adrenal and renal tumors

OBJECTIVE: Recently, some studies suggested that antimicrobial prophylactics (AMP) are not needed to prevent surgical site infection (SSI) for clean operations despite worldwide acceptance of AMP. However, appropriate use of AMP in urological surgery has not been fully studied. Herein, we report an attempt of gradual decrease of AMP to non-use of AMP in minimum incision endoscopic urological surgery (MEUS) of adrenal and renal tumors. MATERIALS AND METHODS: We investigated 95 consecutive patients who underwent 16 MEUS adrenalectomy and 79 MEUS radical and partial nephrectomy in our hospital. Patients were classified into the following three groups by means of prevention of SSI: the first step group received ampicillin sodium/sulbactam sodium 1.5 g i.v. 30 min before the operation; the second step group received a single 300 mg of levofloxacin orally 60 min before the operation; and the third step group received no AMP. Clinical backgrounds and incidences of SSI were compared among these three groups. RESULTS: The first, second and third step groups consisted of 31, 36 and 28 patients, respectively. There was no statistically significant difference among these groups in terms of clinical backgrounds including age, sex, body mass index, American Society of Anesthesiologists classification, National Nosocomial Infections Surveillance risk index, and type and length of operation. The first step group had one superficial SSI that healed without any non-specific treatment. None of the second and third step groups had superficial SSI. There was no case of deep surgical site or distant infection. CONCLUSION: AMP could be discarded in clean MEUS of adrenal and renal tumors without increasing the incidence of SSI.     

A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses

BACKGROUND: Recent prospective and randomized studies have demonstrated that laparoscopy is better than laparotomy in the treatment of benign adnexal masses. The aim of this study is to analyse the perioperative outcomes of laparoscopy and minilaparotomy in these patients, in a prospective and randomized manner. METHODS: Between January 2003 and August 2003, 100 consecutive women with a diagnosis of presumed benign adnexal mass and requiring surgical treatment were randomly assigned to minilaparotomy and laparoscopy. Randomization was centralized and computer-based. RESULTS: All operative procedures were performed without conversion to laparotomy. In the group of patients submitted to minilaparotomy, a shorter operating time than patients submitted to operative laparoscopy (mean+/-SD: 71.9+/-31.8 versus 87.0+/-44.8 min; P<0.05) was found. On the other hand, there were significant differences in terms of postoperative ileus (1.1+/-0.4 days in laparoscopy and 1.4+/-0.6 in minilaparotomy P<0.023), without affecting the day of discharge. No intraoperative or early complications were registered in either group. CONCLUSIONS: Taking into account that laparoscopy has to be considered the first choice for benign adnexal surgery, our data suggest that minilaparotomy could offer the gynaecology surgeon a valid alternative in the minimally invasive surgery field, especially in specific settings.     

Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study

BACKGROUND: To compare in the first 7 days after surgery the outcome of myomectomy performed by three laparotomic approaches: laparotomy (LT), minilaparotomy (MLT) and laparoscopically assisted minilaparotomy (LA-MLT). METHODS: Fifty-one women with 5-15 cm total myoma diameter were randomized blindly using a computer randomization list, to LT (n = 17), MLT (n = 17) or LA-MLT (n = 17). RESULTS: Mean operation length was similar in the three groups. Mean (+/- SEM) time of paralytic ileus (55.0 +/- 4.5 versus 33.4 +/- 3.4 h; P < 0.01) and discharge (141.6 +/- 5.2 versus 81.5 +/- 8.2 h; P < 0.01) was longer in LT than LA-MLT or even MLT. In comparison with LA-MLT, LT induced a greater haemoglobin decline (-3.07 +/- 0.3 versus -1.8 +/- 0.15 mg/dl; P < 0.025), and a greater post-operative stress, as documented by increased prolactin (+15.1 +/- 3.8 versus +0.16 +/- 4.5 ng/ml; P < 0.03) and decreased insulin sensitivity (fasting glucose/insulin; -7.5 +/- 2.6 versus -0.7 +/- 2.1; P < 0.02). Seven days after surgery, abdominal pain (P < 0.05) was higher after LT (3.0 +/- 0.6) than MLT (0.5 +/- 0.2) and LA-MLT (0.9 +/- 0.4). CONCLUSIONS: In selected cases, myomectomy by LA-MLT offers some advantages versus LT and, to a smaller extent, MLT.     

腹腔镜与小切口胆囊切除治疗胆囊结石的疗效探讨

目的比较腹腔镜胆囊切除术与小切口胆囊切除术两种术式治疗胆囊结石的临床疗效。方法选取2009年5月至2012年6月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为实验组,小切口胆囊切除术手术治疗60例作为对照组。观察并比较两组临床疗效结果。结果实验组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义(P0.05);对照组、观察组术后并发症发生率分别为21.7%、8.3%,差异有统计学意义(P0.05)。结论腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广。     

A randomized,controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: Short-term outcomes

Objective

To compare the operative data and early postoperative outcomes for myomectomy performed by minilaparotomy (MLT) with isobaric laparoscopic assisted minilaparotomy myomectomy (LM) in a series of patients with large uterine myomas (≥5 cm) randomly assigned to each surgical technique.

Study design

80 patients were randomized blindly using a computer randomization list to MLT (n = 40) or LM (n = 40).

Results

The mean (±SD) operating time was significantly shorter after LM than after MLT (75.50 ± 25.70 vs 96.00 ± 26.20 min; p < 0.01). Intraoperative blood loss was less with LM (72.15 ± 44.00 vs 96.21 ± 38.50 ml; p < 0.05), and ΔHb was less with LM (1.21 ± 0.55 vs 1.64 ± 0.57; p < 0.05). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary. Hospitalization was shorter after LM than after MLT (4.30 ± 1.20 vs 6.90 ± 2.70 days; p < 0.01). Postoperative ileus was shorter after LM than after MLT (26.20 ± 4.20 vs 40.50 ± 4.90 h; p < 0.01). The mean VAS score at 12 h for abdominal pain was 5.5 ± 0.7 in the LM group and 5.2 ± 0.8 in MLT group (p < 0.05), whereas it was analogous in the two groups at 24 h, and at 48 h was 3.4 ± 1.1 in the LM group and 4.2 ± 1.1 in the MLT group (p < 0.05), and no difference between two groups was detected in the overall mean (at 12, 24 and 48 h).

Conclusions

Several surgical and immediate postoperative outcomes were significantly better in the LM group than in the MLT group.     

SMIT and the future of clinical intervention

Abstract

Introduction: The aim of this review was to assess the role of gasless laparoscopy (GLM) in comparison with two other minimally invasive approaches to myomectomy, CO₂ laparoscopy (LM) and minilaparotomy (MM), focusing on the most recent randomized or prospective controlled studies. Material and methods: A computerized search was made of the Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first reports of GLM, LM, and MM in 1995 to 2010. The fifteen most recent randomized or prospective controlled studies were selected and analyzed considering the operative and postoperative parameters. Results: One randomized controlled, one multicenter controlled, three prospective studies about GLM, four randomized controlled studies and one prospective study about LM, four randomized controlled trials and one prospective study about MM were reviewed and analyzed. Discussion: GLM offers some advantages eliminating the adverse effects and potential risks of CO₂ insufflation, particularly when large myomas have to be removed. The advantages of LM are the tamponade effect generated by the gas on the small vessels and the more precise myoma enucleation by using the endoscopic instruments, thus reducing intraoperative bleeding. MM can be a suitable option being associated with a lower overall level of surgical skill, even if it is desirable to have a standard universally accepted definition of “minilaparotomy” in order to correctly compare the results of the different studies. Lastly, the surgical outcomes of the three minimally invasive approaches to myomectomy are influenced by size, site, and number of the myomas, as well as by the skill and preference of the surgeon.All these criteria should be considered in the choice of the best minimally invasive approach to myomectomy.     

Endoscopic minilaparotomy radical nephrectomy for chronic dialysis patients

BACKGROUND: To assess the feasibility of laparoscope-guided minilaparotomy (endoscopic minilaparotomy) for renal cell carcinoma in patients on chronic dialysis. METHODS: Endoscopic retroperitoneal minilaparotomy using a 30 degrees telescope was carried out through single skin incision (5-8 cm) in eight patients with renal cell carcinoma who were on chronic dialysis. Outcomes of the operations were compared to those in eight patients on chronic dialysis with renal cell carcinoma who underwent standard translumbar radical nephrectomy. RESULTS: Resection of the tumor was successfully completed without complication and the postoperative course was uneventful in both of the treatment groups. No significant difference in mean operative time or mean blood loss was observed between the treatment groups. Wound pain was minimal and analgesics were generally not required in the minilaparotomy group. The endoscopic laparotomy group resumed full diet and began walking earlier than the group that underwent standard radical nephrectomy. CONCLUSIONS: Endoscopic minilaparotomy seems to be a valuable alternative treatment for renal cell carcinoma in patients on chronic dialysis.