Gasless videoendoscopic implantation of aortobifemoral vascular prostheses via transperitoneal versus extraperitoneal approach in an animal model

Background: The goal of this acute experimental study was to demonstrate the practicability and reproducibility of aortobifemoral bifurcational prosthesis implantations via either a transperitoneal or extraperitoneal approach using gasless videoendoscopic instrumentation. The endoscopically sutured end-to-side aortic anastomoses were also examined for fluid tightness. Methods: Eighteen of the 20 domestic pigs in this experimental study received aortobifemoral vascular prostheses in a gasless videoendoscopic procedure. Bursting pressures and leakage (ml/min) were compared for the endoscopically sutured aortic end-to-side anastomoses versus those sutured in conventional techniques using 6-h-old porcine aortas and 6-mm prostheses. Results: The surgical procedures averaged 4 h for the transperitoneal approach (n= 9) and 4.5 h for the extraperitoneal approach (n= 9). However, these times were significantly reduced with increasing routine. Average aortic occlusion times were 1 h for the transperitoneal approach and 1 h 15 min for the extraperitoneal approach; the average iliacofemoral occlusion time ranged from 1 h 45 min with the transperitoneal approach to 1 h 15 min with the extraperitoneal approach, depending on which side was involved. There were no significant differences in in vitro bursting pressure or leakage amounts between endoscopic and conventionally sutured aortic end-to-side anastomoses. Conclusions: Gasless videoendoscopic implantation of aortobifemoral vascular prostheses in animal subjects is both practicable and reproducible using either a transperitoneal or extraperitoneal approach. The extraperitoneal approach has proven advantages over the transperitoneal approach. The in vitro fluid tightness achieved with endoscopically sutured aortic end-to-side anastomoses is comparable to conventionally sutured anastomoses.     

机器人辅助腹腔镜肾肿瘤保留肾单位手术入路：经腰，经腹，还是经腰腹联合?

机器人辅助腹腔镜肾肿瘤保留肾单位手术常用的手术入路可分为经腰（经后腹腔）、经腹（经腹腔）2种,2种手术入路各有优势与不足。我们在整合2种入路优势和不足的基础上,在国际上率先提出并开展了经腰腹联合入路腹腔镜肾肿瘤保留肾单位手术。本文根据不同类型肾脏肿瘤的特点,比较3种手术入路的优缺点,探讨3种入路机器人辅助腹腔镜肾肿瘤保留肾单位手术的适应证。     

Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: A single‐center experience of 100 cases

Objectives: To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic nephrectomy for renal cell carcinoma (RCC). Methods: Between July 2001 and December 2007, 100 patients with RCC underwent laparoscopic radical nephrectomy at our institution for clinically localized RCC. Fifty‐three patients received a retroperitoneal procedure and 47 received a transperitoneal procedure. The perioperative and oncological outcomes of these groups were reviewed retrospectively. Results: Mean follow up was 34 months. No statistically significant difference was found between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling, estimated blood loss, need for blood transfusions, analgesic requirement, length of hospital stay, or the incidence of minor or major complications. The 5‐year disease‐free survival rate was 90% for both the retroperitoneal and transperitoneal procedures. The 5‐year overall survival rates were 98% and 96%, respectively. Therefore, no significant difference was observed in the long‐term oncological outcome between the two groups. Conclusions: Tumor control and surgical morbidity in laparoscopic radical nephrectomy seem not to be significantly influenced by the approach.     

经腹腔径路腹腔镜肾上腺切除术108例手术体会及经验总结

目的总结经腹腔途径行腹腔镜肾上腺切除术治疗肾上腺外科疾病的手术体会及经验。方法 2006年6月至2012年5月,行经腹腔腹腔镜肾上腺切除术108例。男性48例,女性60例;年龄22～76岁;病变位于右侧40例,左侧63例,双侧5例;切除肿瘤/肾上腺大小0.5～11cm,平均4.5cm;其中18例有下腹部经腹腔手术史。结果除1例因膈肌损伤中转开放外,107例腹腔镜手术均顺利完成,术中出血0～200mL,平均20mL,手术时间45～150min,平均70min。术后1～2d肛门排气,2d内下床活动,术后住院时间3～7d。术后无严重并发症发生。术后病理检查:嗜铬细胞瘤38例,醛固酮腺瘤20例,原醛结节性增生6例,皮质醇增多症5例,无功能腺瘤20例,髓质脂肪瘤10例,肾上腺假性囊肿3例,节细胞神经瘤3例,肾上腺皮质癌2例,转移癌1例。结论经腹腔腹腔镜肾上腺切除术,具有手术空间大、视野清晰、解剖标志清楚、便于较早结扎处理肾上腺静脉、符合人体工效学等优点,适合于嗜铬细胞瘤、较大的肾上腺肿瘤及恶性肾上腺肿瘤等的切除。     

ADRENALECTOMY: EXPANDED INDICATIONS FOR THE EXTRAPERITONEAL APPROACH

The adrenal glands can be removed surgically by the anterior transperitoneal approach, or by the extraperitoneal approaches, either posteriorly or posterolaterally. While the extraperitoneal routes have become accepted as the preferred approach to the adrenal glands for small benign cortical adenomas, many authors still recommend the anterior transperitoneal route as the preferred operative approach for phaeochromocytoma, large tumours, adrenal cancers or bilateral hyperplasia. A series of 51 consecutive adrenalectomies performed for a wide range of adrenal disorders is presented, including phaeochromocytoma and large malignant tumours. In 47 cases the tumours were successfully removed through an extraperitoneal approach, with minimal morbidity. The anterior approach had to be employed in only four cases, and in three of these there was pre-operative evidence of tumour invasion into either the major vessels or the liver. The extraperitoneal approach to the adrenal gland is technically simple and can be performed quickly, with a low postoperative morbidity and should be regarded as the routine approach for almost all adrenal procedures.     

复方苦参注射液联合顺铂腹腔灌注治疗卵巢癌腹水的疗效观察

目的 观察复方苦参注射液联合顺铂腹腔灌注冶疗卵巢癌腹水的疗效.方法 确诊为卵巢癌腹水的患者共46例,两组均静脉给于泰素150mg/m2,随机分成两组:A组,复方苦参注射液20ml和顺铂100mg联合腹腔灌注用药组26例,B组单纯顺铂组20例.两组患者在腹腔穿刺抽液后,分别注入不同药物,比较两种处理方法对腹水消失有无差别.结果 腹灌6次后,两组患者腹水消失或减少有差别(P＜0.05),A组优于B组.结论 复方苦参注射液、顺铂联合用药对消除卵巢癌腹水有促进作用,值得进一步推广.     

腰腹联合三步法腹腔镜肾部分切除术的初期临床应用体会

目的 探讨腰腹联合三步法腹腔镜肾部分切除术临床应用的安全性和有效性.方法 回顾分析2015年7月至11月期间,32例接受腹腔镜肾部分切除术患者的临床资料.其中接受腰腹联合三步法术式的患者12例(三步法组),接受传统经腹术式患者20例(对照组).三步法组手术方法:(1)首先经腹入路,切开腹侧Gerota筋膜和肾周脂肪至肾实质表面,并显露肿瘤;(2)沿结肠旁沟Told线切开腹膜和肾周筋膜,由肾脏背侧,贴腰大肌平面分离肾动脉;(3)阻断肾动脉,标记肿瘤边缘,完成肾脏肿瘤的切除和创面重建.比较两组围手术期资料.结果 32例手术均顺利完成,腰腹联合三步法相比传统经腹腔途径可有效缩短手术时间(P=0.014),术中出血等围手术期资料与传统方法类似.结论 腰腹联合三步法改良后的腹腔镜肾部分切除术既保留了经腹途径操作空间大的优点,又结合了经腰途径分离肾动脉便捷的长处,尤其肾动脉出现变异时,优势更加明显,可进行深入的临床对比研究.     

经腹膜外根治性膀胱切除回肠膀胱术的临床应用分析

【目的】 对比分析腹膜外与经腹腔开放性根治性膀胱切除回肠膀胱术的临床应用效果?【方法】 回顾性分析83例肌层浸润性膀胱癌患者的临床资料?其中45例为经腹膜外入路行根治性膀胱切除回肠膀胱术(腹膜外组),38例为经腹腔入路(经腹腔组)?【结果】 腹膜外组平均手术时间240 min,平均出血量300 mL,术后肠道排气时间48.6 h,离床下地时间4.5 d,术后住院时间12.5 d,均明显低于经腹腔组,差异均有统计学意义(P 0.05)? 【结论】 根治性膀胱切除回肠膀胱术中采用经腹膜外入路较经腹腔入路出血少?腹腔干扰少?恢复快,尤其适用于临床分期T2期以下的膀胱肿瘤,是治疗浸润性膀胱癌的有效方法?