Laparoscopic Endoscopic and Robotic Surgery最新文献

Minimally invasive surgery is a trend in hepatobiliary surgery. A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis. The CT scan showed multiple calculi in the left liver, dilation of the left intrahepatic bile duct and liver atrophy of the left lobe. Robotic single-incision left hemihepatectomy by the single-site system was successfully applied. With the idea of enhanced recovery after surgery, the patient was discharged on the third day after the operation without any morbidity. Robotic single-incision surgery is more frequent in gynecologic and urological surgery. As far as we know, this is the first robotic single-incision left hemihepatectomy report in the world.

Objective

Minimally invasive esophagectomy (MIE) was first implemented in 1992 and various MIEs have been performed subsequently. The modified McKeown MIE that includes thoracoscopic and laparoscopic procedures with left neck anastomosis has been implemented in our institution since 2006. We herein report our first 5-year experience in 376 consecutive patients undergone the modified McKeown MIE for esophageal cancer to evaluate perioperative outcomes and survival.

Methods

A total of 376 patients underwent a modified McKeown MIE from March 2016 to March 2021 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patient demographics and perioperative outcomes were collected and assessed, and overall survival and disease-free survival were analyzed.

Results

All procedures were completed successfully with no conversions to open surgery. The median operative time was 240 min, and the median blood loss was 100 mL. The median number of harvested lymph nodes was 29, the median number of harvested thoracic lymph nodes was 18, and of harvested abdominal nodes was 10. The 30-day mortality rate was 0.27% and complications occurred in 133 (35.4%) patients. The median follow-up period was 19 (1–60) months, and 244 patients completed more than 1 year of follow-up. The 1-year overall survival and disease-free survival were 79.5% and 73.8%, respectively.

Conclusion

The modified McKeown MIE is safe and feasible for esophageal cancer, offering satisfactory perioperative outcomes and acceptable oncologic survival.

Pancreatic cancer (PC) is the most lethal cancer among digestive system cancers. Although the only way to radically cure PC is surgical resection, complex surgical procedures and severe post-operative complications lead to high mortality. In recent years, minimally invasive surgery has become more common for PC. Minimally invasive pancreatic resection (MIPR) with the laparoscopic or robotic method has shown its superiority compared with traditional surgery. However, increasing evidence indicates that the long-term or even short-term outcomes of MIPR for PC patients remain controversial. Moreover, the indications and learning curve of MIPR require further assessment. This review aims to discuss the progress in current MIPR, analyze the specific problems and obstacles in the development of MIPR, and try to standardize MIPR procedures and improve the outcomes of MIPR.

Objective

The ulcerative colitis endoscopic index of severity (UCEIS) and the Mayo endoscopic score (MES) are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis (UC). The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.

Methods

Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The median follow-up was 81 months, and all the data were analyzed in January 2021. The primary outcome was the need for step-up treatment, which included the use of corticosteroids, immunomodulatory, or surgery during admission and follow-up. Data were analyzed using the χ² or Fisher exact test, Spearman test, t-test, and Mann–Whitney U test.

Results

Totally, 65 patients were enrolled, of whom 12 (18.5%) needed step-up treatment due to nonresponse to mesalazine. The UCEIS score, MES, and the ulcerative colitis disease activity index (UCDAI) score were significantly higher in patients who had nonresponse to mesalazine (UCEIS score: 6.92 ± 0.69 vs. 4.45 ± 1.17, p < 0.001; MES: 2.67 ± 0.49 vs. 2.15 ± 0.69, p = 0.024; UCDAI score: 9.33 ± 1.87 vs. 6.70 ± 2.38, p = 0.002). In the multivariate analysis, the UCEIS score (OR = 25.65, 95% CI: 3.048–45.985, p = 0.003), UCDAI score (OR = 1.605, 95% CI: 1.144–2.254, p = 0.006), and C-reactive protein level (OR = 1.056, 95% CI: 1.006–1.108, p = 0.026) were independent risk factors of nonresponse. The area under the ROC curve of UCEIS was 0.95, with a sensitivity of 100% and specificity of 84.6%, a cut-off value of 6, which outperformed the MES with an area under the ROC curve of 0.70. When the UCEIS score ≥6, 60% of patients eventually needed step-up treatment.

Conclusions

The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score ≥6.

Although laparoscopic hysterectomy has been used for more than 3 decades, it is not universally adopted due to steep learning curve. The robotic platform can bridge this gap and reduce the need for open hysterectomy with enhanced dexterity and accurate depth perception by 3D vision and wristed intuitive movements. This technical note introduces a two arms-three instruments “Sinha-Apollo technique” for da Vinci Si system for performing robotic-assisted laparoscopic hysterectomy in simplified and reproducible steps.

Most of the parapharyngeal space tumours are benign. The primary treatment is complete resection of the tumour. Due to its location in the deep neck space, a pre-styloid tumour can be resected via the transoral approach. However, the surgical field is limited by the small oral cavity. With the use of rigid endoscopes, removing benign tumours through transoral approach in the parapharyngeal space is possible as they provide a broad and enlarged view of the confined space. Here, we report a case of a 64-year-old male with a giant pre-styloid parapharyngeal space tumour, who successfully underwent transoral endoscopic excision. Postoperatively, the patient had short hospital stay of total 3 days. His chewing and swallowing were not affected, and he resumed oral feeding prior to discharge.

Objective

To investigate the effect of body mass index (BMI) on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.

Methods

A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital. All patients were divided into three groups according to BMI: normal group (BMI<25 kg/m², n = 44), overweight group (BMI = 25–30 kg/m², n = 21), and obese group (BMI>30 kg/m², n = 16). Multiple linear regression was conducted to investigate the correlation.

Results

The three groups were comparable in terms of age, gender, maximum diameter of cyst, and cyst location. In the aspect of operation time, only the patients in obese group had longer duration when compared with those in the normal group (59.1 ± 15.7 min vs. 45.2 ± 12.8 min, p = 0.001). And the patients in the obese group had significantly longer hospital stay compared with those in the normal group (6.2 ± 1.9 d vs. 5.2 ± 0.5 d, p = 0.002) and overweight group (6.2 ± 1.9 d vs. 5.0 ± 1.0 d, p = 0.001). In the analysis of multiple linear regression, it was found that operation time is significantly affected by BMI and location 2, with coefficients of 1.299 and −8.646 respectively. The influence of BMI was greater than location 2 (0.335 vs. −0.289). For hospital stay, only BMI had an effect on it, with a coefficient of 0.110.

Conclusion

BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.

Ventilation strategies in patients with severe tracheal stenosis should be tailored to the patient according to the underlying cause and narrowing location. This report is on a case of a 68-year-old male patient, who was admitted for radiotherapy because of esophageal cancer and then developed severe stenosis at the cervical trachea. We used venovenous extracorporeal membrane oxygenation to secure the airway and ensure adequate oxygenation. Then urgent endoscopic balloon dilation of airway stenosis was successfully performed under general anesthesia. This case shows that venovenous extracorporeal membrane oxygenation can be used in endoscopic tracheal procedures for patients with severe benign stenosis in the upper-trachea who are unable to tolerate conventional ventilation.