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Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH) for treating hepa‐tolithiasis .Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to Novem‐ber 2012 were retrospectively analyzed .Among them ,35 cases underwent laparoscopic hepatectomy(LH group) and 40 cases under‐went open hepatectomies(OH group) .The operative modes in the two groups included the left liver lateral lobe resection ,left hemi‐hepatecomy ,common bile duct incision exploration ,choledochoscopy exploration for calculi extraction ,T tube drainage and cholecys‐tectomy .The clinical indicators including the operation time ,intraoperative blood loss ,analgesic drug use situation ,ambulation time , diet recovery time ,postoperative complication rate ,postoperative hospital stay time ,stone clearance rate and recurrence rate were analyzed and compared between the two groups .Results The operation time of the LH group was longer than that of the OH group[(205 .0 ± 40 .9) min vs .(155 .0 ± 26 .6) min ,P 0 .05) .The use rate of analge‐sic drugs in the LH group was lower than that of the OH group (0 vs .62 .5% ) .The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1 .5 ± 0 .5)d vs .(3 .6 ± 0 .7)d ,P 0 .05) .Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an e‐qual therapeutic effect to that of open hepatectomy .LH has the advanteages of minimally invasive surgery such as small incision , less pain ,fast recovery ,less complications ,etc .
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Objective To determine the safety and feasibility of laparoscopic dissection of hepatic pedicle in liver resections.Methods Laparoscopic dissection of hepatic pedicle was performed to achieve selective hepatic vascular inflow occlusion during anatomical hepatectomies in 43 patients with liver lesions.The average age was (46.1 ± 3.5) years.The hepatic pedicle was dissected precisely with sharp and blunt dissections to expose the portal vein,hepatic artery,and their branches.The hepatic ischemic area was judged after selective hepatic vascular inflow occlusion and the liver lesions were then resected.Results All 43 patients received anatomical hepatectomies successfully using the technique of laparoscopic hepatic pedicle dissection for selective hepatic vascular inflow occlusion.The mean operative time was (63.6 ± 11.2)minutes.The average blood loss was (243.8 ± 35.5)ml,and the mean hospital stay was (7.1 ± 1.6) days.Conclusion Laparoscopic dissection of hepatic pedicle in liver resection was feasible and safe.
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Pancreaticojejunostomy is a difficult procedure in laparoscopic pancreaticoduodenectomy.How to improve the method of laparoscopic pancreaticojejunostomy and decrease the incidence of pancreatic leakage is a never-ending issue for clinicians.From November 2002 to March 2012,the digestive tract of 34 patients who received laparoscopic pancreaticoduodenectomy at the First Affiliated Hospital of Guangxi Medical University was constructed by wrapping pancreatic duct-jejunum anastomosis,and satisfactory outcomes were observed except for 2 patients with slight pancreatic leakage.The results of the study showed that wrapping pancreatic duct-jejunum anastomosis is a fast,safe and effective method for pancreaticojejunostomy.
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Objective To compare the feasibility and safety of laparoscopic versus open hepatectomy.Methods The data of 165 patients who underwent laparoscopic hepatectomy were compared with 170 patients who underwent open hepatectomy in our hospital from November 2002 to December 2010.Results Laparoscopic hepatectomy was successfully carried out in 159 patients and 6 patients were converted to open operation because of intra-operative hemorrhage.The 170 patients in the open operative group had open hepatectomy successfully carried out.The hospital stay and cost in the laparoscopic group(7.6±1.3 d,31767.4±220.1(￥))were less than the open operation group(14.6±3.3 d,35127.3±392.2(￥))(t=-12.657,P＜0.001; t=-78.859,P＜0.001).There was no significant difference in Pringle's manoeuvre time,blood loss and postoperative complications(20.6 ±8.5vs.18.6±6.5 min,t=2.108,P=0.068),(420.8±76.5 vs.395.9±96.1 ml,t=2.157,P=0.063),(0 vs.4 cases,t=2.011,P=0.156))between the 2 groups.The operative time in the laparoscopic group was significantly longer than the open group(59.6 ± 12.2 vs.42.7 ± 22.6 min)(t=6.941,P＜0.001).Conclusions Laparoscopic hepatectomy is feasible and safe.It has the advantages of having less trauma and quicker recovery for tumors which were located superficially in the left liver and in the inferior part of the right liver.The operative time was longer than open hepatectomy,but there was no significant difference between the 2 groups in Pringle's manoeuvre time,blood loss and postoperative complications.The hospital stay and total hospital cost in the open operation group were higher than the laparoscopic hepatectomy group.
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Objective To study the feasibility and safety of laparoscopic anatomical liver lobectomy for liver tumor. Methods The feasibility and therapeutic effect of laparoscopic anatomical liver resection on 67 patients were analyzed in our hospital from January 2005 to February 2010. Results Laparoscopic anatomical liver lobectomy was carried out successfully on all the patients. The operative time was 50.6± 16.2 min and the blood loss was 220. 8±76.5 ml. We did not use Pringle's manoeuvre. There was no postoperative complication. The patients were able to be ambulated out of bed within 24 hours and they started to take in food 1-3 days after surgery. The mean hospital stay was 5-7 days after surgery (mean 6.6±1.1 d). The total hospital cost was 30767.4±150. 1 Yuan. Conclusions Laparoscopic anatomical liver resection is feasible and safe. It has the advantages of minimal trauma and quick recovery for tumors located superficially, in the left liver, and in the inferior part of the right liver. Clinically, it should be used more widely.
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Objective To evaluate the feasibility and efficacy of laparoscopic treatment of hepatic hemangioma. Methods The clinical data of 27 patients who received laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 were retrospectively analyzed. The hepatic inflow to the liver or to a hemiliver was temporarily blocked using a Pringle manoeuvre with a self-invented laparoscopic blocker at the porta hepatis or at the pedicle to the relevant hemiliver. The Electriccautery and ultracision were used for liver transaction. Results Laparoscopic treatment of hepatic hemangioma was successfully performed in 25 patients. Conversion to laparotomy was required in two (8%) patients for uncontrollable bleeding. There were no major postoperative complications and no mortality. The mean tumor diameter was (6.34±2. 17) cm. The operating time was ( 105.21 ±72.76)min. The time of hepatic inflow block was (10. 17±12. 21)min. The blood loss was (115. 5±212.14)ml. The volume of blood transfusion was (0. 87 ± 1.45)U. The volume of postoperative drainage was (112.60±201.03)ml. The time taken to return to normal activity was (2. 0±0. 8) days.The length of postoperative hospital stay was (5.5±2.4) days. The length of total hospital stay was (12. 5 ±5.3) days. The total cost was RMB10041.6±8678. 7. Conclusion In selected patients, laparoscopic treatment of hepatic hemangioma was safe and feasible.
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Objective To assess the safety and effectiveness of laparoscopically total extraperitoneal (TEP) repair using two mesh cross and overlap without stapler technique and to discuss the cause of main complications. Methods In this study 243 cases of inguinal hernia were randomly divided into two groups. One group underwent two meshes cross and overlap no fixation TEP, the other underwent a single mesh stapling fixation TEP. The average postoperative follow-up was ( 28 ± 6 ) months. For comparing the effect of the two approaches, statistical analysis including the χ2 test and Student's t test was carried out where appropriate. A p value of less than 0. 05 was considered statistically significant. Results The recurrence rate for the mesh no fixation group ( 1.9% ) did not increase when compared to mesh fixation group( 2. 9% ) ( P ＞ 0. 05 ). The overall postoperative complication rate or individual complication rate was not significantly different between the two groups. Conclusions Laparoscopically total extraperitonealrepair(TEP) using two mesh cross and overlap no fixation technique is safe and reliable.
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Objective To explore the feasibility, difficulties and indications of video-assisted laparoscopic pancreaticoduodenectomy. Methods Clinical records of 5 cases of laparoscopic pancreaticoduodenectomy in this hospital from November 22, 2002 to April 28, 2005 were analyzed, with respect to preoperative diagnosis, surgical methods and procedures, intraoperative blood loss, operation time, difficulties encountered and countermeasures, and postoperative recovery. Related parameters included patient's temperature, drainage volume, blood routine, liver functions, amylopsin changes, postoperative complications, bowel movement recovery, and length of hospital stay. Results All the 5 cases of operation were successfully performed, with an operation time of 360~660 min (mean, 528 min) and an intraoperative blood loss of 150~2 000 ml (mean, 770 ml). Pathological examinations revealed 3 cases of well-differentiated papillary adenocarcinoma of the duodenum, 1 case of endocrine small-cell carcinoma of the head of pancreas, and 1 case of papillary adenomatoid hyperplasia of the duodenum with malignant changes accompanying intermediated-differentiated adenocarcinoma of upper and middle intrahepatic biliary duct. Postoperatively, a small amount of pancreatic leakage occurred in case number 1 and a digestive tract stress ulcer happened in case number 2, all of which were cured by symptomatic management. In case number 4, a recurrent pancreatitis with pulmonary infection was observed, and the patient died from stress ulcer hemorrhage on the 39th postoperative day. Except for the case number 4 in which the patient's highest temperature reached 39.5 ℃ after the recurrence of pancreatitis, the highest temperatures of the other 4 patients were all
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Objective To investigate short-term effects of laparoscopic liver lobectomy for the treatment of hepatocellular carcinoma. Methods A comparison was made between 17 cases of laparoscopic liver lobectomy (segmentectomy) (Laparoscopic Group) and 22 cases of open hepatectomy (Open Group) from January 2001 to June 2004. The operative time, blood loss, blood transfusion amount, liver functions and blood picture before and after the surgery, and complications between the two groups were compared respectively. Results The operative time was longer in the Laparoscopic Group (median, 300 min) than in the Open Group (median, 145 min) ( u =107.05, P =0.023). Both groups presented a similar appearance in the blood loss and the blood transfusion amount. Serum levels of bilirubin and ALT varied within narrower limits in the Laparoscopic Group than in the Open Group. No significant difference was seen in blood pictures before and after the surgery in both groups. No complications happened in the Laparoscopic Group, whereas 4 cases of complications were observed in the Open Group (1 case of incision infection, 1 case of hydrothorax, 1 case of subphrenic dropsy, and 1 case of postoperative bleeding). Conclusions Laparoscopic liver lobectomy (segmentectomy) for hepatocellular carcinoma is minimally invasive, safe and effective.
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0.05).Conclusions Laparoscopic-assisted radical gastrectomy for gastric cancer is safe and effective,and its short-term outcome is similar to open surgery.
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Objective To explore the feasibility and advantages of endoscopic thyroidectomy via breast areola approach.Methods Endoscopic thyroidectomy via breast areola approach was performed in 113 cases between August 2002 and May 2005.Preoperative diagnosis included 46 cases of adenoma,62 cases of nodular goiter,and 5 cases of Graves' disease.Results The operation was successfully completed endoscopically in 112 cases,and was converted to conventional thyroidectomy in 1 case because of bleeding.The tumor was 2.3?1.6 cm in diameter(range,0.8~7.0 cm).The operating time was 136.7?58.0 min(range,50~310 min),the intraoperative blood loss was 42.5?62.7 ml(range,10~200 ml),the postoperative drainage volume was 87.1?78.1 ml(range,15~310 ml),the time to resume normal activities was 2.2?0.9 d(range,1~4 d),and the length of postoperative hospital stay was 5.5?1.9 d(range,2~9 d).Out of the 113 cases,analgesic requirement was necessary in 18 cases (15.9%).Postoperative complications occurred in 6 cases,including 2 cases of recurrent laryngeal nerve injuries,1 case of superior laryngeal nerve injuries,1 case of hemorrhage,1 case of hypocalcemia,and 1 case of recurrence of Graves' disease.Pathological results showed 43 cases of thyroid adenoma,58 cases of nodular goiter,5 cases of Graves' disease,3 cases of thyroid cancer,and 4 cases of Hashimoto's thyroiditis.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure.It can be employed as the first choice for indicated patients.
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Objective To investigate the laparoscopic techniques in the diagnosis and treatment of acute abdominal emergency. Methods The efficacy of laparoscopic checkups and treatment in 122 consecutive patients with surgical acute abdomen admitted from January 2001 to February 2003 were analyzed retrospectively. Results Diagnosis was clarified under laparoscope in all the patients.Operations were completed under laparoscope in 117 patients,while a conversion to open surgery was required in 5 patients because of the limitation of vision scope or dense adhesion leading to difficult exposure.Two patients expired. Conclusions Laparoscopy is valuable for the differential diagnosis of surgical acute abdomen.Laparoscopic treatment can be completed in the majority of the patients,but is not advisable in certain cases.
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Objective To summarize the anterior trans-sternal approach endoscopic subtotal thyroidectomy. Methods Clinical data of 10 cases of endoscopic subtotal thyroidectomy were reviewed. Results All endoscopic operations in the 10 cases were successfully completed. The operation time was 140～360 min (mean, 164 min), and the postoperative hospital stay ranged 4～8 days (mean, 5 days). No injuries of nerve or parathyroid glands, or other complications occurred. Conclusions The anterior trans-sternal approach endoscopic thyroidectomy is characterized by its safety, reliability, short incision, and good cosmetic results.
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Objective To compare the influence of endoscopic thyroidectomy via breast areola approach and traditional thyroidectomy on the immune function.Methods Fifty cases undergoing partial thyroidectomy were divided into endoscopy and open thyroidectomy groups(25 cases in each).Blood samples were obtained at 1 day before the surgery and 1,2,and 3 days postoperation to count the CD3,CD+4 and CD+8 T lymphocytes using flow cytometry,and determine the concentration of immunoglobulins(IgG,IgA,and IgM),CRP,and complements(C3 and C4)with immunonephelometry.Results In both the groups,the concentrations of CD3,CD+8 T lymphocytes,and complement C4 decreased significantly at 24 hours after the surgery(P0.05).Conclusions Both endoscopic and traditional thyroidectomy could depress the immune function,however no significant difference exists between the two methods in the level of depression.
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Objective To evaluate the feasibility of laparoscopic left lateral hepatic lobectomy(Ⅱand Ⅲ segments)for the treatment of primary hepatic carcinoma(PHC).Methods From January 2002 to June 2007,23 patients with PHC were treated by laparoscopic left lateral hepatic lobectomy.During the operation,after the portal blood stream was blocked by portal clamps,left lateral lobectomy was performed by using electric or ultrasonic scalpel.Then,laparoscopic hepatic suture was carried out,and fibrin sealant was used to cover the surgical surface.Results Laparoscopic left lateral hepatic lobectomy was completed in all the 23 cases with a mean operation time of(131.7?33.9)min and mean blood loss of(297.9?124.0)ml.All the patients recovered well without postoperative complications and were discharged(5.5?1.3)days after the operation.Among the cases,20(20/23,87%)were followed up for 2-24 months(2-12 months for 9 cases,and 13-24 months for 11 cases),during which no patients died,3 patients had recurrent hepatic carcinoma.Conclusions Laparoscopic left lateral hepatic lobectomy is feasible for PHC.The method should be the first choice for left lateral PHC because it is safe and minimally invasive.
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Objective To investigate the laparoscopic anatomy of the spleen vessels and its clinical application. Methods The data of 47 cases of total laparoscopic splenectomy (TLS) were analyzed. Among the patients, 21 had cirrhotic portal hypertension, 19 had thalassemia, 2 idiopathic thrombocytopenic purpura, 2 hereditary spherocytosis, 1 angioma of the spleen, 1 splenic cyst, and 1 primary hypersplenism. The color of the spleen was observed after the splenic artery near the pancreatic tail was ligated. And then the splenic artery was categorized according to the color. Results Among the 47 cases, 34 (72.3%) were categorized as typeⅠ, 9 were type Ⅱ (19.1%), and 2 were type Ⅲ (4.3%). The arterial anatomy was unclear under a laparoscope in 2 cases (4.3%). The TLS was completed in 46 cases with a success rate of 97.9% (46/47). Among the cases, 14 received extensive esophagogastric devascularization simultaneously,and 3 patients who had thalassemia underwent cholecystecotomy after the TLS because of gallbladder stones. One case was converted to an open surgery because of extensive bleeding owning to coagulation disorder. The spleen artery was ligated in 43 cases, and the hilar vessels were resected by dissecting and ligating in 45 cases. The Operation time averaged at (110?35) min (range 50-240 min), and the mean intraoperative blood loss was (160?87) ml (range, 20-1500 ml). Conclusions In spite of the prominent type Ⅱ of the spleen vessels, the spleen artery can be dissected and ligated at the level of the superior edge of the pancreatic tail to stop the blood supply to the spleen. The hilar vessels can be resected by dissecting and ligating. The spleen artery ligation and hilar vessels resection by dissecting and ligating are effective in controlling intraoperative bleeding and avoiding pancreas injury.
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Objective To compare the clinical efficiency of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy in patients with benign thyroid tumor. Methods Ninety-one patients of thyroid adenoma or adenomatous goiter underwent endoscopic thyroidectomy (group endoscopy) , Ninety-nine patients underwent conventional open thyroidectomy (group open). Operative time, blood loss, the volum of drainage, time of hospital stay and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared. Results There were no significant differences in operative time, time of stay and postoperation stay between the two groups. Blood loss was significantly less in group endoscopy (27. 7?17. 4) ml than in group open [ (96. 8?84. 8) ml, P