A single-team experience with robotic pancreatic surgery in 1010 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.</p><p><b>METHODS</b>The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.</p><p><b>RESULTS</b>The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.</p><p><b>CONCLUSION</b>This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.</p>

Transumbilical single-incision laparoscopic hepatectomy: an initial report / 中华医学杂志(英文版)

Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.

A modeling method for laparoscopic left lateral segment liver resection: report of 71 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with a modeling method for laparoscopic left lateral segment liver resection (LLLR).</p><p><b>METHODS</b>The surgical procedures of LLLR were carried out with the patient placed in a supine position and 4 trocars placed on the abdomen. After complete dissociation of the left lobe, the segment II and III vascular pedicles were freed with a harmonic scalpel and transected with a linear cutter stapler. The left hepatic vein (LHV) was dissociated with a harmonic scalpel with a slightly left direction of liver dissection, followed by complete resection of the LHV and finally by wound surface management, specimen removal, wound drainage, and abdominal incision closure.</p><p><b>RESULTS</b>Between July, 2003 and August, 2010, this modeling method for LLLR was performed successfully in 48 cases without conversion to laparotomy. The mean operation time was 75∓30.8 min, blood loss was 58∓36.4 ml, and length of postoperative hospital stay was 4.8∓1.5 days. Postoperative complications occurred in 3 cases, including ascites in 2 cases and mild biliary leakage 1 case, all cured conservatively.</p><p><b>CONCLUSION</b>This modeling method can simplify the surgical procedure of LLLR, reduce blood loss, and avoid air embolism due to vein injury. Being less technically demanding, this method can be safely performed in hospitals at various levels.</p>

A comparative study of laparoscopic fistal pancreatectomy and open distal pancreatectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical results of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP), confirm the potential advantages of LDP.</p><p><b>METHODS</b>The medical records of 30 consecutive patients who underwent LDP were reviewed and compared with those of 42 patients who underwent ODP.</p><p><b>RESULTS</b>Operation time was longer for LDP than for ODP [(186.33±58.98 min) vs (149.29±29.00 min), P=0.001], but blood loss [(223.33±143.68 ml) vs(251.19±103.29 ml), P=0.341] and spleen-saving rate(42.3% vs 61.8%, P=0.192) were no significant difference between the 2 groups. Decreased postoperative bowel recovery time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016], oral intake time [(2.37±0.85 d) vs (2.81±0.67 d), P=0.016] and length of stay [(7.43±1.57 d) vs (9.67±1.41 d), P=0.000] were seen in LDP group. However, the rate of postoperative pancreatic fistula (16.67% vs 21.43%, P=0.619) was no significant difference between the 2 groups. 3 cases of wound infection and 2 cases of lung related complication were occurred in ODP group, but none in LDP group.</p><p><b>CONCLUSION</b>LDP is a safe and effective surgical approach, providing the same surgical results comparable to that of ODP, and substantially faster recovery. However, high requirement of laparoscopic technique and equipments limited its further clinical application.</p>

Laparoscopic resection of pancreatic islet cell tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical technique and clinical experience of total laparoscopic resection of the pancreatic islet cell tumors.</p><p><b>METHODS</b>From July 2002 to December 2007, 30 cases including 12 males and 18 females were diagnosed as pancreatic islet cell tumor. There were at least one positive imaging examination of each patient preoperatively. The location of the tumors included 4 in proximal pancreas and 26 in distal pancreas.</p><p><b>RESULTS</b>The tumors were successfully found and removed in 28 cases and unsuccessfully located in the other 2 cases. The procedures included local resections in 13 cases and distal pancreatectomies in 15 cases (spleen reserved in 7 cases). The mean operation time was 165 min (range, 65 - 465 min). The mean blood loss was 145 ml (range, 50 - 800 ml). Pancreatic leakage occurred in 3 cases, 2 of which were cured conservatively. And the other one were cured by endoscopic retrograde cannulation of the pancreatic duct. The mean postoperative hospital stay was 5.6 days (range, 2 - 17 d). There were no conversions and death. After follow up of (14.3 +/- 16.7) months (range, 4 - 62 months), there were no recurrences.</p><p><b>CONCLUSION</b>Total laparoscopic resection is a safe and effective method for pancreatic islet cell tumors.</p>

Laparoscopic hepatectomy for hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the value of laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>From April 2002 to December 2007, 123 cases of HCC, included 82 males and 41 females, with a mean age of 53.8 years (range 31 - 69 years) underwent LH.</p><p><b>RESULTS</b>Ninety-three cases underwent total laparoscopic hepatectomies (included regular hepatectomies in 52 cases). Twenty-six cases underwent laparoscopy assisted hepatectomies (included regular hepatectomies in 12 cases). Four cases converted to open hepatectomies because of massive bleeding of hepatic vein. The operative time was (205.5 +/- 92.5) min (range 115 - 290 min). The median intraoperative blood loss was 250 ml (rang 100 - 1500 ml). The postoperative hospital stay was (5.8 +/- 1.6) days (range 3 - 15 days). The biggest size of the resections was 18 cm x 16 cm x 12 cm. One patient died of gas embolism during the operation. Biliary fistula occurred in 5 cases and ascites in 8 cases postoperatively, which were cured for several days. By 4 - 61 months of follow up, recurrence in liver occurred in 5 cases. There was no peritoneum and port metastasis.</p><p><b>CONCLUSION</b>LH is a safe and feasible method for the treatment of HCC.</p>

Effect of weight loss induced by laparoscopic adjustable gastric banding on immunity of morbid obesity / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the immunity of morbid obesity (MO) before and after laparoscopic adjustable gastric banding (LAGB).</p><p><b>METHODS</b>15 cases, with a mean body mass index (BMI) of 35.8 kg/m(2), were treated by LAGB from Jun. 2003 to Oct. 2003 in our department. Patients' immune parameters were determined preoperatively and 1, 3 and 6 months postoperatively. 15 cases with a normal BMI (23.6 kg/m(2)) were set as controls.</p><p><b>RESULTS</b>Before surgery, the MO had a significant lower level of CD(4)(+), CD(4)(+)/CD(8)(+) and a higher level of serum interleukin-2 (IL-2), Interleukin-6 (IL-6) than the controls (P < 0.01). There was a significant reduction of weight and BMI 6 months postoperatively (P < 0.01). At the same time, CD(4)(+) increased and serum IL-2 decreased significantly. But CD(4)(+)/CD(8)(+)and serum IL-2, IL-6 were still abnormal compare to the controls.</p><p><b>CONCLUSIONS</b>MO may combined with an abnormal immunity. But after enough weight loss induced by LAGB, it can be partly reversed.</p>