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[ Abstract ] Objective To explore the effect of 3D print-based navigation module assisted placement of thoracolumbar pedicle screws. Methods From January 2019 to May 2021, we received 70 thoracic and lumbar fracture patients, divided into 3D technical group and conventional method group according to the surgical method, with 35 patients in each group. In the 3D technology group, pedicle screws were placed under the sight of the navigation module, while in the conventional group, pedicle screws were placed under the conventional C-arm fluoroscopy. The amount of intraoperative bleeding and time of C arm were counted in each patient. According to the different number of pedicle screw implantation in each patient, the average amount of blood loss, time and C-arm fluoroscopy times of each screw implantation were compared between the two groups. Ideal screw angles were designed for patients in both groups before surgery. Compared with the preoperative design, the difference between preoperative and postoperative screw angle and head angle was calculated and set as the deviation value. Two sets of data were compared. Visual analogue score(VAS), Japanese Orthopaedic Association (JOA) score, Oswestry disability index(ODI), vertebral height recovery ratio and Cobb’ s angle were compared between the two groups. Results The amount of blood loss, required time and exposure times of C-arm in 3D screw implantation group were significantly lower than those in conventional screw implantation group(P0. 05); In terms of Cobb’s angle and vertebral height recovery ratio, the 3D technique group was better than the conventional method group (P<0. 05). Conclusion The 3D printed navigation module can assist the precise placement of thoracolumbar pedicle screws, shorten the operation time, reduce intraoperative bleeding and c-arm exposure times, facilitate the recovery of the injured vertebral height, improve the efficacy.
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Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic surgery in treatment of hepatic cystic echinococcosis.Methods The retrospective cross-sectional study was conducted.The clinical data of 40 patients with hepatic cystic echinococcosis who underwent 3D laparoscopic surgery in the Qinghai Province People's Hospital from March 2016 to July 2017 were collected.All the 40 patients were treated using 100 mg hydrocortisone on preventing intraoperative anaphylaxis.The experienced surgeons with proficiency in the laparoscopic technology in the same team finished surgery.Patients underwent respectively 3D laparoscopic excision of internal capsule in hepatic echinococcosis + residual cavity treatment,external capsule resection in hepatic echinococcosis and partial hepatectomy based on their conditions.Observation indicators:(1) intraoperative situations:operation completion,surgical procedures,operation time,volume of intraoperative blood loss and blood transfusion;(2) postoperative recovery situations:time to initial anal exsufflation,time for initial fluid diet intake,time for out-of-bed activity,time of indwelling drainage-tube,wound healing,postoperative complications and duration of postoperative hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,oral anti-echinococcosis medical therapy during follow-up,hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Follow-up using outpatient examination and telephone interview was performed to detect the abdominal symptoms,oral anti-echinococcosis medicine,hepatic echinococcosis recurrence and metastasis up to September 2017.Measurement data with normal distribution were represented as (x)± s.Measurement data with skewed distribution were described as M (range).Results (1) Intraoperative situations:all the 40 patients underwent successful laparoscopic surgery,including 17 undergoing excision of internal capsule in hepatic echinococcosis + residual cavity treatment,15 undergoing external capsule resection in hepatic echinococcosis and 8 undergoing partial hepatectomy.Two patients were combined with abdominal and pelvic hydatids and underwent 3D laparoscopic excision.Operation time and volume of intraoperative blood loss of 40 patients were respectively (100 ± 28) minutes and (86± 24) mL,without intraoperative blood transfusion.(2) Postoperative recovery situations:time to initial anal exsufflation and time for initial fluid diet intake in 40 patients were (2.4± 1.8)hours and (1.7±0.9)days.Forty patients had out-of-bed activity on the day of surgery.Of 40 patients,abdominal drainage-tubes of 39 were placed for 2-3 days;abdominal drainage-tube of 1 with postoperative residual cavity-induced bile leakage was indwelled for 2 months and then was removed.Wound healing and duration of postoperative hospital stay in 40 patients were Class-A healing and (10.5 ± 2.1) days.During hospitalization,39 patients didn't have bleeding,bile leakage,anaphylactic shock,intestinal adhesion and obstruction;1 patient with postoperative residual cavity-induced bile leakage had indwelling drainage-tube removal at 2 months postoperatively.(3) Follow-up:all patients were followed up for 2-15 months,with a median time of 9 months.During the follow-up,40 patients were not complicated with discomforts and received oral antiechinococcosis medical therapy,without hepatic echinococcosis recurrence and abdominal cavity implantation metastasis.Conclusion The 3D laparoscopic surgery is safe and feasible in the treatment of hepatic cystic echinococcosis,and has an obvious advantage in the treatment of irregular hepatic cystic echinococcosis,with good short-term outcomes.
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Objective To explore the clinical effect of three-dimensional (3D) laparoscopic radical gastrectomy of gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 65 patients with gastric cancer who underwent 3D laparoscopic radical gastrectomy of gastric cancer in the People's Hospital of Zhengzhou University from January 2015 to July 2016 were collected.There were the same surgical procedure and postoperative treatment between 3D and two-dimensional (2D) laparoscopic radical gastrectomy of gastric cancer.Observation indicators:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected;(2) postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay,treatment expenses and postoperative complications;(3) postoperative pathological situations:pathological classification of gastric cancer,T stage,lymph node metastasis,TNM stage,surgical margin;(4) follow-up situations.The follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor metastasis and recurrence up to July 2016.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:all the 65 patients underwent successful 3D laparoscopic radical gastrectomy of gastric cancer and D2 lymph node dissection,without the occurrence of conversion to open surgery,intraoperative complications and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (200± 55) minutes,(110± 80) mL and 32±7,respectively.(2) Postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay and treatment expenses were (3.1 ± 1.0) days,(5.3 ± 1.6) days,(9.4± 3.0) days and (8.1 ± 1.3) × 104 yuan,respectively.Of 65 patients,5 had postoperative complications.One patient with anastomotic leakage underwent percutaneous endoscopic gastrostomy and abdominal drainage again and then was cured.One patient with peritoneal effusion and infection was cured after catheter drainage under CT guided.One patient with delayed gastric emptying was cured after symptomatic treatment.One patient with chylous fistula was cured after short-term fast and total parenteral nutrition treatment.One patient with pulmonary infection was cured after antibiotic therapy.(3) Postoperative pathological situations:① Pathological classification of gastric cancer:high-and moderate-differentiated adenocarcinoma was detected in 30 patients,poor-differentiated adenocarcinoma in 20 patients,signet ring cell carcinoma in 11 patients,mucinous adenocarcinoma in 3 patients and papillary adenocarcinoma in 1 patient.② T stage:27,15 and 23 patients were in T1,T2 and T3 stages.③ Twenty-five patients had lymph node metastases and 40 had no lymph node metastasis.④ TNM stage:19,17,15,12 and 2 patients were in Ⅰ A,Ⅰ B,Ⅱ,Ⅲ A and Ⅲ B,respectively.R0 resection was performed to all the 65 patients,with negative surgical margin under the microscope.(4) Follow-up situations:of 65 patients,61 were followed up for 3-18 months,with a median time of 9 months.During the follow-up,there was no occurrence of surgeryrelated complications,tumor metastasis and recurrence and death.Conclusion The 3D laparoscopic radical gastrectomy of gastric cancer is safe and feasible,with a good short-term outcome.
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Objective To compare the clinical effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries for rectal cancer (RC) after neoadjuvant chemoradiation therapy (nCRT).Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients with RC who received laparoscopic surgery after nCRT in the Liaoning Cancer Hospital from January 2013 to January 2014 were collected.Of 126 patients,63 undergoing 3D laparoscopic surgery and 63 undergoing 2D laparoscopic surgery were respectively allocated into the 3D and 2D groups.Surgery was performed by the same doctors' team.Patients received surgery at 6-8 weeks after nCRT,and surgery followed the principle of total mesorectal excision.Observation indicators:(1) intra-and post-operative situations;(2) postoperative pathological examination;(3)follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect local tumor recurrence and patients' survival up to January 2017.Patients received reexaminations once every 3 months within 1 year postoperatively and once every 6 months after 2-3 years postoperatively.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Comparisons of count data were analyzed using the chi-square test.Comparison of ordinal data was done by the nonparametric test.Survival curve was drawn using the Kaplan-Meier method.Survival was analyzed using the Logrank test.Results (1) Intra-and post-operative situations:all the patients underwent successful laparoscopic surgery for RC,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss,time to anal exsufflation and number of patients with postoperative urinary dysfunction were (125±10)minutes,(54±23)mL,(44±5)hours,0 in the 3D group and (137±12)minutes,(62±20)mL,(46±5) hours,5 in the 2D group,respectively,with statistically significant differences between the 2 groups (t=5.777,2.038,2.575,x2 =7.138,P＜0.05).Number of patients with preserving anus,number of lymph node dissected,number of patients with anastomotic fistula and duration of hospital stay were 60,14.9±2.1,2,(9.5±0.8)days in the 3D group and 58,14.3± 1.7,4,(9.9±2.0)days in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.133,t=1.606,x2 =0.175,t =1.329,P＞0.05).Two and 4 patients with anastomotic leakage in the 3D and 2D groups received defunctioning stoma,and finally anastomotic leakage healed,without anastomotic stenosis.Of 5 patients with urinary dysfunction in the 2D group,4 received indwelling catheter for 3 weeks and then can micturate autonomously after indwelling catheter removal,1 received indwelling catheter for 3 months and then can micturate autonomously after indwelling catheter removal,without suprapubic cystostomy.(2) Postoperative pathological examination:0 and 4 patients in the 3D and 2D groups had positive circumferential margin,with a statistically significant difference (x2=5.676,P＜0.05).One and 2 patients in the 3D and 2D groups had positive distal margin,with no statistically significant difference (x2 =1.606,P＞0.05).Number of patients with stage Ⅱ and Ⅲ of postoperative pathological staging were 30,33 in the 3D group and 32,31 in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.127,P＞0.05).(3) Follow-up and survival situations:126 patients were followed up for 36.0-48.0months,with a median time of 39.5 months.During the follow-up,0 and 3 patients in the 3D and 2D groups were complicated with local tumor recurrence,with a statistically significant difference between the 2 groups (x2 =4.232,P＜0.05).One-and 3-year overall survival rates were 98.4％,82.5％ in the 3D group and 96.8％,79.4％ in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.206,P＞0.05).One-and 3-year disease-free survival rates were 92.7％,77.8％ in the 3D group and 90.5％,73.0％in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.421,P＞0.05).Conclusion Compared with 2D laparoscopic surgery,3D laparoscopic surgery for RC after nCRT is safe and feasible,it can also shorten operation time,reduce intraoperative bleeding,alleviate the influence of intestinal peristalsis function,protect pelvic nerves better and improve operation quality.
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Most colorectal surgeries now are carried out as minimally invasive surgery along with the development and application of laparoscopy.However,the surgical imaging system does not meet the progressing requirement of laparoscopic surgeons.Thanks to the advent of three-dimensional (3D) laparoscopy,a more sophisticated surgical scene with realer images of anatomy is provided to surgeons.It makes identification and manipulation easier,so that to shorten the learning curve.Meanwhile,the 3D laparoscopy is not perfect.But authors believe it will finally be used broadly in colorectal surgery with the improvement of the technology.
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With the rapid development of minimally invasive techniques,the emergence of three-dimensional (3D) laparoscope leading minimally invasive surgical accessPrecise Time.In the past 60 years,bariatric surgery provides a large number of clinical evidences to confirm:metabolic and bariatric surgery is lasting and effective for obesity combined with type 2 diabetes mellitus (T2DM),and it is also the best treatment method for T2DM.The author believes that 3D laparoscopic system can help beginners quickly master laparoscopic surgical techniques and shorten the learning curve to master the technical points.Compared with two-dimensional (2D) laparoscopic surgery,3D laparoscopic stereo vision can help experienced bariatric surgeons shorten operation time which is related to surgical procedures.The shorter surgical procedure in laparoscopic sleeve gastrectomy is hardly affecting the operation time.Because gastric bypass surgery is relatively complex,3D laparoscopic techniques which are fully utilized in gastric bypass surgery can effectively shorten the operation time.