简介：Theuseoflaparoscopyhasbeenestablishedinimprovingperioperativeandpostoperativeoutcomesforpatientswithsimpleappendicitis.Laparoscopicappendectomyisassociatedwithlesswoundpain,lesswoundinfection,ashorterhospitalstay,andfasteroverallrecoverywhencomparedtotheopenappendectomyforuncomplicatedcases.Inthepasttwodecades,theuseoflaparoscopyforthetreatmentofperforatedappendicitistotaketheadvantagesofminimallyinvasivenesshasincreased.Thisarticlereviewedtheprevalence,approaches,safetydisclaimers,perioperativeandpostoperativeoutcomesofthelaparoscopicappendectomyinthetreatmentofpatientswithperforatedappendicitis.Specialissuesincludingtheconversion,intervalappendectomy,laparoscopicapproachforelderlyorobesepatientarealsodiscussedtodefinetheroleoflaparoscopictreatmentforpatientswithperforatedappendicitis.

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简介：Single-portlaparoscopicsurgery(SPLS)isproposedtobeasteptowardsminimizingtheinvasivenessofsurgery,andhassincegainedpopularityinseveralsurgicalsub-specialtiesincludinghepatopancreatobiliarysurgery.SPLShassincebeenappliedtocholecystectomy,liverresectionaswellaspancreatectomyforamultitudeofpathologies.BenefitsofSPLSoverconventionalmulti-incisionlaparoscopicsurgeryincludeimprovedcosmesisandpotentiallypost-operativepainatspecifictimeperiodsandextra-umbilicalsites.However,itisalsoassociatedwithlongeroperatingtime,increasedrateofcomplications,andincreasedrateofport-sitehernia.Thereisnosignificantdifferencebetweenlengthofhospitalstay.SPLShasasignificantlearningcurvethataffectsoperatingtime,rateofconversionandrateofcomplications.Inthisarticle,wereviewtheliteratureonSPLSinhepatobiliarysurgery-cholecystectomy,hepatectomyandpancreatectomy,andoffertipsonovercomingpotentialtechnicalobstaclesandminimizingthecomplicationswhenperformingSPLS-surgeonposition,positionofportandinstruments,instrumentcrossingposition,standardhandgripvsreversehandgrip,snookercueguideposition,preventionofincisionalhernia.SPLSisapromisingdirectioninlaparoscopicsurgery,andwerecommendstep-wiseprogressionofapplicationsofSPLStovarioushepatopancreatobiliarysurgeriestoensuresafeadoptionofthesurgicaltechnique.

简介：胰腺的假包囊(PP)是被纤维组织衬里并且可以包含坏死的碎片或血的胰腺的分泌物的集合。包括经皮、内视镜或外科的途径的干预基于假包囊的尺寸，地点，症状和复杂并发症。与先进成像系统和照相机的可获得性，更好止血的设备和优秀laparoscopic技术，很假的包囊能被腹腔镜检查发现并且设法。我们与对laparoscopic胰囊肿胃吻合术顺从的胰腺的假包囊描述一个30岁的男病人的一个盒子。一个切口通过前面的胃的墙被做用一个超声的联盟者在与假包囊的靠近的接触暴露以后的胃的墙激活的解剖刀。然后，另一个切口被做让胰囊肿胃吻合术获得完全、没有障碍的排水。病人在手术以后恢复了很好并且在6瞬间后续期间是没有症状的，建议laparoscopic胰囊肿胃吻合术是打开为PP的最低限度地侵略的管理的胰囊肿胃吻合术的一种安全、有效的选择。

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简介：瞄准：与胆汁的病理为pyogenic肝脓肿(PLA)调查可行性和laparoscopic外科的治疗学的效果。方法：从2004年1月到2010年10月，有与胆汁的病理会议入口标准相结合的PLA的31个病人在我们的医院里收到了外科的管理。31个病人，13经历了laparoscopic外科(LS组)，18经历了开的外科(OS组)。包括操作时间，intraoperative血损失，手术后的复杂并发症率，一些手术后的医院停留，和脓肿复发率的临床的数据回顾地在二个组之间被分析并且比较。结果：所有病人收到了全身的抗菌素治疗。四个病人在手术前经历了指导超声的经皮的导管排水。手术后的复杂并发症发生在5个病人(16.1%，5/31)在LS组包括2并且3在OS组。一个病人在OS组在普通胆汁管和另一吃的肝脓肿复发保留了演算。没有保留的演算和肝脓肿复发发生在LS组。在二个组，在perioperative时期期间没有死亡。在时间，intraoperative血损失和输送，手术后的复杂并发症率和脓肿复发在二个组之间评估的操作没有重要差别。口头的吸入更早(1.9

简介：Sleevegastrectomy(SG)isarestrictivebariatricsurgerytechniquethatwasfirstusedaspartofrestrictivehorizontalgastrectomyintheoriginalScopinarotypebiliopancreaticdiversion.Itsgoodresultsasasingletechniquehaveledtoariseinitsuse,anditiscurrentlythesecondmostperformedtechniqueworldwide.SGachievesclearlybetterresultsthanotherrestrictivetechniquesandiscomparableinsomeaspectstotheRoux-en-Ygastricbypass,thecurrentgoldstandardinbariatricsurgery.Thesebenefitshavebeenassociatedwithdifferentpathophysiologicmechanismsunrelatedtoweightlosssuchasincreasedgastricemptyingandintestinaltransit,andactivationofhormonalmechanismssuchasincreasedGLP-1hormoneanddecreasedghrelin.TheaimofthisreviewwastohighlightthesalientaspectsofSGregardingitshistoricalevolution,pathophysiologicmechanisms,mainresults,clinicalapplicationsandperioperativecomplications.

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简介：AbstractBackground:Despite the recent large number of studies comparing endoscopic and laparoscopic resection for small gastrointestinal stromal tumors (GISTs) (diameter ≤5 cm), the results remain conflicting. The objective of this work was to perform a cumulative meta-analysis to assess the advantages and disadvantages of endoscopic resection vs. laparoscopic resection.Methods:The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched medical databases up to January 2020. Meta-analytical random or fixed effects models were used in pooled analyses. Meta-regression, cumulative meta-analyses, and sub-group analyses were performed to improve the accuracy of the conclusion. Sensitivity analyses were applied to assess the robustness of the results.Results:A total of 12 cohort studies with 1383 participants comparing endoscopic resection and laparoscopic resection were identified, while three cohort studies with 167 participants comparing endoscopic resection and laparoscopic and endoscopic cooperative surgery were found. We found that endoscopic resection had shorter operation times (weighted mean difference [WMD]= -27.1 min, 95% confidence interval [CI]: -40.8 to -13.4 min) and lengths of hospital stay (WMD = -1.43 days, 95% CI: -2.31 to -0.56 days) than did laparoscopic resection. The results were stable and reliable. There were no significant differences in terms of blood loss, hospitalization costs, incidence of complications or recurrence rates. For tumor sizes 2 to 5 cm, endoscopic resection increased the risk of positive margins (relative risk [RR] = 5.78, 95% CI: 1.31-25.46). Although operation times for endoscopic resection were shorter than those of laparoscopic and endoscopic cooperative surgery (WMD = -41.03 min, 95% CI: -59.53 to -22.54 min), there was a higher incidence of complications (RR = 4.03, 95% CI: 1.57-10.34).Conclusions:In general, endoscopic resection is an alternative method for gastric GISTs ≤5 cm. Laparoscopic and endoscopic cooperative surgery may work well in combination. Further randomized controlled trials are recommended to validate or update these results.

简介：Synchronousoccurrenceofepithelialneoplasiaandgastrointestinalstromaltumor(GIST)inthestomachisuncommon.Onlyrarecaseshavebeenreportedintheliterature.Wepresentherea60-year-oldfemalecaseofsynchronousoccurrenceofgastrichigh-levelintraepithelialneoplasiaandGISTwiththefeaturesof22similarcasesanddetailedinformationreportedintheEnglishlanguageliteraturesummarized.Inthepresentpatient,epithelialneoplasiaandGISTwereremovedenblocbylaparoscopicwedgeresection.Tothebestofourknowledge,thisisthefirstreportedcasetreatedbylaparo-scopicwedgeresection.

简介：AIM:Toperformameta-analysistoanswerwhetherlong-termrecurrenceratesafterlaparoscopic-assistedsurgeryarecomparabletothosereportedafteropensurgery.METHODS:AcomprehensiveliteraturesearchoftheMEDLINEdatabase,EMBASEdatabase,andtheCochraneCentralRegisterofControlledTrialsfortheyears1991-2010wasperformed.Prospectiverandomizedclinicaltrials(RCTs)wereeligibleiftheyincludedpatientswithcoloncancertreatedbylaparoscopicsurgeryvsopensurgeryandfollowedformorethanfiveyears.RESULTS:Threestudiesinvolving2147patientsreportedlong-termoutcomesbasedonfive-yeardataandwereincludedintheanalysis.Theoverallmortalitywassimilarinthetwogroups(24.9%,268/1075inthelaparoscopicgroupand26.4%,283/1072inopengroup).Nosignificantdifferencesbetweenlaparoscopicandopensurgerywerefoundinoverallmortalityduringthefollow-upperiodofthesestudies[OR(fixed)0.92,95%confidenceintervals(95%CI):0.76-1.12,P=0.41].Nosignificantdifferenceinthedevelopmentofoverallrecurrencewasfoundincoloncancerpatients,whencomparinglaparoscopicandopensurgery[2147pts,19.3%vs20.0%;OR(fixed)0.96,95%CI:0.78-1.19,P=0.71].CONCLUSION:Thismeta-analysissuggeststhatlaparoscopicsurgerywasasefficaciousandsafeasopensurgeryforcoloncancer,basedonthefive-yeardataoftheseincludedRCTs.

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简介：Objective:Theaimofthisstudywastoinvestigatethefeasibilityofusingultrasonicscalpelcombinedwithvascularclipinparametrialmanagement,calledlimitedenergyparametrialresection/dissection(LEPRD),inlaparoscopicnerveplane-sparingradicalhysterectomy(NPSRH),amodifiednerve-sparingradicalhysterectomy(NSRH);andtoevaluateitseffectivenessinpelvicautonomicnervepreservation.Methods:FromJuly2012toJanuary2016,257consecutivepatientswithstageIB1toIIA2cervicalcancerwhounderwentNPSRHwereincludedinthisstudy.Patientsweredividedintothreecohortsaccordingtothedifferentparametrialresectionmodality.Theclinical,pathologicalandsurgery-relatedparameterswerecomparedbetweenthethreegroups.Short-andlong-termpostoperativebladderfunctionswereevaluated.Results:LEPRDwasattemptedin94patients,andwassuccessfulin65(69.1%)patients(LEPRDgroup).Theremaining29(30.9%)patientsrequiredbipolarcoagulationafterfailureofvascularclipping(combinedmodalitygroup).Routinebipolarcauterywasusedintheother163patientsduringtheparametrialresection(bipolargroup).ThebloodlossintheLEPRDgroupwassignificantlylowerthanthoseintheothertwogroups(P<0.001).TherateofsuccessfulFoleyremovalonpostoperativeday7wassignificantlyhigherintheLEPRDgroupthaninthebipolargroup(P=0.022).TheincidenceofchronicvoidingdysfunctionwassignificantlylowerintheLEPRDgroupthaninthebipolargroup(P=0.019).Conclusions:ItisfeasibletoperformLEPRDinNPSRHforcervicalcancers.Thiskindoflimitedenergysurgicaltechniqueisassociatedwithlessbloodloss,andleadstoimprovedpostoperativebladderfunction.

简介：AbstractBackground:Although the impact of tumor complexity on peri-operative outcomes has been well established using several nephrometry scoring systems, the impact of adherent perirenal fat remains poorly defined. This study aimed to develop a novel nephrometry scoring system for predicting the peri-operative outcomes of laparoscopic partial nephrectomy (LPN) by integrating and optimizing the RENAL score (RNS) and Mayo adhesive probability (MAP) score.Methods:We retrospectively evaluated 159 patients treated with retroperitoneal LPN. The patients’ demographic parameters, RNSs, and MAP scores were evaluated as potential predictors of perioperative outcomes, including operation time, estimated blood loss (EBL), and margin, ischemia, and complication (MIC) achievement rate. The independent predictors were used to develop a novel nephrometry scoring system. The predictive value and inter-observer agreement for the novel nephrometry scoring system were evaluated.Results:Tumor radius (R score), nearness to the renal sinus or collecting system (N score), and posterior perinephric fat thickness were independent predictors of peri-operative outcomes and were used to develop the RNP score. The univariate analysis revealed that the RNP score was significantly associated with operation time, EBL, and MIC achievement rate (P < 0.050). The RNP score was an independent predictor of operation time (P < 0.001), EBL (P = 0.018), and MIC achievement rate (P = 0.023) in the multivariate analysis. The RNP score was not inferior to RNS in the area under the curve for predicting peri-operative outcomes and performed better in inter-observer agreement (76.7% vs. 57.8%) and kappa value (0.804 vs. 0.726).Conclusion:The RNP score, combining the advantages of the RNS and MAP score, demonstrated a good predictive value for the peri-operative outcomes of retroperitoneal LPN and better inter-observer agreement.

简介：AbstractUterus didelphys occurs in ~0.4% of females and is found in ~11%-20% of all uterus defects. It is a risk factor for cervical insufficiency, consequently contributing to late miscarriage or preterm birth. Thus far, only two prior cases of uterus didelphys accompanied by cervical insufficiency treated through laparoscopic cervical cerclage have been reported; however, livebirth only occurred in one hemiuterus. Herein, we report a case of uterus didelphys in a patient diagnosed with cervical insufficiency. Following the placement of a modified laparoscopic cervical cerclage, the patient had two successful livebirths through both hemiuteruses, respectively, with longer gestation age (ie, >36 weeks). The aim of this case report was to provide useful information for clinical practitioners to make better decisions on the management of cervical insufficiency in patients with uterus didelphys, and identify obstetric complications that clinicians should pay attention to during pregnancy.