AIM:To compare the results of transvaginal cholecystectomy(TVC) and conventional laparoscopic cholecystectomy(CLC) for gallbladder disease.METHODS:We performed a literature search of Pub Med,EMBASE,Ovid,Web of Science...AIM:To compare the results of transvaginal cholecystectomy(TVC) and conventional laparoscopic cholecystectomy(CLC) for gallbladder disease.METHODS:We performed a literature search of Pub Med,EMBASE,Ovid,Web of Science,Cochrane Library,Google Scholar,Meta Register of Controlled Trials,Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC.Data were extracted by two authors.Mean difference (MD), standardized mean difference(SMD),odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models.Statistical heterogeneity was evaluated with the χ2 test.The fixed-effects model was used in the absence of statistically significant heterogeneity.The randomeffects model was chosen when heterogeneity was found.RESULTS:There were 730 patients in nine controlled clinical trials.No significant difference was found regarding demographic characteristics(P > 0.5),including anesthetic risk score,age,body mass index,and abdominal surgical history between the TVC and CLC groups.Both groups had similar mortality,morbidity,and return to work after surgery.Patients in the TVC group had a lower pain score on postoperative day 1(SMD:-0.957,95%CI:-1.488 to-0.426,P < 0.001),needed less postoperative analgesic medication(SMD:-0.574,95%CI:-0.807 to-0.341,P < 0.001) and stayed for a shorter time in hospital(MD:-1.004 d,95%CI:-1.779 to 0.228,P = 0.011),but had longer operative time(MD:17.307 min,95%CI:6.789 to 27.826,P = 0.001).TVC had no significant influence on postoperative sexual function and quality of life.Better cosmetic results and satisfaction were achieved in the TVC group.CONCLUSION:TVC is safe and effective for gallbladder disease.However,vaginal injury might occur,and further trials are needed to compare TVC with CLC.展开更多
AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on...AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.展开更多
基金National Natural Science Foundation of China,No.81001007,No.81100826,and No.81270003Fudan University Youth Fund(2012)the Scientific Research Foundation for the Returned Overseas Chinese Scholars,Chinese Ministry of Education
文摘AIM:To compare the results of transvaginal cholecystectomy(TVC) and conventional laparoscopic cholecystectomy(CLC) for gallbladder disease.METHODS:We performed a literature search of Pub Med,EMBASE,Ovid,Web of Science,Cochrane Library,Google Scholar,Meta Register of Controlled Trials,Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC.Data were extracted by two authors.Mean difference (MD), standardized mean difference(SMD),odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models.Statistical heterogeneity was evaluated with the χ2 test.The fixed-effects model was used in the absence of statistically significant heterogeneity.The randomeffects model was chosen when heterogeneity was found.RESULTS:There were 730 patients in nine controlled clinical trials.No significant difference was found regarding demographic characteristics(P > 0.5),including anesthetic risk score,age,body mass index,and abdominal surgical history between the TVC and CLC groups.Both groups had similar mortality,morbidity,and return to work after surgery.Patients in the TVC group had a lower pain score on postoperative day 1(SMD:-0.957,95%CI:-1.488 to-0.426,P < 0.001),needed less postoperative analgesic medication(SMD:-0.574,95%CI:-0.807 to-0.341,P < 0.001) and stayed for a shorter time in hospital(MD:-1.004 d,95%CI:-1.779 to 0.228,P = 0.011),but had longer operative time(MD:17.307 min,95%CI:6.789 to 27.826,P = 0.001).TVC had no significant influence on postoperative sexual function and quality of life.Better cosmetic results and satisfaction were achieved in the TVC group.CONCLUSION:TVC is safe and effective for gallbladder disease.However,vaginal injury might occur,and further trials are needed to compare TVC with CLC.
文摘AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market. METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl StorzTM, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model. RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence. CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.
