Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experienc...Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.展开更多
AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patient...AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion r展开更多
AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbla...AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males(47%) and 158 females(53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology(P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery(P < 0.05).CONCLUSION: This study shows that this two singleincision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.展开更多
目的评价全景复合式数字腹腔镜在单孔胆囊切除术中的可行性和安全性。方法前瞻性选取2022年7月同济大学附属东方医院因胆囊结石并慢性胆囊炎行单孔腹腔镜胆囊切除术的患者84例,随机分成观察组(全景复合式数字腹腔镜)和对照组(普通光学...目的评价全景复合式数字腹腔镜在单孔胆囊切除术中的可行性和安全性。方法前瞻性选取2022年7月同济大学附属东方医院因胆囊结石并慢性胆囊炎行单孔腹腔镜胆囊切除术的患者84例,随机分成观察组(全景复合式数字腹腔镜)和对照组(普通光学腹腔镜),每组各42例。比较两组手术时间、单孔完成率、术中出血量、镜头擦拭次数、腹腔镜干扰操作满意度评分、视野满意度评分、图像质量评分、排气时间、并发症发生率、住院时间等指标。结果观察组较对照组手术时间更短[(29.48±3.74)min vs(31.52±3.13)min,t=-2.724,P<0.05],镜头擦拭次数更少[1.00(0,1.25)vs 2.00(2.00,3.00),Z=-6.321,P<0.001],术中出血量更少[2.00(2.00,3.25)mL vs 4.00(3.00,5.00)mL,Z=-3.341,P<0.05];且观察组腹腔镜干扰操作满意度评分[(8.93±0.71)vs(8.00±0.83),t=5.517,P<0.001]及视野满意度评分[(8.67±0.69)vs(7.48±0.83),t=7.145,P<0.001]均明显高于对照组。观察组单孔完成率、图像质量评分、排气时间、并发症发生率及住院时间与对照组相比差异无统计学意义(均P>0.05)。结论全景复合式数字腹腔镜用于胆囊切除术安全可行,视野调节范围大,器械干扰性低,更适合单孔胆囊切除手术。展开更多
目的 评估腹腔镜辅助腹直肌鞘阻滞在单孔腹腔镜胆囊切除术患者腹壁镇痛的有效性及安全性。方法 选取2019年10月至2021年3月江门市中心医院肝胆胰脾外科行单孔腹腔镜胆囊切除术的100例患者,其中50例患者作为观察组行腹腔镜辅助腹直肌鞘阻...目的 评估腹腔镜辅助腹直肌鞘阻滞在单孔腹腔镜胆囊切除术患者腹壁镇痛的有效性及安全性。方法 选取2019年10月至2021年3月江门市中心医院肝胆胰脾外科行单孔腹腔镜胆囊切除术的100例患者,其中50例患者作为观察组行腹腔镜辅助腹直肌鞘阻滞,50例患者作为对照组行局部浸润麻醉。采用视觉模拟量表(VAS)疼痛评分进行术后2、6、12、24 h疼痛评分;记录术后患者首次下地活动时间。结果 术后2、6、12 h观察组疼痛明显轻于对照组(1.7±1.1 vs 3.1±1.1,P<0.001;1.7±1.2 vs 2.7±0.9,P<0.001;1.9±0.8 vs 2.4±0.8,P=0.001),在24 h两者无明显差异(1.7±1.0 vs 1.9±1.2,P=0.411)。术后首次下地时间观察组明显早于对照组(8.3±1.1 vs10.7±1.5,P<0.001)两组均无并发症。结论 腹腔镜辅助下腹直肌鞘阻滞是一种可由手术医师操作的、安全易行的、有效的围手术期镇痛方式。展开更多
AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 wer...AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.展开更多
Purpose: Recently, reduced port surgery is becoming popular for laparoscopic surgery. “Reduced” means reducing the size or number of ports, but it is controversial as to which procedure is better. We evaluated doubl...Purpose: Recently, reduced port surgery is becoming popular for laparoscopic surgery. “Reduced” means reducing the size or number of ports, but it is controversial as to which procedure is better. We evaluated double-incision laparoscopic cholecystectomy (DILC) and needlescopic cholecystectomy (NC) as reducing number or size of ports, respectively. Method: Patient records for 51 patients undergoing DILC and 22 patients undergoing NC were retrospectively evaluated. The patient and operation related variables of DILC and NC were compared by age, gender, body mass index (BMI), operative time, blood loss, length of postoperative hospital stay, numerical rating scale (NRS) pain score, and frequency to administer NSAIDs postoperatively for three days. Results: The operative times of both groups were similar (DILC 106 ± 31 min, NC 103 ± 35 min). Blood loss did not show any difference and each of them was small in amount (DILC 14 ± 29 ml, NC 22 ± 31 ml). Length of postoperative hospital stay of DILC (3.2 ± 0.4 days) was significantly shorter than that of NC (3.5 ± 0.7 days). Regarding postoperative pain, frequency to administer NSAIDs and pain score for three days postoperatively showed no significant difference. Conclusion: It is thought that DILC and NC have the same operative difficulty. As far as early postoperative pain was concerned, both procedures did not have any difference.展开更多
文摘Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.
文摘AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion r
基金Supported by Hai Zhu district science and technology plans,Guang Zhou,China,No.2012-cg-26
文摘AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males(47%) and 158 females(53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology(P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery(P < 0.05).CONCLUSION: This study shows that this two singleincision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.
文摘目的评价全景复合式数字腹腔镜在单孔胆囊切除术中的可行性和安全性。方法前瞻性选取2022年7月同济大学附属东方医院因胆囊结石并慢性胆囊炎行单孔腹腔镜胆囊切除术的患者84例,随机分成观察组(全景复合式数字腹腔镜)和对照组(普通光学腹腔镜),每组各42例。比较两组手术时间、单孔完成率、术中出血量、镜头擦拭次数、腹腔镜干扰操作满意度评分、视野满意度评分、图像质量评分、排气时间、并发症发生率、住院时间等指标。结果观察组较对照组手术时间更短[(29.48±3.74)min vs(31.52±3.13)min,t=-2.724,P<0.05],镜头擦拭次数更少[1.00(0,1.25)vs 2.00(2.00,3.00),Z=-6.321,P<0.001],术中出血量更少[2.00(2.00,3.25)mL vs 4.00(3.00,5.00)mL,Z=-3.341,P<0.05];且观察组腹腔镜干扰操作满意度评分[(8.93±0.71)vs(8.00±0.83),t=5.517,P<0.001]及视野满意度评分[(8.67±0.69)vs(7.48±0.83),t=7.145,P<0.001]均明显高于对照组。观察组单孔完成率、图像质量评分、排气时间、并发症发生率及住院时间与对照组相比差异无统计学意义(均P>0.05)。结论全景复合式数字腹腔镜用于胆囊切除术安全可行,视野调节范围大,器械干扰性低,更适合单孔胆囊切除手术。
文摘目的 评估腹腔镜辅助腹直肌鞘阻滞在单孔腹腔镜胆囊切除术患者腹壁镇痛的有效性及安全性。方法 选取2019年10月至2021年3月江门市中心医院肝胆胰脾外科行单孔腹腔镜胆囊切除术的100例患者,其中50例患者作为观察组行腹腔镜辅助腹直肌鞘阻滞,50例患者作为对照组行局部浸润麻醉。采用视觉模拟量表(VAS)疼痛评分进行术后2、6、12、24 h疼痛评分;记录术后患者首次下地活动时间。结果 术后2、6、12 h观察组疼痛明显轻于对照组(1.7±1.1 vs 3.1±1.1,P<0.001;1.7±1.2 vs 2.7±0.9,P<0.001;1.9±0.8 vs 2.4±0.8,P=0.001),在24 h两者无明显差异(1.7±1.0 vs 1.9±1.2,P=0.411)。术后首次下地时间观察组明显早于对照组(8.3±1.1 vs10.7±1.5,P<0.001)两组均无并发症。结论 腹腔镜辅助下腹直肌鞘阻滞是一种可由手术医师操作的、安全易行的、有效的围手术期镇痛方式。
文摘AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
文摘Purpose: Recently, reduced port surgery is becoming popular for laparoscopic surgery. “Reduced” means reducing the size or number of ports, but it is controversial as to which procedure is better. We evaluated double-incision laparoscopic cholecystectomy (DILC) and needlescopic cholecystectomy (NC) as reducing number or size of ports, respectively. Method: Patient records for 51 patients undergoing DILC and 22 patients undergoing NC were retrospectively evaluated. The patient and operation related variables of DILC and NC were compared by age, gender, body mass index (BMI), operative time, blood loss, length of postoperative hospital stay, numerical rating scale (NRS) pain score, and frequency to administer NSAIDs postoperatively for three days. Results: The operative times of both groups were similar (DILC 106 ± 31 min, NC 103 ± 35 min). Blood loss did not show any difference and each of them was small in amount (DILC 14 ± 29 ml, NC 22 ± 31 ml). Length of postoperative hospital stay of DILC (3.2 ± 0.4 days) was significantly shorter than that of NC (3.5 ± 0.7 days). Regarding postoperative pain, frequency to administer NSAIDs and pain score for three days postoperatively showed no significant difference. Conclusion: It is thought that DILC and NC have the same operative difficulty. As far as early postoperative pain was concerned, both procedures did not have any difference.
