Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbi...Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction(NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSEprocedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.展开更多
妇科腹腔镜手术发展至今,技术日臻完善,但也面临着如何追求更微创、带给患者更人文关怀的问题,单孔腹腔镜手术（laparoendoscopic single site surgery,LESS）是基于近年来兴起的自然腔道内镜手术（natural orifice transluminal endosc...妇科腹腔镜手术发展至今,技术日臻完善,但也面临着如何追求更微创、带给患者更人文关怀的问题,单孔腹腔镜手术（laparoendoscopic single site surgery,LESS）是基于近年来兴起的自然腔道内镜手术（natural orifice transluminal endoscopic surgery,NOTES）的基本理念,即减少或隐藏手术瘢痕、减轻术后疼痛、促进术后康复而开展起来的,展开更多
AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and ...In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.展开更多
The energy dissipation of flood discharges has been one of important problems that affect directly the safety of hydropower projects. The energy dissipater with sudden reduction and sudden enlargement forms, used wide...The energy dissipation of flood discharges has been one of important problems that affect directly the safety of hydropower projects. The energy dissipater with sudden reduction and sudden enlargement forms, used widely in large-scale projects has been a kind of effective structure for energy dissipation. The concept of critical thickness was defined, which is related to both the geometric parameters and the hydraulic parameters of the energy dissipater, and the factors affecting the critical thickness, were analzsed by means of dimensional analysis. The empirical expression about the critical thickness was obtained and could be used as the criterion to distinguish the flows through the energy dissipater, i.e., the plug flow and the orifice plate flow. The error analysis showed that the critical thickness calculated by the expression has the errors of smaller than 10% in the estimation of the flows for the energy dissipater mentioned above.展开更多
Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer(EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection(ESD) has been wid...Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer(EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection(ESD) has been widely used for treatment of EGC along with expanding ESD indication, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis(LNM). Recently, new techniques including ESD or endoscopic full-thickness resection combined with sentinel node navigation enable minimal tumor resection and a laparoscopic lymphadenectomy in cases of EGC with high risk of LNM. This review covers the development and challenges of endoscopic treatment for EGC. Moreover, a new microscopic imaging and endoscopic techniques for precise endoscopic diagnosis and minimally invasive treatment of EGC are introduced.展开更多
文摘Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction(NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSEprocedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.
文摘妇科腹腔镜手术发展至今,技术日臻完善,但也面临着如何追求更微创、带给患者更人文关怀的问题,单孔腹腔镜手术（laparoendoscopic single site surgery,LESS）是基于近年来兴起的自然腔道内镜手术（natural orifice transluminal endoscopic surgery,NOTES）的基本理念,即减少或隐藏手术瘢痕、减轻术后疼痛、促进术后康复而开展起来的,
文摘AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.
文摘In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.
基金supported by the Ministry of Science and Technology of China(Grant No.2008BAB19B04)
文摘The energy dissipation of flood discharges has been one of important problems that affect directly the safety of hydropower projects. The energy dissipater with sudden reduction and sudden enlargement forms, used widely in large-scale projects has been a kind of effective structure for energy dissipation. The concept of critical thickness was defined, which is related to both the geometric parameters and the hydraulic parameters of the energy dissipater, and the factors affecting the critical thickness, were analzsed by means of dimensional analysis. The empirical expression about the critical thickness was obtained and could be used as the criterion to distinguish the flows through the energy dissipater, i.e., the plug flow and the orifice plate flow. The error analysis showed that the critical thickness calculated by the expression has the errors of smaller than 10% in the estimation of the flows for the energy dissipater mentioned above.
文摘Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer(EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection(ESD) has been widely used for treatment of EGC along with expanding ESD indication, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis(LNM). Recently, new techniques including ESD or endoscopic full-thickness resection combined with sentinel node navigation enable minimal tumor resection and a laparoscopic lymphadenectomy in cases of EGC with high risk of LNM. This review covers the development and challenges of endoscopic treatment for EGC. Moreover, a new microscopic imaging and endoscopic techniques for precise endoscopic diagnosis and minimally invasive treatment of EGC are introduced.
