Objective To assess the feasibility and adequacy of Harmonic Scalpel in a totally laparoscopic total mesorectal excision (TME) and low,ultralow,colo-anal anastomoses for rectal cancer. Methods Excision of the mesorectum and low，ultralow site anastomoses were performed laparoscopically on 30 patients with low rectal cancer based on the concept of TME. Results All 30 TME were successfully completed by laparoscopic approach, and no one was converted to open procedures. A cholecystectomy and/or an ovariotomy were meanwhile performed laparoscopically for 3 patients with rectal cancer,and 1 patient with chronic cholesyctitis, gallstone,ovarian cyst and torsion of the ovary. The operation time was 155 min (115-320 min). Operative blood loss was 20 ml (5-80 ml).The time of bowel function returned and the time to resume postoperative diet was 1-2 days after the operation. Fourteen patients had postoperative analgesic requirement. Average hospital stay was 8 days (5-14 days) and there were no intraoperative and postoperative complications in all 30 patients.Conclusion Laparoscopic excision of the mesorectum and low,ultralow,coloanal anastomoses with Harmonic Scalpel for low rectal cancer is a perspective minimally invasive technique, which is feasible, safe, effective and has dramatic high rates of sphincter preservation with decreased postoperative pain, rapid recovery.
直肠癌的发病率逐年上升，居消化道恶性肿瘤之首； 低位直肠癌位于腹膜返折以下，约占直肠癌总数的70%，其中约2/3属低位直肠癌患者需实施切除肛门的改道手术。所以，提高肿瘤切除率、降低局部复发率、提高5年生存率、提高保肛率及改善患者术后的生活质量一直是普外学科努力的方向。全直肠系膜切除术(total mesorectal excision, TME)这一具有划时代意义的创新术式，应用于临床20余年，降低了局部复发率，提高了5年生存率及保肛率，已为越来越多的结、直肠外科医生作为直肠癌治疗的金标准。随着TME理念的深入和腹腔镜技术的发展，腹腔镜全直肠系膜切除术（laparoscopic total mesorectal excision，LTME）及其保肛术式正在兴起，前瞻性临床研究已显示出良好的应用前景。
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
Atrial fibrillation (AF) is difficult to cure for its complex etiology and long disease duration. Heart failure, sudden death and stroke are the main causes for consequent high mortality and morbidity. In recent years, minimally invasive surgery has made rapid progress, not only improved treatment efficiency of traditional Cox Maze procedure but also massively reduced surgical injuries, and has become a preferred treatment strategy for lone AF. Minimally invasive surgery and catheter ablation complement each other, and are likely to open up a new prospect of AF treatment.
ObjectiveTo understand the psychological pressure when the surgeon-in-chief remotely completes animal surgery using home-made Tumai surgical robot in combination with 5G network (Abbreviated as“remote robotic surgery” ), and investigate and analyze the sources of psychological pressure, and then provide evidence guidance for the training of surgeon in performing remote robotic surgery. MethodsA modified perceptual stress scale was used to conduct a questionnaire survey. The 44 surgeons-in-chief with robot operation qualification from 10 medical units in the Gansu Province recruited by Gansu Provincial People’s Hospital were as observation subject, who participated in the psychological stress validation test of remote robotic surgery, from September 4, 2022 to October 10, 2022. The difference of psychological stress before and after the test was compared. The stressor of surgeon-in-chief was analyzed by Likert scale. The animals in this study were swines. ResultsA total of 132 valid questionnaires were obtained from 44 surgeons-in-chief. The surgical physician’s perceived stress score after the test was statistically higher than before the test [(47.50±9.06) points vs. (38.34±5.55) points, mean difference and its 95% confidence interval=9.61 (7.00, 12.27), t=7.42, P<0.001]. The analysis results of multiple linear regression showed that the number of robotic surgery performed by the surgeon-in-chief in the past had a negative impact on the psychological pressure of the surgeon-in-chief after the test (β=–0.292, P=0.042); At the same time, the subjective perception data of the surgeon-in-chief, such as unstability of signal transmission and unskilled equipment manipulation by the surgeon had positive impacts on the psychological pressure of the surgeon-in-chief after the test (β=1.987, P=0.026; β=3.184, P=0.010), and the tacit understanding between the surgeon-in-chief and the first assistant had a negative impact on the psychological pressure of the surgeon-in-chief after the test (β=–2.185, P=0.047). ConclusionsAccording to the data from this study, remote robotic surgery will increase the psychological pressure of the surgeon-in-chief. Previous experience in robotic surgery can reduce psychological stress after surgery. The main sources of psychological pressure are unstability of signal transmission, unskilled equipment manipulation by the surgeon, and the tacit understanding between the surgeon-in-chief and the first assistant.
Abstract： Objective To study thoracic bone remodeling and clinical effects after minimally invasive correctionfor pectus excavatum （PE） in children. Methods A retrospective review was conducted of a prospectively gathereddatabase of 74 child patients who underwent minimally invasive repair of PE at General Hospital of Beijing MilitaryDistrict between Apr. 2009 and Sept. 2010. Of the patients, 63 were males and 11 females; the age was（ 11.90±8.50）years, 11 patients ＜ 10-year-old among them. Under general anesthesia, two incisions were made at the side midaxillaryline, and the introducer created a tunnel at the trans-substernum and shaped the thoracic cavity. The bar was then insertedinto the retrosternum by video-assistant thoracoscopic monitoring. All patients were checked by chest computerizedtomography（CT） scan preoperatively and one week after operation, with three-dimensional reconstruction. The sagittalview was by means of the center line of the body of thoracic vertebrae. The distance between the sternum and the frontaledge of the body of thoracic vertebrae was measured and the return of displacement of the heart was observed. ResultsAll 74 operations were successful; there were no deaths. One bar was used for 66 patients （89.19%）, while two barswere used for the other 8 patients （10.81%）. Comparing the results of pre- with post-correction, for patients youngerthan 10 years（n=11） who had one bar placed, the inferior extremity of the manubrium and midsternum displacedforward to 3.76-22.92 mm. For 11-17 year-old patients（n=55） , anterior displacement of only the middle and lowerpart of the midsternum was 2.08-10.42 mm. There was a significant difference between the two groups in the inferiorextremity of the midsternum displaced（t=14.24, P ＜ 0.05）. For those patients with two bars, the inferior extremity ofthe manubrium and the midsternum were each displaced forward 4.19-15.03 mm at 7 d after operation. At 7 d after operation,the cardiac position in 65 patients（ 87.84%） of the all putted back by CT image. The chest shape of patients who received twobars was better than that of patients who received one bar. After 6-23 months of follow-up, it was pre-operative symptomsdisappeared in the patients, chest shape was satiation. Cardiac position in all patients was completely recovered. ConclusionThe thoracic bones of children with PE after minimally invasive repair have favorable remodeling. Older children requiregreater strength of support of the sternum during correction, but still realize a satisfactory therapeutic effect.