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Objective To explore the efficacy of Hongjin Xiaojie Concentrated Pills combined with mifepristone on patients following laparoscopic resection of multiple uterine leiomyomas, as well as their effects on serum sex hormone levels, transforming growth factor-β1 (TGF-β1), and insulin-like growth factor binding protein-3 (IGFBP-3). Methods A total of 124 patients with multiple uterine leiomyomas who were treated in our hospital from June 2020 to June 2022 were selected for this study. The patients were randomly divided into two groups of 62 each. All patients underwent laparoscopic myomectomy (LM). The observation group received combined treatment with Hongjin Xiaojie Concentrated Pills and mifepristone postoperatively, while the control group received only mifepristone. After three months of continuous treatment, clinical efficacy was compared between the two groups. Serum sex hormone levels (estradiol [E2], follicle-stimulating hormone [FSH], luteinizing hormone [LH]), as well as TGF-β1 and IGFBP-3 levels, were measured before and after treatment. The incidence of adverse reactions was recorded, and all patients were followed up for at least 12 months to compare recurrence rates at 6 and 12 months postoperatively. Results The total effective rate in the observation group was 98.39% (61/62), significantly higher than the 87.10% (54/62) in the control group (P＜0.05). After treatment, serum levels of E2, FSH, LH, and TGF-β1 significantly decreased in both groups (P＜0.05), while IGFBP-3 levels significantly increased (P＜0.05). Post-treatment, the observation group had significantly lower serum levels of E2, FSH, LH, and TGF-β1, and significantly higher IGFBP-3 levels compared to the control group (P＜0.05). The recurrence rates at 6 and 12 months post-surgery in the observation group were 1.61% and 4.84%, respectively, compared to 6.45% and 16.13% in the control group; the observation group had a significantly lower recurrence rate at 12 months (P＜0.05). The incidence of adverse reactions in the observation group was 6.45%, while it was 14.52% in the control group, with no significant difference between the two groups (P＞0.05). Conclusion The combination of Hongjin Xiaojie Concentrated Pills and mifepristone after laparoscopic myomectomy for multiple uterine leiomyomas effectively regulates serum sex hormones and levels of TGF-β1 and IGFBP-3, enhances clinical efficacy, and reduces postoperative recurrence. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical therapeutic effects of Laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration and primary suture (LBEPS) and LC + laparoscopic common bile duct exploration through cystic duct ( LTCBDE) . Methods The clinical data of 64 patients with cholecystolithiasis complicated with choledocholithiasis treated by LC + LBEPS and LC + LTCBDE from January 2018 to June 2023 were analyzed retrospectively, including 35 patients with LC + LBEPS and 29 patients with LC + LTCBDE. Besides, the operation time, intraoperative bleeding, abdominal drainage time, operation success rate, total hospitalization time, total hospitalization expenses, surgical complications and stone recurrence rate between the two groups were compared. Results There was no significant difference in baseline data, surgical success rate and postoperative complication rate between these two groups (P > 0.05). The operation time, blood loss, abdominal drainage time, total hospitalization time and total hospitalization cost in the LC + LBEPS group were significantly higher than those in LC + LTCBDE group (P < 0.05). Conclusions LC + LBEPS and LC + LTCBDE are two effective treatment methods for cholecystolithiasis complicated with choledocholithiasis without T tube. However, LC + LTCBDE has lower operation time, intraoperative bleeding, abdominal drainage time, total hospitalization time and total hospitalization cost, as well as better clinical treatment effect, so that it can be preferred on the premise of meeting surgical indications. [ABSTRACT FROM AUTHOR]

The pedicle torsion or red degeneration of uterine fibroids during pregnancy can cause abdominal pain and induce miscarriage. The conservative treatment with drugs is considered the gold standard. However, the surgical treatment may be performed during pregnancy if necessary, if the abdominal pain cannot be relieved. Surgery can be performed by laparotomy or laparoscopy to remove uterine fibroids, based on the type, size and location of uterine fibroids, the gestational age and the doctor′s experience. However, the surgery by singleport laparoscopy to remove uterine fibroids during the second trimester of pregnancy is rarely reported. This case was a threatened abortion caused by degeneration of multiple uterine fibroids in the second trimester. It was diagnosed as type Ⅵ uterine fibroids by magnetic resonance imaging. After the conservative treatment failed, a single -port laparoscopic myomectomy was performed. After operation, the pregnancy was going on, and successfully carried to term birth. This case provides a practical reference of the laparoscopic application in uterine myomectomy during pregnancy. [ABSTRACT FROM AUTHOR]

Objective To compare the therapeutic efficacy of robot-assisted laparoscopic radical prostatectomy versus conventional laparoscopic radical prostatectomy, and analyze the factors influencing treatment outcomes. Methods A retrospective cohort study was conducted on 719 patients (total cohort) who underwent radical prostatectomy in our department from June 2002 to October 2023. According to different surgical methods, they were divided into robot-assisted laparoscopic radical prostatectomy group (robotic group, n=409) and conventional laparoscopic radical prostatectomy group (conventional group, n=310). Clinical characteristics, biochemical recurrence rates, and recovery of urinary continence at 1, 3, 6, and 12 months postoperatively, as well as sexual function recovery at 6 and 12 months after surgery, were compared between the 2 groups. Additionally, the factors influencing biochemical recurrence and urinary continence recovery were analyzed across the entire cohort. Results In the cohort, the robot group demonstrated significantly larger proportions of pathological high T stages (≥pT3, P < 0.01), increased positive lymph node rate (P < 0.01), and greater number of dissected lymph nodes (P < 0.01) than the conventional group. There were no statistical differences between the 2 groups in terms of Gleason score, biochemical recurrence rate, or incidence and type of complications. The robot group exhibited significantly higher rates of urinary continence recovery at 1 (P=0.004), 3 (P < 0.01), 6 (P=0.002) and 12 months (P=0.004) postoperatively. But no obvious difference was seen in the score of International Index of Erectile Function-5 (IIEF-5) between the 2 groups at 6 and 12 months. Across the entire cohort, pathological high T stage (≥pT3, P < 0.01), high Gleason score (>7, P=0.036), fewer lymph nodes dissected (≤10, P < 0.01), and positive lymph nodes (P=0.046) were independent risk factors for biochemical recurrence. Additionally, the surgical method, specifically robot-assisted laparoscopic radical prostatectomy, was identified as a significant factor influencing urinary continence recovery at 12 months postoperatively (P=0.005). Conclusion Compared to conventional laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy shows certain effect on reducing biochemical recurrence rate and enhancing recovery of urinary continence in prostate cancer patients at 1, 3, 6 and 12 months postoperatively.

Objective To investigate the clinical efficacy of laparoscopic peritoneal vaginoplasty (Luohu Type II) in the treatment of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Methods A retrospective analysis was conducted on the clinical data of 221 patients with MRKH syndrome treated at the Third Affiliated Hospital of Shenzhen University (Shenzhen Luohu People's Hospital) between January 2020 and April 2024.The patients were aged between 17 and 35 years, with an average age of (22±8) years. All patients underwent laparoscopic peritoneal vaginoplasty (Luohu Type II). Surgical time, hospital stay, intraoperative blood loss, and postoperative clinical outcomes were analyzed. Results All 221 patients in this group successfully underwent laparoscopic peritoneal vaginoplasty. The surgical time ranged from 25 to 100 minutes, with an average of (35±23) minutes. The hospital stay ranged from 15 to 29 days, with an average of (20±5) days. Intraoperative blood loss was between 10 and 100 mL. The preoperative vaginal indentation depth was 0.5 to 3 cm, and postoperative vaginal depth was (10±2) cm. The difference was statistically significant (P

Adult intussusceptions are a rare cause of abdominal obstruction and are usually associated with a neoplastic disease; idiopathic forms are extremely rare. We report a case of enterocolic intussusception in a young woman who experienced symptoms of abdominal obstruction. Imaging findings were reported. On histological examination, no underlying diseases were found. The patient presented at the hospital for computed tomography because of persistent abdominal pain. Computed tomography revealed an enterocolic invagination involving the ileocecal valve and cecum and widespread edematous thickening of the colonic parietal walls. Idiopathic enterocolic intussusception is an uncommon abdominal urgency in adults. Symptoms can be vague and persistent, delaying an accurate diagnosis. Imaging is crucial in these circumstances to make a diagnosis. Some computed tomography findings, such as a target-like bulk, may be suggestive.

Objective To evaluate the application effect of the three-dimensions(3D) technology in teaching laparoscopic surgical skills in urology. Methods Eighteen clinical interns who rotated in the urology department of Peking Union Medical College Hospital from July 2023 to March 2024 were randomly divided into a test group and a control group with 9 in each. The test group received laparoscopic operation skill training using 3D reconstruction and 3D printing technology, while the control group received laparoscopic operation skill training using conventional methods. After one month of rotating training, two groups of interns underwent laparoscopic operation skill assessment, and the training outcomes were evaluated using a survey questionnaire. Results The laparoscopic operation skill assessment scores of the test group and the control group were (94.33±2.12) and (88.11±2.39) points, respectively (P＜0.01). In terms of clinical skills, the test group showed a significant improvement in skill of clinical performance. According to the feedback from the survey questionnaire, the test group showed satisfaction from trainees and trainers as compared to the control group. Conclusions The 3D digital technology in laparoscopic operation skill training can significantly improve the outcomes of laparoscopic operation skill of interns. The satisfaction of the teaching mode is high among both trainers and trainees, so it is a potential and effective teaching method for the training of interns in department of urology.

Objective: To explore the effectiveness of laparoscopic hook needle hernia ring closure in patients with inguinal incarcerated hernia, as well as the risk factors for postoperative recurrence and chronic pain. Methods: A total of 92 patients with inguinal incarcerated hernia admitted to our hospital from January 2018 to December 2021 were selected, they underwent laparoscopic crochet hernia ring closure surgery. The surgical conditions of all patients were analyzed, and postoperative recurrence and chronic pain were used as variables. Logistic regression models were used to analyze the risk factors for postoperative recurrence and pain in inguinal incarcerated hernia patients. Results: The incidence of postoperative complications was 7.61% (7/92), with 4 cases of subcutaneous hematoma, 1 case of incision infection, 1 case of postoperative bleeding, and 1 case of delayed intestinal perforation. After 2 years of follow-up for all patients, the incidence of postoperative chronic pain was 16.30% (15/92), including 5 cases of mild pain, 7 cases of moderate pain, and 3 cases of severe pain. The postoperative recurrence rate was 10.87% (10/92); There was no difference in gender, age,comorbidities, hernia anatomical classification, lesion location, postoperative drainage, patch type, and emergency surgery between the chronic pain group and the non chronic pain group (P＞0.05). However, there was a significant difference in BMI, number of surgeries,intraoperative neuroprotection, and preoperative pain in the operating area between the chronic pain group and the non chronic pain group (P＜0.05). There was no difference between the recurrent group and the non recurrent group in terms of age, coronary heart disease,number of operations, intraoperative nerve protection, lesion location, postoperative drainage, patch type, preoperative pain in the operating area (P＞0.05). There were significant differences between the recurrent group and the non recurrent group in terms of gender,BMI, diabetes, hypertension, hernia anatomy classification, and emergency surgery (P＜0.05); BMI, diabetes, hypertension and hernia anatomy were classified as independent risk factors for recurrence after inguinal pin hernioplasty for incarcerated hernia (P＜0.05); BMI,number of surgeries, and preoperative pain in the operating area are independent risk factors for postoperative chronic pain in inguinal incarcerated hernia treated with inguinal needle closure, while intraoperative neuroprotection is a protective factor (P＜0.05). Conclusion: Laparoscopic hook needle herniorrhaphy for inguinal incarcerated hernia is effective and safe. However, some patients still have postoperative recurrence and chronic pain. BMI, diabetes, hypertension and hernia anatomy are risk factors for postoperative recurrence. BMI, number of surgeries, and preoperative pain in the surgical area are risk factors for postoperative chronic pain, while intraoperative neuroprotection is a protective factor. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the clinical and pathological differences between pregnant and non -pregnant women with adnexal torsion (AT). Methods: A retrospective analysis was conducted on the clinical data of 376 AT patients who were hospitalized in the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2017 to November 2023, including 72 pregnant women with AT and 304 non -pregnant women with AT. Based on gestational weeks, pregnant women with AT were divided into the first trimester group (≤14 weeks) with 47 cases and the second and third trimester group (＞14 weeks) with 25 cases. A comparative analysis of the clinical data between these groups was performed. Results: ① The proportion of vomiting, abdominal pain time ＜24 hours, persistent abdominal pain, the count of white blood cell and the percentage of neutrophil in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). ② The rates of laparotomy, conservative surgery and postoperative pathology of luteal cyst in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). The diameter of adnexal mass, the proportion of mature teratoma, mucinous cystadenoma and endometriosis cyst by postoperative pathology in pregnant women with AT were significantly lower than those in non-pregnant women with AT (P＜0.05). ③ Compared to the second and third trimester AT group, in the first trimester AT group, the proportion of assisted reproductive technology, laparoscopic surgery and conservative surgery, and the diameter of adnexal mass were higher, the proportion of pathological cysts and the degree of torsion were significantly lower (P＜0.05). Conclusions: The presence of symptoms such as lower abdominal pain, nausea and vomiting during pregnancy necessitates consideration of AT, especially in early pregnancy or following assisted reproductive technology, the pathology is often corpus luteum cysts. The treatment of AT during pregnancy, whether laparoscopic or open surgery, is safe and reliable, without adversely impacting pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and feasibility of indocyanine green guided preservation of the superior rectal artery in patients undergoing laparoscopic radical resection for sigmoid cancer. Methods A total of 73 patients who underwent laparoscopic radical resection of sigmoid cancer in the Department of General Surgery of Xuzhou Central Hospital from October 2019 to February 2024 were analyzed retrospectively. The patients were randomly divided into SRA group (superior rectal artery preservation, n=30) and control group (inferior mesenteric artery high ligation, n=43). The operation time, intraoperative blood loss, incidence of anastomotic fistula and total number of lymph node dissection were compared between the two groups. Results All patients completed the operation successfully and there was no perioperative death. There was no significant difference in operation time, intraoperative blood loss and total number of lymph node dissection between two groups (P＞0.05). The incidence rate of anastomotic fistula in control group was slightly higher than that in SRA group, but the difference was not significant ［14.0%(6/43) vs 0, χ2=2.899, P=0.089］. Conclusion In laparoscopic radical resection for sigmoid cancer, the application of indocyanine green-guided preservation of SRA while ensuring the clearance of group 253 lymph nodes, compared to traditional high ligation of the inferior mesenteric artery, does not affect the duration of surgery, blood loss, surgical safety, or the number of excised lymph nodes. It plays a certain role in reducing the occurrence of anastomotic fistula.

Objective To evaluate the feasibility and effectiveness of enhanced recovery after surgery (ERAS) in minimally invasive surgery for adrenal tumors. Methods A total of 139 patients underwent retroperitoneal laparoscopic adrenalectomy were selected in this study. The maximum tumor diameter was ≤ 6.0 cm. According to the perioperative plan, patients were divided into the ERAS group (n=65) and the conventional group (n=74). The general information (age, gender, tumor location and tumor diameter), surgical indicators (surgical time and surgical blood loss), postoperative rehabilitation indicators (first off-bed ambulation time, first exhaust time, postoperative catheterization time, postoperative drainage tube retention time and postoperative hospitalization time) and incidence of complications were compared between two groups of patients. Results There were no significant differences in gender, age, tumor location, tumor diameter, surgical time and surgical blood loss between the two groups of patients (P＞0.05). In the ERAS group, first off-bed ambulation time, first exhaust time, the indwelling duration of catheters and drainage tubes were shorter than those in the conventional group, and the overall incidence of postoperative complications was lower in the ERAS group than that in the conventional group (P＜ 0.05). Conclusion The ERAS protocol is safe and feasible for minimally invasive surgery in patients with adrenal tumors with a maximum tumor diameter of ≤ 6.0 cm. [ABSTRACT FROM AUTHOR]

Objective To evaluate the application effect of the three-dimensions (3D) technology in teaching laparoscopic surgical skills in urology. Methods Eighteen clinical interns who rotated in the urology department of Peking Union Medical College Hospital from July 2023 to March 2024 were randomly divided into a test group and a control group with 9 in each. The test group received laparoscopic operation skill training using 3D reconstruction and 3D printing technology, while the control group received laparoscopic operation skill training using conventional methods. After one month of rotating training, two groups of interns underwent laparoscopic operation skill assessment, and the training outcomes were evaluated using a survey questionnaire. Results The laparoscopic operation skill assessment scores of the test group and the control group were (94.33±2. 12) and (88.11±2.39) points, respectively (P<0.01). In terms of clinical skills, the test group showed a significant improvement in skill of clinical performance. According to the feedback from the survey questionnaire, the test group showed satisfaction from trainees and trainers as compared to the control group. Conclusions The 3D digital technology in laparoscopic operation skill training can significantly improve the outcomes of laparoscopic operation skill of interns. The satisfaction of the teaching mode is high among both trainers and trainees, so it is a potential and effective teaching method for the training of interns in department of urology. [ABSTRACT FROM AUTHOR]

This paper summarized the nursing practice of Traditional Chinese Medicine emotion regulation in relieving anxiety of a patient undergoing total laparoscopic hysterectomy. Based on the routine care, a comprehensive plan of emotion regulation including psychological support, relaxation training; music-guided imagination and interview-based interventions were carried out to relieve the anxiety before and after surgery, and improve the patient’s sleep quality and postoperative recovery. (本文总结1例应用中医情志护理三部曲缓解腹腔镜子宫全切术患者围手术期焦虑状态的护理体会。在常规护理基础上, 采用心理支持、放松训练、引导性音乐想象及访谈干预措施, 有效缓解患者术前、术后焦虑情绪, 改善患者睡眠质量, 促进早期康复。)

Objective To investigate the predictive factors for positive surgical margin after laparoscopic radical prostatectomy. Methods A retrospective analysis was performed for the clinical data of 238 patients with prostate cancer who received laparoscopic radical prostatectomy in Department of Urinary Surgery, The Affiliated Hospital of Qingdao University from June 2018 to May 2022, and they were divided into negative margin group and positive margin group according to postoperative pathology. Related data of two groups were compared, including general clinical data (age, body mass index, prostate volume, and surgical procedure), preoperative serum total prostate-specific antigen (TPSA), related indices [TPSA, free prostate-specific antigen/TPSA ratio, and prostate-specific antigen density (PSAD)], puncture-related factors (percentage of positive biopsy cores and preoperative puncture Gleason score), and preoperative MRI radiological features (preoperative clinical stage, prostate imaging report and Prostate Imaging Reporting and Data System score, location of abnormal tumor signal on mpMRI, site of abnormal tumor signal on mpMRI, membranous urethra length on mpMRI, and maximum transverse diameter of abnormal tumor signal on mpMRI), and the influencing factors for positive margin after laparoscopic radical prostatectomy were analyzed. Results There were significant differences between the two groups in serum TPSA, serum PSAD, preoperative puncture Gleason score, preoperative percentage of positive biopsy cores, preoperative clinical stage, and location of abnormal signal on mpMRI (χ2=22.539-62.367,P

Objective To investigate the technique and dosage selection of indocyanine green(ICG) fluorescence staining in laparoscopic anatomical hemihepatectomy. Methods A retrospective cross-sectional study was conducted. The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed, and the management of the Glissonean pedicle, the method and effect of ICG fluorescence staining during the operation, the dose of ICG injection, and the postoperative recovery were analyzed. Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study, including 28 right hemihepatectomies and 63 left hemihepatectomies. The Glissonean pedicle was dissected intra-sheath in 9 cases and extra-sheath in 82 cases. ICG fluorescence staining was all performed using the negative staining method, of which 69 cases(75.8%) were successfully stained. The success rate of staining in the extra-sheath dissection and low-dose ICG group was higher than that in the intra-sheath dissection and high-dose ICG group. The average operation time was (168.5±32.2) minutes, the intraoperative bleeding volume was (152.4±56.3) ml, and the intraoperative blood transfusion rate was 6.6% (6/91), the average postoperative hospital stay was (8.5±2.6) days. One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle. Four cases had Clavien-Dindo Ⅰ-Ⅱ complications, all of which improved after treatment. There were 3 cases of grade Ⅲa complications, all of which were caused by bile leakage and abdominal cavity infection. They were cured by puncture and drainage. And there were no serious complications above grade Ⅲb. Conclusions In laparoscopic anatomical hemihepatectomy, the ICG fluorescence staining method was recommended to use the negative staining method of the extra-sheath dissection of the Glissonean pedicle, and a lower dose of ICG could help to increase the success rate of fluorescence staining.

Objective To explore the advantages of laparoscopic total extraperitoneal Sublay (TES) mesh repair for lumbar hernia, and to analyze the complications after lumbar hernia repair surgery. Methods Sixty-eight patients with lumbar hernia were divided into the open Sublay group (n=30) and the TES group (n=38). All patients were treated with lightweight, large mesh patches. The time of operation, the amount of bleeding during operation, the time of first exhaust after operation, the diet at 6 hours after operation, the pain visual analogue scale (VAS) at 1 and 3 days after operation, the time of hospitalization after operation, the recovery of unrestricted activity at 2 weeks after operation, the complications and the recurrence of lumbar hernia were observed in the two groups. According to the postoperative complications, patients were divided into two groups: the complication group (n=22) and the non-complication group (n=46). The characteristics of postoperative complications of lumbar hernia were analyzed. Results There was no significant difference in the time of operation between the open Sublay group and the TES group. Compared with the open Sublay group, there were decreased intraoperative blood loss, the earlier first exhaust time, the lower pain VAS score on the 1st and 3rd day after operation, the more proportion of patients resumed fluid diet at 6 h after operation, the shorter hospital stay, increased non-restrictive activity in two weeks and reduced complication rate in the TES group (P＜0.05). No recurrence occurred in all patients during the follow-up period. Compared with the non complication group, the complication group had a higher proportion of patients with age ≥ 60 years, secondary lumbar hernia, hernia sac diameter ≥ 5 cm, preoperative incarceration, open sublay, surgical time ≥ 100 minutes and intraoperative bleeding ≥ 10 mL (P＜0.05). Conclusion Laparoscopic TES repair for lumbar hernia has the advantages of faster recovery and fewer postoperative complications compared to open Sublay repair, which is safer and more effective. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy of laparoscopic repeat ureteral end-side anastomosis for complete repeat suprarenal ureteral dilatation or ectopic opening and summarize the related operational approaches and experiences. Methods From October 2018 to August 2022, the relevant clinical data were retrospectively reviewed for 23 children with complete duplex kidney undergoing laparoscopic end-to-side ureterostomy. There were 9 boys and 14 girls with a median age of 15(8-26) month. The major clinical manifestations included urinary leakage, febrile urinary tract infection and a combination of both. Anteroposterior diameter of upper renal pelvis and diameter of upper ureter were measured before and after operation. The curative outcomes and complications were recorded. Results All laparoscopic procedures were successfully performed and followed up completely. Operative duration was 100(90-120) min and ureteral stent indwelled for 36(32-41) days. After operation, all preoperative symptoms disappeared. Blood pressure remained normal before and after operation. There was no onset of lower ureteral dilatation before and after operation. Before operation, anteroposterior diameter of upper renal pelvis was (15.22±9.19) and the widest diameter of upper ureter (13.91±5.98); after operation, anteroposterior diameter of upper renal pelvis was (6.87±6.36) and the widest diameter of upper ureter (3.83±1.95). Anteroposterior diameter of upper renal pelvis and the widest diameter of upper ureter before and after operation were compared ( P<0.05). The differences were statistically significant ( P<0.05). None of them showed recurrent fever, abdominal pain or vomiting. No dilation occurred in lower ureter or lower renal pelvis. Conclusions Laparoscopic repeated end-to-side ureteroureterostomy is efficacious for children with complete repetitive upper ureteral lesions. As a simple operation with few complications, it is worthy of wider popularization. [ABSTRACT FROM AUTHOR]

Objective To conduct a preliminary study of clinical experience of laparoscopic-assisted versus transanal Soave alone for common type of congenital megacolon (Hirschsprung's disease, HSCR) aged from 0 to 4 years. Methods For this retrospective study, 128 HSCR children operated from January 2011 to December 2022 with complete data were included. According to surgical approach and age, they were assigned into four groups of laparoscopic-assisted transanal Soave 0~2 years (A, n=37), laparoscopic-assisted transanal Soave 2~4 years (B, n=28), simple transanal Soave 0~2 years (C, n=38) and simple transanal Soave 2-4 years (D, n=25). General profiles, surgery-related parameters, postoperative hospitalization complications and follow-up complications were compared. Results Comparing groups A and C, no statistically significant difference existed in gender, age, weight, intraoperative hemorrhage, postoperative hospitalization time, time to resume eating/drinking, postoperative hospitalization complications or follow-up complications (P>0.05). Орeration duration in groups A and C was (108.78±14.26) and (95.13±11.18) min, anal operative duration (36.46 ±5.32) and (79.08 ±10.96) min and length of resected diseased intestinal tubes (27.11 ±4.92) and (23.16 ±3.37) cm respectively. The differences were statistically significant (P<0.05). Comparing groups B and D, gender, age, weight, operative duration, intraoperative hemorrhage and time to resume eating/ drinking were not statistically significant (P>0.05). Anal operation time in groups B and D was (45.54 ± 6.98) and (110.20±14.61) min, postoperative hospitalization time (8.14±1.43) and (9.60±1.78) day, length of resected diseased intestinal tubes (31.61±6.81) and (27.40±7.38) cm, postoperative hospitalization complication rates 0 and 16.0% and follow-up complication rate 21.4% and 48.0% respectively. The differences were statistically significant (P<0.05). Conclusions For HSCR children aged 0-2 years, no significant difference exists in complication rate between laparoscopic-assisted and transanal Soave alone. Laparoscopic-assisted transanal Soave is preferred if there is difficulty in dragging out intestinal tube or difficulty in liberating it. For HSCR children aged 2~4 years, complication rate of transanal surgery alone is higher than that of laparoscopy so that laparoscopy is recommended. [ABSTRACT FROM AUTHOR]

Objective To evaluate the safety of laparoscopic radical prostatectomy in patients with oligometastatic prostate cancer・ Method A retrospective analysis was carried out on 55 patients with prostate cancer admitted ftom January 2017 to December 2021, including 22 patients in the oligo-metastatic group and 33 patients in the localized group. Perioperative indicators and incidence of surgical complications were compared between the two groups. Result According to Clavien-Dindo complication classification, the incidence of grade I and II mild complications in the two groups was 36. 3% and 15.2%, respectively, with no statistically significant difference（ P >0> 05 ）・ No grade in, IV, V moderate and severe complications occurred in the patients in two groups. Conclusion Through preoperative evaluation, it is safe and feasible to perform radical prostatectomy on patients with oEgometastatic prostate cancer, and a large number of patients with oligometastatic prostate cancer may benefit from it. [ABSTRACT FROM AUTHOR]

Objective To compare the perioperative complications and explore the potential factors contributing to the differences in complications between laparoscopic and open dismembered pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children. Methods Between July 2016 and December 2018, retrospective review was conducted for all children with ureteropelvic junction obstruction (UPJO) undergoing primary transperitoneal laparoscopic pyeloplasty (LP) and retroperitoneal open pyeloplasty (OP) Perioperative complications were compared between LP and OP. Complication rate, Clavien-Dindo grade and types were compared. Complications were also compared between different postoperative drainage modes and groups with or without intraoperative complications. Also the differences in postoperative complications were explored among groups with varying age, weight, anterioposterior pelvic diameter (APD) and surgeon expertise. Results For 583 UPJO kidneys, LP was performed for 355 kidneys and OP for 228 kidneys. The median age of the open group was 16.37 months (9.73 months, 61.37 months) and the median weight was 11.00 kg (9.30 kg, 20.00 kg), which were significantly lower than the median age of the laparoscopic group, which was 46.87 months (19.08 months, 90.49 months), and the median weight of 16.50 kg (12.00 kg, 25.00 kg). The median preoperative renal pelvis anteroposterior diameter in the open group was 39.00 mm (27.00 mm, 52.00 mm), significantly larger than that of the laparoscopic group, which was 28.00 mm (22.00 mm, 36.00 mm). These differences were statistically significant ( P<0.05). The inter-group incidence of intraoperative complications showed no significant difference (LP: 7.61% vs OP: 4.39%). Also no significant inter-group difference existed in restenosis of anastomotic rate (LP: 2.62% vs.OP: 1.33%). Although no significant inter-group difference in the incidence or frequency of postoperative complications, types of complications differed. Urinary tract infections (UTIs) dominated in both groups. Kidneys with intraoperative complications were more prone to higher grades of postoperative complications (χ²=5.600, P=0.018) and UTIs (χ²=8.891, P=0.003). As compared with OP group, LP group showed a higher propensity for high-grade postoperative complications (Clavien Ⅲb) (χ²=6.595, P=0.010) and other complications (χ²=10.289, P=0.001), except for UTIs. Conclusions LP and OP are both safe and effective in UPJO children. However, types of complications differ. As compared with OP, LP requires a higher alert for the occurrence of complications and high-grade postoperative complications, except for UTIs. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors of unplanned reoperation (UR) after laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction (UPJO) and examine the clinical characteristics of UR children. Methods From March 2010 to December 2023, the relevant clinical data were retrospectively reviewed for 678 children of unilateral UPJO undergoing LP. Children undergoing UR after LP were selected as study group and those without UR as control group. Gender, age, history of nephrostomy, Society of Fetal Urology (SFU) grade, surgical proficiency and postoperative hospitalization stay of two groups were collected for univariate and multivariate Logistic regression analyses. Statistical analysis was performed with SPSS version 26.0 software package. Results Among them, 19(2.8%) cases underwent UR. According to the timing of reoperation, it was assigned into short-term and long-term URs. Four children (4/678, 0.6%) underwent short-term UR for uroabdomen and allantois due to anastomotic leakage, varying degrees of intestinal obstruction and abdominal infection. Long-term UR was performed in 15 children (15/678, 2.2%) for recurrent UPJO, aggravation of hydronephrosis, recurrent abdominal pain, urinary tract infection and hematuria. According to univariate analysis, anteroposterior diameter (APD), postoperative hospitalization stay, surgical proficiency, preoperative severity of hydronephrosis and presence of percutaneous nephrostomy were associated with UR ( P<0.05). Based upon multivariable analysis, APD ( OR=1.278, 95% CI: 1.069-1.528), postoperative hospitalization stay ( OR=1.165, 95% CI: 1.094-1.239), surgical proficiency ( OR=1.165, 95% CI: 1.094-1.239) and presence of percutaneous nephrostomy ( OR=17.817, 95% CI: 3.291-96.446) were the strongest predictors of UR ( P<0.05). Conclusions APD, postoperative hospitalization stay, surgical proficiency and presence of percutaneous nephrostomy are correlated with UR. Timely renal ultrasonography, evaluation of renal function, accurate intraoperative handling and a lowered risk of complications are vital for preventing and minimizing UR. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical features and outcomes of massive urinary extravasation after pyeloplasty in children. Methods From January 2016 to December 2023, the relevant clinical data were retrospectively reviewed for 18 children with massive urinary extravasation after pyeloplasty. Demographic profiles, medical history, perioperative images, urinary extravasation during hospitalization, and treatment outcomes were recorded. Results There were 16 boys and 2 girls with an operative age of (6.03±4.79) year. Obstruction was located at left ( n=16) and right ( n=2). Length of hospitalization stay was 20 (13-24) day and median duration of massive postoperative urinary extravasation 2(1-20) day. In 17/18 children, abdominal drainage tube was retained for a median duration of 11(8-15) day. The highest volume of abdominal drainage fluid withinin a single day was 485(298-786) ml. Clavien-Dindo grade of postoperative complications was Ⅰ ( n=8), Ⅱ ( n=4) and Ⅲb ( n=6).The frequency of reoperation during hospitalization was 33.33%(6/18). The perioperative APD were (4.11±1.83) and 2.40(1.58, 4.53) cm with statistically significant difference ( Z=-2.628, P=0.009). Perioperative PTmin was 0.6(0.2, 0.8) and (0.93±0.32) cm with statistically significant difference ( Z=-2.580, P=0.011). Perioperative ratio of APD/PT was 6.05(2.85-13.44) and 2.64(1.95-5.73) with statistically significant difference ( Z=-2.940, P=0.002). Postoperative values of APD, PTmin, and APD/PT significantly improved as compared preoperatively. PI-APD was 20.95%(-0.45%, 60.91%). There were two cases of postoperative re-obstruction. Overall success rate of operation was 88.89%(16/18). Conclusions Severe urinary extravasation after pyeloplasty may result in an extended duration of hospitalization and an elevated probability of reoperation. However, the occurrence of re-obstruction after pyeloplasty with massive urine extravasation remains low. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of laparoscopic salpingectomy on ovarian reserve function and serum neuropeptide Y （NPY） and cortisol （Cor） in patients with ectopic pregnancy. Methods 82 patients with ectopic pregnancy who had visited Chaohu Hospital Affiliated to Anhui Medical University from June 2018 to June 2021 were randomly divided into two groups, with 41 in each group. The control group underwent laparoscopic salpingostomy and suturing for embryo retrieval, while the study group underwent laparoscopic salpingectomy. Surgical duration, intraoperative blood loss, time to postsurgical mobilization, length of hospital stay, serum NPY and Cor levels, antral follicle count （AFC）, indexes for peak flow velocity and resistance of ovarian artery were compared between the two groups. Follow-up was conducted for two years after surgery, and the success rate of pregnancy and the ectopic pregnancy rate were recorded. Results The surgical duration in the study group was shorter than that in the control group （P < 0.05）. The differences in serum NPY and Cor values between the two groups immediately after surgery and at postoperative week one were not statistically significant （P > 0.05）. At postoperative months1 and 6, the peak flow velocity of the affected ovary was lower in the study group than in the control group, whereas the resistance index was higher （P < 0.05）. At postoperative month 6, both groups showed an increase in peak flow velocity and a decrease in resistance index （P < 0.05）. There were no statistically significant differences in AFC and the success rate of pregnancy between the two groups postoperatively （P > 0.05）. The ectopic pregnancy rate in the study group was lower than that in the control group （P < 0.05）. Conclusion As compared with laparoscopic salpingostomy, laparoscopic salpingectomy for ectopic pregnancy can also preserve postoperative ovarian antral follicle count （AFC）, and it has greater advantage in reducing the risk of recurrent ectopic pregnancy after surgery. [ABSTRACT FROM AUTHOR]

With the development of laparoscopic technology in urology, the training of laparoscopic technology operator plays an extremely important role in the specialized education process from medical students to specialist physicians. With various medical students being included in standardized training for specialized physicians, many problems such as uneven quality of trainees appeared, lack of standardization in the training process, deviation in training target positioning, and insufficient quality control management methods. This article explored the construction of a standardized tiered training system for laparoscopic techniques in the urology department of Peking Union Medical College Hospital, including cultural construction, training mode system, assessment mechanism and trainers′ development. By constructing the special model for laparoscopic technology training in urology, it would lay a solid foundation and provide experience for building a standardized training system of laparoscopy in urology.

Objective To explore the effect of individualized positive end expiratory pressure guided by driving pressure on lung protection after laparoscopic radical gastrectomy for elderly patients. Methods A total of 64 patients underwent elective laparoscopic radical gastrectomy for gastric cancer in the Second Affiliated Hospital of Anhui Medical University were selected. According to the random number table method, patients were divided into the driving the pressure guided individualized positive end-expiratory pressure (PEEP) group (experimental group) and the fixed PEEP group (control group), 32 cases in each group. In the control group, PEEP = 5 cmH2O. In the experimental group, PEEP titration was performed according to the increasing method, and the PEEP corresponding to the lowest driving pressure was selected until extubation. Peak airway pressure (Ppeak), plateau airway pressure (Pplat) and PEEP were recorded at 5 min after intubation (T1), immediately after PEEP titration (T2), 1 h after operation (T3), 2 h after operation (T4), and 10 min after pneumoperitoneum release (T5). Driving pressure (ΔP) and lung dynamic compliance (Cdyn) were calculated. Arterial blood was collected at T1-5 for blood gas analysis, arterial partial pressure of oxygen (PaO2) was recorded, and oxygenation index (OI) was calculated. The occurrence of pulmonary complications (PPCs) within 7 days after operation was recorded. Modified clinical pulmonary infection score (mCPIS) was recorded on the second day after operation. The pulmonary function was evaluated before operation, 1 day, 3 days and 5 days after operation. Results Compared with T1, Ppeak, Pplat and ΔP were increased and Cdyn was decreased at T2-5, while OI was decreased at T4 in control group (P＜0.05). Compared with the control group, Ppeak, Pplat and Cdyn in the experimental group were increased at T2-5, ΔP was decreased, and OI was increased at T3-5 (P＜0.05). Compared with the preoperative results, FVC at 1, 3 and 5 days after surgery was decreased, and FEV1 and maximum expiratory flow (PEF) were decreased 1 and 3 days after surgery in the experimental groups (P＜0.05). Compared with the control group, FVC, FEV1 and PEF were higher 1 day after operation in the experimental group (P＜ 0.05). Compared with the preoperative results, mCPIS scores of the two groups were higher on the second day after surgery (P＜0.05). Compared with the control group, the mCPIS score was lower on day 2 after surgery in the experimental group (P＜0.05). The incidence of PPCs within 7 days after surgery was lower in the experimental group than that in the control group (15.6% vs. 40.6%). Conclusion Individualized PEEP guided by drive pressure can improve lung compliance, reduce drive pressure, improve oxygenation function and early postoperative lung function, reduce the incidence of postoperative lung complications, and has a certain lung protection effect. [ABSTRACT FROM AUTHOR]

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Indirect inguinal hernia is the most common surgical disease in pediatric surgery. The main season is the failure of sheath closure, and the clinical symptoms appear when the abdominal pressure increases. When the child is over one year old, the probability of closure of the inner ring decreases, so it should be treated at this time, mainly by surgery. With the development of laparoscopic technology, the minimally invasive treatment of pediatric inguinal hernia has been widely carried out. Laparoscopic indirect inguinal hernia can be divided into the giant type [inner ring(IR) diameter ≥1.5 cm], common type (IR diameter 0.5-1.5 cm) and hidden type (IR diameter <0.5 cm) according to the IR diameter. The surgical methods for different types of indirect inguinal hernia are more detailed, and there are many surgical methods for the treatment of huge indirect inguinal hernia in children. This article retrospectively analyzes the relevant literatures at home and abroad, and reviews the diagnosis and treatment progress of giant indirect inguinal hernia in children. [ABSTRACT FROM AUTHOR]

Objective To explore the causes and related risk factors of unplanned reoperation after laparoscopic colorectal cancer surgery. Methods The clinical data of 1 641 patients undergoing laparoscopic colorectal cancer surgery in the gastrointestinal surgery department of this hospital from January 2020 to December 2022 were retrospectively analyzed. Fifteen patients underwent the unplanned reoperation after surgery. The causes of unplanned reoperation were analyzed, and the risk factors were analyzed by the univariate and multivariate logistic regression. Results The incidence rate of unplanned reoperation after laparoscopic surgery for colorectal cancer was 0.91%. The main causes were the anastomotic fistula (26.67%) and intestinal obstruction (20.00%); through symptomatic treatment, 12 cases were cured, 2 cases were discharged automatically and 1 case died. The univariate and multivariate regression analysis showed that preoperative diabetes, preoperative hypoproteinemia, excessive intraoperative bleeding and history of abdominal surgery were the independent risk factors for unplanned reoperation (P<0.05). Conclusion The most common causes of unplanned reoperation after laparoscopic colorectal cancer surgery are the anastomotic leakage and intestinal obstruction. For the patients with diabetes, hypoproteinemia and excessive intraoperative bleeding, the attention should be paid to the prevention of this disease. [ABSTRACT FROM AUTHOR]

Objective To construct and verify the early warning model of the hypothermic risk factors during laparoscopic surgery in the patients with colorectal cancer in order to guide the clinical preventive measures. Methods A total of 475 patients with colorectal cancer undergoing laparoscopic surgery in this hospital from January 2020 to December 2021 were selected. Eighty-three patients with hypothermia during surgery served as the validation group (n=83) and the other served as the non-hypothermia control group (n= 392). The general data in the two groups were collected. The univariate analysis and multivariate analysis were adopted to analyze the risk factors of hypothermia during laparoscopic surgery in the patients with colorectal cancer. Then the early warning model was constructed and its accuracy was verified. Results The incidence rate of hypothermia during surgery in 475 patients with colorectal cancer was 17.47% (83/475). The univariate and multivariate logistic regression analysis results showed that the anesthesia time 3 h, operating room temperature 23 °C, BMI 24 kg/m², age 60 years old, intraoperative fluid infusion volume 1 000 mL were the independent risk factors for intraoperative hypothermia (P<0.05). The early warning model: logistic (P)=-2. 213+2.580×(age) +1.608×(BMI)+1,460× (operating room temperature) +1.254× (anesthesia time) +1.119× (intraoperative fluid infusion volume). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.709 (95%CI 0.631-0.789). The calibration curve showed that the calibration curve was in good agreement with the actual curve, indicating that the model had good discrimination and good prediction fitting (P<0.001). The result of Hosmer-lemeshow test was χ²=162. 181, P<0.001, indicating that the prediction was more accurate. Conclusion The constructed early warning model has good accuracy and discrimination, which could effectively predict the probability of hypothermia during surgery. [ABSTRACT FROM AUTHOR]

Objective To analyze the influencing factors on urinary control after laparoscopic radical prostatectomy in elderly patients. Methods Clinical data of 180 elderly patients with prostate cancer who underwent laparoscopic radical prostatectomy in our hospital from January 2021 to January 2023 were retrospectively analyzed. Based on whether urinary incontinence has occurred, the patients were divided into the observation group (43 cases with urinary incontinence) and the control group (137 cases without urinary incontinence). Univariate analysis was used to analyze the influencing factors of urinary control after laparoscopic radical prostatectomy in the elderly, and multivariate Logistic regression was used to analyze the risk factors of urinary control after laparoscopic radical prostatectomy in the elderly. Survey factors included age, body mass index, history of diabetes mellitus, history of hypertension, prostate volume, past TURP history, intraoperative and postoperative blood transfusion, post-operative pathological T staging, post-operative pathological margin, length of urethral reserve, Gleason score, bladder neck intact preservation. Results The univariate analysis revealed no statistical differences in the history of diabetes mellitus, hypertension, intraoperative and postoperative blood transfusion, post-operative pathological T stage, post-operative pathological margin and Gleason score between the two groups (P>0. 05), and significant differences in age, body mass index, prostate volume, past TURP history, urethral retention length, bladder neck intact preservation (P <0. 05). The results of multivariate analysis showed that the differences in the above univariate analysis were statistically significant. Multivariate analysis showed that age, body mass index, prostate volume, TURP history, urethral retention length and bladder neck intact retention were risk factors for urinary control after laparoscopic radical prostatectomy in the elderly. Conclusion Urinary control after laparoscopic radical prostatectomy in the elderly has many influencing factors. To reduce the incidence of urinary incontinence after prostate cancer surgery and improve the life quality of patients, some effective measures should be taken to address these risk factors. [ABSTRACT FROM AUTHOR]

Objective To explore the application of laparoscopic-assisted sclerotherapy for giant retroperitoneal lymphatic malformation (rLM). Methods From July 2020 to July 2021, retrospective review was conducted for clinical data of 3 children with giant retroperitoneal lymphatic malformation receiving laparoscopic-assisted doxycycline injection. And the relevant literature was retrived for discuss the approaches of injection therapy, efficacy and cautions. Results There were 1 boy and 2 girls with an age range of (26-68) month. Two cases presented with abdominal pain and inguinal masses. A total of 5 injections were performed and 2 cases treated twice. In case No.1, the maximal diameter of lesion decreased from 14.7 to 4.0 cm after treatment with a volume reduction of 95. 2%; In case No.2, the maximal diameter of lesion dropped from 11.8 to 5.5 cm after treatment with a volume reduction of 95%; In case No. 3, the maximal diameter of lesion declined from 9. 0 to 2.5 cm after treatment with a volume reduction of 98.9%. All of them reached the standard of cure and the symptoms disappeared. Only one case of postoperative vomiting resolved spontaneously. No recurrence or other complications were observed during a follow-up period of (6-12) months. Conclusions Sclerotherapy injection for gaint retroperitoneal lymphatic malformation has a marked efficacy and a high safety. And laparoscopic assistance may offer minimal invasion, improve accuracy of injection and reduce complications. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of laparoscopic surgery in the treatment of periappendiceal abscess in children. Methods A retrospective analysis was performed for 106 children with periappendiceal abscess who underwent laparosco-pic three-hole surgery in Department of Pediatric General Surgery in our hospital from January 2017 to May 2023. These children were analyzed in terms of age, sex, time of onset, clinical symptoms, auxiliary examination, surgery, and postoperative review. Results The 106 children had a mean intraoperative blood loss of (8.55±3.52)mL, an operation duration of (65.05±10.80)min, and a length of postoperative hospital stay of (10.60±1.50)d. Among these children, 5 had postoperative incision infection and 8 had residual abscess in the abdominal cavity, all of whom were cured after conservative anti-inflammatory treatment. Postoperative pathology showed 82 cases of appendiceal gangrene and 24 cases of suppurative inflammation. All children underwent reexamination at the outpatient service of our hospital at 1, 3, and 6 months after discharge; physical examination showed no obvious positive signs, and ultrasound showed no obvious fluid seepage and abdominal mass in the abdominal cavity. Conclusion Laparoscopic surgery has the advantages of low intraoperative blood loss, a short length of hospital stay, and few postoperative complications in the treatment of periappendiceal abscess in children, and therefore, it is recommended for the treatment of such children.

Objective To analyze the clinical benefits of laparoscopic pylorus-preserving pancreaticoduodenectomy with extraluminal and intraluminal gastro-jejunal reconstruction in order to provide evidence-based medical data for the choice of gastro-jejunal anastomosis. Methods A retrospective case-control trial was conducted on 177 consecutive patients undergoing laparoscopic pylorus-preserving pancreaticoduodenectomy in our institute from January 2013 to December 2022, and 161 patients were finally enrolled after the inclusion and exclusion criteria, including 99 cases of endoluminal gastrointestinal reconstruction and 62 cases of extraluminal gastrointestinal reconstruction. Learning curves were drawn using cumulative sum chart (CUSUM). The clinical data of the 2 reconstruction modalities were further compared before and after the learning curves, and the perioperative outcomes were analyzed with propensity score matching. Results The overall data showed the extraluminal group had significant shorter operation time and gastro-jejunal reconstruction time than the intraluminal group (385.8±74.6 vs 436.6±85.2 min, 23.6±13.5 vs 37.2±19.5 min, P < 0.001). After the learning curve was developed, it was found that completion of 77 cases of laparoscopic pylorus-preserving pancreaticoduodenectomy is required to get through the learning curve phase. Further comparisons of the 2 reconstruction modalities before and after the learning curve indicated that after excluding between-group differences with propensity score matching, the endoluminal group during the learning curve phase had better intraoperative results in terms of operation time (451.29±51.16 vs 501.47±47.89 min, P=0.006), gastro-jejunostomy reconstruction time (15.5±11.6 vs 45.2±18.5 min, P < 0.001), and postoperative gastric tube retention time (4.0±3.0 vs 5.6±3.2 d, P=0.028). After completing 77 surgeries through the learning curve, there were no statistically significant differences between the 2 reconstruction procedures in operation time (P=0.059), gastrojejunal reconstruction time (P=0.053), and postoperative gastric tube retention time (P=0.521). No statistical difference was observed in the incidence of complications overall or before and after the learning curve stage. Conclusion Laparoscopic pylorus-preserving pancreaticoduodenectomy is the recommended procedure of gastrointestinal reconstruction in the learning curve stage for elective patients, as compared with endoluminal gastro-jejunal reconstruction, which has the advantages of simplicity and convenience, and facilitates the recovery of gastrointestinal function.

Objective To evaluate the feasibility, safety and efficacy of three-port laparoscopic sleeve gastrectomy(LSG). Methods Clinical data of 130 patients with obesity who underwent LSG from April 2020 to January 2021 and completed follow-up in time were analyzed retrospectively. All patients were divided into two groups as surgical method, there were 52 cases in three-port group and 78 cases in four-port group. Perioperative indicators and improvement of obesity in two groups were compared. Results All procedures were performed via LSG. Compared with four-port group, the mean operative time of three-port group was shorter [(88.35±22.64) min vs. (98.29±26.25) min, P=0.027]. There were no significant differences in amount of bleeding intraoperative, postoperative pain, postoperative drainage, hospital stay after operation, postoperative complication rate and weight loss 6 months and 2 years after surgery (P>0.05). Conclusions Under the premise of no increase in surgical complications and operative time, three-port LSG can reduce the number and size of surgical scars, which is conducive to skin beauty, and obtain the same weight loss effect as four-port LSG, and can be used as a routine operation for sleeve gastrectomy.

With the development of laparoscopic technology in urology, the training of laparoscopic technology operator plays an extremely important role in the specialized education process from medical students to specialist physicians. With various medical students being included in standardized training for specialized physicians, many problems such as uneven quality of trainees appeared, lack of standardization in the training process, deviation in training target positioning, and insufficient quality control management methods. This article explored the construction of a standardized tiered training system for laparoscopic techniques in the urology department of Peking Union Medical College Hospital, including cultural construction, training mode system, assessment mechanism and trainers′ development. By constructing the special model for laparoscopic technology training in urology, it would lay a solid foundation and provide experience for building a standardized training system of laparoscopy in urology. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of quality control circle(QCC) activities in reducing the incidence of abdominal distention after laparoscopic cholecystectomy. Methods Factors influencing the abdominal distention after laparoscopic cholecystectomy were investigated and analyzed, and the problem-solving PDCA procedure was adopted for decision making and countermeasures implementation. Comprehensive interventions such as tube fixation, rehabilitation exercise, enhancing nurse’s scientific literacy, diversified health education, integrative nursing on pain control and establishment of pre-rehabilitant mode were carried out. Results The incidence of abdominal distention was decreased form 67. 28% to 29. 61% after implementation of QCC activities. Conclusion QCC is and effect management tool for reducing the incidence of abdominal distention after laparoscopic cholecystectomy. More efforts should be focused on preoperative and intraoperative issues which could affect the abdominal distention after surgery. (目的 探讨运用品管圈活动降低腹腔镜胆囊切除术后患者腹胀发生率的效果。方法 开展问题解决型品管圈活动, 通过现状分析、原因解析, 制定了针对性对策并予以实施, 包括有效固定管道、合理进行活动等、提升护士科普素养、多元化健康宣教、中西医结合护理缓解疼痛构建预康复模式等。结果 腹腔镜胆囊切除术后患者腹胀发生率从67. 28%下降至29. 61%。结论 品管圈活动能降低腹腔镜胆囊切除术后患者腹胀发生率, 但活动过程中对于术前、术中的改善重点未涉及, 对于围手术期的关注不够全面等问题有待进一步改善。)

This paper summarized the auricular acupoint pressing therapy and nursing of a patient with abdominal distension after ovarian cyst surgery by laparoscopy. Based on the Traditional Chinese Medicine syndrome differentiation, auricular acupoint pressing therapy and comprehensive nursing interventions including diet guidance and lifestyle care were carried out to relieve the abdominal distension after ovarian cyst surgery by laparoscopy. (本文总结采用耳穴压豆疗治疗1例卵巢囊肿患者腹腔镜术后腹胀的护理经验, 基于中医辨证施护理论指导, 辨证选取耳穴给予耳穴压豆, 并配合饮食指导、生活护理等常规护理, 有效缓解患者的腹胀症状。)

With the continuous development and promotion of the concept of minimally invasive and enhanced recovery after surgery, laparoscopy, as an important carrier of minimally invasive surgery, has became one of the indispensable means in the diagnosis and treatment of clinical pancreas-related diseases because of its advantages such as less trauma, wide indications and rapid postoperative recovery. Because of the adjacent relationship between the deep physiological and anatomical position of the pancreas and its complex surrounding tissue, compared with other fields of general surgery, the development of laparoscopy in the field of pancreatic surgery has been relatively slow for a long time. Actively exploring and promoting the clinical application of laparoscopy in the diagnosis and treatment of pancreatic diseases is the focus of pancreatic surgeons. This article reviews the progress in the application of laparoscopy in clinical diagnosis and treatment of pancreatic diseases.

ObjectiveTo study the role of indocyanine green （ICG） fluorescence imaging in biliary tract recognition during laparoscopic difficult biliary tract surgery. MethodsThe clinical data of 54 patients with laparoscopic difficult biliary surgery admitted to The Second Affiliated Hospital of Kunming Medical University from August 2019 to August 2022 were retrospectively collected. All patients had extrahepatic bile duct stones and had a history of upper abdominal surgery. Among them, 25 patients underwent ICG fluorescence imaging surgery （fluorescence imaging group） and 29 patients underwent conventional laparoscopic surgery （conventional surgery group）. The intraoperative and postoperative conditions of two groups were compared. ResultsCompared with the conventional surgery group, the operation time ［（110.68±19.03）min vs（147.83±28.59）min］, the time to find bile duct ［（30.92±9.72）min vs（56.52±18.84）min］, and the amount of bleeding ［（43.61±30.67）mL vs（87.93±15.67）mL）］ were significantly reduced （P＜0.05）, the time of exhaust, extubation, hospitalization and total cost of hospitalization were significantly reduced （P＜0.05） in the fluorescence imaging group. There was no statistically significant difference total complications rate between fluorescence imaging group and conventional surgery group （4.00% vs 27.59%, χ2=3.814, P＞0.05）. ConclusionICG fluorescence imaging technology can display the biliary system in real time during operation. Compared with conventional laparoscopic surgery, it can reduce the time to find bile ducts, reduce the amount of bleeding, shorten the operation time, improve the safety of surgery, and reduce the burden of patients. It has good clinical application value.

Laparoscopic resection of colon cancer in the elderly is one of the common surgical operations, but hypothermia during operation is very harmful to elderly patients undergoing laparoscopic colon cancer surgery. Even the occurrence of mild hypothermia will cause significant damage to patients. This article reviews studies about the effect of hypothermia on the elderly patients, the causes of hypothermia and perioperative nursing measures, and provide reference for improving perioperative nursing quality and surgical safety of laparoscopic resection of colon cancer in the elderly. (老年腹腔镜结肠癌切除术是外科常见的手术之一, 但术中低体温会对老年患者手术安全造成严重影响, 即便是轻度低体温的发生, 也会给患者造成不可忽视的损伤。本文针对低体温对机体的影响、发生的原因及围手术期护理措施进行综述, 旨在为提升腹腔镜结肠癌切除围手术期护理质量和确保老年患者手术安全提供参考。)

Objective To exploratively analyze the efficacy and safety of combined laparoscopy and cystoscopy in the treatment of bladder diverticula. Methods Clinical data of patients who received bladder diverticulectomy in Peking Union Medical College Hospital from March 2007 to September 2022 were retrospectively collected.The patients were divided into open/laparoscopy alone group and combined laparoscopy and cystoscopy group based on surgical approach.Surgery-related outcomes and complication rates were compared. Results A total of 11 patients with bladder diverticula who met the inclusion and exclusion criteria were enrolled in thestudy, including 6 patients in the open/laparoscopy alone group and 5 patients in the combined laparoscopy and cystoscopy group.The median maximum diameter of diverticula in the open/laparoscopy alone group and combined laparoscopy and cystoscopy group were 7.5(4.5, 11.5) cm and 5.2(5.0, 7.9) cm, respectively, and the median diameter of diverticula neck were 1.1(1.0, 1.6) cm and 1.5(1.1, 1.8) cm, respectively.Operations were successfully performed in both two groups and the patients had normal urination after drawing the catheter.No recurrence of bladder diverticulum at 6 to 60 months of follow-up.The median operative time[150.0(142.5, 180.0) min vs. 160.0(108.8, 300.0) min], blood loss[50.0(35.0, 50.0) mL vs. 50.0(45.0, 62.5) mL]and indwelling time of drainage tube[5.0(3.5, 5.5) d vs. 4.5(4.0, 6.8) d]were similar between the two group.Compared to the open/laparoscopy alone group, the combined laparoscopy and cystoscopy group had a shorter postoperative hospital stay[6.0(6.0, 8.5) d vs. 9.5(7.0, 16.0) d]and longer indwelling time of urinary catheter[14.0(10.5, 14.0) d vs. 11.5(6.5, 13.3) d].No complications occurred in the combined laparoscopy and cystoscopy group.In the open/laparoscopy alone group, 2 patients underwent postoperative complications, including 1 patient with deep vein thrombosis of the lower extremities and 1 patient with hyperpyrexia. Conclusion Preliminary results show that cystoscopy combined with laparoscopic resection for bladder diverticula can achieve similar outcomes as open surgery alone or laparoscopic surgery, and with greater safety and faster postoperative patient recovery.

Objective To investigate the survival outcomes and risk factors of patients with stage ⅡB cervical cancer undergoing neoadjuvant chemotherapy (NACT) followed by laparoscopic radical hysterectomy (LRH). Methods A retrospective cohort study was conducted on 178 patients with stage ⅡB cervical cancer who underwent NACT followed by LRH in our department from 2015 to 2018. COX regression analysis was used to analyze the surgical pathological characteristics, and stratified analysis was performed according to the results. Kaplan-Meier survival curve analysis and log-Rank test were employed to analyze the survival outcomes of different subgroups. Results For the 178 subjected patients, their median follow-up period was 51 months, and the rates of 3-year disease-free survival (DFS) and overall survival (OS) were 75.4% and 82.6%, respectively. COX regression analysis showed that lymph node metastasis (LNM) (HR: 2.04, 95%CI: 1.16~3.60) and deep stromal invasion (DSI) (HR: 4.72, 95%CI: 2.11~10.60) were independent risk factors for DFS. LNM (HR: 2.77, 95%CI: 1.48~5.22), DSI (HR: 4.24, 95%CI: 1.64~10.98) and tumor diameter ≥4 cm after NACT (HR: 2.12, 95%CI: 1.14~3.94) were independent risk factors for OS. The rates of 3-year DFS of patients with and without LNM was 55.3% and 81.0% (P < 0.001), and the rates of 3-year OS was 64.8% and 87.7% (P < 0.001), respectively. The rates of 3-year DFS of patients with and without DSI were 64.1% and 92.8% (P < 0.001), and the rates of 3-year OS were 73.2% and 95.7% (P < 0.001), respectively. There was no significant difference in DFS between patients with tumor diameter < 4 cm and ≥4 cm after NACT, while the rates of 3-year OS was 85.1% and 74.4%, respectively (P=0.028). The DFS and OS of patients with tumor diameter reduction >50% after NACT were significantly better than those ≤50% (the 3-year DFS rate: 92.9% vs 71.0%, P < 0.001; the 3-year OS rate: 93.0% vs 82.4%, P=0.017). Conclusion Patients with stage ⅡB cervical cancer with tumor diameter reduced by >50% after NACT have better survival outcomes. LNM, DSI and tumor diameter ≥4 cm after NACT are independent risk factors for the prognosis of stage ⅡB cervical cancer.

Objective: To evaluate the clinical applications and techniques of laparoscopically assisted in vitro gonadal biopsy for celiac type gonadal disorders of sex development (DSD).Methods: From January 2020 to March 2023, 17 cases of celiac gonadal DSD were retrospectively reviewed. Laparoscopically assisted gonadal biopsy was utilized for harvesting gonadal tissue in vitro. Surgical procedures were designed. Social gender, gonadal location, age, height, chromosomal karyotype, gonadal pathology examination, hemorrhagic volume, sex-determined age and therapeutic regimen were recorded. Results: There were 10 males and 7 females with a median monthly age of 25(13.5, 106).Chromosomal karyotypes were 46, XY ( n=6), 46, XX ( n=1), 45, X/46, XY ( n=9) and 45, X/47, XYY ( n=1).Gonads were bilaterally located in abdominal cavity ( n=7), right abdominal cavity & left scrotum ( n=4), right abdominal cavity & left groin ( n=3), left abdominal cavity & right scrotum ( n=2) and left abdominal cavity & right groin ( n=1).The gonads were located in the abdominal cavity in 24 cases, in the left scrotum in 4 cases, in the left groin in 3 cases, in the right scrotum in 2 cases and in the right groin in 1 cases. Laparoscopically assisted in vitro gonad biopsy was performed on 24 sides of celiac type gonad and 10 sides of groin/scrotal incision gonad biopsy on extraperitoneal gonad. Gonadal tissue was successfully harvested for pathological examination. Volume of intraoperative hemorrhage was 2(1, 2.5) mL. There were no such postoperative complications as hemorrhage, incision infection, incisional hernia or abdominal distension. Pathological results indicated bilateral striated gonads ( n=4), bilateral testis ( n=2), left testis & right striated gonads ( n=7), left striated gonads & right testis ( n=3) and left testis & right ovary ( n=1).Sex determination was performed in 12 cases, including clitoroplasty ( n=4), simple bilateral gonadectomy ( n=2) and urethroplasty ( n=6). Conclusions: Laparoscope-assisted ex vivo gonadal biopsy is convenient, safe, effective and accurate for celiac gonadal DSD. It provides an important clinical tool for selecting sex-determining treatments for children of celiac gonadal DSD. [ABSTRACT FROM AUTHOR]

Objective To summarize the pathogenesis, clinical manifestations, diagnosis, and treatment of Torsion necrosis of intra-abdominal cryptorchidism in children. Methods A retrospective analysis of a 13-year-old child with abdominal cryptorchid torsion and necrosis was carried out, and his clinical symptoms were manifested as left lower quadrant tenderness, rebound tenderness, and left scrotum emptiness. Color Doppler ultrasound indicated that left cryptorchid torsion could not be excluded. Results The child underwent laparoscopic exploration. According to the exploration results, the left spermatic cord, left cryptorchidectomy, and high ligation of the left hernia sac were performed. The postoperative pathology showed extensive congestion, hemorrhage, and infarction of the testis and epididymis, dilation of the spermatic cord vessels, congestion, and hemorrhage, consistent with testicular torsion and necrosis. After 2 years of follow-up, the color Doppler ultrasound of the scrotum revealed that the right testis was normal and the left indirect inguinal hernia had no recurrence. Conclusion Cryptorchid torsion is rare clinically, and abdominal cryptorchid torsion is even rarer. Clinical manifestations of the patient are not typical. Patients and their families do not know enough about the disease, and diagnosis and treatment are often delayed to cause a low testicular salvage rate. Clinically, if cryptorchid torsion is suspected, color Doppler ultrasonography and surgical exploration should be performed as soon as possible to confirm the diagnosis and improve the testicular salvage rate as much as possible. Health education for children and their families should be strengthened, and cryptorchidism should be diagnosed early and orchiopexy performed in time to prevent late cryptorchid torsion. [ABSTRACT FROM AUTHOR]

The techniques of uterine and uterine leiomyoma specimen tissue morcellation and extraction in gynecological surgery have been developed for decades, including electromechanical morcellation, transvaginal morcellation and small abdominal incision morcellation. In recent years, with the wide spread development of minimally invasive surgery such as laparoscopy, gynecologic surgeons have paid more and more attention to the tumor-free concept and tumor-free technology, and put forward higher requirements for the specimen morcellation and extraction technology. Different techniques have their own advantages and limitations, and there is no significant difference in the incidence of perioperative complications among them, but there are some limitations, such as the higher crushing rate of specimen bags by vaginal morcellation technique and the longer operation time by minilaparotomy morcellation technique. The practicability and safety of various technologies still need high-quality prospective clinical research to verify. When choosing the method of breaking and taking out specimens removal, the operator should strictly follow the principles of treatment and make individualized decisions so that patients can get a better prognosis. This paper reviews the research progress of large uterine (leiomyoma) tissue morcellation and extraction technology for clinical reference. [ABSTRACT FROM AUTHOR]

Intramural ectopic pregnancy (IMP) currently lacks clear diagnostic and therapeutic criteria. When the diagnosis is not clear, it can lead to inappropriate treatment. Therefore, early diagnosis and correct treatment are particularly important, especially in view of preserving the patient′s future reproductive function. A case of IMP diagnosed by transvaginal gynecological color Doppler ultrasound was retrospectively analyzed. Hysteroscopy combined with laparoscopy and local injection were performed. The high risk factors, transvaginal ultrasound imaging manifestations and experience of hysteroscopy and laparoscopy in the treatment of IMP were analyzed and summarized in order to improve clinicians′ understanding of the disease and reduce the misdiagnosis and under diagnosis of IMP in clinical practice. Transvaginal color Doppler ultrasound can early determine the size, location and relationship between the fetal sac and the muscle wall, which can be used as the first choice for early diagnosis of intramural pregnancy. Hysteroscopy combined with laparoscopy is a more effective method for further clarifying the diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective To systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta－analysis. Methods This study was conducted based on PRISMA guidelines, with a PROSPERO registration number of CRD42023406221. Chinese databases including CNKI, Wanfang Data, and VIP and foreign language databases such as PubMed, Embase, the Cochrane Library, and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones. Dichotomous variables were assessed by odds ratio (OR) and 95% confidence interval (CI), while continuous variables were assessed by weighted mean difference (WMD) and 95%CI, and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity. The Begg test and Egger test were used to evaluate publication bias. Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis. Results A total of 26 retrospective studies from China were included in this study, with 2 238 patients in total. The meta－analysis showed that compared with traditional laparotomy for the treatment of bile duct stones, laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation (WMD＝－1.26, 95%CI: - 1.36 to －1.16, P<0.001), length of hospital stay (WMD＝ －1.93, 95%CI: - 2.64 to －1.12, P <0.001), and time to bowel function recovery (WMD＝－1.52, 95%CI: - 1.68 to －1.35, P<0.001), significantly less intraoperative blood loss (WMD＝－1.79, 95%CI: - 1.93 to －1.66, P<0.001), a significantly lower rate of intraoperative residual stone (OR＝0.15, 95%CI：0.11－0.20, P<0.001), and significantly fewer complications (OR＝0.17, 95%CI：0.13－0.23, P<0.001). Conclusion Compared with traditional laparotomy, laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Qingre Lidan granules in preventing the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy through a retrospective cohort study. Methods A total of 337 inpatients with choledocholithiasis (including those with cholecystolithiasis at the same time) who underwent laparoscopy combined with choledochoscopic lithotomy in The First Affiliated Hospital of Dalian Medical University from January 1, 2010 to December 31, 2020 were enrolled, and related clinical data were collected. According to the follow－up results, the patients were divided into exposure group (conventional treatment+Qingre Lidan granules) with 225 patients and non－exposure group (conventional treatment) with 112 patients. The recurrence of choledocholithiasis and the administration of Qingre Lidan granules were recorded in detail for both groups. The recurrence rate of choledocholithiasis and the time to recurrence were observed for both groups, and the risk factors for the recurrence of choledocholithiasis were analyzed. The independent－ samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann－Whitney U test was used for comparison of non－normally distributed continuous data between two groups； the chi－square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan－Meier curve was used to estimate the cumulative probability of choledocholithiasis recurrence in the two groups, and the Log－rank test was used for comparison between two groups. Results A total of 26 patients experienced the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy, with 12 patients (5.33%) in the exposure group and 14（12.5%) in the non－ exposure group, and the exposure group had a significantly lower recurrence rate than the non－exposure group (χ2 =5.394, P=0.020). The exposure group had a significantly longer mean time to the recurrence of choledocholithiasis than the non－exposure group (40.1±26.7 months vs 19.2±13.5 months, t=2.383, P=0.017). The Kaplan－Meier curve analysis showed that the non－ exposure group had a significantly higher cumulative recurrence rate than the exposure group in different periods of time (P<0.05). The multivariate logistic regression analysis showed that common bile duct diameter ≥14 mm (odds ratio 〔OR〕=2.935, P=0.031) and multiple calculi (OR=2.911, P=0.029) were independent risk factors for the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopic lithotomy. Conclusion Qingre Lidan granules can effectively reduce the recurrence rate of choledocholithiasis and prolong the time to the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy and has a certain clinical effect in preventing the recurrence of choledocholithiasis after surgery. [ABSTRACT FROM AUTHOR]

Objective To introduce a new laparoscopic "spindle" repositioning approach for managing neonatal congenital intestinal malrotation (CIM) and analyze its efficacy and feasibility. Methods From January 2015 to June 2021, 228 CIM children were collected. There were 96 boys and 132 girls with an age range of 8(3-28) days and a weight range of 3. 5(2. 0-4. 3) Kg. Perioperative data and follow-up outcomes were recorded. Measurements with a normal distribution were described by mean and standard deviation while measurements with an abnormal distribution by median and interquartile range. The categorical variables are statistically described in terms of frequency and percentage. Results Among them, 174(77. 6%) were initially diagnosed with vomiting. And 48 cases (21. 4%) had a clinical presentation of bloody stool. And 6 cases (2. 6%) were detected incidentally during abdominal ultrasonography for other reasons. A definite diagnosis of CIM was confirmed after contrast study. Average duration of procedure was (58±15) min, postoperative milk resumption time 2. 5(1-4) days and hospitalization stay 11. 0(9-18) days. Forty-four patients underwent open surgery. The main reasons for converting into open surgery included pneumatization of dilated bowel (n=25, 56. 8%), concurrent Michael's diverticulum (n=14, 31. 8%) and lumpectomic difficulty in achieving hemostasis during laparoscopy (n=4, 9. 0%). During follow-ups, 9 cases of recurrent CIM occurred at Day 10 to Month 30. After re-operation, all of them were discharged and recovered well at the final follow-up. Four children had vomiting during feeding post-discharge and improved after conservative measures. Conclusion Laparoscopic "spindle" repositioning approach for CIM is simple, convenient and easy-to-master in neonates. Wider popularization is worthwhile. [ABSTRACT FROM AUTHOR]