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Efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer

World Journal of Clinical Cases 2024年第9期12卷 1569-1577页

作者： Xian Qin Chen Chen Yang Liu Xian-Hong Hua Jia-Yi Li Meng-Jie Liang Fang Wu Department of Anesthesiology The First People's Hospital of Jiangxia DistrictWuhan 430200Hubei ProvinceChina Department of Obstetrics and Gynecology The First People's Hospital of Jiangxia DistrictWuhan 430200Hubei ProvinceChina

BACKGROUND Ovarian cancer is one of the most common malignant tumors in female reproductive system in the world,and the choice of its treatment is very important for the survival rate and prognosis of patients.Traditional open surgery is the main treatment for ovarian cancer,but it has the disadvantages of big trauma and slow recovery.With the continuous development of minimally invasive technology,minimally invasive laparoscopic surgery under general anesthesia has been gradually applied to the treatment of ovarian cancer because of its advantages of less trauma and quick recovery.However,the efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia in the treatment of ovarian cancer are still controversial.AIM To explore the efficacy and safety of general anesthesia minimally invasive surgery in the treatment of ovarian cancer.METHODS The clinical data of 90 patients with early ovarian cancer in our hospital were analyzed retrospectively.According to the different surgical treatment methods,patients were divided into study group and control group(45 cases in each group).The study group received minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer,while the control group received traditional open surgery for ovarian cancer.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30),clinical efficacy and safety of the two groups were compared.RESULTS The intraoperative blood loss,length of hospital stay,postoperative gas evacuation time,and postoperative EORTC QLQ-C30 score of the study group were significantly better than those of the control group(P<0.05).The incidence of postoperative complications in the study group was significantly lower than in the control group(P<0.05).The two groups had no significant differences in the preoperative adrenocorticotropic hormone(ACTH),androstenedione(AD),cortisol(Cor),cluster of differentiation 3 positive(CD3+),and cluster of differentiation 4 positive(CD4+)indexes(

关键词： Early-stage ovarian cancer Efficacy minimally invasive Laparoscopy Safety Surgery

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minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure

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World Journal of Clinical Cases 2022年第1期10卷 117-127页

作者： Ling-Peng Kong Juan-Juan Yang Fu Wang Fan-Xiao Liu Yong-Liang Yang Department of Orthopaedics Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021Shandong ProvinceChina Department of Radiotherapy Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinan 250117Shandong ProvinceChina

BACKGROUND Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis.The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation,suture anchor fixation,and plate fixation,all of which have treatment-associated complications.To decrease surgical complications,we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.AIM To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.METHODS Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively.All were followed up by clinical examination and radiographs at 3 and 6 wk,3,6 and 12 mo after surgery,and thereafter every 6 mo.Outcomes were assessed preoperatively and postoperatively by a visual analog scale(VAS),the University of California Los Angeles(UCLA)shoulder score,the American Shoulder and Elbow Surgeon score(ASES),and range of motion(ROM)for shoulders.RESULTS Seven men and nine women,with an average age of 44.94 years,were evaluated.The time between injury and surgery was 1-2 d,with an average of 1.75 d.The mean operation time was 103.1±7.23 min.All patients achieved bone union within 3 mo after surgery.VAS scores were significantly decreased(P=0.002),and the mean degrees of forward elevation(P=0.047),mean degrees of abduction(P=0.035),ASES score(P=0.092)were increased at 3 wk.The UCLA score was increased at 6 wk(P=0.029)after surgery.The average degrees of external rotation and internal rotation both improved at 3 mo after surgery(P=0.012 and P=0.007,respectively).No procedure-related deaths or incision-related superficial or deep tissue infections occurred.CONCLUSION Modified suture bridge wa

关键词： minimally invasive Greater tuberosity fracture Open reduction Suture bridge Anchor

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minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis

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World Journal of Orthopedics 2022年第4期13卷 381-387页

作者： Vasiliki Fesatidou Evangelos Petsatodis Dimitrios Kitridis Panagiotis Givissis Efthimios Samoladas 4^(th)Department of General Surgery Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece Department of Interventional Radiology Papanikolaou General Hospital of ThessalonikiThessaloniki 57010Greece 1^(st)Orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece

BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.

关键词： Iliopsoas abscess Spondylodiscitis Percutaneous drainage minimally invasive Outpatient Immunocompromised

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The latest research progress on minimally invasive treatments for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2023年第1期22卷 54-63页

作者： Ya-Wen Zou Zhi-Gang Ren Ying Sun Zhen-Guo Liu Xiao-Bo Hu Hai-Yu Wang Zu-Jiang Yu Department of Infectious Diseases the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province 2959 Yuhangtang RoadHangzhou 310000China Gene Hospital of Henan Province/Precision Medicine Center the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Background:Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer-related death worldwide.Due to the high prevalence of hepatitis B virus(HBV)infection in China,the incidence of HCC in China is high,and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment.This paper reviewed the latest research progress on minimally invasive treatments for HCC,including percutaneous thermal ablation and new nonthermal ablation techniques,and introduced the principles,advantages,and clinical applications of various therapeutic methods in detail.Data sources:The data of treatments for HCC were systematically collected from the Pub Med,Science Direct,American Chemical Society and Web of Science databases published in English,using“minimally invasive”and“hepatocellular carcinoma”or“liver cancer”as the keywords.Results:Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC.The effect of microwave ablation(MWA)on downgrading treatment before liver transplantation is better than that of radiofrequency ablation(RFA),while RFA is more widely used in the clinical practice.High-intensity focused ultrasound(HIFU)is mainly used for the palliative treatment of advanced liver cancer.Electrochemotherapy(ECT)delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC.Irreversible electroporation(IRE)uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response.The nanosecond pulsed electric field(ns PEF)has achieved a good response in the ablation of mice with HCC,but it has not been reported in China for the treatment of human HCC.Conclusions:A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients.Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.

关键词： Hepatocellular carcinoma Radiofrequency ablation minimally invasive Nanosecond pulsed electric field

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Network meta-analysis of randomized controlled trials on esophagectomies in esophageal cancer:The superiority of minimally invasive surgery

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World Journal of Gastroenterology 2022年第30期28卷 4201-4210页

作者： Lajos Szakó Dávid Németh Nelli Farkas Szabolcs Kiss Réka Zsuzsa Domotor Marie Anne Engh Péter Hegyi Balint Eross András Papp Institute of Translational Medicine University of PécsMedical SchoolPécs 7624Hungary János Szentágothai Research Centre University of PécsMedical SchoolPécs 7624Hungary Institute for Translational Medicine University of PécsMedical SchoolPécs 7624Hungary of Bioanalysis University of PécsMedical SchoolPécs 7624Hungary Insittute of Translational Medicine University of PécsMedical SchoolPécs 7624Hungary Doctoral School of Clinical Medicine University of SzegedMedical SchoolSzeged 6720Hungary First Department of Medicine University of SzegedMedical SchoolSzeged 6725Hungary Institute of Translational Medicine University of PecsMedical SchoolPecs 7624Hungary Department of Surgery Clinical CenterUniversity of PécsMedical SchoolPécs 7624Hungary

BACKGROUND Previous meta-analyses,with many limitations,have described the beneficial nature of minimal invasive procedures.AIM To compare all modalities of esophagectomies to each other from the results of randomized controlled trials(RCTs)in a network meta-analysis(NMA).METHODS We conducted a systematic search of the MEDLINE,EMBASE,Reference Citation Analysis(https://***/)and CENTRAL databases to identify RCTs according to the following population,intervention,control,outcome(commonly known as PICO):P:Patients with resectable esophageal cancer;I/C:Transthoracic,transhiatal,minimally invasive(thoracolaparoscopic),hybrid,and robot-assisted esophagectomy;O:Survival,total adverse events,adverse events in subgroups,length of hospital stay,and blood loss.We used the Bayesian approach and the random effects model.We presented the geometry of the network,results with probabilistic statements,estimated intervention effects and their 95% confidence interval(CI),and the surface under the cumulative ranking curve to rank the interventions.RESULTS We included 11 studies in our analysis.We found a significant difference in postoperative pulmonary infection,which favored the minimally invasive intervention compared to transthoracic surgery(risk ratio 0.49;95%CI:0.23 to 0.99).The operation time was significantly shorter for the transhiatal approach compared to transthoracic surgery(mean difference-85 min;95%CI:-150 to-29),hybrid intervention(mean difference-98 min;95%CI:-190 to-9.4),minimally invasive technique(mean difference-130 min;95%CI:-210 to-50),and robot-assisted esophagectomy(mean difference-150 min;95%CI:-240 to-53).Other comparisons did not yield significant differences.CONCLUSION Based on our results,the implication of minimally invasive esophagectomy should be favored.

关键词： Surgery Esophageal cancer Esophagectomy Network meta-analysis minimally invasive Laparoscopy

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Research progress of minimally invasive surgery for gastric cancer

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中国癌症研究:英文版 2023年第4期35卷 343-353页

作者： Hao Su Zhaode Bu Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Center of Gastrointestinal CancerPeking University Cancer Hospital&InstituteBeijing 100142China

Since the first laparoscopic radical surgery for early gastric cancer 30 years ago, there has been a gradual shift from“open” to “minimally invasive” surgery for gastric cancer. This transition is due to advancements in refined anatomy, enlarged field of view, faster recovery, and comparable oncological outcomes. Several high-quality clinical studies have demonstrated the safety and effectiveness of laparoscopy in the treatment of both early and locally advanced gastric cancer. The role of perioperative chemotherapy in managing locally advanced gastric cancer has been widely recognized, and there have been continuous breakthroughs in the exploration of targeted therapy and immunotherapy for perioperative treatment. Additionally, the application of indocyanine green near-infrared imaging technology, 3D laparoscopic technology, and robotic surgery systems has further improved the accuracy and minimally invasive nature of gastric cancer surgeries. Looking ahead, the field of minimally invasive surgery for gastric cancer is expected to become more standardized, resulting in a significant enhancement in the quality of life for gastric cancer patients.

关键词： minimally invasive gastric cancer laparoscopic gastrectomy research progress

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minimally invasive and open gallbladder cancer resections: 30-vs 90-day mortality

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Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 405-411页

作者： Naeem Goussous Motahar Hosseini Anne M Sill Steven C Cunningham Department of Surgery Saint Agnes HospitalBaltimoreMDUSA

BACKGROUND:minimally invasive surgery is increasingly used for gallbladder cancer resection.Postoperative mortality at 30 days is low,but 90-day mortality is underreported.METHODS:Using National Cancer Database(1998-2012),all resection patients were included.Thirty-and 90-day mortality rates were compared.RESULTS:A total of 36 067 patients were identified,19 139(53%) of whom underwent resection.Median age was 71 years and 70.7% were female.Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality(17.1% vs 7.4%).There was a statistically significant increase in 30-and 90-day mortality with poorly differentiated tumors,presence of lymphovascular invasion,tumor stage,incomplete surgical resection and low-volume centers(Pminimally invasive resection between 2010 and 2012,the 90-day mortality was 2.8-fold higher than the 30-day mortality(12.0% vs 4.3%).CONCLUSIONS:Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality.Postoperative mortality is associated with tumor grade,lymphovascular invasion,tumor stage,type and completeness of surgical resection as well as type and volume of facility.

关键词： gallbladder cancer laparoscopic minimally invasive survival radical cholecystectomy complications

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minimally invasive approaches for histological diagnosis of anterior mediastinal masses

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Chinese Medical Journal 2007年第8期120卷 675-679页

作者： FANG Wen-tao XU Mei-ying CHEN Gang CHEN Yong CHEN Wen-hu Department of Thoracic Surgery Shanghai Chest Hospital Shanghai 200030 China Department of Anesthesiology Shanghai Chest Hospital Shanghai 200030 China Department of Pathology Shanghai Chest Hospital Shanghai 200030 China

Background Anterior mediastinal masses include a wide variety of diseases from benign lesions to extremely malignant tumors. Management strategies are highly diverse and depend strongly on the histological diagnosis as well as the extent of the disease. We reported a prospective study comparing the usefulness of core needle biopsy and mini-mediastinotomy under local anesthesia for histological diagnosis in anterior mediastinal masses. Methods Atotal of 40 patients with masses of unknown histology and located either at or near the anterior mediastinum received biopsy prior to treatment. The diagnostic methods were core needle biopsy in 28 patients and biopsy through mini-mediastinotomy under local anesthesia in 15 patients （including 3 patients for whom core needle biopsy failed to yield a definite diagnosis）. Results Histological diagnosis was achieved in 18 of the 28 patients receiving core needle biopsy. Of them, all 4 patients with pleural fibromas and 9 of the 12 patients （75%） with pulmonary mass were diagnosed definitively. In the remaining 12 patients with mediastinal mass, histological diagnosis was achieved in only 5 patients （41.7%）. In contrast, biopsy through a mini-mediastinotomy failed in only 3 patients. In the remaining 12 patients with huge mediastinal masses, who underwent mini-mediastinotomy, a definitive histological diagnosis was reached by pathological and/or immunohistochemical study （diagnostic yield 85.7% in 12 of 14 cases of mediastinal mass, P=0.038 vs core needle biopsy）. For the 9 patients with thymic epithelial tumors, the diagnostic yield was 40% （2 in 5 cases） for core needle biopsy and 83.3% （5 in 6 cases） for mini-mediastinotomy. There was no morbidity in patients receiving mini-mediastinotomy. In the 30 patients with biopsy-proven histological diagnosis, the results contributed to therapeutic decision making in 25 cases （83.3%）.Conclusions Core needle biopsy is effective in the diagnosis of pulmonary and pleural diseases. Yet its diagnostic yield in mediastinal mass is rat

关键词： minimally invasive diagnosis mediastinal tumor

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Chinese expert consensus on minimally invasive radical surgery for pancreatic ductal adenocarcinoma (version 2022)

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胰腺病学杂志(英文) 2022年第3期05卷 111-117页

作者： Zhao Yupei Yu Xianjun Wang Wei Mou Yiping Jiang Chongyi Zhejiang Provincial People’s Hospital 11. Key Laboratory of Gastroenterology of Zhejiang Province 12. People’s Hospital of Hangzhou Medical College 13. Zhejiang 14. Hepato-biliary-pancreatic Center 15. Huadong Hospital 16. Fudan University Department of General Surgery Peking Union Medical College Hospital 3. Chinese Academy of Medical Sciences and Peking Union Medical College 4. Beijing 5. China Department of Pancreatic Surgery Fudan University Shanghai Cancer Center 8. Shanghai Department of Gastrointestinal and Pancreatic Surgery

Various types of minimally invasive pancreatic surgery have been carried out in the last decades with promising outcomes reported by early explorers. Nevertheless, there are still controversies on oncologic outcomes and safety in the use of minimally invasive radical surgery for pancreatic ductal adenocarcinoma (PDAC). This consensus, referring to Chinese expert opinions and worldwide researches, aimed to discuss the related issues on minimally invasive radical surgery for PDAC to ensure the perioperative and oncological outcomes. Quality of evidence and strength of recommendations were evaluated based on the GRADE approach. The 15 recommendations covered 5 topics: oncological outcomes and patient safety of laparoscopic and robotic pancreatoduodenectomy, left-side pancreatectomy for PDAC, learning curve, safety of neoadjuvant therapy, and vascular resection in minimally invasive radical surgery for PDAC. This consensus gives reference and guidance to surgeons on the use of minimally invasive radical surgery for PDAC. Although this consensus is not sufficient to answer all the questions about minimally invasive radical surgery for PDAC, it represents the current consensus on the application of the techniques in the treatment of PDAC on the Chinese mainland.

关键词： Consensus Laparoscopic Learning curve Left-sided pancreatectomy minimally invasive Pancreatic ductal adenocarcinoma Pancreatoduodenectomy Radical surgery Robot Robot-assisted

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minimally invasive surgical treatment of intrahepatic cholangiocarcinoma:A systematic review

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2203-2215页

作者： Renato Patrone Francesco Izzo Raffaele Palaia Vincenza Granata Guglielmo Nasti Alessandro Ottaiano Gilda Pasta Andrea Belli University of Naples Federico II Naples 80100Italy Department of Abdominal Oncology Division of Hepatobiliary Surgical OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy Division of Radiology Istituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy SSD-Innovative Therapies for Abdominal Metastases Clinical and Experimental Abdominal OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy Division of Anesthesia Pain medicine and Supportive CareIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis.Radical surgical resection represents the only potentially curative treatment.Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly performed.In fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node dissection.AIM To review and summarize the current evidences on the minimally invasive resection of ICC.METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included.An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale.RESULTS After a systematic search 9 studies fulfilled the inclusion criteria.Among the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)approach.Baseline characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach.Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.CONCLUSION minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopi

关键词： Cholangiocarcinoma minimally invasive Laparoscopic Liver resection Hepatectomy Biliary neoplasm

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