Objective To evaluate the short-term effectiveness and safety of laparoscopic versus conventional open left hepatectomy. Methods Databases including CENTRAL (Issue 1, 2012), MEDLINE/PubMed (1978 to 2012), EMbase (1966 to 2012), CBM (1978 to 2012), CNKI (1979 to 2012) and the Chinese Medical Association Figures Journal Systems (1990 to 2012) were searched to collect clinical trials on laparoscopic versus conventional open left hepatectomy. Relevant proceedings and references of the included studies were also retrieved manually. According to the inclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then meta-analysis was conducted using RevMan5.0 software. Results No randomized controlled trials were collected, and a total of 5 clinical concurrent controlled trials involving 319 patients were included finally. The results of meta-analysis showed that, compared with the conventional open group, the laparoscopic group was longer in the operation time (WMD=40.89, 95%CI 29.39 to 55.38, Plt;0.000 01), and was lower in the intraoperative blood loss (WMD=−107.84, 95%CI −208.96 to −6.73, Plt;0.04); but there was no significant difference between the two groups in terms of hospital stays (WMD=−3.78, 95%CI −9.60 to 2.04, P=0.20) or postoperative complications (WMD=0.69, 95%CI 0.37 to 1.29, P=0.25). Conclusion As a minimally invasive technique, laparoscopic left hepatectomy has advantages of small abdominal incision and less intraoperative blood loss, and it is helpful to improve the quality of life for patients. Due to the limitation of quantity and quality of the included studies, it is hard to estimate the impact of bias on the reliability of this conclusion. We advise to perform more high quality, large scale and multicenter studies with adequate follow-up in the future.
Objective To systematically review the effectiveness and safety of different laparoscopic surgeries for ovarian endometrioma (OE). Methods Such databases as The Cochrane Library (Issue 3, 2011), MEDLINE (1966 to November 2011), EMbase (1980 to November 2011), CNKI (1980 to November 2011), CBM (1980 to November 2011) and WanFang Data (1978 to November 2011) were searched on computer, and the relevant references of the included literature were also retrieved manually to collect the randomized controlled trials (RCTs) about laparoscopic cystectomy vs. laparoscopic coagulation for OE. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs were included. The results of meta-analysis showed that, laparoscopic cystectomy for OE could reduce the reocurrence rates of dysmenorrhoea (RR=0.29, 95%CI 0.15 to 0.55, P=0.000 2), dyspareunia (RR=0.27, 95% CI 0.09 to 0.77, P=0.01) and non-menstrual pelvic pain (RR=0.19, 95% CI 0.05 to 0.76, P=0.02), decrease 1-year (RR=0.33, 95%CI 0.15 to 0.74, P=0.007) and 2-year (RR=0.49, 95%CI 0.26 to 0.95, P=0.03) postoperative reoccurence of OE, and lower the risk of short-term secondary operation (RR=0.25, 95%CI 0.07 to 0.85, P=0.03). However, it didn’t increase the 12-month (RR=2.82, 95%CI 1.44 to 5.50, P=0.002) and 24-month (RR=2.62, 95%CI 1.47 to 4.68, P=0.001) postoperative spontaneous pregnancy rates (SPR). In addition, although laparoscopic coagulation was superior to laparoscopic cystectomy in the 6-month postoperative ovarian reserve function (ORF), there was no significant difference in the 5-year postoperative ORF between the two groups (WMD=0.27, 95%CI −0.18 to 0.73, P=0.24). Conclusion Laparoscopic cystectomy for OE can reduce the reoccurence of dysmenorrhoea, dyspareunia, non-menstrual pelvic pain and endometriosis, decrease the risk of short-term secondary operation, and increase the postoperative SPR in women who had been diagnosed as infertility. Because of the quantity limitation of present clinical trials, this conclusion requires to be further proved by performing more high quality RCTs.
Objective To compare the efficacy and incidence of complications between laparoscopic surgery and laparotomy on women with polycystic ovarian syndrome (PCOS). Methods We did a systematic literature search for studies from Ovid Database, MEDLINE, EMbase, Cochrane Library (Issue 2, 2008), Chinese Biological Medicine Database, CNKI, Chinese VIP Database, and WANFANG Database on internet. The search time was from establishment of each database to December, 2008. Randomized controlled trials and non-randomized controlled trials were collected. The search was no limitation in language. We manually searched current and conference abstracts, and searched relevant reviews and their reference. RevMan 5.0 software was used for meta-analysis. Results Five non-randomized trials involving 417 patients were included. The results of meta-analyse showed that the short-term pregnancy rate in patients underwent laparoscopic surgery was significantly higher than that in patients underwent laparotomy (RR=1.42, 95% CI 1.13 to 1.80, P=0.003). The long-term pregnancy rate in patients underwent laparoscopic surgery and laparotomy was comparable (RR=0.85, 95%CI 0.68 to 1.07, P=0.17). The regular menstruation in patients underwent laparoscopic surgery and laparotomy was comparable (RR=0.91, 95%CI 0.79 to 1.05, P=0.18). The uterine adhesions in patients underwent laparoscopic surgery was significantly lower than that in patients underwent laparotomy (RR=0.02, 95%CI 0.00 to 0.18, P=0.000 2). The intra-abdominal adhesions of patients underwent laparoscopic surgery was significantly lower than that in patients underwent laparotomy (RR=0.02, 95%CI 0.00 to 0.13, Plt;0.000 1).Conclusions The limited evidence at present shows that the incidence and degree of pelvic adhesions occurred in patients with PCOS after laparoscopic surgery is much lower than those after laparotomy. It is not quite sure at this point about whether the pregnancy rate and regular menstruation of laparoscopic surgery are better than those of lararotomy or not. More evidence from high qualified multi-center studies is needed.
From December 1995 to December 1997, 1 500 patients with gallstones or together with biliary duct stones accepted laparoscopic cholesystectomy (LC) or LC+laparoscopic common bile duct exploration (LCDE). There were 9 had serious complications (0.6%) occured . While the mean age was 54.9 years old. The sex ratio (female∶male) was 1∶1.25. Three cases had major biliary duct disruption, 1 case had stomach perforation, 2 cases had duodenal injuries, 1 bleeding case because cystic artery fail to clip, 1 case had postoperative cystic duct leak, and 1 case with T-tube dislodgement. All complications had been discovered during or shortly after operations. The injuries on the extrahepatic biliary duct with lengths of 0.2-0.4cm, and the gastrodenal injuries sized 0.5-1.0cm. All of the injuries had been sutured laparoscopically without sequela. The one who had postoperative cystic duct leak and jaundice accepted LCDE, proved to have a common bile duct stone. The bleeding cystic artery had been clipped well, and the dislodged T-tube replaced well. The results show if the complications which may be very serious or complex had been discovered shortly after or during the operations, its can be managed with laparoscopic technique safely by experienced operators.
ObjectiveTo summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer. MethodsThe clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed. ResultsLaparoscopic distal gastrectomy was performed successfully in all patients. The operation time was (283.2±27.6) min (270-450 min) and the blood loss was (178.4±67.4) ml (80-350 ml). The time of gastrointestinal function recovery was (2.8±1.2) d (2-4 d), out of bed activity time was (1.5±0.4) d (1-3 d) and liquid diet feeding was (3.5±1.4) d (3-4 d). The hospital stay was (10.0±2.6) d (7-13 d). The number of harvested lymph nodes was 11 to 34 (17.8±7.3). The distance from proximal surgical margin to tumor was (7.0±2.1) cm (5-12 cm) and the distance from distal surgical margin to tumor was (5.5±1.8) cm (4-8 cm), thus surgical margins were negative in all samples. All patients were followed up for 3-48 months (mean 18.5 months), two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months, respectively, and other patients survived well. ConclusionsLaparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible. However, the advantage of laparoscopic technique over the conventional open surgery requires further study.
Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.
Objective To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.
ObjectiveTo investigate the feasibility and advantages of general laparoscopic cholecystectomy and gynecologic uterus and attachment surgery at the same time. MethodsSixty patients with gallbladder stones combined with ovarian cysts, benign gynecological disease or fallopian tube adhesions aged between 35 and 55 were chosen from the department of General Surgery and Gynecology and Obstetrics to be the study subjects between January 2009 and December 2013. The inclusion criteria included: gallbladder stones; gallbladder wall thickness <0.5 cm; non-acute inflammation; symptomatic gynecological diseases; and tumor size between 5.0 and 10.0 cm. Based on similar age, body mass, and histological type, the patients were divided into laparoscopic surgery (GLS) group and staging surgery group (control group) according to the will of the patients. The anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs were detected for comparison between the two groups. ResultsThe first-time operation was successful in all the patients in the CLS group, with two cases of abnormal liver function, which were cured within 5-6 days. In the control group, 2 cases of reoperation were transferred to laparotomy due to umbilical and peritoneal adhesions, and both of them were cured and discharged from hospital without incision infection or iatrogenic tissue and organ damage. CLS group had significant advantages in anesthesia time, surgery time, the number of abdominal perforations, length of hospital stay, and total costs over the control group (P<0.05). ConclusionThe combined gynecologic laparoscopic surgery is feasible, safe, mini-invasive, and economical.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
ObjectiveTo evaluate the safety and clinical effect of laparoscopic Miles and perineal anal recon-struction operation for patients with low rectal cancer. MethodsOne hundred and two patients underwent Mile's and perineal anal reconstruction operation for rectal cancer in this hospital from April 2006 to February 2010 were analyzed retrospectively, in which 58 patients underwent laparoscopic surgery (laparoscope group) and 44 patients underwent open surgery (laparotomy group).All these data such as the survival time, operative time, intraoperative blood loss, harvested lymph nodes, the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization, and postoperative complications were collected and compared between the laparoscope group and laparotomy group. ResultsThe demography and clinicopathologic characteristics were similar between these two groups (P > 0.05).The operation was successfully performed in all the patients.There was no death associated with the operation.Compared with the laparotomy group, the intraoperative blood loss was less (P < 0.05), the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization were shorter (P < 0.05), the harvested lymph node was more (P < 0.05) in the laparoscope group.There were no significant differences in the operative time, postoperative complications, and the survival curves between the two groups (P > 0.05). ConclusionsThe clinical effects of laparoscopic and open Miles and perineal anal reconstruction operation are similar for patients with low rectal cancer.But laparoscopic operation is a safe, feasible choice with quicker recover after the operation.