AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection...AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed.Preoperative antithrombotic therapy(ATT;antiplatelets and/or anticoagulation) was regularly used in 100 patients(ATT group,38.8%) whereas not used in 158(non-ATT group,61.2%).Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation.In both ATT and non-ATT groups,outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection(OLR),and the independent risk factors for increased SBL were determined by multivariate analysis.RESULTS This series included 77 LLR and 181 OLR.There were 3 thromboembolic events(1.2%) in a whole cohort,whereas increased SBL(≥500 mL) and postoperative bleeding complications(BCs) occurred in 66 patients(25.6%) and 8(3.1%),respectively.Both in the ATT and non-ATT groups,LLR was significantly related to reduced SBL and low incidence of BCs,although LLR was less performed as anatomical resection.Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio(RR)=6.54,P<0.001] in the whole cohort,and LLR also had the significant negative impact(RR = 1/10.0,P<0.001).The same effects of anatomical resection(RR=15.77,P<0.001) and LLR(RR=1/5.88,P=0.019) were observed when analyzing the patients in the ATT group.CONCLUSION LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks.Independent from the extent of liver resection,LLR is significantly associated with reduced SBL,both in the ATT and non-ATT groups.展开更多
Dear Editor,Sperm in patients with obstructive azoospermia （OA） have been retrieved from the reproductive tract and/or from the testis for intracytoplasmic sperm injection （ICSI） in several ways, including microsu...Dear Editor,Sperm in patients with obstructive azoospermia （OA） have been retrieved from the reproductive tract and/or from the testis for intracytoplasmic sperm injection （ICSI） in several ways, including microsurgical epididymal sperm aspiration （MESA）, percutaneous epididymal sperm aspiration （PESA）, testicular sperm extraction （TESE）, and other techniques） Each of these has advantages and drawbacks in terms of microsurgical expertise or equipment, number of sperm obtained, invasiveness, and cost. Therefore, we developed a safe, simple, feasible, and low-cost modified MESA technique to collect epididymal sperm under direct vision, which we have labeled macrosurgical epididymal sperm imprint collection （MESIC）. Herein, we present the details of the MESIC technique and our initial experience in patients with suspected OA.展开更多
文摘AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed.Preoperative antithrombotic therapy(ATT;antiplatelets and/or anticoagulation) was regularly used in 100 patients(ATT group,38.8%) whereas not used in 158(non-ATT group,61.2%).Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation.In both ATT and non-ATT groups,outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection(OLR),and the independent risk factors for increased SBL were determined by multivariate analysis.RESULTS This series included 77 LLR and 181 OLR.There were 3 thromboembolic events(1.2%) in a whole cohort,whereas increased SBL(≥500 mL) and postoperative bleeding complications(BCs) occurred in 66 patients(25.6%) and 8(3.1%),respectively.Both in the ATT and non-ATT groups,LLR was significantly related to reduced SBL and low incidence of BCs,although LLR was less performed as anatomical resection.Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio(RR)=6.54,P<0.001] in the whole cohort,and LLR also had the significant negative impact(RR = 1/10.0,P<0.001).The same effects of anatomical resection(RR=15.77,P<0.001) and LLR(RR=1/5.88,P=0.019) were observed when analyzing the patients in the ATT group.CONCLUSION LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks.Independent from the extent of liver resection,LLR is significantly associated with reduced SBL,both in the ATT and non-ATT groups.
文摘Dear Editor,Sperm in patients with obstructive azoospermia （OA） have been retrieved from the reproductive tract and/or from the testis for intracytoplasmic sperm injection （ICSI） in several ways, including microsurgical epididymal sperm aspiration （MESA）, percutaneous epididymal sperm aspiration （PESA）, testicular sperm extraction （TESE）, and other techniques） Each of these has advantages and drawbacks in terms of microsurgical expertise or equipment, number of sperm obtained, invasiveness, and cost. Therefore, we developed a safe, simple, feasible, and low-cost modified MESA technique to collect epididymal sperm under direct vision, which we have labeled macrosurgical epididymal sperm imprint collection （MESIC）. Herein, we present the details of the MESIC technique and our initial experience in patients with suspected OA.
