To the Editor:Hepatobiliary anatomical variations may increase the complexity of surgery with a relevant risk of iatrogenic lesions.Left-sided gallbladder(LSG)is a rare and little known condition whereby the viscus is...To the Editor:Hepatobiliary anatomical variations may increase the complexity of surgery with a relevant risk of iatrogenic lesions.Left-sided gallbladder(LSG)is a rare and little known condition whereby the viscus is located on the visceral surface of the left lobe of the liver and is often discovered unexpectedly during surgery.The position of the gallbladder over the liver pedicle and the simultaneous presence of variations in the liver vascularization are potentially associated to a challenging surgical dissection and consequently to an increased risk of morbidity.Despite open approach remains an option in more complex procedures,cholecystectomy is usually performed with a minimally invasive technique,which is generally safe even in the rare case of an LSG,as long as a high level of awereness of anatomical variations and a careful surgical dissection are pursued.展开更多
BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established.However,the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.AIM To analyze the resu...BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established.However,the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.AIM To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.METHODS A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed.A systematic review was accomplished comparing 2D and 3D right colectomy.RESULTS In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group.The 3D group showed a favorable trend in terms of mean operative time(170.7±32.9 min vs 183.8±35.4 min;P=0.053)and a significant lower anastomotic time(16.9±2.3 min vs 19.6±2.9 min,P<0.001).The complete mesocolic excision(CME)subgroups analysis showed a shorter anastomotic time(16.5±1.8 min vs 19.9±3.0 min;P<0.001)and operative time(175.0±38.5 min vs 193.7±37.1 min;P=0.063)in the 3D group.Six studies and our series were included in the meta-analysis with 551 patients(2D group:291;3D group:260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time(P<0.001)and the anastomotic time(P<0.001)while no differences were identified between groups in terms of blood loss(P=0.827),LNH yield(P=0.243),time to first flatus(P=0.333),postoperative complications(P=0.718)and length of stay(P=0.835).CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy.In our series,the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.展开更多
文摘To the Editor:Hepatobiliary anatomical variations may increase the complexity of surgery with a relevant risk of iatrogenic lesions.Left-sided gallbladder(LSG)is a rare and little known condition whereby the viscus is located on the visceral surface of the left lobe of the liver and is often discovered unexpectedly during surgery.The position of the gallbladder over the liver pedicle and the simultaneous presence of variations in the liver vascularization are potentially associated to a challenging surgical dissection and consequently to an increased risk of morbidity.Despite open approach remains an option in more complex procedures,cholecystectomy is usually performed with a minimally invasive technique,which is generally safe even in the rare case of an LSG,as long as a high level of awereness of anatomical variations and a careful surgical dissection are pursued.
文摘BACKGROUND The benefits of laparoscopic approach for right colectomy have been well established.However,the technical difficulty to construct the intra-corporeal anastomosis is still cumbersome.AIM To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and meta-analysis.METHODS A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed.A systematic review was accomplished comparing 2D and 3D right colectomy.RESULTS In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D group.The 3D group showed a favorable trend in terms of mean operative time(170.7±32.9 min vs 183.8±35.4 min;P=0.053)and a significant lower anastomotic time(16.9±2.3 min vs 19.6±2.9 min,P<0.001).The complete mesocolic excision(CME)subgroups analysis showed a shorter anastomotic time(16.5±1.8 min vs 19.9±3.0 min;P<0.001)and operative time(175.0±38.5 min vs 193.7±37.1 min;P=0.063)in the 3D group.Six studies and our series were included in the meta-analysis with 551 patients(2D group:291;3D group:260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time(P<0.001)and the anastomotic time(P<0.001)while no differences were identified between groups in terms of blood loss(P=0.827),LNH yield(P=0.243),time to first flatus(P=0.333),postoperative complications(P=0.718)and length of stay(P=0.835).CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard lymphadenectomy.In our series,the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.
