Learning curve for hand-assisted laparoscopic D2 radical gastrectomy

AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.

Surgical outcomes of hand-assisted laparoscopic liver resection vs. open liver resection: A retrospective propensity scorematched cohort study

Objective: Hand-assisted laparoscopic liver resection has the advantages of open and laparoscopic surgeries.There is still lack of comparison of surgical outcomes between hand-assistied laparoscopic liver resection(HALLR)and open liver resection(OLR). This study compared the surgical outcomes of the two approaches between wellmatched patient cohorts.Methods: Patients who received liver resection during January 2014 and October 2017 in Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College were included in this retrospective study. Propensity score matching(PSM) was performed to reduce selection bias between the two groups. Operation and short-term surgical outcomes were compared between the well matched groups.Results: During this period, 232 patients with a median age of 55.1 years old received OLR, while 49 patients with a median age of 54.7 years old received HALLR. Compared with HALLR group, OLR group has a higher proportion in male patients(190/232, 81.9% vs. 34/49, 69.4%, P=0.048) and lower albumin(43.2±4.5 vs. 44.8±3.7,P=0.020). After PSM, 49 patients from each group were included in the following analysis. Two groups were well balanced in their baseline characteristics, liver functions, preoperative treatments, abdominal surgery history, and surgical difficulty. None perioperative mortality was observed in both groups. Operation time and postoperative complications were similar in two groups(P=0.935, P=0.056). The HALLR group showed less bleeding amount(177.8±217.1 mL vs. 283.1±225.0 mL, P=0.003) and shorter postoperative stay period(6.9±2.2 d vs. 9.0±3.5 d,P=0.001).Conclusions: We demonstrated that hand-assisted laparoscopic surgery is feasible and safe for liver resection,including some difficult cases. HALLR can provide better bleeding control and faster recovery after surgery.

Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A metaanalysis

BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its advantages.AIM To evaluate the efficacy and advantages of HALS for splenomegaly.METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane,Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from16 trials who met the inclusion criteria were selected.RESULTS In pure splenectomy, blood loss volume(P < 0.001) and conversion rate(P =0.008) were significantly lower in the HALS group than in the LS group.Conversely, for splenomegaly, the operative time(P = 0.04) was shorter and blood loss volume(P < 0.001) and conversion rate(P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach(DUS), the operative time(P = 0.04) was significantly shorter and blood loss volume(P < 0.001) andconversion rate(P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.

Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis

AIM To evaluate the utility of hand-assisted laparoscopic restorative proctocolectomy(HALS-RP) compared with the conventional open procedure(OPEN-RP).METHODS Fifty-one patients who underwent restorative total proctocolectomy with rectal mucosectomy and ileal pouch anal anastomosis between January 2008 and July 2015 were retrospectively analyzed.Twentythree patients in the HALS-RP group and twentyfour patients in the OPEN-RP group were compared.Four patients who had purely laparoscopic surgery were excluded.Restorative total proctocolectomy was performed with mucosectomy and a hand-sewn ilealpouch-anal anastomosis.Preoperative comorbidities,intraoperative factors such as blood loss and operative time,postoperative complications,and postoperative course were compared between two groups.RESULTS Patients in both groups were matched with regards to patient age,gender,and American Society of Anesthesiologists score.There were no significant differences in extent of colitis,indications for surgery,preoperative comorbidities,and preoperative medications in the two groups.The median operative time for the HALS-RP group was 369(320-420) min,slightly longer than the OPEN-RP group at 355(318-421) min; this was not statistically significant.Blood loss was significantly less in HALS-RP [300(230-402) m L] compared to OPEN-RP [512(401-1162) m L,P = 0.003].Anastomotic leakage was noted in 3 patients in the HALS-RP group and 2 patients in the OPEN-RP group(13% vs 8.3%,NS).The rates of other postoperative complications and the length of hospital stay were not different between the two groups.CONCLUSION HALS-RP can be performed with less blood loss and smaller skin incisions.This procedure is a feasible technique for total proctocolectomy for ulcerative colitis.

Comparison of hand-assisted laparoscopic radical gastrectomy and laparoscopic-assisted radical gastrectomy:A systematic review and meta-analysis

BACKGROUND Gastrectomy is the optimal treatment for gastric cancer.Laparoscopic-assisted gastrectomy(LAG)has been extensively employed,while hand-assisted laparoscopic gastrectomy(HALG),which is similar to LAG,remains controversial.Although HALG is popular in China,some surgeons do not accept it as a minimal-access technique.AIM To assess the safety and practicability of HALG by comparing the short-term outcomes of HALG and LAG.METHODS The electronic databases of EMBASE,PubMed,China National Knowledge Infrastructure,and Cochrane Library were thoroughly searched,and randomized controlled trials(RCTs)comparing HALG and LAG were included.The study results,including surgery time,blood loss,retrieved lymphatic nodes,incision length,time to first flatus,hospitalization duration,and all postsurgical complications,were compared between the two groups.RESULTS Five RCTs,which included 302 cases with HALG and 298 cases with LAG,were considered eligible for inclusion.Meta-analysis showed that HALG significantly reduced surgery time(P<0.01),hospital duration(P<0.01),and overall postsurgical complications(P<0.01).Additionally,HALG significantly increased the number of retrieved lymphatic nodes(P=0.01)and incision length(P<0.01)compared with LAG.The blood loss and time to first flatus were similar between the two groups(P>0.05).CONCLUSION Compared with LAG,HALG is a simpler and safer technique.Additionally,HALG should be used as a minimal-access technique,especially in technologically undeveloped areas.

Hand-assisted laparoscopic approach for the treatment of gastrosplenic fistula:A case report and review of the literature

Gastrosplenic fistula is a rare complication of gastric or splenic lymphoma.Here we report the case of a 48 years old man who developed a gastrosplenic fistula secondary to splenic diffuse large B-cell lymphoma,successfully managed with hand-assisted laparoscopic splenectomy and gastric wedge resection.A review of the available literature is also presented,33 cases of gastrosplenic fistula associated to gastric or splenic lymphoma were found,of which 25 were treated surgically.This case represents the first report of laparoscopic treatment of lymphoma-related gastrosplenic fistula described to our knowledge in the available literature.

Controversy of hand-assisted laparoscopic colorectal surgery

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.

Hand-assisted laparoscopic colorectal resections:the preferred option

作者对1995年至2009年间该院的微创结直肠手术进行了总结和综述,2002年后,作者开始实施手辅助下腔镜结直肠手术。在这14年间,一共实施了155例开腹手术,225例全腔镜手术和504例手辅助腔镜结肠手术。全腔镜组和手辅助组总的手术并发症发生率是2.9%,其中全腔镜组为5.3%,手辅助组为1.8%。吻合口瘘发生率在开腹组、全腔镜组和手辅助组分别为1.9%(3/155)、1.3%(3/225)和1.3%(7/504)。开腹组、全腔镜组和手辅助组的平均住院天数分别为6.4 d、3.1 d和2.9 d。腔镜组住院时间的缩短抵消了手术费用的增加,腔镜组的总费用明显少于开腹组(平均节省5053美元)。得益于手术时间的缩短和较少的器械费用,手辅助组的成本效益(7334美元)甚至优于全腔镜组(4215美元)。结果显示微创手术在并发症发生率、住院时间和总费用方面优于开腹手术,而且与开腹手术相比,手辅助下腔镜手术不仅具有腹腔镜手术的先天优势,而且手术时间更短,费用更少。

Precision at scale:Machine learning revolutionizing laparoscopic surgery

In their recent study published in the World Journal of Clinical Cases,the article found that minimally invasive laparoscopic surgery under general anesthesia demonstrates superior efficacy and safety compared to traditional open surgery for early ovarian cancer patients.This editorial discusses the integration of machine learning in laparoscopic surgery,emphasizing its transformative po-tential in improving patient outcomes and surgical precision.Machine learning algorithms analyze extensive datasets to optimize procedural techniques,enhance decision-making,and personalize treatment plans.Advanced imaging modalities like augmented reality and real-time tissue classification,alongside robotic surgical systems and virtual reality simulations driven by machine learning,enhance imaging and training techniques,offering surgeons clearer visualization and precise tissue manipulation.Despite promising advancements,challenges such as data privacy,algorithm bias,and regulatory hurdles need addressing for the responsible deployment of machine learning technologies.Interdisciplinary collaborations and ongoing technological innovations promise further enha-ncement in laparoscopic surgery,fostering a future where personalized medicine and precision surgery redefine patient care.

手助腹腔镜下活体供肾切取手术时间的影响因素及其与术后并发症的关系分析

目的探究手助腹腔镜下活体供肾切取手术时间的影响因素,并探究其与术后并发症严重程度间的关系。方法回顾性分析91例行手助腹腔镜下活体供肾切取术的供者的临床资料,分析供者术前基线资料与手术时间之间的相关性,研究手术时间与术后并发症的关系并确定手术时间的阈值。结果肾动脉数量多、肾周脂肪及肾脏后侧脂肪较厚、罹患代谢综合征、梅奥粘连概率(MAP)评分及Clavien-Dindo评分较高均会导致手术时间延长。通过分析受试者工作特征(ROC)曲线发现,当手术时间≥138 min时,供者术后并发症的发生率显著升高(P<0.05)。结论对于具有多支肾动脉、肾周及肾脏后侧脂肪厚度较厚、罹患代谢综合征、MAP评分及Clavien-Dindo评分较高的供者,可选择手术经验更为丰富的医师,做好充分的术前准备并在术后予以密切关注,以及时发现术后并发症并降低并发症的严重程度,改善供者预后。

一种基于STM32单片机的手部运动机能康复训练系统设计

针对脑卒中等疾病引起的手部运动机能减退以及由于长期活动不畅可能导致肌肉萎缩甚至手部功能逐步丧失问题,提出一种基于STM32单片机的手部康复训练系统,该系统由运动辅助训练模块和康复训练动作示范模块组成。STM32处理器通过设定、保存并记录一个训练周期的康复示范动作全过程,并由带高精度编码器的直流伺服电机配合减速器完成各关节设定动作的执行。利用所提出的从动式康复训练方法,经过阶段性训练,可以在一定程度上保持或者增强手部各关节的运动机能,达到防止肌肉萎缩或关节功能退化等问题的产生,有效提升手部功能康复的效果。

光子晶体结构生色真丝织物的制备及应用研究

为实现真丝织物的结构生色,文章分别利用真空辅助过滤法和手绘法在白色真丝织物上构筑光子晶体结构。进一步探究真空辅助过滤法中微球组装液体积浓度对结构色的影响规律,分析微球在真丝织物上形成光子晶体运动机制,讨论真丝织物上光子晶体结构色的虹彩效应,并探究手绘法在真丝织物光子晶体结构生色中的应用效果。结果表明:真空辅助过滤法中聚(苯乙烯-甲基丙烯酸),即P(St-MAA)微球组装液的体积浓度为2.4 L/m^(2)时,真丝织物的两面能同时获得光子晶体结构色,此时正反面结构色的反射率峰值在18%左右;在真空辅助过滤法中,P(St-MAA)微球在真丝织物上形成光子晶体结构的过程遵循“先反后正”堆积原则,即织物反面先形成光子晶体,随后微球进一步透过织物堆积在正面。此外,该光子晶体结构生色真丝织物的虹彩效应不明显,与常规染料或颜料着色效果接近;手绘法可以获得图案化的光子晶体生色结构,较适合于个性化加工。该研究为光子晶体结构生色在真丝织物着色中的应用提供参考。

太极云手联合机器人辅助训练对脑卒中患者手功能的影响

目的:探讨太极云手结合机器人辅助训练对脑卒中患者手功能的康复效果。方法:将60例脑卒中患者随机分为治疗组(n=30)和对照组(n=30),两组均接受常规康复治疗,治疗组接受太极云手训练结合结合机器人辅助训练,对照组接受机器人辅助训练。两组的训练频率为60min/天,5天/周,持续治疗8周。于治疗前、治疗4周后、治疗8周后采用Fugl-Meyer运动功能量表(Fugl-Meyer motor assessment,FMA)腕手部分、Wolf运动功能量表(Wolf motor function test,WMFT)、箱块测试(Box and Block test,BBT)、握力和捏力来评估受试者的手功能。结果:两组患者治疗后与治疗前比较,差异具有统计学意义(P<0.001)。治疗4周后组间比较差异不具有统计学意义(P>0.05);治疗8周后组间比较,WMFT差异具有统计学意义(P<0.05),FMA腕手部分、BBT、握力和捏力不具有统计学差异(P>0.05)。结论:太极云手结合机器人辅助训练能够改善脑卒中患者的手功能。

免打结双倒刺线手工缝合法在机器人辅助全胃切除术中的应用及疗效分析(附手术视频)

目的:探讨免打结双倒刺线手工缝合法在机器人辅助根治性全胃切除术后的近期临床疗效。方法:回顾性分析2020年10月—2023年7月吉林大学第一医院普通外科中心胃结直肠外科行机器人辅助根治性全胃切除术的42例胃体或贲门癌患者的临床病理资料,主要包括手术时间、吻合时间、术中出血量、术后住院时间、术后并发症及随访情况。结果:手术时间(290±37)min,吻合时间(23±3)min,术中出血量20(20,100)m L,术后住院时间(8±1)d,术后并发症发生率为33.3%(14/42)。42例患者失访2例,其余40例患者随访时间1~34个月,中位随访时间为19个月。结论:患者行机器人辅助根治性全胃切除术后,采用免打结双倒刺线手工缝合食管空肠法重建消化道,不会增加并发症,且术后近期吻合口瘘和吻合口狭窄发生率较低。

手助腹腔镜手术联合全腔镜手术治疗低位局部进展期直肠癌的效果观察

目的 探讨手助腹腔镜手术(HALS)联合全腔镜手术(LAP)治疗低位局部进展期直肠癌的效果,以防止延误治疗、减少术后并发症发生。方法 选取2022年12月至2024年1月收治的低位局部进展期直肠癌患者198例,按照随机数字表法分为HALS组、LAP组及联合组各66例。LAP组行LAP治疗,HALS组行HALS治疗,联合组行LAP联合HALS治疗。比较3组术中出血量、清扫淋巴结数量、手术时间、术后肛门排气时间、下床活动时间及住院时间,术前及术后1、3、7 d C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、淀粉样蛋白A(SAA)水平,术前、术后3个月直肠肛管抑制反射阈值(AIRT)、最大耐受容量(MTV)、肛管最大收缩压(MSP)、肛管静息压(ARP)、直肠静息压(RRP),以及术后并发症发生率。结果 联合组术中出血量、手术时间、术后肛门排气时间、下床活动时间及住院时间少于或短于HALS组、LAP组,HALS组少于或短于LAP组(P<0.05)。联合组术后1、3、7 d血清CRP、TNF-α、IL-6、SAA水平低于HALS组、LAP组,HALS组低于LAP组(P<0.05)。联合组术后3个月MSP、ARP、MTV高于HALS组、LAP组,HALS组高于LAP组,RRP、AIRT低于HALS组、LAP组,HALS组低于LAP组(P<0.05)。联合组术后并发症总发生率低于LAP组(P<0.05)。结论 HALS联合LAP治疗低位局部进展期直肠癌创伤小,术后恢复快,并可有效改善肛肠功能、减少术后并发症发生,避免延误治疗。

手辅助腹腔镜、腹腔镜辅助和开腹结直肠癌手术近期疗效的比较

目的比较手辅助腹腔镜手术(HALS)和腹腔镜辅助手术(LAS)以及开腹手术(OS)在结直肠癌中的近期临床疗效。方法回顾性分析2011年10月至2015年12月我科由同一组医师采用3种术式完成治疗的74例结直肠癌患者的临床资料,比较3组患者的术后近期临床疗效,包括术中指标、术后恢复情况、术后并发症、肿瘤根治性和住院费用。结果最终纳入HALS组24例患者,LAS组和OS组各25例患者,3组患者的一般资料和肿瘤基线具有可比性。对比结果显示,OS组、HALS组和LAS组的手术时间依次增加,切口长度依次缩短(P<0.05);HALS组的戳卡数少于LAS组(P<0.05),2组的中转率无统计学差异(P>0.05)。在术后恢复、术后并发症发生率和肿瘤根治性方面,3组无统计学差异(P>0.05)。在住院费用方面,HALS组和LAS组的总费用和手术费高于OS组(P<0.05),而HALS组和LAS组之间无统计学差异(P>0.05);对于材料费,OS组、HALS组和LAS组依次增加(P<0.05);其他费用明细3组之间无统计学差异(P>0.05)。结论 3种术式各具优势,既相互独立又能互相补充,临床医师可根据个人掌握程度和患者情况选择合理术式。

手辅助腹腔镜与腹腔镜辅助手术治疗结直肠癌的对比研究

目的比较手辅助腹腔镜与腹腔镜辅助手术在外科治疗结直肠癌中的近期疗效,评估手辅助腹腔镜外科治疗结直肠癌的安全性及对全身应激炎症的影响。方法选取2012年9月-2016年3月收治的100例结直肠癌患者,按照随机数字表法分为腹腔镜辅助治疗组(A组,n=63)与手辅助腹腔镜治疗组(B组,n=37),对比两组手术相关指标、术后并发症及全身应激炎症反应水平。结果 B组在手术时间、手术出血量、引流量均优于A组(P<0.05),排气时间较A组长(P<0.05)。两组术后住院时间及术后并发症发生率的差异无统计学意义(P>0.05)。B组全身应激炎症反应指标中性粒细胞数和C反应蛋白(CRP)与A组差异无统计学意义(P>0.05),而B组血清中炎症因子白细胞介素-6(IL-6)水平高于A组水平,差异有统计学意义(P<0.05)。结论在结直肠癌治疗中,手辅助腹腔镜手术具有手术时间短、术中出血量低等优点,但腹腔镜辅助手术在术后胃肠功能恢复方面更具优势,手辅助腹腔镜手术的全身炎症因子IL-6水平高于腹腔镜组,在临床应用时应依据实际情况合理选取腹腔镜手术术式。

手辅助腹腔镜技术与开腹手术治疗直肠癌的疗效对比研究

目的探讨手辅助腹腔镜技术在直肠癌根治术中的疗效。方法对90例直肠癌患者资料进行回顾性分析,根据手术选择分为研究组(手辅助腹腔镜治疗,n=40)和对照组(传统开腹手术治疗,n=50)。比较两组患者临床特征、手术时间、失血量、术后并发症、住院费用、住院时间、R0切除率、淋巴结检出个数、保肛率、3年局部复发率、3年无复发生存率和3年生存率。结果研究组术中失血量和住院时间均低于对照组,手术时间和住院费用均高于对照组,差异均具有统计学意义(均P<0.01)。研究组和对照组在淋巴结检出个数、R0切除率、保肛率、3年局部复发率、3年无复发生存率、3年总生存率、术后排便异常发生率和术后并发症发生率方面比较,差异均无统计学意义(均P>0.05)。结论与传统开腹手术比较,采用手辅助腹腔镜切除手术治疗直肠癌患者,具有创伤小、出血少和住院时间短等优点,且能够获得与传统开腹手术相同的预后,是可选择的外科技术。

腹腔镜辅助或手助结直肠癌根治术

目的总结腹腔镜根治术治疗13例结直肠癌的临床经验。方法回顾分析我科2002年11月-2006年4月13例腹腔镜根治术治疗结直肠癌的临床资料。结肠癌10例，Duke’s A期4例，Duke’s B期6例；直肠癌3例，均为Duke’s A期。结果13例结直肠癌根据肿瘤大小分别采取腹腔镜辅助根治术10例，手助腹腔镜根治术3例，均获成功，无中转开腹手术。无死亡病例。随访1—36个月，平均17个月，未见肿瘤复发。结论依据肿瘤大小和部位选择腹腔镜辅助或手助腹腔镜手术治疗结直肠癌，可以保证手术的安全有效性。

快速康复外科在手辅助腹腔镜胃腺癌根治术中的应用

目的探讨快速康复外科技术在手辅助腹腔镜胃腺癌根治术中的应用价值。方法将90例胃腺癌手术患者分为3组:A组采取传统的围手术期处理方法行开腹手术;B组应用快速康复处科(FTS)理念行传统开腹手术;C组应用FTS理念行手辅助腹腔镜下手术。将3组病例进行对比研究,统计其手术时间、术中出血量、并发症发生率、皮肤切口大小、术后下床时间、进食半流质饮食时间等。结果 C组与A组手术患者比较,皮肤切口小,出血量减少,术后肠道功能恢复快(P<0.05);C组与B组比较,术中出血量减少,术后下床活动时间提前(P<0.05);B组与A组比较,术后肠道功能恢复快,进食半流质时间提前,住院时间缩短(P<0.05);3组患者在手术时间、淋巴结清扫数目上差异无统计学意义(P>0.05)。结论 FTS用于手辅助腹腔镜胃腺癌根治手术安全有效,有利于促进患者早期康复,在胃腺癌手辅助腹腔镜手术中有较好的应用前景。