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.

Laparoscopic splenectomy:Current concepts

Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.

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.

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 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.

HandPort手辅式腹腔镜大器官切除10例效益评估

目的 对采用HandPort手辅式腹腔镜大器官切除术的疗效及其效益进行评估。方法 在病人腹壁切一个5～6cm长的小切口,另置2个trocar(套管)。采用HandPort手辅式装置和超声刀,充分利用这个“小口”,运用开放手术和腹腔镜手术的技术,施行肝切除、结肠切除、空肠切除、脾切除和胃大部分切除等10例腹部大器官切除术。9例为择期手术,另1例结肠憩室大出血的病人急诊施行了右半结肠切除术。结果 10例手术时间为30′～2h,手术失血量为几毫升～80ml,中转开放手术率为0。病人术后过程平稳,痛苦小,进食早(术后1～2天),恢复快。结论 本方法在腹腔镜大器官切除术所需腹壁最小创伤的条件下,运用HandPort手辅式腹腔镜技术,在手术步骤上集中了传统开放手术和腹腔镜手术的优势,扬长避短,变难为易,使手术达到微创的目的。

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。

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。

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。

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。

机器人辅助完全腹腔镜下脾切断流术联合肝肿瘤切除术的护理配合

目的:探讨机器人辅助完全腹腔镜下脾切断流术联合肝肿瘤切除术的手术护理配合要点。方法:回顾性分析并总结了1例机器人辅助完全腹腔镜下脾切断流术联合肝肿瘤切除术的术前准备,术中配合以及术后护理经验。结果:患者顺利完成手术。术后疼痛缓解迅速,手术创伤小、恢复快,无重大并发症发生。结论:术前的充分准备,术中医护的密切配合及术后的精心护理是顺利完成机器人辅助完全腹腔镜下脾切断流术联合肝肿瘤切除术的关键。

手助腹腔镜与开腹巨脾切除术的临床对比研究

目的对比手助腹腔镜与开腹手术治疗巨脾症的临床疗效。方法 2006年8月～2011年6月,将40例巨脾按患者意愿分成2组各20例,分别进行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)和传统开腹脾切除术(open splenectomy,OS),比较两组的手术时间、术中出血量、术后肛门排气时间、术后并发症发生率及术后住院时间等。结果 20例HALS组手术均获得成功,无中转开腹。与OS组相比,HALS组手术时间长[(110.9±37.2)min vs.(80.2±20.7)min,t=3.225,P=0.003],术中出血量少[(205.2±70.7)ml vs.(390.7±175.1)ml,t=-4.393,P=0.000],术后肛门排气早[(1.8±0.6)d vs.(2.4±0.9)d,t=-2.481,P=0.018],术后住院时间短[(8.9±1.2)d vs.(10.9±1.8)d,t=-4.134,P=0.000],术后并发症发生率差异无显著性[0(0例)vs.5.0%(1例),P=1.000]。结论 相比开腹手术,手助腹腔镜巨脾切除术具有切口美观、创伤小、恢复快的优点,是一种安全可行的治疗巨脾症的手术方式。

手助的腹腔镜脾切除术

本文报道用手助技术完成腹腔镜脾切除术治疗 1例原发性血小板减少性紫癜症。 2 5h完成手术 ,术中出血少。3天之内恢复。手助腹腔镜脾切除术操作安全、手术时间缩短 ,并使腹腔镜技术切除较大脾脏成为可能。

应用脾蒂先离断技术行手助腹腔镜巨脾切除与断流术

目的探讨手助腹腔镜巨脾切除术中脾门先离断技术的可行性。方法 2003年8月～2009年12月,用脾门先离断技术完成手助腹腔镜巨脾切除16例,其中14例同时行贲门周围血管离断术。离断胃结肠韧带后,用伸入腹腔的手指分离脾蒂与其外侧腹膜之间的疏松组织,穿过脾蒂下方后,在手指引导下于脾蒂后方穿过吻合器钉座,击发后离断脾蒂。然后再离断脾周围韧带,完整切除脾脏。结果所有手术均顺利完成。手术时间(152.0±39.9)min,术中出血量(263.8±161.2)ml,3例需要术中输血。无术后出血、膈下感染、发热等并发症。所有病例均获电话随访,随访时间1～40个月,平均24个月。无术后远期并发症,血小板计数1个月内恢复正常,随访期间无食管静脉曲张破裂再出血。结论脾蒂先离断技术可以增加手术安全性,缩短手术时间,减少术后并发症发生机会。

腹腔镜下脾切除术56例分析

目的探讨腹腔镜下脾切除术的临床应用价值。方法 2012年8月~2013年12月完成56例腹腔镜下脾切除术。右侧垫高45°体位。常规四孔法入路,分离脾周围韧带,切割闭合或Hem-o-lok加钛夹结扎脾门血管,穿刺孔扩大成小切口取出标本;手助式腹腔镜三孔法,上腹正中取一切口置入左手,余方法同前。结果 1例因术中合并肝癌,镜下处理困难,中转开腹行肝部分切除联合脾切除术,手术时间215 min,出血520 ml。48例腹腔镜脾切除术（laparoscopic splenectomy,LS）手术时间90~160 min,（105±15）min;术中出血40~550 ml,（90±38）ml;引流管拔除时间术后4~12 d,（4.2±1.6）d;住院5~15 d,（5.7±2.1）d。7例手助腹腔镜下脾切除术（hand assisted laparoscopic splenectomy,HALS）手术时间80~140min,（95±20）min;术中出血200~600 ml,（110±91）ml;引流管拔除时间术后2~6 d,（3.6±1.3）d;住院4~8 d,（4.8±1.5）d。1例术后门静脉血栓,1例术后轻度胰漏,对症处理后好转出院。56例随访6个月,无死亡,无术后肝功能衰竭、感染等。结论腹腔镜下脾切除术操作简便,在手术技术熟练的情况下能安全有效的适用于各种脾脏疾病。

腹腔镜脾切除治疗外伤性脾破裂

目的探讨采用腹腔镜脾切除的方法治疗外伤性脾破裂的可行性。方法2004年8月～2005年5月我院采用腹腔镜脾切除方法治疗外伤性脾破裂8例。结果7例顺利完成腹腔镜脾切除术,1例改行手辅助腹腔镜脾切除术成功。手术时间150～200min,平均180min。术中出血量600～5500ml,平均2200ml。Ⅱ级损伤5例,Ⅲ级3例,术后恢复佳,无并发症。结论腹腔镜脾切除治疗外伤性脾破裂安全、可行。

手助腹腔镜脾切除联合门奇静脉断流术

目的 探讨手助腹腔镜脾切除联合门奇静脉断流术的可行性. 方法 肝硬化并食管胃底静脉曲张破裂出血及脾功能亢进12例,在手助腹腔镜下采用超声刀分离脾周韧带,Endo-Cutter切断脾蒂,袋装取出;按开腹手术的要求分离切断胃底、食管下段6～8 cm范围内所有曲张血管. 结果 10 例顺利完成手助腹腔镜脾切除联合门奇静脉断流术,2 例因术中大出血中转开腹手术.10例成功者手术时间2.5～5 h,平均3.4 h,术中出血量100～500 ml,平均250 ml.1例因术后腹腔内出血开腹手术止血,其余病人无其他并发症.10例随访0.5～2年,平均1.5年,4例死于肝功能衰竭,6例1年左右再次出现上消化道出血,6例于1年左右出现上消化道出血,均为小量出血,胃镜检查显示出血原因3例为门脉高压性胃病,1例为胃溃疡,2例食管曲张静脉破裂,均经内科保守治疗缓解. 结论 手助腹腔镜脾切除联合门奇静脉断流术切实可行.

腹腔镜与手助腹腔镜脾切除术的临床应用

目的探讨腹腔镜与手助式腹腔镜脾切除术的方法、安全性和有效性。方法需行脾切除术的患者26例,包括肝硬化继发性脾功能亢进13例,原发性血小板减少性紫癜6例,外伤性脾破裂4例,假性脾囊肿1例,遗传性红细胞增多症2例。脾亢患者中有8例接受手助式腹腔镜脾切除术,8例中有5例同时行贲门周围血管离断术,4例脾外伤行手助式腹腔镜脾切除术,其余14例患者均采用腹腔镜脾切除术。结果除1例因大出血而中转开腹,余25例顺利完成手术,术中出血量约200～400mL,平均手术时间约为2.5～4.0h,平均术后5～9d出院,无手术并发症。结论腹腔镜及手助式腹腔镜脾切除术安全可行,创伤小,恢复快,值得临床推广。