Laparoscopic vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively.

Comparison of minimally invasive surgery and mini-incision technique for total hip arthroplasty： a sub-group meta-analysis

Background It is well accepted that the minimally invasive surgery （MIS） for total hip arthroplasty （THA） should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery. The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true. Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs. A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis. The data were extracted, and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out. The P（sub） value for difference between MIS sub-group and mini-incision sub-group was also calculated. Results Eleven studies that fulfilling the inclusion criteria were included, with 472 cases in the study group （MIS or mini-incision） and 492 cases in the conventional group. The overall analysis showed the study group would achieve less surgical duration （P=0.037）, intraoperative blood （P 〈0.001） and incision length （P 〈0.001） than conventional group. The difference between sub-groups showed, the MIS would achieve shorter incision length （P（sub） 〈0.05） and bigger cup abduction angle （P（sub） 〈0.05）, and cause more blood loss （P （sub） 〈0.05） than mini-incision technique. Other indexes were comparable between the two sub-groups. Conclusions Though further high quality studies are still needed, the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique. The exact definition of MIS still needs to be improved.

Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with varied etiologies

Stepwise mini-incision microdissection testicular sperm extraction(mTESE)is a procedure that attempts to minimize testicular damage.However,the mini-incision approach may vary in patients with different etiologies.Here,we performed a retrospective analysis of 665 men with nonobstructive azoospermia(NOA)who underwent stepwise mini-incision mTESE(Group 1)and 365 men who underwent standard mTESE(Group 2).The results showed that the operation time(mean±standard deviation)for patients with successful sperm retrieval in Group1(64.0±26.6min)was significantly shorter than that in Group2(80.2±31.3min),with P<0.001.The total sperm retrieval rate(SRR)was 23.1%in our study,and there was no significant difference between Group 1 and Group 2(P>0.05),even when the etiologies of NOA were taken into consideration.The results of consecutive multivariate logistic regression analysis(odds ratio[0R]:0.57;95%confidence interval[Cl]:0.38-0.87;P=0.009)and receiver operating characteristic(ROC)analysis(area under the ROC curve[AUC]=O.628)showed that preoperative anti-Mullerian hormone(AMH)level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope(Steps 2-4).In conclusion,stepwise mini-incision mTESE is a useful technique for NOA patients,with comparable SRR,less surgical invasiveness,and shorter operation time compared with the standard approach.Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.

亚洲人重睑成形术的研究进展

亚洲眼睑和高加索眼睑之间存在着明显的差异。99%的高加索人存在重睑,而亚洲人的重睑率仅为50%。现代人的审美认为,单眼皮的眼睛周围皮肤没有褶皱,显得单调而冷漠,而双眼皮则可以使人的眼神更加明媚、清秀。因此,重睑成形术已经成为亚洲眼部整形中最常见的手术。重睑成形术的手术方式归纳起来大致可分为非切开法和切开法。切开法创伤相对较大,恢复慢,肿胀时间长,并有明显的手术瘢痕。而非切开法创伤小,恢复快,肿胀轻,术后瘢痕不明显,但是术后部分重睑可能消失。随着受术者对重睑成形术术后效果的要求越来越高,小切口重睑成形术在临床上的应用和研究不断增加,逐渐从一点小切口重睑成形术发展为两点小切口重睑成形术、三点式小切口重睑成形术、三点四针法小切口重睑成形术、五点式小切口重睑成形术等多种术式,并可与非切开法如埋线法有效结合。

腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果

目的分析腹腔镜辅助下小切口手术治疗腹壁切口疝的临床效果。方法选择2017年1月至2019年1月南京市中西医结合医院收治的100例腹壁切口疝患者,对照组采用开放切口疝修补术,研究组应用腹腔镜辅助下小切口手术治疗,各50例,对比两组治疗效果。结果研究组术中出血量(22.8±4.3)ml明显少于对照组的(51.7±5.6)ml,术后肛门排气时间、下床活动时间、住院时间均显著少于对照组,差异有统计学意义(均P<0.001)。研究组手术当天VAS评分为(5.7±0.6)分,术后1、2、3 d的VAS评分为(4.7±0.7)分、(2.8±0.5)分、(1.2±0.2)分,显著低于对照组同时间点评分,差异有统计学意义(均P<0.001)。研究组并发症发生率为4.0%(2/50),低于对照组的22.0%(11/50),差异有统计学意义(χ2=7.162,P=0.007)。结论腹腔镜辅助下小切口手术可有效减轻腹壁切口疝患者的手术创伤和术后疼痛,降低并发症发生风险,从而缩短住院时间,加速患者恢复。

“微小切口开放sublay（MILOS）概念”在腹壁疝修补中的应用进展

腹壁疝的主要手术方法是直接缝合结合补片加强修补，放置补片的最佳位置是肌后间隙（即sublay）。常见手术方式有开放sublay补片修补和腹腔镜腹腔内补片修补（IPOM）。但开放sublay手术创伤较大，切口并发症发生率高；而腹腔镜IPOM的肠管损伤、补片相关并发症和术后疼痛等风险较高。结合上述两种术式的优点，德国专家Reinpold首先提出了＂微小切口开放sublay（MILOS）概念＂，利用微小的手术切口结合腹腔镜技术，完成微创sublay修补。MILOS手术适用范围较广，几乎适用于所有原发性或复发性腹壁疝，其中白线疝、中线切口疝和脐疝为最佳适应证。MILOS手术具有手术创伤小、术后并发症少、复发率低和经济效益比高等优点。在＂MILOS概念＂的基础上手术可进一步改良扩展，根据需要转为腹腔镜手术（EMILOS、eTEP）或机器人手术。MILOS手术这个最新的腹壁疝微创修补方式正逐渐被世界范围的外科医生所接受，并应用于腹壁疝的临床治疗中。目前已有多篇文献报道了MILOS手术的疗效，证实了其进一步推广应用的价值。