Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct in...Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.展开更多
Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experienc...Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.展开更多
BACKGROUND:Minimally invasive surgery is increasingly used for gallbladder cancer resection.Postoperative mortality at 30 days is low,but 90-day mortality is underreported.METHODS:Using National Cancer Database(1998-2...BACKGROUND:Minimally invasive surgery is increasingly used for gallbladder cancer resection.Postoperative mortality at 30 days is low,but 90-day mortality is underreported.METHODS:Using National Cancer Database(1998-2012),all resection patients were included.Thirty-and 90-day mortality rates were compared.RESULTS:A total of 36 067 patients were identified,19 139(53%) of whom underwent resection.Median age was 71 years and 70.7% were female.Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality(17.1% vs 7.4%).There was a statistically significant increase in 30-and 90-day mortality with poorly differentiated tumors,presence of lymphovascular invasion,tumor stage,incomplete surgical resection and low-volume centers(P<0.001 for all).Even for the 1885 patients who underwent minimally invasive resection between 2010 and 2012,the 90-day mortality was 2.8-fold higher than the 30-day mortality(12.0% vs 4.3%).CONCLUSIONS:Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality.Postoperative mortality is associated with tumor grade,lymphovascular invasion,tumor stage,type and completeness of surgical resection as well as type and volume of facility.展开更多
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the ga...BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.展开更多
Purpose: Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for cholecystectomy. Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional la...Purpose: Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for cholecystectomy. Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic. The results are presented here of a single surgeon’s initial experience with single-incision laparoscopic cholecystectomy with conventional laparoscopic instruments through his first 11 cases. Materials and Methods: A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus. A 12-mm trocar was placed through an open approach, and the abdominal cavity was explored with a 10-mm laparoscope. One 10-mm and one 5-mm port were inserted laterally from the laparoscope port. Dissection was performed using a dissector, which was not articulated. The gallbladder was investigated with an Endograsper, which was not articulated either. The hilum was dissected, and the cystic duct and artery were clipped and divided. Results: The patients are comprised of 9 females and 2 males with a mean age of 43.3 years and mean body mass index (BMI) of 27.6 kg/m2. Open cholecystectomy was not required. The mean operative time was 69.9 min. Length of stay was only one day. All procedures were completed successfully without any perioperative or postoperative complications. In all cases, there was no need to extend the skin incision. Postoperative follow-up did not reveal any umbilical wound complications. The cosmetic results were scored as excellent by all patients. Conclusion: These results suggest that single-incision laparoscopic cholecystectomy is feasible, safe and effective and a promising alternative method to four-port and SILS-port laparoscopic cholecystectomy and as scarless abdominal surgery for the treatment of some patients with gallbladder disease with standard laparoscopic instruments.展开更多
目的用Meta分析方法比较评价内镜微创保胆取石术(EMIC)与腹腔镜胆囊切除术(LC)的可行性及有效性。方法利用计算机MEDLINE(PubMed)、OVID、中国知网全文数据库(CNKI)、万方数据库全面搜索内镜微创保胆取石与腹腔镜胆囊切除术的可行性及...目的用Meta分析方法比较评价内镜微创保胆取石术(EMIC)与腹腔镜胆囊切除术(LC)的可行性及有效性。方法利用计算机MEDLINE(PubMed)、OVID、中国知网全文数据库(CNKI)、万方数据库全面搜索内镜微创保胆取石与腹腔镜胆囊切除术的可行性及有效性的比较研究的中英文随机对照试验和回顾性分析文献,利用Rev Man 5.1软件对2种治疗方法的可行性和有效性指标进行Meta分析。结果最终纳入13篇文献共2 441例患者,其中随机对照研究4篇,回顾性分析9篇。内镜微创保胆取石术与腹腔镜胆囊切除术相比,内镜微创保胆取石的术中出血量减少,术后排气时间、术后住院时间缩短,术后并发症及消化道症状发生率降低;2种方法手术时间则无统计学意义。结论内镜微创保胆取石术的可行性和有效性均优于腹腔镜胆囊切除术。展开更多
文摘Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.
文摘Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.
基金This study was presented at the 57th annual (2016) meeting of the Societyfor Surgery of the Alimentary Tract,during the Digestive Disease Week(DDW),San Diego,CA,USA
文摘BACKGROUND:Minimally invasive surgery is increasingly used for gallbladder cancer resection.Postoperative mortality at 30 days is low,but 90-day mortality is underreported.METHODS:Using National Cancer Database(1998-2012),all resection patients were included.Thirty-and 90-day mortality rates were compared.RESULTS:A total of 36 067 patients were identified,19 139(53%) of whom underwent resection.Median age was 71 years and 70.7% were female.Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality(17.1% vs 7.4%).There was a statistically significant increase in 30-and 90-day mortality with poorly differentiated tumors,presence of lymphovascular invasion,tumor stage,incomplete surgical resection and low-volume centers(P<0.001 for all).Even for the 1885 patients who underwent minimally invasive resection between 2010 and 2012,the 90-day mortality was 2.8-fold higher than the 30-day mortality(12.0% vs 4.3%).CONCLUSIONS:Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality.Postoperative mortality is associated with tumor grade,lymphovascular invasion,tumor stage,type and completeness of surgical resection as well as type and volume of facility.
基金Supported by Outstanding Foreign Scientist Studio Project of Henan Province,No.GZS2020006.
文摘BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
文摘Purpose: Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for cholecystectomy. Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic. The results are presented here of a single surgeon’s initial experience with single-incision laparoscopic cholecystectomy with conventional laparoscopic instruments through his first 11 cases. Materials and Methods: A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus. A 12-mm trocar was placed through an open approach, and the abdominal cavity was explored with a 10-mm laparoscope. One 10-mm and one 5-mm port were inserted laterally from the laparoscope port. Dissection was performed using a dissector, which was not articulated. The gallbladder was investigated with an Endograsper, which was not articulated either. The hilum was dissected, and the cystic duct and artery were clipped and divided. Results: The patients are comprised of 9 females and 2 males with a mean age of 43.3 years and mean body mass index (BMI) of 27.6 kg/m2. Open cholecystectomy was not required. The mean operative time was 69.9 min. Length of stay was only one day. All procedures were completed successfully without any perioperative or postoperative complications. In all cases, there was no need to extend the skin incision. Postoperative follow-up did not reveal any umbilical wound complications. The cosmetic results were scored as excellent by all patients. Conclusion: These results suggest that single-incision laparoscopic cholecystectomy is feasible, safe and effective and a promising alternative method to four-port and SILS-port laparoscopic cholecystectomy and as scarless abdominal surgery for the treatment of some patients with gallbladder disease with standard laparoscopic instruments.
文摘目的用Meta分析方法比较评价内镜微创保胆取石术(EMIC)与腹腔镜胆囊切除术(LC)的可行性及有效性。方法利用计算机MEDLINE(PubMed)、OVID、中国知网全文数据库(CNKI)、万方数据库全面搜索内镜微创保胆取石与腹腔镜胆囊切除术的可行性及有效性的比较研究的中英文随机对照试验和回顾性分析文献,利用Rev Man 5.1软件对2种治疗方法的可行性和有效性指标进行Meta分析。结果最终纳入13篇文献共2 441例患者,其中随机对照研究4篇,回顾性分析9篇。内镜微创保胆取石术与腹腔镜胆囊切除术相比,内镜微创保胆取石的术中出血量减少,术后排气时间、术后住院时间缩短,术后并发症及消化道症状发生率降低;2种方法手术时间则无统计学意义。结论内镜微创保胆取石术的可行性和有效性均优于腹腔镜胆囊切除术。
