Laparoscopic-endoscopic cooperative surgery for gastric submucosal tumors

AIM:To assess the feasibility,safety,and advantages of minimally invasive laparoscopic-endoscopic cooperative surgery(LECS)for gastric submucosal tumors(SMT).METHODS:We retrospectively analyzed 101 consecutive patients,who had undergone partial,proximal,or distal gastrectomy using LECS for gastric SMT at Peking Union Medical College Hospital from June 2006to April 2013.All patients were followed up by visit or telephone.Clinical data,surgical approach,pathological features such as the size,location,and pathological type of each tumor;and follow-up results were analyzed.The feasibility,safety and effectiveness of LECS for gastric SMT were evaluated,especially for patients with tumors located near the cardia or pylorus.RESULTS:The 101 patients included 43(42.6%)menand 58(57.4%)women,with mean age of 51.2±13.1 years(range,14-76 years).The most common symptom was belching.Almost all(n=97)patients underwent surgery with preservation of the cardia and pylorus,with the other four patients undergoing proximal or distal gastrectomy.The mean distance from the lesion to the cardia or pylorus was 3.4±1.3 cm,and the minimum distance from the tumor edge to the cardia was 1.5 cm.Tumor pathology included gastrointestinal stromal tumor in 78 patients,leiomyoma in 13,carcinoid tumors in three,ectopic pancreas in three,lipoma in two,glomus tumor in one,and inflammatory pseudotumor in one.Tumor size ranged from 1 to8.2 cm,with 65(64.4%)lesions<2 cm,32(31.7%)>2 cm,and four>5 cm.Sixty-six lesions(65.3%)were located in the fundus,21(20.8%)in the body,10(9.9%)in the antrum,three(3.0%)in the cardia,and one(1.0%)in the pylorus.During a median follow-up of 28 mo(range,1-69 mo),none of these patients experienced recurrence or metastasis.The three patients who underwent proximal gastrectomy experienced symptoms of regurgitation and belching.CONCLUSION:Laparoscopic-endoscopic cooperative surgery is feasible and safe for patients with gastric submucosal tumor.Endoscopic intraoperative localization and support can help preserve the cardia and pylorus during surgery.

New-style laparoscopic and endoscopic cooperative surgery for gastric stromal tumors

AIM: To evaluate the feasibility and safety of a new style of laparoscopic and endoscopic cooperative surgery (LECS), an improved method of laparoscopic intragastric surgery (LIGS) for the treatment of gastric stromal tumors (GSTs). METHODS: Six patients were treated with the newstyle LECS. Surgery was performed according to the following procedures: (1) Exposing and confirming the location of the tumor with gastroscopy; (2) A laparoscopy light was placed in the cavity using the trocar at the navel, and the other two trocars penetrated both the abdominal and stomach walls; (3) With gastroscopy monitoring, the operation was carried out in the gastric lumen using laparoscopic instruments and the tumor was resected; and (4) The tumor tissue was removed orally using a gastroscopy basket, and puncture holes and perforations were sutured using titanium clips. RESULTS: Tumor size ranged from 2.0 to 4.5 cm (average 3.50 ± 0.84 cm). The operative time ranged from 60 to 130 min (average 83.33 ± 26.58 min). Blood loss was less than 20 mL and hospital stay ranged from 6 to 8 d (average 6.67 ± 0.82 d). The patients were allowed out of bed 12 h later. A stomach tube was inserted for 72 h after surgery, and a liquid diet was then taken. All cases had single tumors which were completely resected using the new-style LECS. No postoperative complications occurred. Pathology of all resected specimens showed GST: no cases of implantation or metastasis were found.CONCLUSION: New-style LECS for GSTs is a quick, optimized, fast recovery, safe and effective therapy.

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Laparoscopic and endoscopic cooperative surgery(LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors(GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to av-oid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according tothe concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery

AIM: To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.

Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland(HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery(LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor(SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm intothe submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG.

Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer

The endoscopic submucosal dissection(ESD)technique has become the gold standard for submucosal tumors that have negligible risk of lymph node metastasis(LNM),due to its minimal invasiveness and ability to improve quality of life.However,this technique is limited in stage T1 cancers that have a low risk of LNM.Endoscopic full thickness resection can be achieved with laparoscopic endoscopic cooperative surgery(LECS),which combines laparoscopic gastric wall resection and ESD.In LECS,the surgical margins from the tumor are clearly achieved while performing organ-preserving surgery.To overcome the limitation of classical LECS,namely the opening of the gastric wall during the procedure,which increases the risk of peritoneal tumor seeding,non-exposed endoscopic wall-inversion surgery was developed.With this full-thickness resection technique,contact between the intra-abdominal space and the intragastric space was eliminated.

Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors:Personal experience and literature review

BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe,organ-sparing surgery that achieves full-thickness resection with adequate margins.Recent studies have demonstrated the safety and efficacy of these procedures.However,these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity,which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity.Non-exposed endoscopic wallinversion surgery(NEWS)is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity.Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection.One-step nucleic acid amplification(OSNA)can provide a rapid method of evaluating nodal tissue,whilst nearinfrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node(LN)assessment with OSNA.METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St.Giuseppe Moscati Hospital(Avellino,Italy).Patients with early-stage gastric or colon cancer(diagnosed via endoscopy,endoscopic ultrasound,and computed tomography)were included.All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022.LNs were examined intraoperatively with OSNA and postoperatively with conventional histology.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.Data were collected prospectively and analyzed retrospectively.RESULTS A total of 10 patients(5 males and 5 females)with an average age of 70.4±4.5 years(range:62-78 years)were enrolled in this study.Five patients were diagnosed with gastric cancer.The remaining 5 patients were diagnosed with early-stage colon cancer.The mean tumor diameter was 23.8±11.6 mm(range:15-36 mm).The NEWS procedure was successful in all cases.The mean procedure time was 111.5±10.7 min(range:80-145 min).The OSNA assay revealed no LN metastases in any patients.Histologically complete resection(R0)was achieved in 9 patients(90.0%).There was no recurrence during the follow-up period.CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques.This procedure allows clinicians to acquire additional information on the LN status intraoperatively.

全程标准化护理配合在正颌亚专科手术患者中的效果分析

目的:探讨全程标准化护理配合在正颌亚专科手术患者中的应用效果。方法:选取2022年1月至12月来南京医科大学附属口腔医院行正颌手术治疗的97例患者为研究对象,随机分为对照组48例和观察组49例。对照组采用常规护理配合模式,观察组在此基础上采用全程标准化护理配合,通过成立正颌护理管理小组,对专科小组护士进行专业培训,规范护理人员配合标准,比较两组护理配合效果、术中护理缺陷和术后并发症发生率,患者满意度以及医生对护理配合满意度的差异。结果:观察组患者的护理配合效果、护理缺陷和并发症发生率、患者及医生满意度,均高于对照组,差异有统计学意义(P<0.05)。结论:通过对行正颌手术治疗的患者全程给予标准化护理配合,在流程上对护理各环节进行质量控制,可以明显降低护理缺陷及并发症发生,缩短手术时长,减少术中出血量,保证护理质量和患者安全,有效提高医生和患者满意度。

中国特色学徒制视角下的《兽医外科手术学》实践教学改革探索

《兽医外科手术学》作为动物医学专业必修课,是一门实践性和操作性较强的专业课程。兽医外科手术同时也是兽医临床中重要的治疗手段。为了提高兽医外科手术学实践教学质量和水平,提升学生的兽医外科手术基本操作技能,在教学过程中与企业合作,引入校外宠物医院医师导师,以“学徒制”的理念,将课堂知识应用到临床实践,强化实践教学,提高学生学习积极性,提升职业素养。

模块化学习模式在TAVI手术配合中的应用研究

探讨模块化学习模式应用于手术室专科护士经导管主动脉瓣置入术(transcatheter aortic valve implantation,TAVI)手术护理配合中的效果。将手术配合拆分为三个模块,针对三个模块分别确定学习内容,进行测试评价,在学习前进行初测,学习后进行复测。结果显示,通过模块化的学习,手术室专科护士在学习前和学习后的理论和操作成绩均得到显著提高(P<0.05)。研究发现,模块化学习模式应用于手术室专科护士TAVI手术护理配合中,可以从不同方面丰富学习内容,优化学习效果,激发护士学习的积极性和主动性,缩短学习周期,提高学习质量。

腹腔镜-内镜联合手术治疗早期胃癌初期病例技术分析

目的:回顾性分析既往接受双镜联合手术的早期胃癌患者,评价该手术治疗早期胃癌的可行性。方法:回顾性收集2013年5月至2024年4月于北京大学肿瘤医院接受双镜联合手术的早期胃癌患者。手术方式包括内镜下黏膜切除(endoscopic submucosal dissection,ESD)联合腹腔镜淋巴结活检、经典腹腔镜-内镜联合手术(laparoscopic and endoscopic cooperative surgery,LECS)及其改良术式。收集患者临床病理特点、术后恢复指标、并发症及生存结局纳入分析。结果:共纳入9例患者,中位年龄64岁,男性6例(66.7%),女性3例(33.3%)。所有患者活检病理均为分化型胃癌。5例(55.6%)患者手术方式为ESD联合腹腔镜淋巴结活检,4例(44.4%)患者行腹腔镜辅助内镜全层切除及前哨淋巴结切检,平均麻醉时间(351.2±91.4)min,平均出血量(34.4±15.1)mL。术后出现3例(33.3%)并发症,包括1例胃排空障碍(CD2级),1例腹腔感染(CD2级),1例消化道穿孔(CD3级)。中位随访时间52个月,所有患者无复发及死亡。结论:双镜联合手术治疗早期胃癌具有可行性,其肿瘤学安全性仍需要进一步研究证实。LECS技术、适应证人群选择和前哨淋巴结切检准确率是进一步研究的重点。

中西医协同分级管理策略在鼻内镜术后鼻腔填塞患者口干症护理中的应用

目的探究中西医协同分级管理策略对鼻内镜术后鼻腔填塞患者口干症的改善效果。方法采用便利抽样法,选取2022年6月~11月南京市某三级甲等医院耳鼻咽喉头颈外科鼻内镜术后行鼻腔填塞的101例作为研究对象,按照住院时间分为对照组50例和试验组51例,对照组给予常规护理,试验组给予中西医协同分级管理策略。比较2组干预后三级口干的发生率、误吸的发生率、患者满意度。结果两组患者在手术日回室时的三级口干发生率对比并无统计学意义(P>0.05);试验组术后2h、4h、8h及术后2d的上、下午三级口干发生率、误吸发生率均低于对照组,差异有统计学意义(P<0.01);试验组的满意度为90.1%,高于对照组的64%,差异有统计学意义(P<0.05)。结论中西医协同分级管理策略能够有效降低鼻内镜术后鼻腔填塞患者三级口干的发生率,误吸发生率,提高患者满意度。

HFMEA在腹腔镜手术中转开放手术配合中的应用

目的探讨医疗失效模式与效应分析(healthfailuremode and effect analysis,HFMEA)在腹腔镜手术中转开放手术配合中的应用效果。方法选取2022年1—6月厦门大学附属第一医院收治的718例腹腔镜手术患者作为实施前;选取2022年7—12月厦门大学附属第一医院收治的662例腹腔镜手术患者作为实施后。2022年6月组建跨专业的多学科小组,梳理腹腔镜手术中转开放手术实施的关键环节,对中转开放手术实施过程中可能出现的失效模式进行严重度、发生的可能性、探测的可能性评分,根据危害评分矩阵评估风险优先指数(risk priority number,RPN),针对RPN>125分的5项失效模式进行改进。比较实施前后的RPN和应急抢救配合满意度。结果腹腔镜手术中转开放手术安全管理体系中包括手术间管理不符合要求、人员管理不符合要求、临床实施操作不规范、仪器及设备运行失效、手术护理记录不规范5个方面17个风险点;其中有8个风险点需要采取措施进行控制,实施控制措施后,8个风险点的RPN值均有下降,且均<8分。手术医护团队对于实施腹腔镜手术中转开放手术管理策略的实践均表示认可。结论基于HFMEA对腹腔镜手术中转开放手术配合应急抢救进行风险识别及评估,建立腹腔镜手术中转开放手术配合安全管理机制,可有效降低腹腔镜手术中转开放手术配合应急抢救RPN,保障腹腔镜手术中转开放手术配合顺利,保障患者安全。

“天玑”骨科手术机器人辅助下后路椎弓根螺钉内固定术患者的护理

文章总结了27例“天玑”骨科机器人辅助下后路椎弓根螺钉内固定术患者的手术配合及护理经验,包括术前合理规划机器人设备摆位、做好患者评估及物品准备,术中做好体位护理、手术配合及皮肤护理,术后做好患者安全管理及手术机器人相关器械管理。除1例患者因椎动脉出血改为徒手置钉外,其余26例患者均在机器人辅助下顺利完成手术,置钉效果满意,患者恢复良好。

达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术的1例手术护理配合体会

本文总结了1例达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术的手术护理配合体会,包括护理人员应提前做好术前访视和规划,参与多学科会诊,术中加强手术患者转换体位、手术体位用物管理,重视手术体位压力性损伤的预防,做好机器人手臂器械和急救器械的管理等,从而促进达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术顺利完成。

骨科手术机器人辅助空心螺钉内固定治疗中青年股骨颈骨折的护理

目的:探讨应用骨科手术机器人辅助空心螺钉内固定治疗中青年股骨颈骨折的手术配合及护理要点。方法:回顾性分析武汉科技大学附属普仁医院2021年12月—2023年3月采用骨科手术机器人辅助空心螺钉内固定治疗的30例中青年股骨颈骨折病人的临床资料,对手术过程中的手术配合及护理要点进行分析和总结。结果:30例病人均成功完成手术,术后手术伤口均愈合良好,未发现伤口感染或不愈合病例,术中无不良事件发生。结论:充分的术前准备及熟练的术中配合是骨科手术机器人辅助空心螺钉内固定治疗中青年股骨颈骨折手术成功的关键措施。

基于加速康复外科理念的多学科合作管理对二次剖宫产产妇术后恢复及早期转归的影响

目的探讨基于加速康复外科(ERAS)理念的多学科合作管理对二次剖宫产产妇术后恢复及早期转归的影响。方法选择2022年12月至2024年3月于济宁市第一人民医院行二次剖宫产手术的产妇60例,采用随机数字表法分为常规组和ERAS组,各30例。常规组给予传统管理方案,ERAS组给予基于ERAS理念的多学科合作管理方案。比较两组产妇术后恢复情况、术后镇痛情况及术后并发症发生情况。结果ERAS组产妇术后24h 11项产科恢复质量(ObsQoR-11)评分为(92.90±7.16)分高于常规组(85.20±11.86)分,术后首次排气时间为(25.17±4.91)h、初始泌乳时间为(21.20±1.67)h分别短于常规组(29.80±5.11)h和(25.67±3.04)h,子宫复旧程度为(2.26±0.71)cm大于常规组(1.67±0.42)cm,术后48h舒芬太尼用量为[50.00(48.00,52.00)]μg少于常规组[52.00(48.00,56.00)]μg,差异有统计学意义(t=3.044、-3.583、-7.048、3.908,Z=-2.354,均P<0.05)。ERAS组术后静息及咳嗽时中重度疼痛发生率、镇痛补救率、术后并发症总发生率分别为6.67%、10.00%、6.67%、26.67%,均明显低于常规组的26.67%、33.33%、30.00%、73.33%,差异有统计学意义(χ^(2)=4.320、4.812、5.455、13.067,均P<0.05)。结论基于ERAS理念的多学科合作管理有利于促进二次剖宫产产妇术后恢复,降低并发症,改善术后早期转归。

Present situation of minimally invasive surgical treatment for early gastric cancer

Minimally invasive surgery is a kind of surgical operation,which is performed by using professional surgical instruments and equipment to inactivate,resect,repair or reconstruct the pathological changes,deformities and wounds in human body through micro-trauma or micro-approach,in order to achieve the goal of treatment,its surgical effect is equivalent to the traditional open surgery,while avoiding the morbidity of conventional surgical wounds.In addition,it also has the advantages of less trauma,less blood loss during operation,less psychological burden and quick recovery on patients,and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer patients.Surgical minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer(EGC):endoscopic mucosal resection(EMR),underwater EMR(UEMR),endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR),endoscopic submu-cosal excavation(ESE),submucosal tunnel endoscopic resection,laparoscopic and endoscopic cooperative surgery(LECS);Among them,EMR,EFTR and LECS technologies have a wide range of applications and different modific-ations have been derived from their respective surgical operations,such as band-assisted EMR(BA-EMR),conven-tional EMR(CEMR),over-the-scope clip-assisted EFTR,no-touch EFTR,the inverted LECS,closed LECS,and so on.These new and improved minimally invasive surgeries are more precise,specific and effective in treating different types of EGC.

无痛消化内镜下高频电刀在胃肠息肉中的应用效果及术后复发影响因素分析

目的 调查无痛消化内镜下高频电刀在胃肠息肉中的应用效果及术后复发的影响因素。方法 回顾性搜集2020年6月至12月空军军医大学第一附属医院消化内镜中心手术治疗的胃肠息肉患者500例,其中124例接受常规内镜下高频电刀治疗记为常规组,376例采用无痛消化内镜下高频电刀治疗记为研究组,比较两种内镜方案在息肉切除效率、围术期镇痛及胃肠恢复方面的应用效果;另外对研究组展开为期3年的术后随访研究,并据此总结为复发与未复发两种结局,单因素及二元logistic回归调查术后复发的影响因素。结果 两组术中息肉切除数目差异不显著(P>0.05),但研究组息肉切除时间短于常规组(P<0.05)。研究组术中及术后0.5、1、6 h的疼痛水平均低于常规组(P<0.05)。两组术后第1次肛门排气、排便时间差异均不显著(P>0.05)。研究组患者术后3年内息肉复发141例,复发率37.50%,单因素及二元logistic回归调查显示,年龄≥49岁、超重、合并Hp感染、腺瘤性息肉、多发息肉以及息肉直径≥1 cm均是胃肠息肉患者无痛消化内镜下高频电刀治疗后3年内复发的独立危险因素(P<0.05)。结论 无痛消化内镜下高频电刀治疗胃肠息肉患者的息肉切除效率较高且围术期镇痛效果满意,但术后仍具有一定复发率,临床需对其合并有年龄≥49岁、超重、Hp感染、腺瘤性息肉、多发息肉以及息肉直径≥1 cm等类特征的患者加强随访监督管理,预防术后复发。