Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction

BACKGROUND Single incision plus one port left-side approach(SILS+1/L)totally laparoscopic distal gastrectomy(TLDG)is an emerging technique for the treatment of gastric cancer.Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy:relieving postoperative pain,shortening hospital stay and offering a better cosmetic outcome.Nevertheless,there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y(uncut R-Y)reconstruction.AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction(uncut R-Y reconstruction)to treat distal gastric cancer.METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled.All patients were treated at The Second Hospital of Shandong University.Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler.The clinicopathological characteristics,surgical details,postoperative short-term outcomes,postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully.The patient population included 13 men and 8 women with a mean age of 48.2 years(ranged from 40 years to 70 years)and median body mass index of 22.8 kg/m^2.There were no conversions to open laparotomy,and no other port was placed.The mean operation time was 146 min(ranged 130-180 min),and the estimated mean blood loss was 54 mL(ranged 20-110 mL).The mean duration to flatus and discharge was 2.3(ranged 1-3.5)and 7.3(ranged 6-9)d,respectively.The mean number of retrieved lymph nodes was 42(ranged 30-47).Two patients experienced mild postoperative complications,including surgical site infection(wound at the navel incision)and mild postoperative pancreatic fistula(grade A).Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively.No patients experienced moderate or severe food stasis,alkaline gastritis or bile reflux during the follow-up period.No recanalization of the biliopancreatic limb was found.CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.

Short-term outcomes of single-incision compared to multi-port laparoscopic gastrectomy for gastric cancer:A meta-analysis of randomized controlled trials

Objective:Single-incision laparoscopic sugery has emerged as a safe and less invasive approach to conventional multi-port laparoscopy.The present meta-analysis aimed to assess the collective outcomes of single-incision laparoscopic gastrectomy(SILG)compared to multi-port laparoscopic gastrectomy(MLG)for gastric cancer.Methods:A PRISMA-compliant systematic review of randomized controlled trials(RCTs)that compared SILG and MLG for gastric cancer in PubMed and Scopus through January 2023 was conducted.The main outcomes of the review were complications,postoperative pain,conversion to open surgery,hospital stay,and recovery.Results:Three RCTs including 301 patients(61.8%male)were incuded.A total of 151 patients underwent SILG,and 150 underwent MLG.SILG was associated with a shorter operative time(WMD=-16.39,95%CI:=27.38 to=5.40,p=0.003;2=0%)and lower pain scores at postoperative day 3(WMD=-1.18,95%CI:=2.27 to=0.091,p=0.033;I^(2)=99%)than MLG.There were no statistically significant differences between the two groups in es timated blood loss(WMD=-16.95,95%CI:-35.84 to 1.95,p=0.078;I^(2)=82%),complications(OR=0.71,95%Cl:0.36 to 1.42,p=0.337;I^(2)=0%),conversion to open surgery(OR=0.33,95%C:0.01 to 8.38,p=0.504),hospital stay(WMD=0.72,95%CI:-0.92 to 2.36,p=0.056;P=84%),time to first flatus(WMD=0.06,95%CI:=0.14 to 0.26,p=0.566;I^(2)=0%),time to first defecation(WMD=-0.14,95%CI:=0.46 to 0.18,p=0.392;I^(2)=0%),or time to first oral intake(WMD=0.37,95%a:=0.75 to 1.49,p=0.520;I^(2)=94%).Conclusions:SILG is associated with shorter operative times and less early postoperative pain than MLG.The odds of complications,blood loss,hospital stay,and gastrointestinal recovery were similar between the two procedures.

Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Transumbilical single-incision endoscopic splenectomy:Report of ten cases

AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.

Robotic single-incision left hemihepatectomy for intrahepatic bile duct stones by Da Vinci single-site surgical system: A case report with video

Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.

循证护理在降低肺癌患者PORT并发症中的应用效果

目的:评估循证护理在降低肺癌患者植入式静脉输液港(PORT)相关并发症中的应用效果。方法:选取2021年1月—2023年6月江苏省肿瘤医院确诊肺癌并行PORT植入化疗的150例患者,根据护理方式的不同分为对照组和观察组,每组75例。对照组给予常规护理,观察组给予循证护理。比较两组的并发症发生率、情绪状态、知识掌握度评分。结果:观察组PORT相关性并发症总发生率低于对照组,差异有统计学意义(P<0.05)。护理前,两组不良情绪评分比较,差异无统计学意义(P>0.05);护理后,观察组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分低于对照组,差异有统计学意义(P<0.05)。观察组知识掌握度评分均高于对照组,差异有统计学意义(P<0.05)。结论:循证护理在降低肺癌患者PORT并发症发生率、改善患者心理状态和生活质量方面效果显著,值得临床中应用。

基于port write事件触发的RapidIO节点动态管理方法

针对现有大规模的综合化电子信息系统中RapidIO节点管理实时性不强、CPU资源占用多的问题,提出了一种基于port write事件触发的RapidIO节点动态管理方法。该方法利用RapidIO交换芯片的port write包上报退网或者入网的节点信息,通过该信息动态管理RapidIO网络中的所有节点。工程应用实测结果表明,该方法实时性高,CPU资源占用少。

Basilic vein variation encountered during surgery for arm vein port:A case report

BACKGROUND Venous variations are uncommon and usually hard to identify,and basilic vein variation is particularly rare.Basilic vein variation usually presents without any clinical symptoms and is often regarded as a benign alteration.This case was a patient with congenital basilic vein variation encountered during surgery for an infusion port.CASE SUMMARY We documented and analyzed an uncommon anatomical variation in the basilic vein encountered during arm port insertion.This peculiarity has hitherto remained undescribed in the literature.We offer remedial strategies for addressing this anomaly in the future and precautionary measures to circumvent its occurrence.We conducted a comprehensive review of analogous cases in the literature,offering pertinent therapeutic recommendations and solutions,with the aim of enhancing the efficacy and safety of future arm port implantations.CONCLUSION Venous variation is rare and requires detailed intraoperative and postoperative examination to ensure accuracy,so as not to affect subsequent treatment.

The Impact of Privatization on Terminal Efficiency: A Case Study of Tema Port

Port and terminal efficiency are of utmost importance to the container shipping industry due to their significance in enhancing the competitive advantage of ports within a region. Consequently, there have always been notable variations of studies around it. This paper analyzes the impact of privatization on terminal efficiency using the Port of Tema as a Case Study. The main objective of this paper is to analyze the efficiency trends of the public and private terminals in the port over the years. To achieve this objective, DEA-CCR methodology was employed to calculate the annual technical efficiency trends of the private and public terminals using four input variables and three output variables. The main results of the paper indicated that the public and private terminals were efficient for multiple years. However, the efficiency scores over the years demonstrated inconsistency, exhibiting notable fluctuations. The findings of this study will aid policymakers across the region on policies relating to the efficiency and ownership structure of ports and terminals.

AGV Scheduling Optimization of Automated Port Based on Disruption Management

The recent rapid development of China’s foreign trade has led to the significant increase in waterway transportation and automated container ports. Automated terminals can significantly improve the loading and unloading efficiency of container terminals. These terminals can also increase the port’s transportation volume while ensuring the quality of cargo loading and unloading, which has become an inevitable trend in the future development of ports. However, the continuous growth of the port’s transportation volume has increased the horizontal transportation pressure on the automated terminal, and the problems of route conflicts and road locks faced by automated guided vehicles (AGV) have become increasingly prominent. Accordingly, this work takes Xiamen Yuanhai automated container terminal as an example. This work focuses on analyzing the interference problem of path conflict in its horizontal transportation AGV scheduling. Results show that path conflict, the most prominent interference factor, will cause AGV scheduling to be unable to execute the original plan. Consequently, the disruption management was used to establish a disturbance recovery model, and the Dijkstra algorithm for combining with time windows is adopted to plan a conflict-free path. Based on the comparison with the rescheduling method, the research obtains that the deviation of the transportation path and the deviation degree of the transportation path under the disruption management method are much lower than those of the rescheduling method. The transportation path deviation degree of the disruption management method is only 5.56%. Meanwhile, the deviation degree of the transportation path under the rescheduling method is 44.44%.

Seroprevalence Survey of HIV and Hepatitis B Virus and Behavioral Characteristics among Heavy Truck Drivers along Port Sudan-Khartoum Highways

The prevalence of human immunodeficiency virus (AIDS) and hepatitis B virus among heavy truck drivers and their assistants has been well documented globally in correlation with their behavioral characteristics. The present study aimed to screen for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and behavioral characteristics among heavy truck drivers in Port Sudan. A cross-sectional study was conducted on 274 heavy truck drivers and their assistants who used the highway Port Sudan-Khartoum in Port Sudan city during 2019-2021. Data on behavioral characteristics and substance use habits were collected using a structured questionnaire, and an ELISA test was used to screen for HIV and HBV infections in the study participants. The chi-square test, odds ratio, and confidence intervals were used to find the association between behavioral characteristics and seropositive HIV/HBV. Of the 274 enrolled participants, the seroprevalence rates of HIV were 2.7% and HBV was 23.7%. Ninety-four (34.3%) of them had a history of high-risk sexual behavior outside of marriage;only two (0.7%) used condoms;14.2% of participants reported alcohol use;and 1.1% reported drug use. Univariate analysis revealed that having a sex history outside of marriage with ≥1 sex partner and never using a condom with a spouse or casual partner were significant risk factors for HIV and HBV among drivers. Fortunately, we found that most of the drivers reported low alcohol and drug use. Concerning this study, the seroprevalence of HIV and HBV is highly associated with a history of having sex outside of marriage and sexual behavior among truck drivers and assistances. Additional studies are needed to further investigate other STIs and behavioral characteristics associated with factors in truck drivers/assistance in different truck stop regions in Sudan.

Function Evolution and Landscape Planning Strategy of Inland Rivers in Beilun Port City of Ningbo

In the history, the main roles of inland rivers in Beilun Port City of Ningbo were desalination,blocking tides, shipping, and flood control. Nowadays, with the continuous spread and deepening ofurbanization, the ecological environment of river courses has been destroyed. In the past, remediationmeasures based on engineering and technology played a certain role, but can not “cure the root cause”. Itshould respect the historical evolution process of river courses, and highlight the ecological service functionand leisure tourism value of river courses from the coordination perspective of urban and rural ecologicalenvironment, economic industries, society and culture in the planning ideas of ecology, production, andlife integration. Four aspects of the measures are as below: protecting and repairing the ecological matrixof river courses;building green space system and maintaining flood control functions through the waternetwork;protecting cultural heritage along the rivers;developing waterfront leisure tourism scenic area.

Impact of Hinterland Manufacturing on the Development of Container Ports: Evidence from the Pearl River Delta, China

Container ports and hinterland manufacturing are two important forces of the local participation in economic globalization.This study,taking the Pearl River Delta(PRD),China with an export-oriented economy as an example,applies Huff and panel regres-sion models to evaluate the impact of hinterland manufacturing on the development of container ports during the period of 1993–2019.The results show that 1)the spatial patterns of hinterlands for hub ports help to determine the distribution range and scale of economic variables that affect port throughput;2)the hinterland’s gross manufacturing output has universally positive influence on port through-put,wherein export-oriented processing and the entire manufacturing industry have significantly positive impact on port throughput in 1993–2011 and 2001–2019,respectively;3)the two internal structural factors related to an export-oriented economy,labor-intensive sectors and foreign-funded terminals,have positively moderate the direct influence of hinterland manufacturing on port throughput.Our results highlight the importance of local context in understanding port-manufacturing relationship in developing economies.Based on our findings,policy implications are further proposed to enhance port network organization in PRD.

Impact of coupling coordination development of port and city environments on urban economic competitiveness:Evidence from the coastal port cities in eastern China

Promoting the coupling coordination development of port and its hinterland city environments is an important way to improve urban economic competitiveness.Based on relevant data of 13 coastal port cities in eastern China from 2000 to 2018,this study explores the coupling coordination development of port and city environments and its impact on urban economic competitiveness by constructing the coupling coordination degree model and the panel threshold model.The research results show that:(1)In terms of the coupling coordination development of port and city environments,most coastal ports and their hinterland cities are in a state of moderate or serious disorder.Overall,the degree of coupling coordination of port and city environments needs to be further improved;(2)The coupling coordination degree of port and city environments has a significant impact on urban economic competitiveness,and this effect gradually increases with the development of the ports and the urban economy.Among the variables that impact the urban economic competitiveness,fixed assets investment and foreign trade are significant factors that can enhance urban economic competitiveness.(3)At present,there is a“U-shaped”relationship between the coupling coordination degree of port-city environments and the urban economic competitiveness.This relationship lies on the right side of the inflection point of the“U-shaped”curve.Therefore,following the concept of assigning priority to ecological development,expanding fixed assets investment and actively developing foreign trade can further enhance the urban economic competitiveness.

Innovative Exploration and Research on International Exchange and Cooperation Mechanisms under the Background of Hainan Free Trade Port

In order to explore and foster innovation in international exchange and cooperation,this study focuses on the background of the construction of the Hainan Free Trade Port.It delves into the current development status,characteristic demands,and potential challenges of its international exchange and cooperation mechanisms.Through a comprehensive analysis of relevant cases,survey questionnaires,and literature,this study aims to provide feasible innovative models and recommendations to promote the sustained development of the Hainan Free Trade Port in the field of international exchange and cooperation,injecting new vitality into China’s economic globalization.This exploration contributes to a deeper understanding of the development of free trade ports and provides insights and references for other countries and regions.

Exploration of the Construction of Economic Service Trade System under the Background of Hainan Free Trade Port

China has a large population,a large middle-income group,and a wide consumer market coverage.In the context of economic globalization,the connection between the Chinese economy and the world industrial chain has been further strengthened,contributing to the development of the global economy.Under the background of the Hainan Free Trade Port,building an economic service trade system will help to create a new highland for economic service trade,promote the development of China’s service trade,and facilitate the rational allocation of resources on a global scale.Because of this,the article will analyze the opportunities for building an economic service trade system and the challenges of building an economic service trade system under the background of Hainan Free Trade Port,and focus on analyzing the path strategies for building an economic service trade system to create a high-level new highland of service trade and actively face the challenges of era development and economic upgrading[1].

同质化管理模式在胃肠癌PORT患者冲管护理中的应用

目的:探讨同质化管理模式在胃肠癌静脉输液港(PORT)患者冲管护理中的应用效果。方法:将2019年6月1日~2022年12月1日收治的90例胃肠癌PORT患者作为研究对象,根据随机数字法将患者分为对照组和观察组各45例,对照组实施常规护理模式,观察组实施同质化管理模式;比较两组患者冲管满意度、不良事件发生率、护理人员知识掌握度及工作质量评分情况。结果:观察组患者冲管满意度高于对照组(P<0.05);观察组不良事件发生率低于对照组(P<0.05);观察组护理人员工作质量评分及知识掌握度高于对照组(P<0.05)。结论:实施同质化管理模式可降低胃肠癌PORT患者冲管中的不良事件发生率,提升冲管满意度,从而提高护理人员知识掌握度及工作质量。

PICC和PORT静脉输液技术综合输液效果比较

目的对PICC和PORT的综合效果指数进行测算,以评价两种中心静脉输液技术的综合输液效果。方法抽取上海市某三级甲等医院采用PICC或PORT行中长期静脉输液的肿瘤患者为研究对象,通过回顾性队列研究和横断面调查收集两种静脉输液技术的安全性、有效性及患者体验相关指标,测算并比较两种中心静脉输液技术在总留置时间、留置3~个月、6~个月及9~12个月的综合效果指数。结果PICC和PORT置管患者分别纳入377例、293例,PICC留置时间显著短于PORT,置管及维护过程中次要并发症发生率显著高于PORT,生活质量得分显著低于PORT(均P<0.05)。PICC在总留置时间、留置3~个月、6~个月及9~12个月的综合效果指数值均小于PORT。结论PORT的综合输液效果优于PICC,从输液效果角度,建议优先选择PORT作为中长期静脉输液的血管管路。

Single-incision laparoscopic cholecystectomy:Single institution experience and literature review

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.

Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis

AIM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute cholecystitis.METHODS:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital.One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional ports.Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded.The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings.Patient demography,clinical data,operative results and complications were recorded and analyzed.RESULTS:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated group.Twenty-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent 3ILC.The postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,P<0.01 in the complicated group;2.9±1.1 d vs 3.7±1.4 d,P<0.05 in the uncomplicated group).The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups,but the difference reached statistical significance only in the uncomplicated group(37.41±0.56℃vs 37.80±0.72℃,P<0.05 on postoperative day 1;37.10±0.43℃vs 37.57±0.54℃,P<0.01 on postoperative day 2).The operative time,estimated blood loss,postoperative narcotic use,total length of hospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC subgroups.The complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.001),and higher conversion rates(36.0%vs 19.0%,P<0.05)compared with the uncomplicated group.CONCLUSION:SILC is safe and efficacious for patients with acute cholecystitis.The main benefit is a faster recovery than that achieved with 3ILC.