Combined Laparoscopic Surgery Research Articles

Методы коррекции сочетанных форм генитального пролапса лапароскопическим доступом

Aim: to evaluate the efficacy and safety of a combined technique — pectopexy, and the most common — laparoscopic sacrocolpopexy for pelvic organ prolapse correction. Patients and Methods: the study included 32 female patients with a similar nosological form of pelvic organ prolapse. All the subjects were divided into two groups depending on the surgical treatment method. Group 1 (main group) included 14 female patients who had a combined laparoscopic correction of pelvic organ prolapse with transverse and longitudinal fixation of synthetic implants — combined pectopexy. Group 2 (control group) included 18 female patients who underwent sacrocolpopexy. Comprehensive clinical and instrumental examination of female patients was performed before and within 24 months after surgery. Results: there were no intraoperative complications in female patients of both groups. In all cases, the surgical intervention result was recognized as positive both according to the patient assessment and medical researcher assessment. There was a significant improvement in indicators reflecting the central compartment condition (apical prolapse), as well as the anterior and posterior vaginal walls. All female patients showed an improvement in their life quality. The patients also showed positive tendency according to pelvic ultrasound after surgery. No pelvic mesh complications were reported. The parameters of the Pelvic Organ Prolapse Quantification (POP-Q) system assessment did not differ significantly in female patients from both groups 1, 6, 12 and 24 months of follow-up after surgery. Conclusion: based on the obtained follow-up data, correction of central, posterior and partially anterior prolapse was achieved in patients after combined transverse and longitudinal fixation of synthetic implants. Pectopexy is safe and comparable to sacrocolpopexy, which is currently considered the most common surgery, gives a positive effect in correcting pelvic organ prolapse and improves the life quality of female patients. KEYWORDS: genital prolapse, combined laparoscopic surgery, mesh implants, surgical treatment of pelvic organ prolapse, laparoscopic sacrocolpopexy, laparoscopic pectopexy, life quality. FOR CITATION: Pyatkina A.N., Bryunin D.V., Chushkov Yu.V. Laparoscopic correction methods of pelvic organ prolapse. Russian Journal of Woman and Child Health. 2024;7(1):18–25 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-3.

Exploration of the clinical application of combined endoscopic and laparoscopic surgery in early gastric cancer: 15 cases

Objective: To investigate the application of combined gastroscopy and laparoscopy (dual scope) in the treatment of early gastric cancer. Methods: In this descriptive case series study, we retrospectively collected data on 15 patients with cT1b stage gastric cancer who had undergone combined laparoscopic and endoscopic surgery in the 900th Hospital of the People's Liberation Army of China from May 2020 to October 2022. The study cohort comprised nine men and six women of median age 59 (range: 47-76) years and median body mass index 20.9 (range: 18.3-26.2) kg/m2. Seven of the lesions were located on the lesser curvature of the gastric antrum and eight in the gastric angle. All lesions were biopsied for pathological examination and evaluated by endoscopic ultrasonography, followed by endoscopic submucosal dissection (ESD) and laparoscopic regional lymph node dissection. Studied variables included surgical and pathological features, postoperative factors, and outcomes. Results: In this group of patients, the median (range) operative time for ESD was 45 (30-82) minutes, the duration of laparoscopic lymph node dissection (45.1±8.6) minutes, and the median (range) intraoperative blood loss during lymph node dissection 30 (10-80) mL. Of the 13 patients with negative postoperative horizontal margins, four were stage SM1 and had no lymph node metastases (Stage SM1) and nine were Stage SM2, of which had one positive regional lymph node and two received additional standard distal gastrectomy with D2 lymphadenectomy concurrently because of positive ESD specimens (lymph node negative). No lymph node metastases were found in the surgical specimens of these patients. The remaining two patients had positive vertical margins; both had undergone concurrent standard distal gastrectomy with D2 lymphadenectomy. One of them was found to be lymph node positive (No. 3, one node). Four patients had impaired gastric emptying after dual-scope treatment, all of whom recovered well with symptomatic management; one patient with a suspected lymphatic leak was also managed conservatively. There were no cases of postoperative bleeding, abdominal infection, or incisional infection. At a median follow-up of 14 (6-26) months, no tumor recurrence or metastasis had been identified in any of the patients. Three patients had a grade B nutrition score 3 to 6 months after surgery, all of whom had undergone major gastrectomy, and two patients who had undergone dual-scope surgery reported an increase in acid reflux and belching after surgery compared with the preoperative period. Conclusion: A combined technique is safe and feasible for the treatment of early gastric cancer and is worthy of further exploration.

Thoracolaparoscopic radical resection of esophagogastric junction cancers with a NOSE-like approach to extract large specimens.

To investigate the efficacy and safety of combined thoracoscopic and laparoscopic radical resection of esophagogastric junction cancers using a natural orifice specimen extraction-like approach for extraction of large surgical specimens. Patients who had esophagogastric junction cancers treated with thoracolaparoscopic resection using the natural orifice specimen extraction-like approach for specimen extraction were retrospectively enrolled. A 5-cm transverse incision on the abdominal wall at the middle of the superior pubic symphysis was made for surgical specimen extraction. The clinical, surgical, complications, and follow-up data were analyzed. A total of 162 patients were enrolled, and the surgery was successful in all patients (100%). The total surgical duration ranged 165 to 270 minutes, with blood loss 20 to 150 mL, hospital stay 8 to 22 days, first flatus time 2 to 7 days, extubation time of drainage tubes 1 to 26 days, first oral feeding time 5 to 10 days, number of lymph nodes resected 15 to 39, postoperative ambulation time 1 to 2 days, and postoperative residual rate of cancerous cells at the surgical margins 0. Postoperative complications occurred in 14 (8.6%), including anastomotic leakage in 4 (2.5%), anastomotic stenosis in 3 (1.9%), hydrothorax in 4 (2.5%), and incision infection in 3 (1.9%). At follow-up (mean 12 months), all patients were alive, and the transverse incision was a linear scar concealed in the suprapubic pubic hair area. The combined laparoscopic and thoracoscopic surgery for radical resection of carcinomas at the esophagogastric junction is safe and effective, and a transverse incision at the suprapubic symphysis for specimen extraction results in improved minimal invasiveness and cosmesis.

Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome.

PurposeThere are only a few case reports and case series that investigated combined laparoscopic or robotic surgery for simultaneous prostate and kidney cancer. In this study, we want to close a gap in existing research to assess the feasibility and oncological outcome of combined open prostatectomy and kidney surgery.MethodsWe retrospectively analyzed patients who underwent a combined open prostatectomy and either a partial or complete nephrectomy from 2013 to 2020. Descriptive statistics were used to assess perioperative parameters and the 12-month functional and oncological outcomes after combined surgery.ResultsWe identified 10 patients undergoing combined open surgery. Partial nephrectomy was performed in 4, radical nephrectomy in 6 patients. For prostate cancer, histopathological analysis showed a tumor stage ≥ pT2c in all 10 patients. For renal tumors, histopathological analysis showed clear cell renal cell carcinoma in 8 patients and oncocytoma in 2 patients. Operating time was 177 ± 36 minutes. Two perioperative complications (Clavien 2a and 3) were observed. Three months postoperatively, the International Index of Erectile Function (IIEF-5) score was 5.6 ± 5.9, the ICIQ-SF score was 7.3 ± 5.6 and were using 1.9 ± 2.2 pads per day. This improved after 12 months postoperatively, as patients had an IIEF-5 score of 6.33 ± 6.5, an ICIQ-SF score of 4.4 ± 5.7 and were using pads 0.9 ± 1.7 per day.ConclusionIn this study, we showed that open surgery is a safe and valid approach for combined prostatectomy and renal surgery with acceptable complications and oncological outcomes. The combined open approach could be a good alternative to combined laparoscopic/robotic surgery in this field, especially to treat patients with advanced renal tumors or previous abdominal surgery or radiation.

Cost-effectiveness analysis comparing laparoscopic hysterectomy to combined laparoscopic hysterectomy and bariatric surgery in obese women with obesity-related disease and atypical endometrial hyperplasia or early-stage endometrial cancer

<h3>Objectives:</h3> Women with early-stage endometrial cancer (EC) are twice as likely to die of cardiovascular disease than their cancer. For this reason, more emphasis needs to be placed on weight management in early-stage EC to decrease morbidity and mortality in that population. Bariatric surgery has sustainable effects on weight loss and comorbidity improvement. That the primary approach to managing early-stage EC is laparoscopic hysterectomy (LH) presents an opportunity to perform simultaneous bariatric surgery. As this combined surgery is rarely performed, a potential opportunity to address the true underlying problem is missed. We aimed to study the cost-effectiveness of the combined procedure in comparison to LH alone. We performed a cost-effectiveness analysis of combined LH with bariatric surgery (combined surgery) to assess the lifetime costs and quality-adjusted life years (QALYs) in EC survivors with obesity-related disease (ORD). <h3>Methods:</h3> The study population was obese women aged 50-59 with ORD (hypertension and diabetes) undergoing surgery for atypical endometrial hyperplasia or early stage EC. A decision-analytic model with lifetime horizon was constructed to compare combined surgery to LH alone. Following surgery, 17 health-state Markov models consisting of no ORD, any combination of the four ORDs, and all four ORDs were used to estimate life expectancy and lifetime healthcare costs. Annual probabilities and healthcare costs for normal weight, overweight, and obese women were estimated using nationally representative data from the 2008-2016 Medical Expenditure Panel Survey. Utility weights were obtained from published studies and used to discount life expectancy estimates to calculate QALYs. Surgery costs for combined surgery were obtained from Washington University in St. Louis. Surgery costs for LH and surgical complication costs were obtained from published studies. Costs were evaluated from the healthcare sector perspective and presented in U.S. dollars at the 2020 price level based on the Medical Care Component of the Consumer Price Index for All Urban Consumers. Future costs and QALYs were discounted to present values using an annual rate of 3%. <h3>Results:</h3> Life expectancy after combined surgery was 30.69 years and 16.56 QALYs compared to 23.96 years and 11.47 QALYs for LH. The lifetime healthcare cost for patients with combined surgery was $130,366 compared to $267,742 for patients with LH alone. In terms of cost-effectiveness, LH was dominated by combined surgery, because combined surgery was more effective and less costly. <h3>Conclusions:</h3> This study is the first to conduct a cost-effectiveness analysis comparing LH to combined LH and bariatric surgery in obese women with ORD undergoing surgery for early-stage EC. Combined surgery is cost-saving and should be considered as a treatment option for this population. Further study of improving access to combination surgery is warranted.

Clinical Study of Laparoscopy Combined with Choledochoscope in the Treatment of Cholecystolithiasis Combined with Choledocholithiasis

To observe the clinical effect of combined laparoscopic and choledochoscopic surgery for gallbladder combined with common bile duct stones. A total of 102 patients with gallbladder stones combined with common bile duct stones admitted to our hospital between January 2017 and December 2020 were selected and randomly divided into 51 cases in the study group and 51 cases in the control group. The control group was treated with laparoscopic gallbladder stones treatment and the trial group was treated with laparoscopic combined with choledochoscopic surgery. The surgery-related indexes, serum inflammatory indexes and postoperative complications of patients in the two groups were compared, as well as the treatment efficiency. After treatment, the intraoperative bleeding, average postoperative hospitalization time, 24 h postoperative visual analogue scale score and time to first postoperative venting of patients in the laparoscopic group were significantly better than those in the control group, but the operative time was significantly more than that in the control group and the difference was statistically significant (p 0.05); 1 d after surgery, the serum procalcitonin and high-sensitivity C-reactive protein levels of the two groups were lower than those before surgery and the study group was significantly lower than the control group and the difference was statistically significant (p 0.05). The total complication rate of the test group was lower than that of the control group (p<0.05). The treatment of patients with gallbladder combined with common bile duct stones by laparoscopy combined with choledochoscopy has better clinical treatment effect than laparoscopic gallbladder stones treatment and has the advantages of less trauma, faster postoperative recovery and less inflammatory reaction, which is worthy of clinical promotion and application.

Промонтофиксация с использованием титанового имплантата у пациенток с поливалентной аллергией и комбинированной гинекологической патологией

Clinical observation of two patients with polyvalent allergy, uterine leiomyoma, and stage II apical prolapse who underwent a combined surgical intervention of subtotal/total hysterectomy followed by cervical stump/vaginal stump promontofixation using titanium mesh implants. Dynamic follow-up for 3–12 months after surgery showed the absence of pelvic organ prolapse during gynecologic examination, Valsalva maneuver, and transperineal ultrasound. A questionnaire survey of the patients revealed satisfaction with the results of surgery and improvement of the quality of life. Conclusion. The study demonstrated the efficacy and safety of combined laparoscopic surgery for uterine leiomyoma and stage II apical prolapse in premenopausal patients with polyvalent allergy. The surgery contributed to the normalization of anatomical relations in the small pelvis and relieving the apical prolapse symptoms. The use of titanium mesh implants minimized the risk of allergic reactions and mesh-associated complications, which resulted in satisfaction with the results of surgery and improvement in the quality of life of the patients. Key words: pelvic organ prolapse, apical prolapse, hysterectomy, titanium mesh implants

Endoscopic surgical treatment of isthmocele and it’s probale link with endometriosis. A 3-years retrospective review of combined laparoscopic and hysteroscopic surgery

The aim, is to share our experience on the efficacy of combined laparoscopic and hysteroscopic surgical treatment of isthmocele, and the possible link with endometriosis. 28 patients with isthmocele, who underwent combined laparoscopic and hysteroscopic repair were retrospectively analysed. Presenting symptoms were; bleeding disorder, infertility, lower abdominal pain, dysmenorrhea and chronic vaginal discharge. All noticeable changes observed in the preoperative symptoms, were evaluated at 1, 3, and 6 months postoperatively, while fertility return within the first 24 months postoperatively was also evaluated. Average age of the patients was 36.9±4.5, fertility return after surgery was 82.4% (n=14/17), post menstrual bleeding disorders was almost completely resolved in all the patients in the 1, 3, and 6 months after surgery, mean bleeding duration was significantly shorter than the preoperative period 3.6±1.1 days as against 10.3±1.7days. There was significant resolution of the other symptoms like dysmenorrhea, chronic vaginal discharge and suprapubic pain at 6 months after surgery. Endometriosis was found in 16 (57.1%) patients, which is remarkably high in patients who had no previous history or diagnosis of endometriosis. The overall patient satisfaction rate was 92.9% (26/28). Our experience shows that, the combined used of hysteroscopy and laparoscopy is very effective in the management of isthmocele with minimal complications. Our findings also suggests a possible link between endometriosis and isthmocele. Further large scale studies may be required to ascertain these findings. Keywords: Endometriosis, Pelvic pain, Dysmenorrhea, Premenstrual syndrome, Abnormal uterine bleeding, Laparoscopy, Hysteroscopy, Caesarean section, Isthmocele.

Feasibility analysis of different surgical methods for uterine cesarean section scar diverticulum.

This study analyses the effects of surgical indicators and clinical efficacy of different surgical methods for uterine cesarean section scar diverticulum. This retrospective cohort study included 65 patients who underwent surgery and postoperative follow-up at Gansu Provincial Maternity and Child-care Hospital from 1 January 2013 to 31 February 2019. All participants were treated surgically. Among them, patients in Group A underwent combined laparoscopic and hysteroscopic surgery (n = 45), Group B underwent transvaginal surgery (n = 11), Group C underwent laparotomy (n = 9). The primary outcomes were surgical indicators. The secondary outcomes were clinical efficacy. Bleeding, operation time and hospitalization expenses were significantly different among the three groups (P < 0.05). There was no difference in the hospital stay among the three groups P = 0.22). The menstrual period before and after surgery was significantly different among the groups (P < 0.05). The recurrence outcome was no significantly different (P = 0.16), but the pregnancy outcome was not (P = 0.78). The three surgical methods are effective for treating cesarean section scar diverticulum with favorable effects. Laparoscopic combined with hysteroscopic surgery is minimally invasive with less bleeding compared with the other two techniques and it is easier for patients to accept. It is the most widely used surgical method.

Ultrasound evaluation of pouch of Douglas obliteration and rectal deep endometriosis in women who have had previous combined colorectal and gynaecological laparoscopic surgery for rectal endometriosis: A pilot study.

Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8±24.6months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.

Laparoscopy combined with hysteroscopy for cesarean scar pregnancy

Purpose: The aim of this study was to investigate the safety of combined laparoscopic surgery and hysteroscopic electrosurgery for partial repair of the cesarean scar and removal of the conceptus, respectively, in cesarean scar pregnancy (CSP). Methods: This was a retrospective analysis of data from 23 patients with CSP who underwent laparoscopic surgery together with hysteroscopic electrosurgery between January 2008 and January 2016 at our medical center. Under hysteroscopic visualization, the gestational sac and the complete cesarean section scar were cut by laparoscopic surgery. Results: Patient age was 28 ± 3.3 years (mean ± SD) with a range of 22-38 years. Patient gravidity was 3.0 ± 1.2 with a range of 1-6, while parity was 1.0 ± 1.5 with a range of 1-3. Intraoperative blood loss was 100.2 ± 32.7 mL (mean ± SD), operating time was 60 ± 48.6 min and the duration of hospitalization was 5 ± 1.2 days. Surgery was successful in all patients, with no instances of bladder injury. The level of β-human chorionic gonadotropin (β-HCG) began to decrease on the second postoperative day and returned to normal levels within one month of surgery. The mean time required for normalization of serum β-HCG levels was 25 ± 5.2 days (mean ± SD) with a range of 20-35 days. Conclusions: Laparoscopic surgery combined with hysteroscopic electrosurgery for partial repair of the cesarean scar and removal of the conceptus, respectively, is a safe, feasible and effective treatment approach for CSP.

Clinical outcomes of non-exposed endoscopic wall-inversion surgery for gastric submucosal tumors: long-term follow-up and functional results.

To avoid the risk of iatrogenic dissemination during procedures, we have developed a combined laparoscopic and endoscopic surgery with a nonexposure technique for resection of gastric tumors. The study aim was to evaluate the feasibility and safety of non-exposed endoscopic wall-inversion surgery (NEWS) for gastric submucosal tumors (SMTs). Between August 2013 and February 2018, NEWS was performed for 42 patients with gastric SMTs ≤ 3cm in diameter at our institution. We retrospectively investigated the patients' backgrounds, operative and perioperative outcomes, tumor pathological characteristics, and follow-up data. All tumors were resected with negative margins by NEWS. The median operation time was 198min, and the median estimated blood loss was 5.0mL. Adverse events occurred in one patient with pneumonia. All patients were alive without recurrence within the median follow-up period of 29.2months. The average body weight loss rate was 0.3 ± 4.0%. No food residue was observed at endoscopic follow-up. On the basis of slight body weight loss and the absence of food residue observed in the postoperative endoscopy, NEWS appeared to be safe and feasible for gastric SMTs and to preserve function of the remnant stomach.

Clinical application of combined laparoscopic surgery in the treatment of primary hepatocellular carcinoma with portal hypertension: a report of 16 cases

Primary hepatocellular carcinoma (HCC) is a common malignant tumor in China and is often accompanied by portal hypertension (PHT). Whether simultaneous operation can be used in patients with liver cirrhosis and PHT accompanied by HCC is controversial. The aim of the present study was to investigate the safety and feasibility of simultaneous laparoscopic hepatectomy, splenectomy and pericardial devascularization in the treatment of HCC with PHT. A total of 16 patients were treated with laparoscopic surgery for PHT and HCC from April 2011. The operation time, volume of intraoperative blood loss, red blood cell transfusion, plasma transfusion, time for diet intake, drainage time, duration of hospital stay and occurrence of complications were observed. The follow-up time was 3 years, and long-term outcomes included overall survival rates and recurrence-free survival rates. The operation time and volume of blood loss were 336±18 min and 337±351 mL, respectively. Of the patients, 2 received intraoperative homologous blood transfusion and 9 received plasma transfusion. The time for diet intake, drainage time and duration of hospital stay were 3.5±0.5, 7.3±1.0 and 13.6±3.6 days, respectively. The postoperative complications included 1 patient with anastomosis-site bleeding, 2 patients with abdominal effusion and 3 patients with portal vein thrombosis, which were treated conservatively. The overall survival rates at 1 and 3 years were 100% (16/16) and 87.5% (14/16), respectively. The recurrence-free survival rates at 1 and 3 years were 87.5% (14/16) and 62.5% (10/16), respectively. In conclusion, simultaneous laparoscopic hepatectomy, splenectomy and pericardial devascularization is an effective treatment for PHT and primary HCC, and provides a potential new therapy for patients.

Clinical application of combined laparoscopic surgery in the treatment of primary hepatocellular carcinoma with portal hypertension: a report of 16 cases.

Primary hepatocellular carcinoma (HCC) is a common malignant tumor in China and is often accompanied by portal hypertension (PHT). Whether simultaneous operation can be used in patients with liver cirrhosis and PHT accompanied by HCC is controversial. The aim of the present study was to investigate the safety and feasibility of simultaneous laparoscopic hepatectomy, splenectomy and pericardial devascularization in the treatment of HCC with PHT. A total of 16 patients were treated with laparoscopic surgery for PHT and HCC from April 2011. The operation time, volume of intraoperative blood loss, red blood cell transfusion, plasma transfusion, time for diet intake, drainage time, duration of hospital stay and occurrence of complications were observed. The follow-up time was 3 years, and long-term outcomes included overall survival rates and recurrence-free survival rates. The operation time and volume of blood loss were 336±18 min and 337±351 mL, respectively. Of the patients, 2 received intraoperative homologous blood transfusion and 9 received plasma transfusion. The time for diet intake, drainage time and duration of hospital stay were 3.5±0.5, 7.3±1.0 and 13.6±3.6 days, respectively. The postoperative complications included 1 patient with anastomosis-site bleeding, 2 patients with abdominal effusion and 3 patients with portal vein thrombosis, which were treated conservatively. The overall survival rates at 1 and 3 years were 100% (16/16) and 87.5% (14/16), respectively. The recurrence-free survival rates at 1 and 3 years were 87.5% (14/16) and 62.5% (10/16), respectively. In conclusion, simultaneous laparoscopic hepatectomy, splenectomy and pericardial devascularization is an effective treatment for PHT and primary HCC, and provides a potential new therapy for patients.

Simultaneous laparoscopic resection of colorectal cancer and liver metastases- Initial experience

Background: Simultaneous resection(SR) of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens length of stay, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 32 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 10 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (29p.) or hybrid technik (3 p.). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150–320) minutes with a total blood loss of 600 (range 200–750) ml. Postoperative hospital stay was 7day (5-12). An R0 resection was achieved in all patients. Conversion rate was 3,8%(1p.), because we did not find matastasis. Complication rate was 3,8% too, 1 patient with low debit biliary fistula.(grade B). Conclusion: SLC and LR appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term Results.

Clinical study of gynecological endoscopic surgery in the combined treatment of previous cesarean scar diverticulum

Objective To investigate the clinical value of hysteroscopy and combined laparoscopic surgery in the treatment of previous cesarean scar diverticulum (PCSD). Methods 36 cases of PCSD in our hospital from January 2013 to January 2015 were selected. Among them, 13 cases were treated with hysteroscopy diverticulum incision (hysteroscopic surgery group), and 23 cases underwent hysteroscopy combined with laparoscopy diverticulectomy repair (combined operation group). The diagnosis and surgical treatment of PCSD patients were recorded and the pregnancy outcome was followed up. Results The operation time [(39.5±17.1)min vs ( 92.3±30.8)min], the amount of bleeding [(18.2±5.6)ml vs (98.6±24.4)ml] and the length of hospital stay [(2.3±0.6)days vs (5.2±1.1)days] in hysteroscopic surgery group were less than those of hysteroscopy combined with laparoscopy (P 0.05). 17 cases of fertility requiring patients underwent hysteroscopy combined with laparoscopy diverticulectomy repair, of which 8 cases were successfully delivered after operation. Conclusions Individualized clinical decision-making should be made for PCSD patients. Hysteroscopy and combined hysteroperitoneal surgery have the same effect, but the latter should be chosen for those with severe clinical symptoms or reproductive needs. Key words: Cesarean section/AE; Cicatrix; Uterus/SU; Diverticulum/SU; Hysteroscopy; Laparoscopy

Combined laparoscopic and robotic surgery for synchronous colorectal and genitourinary cancer: A case series

IntroductionAdvances in diagnostic techniques and treatment have resulted in an increase in patients with synchronous cancer. Surgical reports of combined laparoscopic and robotic resection for synchronous colorectal and genitourinary cancer are rare. Materials and methodsBetween August 2015 and November 2017, three patients underwent combined laparoscopic and robotic surgery for synchronous colorectal and genitourinary cancer in our hospital. ResultsCase 1 was a 59-year-old man with synchronous rectal and prostate cancer treated by combined laparoscopic anterior resection and robotic-assisted prostatectomy. Case 2 was a 77-year-old man with synchronous cancer of transverse colon and left kidney treated by combined laparoscopic transverse colectomy and robotic-assisted partial nephrectomy. Case 3 was a 74-year-old man with synchronous adenocarcinoma of descending colon and prostate treated by combined laparoscopic left hemicolectomy and robotic-assisted prostatectomy. DiscussionIn simultaneous endoscopic surgery, it is necessary to consider sequence of resection, intraoperative position of patient and port arrangement. Simultaneous surgery allows promptly for postoperative adjuvant chemotherapy. ConclusionCombined laparoscopic and robotic surgery for synchronous colorectal and genitourinary cancer is suitable for advanced cancer cases requiring multidisciplinary treatment.

Laparoscopic and luminal endoscopic cooperative surgery can be a standard treatment for submucosal tumors of the stomach: a retrospective multicenter study.

Background and study aims We have developed a combined laparoscopic and luminal endoscopic surgery technique for resection of gastric submucosal tumors (SMTs) that can be performed without excessive resection of the stomach. In a multicenter retrospective study we aimed to evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery (LECS) for gastric SMT resection. Patients and methods Between October 2007 and December 2011, 126 patients with gastric SMTs underwent LECS at 8 institutions. Patient demographics, tumor histopathologic characteristics, and operative and follow-up data were reviewed. Results 16 tumors (12.7 %) were located in the upper third of the stomach, 88 (69.8 %) in the middle third, 5 (4.0 %) in the lower third, and 17 (13.5 %) at the esophagogastric junction. The mean (standard deviation [SD]) operation time for LECS was 190.2 (66.8) min, with a mean estimated blood loss of 15.1 (38.6) mL. In 2 cases (1.6 %), the procedure was converted to open surgery because of intra-abdominal adhesions or stenosis. Morbidity was found in 6 cases (4.8 %), including 2 leakage, 2 gastric stasis, 1 fever, and 1 cystitis. Histologically, a gastrointestinal stromal tumor (GIST) was found in 86 (68.3 %) cases. The median follow-up period was 54.7 months; no local or distant tumor recurrence was observed and all patients were alive. Conclusions LECS proved to be a safe and feasible procedure for the resection of gastric SMTs, with a reasonable operation time, low bleeding, and an acceptable complication rate in this multicenter study in Japan.

Simultaneuos laparoscopic resection of colorectal cancer and liver metastases

Aims: Synchronous liver metastases (SLMs) are found in 15%–25% of patients at the time the presentation with colorectal cancer, which is limited to the liver in 30%. Surgical resection is the most effective and potential curative therapy for metastatic colorectal carcinoma (CRC) to the liver. Simultaneous resection of primary CRC and synchronous liver metastases is subject of debate with respect to morbidity in comparison to staged resection. Minimally invasive laparoscopic surgery improves postoperative recovery, diminishes postoperative pain, reduces wound infections, shortens hospitalization, and yields superior cosmetic results, without compromising oncological outcome. The aim of this study is therefore to evaluate our initial experiences of simultaneous laparoscopic resection of primary CRC and SLM. Methods: Currently, laparoscopic resection of primary CRC is performed in more than 53% of all patients in our surgical department. 18 patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. 6 of them underwent laparoscopic colorectal resection combine by major laparoscopic liver resection. Results: Surgical approach was total laparoscopic (17 patients) or hand-assisted laparoscopic (1 patients). The incision created for the extraction of the specimen varied between 5 and 8cm. Median operation time was 245 (range 150–320) minutes with a total blood loss of 600 (range 200-750) ml. Postoperative hospital stay was 7day (5–12). An R0 resection was achieved in all patients. Conclusions: Simultaneous laparoscopic colorectal and liver resection appears to be save and feasible in selected patients with CRC and SLM, with satisfying short-term results.

Sleeve Gastrectomy with Concomitant Abdominoplasty: A Novel Procedure

Background: Obesity is a major health problem and bariatric surgery has been shown to be the most effective approach in the management of obesity. Abdominoplasty is a common aesthetic procedure for divarication recti with abdominal apron and it has a wide appeal. The aim of this study is to determine the usefulness of laparoscopic sleeve gastrectomy with concomitant abdominoplasty.Subjects/methods: This is a retrospective study over a 7 - year period from 2009 to 2015, conducted on 82 patients who underwent sleeve gastrectomy and simultaneous abdominoplasty at Sunrise Group of Hospitals, Kochi and Dubai. A classical Pfannenstiel incision was made and the skin flap raised, laparoscopic sleeve gastrectomy carried out with the usual port placement directly on the sheath. Ventral hernia (if present) repaired, neoumbilicus created, redundant skin and fat excised and the flap sutured in layers over suction drains. Patients were followed up indefinitely.Results: Eighty two patients underwent combined laparoscopic bariatric surgery and abdominoplasty. Of these, 68 (82.93%) had ventral hernia repair carried out and 14 (17.07%) underwent abdominoplasty alone. The median length of stay was 4 days. 6 patients developed postoperative seroma, and 1 patient had surgical site cellulitis; whereas 3 patients developed surgical site infection. To date, one patient required a revision abdominoplasty.Conclusion: Considering the advantages, comparable hospital stay and the low rate of complications, it would be safe to conclude that LSG with concomitant abdominoplasty is a beneficial procedure in patients of obesity and abdominal apron.