Incision Satisfaction Research Articles

Comparison between gas insufflation and gasless techniques for endoscopic transaxillary thyroidectomy.

This study aimed to compare clinical outcomes and prognosis of endoscopic thyroidectomy via axillary approach using insufflation and gasless methods. Retrospective analysis included patients undergoing endoscopic thyroidectomy at our institution from June 2022 to October 2023. Patients were categorized into insufflation and gasless groups. Analysis compared surgical time, blood loss, drainage volume, tube removal time, hospital stay, complications, pain score, and incision satisfaction. 73 patients (48 insufflation, 25 gasless) were analyzed. Insufflation technique showed significantly superior outcomes: shorter surgery duration, reduced drainage volume, earlier tube removal, shorter hospital stay, and higher incision satisfaction (all P < 0.05). Postoperative pain (VAS) was lower in insufflation group on first day, but no significant difference on seventh day. No significant differences in blood loss or complications were observed. Insufflation technique offers advantages over gasless method including shorter operation time, reduced drainage, earlier tube removal, and shorter hospital stays, with comparable outcomes in pain and incision satisfaction.

Prophylactic central lymph node dissection in cN0 papillary thyroid cancer: a comparative study of via breast and transoral approach versus via breast approach alone.

Papillary thyroid cancer (PTC) progresses slowly and has a good prognosis, while the prognosis is worse if combined with central neck lymph node metastasis at an early stage. The different endoscope approaches may affect the thoroughness of lymph node dissection. This study aimed to compare the clinical efficacy and safety of prophylactic central lymph node dissection(CLND) for cN0 PTC performed via breast and transoral approach versus via breast approach alone. A retrospective analysis of the surgical data of 136 patients with stage cN0 PTC was performed from August 2020 to December 2022. Among them, 64 underwent the breast and transoral approach (combined approach group), and 72 underwent the breast approach alone (breast approach group). The relevant indexes of surgery, the number of lymph nodes dissected, the occurrence of postoperative complications, and the cosmetic satisfaction of incision were statistically compared between the two groups. The operation time of the combined approach group was 156.4 ± 29.8min, significantly longer than that of the breast approach group, 119.6 ± 55.9min, and the difference was statistically significant (P<0.05). The two groups of patients were compared in terms of intraoperative bleeding, postoperative drainage, hospitalization time, incision cosmetic satisfaction, and the occurrence of postoperative complications, and the differences were not statistically significant (P>0.05). The total number of lymph nodes retrieved in the central area (10.6 ± 7.1) and the number of positive lymph nodes (4.6 ± 4.9) in the combined approach group were significantly more than those in the breast approach group (7.4 ± 4.8, 1.6 ± 2.7), and the difference was statistically significant (P<0.05). The difference between the two groups in terms of the number of negative lymph nodes was not statistically significant (P>0.05). The study demonstrated that choosing the breast combined transoral approach for prophylactic CLND of cN0 PTC could more thoroughly clear the central area lymph nodes, especially the positive lymph nodes, which could help in the evaluation of the disease and the guidance of the treatment, while not increasing the postoperative complications. It provides a reference for clinicians to choose the appropriate surgical approach and also provides new ideas and methods for prophylactic CLND in patients with cN0 PTC.

Sub-axillary cosmetic incision versus single-incision thoracoscopic surgery for primary spontaneous pneumothorax

BackgroundIn recent years, single-incision thoracoscopic surgery (SITS) has been increasingly applied as an optimal treatment option for primary spontaneous pneumothorax (PSP). However, most SITS techniques are used in the fourth to sixth intercostal space between the anterior axillary and mid axillary lines. To find out more concealed incisions, this study performed PSP surgery via the sub-axillary cosmetic incision (SACI) technique.MethodsA total of 128 PSP patients were subjected to video-assisted thoracoscopic surgery (VATS) between January 2017 and January 2019 at our institution. These patients were evaluated and assigned into SACI (n = 21) and SITS (n = 57) groups. Propensity score matching (PSM) was performed based on patients’ backgrounds, and the enrolled cohort was divided into 21 pairs. The incision satisfaction was assessed at 2 weeks and 6 months post-surgery.ResultsThe 21 pairs with matching baseline characteristics in the two groups did not exhibit significant differences in their backgrounds and surgical results. However, compared with the SITS group, the operation time was longer in the SACI group (p = 0.013). There were no post-operative complications in both groups. At 2 weeks and 6 months, incision satisfaction scores in the SACI group were significantly lower than those in the SITS group (p = 0.022 and p = 0.039, respectively). There were no recurrences of ipsilateral pneumothorax in both groups.ConclusionsSACI is a safe and feasible surgical method for PSP treatment. In addition, incision concealment can be used for patients with incision needs.

Clinical application of endoscopic surgery using a gasless unilateral transaxillary approach in the treatment of primary hyperparathyroidism.

To investigate the safety and feasibility of gasless axillary parathyroid surgery in the treatment of primary hyperparathyroidism. A total of 12 patients who received gasless axillary parathyroidectomy (endoscope group) and 14 patients who received traditional open parathyroidectomy (open group) from January 2019 to April 2022 were screened and included. The differences in baseline characteristics, surgical efficiency, incidence rate of complications, changes in biochemical indicators, and incision satisfaction between the two groups were analyzed and compared. The proportion of young patients was higher in the endoscopic group than in the open group, and the difference was statistically significant [(41.33 ± 13.65) years vs. (58.00 ± 9.44) years, P < 0.01]. The differences in operation time, intra-operative blood loss, post-operative drainage volume, hospital stay, and surgical efficiency between the two groups yielded no statistical significance (P > 0.05). Patients in the open group had more significant neck pain 3 days after surgery (P = 0.046), but the degree of pain 3 months after surgery was the same in the 2 groups (P = 0.432). Evaluation of post-operative mature stage scar and incision satisfaction regarding aesthetics in the endoscope group were significantly superior to that in the open group [(1.92 ± 0.92) points vs. (0.92 ± 1.00) points, P = 0.017 and (1.57 ± 0.51) points vs. (1.00 ± 0.013) points, P = 0.013, respectively]. No statistical significance was found in terms of incidence rate of post-operative fever (P > 0.05). No temporary recurrent laryngeal nerve injury, post-operative bleeding, incision hematoma infection, or other complications were observed. Comparing the two groups, the extent of the level decrease of PTH was similar to that of serum calcium and phosphorus (P < 0.05), where most patients experienced transient hypocalcemia after operation yielding no significant difference in incidence (P = 0.225). During a follow-up period of 3 to 36 months, a total of 1 patient in the open group experienced recurrence at 10 months after surgery and was treated non-surgically. Gasless axillary approach to parathyroid surgery for primary hyperparathyroidism possesses good safety and patient satisfaction in terms of aesthetics.

Efficacy of Otomicroscopy Combined with Otoendoscopy Double-Lens Technology-Assisted Tympanic Membrane Repair on Elderly Patients with Chronic Suppurative Otitis Media.

Objective To investigate the effect of otomicroscopy combined with otoendoscopy double-lens technology-assisted tympanic membrane repair on elderly patients chronic suppurative otitis media (CSOM). Methods 120 elderly CSOM patients from January 2017 to July 2019 were selected and divided into the otomicroscopy group (n = 40), the otoendoscopy group (n = 40), and the double-lens group (n = 40) by the random number method. All patients were treated with tympanic membrane repair. The otomicroscopy group was assisted by otomicroscopy, the otoendoscopy group was assisted by otoendoscopy. and the double-lens group was assisted by otomicroscopy combined with otoendoscopy. The three groups of operations status, clinical efficacy, the incidence of adverse reactions, hearing improvement rate, and satisfaction rate with incision after 6 months were compared. Results The operation time, intraoperative blood loss, hospitalization time, and VAS score of the otoendoscopy group and the double-lens group were all lower than those of the otoendoscopy group, and the operation time of the double-lens group was lower than that of the otoendoscopy group (P < 0.05). The clinical efficacy of the double-lens group was better than that of the otomicroscopy group and otoendoscopy group (P < 0.05). The adverse reaction rate of the otoendoscopy group and the double-lens group was lower than that of the otomicroscopy group, and the average postoperative air-bone conductance of the double-lens group was lower than that of the otomicroscopy group and the otoendoscopy group, and the hearing improvement rate was higher than that of the otomicroscopy and otoendoscopy groups (P < 0.05). The satisfaction rate with postoperative incision in the otoendoscopy group and double-lens group was higher than that in the otomicroscopy group (P < 0.05). Conclusion The double-lens technology-assisted tympanic membrane repair has an obvious effect on elderly patients with CSOM. Compared with the single-use otomicroscopy, the operation time, intraoperative blood loss, hospitalization time, patient's dry ear condition, degree of surgical pain, clinical efficacy, adverse reaction rate, hearing improvement rate, and patient's incision satisfaction of the double-lens technology are better. Compared with the single-use otoendoscopy, the operation time, clinical efficacy, and hearing improvement rate of the double-lens technology are better.

Research on the application of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients with non-small cell lung cancer aged over 65 years.

IntroductionThe literature regarding the application of uniportal video-assisted thoracoscopic segmental resection of the lung in patients aged over 65 years with non-small cell lung cancer (NSCLC) is sparse. This paper reports 175 cases of uniportal video-assisted thoracoscopic segmental resection of the lung performed at one center, of which 63 patients were over 65 years old.AimTo investigate the safety and feasibility of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients aged over 65 years with NSCLC.Material and methodsA retrospective analysis of 175 NSCLC patients who underwent uniport video-assisted thoracoscopic segmental resection of the lung in the center from August 2018 to August 2020 was conducted, and based on the age of 65 years, patients were divided into elderly and non-elderly groups. The general data and perioperative indicators of the two groups were compared.ResultsThe procedures were completed in all patients without death or conversion to open surgery. In the general data of the two groups of patients, the prevalence of emphysema in the elderly group was significantly higher than that in the non-elderly group (p = 0.001). However, there was no statistically significant difference between the two groups in surgery time, intraoperative blood loss, thoracic drainage tube retention time, postoperative hospital stay, incision satisfaction, or postoperative complications (p > 0.05).ConclusionsUniportal video-assisted thoracoscopic segmental resection of the lung is feasible and safe in elderly patients with NSCLC aged over 65 years.

Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery

Objective: To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery. Methods: A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis. Results: The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant (t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups (P>0.05). Conclusion: GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.

Clinical effect of right subaxillary small incision approach on children with congenital heart disease

Objective To analyze the clinical effect of right subaxillary small incision approach on children with congenital heart disease (CHD). Methods Eighty-six patients with CHD admitted to Henan Children′s Hospital from January 2015 to September 2017 were enrolled in this study.The patients were randomly divided into the control group and the observation group with 43 cases each group.The control group underwent sternal median incision, and the observation group underwent right subaxillary small incision.The total effective rate, incision satisfaction, general conditions of surgery (cardiopulmonary bypass time, operation time, aortic occlusion time, intraoperative blood loss), postoperative related conditions (thoracic drainage volume, postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, hospitalization expenses), Wong-Baker facial expression scale (FPS-R) score, as well as the respiratory function index including the levels of peak inspiratory pressure (PIP) and alveolar-arterial oxygen pressure difference [p(A-a) (O2)]after anesthesia (T1), after operation (T2), at admission to intensive care unit (T3) and before extubation (T4) and complication rate between 2 groups were compared. Results (1)The incision satisfaction in the observation group [90.70% (39/43 cases)] was higher than that in the control group [62.79% (27/43 cases)], and the difference was statistically significant (χ2=9.382, P=0.002). (2)There was no significant difference in the the extracorporeal circulation time, operation time and aortic block time between the two groups [observation group: (68.94±8.26) min, (2.33±0.21) h, (28.79±7.32) min; control group: (67.11±9.11) min, (2.25±0.31) h, (30.02±6.88) min] (P>0.05). (3)The intraoperative blood loss [(89.87±11.25) mL] in the observation group was less than that in the control group [(105.91±31.01) mL], which difference was statistically significant (t=3.189, P=0.002). (4)Also there was significant difference in postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, thoracic drainage volume and hospitalization expenses between the two groups (the observation group: postoperative monitoring time (30.55±10.39) h, postoperative assisted ventilation time [(9.68±2.19) h, hospitalization time (9.61±2.17) d, thoracic drainage volume (90.36±26.14) mL, hospitalization expenses (36 956.15±1 097.84) yuan; the control group: (41.39±9.93) h, (12.72±3.81) h, (12.33±3.15) d, (163.24±29.36) mL and (45 271.97±1 134.55) yuan] (t=4.946, 4.536, 4.663, 12.157, 34.540, all P 0.05). There was no significant difference in the complication rate between the observation group [6.98% (3/43 cases)] and the control group [4.65% (2/43 cases)] (χ2=0.000, P>0.05). Conclusions Right subaxillary small incision approach does not affect the respiratory function of children with CHD, which can improve the satisfaction of incision, reduce the amount of blood loss, accelerate postoperative recovery of children, relieve postoperative pain, and reduce the financial burden of parents.Besides, intra-operative proficient and accurate operations can reduce or avoid the occurrence of related complications and ensure the safety of surgery. Key words: Minimally invasive; Sternal median incision; Congenital heart disease; Small incision in right axillary; Child; Open surgery

PD18-08 PROSPECTIVE MULTICENTER COMPARISON OF OPEN AND ROBOTIC RADICAL PROSTATECTOMY: THE PROST-QA/RP2 CONSORTIUM

PD18-08 PROSPECTIVE MULTICENTER COMPARISON OF OPEN AND ROBOTIC RADICAL PROSTATECTOMY: THE PROST-QA/RP2 CONSORTIUM

COMPARISON OF HISTOACRYL TOPICAL SKIN ADHESIVE AND TRADITIONAL METHOD FOR WOUND CLOSURE IN TOTAL HIP ARTHROPLASTY

To compare the effectiveness between histoacryl topical skin adhesive and traditional method for wound closure in total hip arthroplasty (THA). A total of 159 patients undergoing THA were divided into 2 groups between January and October in 2015. Subcuticular suture and histoacryl topical skin adhesive (cyanoacrylate adhesive) were used in 80 patients (100 hips) (test group), and traditional method (skin staples and wound drainage) was used in 79 patients (100 hips) (control group) for wound closure. There was no significant difference (P>0.05) in gender, age, body mass index, and etiology between 2 groups. The operation time, length of stay, incision pain visual analogue scale (VAS) score and healing of incision, and incision satisfaction evaluation, and classification were compared between 2 groups. All patients were followed up 3-6 months (mean. 4.7 months). There was no significant difference in operation time between 2 groups (Z=-0.527, P=0.598); but the length of stay of test group was less than that of control group (Z=-2.004, P=0.045). Incision exudation and dehiscence occurred in 1 case (1 hip) and 1 case (1 hip) of test group respectively; incision swollen, persistent wound exudation, exudation, and sutured drainage tube occurred in 2 cases (2 hips), 2 cases (2 hips), 4 cases (4 hips), and 1 case (1 hip) of control group. No statistically significant difference was found in VAS score between 2 groups at 15 days after operation (Z=-0.125, P=0.901), but wound healing score of test group was significantly higher than that of control group (Z=-2.943, P=0.003). Wound healing was class A in 98 hips and class B in 2 hips in test group, and was class A in 92 hips and class B in 8 hips in control group, and difference was statistically significant (χ2=3.789, P=0.048). The incision satisfaction of test group was significantly higher than that of control group (Z=-2.626, P=0.009). Compared with traditional method, histoacryl topical skin adhesive has decreased wound complication rate, and it is an easy and safe method with high satisfaction.

Single-port video-assisted thoracoscopic wedge resection: novel approaches in different genders.

To discuss the feasibility, safety and superiority of novel approaches in single-port video-assisted thoracoscopic wedge resection in different genders. The clinical data of patients who underwent thoracoscopic pulmonary wedge resection were analysed. A total of 197 consecutive male patients from January 2012 to December 2014, and 72 female patients from June 2013 to December 2014 were included retrospectively. Of the males, 65 received a transareolar single-port procedure (TASP Group) and 132 received a standard two-port procedure (Standard Group A). Among the females, 18 were treated with a subxiphoid single-port procedure (SXSP Group), and 54 were treated with the standard procedure (Standard Group B). The general clinical materials and surgical outcomes were evaluated. All patients underwent total thoracoscopic wedge resection successfully, and no severe complications were observed. In men, there were no significant differences in operation time, blood loss, postoperative drainage amount, chest drainage duration, postoperative hospital stay or pain score on the first postoperative day (P = 0.827; 0.423; 0.174; 0.440; 0.115; 0.159, respectively). The pain scores of the TASP Group on the day before and after removal of the chest tube were lower (P = 0.006; 0.023, respectively) than those of Standard Group A, and the incision-associated paraesthesia in the third and sixth month after operation was reduced (P = 0.041; 0.026, respectively). The incision satisfaction degree was significantly improved in the TASP Group (P = 0.001). In women, there were no significant differences in blood loss, drainage amount, chest drainage duration or postoperative hospital stay (P = 0.680; 0.757; 0.651; 0.608, respectively). The operation time of the SXSP Group was longer (P = 0.000), and the pain scores on the first postoperative day and the days before and after removal were all significantly lower (P = 0.000; 0.000; 0.000, respectively) than those of the Standard Group B. Furthermore, the incision paraesthesia 3 and 6 months after surgery was greatly reduced (P = 0.001; 0.001, respectively), although the patients were not very satisfied with the cosmetic results (P = 0.577). In single-port thoracoscopic pulmonary wedge resection, we performed 'individualized' procedures based on gender, namely, the transareolar approach in males and the subxiphoid approach in females. These procedures were considered feasible and safe, and showed superiority in reducing postoperative pain. However, the cosmetic results of the subxiphoid approach require further improvement.

Natural orifice transumbilical versus conventional incision laparoscopic splenectomy: a comparative study

Objective To study the feasibility, safety, operative skills and clinical advantage of natural orifice transumbilical laparoscopic splenectomy. Methods The clinical data of patients who underwent natural orifice transumbilical laparoscopic splenectomy (group A, n=9) and conventional laparoscopic splenectomy (group B, n=15) in our department from Nov. 2011 to Nov. 2014 were reviewed. The operative time, estimated blood loss, post-operation complications, hospital stay, incision satisfaction score and total cost were compared between two groups. Patients with immune thrombocytopenia, presume hereditary splecocytosis and idiopathic hypersplenism were included. Results All the procedures were successfully carried out laparoscopically. The estimated blood loss and total cost showed no significant differences between group A and group B [(196.7±118.7) ml vs (188.7±110.8) ml; (3.7±0.5) vs (3.6±0.7)×104 yuan, P>0.05]. As to the incision satisfaction score, group A was superior to group B [(4.1±0.6) vs (3.4±0.7), P<0.05]. The operation time of group A was significantly longer than that of group B [(201.7±43.2) min vs (131.0±37.1) min, P<0.05]. Conclusion Natural orifice transumbilical laparoscopic splenectomy is a safe and feasible procedure with better satisfactory clinical outcomes than conventional laparoscopic splenectomy. Key words: Laparoscopic splenectomy, transumbilical, concealed approach, conventional approach

270 Laparo-Endoscopic Single Site (LESS) Fundoplications: Lessons Learned

Introduction: Laparo-Endoscopic Single Site (LESS) surgery is a more recent advance in the progression of minimally invasive surgery. This study was undertaken to assess lessons learned after our first 270 LESS fundoplications for gastroesophageal reflux disease (GERD). Methods: All patients undergoing LESS fundoplications were prospectively followed from 2008-2014. Patients scored the frequency/severity of their symptoms before/after LESS fundoplication using a Likert scale (0=never/not bothersome to 10=always/very bothersome). Patients also scored their incision satisfaction using a Likert scale (0=revolting to 10=beautiful). Median data are reported. Results: Of 270 patients, 186 underwent nissen fundoplictions and 84 underwent toupet fundoplications. The median patient was 61 years old with a BMI of 26.7 and a Demeester score of 27. The most common preoperative symptom was heartburn (frequency = 6, severity=7). 14 (5%) patients had postoperative complications, most notably pneumonic pleural effusions (n=2), ileus (n=2), and dysphagia (n=3). Length of stay was 1 day with 52% of patients returned to usual activities by 2 - 4 weeks. Symptoms were ameliorated postoperatively (e.g. heartburn: frequency=0, severity=0, p < 0.01). One month postoperativiely, no patients were using proton pump inhibitors or H2-blockers. At 3 months and at one year, 46% of patients returned to using PPI's and H2—blockers. Postoperatively, patients felt size of scar was most important and scored satisfaction with their incisions as a 10. 85% of patients were satisfied with their overall experience; nearly all would still have the operation knowing what they know now. Conclusion: Patients report significant symptom relief, high satisfaction, and excellent cosmesis after LESS fundoplication. LESS fundoplication safely ameliorates symptoms of GERD with short confinement and pronounced satisfaction, in part because of the cosmetic outcome (i.e. lack of scaring). It's future application is encouraged.

Single-port VATS resection for some pulmonary diseases:strategies of the incision location in different gender

To discuss the feasibility and advantages of aberrant incision location of single-port video-assisted thoracoscopic surgery(VATS) in different gender when treating some lung diseases. Retrospectively analyze the clinical data of these patients who were received lung partial resection from the same surgeon in the First Affiliated Hospital of Soochow University, the 100 Hospital of PLA, Wu Zhong People's Hospital from January 2012 to December 2014. Among the males, 57 were undertook a single-port VATS surgery through areola incision (Observation Group A), and the rest 114 were received conventional uniportal VATS surgery (Control Group A). Among the females, 15 were operated through the subxiphoid incision (Observation Group B) and 45 were received conventional one (Control Group B). The operation time, blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital stay, the Visual Analogue Scale (VAS) pain score of the 1st and 2nd postoperative day, the incision discomfort in the 30th and 90th postoperative day, and the incision satisfaction degree were evaluated. All the patients were underwent total VATS surgery successfully and no severe complications were observed.In males, there were no significant differences in operation time, blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital day and the VAS score of the 1st postoperative day (P>0.05). Compared to control group A, the VAS score of the 2nd postoperative day was lower (3.5 ± 1.78 vs 4.14 ± 1.62, P=0.035), the incision discomfort of 30th and 90th postoperative day was reduced (33 (57.9%) vs 86 (75.4%), P=0.019; 29 (50.9%) vs 76 (66.7%), P=0.046) and the incision satisfaction degree was significantly improved (45 (79.0%) vs 61 (53.5%), P=0.001). In females, there were no statistical differences in intraoperative blood loss, postoperative drainage amount, chest tube drainage duration, postoperative hospital day and the incision satisfaction degree (P>0.05). Compared to control group B, the operation time was obviously prolonged (57.67 ± 5.72 vs 42.91 ± 7.82, P=0.000), the VAS score of the 1st and 2nd postoperative day was significantly lower (2.13 ± 1.06 vs 3.84 ± 1.69, P=0.001; 2.60 ± 1.24 vs 4.18 ± 1.56, P=0.001) and the incision discomfort in 30th and 90th postoperative day was reduced (4 (26.7%) vs 34 (75.6%), P=0.001; 4 (26.7%) vs 28 (62.2%), P=0.017). In single-port VATS surgery for some pulmonary diseases, we choose "individualized" incision location--trans-areola incision in males and subxiphoid incision in females--according to different gender and varieties of diseases, which was considered to raise incision satisfaction degree in males and reduce postoperative pain in females, it warrants further clinical practice.

Relationship between the residual gastric volume and effect of weight loss after laparoscopic sleeve gastrectomy

Objective To investigate the measuring method of residual gastric volume and its correlation with the effect of weight loss after laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 25 patients with obesity who received LSG at the Ruijin Hospital of Shanghai Jiaotong University between June 2012 and October 2013 were retrospectively analyzed. All the patients received the management during the perioperative period based on the International Sleeve Gastrectomy Expert Panel Consensus Statement (2013), and the intra- and post-operative conditions were recorded. All the patients were followed up by outpatient examination and admission to hospital at postoperative month 1, 6, 12 and 18, and the body mass index (BMI), excess of body weight and excess weight loss (EWL) rate were recorded. The postoperative residual gastric volumes of patients were estimated by simulating geometry after X-ray radiography using oral iodine. A correlation between the residual gastric volume at postoperative month 12 and increment of residual gastric volume from postoperative week 1 to month 12 and EWL at postoperative month 18 was studied. All the patients were divided into the large fundus group (residual gastric fundus volume>20 mL) and the small fundus group (residual gastric fundus volume≤20 mL). EWL of the 2 groups at postoperative month 18 was analyzed. Measurement data with normal distribution were presented as ±s and analyzed by the t test, and repeated measurement data were analyzed by the repealed measures ANOVA. Correlation analysis among the multivariate data was done by the multiple linear regression. Results All the 25 patients received successful LSG and regular follow-up with operation time of (180±60)minutes and volume of blood loss of (30±20)mL. All the patients were not complicated with intraoperative hemorrhea and splenic rupture and postoperative anastomotic leakage, stenosis and hemorrhea with the good recovery and satisfaction of incision. BMI at postoperative year 1 was (29±7)kg/m2, which was significantly different from (39±5)kg/m2 before operation (F=6.773, P 0.05). Conclusion The residual gastric volume of patients is increased gradually within postoperative year 1. There is a negative correlation between the effect of postoperative weight loss and the postoperative residual gastric volume and increment of residual gastric volume, and no obvious correlation between the postoperative volume of residual gastric fundus and short-term effect of weight loss. Key words: Obesity; Bariatric surgery; Gastrectomy; Radiography; Residual gastric volume; Laparoscopy