Laparoscopic Cyst Research Articles

Comparison of different surgical in the treatment of simple renal cysts

Objective To explore and analyze the effect of different surgical in the treatment of simple renal cysts. Methods A total of 108 patients with simple renal cysts in our hospital from June 2014 to July 2016 were selected. All patients were randomly divided into experimental group and control group. In the experimental group, 50 patients were treated with percutaneous renal puncture and absolute alcohol (PAES), and 58 patients in the control group were treated with laparoscopic renal cyst. Postoperative recovery condition, operation effect and the cost of the patients were collected and compared with the statistical analysis. Results There was not statistically significant in age, gender, renal cyst, renal cyst type data between the two groups (P>0.05). The incidence of complications in the two groups was not significantly associated with the rate of surgical treatment and the choice of treatment, and the comparison was not statistically significant (P>0.05). Operation time, the cost of treatment, hospitalization time after surgery and the selected treatment had a certain correlation results, the difference was statistical significant (P<0.05). The postoperative follow-up of two patients for 12 months, the average amount of epispastic bursa fluid in the experimental group was (135±17.9) mL, 99% ethanol injection required average(34±6.4) mL.Extraction of cystic fluid colors of all pa-tients were light yellow or colorless, bacterial culture and cell examination showed no positive control. Postoperative data of follow-up were postoperative cyst without recurrence in 55 cases and relapsed operation in 3 cases. Conclusions For patients with renal cysts, PAES and laparoscopic renal cyst to the top of each have advantages and disadvantages, the specific implementation of the program should be based on the patient's own situation. PAES surgery has advantages of fewer complications, low expense, less pain, quick recovery. And laparoscopic renal cyst removal is applicable to other types of renal cyst patients, including huge renal cysts, multiple renal cysts or malignant patients can not be excluded. If the patient is poor or ineffective by PEAS or the implementation of percutaneous renal puncture is not easy, should be considered to go to the top of the laparoscopic renal cyst. Key words: Kidney Diseases; Cysts; Laparoscopes

Application of bipolar coagulation hemostasis in laparoscopic ovarian endometriosis cyst stripping

Objective To investigate the effect of bipolar coagulation hemostasis on ovarian function in patients with laparoscopic ovarian endometriosis cyst stripping. Methods From January 2015 to February 2016, 88 cases of ovarian endometriosis cyst were selected by using the random number table method.They were randomly divided into observation group and control group, 44 cases in each group.The observation group was treated with bipolar coagulation hemostasis, and the control group was treated with endoscopic suturing.The luteinizing hormone(LH), follicle stimulating hormone(FSH), estradiol(E2), sinus follicle number(FO) and ovarian stroma systolic blood flow velocity peak preoperation, postoperation and postoperative 6 months were detected. Results The E2 levels in the observation group postoperation and postoperative 6 months were (190.03±30.88)pmol/L and (179.82±29.94)pmol/L, which were significantly lower than those in the control group[(230.04±32.22)pmol/L and (232.49±28.41)pmol/L, t=5.947, 9.465, all P 0.05). Conclusion The application of different hemostatic methods in laparoscopic ovarian endometriosis cyst stripping have effect on ovarian reserve function, but bipolar coagulation and hemostasis can significantly decrease ovarian reserve function, and it should be used as little as possible during the operation. Key words: Cysts; Endometriosis; Laparoscopy

The safety and efficacy for percutaneous ureteroscopic laser deroofing in the management of renal cysts

Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts. Methods From November 2014 to August 2016, 59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan. Of all the 59 patients, 36 were males and 23 were females. Their mean age was 46 years (ranging 35-64 years). 41 patients complained about the reported flank and abdominal pain. 18 patients were found by imaging examination. Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm). In regards to the 59 patients, include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi. Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2). All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia. Patients were placed in the prone position for percutaneous puncture and tract dilation. Under ultrasound guidance, an eighteen gauge needle was placed inside the cyst cavity percutaneously, a metal guidewire was introduced followed by sequential dilation up to F26-28. 9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity. Then sheath and ureteroscope both returned to the exterior cyst together. Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope. A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40~50W) or Holmium laser(Power 60~70W) and was taken for pathological examination. Nephrostomy tube was left in place for 2-3 days and removed before discharge. For parapelvic cysts patients, ureter stent was inserted into the renal pelvis in the dorsal lithotomy position firstly. Patients were then placed in the prone position for percutaneous puncture and tract dilation. Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system. F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months. F22 nephrostomy tube was left in renal pelvis for two weeks. For renal cyst complicated with ipsilateral renal calculi patients, a puncture was created targeting the stone through the cyst, after fragmenting and extracting the stone, the same laser was used to deroof the cyst. More than 50% reduction in cyst volume was considered a success. The perioperative complications, hospitalization days and the effective rate of surgery were evaluated. Results All operations were conducted without intraoperative complications such as bleeding, urinary leakage or injury of the renal parenchyma and the adjacent organs. The hospital stay after the surgery was 2-4 days (mean 2.5 days). After 3-12 months follow-up (mean 8.1 months), patients underwent imaging examinations. 42 out of 59 cases were completely resolved, 15 were reduced to less than 50%, the total effective rate for the operation is 96.6%(57/59). 4 patients with ipsilateral renal calculi were completely clear. However, two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing. Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe, effective, less invasive, which can be performed in any endourological center without the need of special instruments and training. Key words: Percutaneous ureteroscopy; Renal cysts; Deroofing; Safety; Effectiveness

Duel-stage treatment for biliary cysts with cholangitis during pregnancy.

Background & Objective:Biliary cysts in pregnant women are a complex medical issue, especially when complicated with cholangitis. It is a serious and life-threatening diagnosis that can seriously endanger both the expectant mother and the fetus. However, during pregnancy, surgical treatment would lead to further complications and higher fetal mortality. Here, we propose a novel therapeutic approach that would be safe for both mother and child during pregnancy, with a definitive treatment postponed until after delivery.Methods:In this retrospective study we have summarized the clinical course of six adult patients diagnosed with choledochal cysts during pregnancy. Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst excision when the patients recovered from delivery.Results:All the six patients gave birth to healthy babies. Four patients had Type-I choledochal cysts, and underwent Roux-en-Y hepaticojejunostomy surgery. Two patients had a Type-IV choledochal cyst. The first patient with Type-IV choledochal cyst underwent anastomosis between the secondary hepatic bile duct and jejunum and the second patient underwent laparoscopic cyst internal drainage. No serious complications were recorded after gallbladder drainage or during the perioperative period.Conclusions:Based on our single-centre experience we can conclude that treatment of choledochal cyst with cholangitis during pregnancy can be conducted safely and efficiently through the two stages strategy that we proposed in this paper. The first stage should be percutaneous cholecystostomy followed by elective surgical treatment following delivery.

CHOEDOCHAL CYST: OUR EXPERIENCE IN A SINGLE CASE BY LAPAROSCOPIC APPROACH

&lt;strong&gt;Introduction&lt;/strong&gt; Choledochal cysts are disproportionate dilatations of the biliary system for the presence of a congenital malformation, the persistence of the common biliary pancreatic channel. Complete excision of the cyst is the best treatment strategy to avoid long-term complications especially malignant transformation, recurrent cholangitis and gallstones. We present a clinical case treated at our center with minimally invasive surgery. &lt;br /&gt;&lt;strong&gt;Case Report&lt;/strong&gt; A female patient was admitted to our center at the age of 3 years, with right hypocondrial pain, followed by jaundice, vomiting and recurrent fever. No abdominal mass present. Abdominal ultrasound was performed and also Magnetic resonance cholangiopancreatography. According to the Todani classification modified by Alonso-Lej classification we identified a type I with three gallonstones. She underwent laparoscopic cyst excision and hepatico-jejunostomy Roux-en-Y with perianastomotic drainage positioned. No early and late postoperative complications after 1 year of follow-up. &lt;br /&gt;&lt;strong&gt;Discussion and Conclusions&lt;/strong&gt; Choledochal cysts can present at different ages with variable symptoms. Common presentations include abdominal pain, jaundice, and right upper quadrant mass and are most common seen in pediatric patients. Associated congenital anomalies of biliary tract may be present. Most cases of choledochal cyst disease have type I and IV-A cysts. If left untreated, choledochal cysts have an increased risk of malignant transformation. Early surgical excision and restoration of biliary tract continuity is mandatory, whatever the symptom severity to avoid long term complications whenever possible. Currently the gold standard treatment is the mini invasive surgery, in fact the advantages of this technique is the intraoperative visualization of deeper structures, decreased postoperative pain, shorter hospital stay, improved cosmetic result and decreased postoperative ileus. However, these cases remain reserved for highly specialized surgeons with a thorough understanding of hepatobiliary anatomy and minimally invasive techniques. Finally, limited case series of robotic pediatric choledochal cysts resection and reconstruction have been reported with acceptable outcomes, although more studies are needed before widespread acceptance and implementation of this technique in pediatric age.

Transmesentric laparoscopic unroofing of left simple renal cyst: a report of 12 cases

Objective To investigate the method and efficacy of transmesentric laparoscopic unroofing of the left simple renal cyst. Methods The clinical data of 12 patients(4 males, 8 females) with left renal simple cyst treated by transmesentric laparoscopic unroofing were retrospectively analyzed.The mean age was 55 years(ranged 32~72). The mean diameter of the cases was 6.2 cm(ranged 4.8~8.6 cm). All the renal cysts were indicated by ultrosonography, CT scan and IVP.For each patient, the body mass index(BMI), blood loss, operative time, time to resumption of oral intake and complications, postoperative hospitalization days were recorded. Results All 27 cases of transemensetic laparoscopic unroofing renal cyst were successfully performed, without conversion to open surgery or serious intraoperative complications.Mean operative time was (36.3±11.6)min, and blood loss was (14.6±5.3)mL.The mean time of ambulation was 12h, and time of oral intake was 16h.The mean postoperative hospitalization time was (3.89±2.13)d.All the cases were assessed with ultrosonography and CT scan, no renal cyst recurrence was found during the follow-up of 3 months to 5 years. Conclusion Transmesentric laparoscopic unroofing of left simple renal cyst is a new and effective technique, which enables a shorter operation time without increasing morbidity, especially for slim patients. Key words: Laparoscopy; Cysts; Kidney

Transperitoneal laparoscopic parapelvic cyst unroofing of 45 cases

Objectives To evaluate the experience and clinical efficacy of transperitoneal laparoscopic parapelvic cyst unroofing. Methods From 2008 to 2015, 45 cases of transperitoneal laparoscopic parapelvic cyst unroofing were collected. Of all the cases, 33 males and 12 females, aged from 35 to 65 years, and 27 patients in left, 18 patients in right. Results All of these 44 operations were successful, no cases convert to open surgery. 1 case for kidney seeper was misdiagnosed as renal pelvis cyst. And double J tube was placed intraoperative and no leakage of urine. All of these cases had no complications after sutured.The average operation time was 35min. No obvious activity bleeding occured, and the average hospital stays after operation was 3~5 d. Histological studies showed 44 cases parapelvic cyst. Clinical symptoms repeatedly and recurrence under the imaging diagnosis were found during 3~18 months' follow-up in 45 cases. Conclusions The transperitoneal laparoscopic parapelvic cyst unroofing have the advantages of clear surgical field, less trauma and rapid recovery. It is an effective treatment for the renal pelvis cyst. Key words: Kidney Pelvis; Cysts; Laparoscopes

Comparison of the effect of three kinds of specimen collectionin laparoscopic ovarian cyst resection

Objective To investigate the comparison of rubber gloves collection bag, linear closing type plastic collection bags and plastic specimen collection bag is used for application effect of laparoscopic ovarian cyst resection. Methods From 2013 June to 2014 December underwent laparoscopic ovarian cyst resection in 90 cases, according to the first date of surgery were divided into 3 groups, from the standard sample collection bag for rubber gloves (A group) 30 cases, linear closing type plastic collection bag (B group) 30 cases, collecting bag plastic specimens (C group) 30 cases. Respectively calculate autologous peritoneal bag mouth opening into time, time to complete transection of tissue into the specimen collection bag time, specimen collection bag left abdominal contents to the in vitro observation time, specimen collection bags in use in the course of rupture occurrence rate of specimen content leakage. Results The 3 groups of patients with autologous abdominal time were (7.18±0.61),(6.72±0.57), (5.98±0.30) s, the difference was not statistically significant (t=41.80, P > 0.01). The 3 groups of specimens collected pouch specimens respectively (40.84±6.27), (49.86±6.10), (32.98±3.93) s, group C open pocket to maintain state of distraction to amputated tissue fully into the specimen collection bag in the shortest time, with a group and B group, the difference was statistically significant (F=69.87, P < 0.01). The 3 groups of specimens collected from the abdominal cavity were (498.39±55.60), (315.70±47.32), (448.65±54.90) s, the difference was statistically significant (F=96.18, P < 0.01). The 3 groups of specimens collected specimen bag collection bag rupture were 26.7% (8 /30),10.0% (3 /30),3.33% (1 /30), group A of the most common (χ2=0.926, P < 0.05), The 3 groups of specimens collected the bag contents leakage were 23.30%(7/30), 6.67% (2 /30)、3.33% (1 / 30), group A of frequency was the highest, and in group B and C, the difference had statistical significance (χ2= 0.635, P < 0.05). Conclusions Plastic type specimen collection bag for soft bag with built-in wire, the bag opening is a certain tension, easy operation by operation control, convenient and reliable safety, shorten operation time, reduce the occurrence of complications, reduce surgical risks and costs, and improve the office efficiency and quality of the operation. Key words: Rubber gloves; Plasticity; Specimen bag; Laparoscopic operation; Effect

Laparoscopic Treatment of Choledochal Cyst Using Barbed Sutures.

The usage of barbed sutures is increasingly being reported in the field of laparoscopic surgery. However, there have been reports of suture-related complications such as small bowel obstruction or anastomosis stricture. We present our experience of hepaticojejunostomy (HJ) using V-loc, during laparoscopic cyst excision for choledochal cyst. At our center, from August 2014 to January 2015, 4 patients were treated for choledochal cyst. Laparoscopic cyst excision with Roux-en-Y HJ was performed, and HJ was performed with intracorporeal suturing using unidirectional barbed sutures. After surgery, the patients were followed up in the outpatient clinic every 3 months to monitor for long-term complications such as biliary stricture. There were no short-term complications. Among the 4 patients, 3 patients did not experience any long-term complications. As of this writing, the follow-up period for the 4 patients is 16 months for the first 2 patients and 11 months for the later 2 patients. Biliary stricture was diagnosed in 1 patient at 7 month follow-up. HJ revision was performed with an open right subcostal incision. The anastomosis showed dense fibrosis and stricture. The patient recovered uneventfully after the surgery. HJ using barbed sutures was relatively easy to perform, but barbed sutures may have a tendency to cause stricture when used in biliary enteric anastomosis. Caution must be taken to prevent overtightening of the suture.

Percutaneous sclerotherapy of liver and renal cysts, comments on the EFSUMB guidelines.

Cystic lesions in the liver and kidneys are common incidental findings. They are generally benign and require no treatment. They can appear sporadically or as part of a syndrome, and are characterised by their anechoic structure and posterior enhancement in ultrasound imaging. Increased size, haemorrhage or infection of a cyst can lead to development of symptoms. Along with surgical options and laparoscopic cyst fenestration, ultrasound-guided sclerotherapy of symptomatic cysts represents an effective and safe minimally invasive treatment option.

Recurrence of Ovarian Endometrioma in Adolescents after Conservative, Laparoscopic Cyst Enucleation

Study ObjectiveTo evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence. DesignA multicenter retrospective cohort study. SettingThree university hospitals. ParticipantsOne hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected. InterventionsNone. Main Outcome MeasuresEndometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated. ResultsIn total, 105 patients were followed for 47.3 (±44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (±8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group. ConclusionAlthough the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period.

Comparison of Single-Incision and Conventional Laparoscopic Cyst Excision and Roux-en-Y Hepaticojejunostomy for Children with Choledochal Cysts.

The purpose of this study was to elucidate the potential benefits of single-incision laparoscopic Roux-en-Y hepaticojejunostomy comparing the conventional laparoscopic procedures. From January 2013 to July 2013, 17 consecutive children with choledochal cysts received single-incision laparoscopic Roux-en-Y hepaticojejunostomies by a single surgeon at our institution. Seventeen standard laparoscopic hepaticojejunostomies of consecutive children with choledochal cysts from July 2012 to December 2012 were employed as control. Demographic and perioperative information was identified retrospectively using clinic and hospital records including gender, age, total operating time, estimated blood loss, time to oral intake, drainage removal time, postoperative complications, and postoperative hospital stay. One patient was converted to open surgery and another 8-year-old boy conversed to conventional four-port laparoscopic procedure. There were no significant differences between the conventional laparoscopic group and the single-incision laparoscopic group with regard to preoperative variables including age (P = 0.697) and sex distribution (P = 1.000). For mean operative time (209.9 ± 7.5 vs 204.1 ± 6.9min, P = 0.951), estimated blood loss (10.7 ± 1.1 vs 13.4 ± 1.7ml, P = 0.103), time to oral intake (3.73 ± 0.21 vs 3.77 ± 0.20days, P = 0.889), drainage removal time (4.20 ± 0.45 vs 4.06 ± 0.23days, P = 0.067), and postoperative hospital stay (7.60 ± 0.25 vs 7.41 ± 0.21days, P = 0.627), the differences were also nonsignificant. Nevertheless, this technique demonstrated improved cosmetic outcomes comparing with the conventional laparoscopic group. The results showed better cosmetic results and comparable postoperative outcomes. However, well-designed prospective studies are warranted to better address this issue.

Comparison between Retroperitoneal and Transperitoneal Approaches in the Laparoscopic Treatment of Bosniak Type I Renal Cysts: A Retrospective Study.

We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decor­tication of simple renal cysts with respect to safety, postoperative pain, and clinical results. The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and phys­ical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creati­nine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal com­puted tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain. The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient. We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.

Laparoscopic Management of Choledochal Cyst-Technical Modifications and Outcome Analysis.

Choledochal cyst (CDC) is a well described albeit rare clinical entity. Complete cyst excision with biliary-enteric reconstruction is the recommended treatment for Todani type I, II, and IVA cysts to prevent complications. The aim of this study is to evaluate outcomes of laparoscopic CDC excision from a tertiary care center. This is a retrospective analysis of prospectively collected data of 110 patients who underwent laparoscopic cyst excision and biliary-enteric reconstruction for CDC type I and IVA from 1998 to 2013. Out of 110 patients, 55 were children (<16 years) and 55 were adults (>16 years) with mean age 21.19 ± 17.75 years and male:female ratio of 1:2.14. Abdominal pain was the most common presenting symptom (59.09 %). Surprisingly, 32.73 % of adults presented with incidentally detected cyst. Type I cyst was the most common (71.82 %) with mean size of 4.67 ± 1.59 cm. Blood loss (56.0 ± 16.62 vs. 76.55 ± 26.61 ml) and operative time (199.8 ± 44.66 vs. 251.6 ± 54.25 min) were significantly low in pediatric group. Three adults required conversion. Overall complication rate was 10 %. Re-exploration rate was 1.81 % with one patient died post-operatively. Mean hospital stay was significantly low in children (5.9 ± 1.39 vs. 7.0 ± 2.66 days). Median follow-up was 60 months (8-110). Cholangitis developed in six patients with three having anastomotic stricture requiring intervention. Laparoscopic excision of CDC is safe and feasible. Surgery should be performed early as outcomes are better in pediatric age as compared to adults.

Ureteroscopic management of asymptomatic and symptomatic simple parapelvic renal cysts.

BackgroundTo investigate feasibility and safety of treating simple parapelvic renal cysts using flexible ureteroscopy with the Holmium laser.MethodsBetween February 2010 and July 2013, a total of 21 patients, aging from 29 to 71 (49.00 ± 13.23), were diagnosed with parapelvic renal cysts by ultrasonography in combination with contrast-enhanced computer tomography (CT) and intravenous urography (IVU) in the Department of Urology Surgery, People’s Hospital of the Zhejiang province. Fifteen patients were asymptomatic and 6 patients were symptomatic with flank pain. All patients underwent drainage of the cysts using flexible ureteroscopy with Holmium laser. Patients were followed up 1, 3 and 12 months after the operation.ResultsThe intervention was successful in 20 patients and failed in 1 patient who, subsequently successfully underwent a laparoscopic cyst removal. There were no intra-operative and post-operative complications reported. The mean operation time was 27 min (range: 15 to 45 min). The mean hospital stay was 2.6 days (range: 1 to 5 days). Twenty patients were followed up until 15 months after surgery. After such ureteroscopic management, there were no renal cysts detected in 7 patients (35 %) and a reduction in size of the renal cysts was found in 13 patients (65 %). Flank pain subsided in all 6 (100 %) previously symptomatic patients.ConclusionsFlexible ureteroscopy with the Holmium laser may be a feasible and effective treatment option in selected patients with simple parapelvic renal cysts. Further prospective randomized studies that compare the procedure to laparoscopic treatments are needed.

Effect of propofol combined with sufentanil on patients with laparoscopic ovarian cystectomy

Objective To observe the clinical effect of propofol combined with sufentanil in laparoscopic ovarian cyst resection. Methods 80 cases who underwent laparoscopic ovarian cyst resection were chosen,they were divided into the observation group and control group with 40 patients in each group according to the random number table method. The observation group was anaesthetized with propofol combined with sufentanil, while the control group was anaesthetized with propofol combined with fentanyl, the recovery status, operation time,intraoperative bleeding volume, recovery time of gastrointestinal function and postoperative complications in the two groups were compared. Results The recovered spontaneous breathing time, recovery time, extubation time of the observation group were(8.4±2.3)min,(10.51±3.3)min,(12.7±2.3)min,which of the control group were(10.11±2.2)min,(12.3±2.6)min,(15.3±3.5)min, there was statistically significant difference between the two groups(t=3.378,2.710,3.926,all P<0.05);The operation time,operation amount of bleeding, gastrointestinal function recovery time of the observation group were(44.7±5.4)min,(19.5±3.5) m L,(18.3±2.4)h,which of the control group were(67.5±7.8)min,(42.7±2.8)m L,(42.4±3.2)h,there were significant differences between the two groups(t=15.200,32.736,38.105,all P<0.05). Postoperative analgesia, postoperative awareness, emergence delirium incidence rates of the observation group were 25%,0%,7.5%, which were significantly lower than 57.5%,12.5%,37.5%of the control group,the differences were statistically significant(χ2=8.717,5.333,10.323,all P<0.05). Conclusion The propofol combined with sufentanil in laparoscopic ovarian cyst resection has more significant effect, which can shorten the operation time, promote the postoperative recovery, reduce complications, worthy to be widely used in clinical practice. Key words: Propofol; Sufentanil; Laparoscopy; Excision of cyst of ovary

Comparison of surgical intervention and non-surgery result in early prostate cancer

s / Urological Science 26 (2015) S50eS81 S57 The operation began with 7ecm midline incision above the umbilicus. A small hole of cystic wall was created and more than 6 L of yellowish clear fluid was drained. The hand-assisted device was placed in midline wound. While other two 10-mm trocar were placed in left lower abdomen and left anterior axillary line subcostally. The membrane of cyst was dissected as much as possible. Nephropexy was done to attach migrating left kidney to the back of the abdominal wall. The postoperative course was uneventful and the patient was discharged 3 days after the operation. Intravenous urography done 3 months later showed normal kidney position and bilateral patent ureters. Discussion: A huge renal cyst measuring more than 15 cm is an extremely rare. Cases presenting simply with progressive abdominal distention can lead to misdiagnosis, such as obesity or ascites. In our case, huge left renal cyst caused left kidney migration to right side, leading to initial misdiagnosis of right acute pyelonephritis. Surgery has been considered the mainstay of treatment for giant cyst. We performed hand assisted laparoscopic renal cyst unroofing and nephropexy with uneventful postoperative course and good outcome. NDP028: UNUSUAL URETHRAL FOREIGN BODIES Wei-Chung Hsiao , Sung-Lang Chen , Yu-Lin Kao , Wen-Jung Chen , Tzuo-Yi Hsieh , Shao-Chuan Wang . Division of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Purpose: Urethral foreign bodies are uncommon clinical conditions. Most of the foreign bodies are self-introduced under the circumstances of autoerotic impulses, sexual curiosity, psychiatric illness, or rarely migration from adjacent organs. Retrieval of the urethral foreign body is casespecific due to wide variety of foreign bodies. Materials and Methods: A 75-year-old man was sent to emergency department after a motorcycle accident. Serial examinations including pelvic radiography and computed tomography discovered 5 fishhooks within the urethra unexpectedly. Ingrowth into urethral mucosa of the fishhooks with related inflammatory process was noted. Due to complexity of the fishhook position and pelvic fracture condition, cystourethroscopic retrieval of the foreign bodies was performed successfully in a two-step manner. Results: Self-inflicted urethral foreign bodies have a very low incidence. Major complications of urethral foreign bodies include trauma, infection, urine retention, and urethral stricture. Most of the foreign bodies of lower urinary tract can be treated with endourological modalities. The key point of urethral foreign body extraction relies on its physical attributes and morphology with the purpose of minimal urothelial injury. Conclusion: The urethral foreign bodies could be removed successfully by cystourethroscopic procedure without any complication, even in the presentation of mucosal ingrowth.

Comparison of the efficacies of open and laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst

Objective To explore the clinical efficacies of open and laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst. Methods The clinical data of 36 adult patients with congenital choledochal cysts who were admitted to the Sir Run Run Shaw Hospital from February 2008 to February 2015 were retrospectively analyzed. Twenty-four patients underwent common bile duct cyst resection + cholecystectomy + biliojejunal Roux-en-Y anastomosis (open surgery group) , 12 patients underwent laparoscopic common bile duct cyst resection + cholecystectomy + biliojejunal Roux-en-Y anastomosis (laparoscopy group) . The intraoperative conditions, detection indexes and postoperative recovery indexes in the 2 groups were analyzed. The follow-up by regular outpatient examination and telephone interview were done up to March 2015. Non-normal distribution data were described as M (P25 , P75) . Comparison between groups was analyzed using the Mann-Whitney U test and Fisher exact probability . Measurement data with normal distribution were presented as ±s and analyzed using t test. Count data were evaluated by the ratio and proportion. Results The operation time of the open surgery group and laparoscopy group were 238 minutes (191 minutes, 283 minutes) and 270 minutes (225 minutes, 326 minutes) , with a significant difference between the 2 groups (Z=–1.360, P >0.05) . The volume of intraoperative blood loss in the open surgery group and laparoscopy group were 200 mL (113 mL, 363 mL) and 75 mL(50 mL, 138 mL), with a significant difference between the 2 groups (Z=–3.377 , P 0.05) . All the 36 patients were followed up for a median time of 36 months (range, 1-72 months) with good recovery, without long-term postoperative complications and re-operation. Conclusion Laparoscopic surgery in the treatment of adult patients with congenital choledochal cyst is safe and feasible, with the advantages of less intraoperative bleeding, less surgical trauma, fast recovery compared with open surgery. Key words: Congenital choledochal cysts; Laparoscopy; Complications; Minimally invasive surgery

Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis.

To compare the safety and efficacy between laparoscopic and open cyst excision with hepaticojejunostomy for children with choledochal cysts using meta-analysis. Studies comparing the laparoscopic and the open choledochal cyst excision that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to November 2014. The proceedings of relevant congress were also searched. The outcomes were operative time, intraoperative blood loss, time to food intake, postoperative morbidity and mortality, length of hospital stay. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2. Seven retrospective studies were finally included, involving a total of 1016 patients, of whom, 408 cases underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy (LH) and 608 cases underwent open cyst excision and Roux-en-Y hepaticojejunostomy (OH). In LH group compared with OH group, the operative time was longer (MD = 59.11, 95% CI 27.61-90.61, P = 0.0002), while the length of postoperative hospital stay was less (MD = -2.01, 95% CI -2.49 to -1.54, P < 0.00001), the intraoperative blood loss was lower (MD = -37.14, 95% CI -66.69 to -7.60, P = 0.01) and time to food intake was less (MD = -1.14, 95% CI -1.61 to -0.67, P = 0.01). The rate of postoperative morbidity was more in the OH group, but there is no statistically significant difference between the two groups in postoperative morbidity (OR = 0.52, 95% CI 0.13-2.06, P = 0.35). Laparoscopic surgery is a feasible, safe treatment of choledochal cyst with less postoperative morbidity, a shorter length of stay and a lower blood loss when compared with open approach. With the improvement of laparoscopic techniques and deftness of surgeons practice, laparoscopic surgery may become the first choice procedure for choledochal cyst.

Totally laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for choledochal cyst in adults: a single-institute experience of 5 years.

The present study aimed to describe the authors' experience and the intermediate-term outcome for totally laparoscopic choledochal cyst excision and Roux-en-Y hepatoenterostomy at a single center in a 5-year period. We retrospectively analyzed the clinical data of totally laparoscopic choledochal cyst excision and Roux-en-Y hepatoenterostomy on 31 adult patients from January 2009 to November 2013. Thirty-one cases successfully underwent totally laparoscopic choledochal cyst excision laparoscopy and Roux-en-Y hepatoenterostomy. The operation time varied from 200 to 360 minutes. The intraoperative blood loss was 50 to 210 mL. The patients passed flatus in 3.0 ± 1.3 days. The mean time interval to resume oral intake from the time of surgery was 3.8 ± 1.4 days. The duration of postoperative intravenous fluids was 4 to 11 days. Postoperative ambulation varied from 2 to 4 days. The duration of hospital stay was 4 to 13 days. Follow-up observations lasted 3 to 59 months and complications were noted in 4 patients. Of these patients, 1 patient suffered postoperative respiratory tract infection, 1 patient had an episode of adhesive small bowel obstruction, biliary leakage occurred in 1 patient, and 1 patient developed an anastomotic stoma stricture and cholangitis. There were no perioperative deaths. Totally laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is a safe, efficacious, and minimally invasive procedure for the most instances of adult choledochal cyst. The key of success is skilled laparoscopic skills, good team cooperation, and stapler anastomosis.