Postoperative Intestinal Function Recovery Time Research Articles

Application Value of High-Quality Nursing in Operating Room in Rectal Cancer Operation and its Influence on Postoperative Rehabilitation.

To study the value of high-quality care in operating room during operation of patients with rectal cancer and the effect of this nursing model on postoperative rehabilitation. This study recruited 72 patients with rectal cancer, including 36 in the control group and 36 in the observation group. Patients in the control group received routine care, and those in the observation group received high-quality care in operating room. The anxiety score (5.50 ± .77 vs 10. 08 ± 1.13), stress score (6.97 ± .60 vs 8.61 ± .99), and depression score (4.02 ± .65 vs 5.50 ± .91) in the observation group were less than the control group after treatment (P < .05). The measured values of diastolic blood pressure (73.19 ± 1.96 vs 86.13 ± 2.0), systolic blood pressure (121.08 ± 1.62 vs 130.63 ± 2.84), heart rate (73.05 ± 1.63 vs 87.11 ± 2.91) and adrenaline E(E) (58.40 ± 3.02 vs 61.42 ± 3.86) in the observation group were less than the control group after treatment (P < .05). The cooperation degree (94.44 vs 75.00) in the observation group was greater than the control group, but the operation time (308.47 ± 9.92 vs 339.47 ± 12.70), postoperative intestinal function recovery time (16.30 ± 1.14 vs 30.94 ± 2.10) and length of stay (10.47 ± 1.85 vs 13.33 ± 1.95) were all shorter than the control group (P < .05). The nasopharyngeal temperature in the observation group was greater than the control group at 30 minutes during operation (36.16 ± .50 vs 35.19 ± .40) and after operation, and fear score (2.22 ± .42 vs 3.63 ± .72) was less than the control group (P < .05). The application of high-quality care in the operating room during rectal cancer surgery has a significantly good clinical outcome.

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence.

Renal cell carcinoma is abbreviated as renal carcinoma, and its clinical symptoms are basically hematuria, lumbago, and abdomen bump. As people's lifestyles change, the incidence of renal carcinoma continues to rise due to factors such as smoking and obesity. At present, surgical treatment is mostly used in clinical practice. Traditional open radical nephrectomy (ORN) is one of the main methods for clinical treatment of renal carcinoma. However, due to its large wound and large amount of intraoperative blood loss, the renal function of patients after surgery is poor, which is not conducive to the postoperative recovery of patients. Retroperitoneal laparoscopic radical nephrectomy (RLRN) has been widely used in the surgical treatment of renal cancer due to its advantages of small wound, less bleeding, and rapid recovery. The purpose of this study was to investigate the efficacy of RLRN in the treatment of renal cancer patients and its effect on renal function and to analyze the related factors affecting postoperative recurrence of patients. We adopt ORN and RLRN, two kinds of treatment, in patients with renal cancer surgery way, contrast analysis of the two groups of operation time, intraoperative blood loss, postoperative intestinal function recovery time, drainage tube indwelling time, length of hospital stay, and other clinical indicators and renal function indexes and use the single factor analysis and multifactor analysis, the relevant factors that affect kidney cancer patients with postoperative recurrence. The results showed that, compared with ORN treatment, RLRN treatment of renal cancer patients has a short operation time, less trauma, quick recovery after surgery, and fewer complications and can effectively alleviate the renal function injury and the body's inflammatory response, which is worthy of promotion. Postoperative recurrence was related to age, tumor diameter, TNM stage, surgical method, and postoperative immunotherapy.

Clinical Evaluation of Laparoscopic Cholecystectomy in the Treatment of Acute Cholecystitis in the Elderly

To evaluate the efficacy of laparoscopic cholecystectomy in the treatment of senile acute cholecystitis. A total of 96 elderly patients with acute cholecystitis admitted to our hospital from January 2014 to January 2019 were selected and all the patients were divided into groups according to their treatment timing. Patients within 3 d from the onset of the disease to the operation time were selected as Group A. Patients with an onset time of 3 d to 3 w of surgery were treated as Group B, while patients with an onset time of more than 3 w of surgery were treated as Group C. The operative time, intraoperative blood loss, postoperative intestinal function recovery time and hospital stay time were compared among the groups. Postoperative complications such as bleeding, pulmonary infection, abdominal infection, bile leakage and intestinal fistula, deep vein thrombosis and myocardial infarction were compared among all groups. Compared with Group A, there were no significant differences in intraoperative blood loss, operative time, postoperative bowel function recovery and length of hospital stay in Group B (p>0.05). Compared with group A and B, patients in Group C had higher operative time, intraoperative blood loss, postoperative intestinal function recovery and hospital stay (p 0.05). Early laparoscopic cholecystectomy can reduce intraoperative blood loss, operation time, hospital stay and recovery time of intestinal function in elderly patients with acute cholecystitis.

Clinical Efficacy Analysis of Two Different Surgical Approaches to Laparoscopic Radical Cystectomy with Urinary Diversion for Invasive Bladder Cancer

Objective: The present study aimed to compare the efficacy, and advantages and disadvantages of laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy versus laparoscopic radical cystectomy + ileal cystoplasty (Bricker procedure) in the treatment of invasive bladder cancer. Method: Forty-five patients (retrospectively registered) with grade II–III bladder invasive urothelial carcinoma were divided into two groups to compare clinical efficacy, operative duration and blood loss, postoperative intestinal function recovery, length of hospitalization, and complications. Those in the ureterocutaneostomy group (n=25) were treated using laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy, while those in the ileal cystoplasty group (n=20) were treated using laparoscopic radical cystectomy + ileal cystoplasty. Results: Laparoscopic radical cystectomy + extraperitoneal bilateral ureterocutaneostomy shortened the operation, improved patient tolerance, and decreased postoperative intestinal function recovery time. However, its long-term clinical efficacy needs further study using larger sample sizes to confirm these results. Conclusion: Results of this study demonstrated that extraperitoneal bilateral ureterocutaneostomy after cystectomy had advantages of less trauma, a shorter learning curve, less surgical bleeding, and quicker postoperative recovery. Although early and mid-term follow-up revealed a slightly higher incidence of hydronephrosis, the severity of complications was not high in most patients. Nevertheless, the long-term clinical efficacy of this procedure needs further study using larger sample sizes.

MP04-17 SUPRAPUBIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS OPEN URETEROVESICAL REIMPLANTATION USING INSERTION METHOD

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP04)1 Apr 2020MP04-17 SUPRAPUBIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS OPEN URETEROVESICAL REIMPLANTATION USING INSERTION METHOD Guoxi Zhang*, Xiaofeng Zou, Liang Wang, and Rihai Xiao Guoxi Zhang*Guoxi Zhang* More articles by this author , Xiaofeng ZouXiaofeng Zou More articles by this author , Liang WangLiang Wang More articles by this author , and Rihai XiaoRihai Xiao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000818.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the efficacy of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) and open ureterovesical reimplantation using insertion method, and to evaluate its clinical value. METHODS: Thirty patients who underwent SA-LESS ureterovesical reimplantation and 32 patients who underwent open ureterovesical reimplantation using insertion method were selected from July 2010 to December 2016 in the Department of Urology, First Affiliated Hospital of Gannan Medical College. To collect the material such as gender, age, preoperative water accumulation, operation time, intraoperative blood loss, postoperative complications, postoperative day 1 visual analog simulation score (Visual Analogue Scale/Score, VAS), postoperative analgesia time, postoperative ventilation time, postoperative drainage withdrawal time, postoperative catheter indwelling time, postoperative hospital stay. The main clinical items were compared and analyzed. All patients were reexamined 3 months, 6 months and 12 months after operation, and then every year. The follow-up included urinary color Doppler ultrasound, urinary analysis, renal function, intravenous urography and cystography, and patient scar assessment questionnaire. The differences of intraoperative and postoperative items between the two groups were compared. RESULTS: All 30 patients in the SA-LESS group were successful with no open surgery, no addtion port. 32 cases of the open group were successfully operated. No significant differences were found in operative time [(116.7±25.2)min vs (107.9±16.4)min, P=0.065], and postoperative catheter indwelling time [(8.0±1.8)d vs (8.9±2.1)d, P=0.088] between the two groups. Significant differences in intraoperative blood loss [(61.2±37.8)ml vs (110.8±39.1)ml, P=0.000], intraoperative incision length [(2.7±0.3)cm vs (12.8±2.4)cm, P=0.000], and postoperative intestinal function recovery time [(36.0±13.9)h vs (50.2±18.4)h, P=0.001] between the two groups were found. Significant differences in VAS score on the first postoperative day [(2.1±1.0) vs (3.8±1.2), P=0.001], VAS score on the third day after surgery [(1.0±1.0) vs (1.8±1.2), P=0.009], and postoperative analgesia time [(22.8±14.6)h vs (37.2±14.5)h, P=0.000] between the two groups were also found. There were significant differences in postoperative drainage tube indwelling time [(4.4±1.5)d vs (5.9±2.4)d, P=0.003],and postoperative hospital stay [(9.1±2.0)d vs (11.0±3.1)d, P=0.003] between the two groups. Complications occurred in 2 patients in the SA-LESS group, all of which were anastomotic leakage. In the open group, 9 patients had complications after operation. Among them, 4 patients had anastomotic leakage and 5 patients developed a wound infection. Significant difference was found in complication rates (x2=4.885, P=0.027). The total PSAQ of the SA-LESS group was lower than that of the open group at 3 months, 6 months and 1 year [(61.9±8.7) vs (85.9±8.3), P=0.000; (48.2±6.4) vs (74.0±8.2), P=0.000; (37.5±4.8) vs (64.9±6.3), P=0.000]. The SA-LESS group was followed up for 24-90 months, and the open group was followed up for 28-91 months. All cases were followed up for B-ultrasound and IVU, and postoperative hydronephrosis was improved to varying degrees. All cases were followed up for cystoscopy and no ureteral reflux was seen. CONCLUSIONS: SA-LESS ureterovesical reimplantation using insertion method, can result in small trauma, rapid postoperative recovery, less complications, and better cosmetic results with stable, long-term postoperative effect, which is worthy of application in clinic. Source of Funding: National Nature Science Foudation of China (Grant no. 81760462) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e38-e39 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guoxi Zhang* More articles by this author Xiaofeng Zou More articles by this author Liang Wang More articles by this author Rihai Xiao More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of laparoscopic surgery on the treatment of Dong Type C adult biliary dilatation

Objective To investigate the technical and therapeutic effects of laparoscopic surgery for adult patients with Dong Type C bile duct dilatation. Methods A retrospective cohort study approach was used. The clinical data of 47 patients with Dong Type C adult biliary dilatation who underwent surgery in Fujian Provincial Hospital from January 2014 to December 2017 were collected. There were 12 males and 35 females. The age ranged from 16 to 68 years, with a median age of 30 years. According to different surgical methods, the patients were divided into the laparoscopic group (treated with laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy, n=21) and the open group (treated with traditional open operation, n=26). The intraoperative blood loss, complication rate, operation time, postoperative intestinal function recovery time and postoperative hospital stay were observed. Measurement data with normal distribution were expressed as mean ± standard deviation (Mean±SD) and analyzed by t test. Comparison of count data was done by the chi-square test. Results There was no perioperative deaths in either group. There was no significant difference in intraoperative blood loss and complication rate between the two groups (P>0.05). The operation time of the laparoscopic group was significantly longer than that of the open group[ (333.7±61.1) min vs (235.9±64.3) min], with statistically significant difference between graps (P=0.000). The recovery time for the intestinal function of the laparoscopic group was significantly shorter than that of the open group [(2.2±0.5) d vs (2.9±0.6) d], with statistically significant difference between groups (P=0.000). The postoperative hospital stay in the laparoscopic group was significantly shorter than the open group [(7.1±1.8) d vs (12.0±5.9) d], with statistically significant difference between groups (P=0.001). Conclusion For adult biliary dilatation patiens with Dong Type C, laparoscopic surgery is safe and feasible with the advantages of mini-invasive and quick recovery. Key words: Laparoscopes; Comparative effectiveness research; Biliary dilatation; Surgery treatment

No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn\u2019s Disease

The aim of this study was to investigate the impact of staging operation on the risk of reoperation in patients with CD who underwent primary bowel resection. This was a retrospective study of 980 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1, 2001, and October 1, 2016. The patients were grouped according to staging operation (n = 64) and one-stage operation (n = 148). Postoperative intestinal function recovery time, postoperative short-term complications, and reoperation rates were compared between the two groups. There was significant difference in disease behavior between the staging operation group and the one-stage operation group. There was no significant difference in postoperative tolerance of enteral nutrition among groups (P > 0.05). Obvious differences were found in the comparison of the first time of exhaustion, defecation after operation, postoperative length of stay and postoperative complications among groups (all P < 0.05). There was no difference in the 5-year cumulative reoperation-free rates between the two groups (P > 0.05). In conclusion, surgical intervention at proper time and appropriate operation during operation are essential for patients with CD. It is believed that staging operation with ostomy followed by intestinal anastomosis is feasible when there are more than two risk factors for postoperative intra-abdominal infectious complications.

Extraperitoneal Laparoscopic Radical Nephroureterectomy and Lymph Node Dissection in Modified Supine Position

To explore the feasibility of extraperitoneal laparoscopic radical nephroureterectomy (EL-RNU) and lymph node dissection in a modified supine position for managing urothelial carcinomas in the renal pelvis or in the upper two-thirds of the ureter. Consecutively from January 2014 to October 2015, 15 patients with high-risk urothelial carcinoma in the renal pelvis or in the upper two-thirds of the ureter underwent EL-RNU and extraperitoneal laparoscopic lymph node dissection (EL-LND). Clinical and pathologic data, histologic nodal status, perioperative complications, and recurrence data were collected. All of the 15 patients were treated with EL-RNU and EL-LND in a modified supine position, and none was converted to open surgery. The mean operation time was 178 ± 18 minutes. The mean estimated blood loss was 140 ± 40 mL. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 7 ± 1 days. Pathologic studies revealed positive lymph nodes in 3 patients (20%). The mean number of harvested lymph nodes was 12 ± 3. No local recurrence and distant metastasis were found after a median follow-up of 14.4 months (7-23 months). EL-RNU and EL-LND in the modified supine position are mini-invasive and feasible for patients with urothelial carcinoma in the renal pelvis or in the upper two-thirds of the ureter. Good exposure and dissection of the abdominal aorta and inferior vena cava and the integrity of the peritoneum are key to the operational success of this approach.

Application practice of comfortable medical concept in patients with gastric cancer surgery

Objective To explore the application effect of comfortable medical concept in patients with gastric cancer surgery. Methods A total of 238 patients who underwent radical resections for gastric cancer in Department of Gastrointestinal Surgery were chosen from January 2015 to November 2015. These patients were divided into observation group (120 cases) and control group (118 cases) according to development time of comfortable medical concept. Comfortable medical concept was applied in the observation group and routine medical concept for control group. Preoperative anxiety score, postoperative pain score, postoperative length of intestinal function recovery time, leaving bed and hospital stay, hospitalization expense, postoperative complication and satisfaction degree were observed as the main indexes to discriminate the two groups. Results Patients in observation group were demonstrated having lower postoperative anxiety score and pain score, shorter length of postoperative intestinal function recovery time and hospital stay, faster time of leaving bed, lower hospitalization expense, higher satisfaction degree compared with that of control group (P 0.05) . Conclusions It is safe and effective to apply the comfortable medical concept to perioperative treatments for gastric cancer patients, which can significantly improve the patient's comfortable experience and accelerate the postoperative rehabilitation. Key words: Gastric cancer; Perioperative period; Comfortable medical concept

Pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder: surgical technique

Objective To investigate the surgical skills of pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder. Methods From October 2014 to September 2016, 37 patients with locally advanced bladder cancer(cT2-3N0-2M0)were diagnosed, including 29 males and 8 females, Their age ranged from 52 to 71 years old. According to preoperative cystoscopy, pathological diagnosis and bladder enhanced CT and other examination, 25 patients were staged as cT2, 12 cases were staged as cT3. 25 cases of them were primary tumors, who underwent pure robotic-assisted radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction. First, bilateral lymph nodes were dissected. And the ureter was explored and dissected to the outer wall of the bladder. Then, we ligated the superior artery of bladder and expose the seminal vesicle, vas deferent duct. The DV fascia was opened to expose the posterior wall of prostate. Incise was performed along the both sides of the bladder and prostate fascia to maintain the vascular nerve bundle until the tip of prostate. The urethra was cut off and then the bladder was remove. We used Endo-GIA to cut 30-35 cm ileum and construct U-shaped bladder. The anastomosis between ureter and neo-bladder and the anastomosis between urethra and neo-bladder were performed. Perioperative and follow-up data were collected. Results The surgeries were successful in all 37 cases. The operation time ranged from 245 to 335 min , mean (285±37)min. The mean intraoperative blood loss was(187±56) ml(ranging 90-300 ml). The average postoperative hospital stay was (17±2)days (ranging 15-20 days). Postoperative intestinal function recovery time ranged from 1.3 to 2.2 days, mean (1.7±0.4)days. Surgical margins were all negative. Lymph node positive rate was 21.6% (8/37). After 1 month, 22 cases achieved complete continence. After 3 months, 35 cases get fully self-control urination, 8 cases have noctual incontinence. Postoperative follow-up ranged from 6 to 24 months, no recurrence or distant metastasis was found in this study. After 6 months, cystoscopy showed no obvious formation of bladder stones. Neo-bladder capacity ranged from 270 to 350 ml. The urodynamic examination showed bladder pressure was maintained between 19 and 25cm H2O. Conclusions Pure robotic-assisted radical cystectomy can achieve better bladder resection, better remaining of urethral and neurovascular bundles and good control of urinary continence after operation. Endo-GIA assisted orthotopic U-shaped ileal bladder need shorter intestinal tract and cause less influence to the intestinal function. The neo-bladder shape is more regular, simple doing, earn shorter operation duration, less bleeding, quick recovery, which is a safe and effective surgical approach. Key words: Urinary bladder cancer; Pure robotic-assisted; Radical cystectomy; Orthotopic U-shape ileal neobladder

Comparison of the clinical effect of laparoscopic and laparotomy D2 gastric cancer radical on advanced gastric cancer

Objective To evaluate the clinical value of laparoscopic and open radical gastrectomy for gastric cancer in advanced stage(D2). Methods A retrospective analysis was conducted in 100 patients with advanced gastric cancer who underwent surgical treatment. The patients were randomly divided into laparotomy group (n=44) and laparoscopic group (n=56). The laparotomy group was treated with D2 radical operation for advanced gastric cancer by the conventional laparotomy, while the laparoscopic group underwent laparoscopic radical resection of advanced gastric cancer with D2. The surgery related indicators, as well as intraoperative and postoperative complications etc. were compared between the two groups. All patients were followed up for 24 months. The recurrence, metastasis and mortality of the patients in the two groups were compared. Results The operation time and the amount of bleeding of the laparoscopic group were less than those of the laparotomy group (P=0.020, 0.001). The postoperative intestinal function recovery and hospitalization time of the laparoscopic group were shorter than those of the laparotomy group (P=0.020, 0.001). There was no significant difference between the two groups in the number of lymph node dissection (P=0.650). Various complications occurred in the two groups, such as bleeding, spleen injury, vascular injury of colon injury and pancreatic injury, but the difference between the two groups was not statistically significant (P=1.000, 0.570, 1.000, 1.000). There was no significant differences between the two groups in pancreatic fistula, anastomotic leakage, remnant stomach weakness and anastomotic bleeding (P=0.020, 0.005, 1.000, 1.000, 0.570). After 24 months of follow-up, there was no significant difference in recurrence, metastasis and mortality between the two groups (P=0.450, 0.290, 0.530). Conclusion Endoscopic surgery for D2 resection in the treatment of advanced gastric cancer has advantages, such as less trauma, rapid recovery and so on, can reduce the occurrence of postoperative complications. Key words: Stomach neoplasms; Laparoscopy; Digestive system surgical procedures

The preliminary clinical results of laparoscopic ileum augmentation cystoplasty for low compliance bladder

To study the effectiveness and safety of the laparoscopic ileal bladder augmentation treatment for low compliance bladder. A retrospective analysis was performed based on 36 cases admitted to the Zhejiang Provincial People's Hospital with highly reflective and low compliance bladder accepted laparoscopic ileal bladder augmentation surgical treatment from June 2011 to December 2013. In accordance with inclusion and exclusion criteria, 22 patients were enrolled in this study, including 13 males, 9 females who aged from 22 to 62 years with an average of 35.8 years. Among the selected sample, there were 15 cases of spinal cord injury, 4 cases of spinal cord dysplasia, and 3 cases of urinary tuberculosis. The duration of disease varied from 1 to 15 years, with an average of 8.5 years. For surgery, intraoperative and perioperative complications were observed, and preoperative serum creatinine in patients with postoperative at 3, 6, 12, 18, 24, 36 months, hydronephrosis, and glomerular filtration rate urodynamic parameters were used for univariate analysis of variance. All patients were successfully completed in laparoscopic surgery, the operative time were (105 ± 17) minutes (90-150 minutes), blood loss was (90 ± 26) ml (60-150 ml), postoperative intestinal function recovery time were (2.5 ± 0.7) d (2-5 d), and postoperative hospital stay was (15.0 ± 4.2) d (11-20 d), while postoperative anastomotic leakage, intestinal blockage, severe abdominal infection or sepsis and other complications did not occur. Patients were followed up for 6 to 36 months, with an average of 16.5 months, among which 17 patients were followed up for over 12 months. The bladder safety capacity increased from (103 ± 38) ml preoperatively to (405 ± 46) ml at the end of the follow-up (F = 381.7, P = 0.000), and bladder compliance increased from (10 ± 3) cmH₂O (1 cmH₂O = 0.098 kPa) preoperatively to (38 ± 4) cmH₂O (F = 678.1, P = 0.000); the average pressure within the bladder filling at the end of the follow-up was (16 ± 6) cmH₂O, which was significantly lower (F = 221.5, P = 0.000) compared to preoperative level of (45 ± 16) cmH₂O, preoperative serum creatinine went down from (184 ± 32) µmol/L to (120 ± 28) µmol/L at the end of the follow-up (F = 189.1, P = 0.000); total glomerular filtration rate rose from (40 ± 26) ml⁻¹ · min⁻¹ · 1.73 m⁻² preoperatively to (66 ± 32) ml⁻¹ · min(-1) · 1.73 m⁻² (F = 137.7, P = 0.000). Qmax of the 3 cases of urinary bladder contracture tuberculosis patients increased significantly, while 4 female patients with residual urine volume decrease had voluntary urination. Laparoscopic ileal bladder augmentation treatment for low compliance bladder is feasible and safe, with less trauma, less bleeding, less post-operative complications, and faster recovery of bowel function. Urinary function improves significantly after surgery, and function of upper urinary tract can also be effectively improved and protected in patients.

Efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer

Objective To evaluate of efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer. Methods From January 2001 to September 2014, 83 patients with primary testicular nonseminomatous germ cell tumors (NSGCT) received nerve sparing LRPLND at 1-4 week after orchiectomy.Their age ranged from 18 to 44 years old, mean 25 years old.Serum AFP was abnormally elevated in 51 patients, ranged from 15to 1432μg/L (mean 874 μg/L). beta-HCG were abnormally elevated in 46 patients, ranged from 5-70 IU/L(mean 56 IU/L). All of their clinical stage was stage Ⅰ and did not suffer from ejaculatory dysfunction.The operating time, intraoperative blood loss, postoperative intestinal function recovery time, drainage removal time, hospital stay, intra - and post - operative complications were recorded. Results The nerve sparing laparoscopic retroperitoneal lymph was successfully performed in all patients.The mean operating time was 218 min, (range 158-285 min). The mean intraoperative blood loss was 368ml (range 255-587ml). The postoperative intestinal function recovery time ranged from 24 to 48 hours (mean 31 hours). And the hospital stay ranged from 5 to 9 days (mean 7days). The inferior vena cava was injured during operation and was sutured laparoscopically in 1 patient.Mild chylous retroperitoneal drainage was seen in 3 patients, which was cured within 1 week after operation by restriction of high - fat diet.22 cases were noticed ejaculation dysfunction postoperatively, which recovered spontaneously within 8 to 12 weeks.Within the 3 to 76 months follow - up, 73 patients revealed no evidence of recurrence or distant metastasis. Conclusions Nerve sparing LRPLND is technically feasible, mini invasive, the morbidity and complication were significantly lower.It can be performed with satisfactory results in young patients with early stage NSGCT. Key words: Testicle; Nonseminomatous germ cell tumors; Nerve sparing retroperitoneal lymph node dissection; Laparoscopy; Ejaculation

Pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder: report of 19 cases

Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder. Methods From August 2010 to April 2014, 19 patients with locally advanced bladder cancer (cT2-3N0-2M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction. Perioperative and follow-up data were collected. Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min, blood loss of 100 to 350 ml. Postoperative hospital stay was 21±4 (15-26) days, postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days. Surgical margins were all negative. Lymph node positive rate was 32% (6/19). Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula. There were 17 cases of urinary incontinence, all these cases were improved after 3 months, but there were still 8 cases of night-time incontinence. Three cases had unilateral ureteral reflux, ureter mild hydrocephalus, 1 of the cases had recurrent infections within 1 month after surgery. After the anti-inflammatory and catheterization treatment, the symptoms were improved. Two cases had unilateral ureteral anastomotic stricture, one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement, another underwent laparoscopic ureteral neobladder reimplantation. One case had bilateral ureteral stenosis due to recurrent infections, and underwent bilateral laparoscopic ureteral-new bladder reimplantation. Patients were followed up for 8-42 months, no recurrence or distant metastasis was found. Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient′s postoperative recovery. Key words: Urinary bladder neoplasms; Pure laparoscopy; Radical cystectomy; Orthotopic U-shape ileal neobladder

Effect analysis on different surgical approach in the laparoscopic for the right hemicolon carcinoma radical operation

Objective To analyze the effects of different surgical approach in the laparoscopic for the right hemicolon carcinoma radical operation.Methods 80 patients with the need of laparoscopic for the right hemicolon carcinoma radical operation were divided into observation group and control group.The observation group used middle approach and the control group was given outboard approach.The difference of surgery,postoperative recovery and surgery effect between two groups were compared.Results There was no significant difference between two groups in the field of operation time,postoperative intestinal function recovery time,postoperative hospital stay time and the incidence of complications (P ＞ 0.05).The amount of bleed in the observation group was more than that of control group,showing significant difference (P ＜ 0.05).In the comparison of postoperative neoplasm staging,lymph node dissection rate,the observation group get more positive results than those of control group (P ＜ 0.05).Conclusion It would not cause more damage using the middle approach than the outboard approach in the laparoscopic for the right hemicolon carcinoma radical operation,if the condition of clinical technology and environmental conditions are done well. Key words: Surgical approach; Laparoscopic; Right hemicolon carcinoma radical operation

Trans- and extraperitoneal retroperitoneal lymph node dissection (RPLND) in the treatment for nonseminomatous germ cell testicular tumors (NSGCT): a single Chinese center’s retrospective analysis

To evaluate the role of two different approaches to perform laparoscopic RPLND: transperitoneal laparoscopic retroperitoneal lymph node dissection (TL-RPLND) and extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RPLND). Between February 2003 and April 2013, 39 patients with nonseminomatous germ cell testicular tumors were treated by RPLND in our center. Twenty-one patients had TL-RPLND, and 18 patients had EL-RPLND. We performed a comprehensive retrospective study comparing TL-RPLND and EL-RPLND. Certain parameters, including operative time, estimated blood loss, perioperative complications, resected lymph nodes, postoperative intestinal function recovery time, ejaculation, and postoperative tumor markers, were abstracted and compared. In the EL-RPLND and TL-RPLND groups, the operation times were 178 ± 31 and 207 ± 25 min; the amounts of estimated blood loss were 87 ± 26 and 111 ± 21 ml; the postoperative intestinal function recovery times were 1.2 ± 0.7 and 2.4 ± 0.6 days; the postoperative hospital stays were 5.8 ± 1.1 and 5.5 ± 1.4 days; and the numbers of resected lymph nodes were 16.2 ± 1.5 and 15.8 ± 1.6, respectively. No conversion from laparoscopic to open surgery occurred. No patient in either group received an intraoperative blood transfusion. Overall, two patients developed postoperative fever, and one developed abdominal distension. After a median follow-up of 45 months, no regional relapse or metastases occurred, but 4 patients at clinical stage II were treated successfully by three cycles of platinum-based postoperative chemotherapy. Currently, all patients show no evidence of disease. Our results demonstrate that EL-RPLND was superior to the transperitoneal approach in terms of the operation time, estimated blood loss, and postoperative intestinal function recovery time, whereas no differences were observed in the number of lymph nodes resected. EL-RPLND was demonstrated to be safe and feasible, with satisfactory clinical outcomes when performed by experienced laparoscopic surgeons. Larger cohorts of patients with longer term follow-up are needed for further studies to determine the role of different approaches to L-RPLND.

Technology and experience in laparoscopic radical cystectomy with ileal conduit

Objective To investigate the safety and efficacy of laparoscopic radical cystectomy with ileal conduit.Methods Fifty-four cases of laparoscopic radical cystectomy with ileal conduit (22 cases in T2 stage,27 cases in T3 stage,and 5 cases in T4a stage) were performed from May 2008 to June 2011.Forty-nine cases were males and 5 cases were females.The perioperative conditions,postoperative complications,and treatment methods were analyzed respectively and follow-up was carried out.Results The median operative time was 340 min (240-420 min),the mean intraoperative blood loss was 220 ml (100-400 ml),postoperative intestinal function recovery time was 3-6 days,and no perioperative death occurred.The total postoperative complication rate was 20.4％ (11/54).Three cases had positive margins in pathology,and local radiotherapy was perfomed postoperatively.The average number of lymph nodes in laparoscopic pelvic lymphadenectomy was 10 per person.Four cases were positive with lymph node,and all node-positive patients received adjuvant systemic chemotherapy after postoperative recovery.The overall survival rate was 79.6％ (43/54) with an average follow-up of 2.9 years (1.5-4.5 years).Conclusions For patients without surgery opportunities of orthotopic ileal neobladder,laparoscopic radical cystectomy with ileal conduit could be a safe and feasible minimally invasive option,with less bleeding and fewer complications.The postoperative early tumor radical effect is good,and for the patients with local positive margins could receive local salvage pelvic radiotherapy. Key words: Laparoscopes; Cystectomy; Urinary diversion; Ileal conduit; Urinary bladder neoplasms

Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in total gastrectomy patients

Objective To compare the effect of comparion of the effect of postoperative.Methods Forty patients with total gastrectomy for gastric cancer surgery were randomly divided into groups of early parenteral nutrition (EEN) and total parental nutrition (TPN) group,20 patients in each group.Nutritional index,immune status,complication rate and postoperative intestinal function recovery time and average hospital stay were observed.Results The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than that in TPN group(t =5.091,7.007,all P ＜ 0.05).and the hospital stays of EEN group all so significantly shorter than TPN group (t =5.802,P ＜ 0.05).Prealbumin and transferrin were significantly reduced on post-operative day (POD)7 and were slowly recovered until POD 90.but the increased rate in EEN group was significantly faster than that in TPN group [cprealbumin:t =9.501,7.913,7.182,6.154,all P ＜ 0.05] ; transferrin:t =5.501,5.712,5.733,5.801,all P ＜ 0.05).The TLC,CD4 and CD8 are lower than before total gastrectomy on POD 7,and have been recovered to the level before surgery.The TLC level on POD 7 and 14 were significantly higher in EEN group than that in TPN group (t =5.645,5.134,all P ＜ 0.05).The PG-SGA score was lower in EEN group than that in TPN group,particularly on POD 21 (t =5.211,P ＜ 0.05).Conclusion Total gastreetomy for gastric cancer after curative resection of early enteral nutrition support can improve the postoperative intestinal function recovery and shorten the time of hospital stay for patients. Key words: Enteral nutrition; Parenteral nutrition; Gastrectomy; Stomach neoplasms

Extraperitoneal Laparoscopic Retroperitoneal Lymph Node Dissection for Early-Stage Testicular Nonseminomatous Germ Cell Tumors: Initial Experience

To investigate a modified laparoscopic retroperitoneal lymph node dissection technique using an extraperitoneal approach and to evaluate its feasibility. A group of consecutive patients from a single institution underwent extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RLND) at weeks after orchiectomy for primary testicular nonseminomatous germ cell tumors (NSGCT). All patients were placed in the supine position and tilted up 15 degrees on the affected side. Four trocars were introduced. The templates of lymph node dissection conformed to those of Weissbach and Boedefeld. EL-RLND was successfully performed in 15 patients (left, 6 patients; right, 9 patients). The mean total operative time for the entire series was 164 ± 49 minutes. The mean blood loss was 118 ± 74 mL. One intraoperative complication was injury of the vena cava, which occurred in one patient. Ureteral obstruction occurred in another patient. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 5.5 ± 1.1 days. Normal antegrade ejaculation was preserved in all patients. Pathologic studies revealed positive lymph nodes in three (20%) patients. No recurrence or distant metastasis occurred during 2 to 32 months of follow-up. EL-RLND is a safe and feasible procedure using an improved extraperitoneal approach that provides minimal invasion and rapid recovery of patients.

Comparison of Open Surgery Versus Retroperitoneoscopic Approach To Chyluria

We compared the clinical effectiveness of renal pedicle lymphatic disconnection for chyluria performed by retroperitoneoscopy and by open surgery. Three male and 4 female patients 33 to 68 years old (mean age 49) with chyluria underwent retroperitoneoscopic renal pedicle lymphatic disconnection. Chyluria was on the left side in 5 cases and on the right side in 2. Open renal pedicle lymphatic disconnection was performed in 4 men and 2 women 33 to 61 years old (mean age 45.8). Chyluria was on the left and right sides in 3 cases each. Mean operative time, intraoperative blood loss, postoperative intestinal function recovery time, intraoperative and postoperative complications, postoperative hospital delay and operative outcome were compared in these 2 groups. Compared with the open surgery group results in the retroperitoneoscopic group were superior in terms of operative time (42 to 90 minutes, mean +/- SD 65.0 +/- 18.8 versus 120 to 220, mean 156.7 +/- 38.8), intraoperative blood loss (20 to 50 ml., mean 29.3 +/- 10.2 versus 60 to 250, mean 171.7 +/- 76.5), postoperative intestinal function recovery time (24 to 48 hours, mean 36.0 +/- 6.9 versus 24 to 72, mean 54.0 +/- 21.1), intraoperative and postoperative complications, and postoperative hospital stay (3 to 6 days, mean 4.7 +/- 0.7 versus 7 to 9 days, mean 7.8 +/- 1.0). In the open surgery group primary anastomosis was performed in 1 case due to injury to a renal artery branch during the operation. Chyluria resolved the day after surgery in the 2 groups. No obvious complications developed postoperatively. The followup of 2 to 12 months (mean 6.7 +/- 4.0) showed no recurrence of chyluria. Retroperitoneoscopic renal pedicle lymphatic disconnection completely ligates the lymphatic vessels with minimal invasion, less blood loss, rapid recovery and a good short-term outcome.