Objective To summarize the experience of laparoscopic common bile duct exploration(LCBDE)by means of micro-incision of the cystic duct confluence.Methods From January 2020 to March 2023,267 cases of cholecystolithiasis complicated with choledocholithiasis were given LCBDE by means of micro-incision through the cystic duct confluence.An incision was made along the inferior wall of the cystic duct to the conjunctive part of the common bile duct,and the lateral wall of the common bile duct was cut for 3-5 mm longitudinally.The bile duct exploration and stone extraction were completed under choledochoscope.Primary suture was performed.An abdominal drainage tube was placed.Results The operations were completed in all the 267 cases and the common bile duct stones were thoroughly removed.The operation time was 45-128 min(mean,96.5±9.7 min),the postoperative drainage indwelling time was 3-13 d(mean,5.1±1.2 d),and the postoperative hospitalization time was 5-13 d(mean,6.8±1.1 d).Biliary leakage occurred in 4 cases and was cured after abdominal drainage for 9-11 d.Postoperative fever was noted in 1 1 cases and was treated with anti-inflammatory therapy for 1-3 d.Abdominal abscess developed in 2 cases and was cured by abdominal drainage.A total of 242 cases(90.6％)were followed up for 6-39 months(median,11 months),of which 66 cases were followed up for more than or equal to 36 months.Residual stones were found in 2 cases,stone recurrence was noted in 2 cases,and no choledochal stenosis was found.Conclusion Laparoscopic lithotomy with micro-incision of the cystic duct confluence has a good clinical effect in the treatment of choledocholithiasis.

Objective To explore the effectiveness of transperineal tension-free repair of rectal seromuscular layer in the treatment of acquired rectovestibular fistula.Methods Clinical data of 97 girls with acquired rectovestibular fistula from May 2016 to November 2023 were enrolled.The surgical age ranged from 6 months to 11 years old(median,3 years old).The fistula was disconnected and resected via the perineal approach.The anterior wall of the rectum was fully disconnected.Then the fistula was repaired with horizontal continuous tension-free suture of rectal plasmomuscular layer with 5-0 PDS sutures.After continuous suture reinforcement,the perineal muscle layer and skin were longitudinally continuously sutured.The internal fistula opening was exposured with an anal dilator or small hook,and the mucosal layer was continuously sutured with 5-0 PDS sutures.Postoperatively,the anal tube and urinary tube were retained for 5-7 d and antibiotics was administered for treatment.Results The mean operation time was(60.5±9.0)min,the mean fistula diameter was(5.2±2.1)mm,and the mean hospital stay was(7.4±1.9)d.The follow-ups time was 4.5 months to 8.5 years(median,4.25 years).Primary healing was achieved in 92 cases(94.8％),with satisfactory perineal appearance,smooth stool passage,and regular defecation.Fistula recurred within 5-10 d after operation in 5 cases(5.2％),2 of which healed after 3 weeks of sitz baths by using 3％boric acid or Kangfuxin solution,2 of which healed after second operation,and 1 of which experienced recurrence after secondary fistula repair.Conclusion Transperineal tension-free rectal seromuscular layer repair is a simple,safe,and effective surgical method for the treatment of acquired rectovestibular fistula in girls.

Objective To analyze the clinical efficacy of percutaneous endoscopic decompression for adjacent segment diseases after lumbar fusion surgery.Methods A total of 26 patients with adjacent segment diseases after lumbar fusion surgery undergoing percutaneous endoscopy decompression in our hospital from January 2020 to June 2022 were retrospectively analyzed.The patients were operated through transforaminal approach in 11 cases and translaminar approach in 15 cases.There were 21 cases of unilateral decompression and 5 cases bilateral decompression.The clinical efficacy were evaluated by using the Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),Japanese Orthopedic Association(JOA)scores,and modified MacNab criteria.Results All the operations were completed successfully without serious complications.The operative time was(85.4±21.7)min,the blood loss was(19.8±5.9)ml,and the number of intraoperative fluoroscopy was(7.7±2.4)times.The VAS scores of lower limb pain were significantly decreased immediately after operation(P=0.000).The patients were followed up for 10-24 months postoperatively,with an average of(16.0±3.7)months.At 3 months after operation and at the last follow-up,the VAS scores and ODI were significantly reduced compared to before surgery(F=105.444,P=0.000;F=852.714,P=0.000),while the JOA scores were significantly increased(F=256.222,P=0.000).At the last follow-up,the efficacy was excellent in 18 cases(69.2％),good in 5 cases(19.2％),and fair in 3 cases(11.5％),with an overall excellent and good rate of 88.5％(23/26).Conclusion Percutaneous endoscopic treatment of adjacent segment diseases after lumbar fusion can achieve good clinical efficacy.

Objective To evaluate the efficacy and safety of single-used flexible ureteroscope lithotripsy(FURL)in the treatment of 2.0-3.0 cm non-lower-pole renal stones in elderly patients.Methods A total of 78 elderly patients with non-lower-pole renal stones measuring 2.0-3.0 cm admitted to our hospital were included in this study.Based on the surgical procedure,the patients were divided into the FURL group(42 cases of FURL with holmium laser lithotripsy)and the MPCNL group[36 cases of minimally invasive percutaneous nephrolithotomy(MPCNL)with holmium caser lithotripsy].Various parameters including operation time,stone fragmentation time,postoperative decrease of hemoglobin(Hb)level,postoperative Visual Analog Scale(VAS)for pain,hospitalization duration,stone-free rate(SFR)at 1 week and 4 weeks after surgery,secondary surgery rate,and incidence of complications were compared between the two groups.Results All the patients successfully underwent surgery.The decrease of Hb in the FURL group was(4.4±1.6)g/L,significantly lower than that in the MPCNL group[(24.7±4.6)g/L,t=-25.342,P=0.000].The postoperative VAS scores of the FURL group was(1.6±0.4)points,significantly lower than that of the MPCNL group[(5.6±0.9)points,t=-25.642,P=0.000].The stone fragmentation time in the FURL group was(82.5±10.2)min,significantly longer than that in the MPCNL group[(53.8±8.4)min,t=13.437,P=0.000].The operation time in the FURL group was(98.3±12.5)min,and there was no statistically significant difference compared to the MPCNL group[(96.7±11.8)min,t=0.555,P=0581].The hospitalization time in the FURL group was(3.5±1.5)d,significantly shorter than that in the MPCNL group[(8.6±1.7)d,t=-13.947,P=0.000].The incidence of complications in the FURL group was 26.2％(11/42),and there was no significant difference compared to the MPCNL group[27.8％(10/36),x2=0.025,P=0.875].The proportion of secondary treatment in the FURL group was 19.0％(8/42),and there was no significant difference compared to the MPCNL group[11.1％(4/36),x2=0.938,P=0.333].At 1 week after surgery,the SFR of the FURL group was 54.8％(23/42),significantly lower than that of the MPCNL group[86.1％(31/36),x2=8.943,P=0.003].At 4 weeks after surgery,there was no significant difference in SFR between the FURL group[90.5％(38/42)]and the MPCNL group[91.7％(33/36),x2=0.000,P=1.000].Conclusions Single-used flexible ureteroscope lithotripsy is highly effective in the treatment of non-lower-pole renal stones measuring 2.0-3.0 cm in elderly patients.It offers advantages such as minimal invasion,rapid recovery,minimal bleeding,low incidence of complications,and shorter hospitalization duration,which is worthy of promotion.

Objective To explore application value of transaxillary single-port gasless endoscopic-assisted fibroadenomas excision in adolescents.Methods A retrospective analysis was conducted on clinical data of 60 cases of fibroadenoma from June 2019 to June 2023.The patients were 17.3(range,13-19)years old.There were 54 cases of unilateral tumors and 6 cases of bilateral tumors.The average number of tumors was 2.5(range,1-13),and the mean tumor diameter was 4.0(range,3-10)cm.The fibroadenoma excision was performed by using transaxillary single-port gasless endoscopy.Results Of the 60 patients,the average operation time was 64.9(range,35-130)min and the intraoperative blood loss was less than 20 ml.Postoperative complications occurred in 5 cases(8.3％).At 3 months after surgery,the psychosocial well-being scores of BREAST-Q Scale were increased from(79.2±8.9)to(83.4±9.9)(P＜0.001).Conclusion Transaxillary single-port gasless endoscopic-assisted fibroadenomas excision is safe and effective for multiple or large fibroadenomas in adolescents,offering minimal invasion and concealed incision.

Objective To explore the safety and mid-term efficacy of autologous hamstring tendon implantation in the treatment of severe anterior vaginal wall prolapse.Methods We performed a prospective single arm clinical study.From May 2021,pelvic organ prolapse(POP)patients with severe anterior vaginal wall prolapse as the main cause who had symptoms and required surgical treatment were included.The patient was fully informed and voluntarily selected autologous hamstring tendon implantation and high sacral ligament suspension.Postoperative follow-ups were carried out on the Pelvic Organ Prolapse Quantification(POP-Q),Pelvic Floor Distress Inventory-Short Form 20(PFDI-20),postoperative satisfaction score,and Patient Global Impression of Improvement(PGI-I).Function of the lower limb on the tendon removal side,as well as postoperative complications and re-operations were recorded.Results The operation time of tendon removal was(19.7±8.3)min,the operation time of pelvic floor was(122.1±37.8)min,the median intraoperative bleeding volume was 70 ml(range,50-400 ml),and there was no intraoperative co-morbidity or postoperative fever.A total of 12 cases were followed up for(26.4±2.5)months.The measured values of Aa,Ba,and C were 3(-1-3),5(2-10),and 4(-1-10)before operation and-3(-3-3),-3(-3-3),and-6(-6-3)at 24 months after operation,respectively,with significant difference(P＜0.05).The PFDI-20 scores of the 12 patients before surgery and at 24 months after surgery were 88.0 points(range,16.7-204.2 points)and 8.3 points(range,0-32.3 points),respectively,with significant difference(Z=-2.803,P=0.005).The PGI-I questionnaire showed 11 patients with significant improvement in postoperative symptoms and 1 patient with improvement.The satisfaction scores at 6 and 24 months after surgery were(4.8±0.4)points and(4.6±0.7)points,respectively.One patient experienced vaginal prolapse at 12 months after surgery,with a Ⅲ degree prolapse of the anterior wall and vaginal vault,the recurrence rate being 8.3％(1/12).Two patients had pulmonary embolism at 9 d and 2 weeks after surgery,with Clavien-Dindo Ⅱ and Ⅲ grades,and recovered after outpatient and hospitalization treatment.One patient was found fascia exposure at the vagina,and had improvement with medication treatment.All the patients had good wound healing at the tendon removal site,with normal muscle strength and lower limb activity.No re-operation was required due to recurrence or complications of tendon surgery.Conclusions Autologous hamstring tendon implantation is safe in the treatment of severe anterior vaginal wall prolapse with satisfactory mid-term efficacy.Before surgery,it is necessary to educate patients on lower limb exercise to prevent complications of venous thrombosis.

Objective To explore the effectiveness of da Vinci Robot Xi system-assisted single-incision laparoscopic surgery for treating benign ovarian lesions in children and adolescents.Methods From June 2020 to March 2023,13 cases of benign ovarian lesions were operated by using a specially designed 4-channel single-incision laparoscopic device assisted by the da Vinci Robot Xi system.The docking between the da Vinci Robot and the patient was completed,and the affected ovaries were cut open with a non-powered scissors to expose the tumor tissue.The tumor tissue was removed as completely as possible along the edge of the tumor,and an absorbable suture was used to seal the wound followed by restoring the umbilical structure.Results All the 13 cases underwent ovarian benign lesion resection through a single incision in the umbilical region,without conversion to open surgery.The surgical time was 81-246 min,with an average of 161.4 min.The intraoperative bleeding volume was 5-50 ml,with an average of 21.2 ml.During the operation,2 cases of ovarian torsion and 3 cases of ovarian benign lesion rupture(with postoperative drainage tube placement)were found.Postoperative pathological findings showed 9 cases of mature teratoma,2 cases of serous cystadenoma,and 2 cases of simple cyst.The postoperative hospitalization time was 2-7 d,with an average of 4.2 d.There was 1 case of postoperative incision infection who was cured after antibiotic treatment.The follow-up period was 6-36 months,with an average of 21.1 months.No tumor recurrence or complications occurred,and all the patients had hidden scars on the umbilical incision.The patients and their families were satisfied with the postoperative appearance.Conclusion The application of da Vinci Robot Xi system-assisted single-incision laparoscopic surgery in the treatment of benign ovarian lesions in children and adolescents is safe and feasible,which can be considered as an option for treating such conditions.

Objective To explore the feasibility of a modified technique of extracorporeal appendectomy assisted by transumbilical single-site laparoscopy for non-encapsulated appendicitis in children.Methods Between June 2022 and December 2023,extracorporeal appendectomy assisted by transumbilical single-site laparoscopy was performed in our department for non-encapsulated appendicitis in 30 children(aged from 2 to 6 years old).A 5 mm trocar and a 30° laparoscope were inserted in the center of the umbilicus,and a 5 mm trocar and operating forceps were inserted at the lower edge of the umbilicus.The diseased appendix was explored and located.Non-invasive laparoscopic grasping forceps were used to clamp the head or center of the appendix.The tissue between the two trocar ports was cut open with the use of an electric knife.The appendix and distal cecum were pulled out of abdominal cavity to ligate the appendix root and mesentery.Then the appendix was disconnected with an electric hook.Results The operating time of the 30 cases was 15-22 min(average,18.0±2.5 min).Patients got out of bed and walked around at 6-8 h after surgery,and passed flatus and consumed liquid food within 1 d after surgery.Postoperative hospitalization was 2-5 d(average,3.5 d).Follow-ups for 1-15 months(average,4.5 months)showed no complications such as incision infection,adhesive intestinal obstruction,or pelvic abscess.Conclusion Transumbilical single-site laparoscopy assisted extracorporeal appendectomy is an effective procedure to resect the appendix,with characteristics of handy and convenient performance,being suitable for non-encapsulated appendicitis.

Objective To investigate the experience of intrauterine device(IUD)removal in patients with cervical cancer after radiotherapy.Methods A total of 23 patients with cervical cancer after radiotherapy underwent abdominal ultrasound guided hysteroscopic removal of IUD in our department from January 2020 to December 2022.For vaginal and/or cervical adhesions,blunt separation of adhesions was performed by using hysteroscope head or curved forceps under abdominal ultrasound guidance.If it was difficult to separate the adhesions for hysteroscope head entering the uterine cavity,a probe was inserted into the uterine cavity under ultrasound guidance,and the cervical canal was gradually expanded to 6-caliber dilation rod.Then the hysteroscope was inserted again into the uterine cavity.For obvious cervical atrophy that was tough in which cervical forceps could not be used to clamp the cervix,a 1-0 absorbable suture line was used to suture the anterior and/or posterior lips of the atrophied cervix at the top of the vagina,with an assistant firmly pulling and fixing the cervix.Results There were 4 cases of vaginal partial adhesions and cervical contracture,10 cases of cervical contracture,and remaining 9 cases having no vaginal adhesions and cervical contracture.Under hysteroscopy,there were 3 cases of cervical adhesions,2 cases of endometrial polyps,1 case of submucosal uterine fibroids,2 cases of uterine abscess,2 cases of incarcerated IUD,and remaining 13 cases having normal uterine cavity morphology.All the 23 cases of IUD were successfully removed by using abdominal ultrasound guided hysteroscopy(circular shaped in 12 cases,uterine shaped in 6 cases,V-shaped in 2 cases,Y-shaped in 1 case,T-shaped in 1 case,and umbrella shaped in 1 case).The surgical time was(19.2±10.9)min,and there were no complications such as false passage formation,uterine perforation,organ damage,massive vaginal bleeding,transurethral resection of the prostate syndrome,infection,embolism,or shock.The 23 cases were followed up for 2-24 months postoperatively,with a median of 12 months.One case continued concurrent radiotherapy and chemotherapy,3 cases continued post-loading radiotherapy,1 case continued chemotherapy,and 2 cases received targeted treatment(distant metastasis).The remaining 16 cases recovered well in regular reviews without complications such as abdominal pain,fever,or vaginal bleeding.Conclusions If the size and location of the cancer lesion do not affect the removal of IUD after radiotherapy for cervical cancer,it should be removed as soon as possible.The application of abdominal ultrasound guided hysteroscopy in IUD removal in patients with cervical cancer after radiotherapy is safe and feasible to a certain extent.

Objective To investigate the comfort of total video-assisted thoracoscopic intracardiac repair of atrial septal defect.Methods A total of 546 cases undergoing intracardiac repair of atrial septal defect form January 2015 to December 2020 in our hospital were selected into the study.According to the operation method,the patients were divided into thoracoscopic group and thoracotomy group,with 273 cases in each group.The pain degree,thoracic numbness,pressure feeling,thoracic deformation,anxiety,depression and phobia,and incision complications were recorded and compared between the two groups during ICU stay,at discharge,and at 1 and 3 months after discharge.Results According to the numeric rating scales(NRS),the degree of pain in the thoracoscopic group was higher than that in the thoracotomy group during ICU stay[(6.5±2.1)points vs.(5.3±2.2)points,t = 5.736,P =0.000],and lower than that in the thoracotomy group at other stages(all P =0.000).There was no significant difference in thoracic numbness and pressure feeling between the two groups during ICU stay(P>0.05),but the extant in the thoracoscopic group was significantly lower than that in thoracotomy group at discharge and 1 and 3 months after discharge(P<0.05).There was no thoracic deformation in the thoracoscopic group.The thoracic deformation rate in the thoracotomy group showed an upward trend at 1 and 3 months after discharge,and there was significant difference between the two groups(P<0.05).There was no significant difference in anxiety,depression and phobia between the two groups at discharge(P = 0.785).The psychological state of the thoracoscopic group was significantly better than that of the thoracotomy group at 1 and 3 months after discharge(P<0.05).There was no significant difference in incision complication rate between the two groups(P>0.05).Conclusion Total video-assisted thoracoscopic intracardiac repair of atrial septal defect is safe and effective,which improves the patient's medical comfort,being worthy of popularization and application.