Objective To explore whether preserving deep inguinal lymph nodes during surgery for early cervical cancer,endometrial cancer,and ovarian cancer can reduce postoperative lower limb lymphedema.Methods Under a prospective randomized controlled study design,100 cases of early cervical cancer,endometrial cancer,and ovarian cancer from July 2022 to July 2023 were included and randomly divided into a preservation group(preserving deep inguinal lymph nodes,n=50)and a resection group(removing deep inguinal lymph nodes,n=50).All the radical surgeries were performed by the same surgical team.The lower limb lymphedema was assessed at 1,2,6,and 12 months postoperatively,by using the Gynecologic Cancer Lymphedema Questionnaire(GCLQ)and lower limb circumference measurement.Results The incidence of lower limb lymphedema in the preservation group was 6％(3/50),significantly lower than the 20％(10/50)in the resection group(x2=4.332,P=0.037),and the onset time was later[(5.3±3.1)months vs.(2.3±1.6)months,t=2.394,P=0.036].There was no significant difference in the staging and location of lower limb lymphedema between the two groups(P＞0.05).Conclusion Preservation of deep inguinal lymph nodes during surgery for early cervical cancer,endometrial cancer,and ovarian cancer can significantly reduce the incidence of postoperative lower limb lymphedema.

Objective To investigate the effects of preoperative oral electrolyte solution on intraoperative stress response and postoperative nausea and vomiting(PONV)in patients undergoing gynecological laparoscopic surgery.Methods From January to April 2025,200 cases of elective gynecological laparoscopic surgery due to benign diseases were selected and randomly divided into observation group and control group by the envelope method,with 100 cases in each group.The observation group orally took 5 ml/kg electrolyte solution(with a maximum dose of 300 ml)at 2 h before surgery,while the control group was fasted and prohibited from drinking at 2 h before the operation according to the traditional protocol.The mean arterial pressure(MAP),heart rate(HR),end-tidal CO2 partial pressure(PETCO2),Cerebral State Index(CSI),and pneumoperitoneum pressure were recorded at 6 time points:entering the room(T1),entering the laparoscope(T2),30 min after the start of the operation(T3),60 min after the start of the operation(T4),the end of the operation(T5),and 30 min after the operation(T6).The blood samples were taken at T3 and T6 to detect catecholamines(adrenaline,norepinephrine,dopamine),cortisol,and blood glucose levels.The recovery time of bowel sounds,anal exhaust time,and incidence of PONV within 2,6,and 12 h after surgery were recorded.Results There were no statistically significant differences in MAP,HR,PETCO2,CSI,and pneumoperitoneum pressure between the two groups(P＞0.05).The average levels of norepinephrine at T3 and T6 and blood glucose at T3 in the observation group were lower than those in the control group(P＜0.05).The incidence of PONV at 2,6,and 12 h after surgery,recovery time of bowel sounds,and anal exhaust time were all better in the observation group than those in the control group(P＜0.05).Conclusion Preoperative oral electrolyte solution can effectively alleviate the intraoperative stress response of gynecological laparoscopic surgery patients,reduce the incidence of PONV,promote the recovery of gastrointestinal function,and conform to the concept of Enhanced Recovery After Surgery(ERAS).

Objective To evaluate the application value of fascial platform versus commercial platform in transumbilical single-port laparoscopic transabdominal preperitoneal repair(TAPP)for inguinal hernia.Methods One hundred patients with inguinal hernia admitted between January and December 2024 were prospectively enrolled and randomly assigned to either the fascial platform group(n=50)or the commercial platform group(n=50)by using a random number table.The following parameters were compared between the two groups:platform establishment time,operative time,intraoperative blood loss,incision suture time,operative difficulty score,camera manipulation difficulty score,postoperative 24-hour Visual Analogue Scale(VAS)score of pain,postoperative hospital stay,total hospitalization cost,comprehensive satisfaction score,and postoperative complications.Results The fascial platform group demonstrated significantly superior outcomes compared to the commercial platform group in platform establishment time[(3.4±1.0)min vs.(8.1±1.5)min,t=-18.389,P＜0.001],operative time[(67.5±7.9)min vs.(72.2±11.5)min,t=-2.380,P=0.019],intraoperative blood loss[(8.3±4.3)ml vs.(11.1±5.7)ml,t=-2.798,P=0.006],incision suture time[(7.0±1.4)min vs.(11.8±2.7)min,t=-11.212,P＜0.001],operative difficulty score(14.4±3.6 vs.23.1±4.1,t=-11.215,P＜0.001),camera manipulation difficulty score(11.4±2.6 vs.18.3±2.5,t=-13.370,P＜0.001),VAS score of postoperative 24-hour pain(2.4±1.0 vs.3.7±1.1,t=-6.139,P＜0.001),total hospitalization cost[(15.8±1.6)thousand yuan vs.(18.3±1.6)thousand yuan,t=-7.841,P＜0.001],and comprehensive satisfaction score(7.3±1.1 vs.6.3±1.0,t=5.271,P＜0.001).However,there were no statistically significant differences in postoperative hospital stay or postoperative complication between the two groups(P＞0.05).All the patients were followed up for 1-12 months postoperatively[(5.3±1.8)months vs.(5.7±2.0)months,t=-0.945,P=0.347],with no recurrence observed in either group.Conclusions Both fascial platform and commercial platform can be used for transumbilical single-port TAPP.The fascial platform offers advantages including shorter platform establishment time,reduced incision suture time,lower operative and camera manipulation difficulty,decreased cost,less postoperative pain,and higher patient satisfaction.

Objective To investigate the safety of robotic single-site hysterectomy(RSSH)for benign diseases.Methods We retrospectively analyzed data of patients who underwent RSSH or traditional transumbilical laparoendoscopic single-site hysterectomy(LESSH)for benign indications from May 2024 to May 2025.The study was comprised of 24 patients in the RSSH group and 42 patients in the LESSH group.Perioperative indicators were compared between the two groups.Results All the surgeries were successfully completed in both groups without conversion or intraoperative/postoperative blood transfusion.The RSSH group had a longer operation time than the LESSH group[161.5(131.3,179.5)min vs.97.5(76.5,123.3)min,Z=-5.226,P＜0.001].However,there were no significant differences in intraoperative blood loss,pre-postoperative hemoglobin difference,postoperative pain score,maximum postoperative temperature,time to flatus,indwelling catheter duration,or postoperative hospital stay(P＞0.05).Conclusion RSSH for benign diseases has a safety profile comparable to traditional LESSH.

Objective To observe the clinical efficacy of uterine-sparing U-shaped reconstruction surgery in the treatment of diffuse uterine adenomyosis.Methods A total of 48 patients with diffuse uterine adenomyosis underwent surgical treatment from October 2019 to September 2022.All the patients underwent a modified lesion resection procedure via sagittal plane incision of the uterine corpus,enabling direct visualization for U-shaped excision of adenomyotic foci within the myometrium,followed by endometrial cavity reconstruction and uterine remodeling.The dysmenorrhea score,menstrual volume score,serum CA125,and uterine volume were assessed at 1,6,and 12 months postoperatively.Results All the 48 patients underwent surgery successfully.The average surgery time was(115.7±13.6)min,the average intraoperative blood loss was(109.4±30.9)ml,and the total length of hospital stay was(8.6±1.7)d.At 1,6,and 12 months after surgery,the dysmenorrhea score,menstrual volume score,serum CA125 levels,and uterine volume were significantly lower as compared to the pre-operative values(all P=0.000).The hemoglobin level at 1 month after surgery was significantly higher than that before surgery(P=0.000).No symptomatic or ultrasonic recurrences were observed in all the 48 cases.Two cases got unexpected pregnancy after surgery.Conclusions Uterine-sparing U-shaped reconstruction surgery is a safe and effective treatment for diffuse uterine adenomyosis.It does not require special instruments,and is simple and easy to perform.

Objective To explore the application value of laparoscopic assisted ileostomy closure after prophylactic ileostomy.Methods A retrospective analysis was conducted on 63 cases of middle and low rectal cancer who received ileostomy closure after prophylactic ileostomy in natural orifice specimen extraction surgery(NOSES)from September 2017 to May 2023.Among them,31 cases underwent laparoscopic assisted ileostomy closure(observation group),and 32 cases underwent conventional open ileostomy closure(control group).The operative time,intraoperative blood loss,time to first ambulation,time to first flatus,time to first liquid diet,postoperative pain score,postoperative hospital stay time,and postoperative complications were compared between the two groups.Results All the 63 cases successfully underwent ileostomy closure.The observation group showed significantly better outcomes than the control group in operative time[(63.2±5.7)min vs.(93.5±4.7)min,t=-23.109,P=0.000],intraoperative blood loss[7.0(6.0,8.0)ml vs.22.5(21.0,24.0)ml,Z=-6.853,P=0.000],time to first ambulation[1.0(1.0,1.0)d vs.2.0(2.0,2.0)d,Z=-5.653,P=0.000],time to first flatus[1.0(1.0,2.0)d vs.2.0(2.0,2.0)d,Z=-5.304,P=0.000],time to first liquid diet[2.0(2.0,3.0)d vs.3.0(2.0,3.0)d,Z=-3.000,P=0.003],postoperative pain score[24 h:3.0(3.0,4.0)vs.4.0(3.0,4.0),Z=-4.501,P=0.000;48 h:2.0(2.0,2.0)vs.3.0(2.0,3.0),Z=-3.750,P=0.000;72 h:1.0(1.0,2.0)vs.2.0(2.0,2.0),Z=-2.996,P=0.003],and postoperative hospital stay[(6.8±1.6)dvs.(8.5±1.5)d,t=-4.297,P=0.000].The observation group had a lower postoperative incision infection rate than the control group[3.2％(1/31)vs.34.4％(11/32),x2=9.908,P=0.002],while no significant differences were observed in incision dehiscence,intestinal obstruction,or abdominal hemorrhage(P＞0.05).Conclusions For patients with middle and low rectal cancer who undergoing ileostomy closure after prophylactic ileostomy in NOSES,laparoscopic assisted ileostomy closure is safe and feasible.Compared with open surgery,it reduces incision infection rate,alleviates postoperative pain,shortens hospital stay,and promotes recovery.

Objective To explore clinical effects of local anesthesia non-tourniquet technique in surgery for the treatment of cubital tunnel syndrome.Methods Between July 2020 and June 2023,20 patients with severe cubital tunnel syndrome were treated by using local anesthesia non-tourniquet technique.The local anesthetic was prepared,consisting of lidocaine with epinephrine,and in situ ulnar release was performed.Based on the evaluation for ulnar nerve instability,a decision was made on whether to perform anterior transposition of the ulnar nerve or not.Results In situ ulnar release was performed in 13 cases and anterior subcutaneous transposition of the ulnar nerve due to ulnar nerve subluxation were conducted in 7 cases.During anesthesia injection,there was only mild pain in the first injection[Numerical Rating Scale(NRS)score of 2-3 points],mild pain during intraoperative procedures(NRS score of 1-2 points),and mild to moderate pain after surgery(NRS score of 1-6 points).No anesthetic complications were recorded and the wound healed well.All the cases were followed up for 8-22 months(mean,17.1 months).According to classification of cubital tunnel syndrome introduced by Gu Yudong,the results were excellent in 5 patients,good in 12 patients and fair in 3 patients,with an excellent and good rate of 85.0％(17/20).At the last follow up visit,the 2-point discrimination of the little finger was 4-7 mm(mean,5.1 mm).Conclusion The local anesthesia non-tourniquet technique is safe and effective in surgery for the treatment of severe cubital tunnel syndrome,being worthy of clinical application.

Objective To explore the clinical efficacy of wrist arthroscopy assisted closed reduction with external fixation in the treatment of intra-articular comminuted fractures of the distal radius(type C3).Methods A retrospective analysis was conducted on 98 patients with type C3 intra-articular comminuted fractures of the distal radius admitted to our hospital from March 2022 to February 2023.Among them,48 patients underwent wrist arthroscopy assisted closed reduction with external fixation with a bracket(arthroscopy group),and another 50 patients underwent open reduction with steel plate internal fixation surgery(control group).The two groups were compared in terms of operation time,intraoperative bleeding volume,incision length,fracture union time,range of motion(ROM)of joint,Visual Analogue Scale(VAS),and Gartland-Werley wrist scores,as well as radiographic parameters(palmar tilt,ulnar inclination,and radial height)evaluated at various follow-up intervals.Results The arthroscopy group had an operation time of(55.3±10.5)min,which was significantly shorter than that in the control group[(83.4±14.6)min;t=-10.979,P=0.000].The intraoperative bleeding volume in the arthroscopy group was(42.3±8.6)ml,which was less than that in the control group[(71.4±10.5)ml;t=-14.953,P=0.000].The incision length of the arthroscopy group was(1.3±0.3)cm,which was shorter than that of the control group[(5.1±1.5)cm;t=-18.550,P=0.000].The arthroscopy group had a fracture healing time of(10.7±1.4)weeks,which was shorter than that in the control group[(12.2±1.6)weeks;t=-4.855,P=0.000].The palmar flexion ROM in the arthroscopy group was 68.8°±8.3°,which was significantly higher than that in the control group(61.5°±9.4°;t=4.002,P=0.000).The dorsiflexion ROM in the arthroscopy group was 63.9°±7.5°,which was significantly higher than that in the comtrol group(59.2°±8.3°;t=2.931,P=0.004).The pronation ROM in the arthroscopy group was 67.4°±10.3°,which was significantly higher than that in the control group(62.1°±9.9°;t=2.604,P=0.011).The supination ROM in the arthroscopy group was 70.5°±7.4°,which was significantly higher than that in the control group(64.4°±8.6°;t=3.777,P=0.000).The VAS score of the arthroscopy group was(1.3±0.6)points,which was significantly lower than that in the control group[(1.7±0.5)points;t=-3.941,P=0.000].After 6 months,the Gartland-Werley wrist scores of the arthroscopy group was significantly higher than that of the control group(Z=-2.614,P=0.009).The wrist joint imaging showed significantly higher radial height,palmar inclination angle,and ulnar deviation angle in the arthroscopy group than the control group(all P=0.000),while there were no significant differences in palmar inclination angle and ulnar deviation angle at different time points within each group(P＞0.05).Except for significant differences in radial height at 3 d,1 month,and 6 months after surgery(P=0.015,P=0.035),there were no significant differences between any other time points(P＞0.05).The interaction between time and group was not significant for palm inclination angle,ulnar deviation angle,and radial height(P＞0.05).Conclusion Wrist arthroscopy assisted closed reduction with external fixation for intra-articular comminuted fractures of distal radius has advantages of short operation time,less intraoperative blood loss,and good recovery of wrist joint functions.

Objective To clarify the biomechanical properties of oblique lumbar interbody fusion(OLIF)combined with lateral plate(LP)fixation under different bone conditions by means of finite element(FE)analysis,so as to provide mechanical basis for clinical practice.Methods The three-dimensional nonlinear L3_5 FE model of the spine was constructed.Different material properties were assigned to each part of the model to establish a model of normal bone(NB),osteopenia(OS)and osteoporosis(OP)of the lumbar spine.OLIF combined with the following three internal fixation models were established.For NB,there were OLIF alone(M0),OLIF+LP fixation(M1),and OLIF+bilateral pedicle screw(BPS)fixation(M2);for OS,there were OLIF alone(N0),OLIF+LP fixation(N1),and OLIF+BPS fixation(N2);for OP,there were OLIF alone(P0),OLIF+LP fixation(P1),and OLIF+BPS fixation(P2).A 500 N load was applied on the upper surface of L3 to represent the weight of the upper body,and a 7.5 N·m moment was used to simulate the vertebral motion under six different conditions:flexion(FL),extension(EX),left bending(LB),right bending(RB),left rotation(LR)and right rotation(RR).The range of motion(ROM)of the fixed segment of NB,OS and OP models was calculated,and the overall stress of the vertebral body,the stress of the cage and the internal fixation device were recorded.Results Compared with the complete model,the stability of each surgical model increased.Compared with M0,ROM of M1 decreased,especially in the LB and RB,which was roughly equivalent to the stability of BPS but weaker than BPS in the control FL and EX direction.The situation in OS and OP model was similar to that in NB.Under the same internal fixation,L4_5 ROM gradually increased with bone deterioration.The overall intervertebral ROM of N1 in the FL direction increased by 16.1％compared with M1,P1 in the FL direction increased by 32.1％compared with M1,and P1 in the FL direction increased by 19.0％compared with N1.With the increase of posterior internal fixation,the overall stress of vertebral body,Cage and internal fixation stress showed a downward trend.Under the same internal fixation,with the loss of bone mass,the overall stress of the model gradually increased.Compared with M0,P0 increased the most in LR,reaching 56.5％.In the NB and OS models,the peak stress of the LP fixation under FL exceeded the minimum yield strength of the material by 22.7％and 33.8％,respectively,and was less than the minimum fatigue strength and yield strength of the material under the rest of the motion.In the OP,the peak stress of the internal fixation exceeded the minimum fatigue strength of the material at FL and EX,and reached 53.3％(＞50％)at FL.Conclusions Under NB and OS,OLIF combined with LP fixation can significantly improve the stability of the surgical segment,especially in LB and RB directions,and the overall stability is weaker than that of BPS fixation.Under OP,FL and EX may increase the risk of internal fixation failure.Combination with BPS fixation should be considered to improve the safety of fixation.

Objective To explore the safety and feasibility of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing for the treatment of inguinal indirect hernia in children≤3 months old.Methods From January 2020 to September 2024,49 children ≤ 3 months old with indirect hernia underwent external silk thread traction-assisted two-port laparoscopic internal ring suturing.All the patients were found to complicated with redundant peritoneum around internal ring.Under transumbilical single-port laparoscopic monitoring,the 3-mm laparoscopic needle holder holing the 3-0 needle-thread nylon was inserted through the inferior edge of the internal ring,entering the peritoneum and traveling through the retroperitoneal space.The external nylon thread was advanced to drag the redundant peritoneum,allowing the suture needle cross the surface of the spermatic cord vessels,the Doom's triangle,and the vas deferens(boys)or the uterine round ligament(girls)in the retroperitoneal space,followed by circular suturing and closure of the internal ring.Results The surgery time was(13.5±2.5)min for the 35 cases of unilateral hernia and(24.5±3.5)min for the 14 cases of bilateral hernia.No intraoperative complications occurred,and all the patients were discharged within 6 h post-operation.Except for 3 children of lost to follow-up,46 children were followed up for 6-26 months(mean,9.5 months),with 19 cases followed for＞12 months.No complications such as recurrence,wound infection,hydrocele,iatrogenic undescended testicle,or testicular atrophy were observed during the follow-ups.Conclusion For children ≤ 3 months old with indirect hernia,the use of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing enhances the flexibility and convenience of the procedure,being safety and feasibility.