Objective To explore the feasibility of laparoscopic subtotal colectomy on the basis of lesion identification with the combined use of laparoscopy and fibrocolonoscopy.Methods The operation was carried out under general anesthesia.The patients were maintained at a supine position.Four 10 mm trocars were introduced at the upper and lower borders of the umbilicus,and the left and right lower quadrants of the abdomen,respectively,and a 5 mm trocar was introduced at the right upper quadrant of the abdomen.The laparoscope was placed at the hypogastrium when performing right hemicolectomy,and at the left lower abdomen when left hemicolectomy.During the operation,a fibrocolonoscope was inserted by way of the severed end of the right colon for lesion identification.The colon was disconnected from the cecum to the sigmoid colon.Then the incision at the left lower abdomen was extended to 4 cm in length,and an extracorporeal ileosigmoidostomy was conducted. Results Pathologic changes of thickening and hardening intestinal walls were clearly observed under laparoscope.Fibrocolonoscopic examinations revealed that the false polyps and ulcers on the colonic mucosa had involved the descending colon and the part of the sigmoid colon.The operation time was 170 min and 190 min,respectively,and the intraoperative blood loss was 150 ml and 200 ml,respectively.Pathological examinations after the operation verified the presence of intestinal tuberculosis.No short-term complications occurred after the operation.The frequency of defecation was 5~6 times daily at short-term postoperative period and 1~2 times daily at 5~6 months after the operation.The patients' body weight increased by 2.5 kg and 4 kg,respectively. Conclusions Combined use of laparoscopy and fibrocolonoscopy can accurately evaluate the affected extent of the lesion.Laparoscopic subtotal colectomy is safe and feasible.

Objective To evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma. Methods Four trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for Roux-en-Y jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middle-upper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bile-jejunum Roux-en-Y anastomosis was performed. Results The hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively. Conclusions Upper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.