Radical resection is still the only possible cure for gallbladder cancer nowadays. Rational procedures vary according to different TNM stages, locations and biological behavior of tumor. Diagnostic laparoscopic exploration offers the opportunity to identify peritoneal metastasis which may be negative on preoperative radiological findings. Besides, this can also minimize trauma to abdomen. Therefore, laparoscopic exploration is suggested in cases highly suspected of peritoneal metastasis. For incidental gallbladder cancer, radical surgery should be performed because of positive margin of cystic duct, inadequate trocar management or advanced tumor stages. Timing for reoperation is still controversial. Most scholars recommended that it should be proceed within two months after the first surgery.

From the first Laparoscopic pancreaticoduodenectomy (LPD) in 1994 to the first Da Vinci robotic pancreaticoduodenectomy(RPD) in 2003, minimally invasive pancreaticoduodenectomy has achieved a breakthrough after 20-year exploration and development.It is a well-established procedure for periampullary carcinomas in some specialized centers now.Some outstanding reports including large clinical trials more than 100 cases of L/RPD in a single center and review analysis about the short and long outcomes between L/RPD and open PD for large cases have been published.For the sake of increasing popularity and acceptance of L/RPD, it is very important for researchers to update the current status of L/RPD and summarize experience and development.

ObjectiveTo evaluate the feasibility,effectiveness and safety of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension in cirrhotic patients. MethodsIn this study 16 cases underwent initial totally laparoscopic splenectomy and paraesophagogastric devascularization,with 10 cases undergoing upfront open surgery as controls by one treatment group.Clinical data including operative time,intraoperative blood loss,post-operative complications and hospitalization were compared between the two groups.ResultsIn the laparoscopic group the procedure was successfully performed in 12 cases.4 cases were converted to open surgery.The operative time in laparoscopic group and the open group was respectively (315 ± 77 ) min and (291± 31) min (P =0.384).The mean intro-operative blood loss was (409 ±216) ml and (980 ±402) ml (P ＜0.01).The post-operative stay was ( 10 ± 3 ) d and ( 17 ± 8 ) d ( P ＜ 0.01).Differences in post-operative complication rate between the two groups was not statistically significant ( 17％ vs.30％,P =0.525 ).ConclusionsLaparoscopic splenectomy and pericardial devascularization is feasible,effective and safe for cirrhotic patients with portal hypertension,it has the advantage of less intra-operative blood loss,less pain and shorter hospitalization than open surgery.

Objective To evaluate the effects of Laparoscopic cholecystectomy (LC) combined with intraoperative cholanggiography (IOC)and intraoperative endoscopic sphincterotomy (IOEST) for the treatment of cholecystocholedocolithiasis. Methods 106 cases with cholecystocholedocolithiasis diagnosed and treated by LC combined with IOC and IOEST were reviewed retrospectively. Results 60 40%(64/106)patients diagnosed cholelithiasis pre-LC were found choledocholithisis; LC combined with IOC and IOEST was successfully performed on 99 of 106 cases(93 40%),and their CBD stones were completely cleared in 98 of 99 cases(99 00%). Six cases(6 1%) were complicated with mild acute pancreatitis, 1 case(0 01%) with duodenal perforation,1 case(0 01%) with bile leakage, and 2 cases(0 02%) with stomach stasis. Conclusions LC combined with IOC and IOEST was a safe ,effective approach to diagnosis and minimally invasive treatment of cholecystocholedocholithiasis.

Objective To discuss the technique and clinical value of laparoscopic splenectomy (LS) without using Endo-GIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2005 to October 2006, 23 patients with cirrhotic portal hypertension-induced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endo-GIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole. Results The operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonography-guided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.Conclusions It is a low-cost and superior method to disconnect the secondary splenic pedicle without using endo-GIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

Objective To evaluate the management strategy for gallbladder carcinoma found during the procedure of intended laparoscopic cholecystectomy (LC) Methods Twenty one cases of primary gallbladder carcinoma were incidently found during a period of 1996-2003, among them 17 cases of Nevin stage Ⅱ、Ⅲ and Ⅳ were divided into group A (6 cases) converted to open radical resection, and group B (11 cases) treated by LC ? 2 test and Kaplan Meier analysis were used to analyze postoperative survival rates Results (1) Two Nevin stage Ⅰ cases are still alive for 6 and 47 months at a follow up after LC; (2) For stage Ⅱ、 Ⅲ and Ⅳ patients, open surgery resulted a much longer survival ( ? 2=4 55, P =0 0328) Conclusion (1) For Nevin stage Ⅰ patients, simple LC is enough; (2) Patients of Nevin stage Ⅱ、 Ⅲ and Ⅳ should be coverted to open radical resection

Objective To explore the treatment of primary hepatic neuroendocrine tumors (PHNET).Methods The therapeutic treatments of 9 PHNET patients from January 2003 to January 2010 in 3 hospitals were retrospective analyzed and followed up.Results Diagnosis of PHNET was confirmed immunohistochemically and by excluding extrahepatic primary sites.The survival is significantly dependent on tumor resectability.One patient received only radiotherapy and one with only chemotherapy,one with radiofrequency ablation.Six patients received R0 resection,one received postoperative radiotherapy,one with TACE perioperatively and internal radiotherapy.Two patients were lost to follow up 3 patients died and 4 were alive.Intrahepatic recurrence was found in 1 patient and metastasis to bone in 2 patients.Survival time ranged from 11 days to 66 months.Conclusions PHNET is an extremely rare entity with difficulty in early diagnosis.Curative liver resection integrated with transarterial chemoembolization or radiotherapy is considered to be an effective modality.

Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection (DBPPHR) in treatment of benign or low-grade malignant diseases located in the head of pancreas.Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People's Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively.Results Of the 31 patients,4 patients underwent laparoscopic DBPPHR.One patient in the open group was converted to pancreaticoduodenectomy.For the open group,the mean operation time was (165.3 ±63.6) min;the mean estimated blood loss was (258.1 ± 156.9) ml;and the mean postoperative stay was (11.7 ± 6.3) days.The postoperative complications included 1 reoperation due to postoperative bleeding,1 bile leakage and 13 patients developed grade A pancreatic fistula (48.2％).For the laparoscopic group,the mean operation time was 350.0 (280.0 ～ 450.0) min;the mean estimated blood loss was 425.0 (250.0 ～600.0) ml;and the mean postoperative stay was 14 days.Three patients developed postoperative pancreatic fistula (grade A).The pathological diagnosis were:12 patients with pancreatolithiasis,8 patients with serous cystadenoma,4 patients with branched intraductal papillary mucinous neoplasm,5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma.The follow-up period was 1 ～ 48 month,and there was no patient with diabetes or diarrhea.Conclusions DBPPHR was safe and efficacious.It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas.

ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.

Objective To investigate the value of laparoscopic total pancreastectomy for the treatment of noncancerous pancreatic lesions.Methods Clinical data of 3 cases of noncancerous pancreatic lesions undergoing laparoscopic total pancreatectomy in Zhejiang Provincial People's Hospital were reviewed retrospectively.Results One patient underwent laparoscopic total pancreatectomy,one patient underwent laparoscopic resection with robotic reconstruction and one did laparoscopic resection with open reconstruction.All were spleen preserving surgery.The operation time was 310 (280-350) minutes,estimated blood loss was 483 ml(250-700)ml and postoperative hospital stay was 27 (14-38) days.One patient had postoperative bile leakage.Insulin was used to control blood glucose level in all postoperative cases.As showed by pathology there were intraductal papillary mucinous neoplasms in two patients and multiple neurocndocrine tumor in one patient.Conclusion Laparoscopic total pancreatectomy is safe and minimally invasive for the treatment of noncancerous pancreatic diseases.