OBJECTIVETo assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer.

METHODSRetrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with COunder 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated.

RESULTSThere were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion and 20 cases of intra-abdominal metastasis were still missed by diagnostic laparoscopy, and 12 cases received non-therapeutic laparotomy.

CONCLUSIONDiagnostic laparoscopy has considerable value in assessing adjacent organ invasion and intra-abdominal metastasis and has great clinical significance in making precise treatment plans.

Abdominal Neoplasms ; diagnostic imaging ; secondary ; Digestive System ; pathology ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopes ; Laparoscopy ; instrumentation ; methods ; statistics & numerical data ; Laparotomy ; statistics & numerical data ; Male ; Neoplasm Invasiveness ; diagnostic imaging ; Patient Care Planning ; statistics & numerical data ; Retrospective Studies ; Stomach Neoplasms ; diagnostic imaging ; surgery ; Surgical Instruments ; Unnecessary Procedures ; statistics & numerical data

Harmonic scalpel is an important instrument for laparoscopic surgery, and it can be used for dissection and hemostasis. During the procedure of laparoscopic surgery for colorectal tumor, surgeons can use Harmonic scalpel to identify the surgical plane around the mesorectum and mesocolon. We summarized technical points based on our own 15-year experiences of harmonic scalpel use in laparoscopic surgery for colorectal surgery, and extracts them into five words, which are 'shave, poke, cut, peel and push'. These skills are described in combination of the illustrations and videos in this article.
Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; instrumentation ; Humans ; Laparoscopy ; instrumentation ; Surgical Instruments

OBJECTIVEDesign and make triple cannula dual-lumen vacuum extractor to improve effect of decompression in operation of intestinal obstruction.

METHODSTriple cannula dual-lumen vacuum extractor was applied in 32 patients who underwent operation of intestinal obstruction from 2012 to 2015 in our hospital. The effect of intestinal decompression and patient prognosis were observed.

RESULTS32 patients that used triple cannula dual-lumen vacuum extractor had good recovery except for one patient abdominal incision with fatty liquefaction. The other patients had one-stage healed without any complication such as intestinal fistula, abdominal infection etc.

CONCLUSIONApplication of triple cannula dual-lumen vacuum extractor in operation for intestinal decompression could avoid contamination of abdomen and injury of intestinal mucosa, which had satisfied effect of intestinal decompression and promoted the effect of operation for intestinal obstruction.

Catheters ; Decompression, Surgical ; Digestive System Surgical Procedures ; instrumentation ; Humans ; Intestinal Obstruction ; surgery ; Vacuum

BACKGROUNDThe Da Vinci system is a newly developed device for colorectal surgery. With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Since conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the Da Vinci robotic system in anterior resections for rectal cancer.

METHODSBetween November 2010 and December 2011, a total of 22 patients affected by rectal cancer were operated on with robotic technique, using the Da Vinci robot. Data regarding the outcome and pathology reports were prospectively collected in a dedicated database.

RESULTSThere were no conversions to open surgery and no postoperative mortality of any patient. Mean operative time was (220 ± 46) minutes (range, 152 - 286 minutes). The median number of lymph nodes harvested was (14.6 ± 6.5) (range, 8 - 32), and the circumferential margin was negative in all cases. The distal margin was (2.6 ± 1.2) cm (range, 1.0 - 5.5 cm). The mean length of hospital stay was (7.8 ± 2.6) days (range, 7.0 - 13.0 days). Macroscopic grading of the specimen was complete in 19 cases and nearly complete in three patients.

CONCLUSIONSRobotic anterior resection for rectal surgery is safe and feasible in experienced hands. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures. This technique may facilitate minimally invasive radical rectal surgery.

Aged ; Digestive System Surgical Procedures ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Robotics ; methods ; Treatment Outcome

Digestive tract reconstruction is the main part of gastrointestinal surgery. With the rapid development of technology and widely application in stapling device, more and more surgeons are using stapled anastomosis. Stapled anastomosis is associated with shorter operating time and hospital stay than hand-sewn anastomosis. However, it is not easy to select suitable ones from various staplers and use them correctly. Choice and reasonable application of staplers for anastomosis in gastrointestinal surgery are summarized and evaluated in this article.
Anastomosis, Surgical ; instrumentation ; Digestive System Surgical Procedures ; instrumentation ; Humans ; Surgical Staplers

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.
Aged ; Digestive System Surgical Procedures/*methods ; Female ; Fluorescence ; Humans ; Image Processing, Computer-Assisted/instrumentation/*methods ; *Intraoperative Care ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Rectum/*surgery ; Robotics/*methods ; Spectroscopy, Near-Infrared/*methods ; Treatment Outcome

Harmonic scalpel, one of the most commonly used energy tools, have been recognized as an important revolutionary development in surgical device. Due to its convenience in cutting, coagulating, and dissecting harmonic scalpel has been increasingly used to performed surgery by more and more surgeons. In gastrointestinal surgeries, however, many manipulationssuch as dissecting soft connective tissues off the stomach or colon, isolating and cutting particular vessels, would require proper techniques in handling harmonic scalpels. Thus, based on our experiences of using harmonic scalpel in laparoscopic gastrointestinal surgeries, we summarized a "nine-word tactics", which may be helpful for beginners to use harmonic scalpels in a proper and efficient manner.
Digestive System Surgical Procedures ; instrumentation ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy ; Surgical Instruments ; Ultrasonics ; instrumentation

OBJECTIVE: To assess the safety and efficacy of gastrointestinal anastomosis with nickel titanium shape memory alloy compression anastomosis clip. METHODS: We randomized 51 patients to undergo gastrointestinal anastomosis with stapler (n=25) and nickel titanium compression anastomosis clip (n=26) respectively. The following parameters were recorded to evaluate the safety and efficacy: mean hospitalization time, anastomotic complication, first post-operation flatus and bowel movement, and extrusion of the clip. RESULTS: Anastomotic complications such as leakage, stenosis and obstruction were not observed in both groups. There were no significant differences in the first post-operation flatus time and bowel movement time between the 2 groups (P>0.05). The clip was expelled with stool within 9-15 d. CONCLUSION Compression anastomosis clip is safe and effective.
Anastomosis, Surgical ; instrumentation ; methods ; Anastomotic Leak ; prevention & control ; Digestive System Surgical Procedures ; methods ; Female ; Gastroenterostomy ; instrumentation ; methods ; Gastrointestinal Diseases ; pathology ; surgery ; Humans ; Male ; Nickel ; Surgical Staplers ; Titanium

BACKGROUNDThe biofragmentable anastomosis ring (BAR) is a simple alternative device to create intestinal anastomosis. Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis.

METHODSA total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group (n = 82) and manual suture group (n = 85) as control. They were equally allocated to the two groups regarding sex, age, site of anastomosis, emergent or elective surgery and contaminant diseases. The results of postoperative complications and recovery were recorded in each group.

RESULTSEighty-seven intraperitoneal BAR anastomoses were completed in 82 patients. Two and one postoperative deaths were recorded in BAR and suture group, respectively, no deaths were directly related to anastomotic technique. In suture group, anastomotic leakage and early bleeding both occurred in two patients respectively, no anastomotic bleeding occurred in BAR group, one patient in BAR group developed enterocutaneous fistulae. Perioperative bleeding, operation time and length of hospitalization were similar in two groups (P > 0.05). Time for return of bowel function was significantly shortened in BAR group than that in suture group (P < 0.05).

CONCLUSIONThe BAR appears to be a standard, easy, safe and effective alternative either in elective or emergent intraperitoneal intestinal anastomotic surgery.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; instrumentation ; Digestive System Surgical Procedures ; instrumentation ; Female ; Humans ; Intestines ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Suture Techniques ; instrumentation ; Treatment Outcome ; Young Adult

Robotic colorectal surgery has gradually been performed more with the help of the technological advantages of the da Vinci(R) system. Advanced technological advantages of the da Vinci(R) system compared with standard laparoscopic colorectal surgery have been reported. These are a stable camera platform, three-dimensional imaging, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling, and instruments with multiple degrees of freedom. However, despite these technological advantages, most studies did not report the clinical advantages of robotic colorectal surgery compared to standard laparoscopic colorectal surgery. Only one study recently implies the real benefits of robotic rectal cancer surgery. The purpose of this review article is to outline the early concerns of robotic colorectal surgery using the da Vinci(R) system, to present early clinical outcomes from the most current series, and to discuss not only the safety and the feasibility but also the real benefits of robotic colorectal surgery. Moreover, this article will comment on the possible future clinical advantages and limitations of the da Vinci(R) system in robotic colorectal surgery.
Colorectal Neoplasms/*surgery ; Digestive System Surgical Procedures/history/instrumentation/*methods ; History, 20th Century ; History, 21st Century ; Humans ; Robotics/history/instrumentation/*methods