*Endoscopy ; *Endoscopy, Gastrointestinal ; Gastric Mucosa/*surgery ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal System/surgery ; Human ; Intestinal Mucosa/*surgery

*Endoscopy ; *Endoscopy, Gastrointestinal ; Gastric Mucosa/*surgery ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal System/surgery ; Human ; Intestinal Mucosa/*surgery

With process optimization and technical innovation, laparoscopic gastrointestinal surgery has evolved dramatically over the last two decades and provided important improvement in the contemporary surgical practice and patients' recovery. With the emergence of many new minimally invasive technologies, including total laparoscopic surgery, single-incision laparoscopic surgery, and natural orifice specimen extraction, patents with gastrointestinal carcinomas may experience less pain and have lower perioperative complications, but the exact efficacy remains to be proven. Large-scale international multi-centre randomized controlled trial data have revealed that laparoscopic colorectal surgery is safe both in terms of short-term perioperative outcomes and long-term oncological efficacy. However, the question whether there is an equivalent oncological outcome compared to the open approach in gastric cancer is still unanswered by now and needs to be proven by future studies.
Digestive System Surgical Procedures ; methods ; Gastrointestinal Neoplasms ; surgery ; Humans ; Laparoscopy

Laparoendoscopic single site surgery(LESS), which has been applied in gastrointestinal surgery domestically and abroad, is the most feasible "scarless" operation at present. Combined with our expierience the problems and strategies of laparoendoscopic single site surgery in gastrointestinal surgery are reviewed and discussed in this paper. Inline vision, chopsticks effect and equipment congestion are the difficulties in LESS, especially when it is used in gastrointestinal surgery. Improving skills, selecting appropriate apparatus, fixed operating team and flexible exposure method can ensure the safety of LESS. In order to ensure that LESS is accepted, the safety and effectiveness of LESS used in the operation of gastric and colorectal cancer need assessment. As a new surgical technique, the further development of LESS in gastrointestinal surgery is not possible without concept recognition, breakthrough of technical limitation and equipment innovation.
Digestive System Surgical Procedures ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy

At present, the level of diagnosis and treatment of early gastrointestinal cancer has a larger gap between China and developed countries. In recent years, the advent of new endoscopic imaging techniques has improved the detection rate of early gastrointestinal cancer. Along with this, endoscopic submucosal dissection(ESD) enables radical resection for early cancer. In this article, we discuss how to improve the level of endoscopic diagnosis and treatment of early gastrointestinal cancer.
China ; Endoscopy, Digestive System ; Gastrointestinal Neoplasms ; diagnosis ; surgery ; Humans

The art and science of gastrointestinal endoscopy will continue to evolve at an amazing pace, with both endoscopists and industry providing new techniques and technologies for us to learn, investigate and apply to the benefit of our patients. It is not difficult to imagine that the next decade may see the maturation of a distinct specialty of gastrointestinal endoscopic surgery, currently in its adolescence, which crosses traditional boundaries. Practitioners will originate from a variety of backgrounds--gastroenterological, surgical or radiological--but must be trained specifically to perform the wide range of endoscopic procedures already in existence and those continually being introduced. Such 'endotherapists' will be an integral part of multidisciplinary units where optimal management strategies are planned based on available scientific evaluation of techniques irrespective of who performs them. Currently, numerous gastroinestinal diseases including both benign and malignant conditions have been managed using only endoscopic measurements. Control of gastrointestinal bleeding (variceal and non-variceal), dilation of benign and malignant strictures, antireflux management for esophagogastric reflux, endoscopic curative resection of premalignant and malignant lesions, treatment of submucosal tumors, percutaneous endoscopic gastrostomy or jejunostomy, stenting for malignant stricture of hollow viscus or pancreaticobiliary diseases, tumor ablation, and removal of biliary or pancreatic duct stones, etc. have been widely performed and various fascinating techniques and instruments have been continuously developed. It would be difficult to handle all of these various treatment modalities in a limited space. In this review we would like to discuss the fields of gastrointestinal tumors.
Endoscopy, Digestive System* ; Esophageal Neoplasms/surgery ; Gastrointestinal Neoplasms/surgery* ; Human ; Palliative Care ; Stents ; Stomach Neoplasms/surgery

OBJECTIVETo explore the method of digestive tract reconstruction and postoperative management in the upper abdominal multivisceral transplantation (MVT).

METHODSThe data of a pancreatic cancer patient with multiple liver metastases, undergone the first upper abdominal MVT in Asia on May 2004, was investigated retrospectively.

RESULTSDuring the operation, liver, gall bladder, pancreas, duodenum, part of jejunum, total stomach, greater and lesser omentum, and spleen were all resected from the recipient. Roux-en-Y procedure was adopted for the reconstruction of digestive tract, including closing the proximal end of donor duodenum, anastomosing recipient jejunum with horizontal part of donor duodenum, transecting the jejunum 35 cm from the anastomosis, end-to-side anastomosing the distal cut end of jejunum with the end of esophagus, and end-to-side anastomosing proximal cut jejunum with jejunum 50 cm away from esophageal anastomosis. Drainage tube was left inside duodenum and jejunum stoma was made for nutrient canal.The endocrine of pancreas was suppressed by the use of somatostatin postoperatively. Removing of nasogastric tube and duodenum draining tube were delayed. Bowel function recovered 4 days postoperatively and gradually resumed ordinary diet. One month after operation, the patient had no other complications except diarrhea.

CONCLUSIONThe success of upper abdominal MVT supplies precious experience in digestive tract construction and postoperative management.

Adult ; Digestive System Surgical Procedures ; methods ; Duodenum ; surgery ; Female ; Gastrointestinal Tract ; surgery ; Humans ; Jejunum ; surgery ; Liver ; surgery ; Organ Transplantation ; Pancreatic Neoplasms ; surgery ; Reconstructive Surgical Procedures ; methods ; Stomach ; surgery

Combined Modality Therapy ; Digestive System Surgical Procedures ; methods ; Gastrointestinal Neoplasms ; surgery ; Humans ; 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

Laparoscopic surgery for gastrointestinal diseases had a remarkable achievement in the past 20 years. To ensure the high quality of minimally invasive gastrointestinal surgery, several issues should be addressed, including correct guidelines and standard based on the consensus, high quality evidence from multi-center randomized control studies, proper training system for the technique, and constant innovations to improve the technique. We believe that with the great efforts of gastrointestinal surgeons, the minimally invasive gastrointestinal surgery in China is promising in the near future.
China ; Digestive System Surgical Procedures ; Gastrointestinal Diseases ; surgery ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures