Objective To evaluate the clinic efficacy of laparoscopic totally extraperitoneal technique in complex inguinal hernia repair. Methods Totally 42 patients with complex inguinal hernia were repaired by laparoscopic totally extraperitoneal technique in our hospital during July 2004 to June 2008. Among the cases,18 patients had bilateral indirect inguinal hernia,8 had unilateral indirect and direct inguinal hernia,5 suffered from indirect inguinal hernia at one side and direct inguinal hernia in the other side,4 patients showed bilateral direct inguinal,3 showed bilateral indirect inguinal hernia and unilateral direct inguinal hernia,2 had bilateral direct inguinal hernia and unilateral indirect inguinal hernia,1 patient showed indirect inguinal hernia complicated with femoral hernia at the same side,and 1 patient had indirect and direct inguinal hernia at the both sides.During the operation,a 10-mm incision was made at 15 mm below the umbilicus reaching the Hunter's line,to place the laparoscope and separate the extraperitoneal space.Afterwards,two 5-mm trocars were inserted and then extraperitoneal pneumorperitoneum was established involving the retropublic space extending up to the anterior superior spine,so that to return the complex hernias.A polypropylene patch was then used to cover the pubic foramen and Hesselbach triangle. Results TEP was successfully completed in all of the 42 patients with a mean operation time of 85-165 min (mean,107.3 min) and estimated intraoperative blood loss of 10-20 ml. Scrotum aerocele was detected in all of the cases during the operation. The patients received normal diet in 2 days postoperation. They were discharged from our hospital in 7 to 9 days (mean,7.6 days). Follow-up was achieved for 3 to 32 months (mean,15.3 months) in all of the patients,during the period,2 patients showed recurrent direct inguinal hernia,and 5 had mild paraesthesia in the lower abdominal wall. Conclusions TEP is safe and effective for complex inguinal hernia.

Objective To study the efficacy and superiority of laparoscopy for the treatment of urachal fistula.Methods From January 2003 to March 2007,15 patients with urachal fistula received resection of the urachus in our hospital by laparoscopy with three trocar technique.The urachus was resected by clipping both the ends with Hem-o-lok and then cutting by ultrasonic scalpel.Frozen section examination of the resected tissues were carried out during the surgery.Results All the operations were completed under a laparoscope without conversions to open surgery.The operation time ranged from 25 to 50 minutes(mean,30 minutes).The intraoperative blood loss was 10 to 20 ml.The patients were discharged form hospital 2 to 4 days after the operation(mean,3 days).Among our cases,12 achieved a mean of 25.3 months follow-up(2 to 50 months),during this period none of them developed infections,recurrence,or carcinomatous changes.Conclusions Laparoscopy is feasible for urachal fistula.The method is simple and minimal invasive with good cosmetic outcomes and results in quick recovery.

Objective To evaluate the efficacy and priority of laparoscopy in the diagnosis and treatment of acute peritonitis. Methods Clinical data of 133 cases of acute peritonitis diagnosed and treated under laparoscope between April 2001 and October 2004 were retrospectively reviewed. Results Of the 133 cases, there were 60 cases of gastroduodenal perforation, 15 cases of acute cholecystitis, 8 cases of gallbladder perforation, 2 cases of sigmoid colon perforation, 35 cases of acute perforated appendicitis, 3 cases of jejunal diverticulum perforation, 1 case of foramen of Winslow hernia, 4 cases of acute pancreatitis, and 5 cases of primary peritonitis. The diagnostic accuracy was 100%. All the patients were treated laparoscopically without complications. Conclusions Laparoscopy gives a high diagnostic accuracy for acute peritonitis. The rationale for the use of it lies in the possibility of avoiding time- consuming preoperative B-ultrasonography or CT scans and performing minimally invasive surgical interventions directly.

Objective To investigate the clinical feas ib ility of endoscopic resection of benign mammary tumors. Methods A total of 22 cases were detected as benign mammary tumors by molybdenum targe t X-ray examinations from March 2002 to August 2003, including 15 cases of fibro ma and 7 cases of cystoid adenoma. The tumor was 2~4 cm in diameter (mean, 2.8 c m). A two-port transaxillary endoscopic resection using the electrotome and harm onic scalpel was carried out. Results The resection was comple ted endoscopically in all the 22 cases. The operation time was 28~68 min (mean, 42 min). A drainage tube was maintained for 1 day. Except for 1 case of subcutan eous effusion, no skin necrosis and other complications happened. The patients r ecovered uneventfully and stayed in hospital for 2~4 d (mean, 3 d) postoperative ly. There were no scars on the breast. Conclusions Transaxilla ry endoscopic resection of benign mammary tumors is safe and feasible and gives good cosmetic results.

Objective To explore the feasibility and surgical techniques of laparoscopic cholecystectomy(LC) in the treatment of incarcerated cystic duct stones associated with gallbladder empyema. Methods Laparoscopic cholecystectomy was performed in 76 cases of acute cholecystitis with incarcerated cystic duct stones and gallbladder empyema.During operation the cystic duct was found wide in 37 cases and was transected with overlapped clipping(11 cases),large-sized titanium clipping(9 cases),preformed knot ligation(3 cases),or Hem-o-lok ligation(14 cases),respectively.Cystic duct stones were removed during operation in 9 cases.Gallbladder bed hemorrhage occurred and was successfully stopped in 6 cases.Partial cholecystectomy was conducted in 6 cases. Results Laparoscopic cholecystectomy was successfully accomplished in all the 76 cases.The operation time was 50~125 min(mean,65.0?32.8 min).A drainage tube was placed in all the cases and was removed at 18~36 hours postoperatively,with a drainage volume of 40~90 ml/d (mean,55.0?10.4 ml/d).Biliary leakage happened in 2 cases and was cured with indwelling abdominal drainage.No patients were complicated with postoperative hemorrhage,visceral injuries,or bile duct injuries. Conclusions Laparoscopic cholecystectomy in the management of incarcerated cystic duct stones associated with gallbladder empyema is feasible.

Objective To explore the feasibility of mastoscopic resection of benign mammary gland tumors. Methods A total of 68 cases were diagnosed as having benign mammary gland tumors(42 cases of fibroma and 26 cases of cystic adenoma) by using molybdenum target X-ray examinations.The tumor was located at lower outer quadrant in 26 cases,upper inner quadrant in 16 cases,lower inner quadrant in 14 cases,and upper outer quadrant in 12 cases,respectively.The operation was conducted via a transaxillary approach.A specially-designed flap dissector was utilized to establish a tunnel underneath the breast skin,where the air was inflated to build a surgical space.Then the tumor was resected by using an electrotome or harmonic scalpel. Frozen-section examination was routinely carried out during operation. Results The operation was successfully completed in all the 68 cases,without intraoperative complications.The operation time was 28~45 min(mean,35 min).The drainage tube was indwelled for 1~2 d.Subcutaneous effusion occurred in 1 case.Postoperative recovery was uneventful without skin necrosis or other complications.The length of postoperative hospital stay was 2~5 d(3.0?1.5 d).Follow-up checkups in the 68 cases for 3~36 months(mean,12 months) revealed good cosmetic outcomes. Conclusions Transaxillary mastoscopic resection of benign mammary gland tumors is safe and feasible,with good cosmetic results.

Objective To compare effects between laparoscopic appendectomy(LA) and open appendectomy(OA) for acute appendicitis in children.Methods A total of 95 children with acute appendicitis from July 2000 to July 2005 were given either LA(LA Group,n=50) or OA(OA Group,n=45).The surgical outcomes and curative effects were compared between the two groups.Results The operation was successfully completed in both of the groups.No bleeding,intestinal fistula,or stump appendicitis was seen.There was no difference in the operation time between the LA Group(38.8?17.4 min) and the OA Group(41.9?15.8 min)(t=-0.905,P=0.368).The time to first defecation was significantly shorter in the LA Group(26.4?7.2 h) than in the OA Group(39.7?8.8 h)(t=-8.094,P=0.000).Appendiceal perforation was found in 29 children in the LA Group and 26 children in the OA Group,without significant difference(?~2=1.633,P=0.983),but the incidence of wound infection was significantly higher in the OA Group(11 children) than in the LA Group(2 children)(?~2=8.381,P=0.004).A drainage placement was required in 3 children in the LA Group and 9 children in the OA Group,with significant difference(?~2=4.206,P=0.040).The LA Group had significantly shorter time to normal temperature(55.4?16.2 h) than the OA Group(77.8?30.6 h)(t=-4.522,P=0.000),shorter hospital stay(5.4?1.3 d) than the OA Group(13.4?6.5 d)(t=-8.520,P=0.000),but higher hospitalization costs(6 117.9?836.5 yuan) than the OA Group(4 528.6?527.1 yuan)(t=10.937,P=0.000).Conclusions Laparoscopic appendectomy is superior to open surgery for acute appendicitis in children because of its advantages of minimal invasion,little pain,early recovery,good cosmetic appearance,low complication rate,and short hospital stay.

Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoscopic splenectomy(LS).Methods Twenty-one cases of idiopathic thrombocytopenic purpura(ITP) and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy.After the spleen was mobilized,a non-traumatic forceps was used to clip the pedicel at the site 3~5 cm from the hilus of spleen for the control of hemorrhage.The serosa on the spleen pedicel was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from without upward,double ligated with the Hem-o-lok clips,and severed with the harmonic scalpel.The spleen was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The laparoscopic splenectomy was successfully completed in all the 22 cases.The operative time was 75~180 min(mean,117 min),and the estimated intraoperative blood loss was 20~280 ml(mean,87 ml).All the patients got out of bed and began to take food at 1~2 days after operation. The length of postoperative hospitalization was 5~11 d(mean,5.6 d).There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema.Follow-up for 1.5～52 months(mean,19.3 months) in the 22 cases revealed no surgery-related complications.Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoscopic splenectomy.

Objective To investigate the clinical value of two kinds of endoscopic thyroidectomy for thyroid diseases.Methods Endoscopic thyroidectomy via breast approach or axillary approach was performed in 98 cases from December 2003 to August 2005.The subcutaneous space beneath the breast area and the subplatysmal space in the neck were bluntly dissected through a 5-mm incision.The CO_2 was insufflated at the pressure of 8~10 mm Hg to create an operative space.Three trocars were inserted.The dissection of the thyroid parenchyma and vessels was performed endoscopically by using an ultrasonically activated scalpel.The recurrent laryngeal nerve,the superior laryngeal nerve,and the parathyroid glands were preserved carefully.There were 1 case of lobectomy on one side and partial thyroidectomy on the other side,18 cases of unilateral lobectomy,12 cases of bilateral subtotal thyroidectomy,46 cases of unilateral subtotal lobectomy,and 21 cases of resection of thyroid mass. Results The operation was successfully completed in all the 98 cases,without conversions to open surgery.No complications were noted.The operative time was 69.1?29.0 min,the estimated blood loss was 37.9?10.6 ml,and the postoperative hospital stay was 3.5?0.7 days.The drainage tube was removed at 24~36 hours after operation.Two cases of thyroid cancer were followed for 24 months without recurrence.The remaining 96 cases were followed for 6~28 months(mean,16 months) without recurrence.Conclusions Endoscopic thyroidectomy via breast or axillary approach is feasible and safe,giving patients satisfactory cosmetic results.

Objective To study the effect and value of the application of the median umbilical fold in laparoscopic treatment for indirect inguinal hernia in children.Methods A total of 105 cases of pediatric indirect inguinal hernia(including 32 cases of incarcerated hernia, 25 cases of bilateral hernia,and 6 cases of recurrent hernia after open surgery) was treated with laparoscopic high ligation of the hernia sac and repair with the median umbilical fold from January 2004 to August 2005.The operation was performed through two or three trocars.Under laparoscopic visualization,the internal ring was identified for a purse-string suture.Then the median umbilical fold was sutured on the internal ring to repair the defect.Results The operation was successfully performed under laparoscope in all the 105 cases.The operative time was 10~25 min(mean,15 min) for unilateral hernia and 20~35 min(mean,25 min) for bilateral hernia.The intraoperative blood loss was hardly seen.The length of hospital stay was 2~3 days.The postoperative recovery was uneventful,without intestinal adhesion,infection,or hematoma of the scrotum.Follow-up observations in the 105 cases for 5~24 months(mean,18 months) found no recurrence.Conclusions Laparoscopic high ligation of the hernia sac and repair with the median umbilical fold is safe and effect for pediatric indirect inguinal hernia,with advantages of mini-invasion,simple performance,short operation time,low complication rate,and quick recovery.