Objective To study the anatomical feature s of the retroperitoneal cavity around kidney under laparoscope and to provide ana tomical guidance for laparoscopic surgery. Methods Lapar oscopic renal and ureteral operations were performed on 241 patients (145 men an d 96 women; age range,16-75 years;mean age,45.3 years).Through the videos and ph otographs of these operations,the anatomical features were analyzed.The atlas wa s drawn and surgical access was designed. Results Under laparoscope lateral conal fascia continues from the fascia of quadratus lumborum at its lateral border.This fascia covers posterior lamella of Gerota’s fascia and fuses into transversalis fascia beneath peritoneum. Fusion fascia lies befor e anterior lamella of Gerota’s fascia. It extends laterally and disappears grad ually to the lateral reflexion of peritoneum.The plane between fusion fascia and anterior lamella of Gerota's fascia, the plane between lateral conal fascia and posterior lamella of Gerota’s fascia, the plane before the quadratus lumborum and psoas major, are all vessel-free planes.Lateral border of colon,peritoneum and fusion fascia form a triangle lateral to colon.Fusion fascia,lateral conal f ascia and Gerota’s fascia form a vessel-free triangle. Conclusions Dissection through the vessel-free planes prevents laparoscopic op erations from bleeding and organ injury.Full understanding of the laparoscopic a natomical features of the retroperitoneal cavity around kidney provides the anat omic theoretical basis for laparoscopic operations.

Objective To evaluate the therapeutic effects of functional reconstructive technique of laparoscopic radical prostatectomy (LRP) for organ confined prostate cancer. Methods From October 2000 to September 2004,54 patients with organ confined prostate cancer (TNM stage of T 1b-T 2) underwent LRP.After completion of the first group of 15 consecutive cases (group A) by Monstouris techniques, the functional reconstructive surgical technique, which is basically composed of anatomical radical prostatectomy,was introduced to LRP in the second group of 39 consecutive cases (group B).These techniques mainly consisted of preservation of urethral and bladder outlet sphincter muscles,reconstruction of bladder neck,and fine anastomosis between urethra and bladder neck with fixation of anterior wall of anastomotic stoma and retropubic vascular complex.The operative time, bleeding volume,complications,continence recovery time and PSA level were comparatively analyzed between the 2 groups. Results All the operations were successful in 54 patients.In group A and group B,the mean operative time was 390 min(range,270-660 min)vs 240 min(range,180-360 min);the mean bleeding volume was 430 ml(range,200-1100 ml) vs 160 ml(100-400 ml);the complication rate was 40% (6/15) vs 13% (5/39) and the continence recovery time was on average 6 months vs 3 months,respectively. There were statistically significant differences in these parameters between the 2 groups (P

Objective To evaluate the technique of laparoscopic pyeloplasty. Methods 11 cases with ureteropelvic junction (UPJ) obstruction underwent laparoscopic pyeloplasty via post abdominal cavity approach. Results All the operations have been successful,the operating time being 2 to 4 h and the blood loss 40 to 90 ml. Ultrasound B investigation 3 to 24 months after the procedure showed no hydronephrosis in all and IVU analysis in 6 cases one year after the operation disclosed good outcome with less morbidity. Conclusions Laparoscopic pyeloplasty is an effective way to treat UPJ obstruction with minimal trauma to the patient.

Objective To evaluate laparoscopic radical prostatectomy for prostate cancer. Methods 8 patients presented clinical stages pT 1b to pT 2 prostate cancer.Laparoscopic radical prostatecomy was carried out transperitoneally with combining posterior and anterior approachs to the prostate,transecting the bladder neck,lateral dissection of the prostate and urethrovesical anastomosis. Results The operation time was 5 to 11 h with an average of 7.3 h and the blood loss 200 to 1 100 ml,averaged 620 ml.All the patients recovered well and uneventful with no complications such as urethral stricture or incontinence. Conclusions Laparoscopic radical prostatectomy is a better approach and least invasive.The procedure provides clear anatomic vision that facilitates operative performance and quicker recovery.

Objective To describe the ureteroplasty of congenital obstructive megaureter by laparoscopy and to evaluate the efficacy and feasibility of laparoscopic intervention for congenital obstructive megaureter. Methods Six patients with congenital obstructive megaureter were prepared for the laparoscopic surgery.The surgical procedure was briefly described as follows.The dilated ureter was dissected and cut off near the ureter orifice to the bladder by laparoscopy.Next,the free ureter was pulled out through the skin trocar site and was tailored as open surgery.After that,the ureter was placed back to the abdominal cavity and reimplanted laparoscopically into the bladder. Results The operation duration was 2 to 4 h (mean 2.4 h) and blood loss was very little (20～35 ml).No complication developed.The double J stent was removed at 3 months after the operation.Follow-up for half to 2 years showed that all the ureter drainage in the 6 cases was well without any infection. Conclusions Our preliminary result shows that laparoscopic surgery is a safe and effective method for treatment of megaureter.

Objective To compare clinical outcome between 3D and 2D laparoscopic nephron sparing surgery for renal tumor. Methods Ninety patients who underwent laparoscopic nephron sparing surgery for renal tumor were collected. The patients were divided into 3D laparoscopic nephron sparing surgery (observation group) and traditional laparoscopic nephron sparing surgery (control group) according to the surgery method with 45 cases in each group. The operating time, renal warm ischemia time, blood loss, postoperative length of stay, hospitalization cost and rate of postoperative complications were compared between 2 groups. Results The operating time and renal warm ischemia time in observation group were significantly shorter than those in control group:(80.3 ± 10.7) min vs. (94.6 ± 18.5) min and (17.8 ± 3.1) min vs. (23.4 ± 4.7) min, and there were statistical differences (P<0.01 or 0.05). There were no statistical differences in blood loss, postoperative length of stay, hospitalization cost and rate of postoperative complications between 2 groups (P>0.05). Conclusions Compared with the traditional 2D laparoscopic technology, 3D laparoscopic technology has obvious advantage in spatial location and the sense of depth. To some extent, 3D laparoscopy reduces the operation difficulty, and shortens the operative time and renal warm ischemia time.

BACKGROUND:Topping-off technique can be used for fixation treatment through the combination of fusion and interspinous dynamic device, in order to prevent or slow down the adjacent lumbar segment degeneration.
OBJECTIVE:To obverse the protective effect of Topping-off technique (posterior lumbar interbody fusion
procedure combined with the fixation of dynamic interspinous device Coflex) for the degenerative intervertebral disc. METHODS:A total of 32 patients with degenerative lumbar diseases who had been treated with Topping-off technique were included in this study. The Oswestry disability index, the Japanese Orthopaedic Association scores, range of motion for Coflex implanted segment and during the relative signal intensity of the Coflex implanted segment in MRI image were recorded and calculated preoperatively and the entire fol ow-up period.
RESULTS AND CONCLUSION:Al patients were fol owed-up for 20.6 months averagely. Up to the last fol ow-up, the Oswestry disability index and Japanese Orthopaedic Association scores were significantly improved when compared with those before treatment (P<0.001). There was no significant difference in the range of motion for Coflex implanted segment before and after treatment (P=0.19). The relative signal intensity of the Coflex implanted segment was significantly improved when compared with that before treatment (P<0.01). The clinical application of the Topping-off technique showed a protective effect on the intervertebral disc.

Objective To evaluate the minimally invasive technique of laparoscopy by retroperitoneal access for the treatment of parapelvic cyst. Methods Twelve patients(7 men and 5 women;mean age,52 years;age range,34-75 years) with parapelvic cysts were included.The cyst size ranged from 2.8 cm?3.0 cm to 2.5 cm?11.5 cm.The cysts were on the left side in 6 cases and on the right in another 6 cases.Laparoscopic resection or de-roofing of the parapelvic cysts by retroperitoneal access was performed in them.The relevant parameters of the procedures were summarized.Results The success rate of the operation was 100%.The mean operative time of the first 6 patients was 190 min,while it was 86 min in the rest 6 patients.The mean intraoperative blood loss was 25 ml.No injury to the kidney pedicle or pelvis occurred.The mean hospital stay was 9 d.In 11 patients,no recurrence of the cyst occurred during a follow-up of 7-31 months.Only 1 patient with concomitant renal cyst had recurrence of the cyst found by B-ultrasound 2 years after operation.Conclusions Therapeutic laparoscopy by retroperitoneal access has advantages of minimal trauma,less blood loss,rapid recovery and better effect,therefore it is the ideal treatment choice for parapelvic cyst.

Objective To analyze the epidemiologic data of patients withClostridium botulinum food poisoning, and to improve the understanding, diagnosis and treatment of food borne botulism.Methods A retrospective study was conducted. Fifty-three patients withClostridium botulinum food poisoning admitted to Chinese PLA Center of Poisoning and Treatment from January 2009 to December 2016 were enrolled, and they were divided into mild, moderate, and severe groups according to the severity of disease. The clinical data including medical history, epidemiology data, routine blood test and blood biochemistry at hospital admission, the vital signs and arterial blood gas analysis before and after treatment, as well as the occurrence frequency of symptom and sign on set were collected.Results Fifty-three patients with food borne botulism were enrolled, with 33 patients in mild group, 13 in moderate group, and 7 in severe group. Most of the patients were female, the age distribution was in large span, the outbreak of disease was in groups mainly with the family, and patients were mainly located in Hebei Province, Beijing and Henan Province. The outbreaks were mainly happened in Spring and Summer, and homemade fermentation products were still the first cause of poisoning with the average latent period of (51.01±4.78) hours. The majority of patients with botulism were in mild resulted from the type A toxin. With the aggravation of disease, hospitalization time was gradually increased, white blood cell (WBC) and neutrophils (NEUT) at hospitalization admission, and respiratory rate (RR), heart rate (HR), fraction of inspired oxygen (FiO2) before the treatment were shown in obviously rising trend, albumin (ALB) at hospitalization admission and pH, arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2) before treatment were in decline. The parameters in severe group were most severe, and had significant differences as compared with those of mild group [hospitalization time (days): 72.57±39.52 vs. 6.61±3.72, WBC (×109/L): 13.01±6.44 vs. 6.85±2.07, NEUT: 0.85±0.07 vs.0.63±0.14, RR (bpm): 32.14±4.33 vs. 15.18±1.70, HR (bpm): 132.29±5.19 vs. 75.54±8.24, FiO2: 0.32±0.05 vs. 0.21±0.00, ALB (g/L): 38.57±4.65 vs. 42.09±4.57, pH: 7.08±0.10 vs. 7.38±0.07, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 75.16±5.24 vs. 98.39±1.50, SaO2: 0.78±0.06 vs. 0.97±0.02, allP < 0.05]. The symptom and sign on set of 53 patients with food borne botulism was dizziness, followed by fatigue, blurred vision, nausea, and other symptoms and signs were lower than 50%, and the occurrence of dizziness with rank one happen rate was significantly higher than blurred vision and nausea (χ2 values were 7.209 and 10.502 respectively, andP values were 0.007 and 0.004 respectively). After the on time prescription of botulinum antitoxins treatment, the clinical symptoms of patients could be relived quickly. All the patients were discharged without deaths.Conclusion In order to improve the recovery of the food borne botulism poisoning patients, adequate antitoxin and the related organ supports should be prescribed on time.

Objective: To report our prelimilary experience of laparoscopic radical prostatectomy (LRP) for clinically localized prostatic cancer.Methods:23 cases with localized prostatic cancer underwent LRP in our institution from October 2000 to August 2003. The median age was 64.5 years old, the median PSA was 13 ng/ml and median Gleason score of biopsy specimens was < 7. The operations were performed according to Montsouris technique. Briefly, operations were carried out transperitonealty, combining posterior and anterior approachs to the prostate, transecting the bladder neck, lateral dissection of the prostate, urcthrovesical anastomosis, completing the operation.Results:No death and no conversion rate were observed in this series of 23 cases of LRP. No re-intervention was needed. The median operating time was 325 minutes (range 270 to 660 min) including the lymphadenectomy phase that was considered necessary in the case whose PSA value was 51ng/ml and pathological reading was negative to thoses lymph nodes; The median intraoperative blood loss was 430 ml(rang 200 to 1100 ml). Postoperative bladder catheterization time was 20 days. Surgical positive margin was found in I case of pathlogical stage of pT2b and Casodex 50 mg had been used on this case for 3 mon after the PSA value was < 0.2 ng/ml. Postoperation follow-up of 3 to 24 mo. showed no signs of complications such as urethral stricture or urine incontinence. The PSA concentrations was < 0.3 ng/ml in all cases.Conclusions: LRP provides a clear and magnified anatomical image to allow a more precise and safer dissection.