The lack of depth perception and spatial orientation in two-dimensional image of traditional laparoscopy require long-term training of the surgeons. Three-dimensional (3D) laparoscopy provides stereoscopic visions as compared to monocular views in a traditional laparoscopic system. In this review, the authors summarize the clinical application of 3D laparoscopy and its current research progress.
Imaging, Three-Dimensional ; instrumentation ; methods ; Laparoscopy ; methods

The authors summarize the current techniques of laparoendoscopic single-site colorectal surgery in light of choice of abdominal incisions, single-site platform and instrument. System analysis suggests that laparoendoscopic single-site colorectal surgery is safe and feasible, and its short term result is similar to that of conventional laparoscopy. However, further trials are needed to investigate its potential benefits and long-term oncologic outcomes.
Colorectal Surgery ; Humans ; Laparoscopy ; instrumentation ; methods

This paper introduces the recent study and development of an aided endoscopic surgical robot system, and discusses its future trends--teleoperative robot system and telesurgery system. In addition, their key technologies are analyzed here in the paper.
Angioscopy ; Endoscopy ; methods ; trends ; Humans ; Laparoscopy ; Robotics ; instrumentation ; trends ; Surgery, Computer-Assisted ; instrumentation ; Telemedicine ; instrumentation ; Thoracoscopy

BACKGROUNDOpen pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction (UPJO), even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty (LP) is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.

METHODSAccording to the ideas from the surgeons, our medical engineer designed three new instruments, including the right angle laparoscopy scissors, the petal-shape ureter dilator and the guide tube. Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments. Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing the double J stent anterograde. Then, the opposite lateral was done by the same surgeon plus these new devices for side-by-side comparative analysis. All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale (VAS) from 1 (none) to 10 (very much).

RESULTSThe procedures were all technically successful. The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Score were 6.75 and 4.25 respectively, at the same time the New Difficulty Score 1.25 and 1.75. However, the petal-shape ureter dilator got 1.5 Help Score and 6.5 New Difficulty Score. These surgeons made a negative comment and one of surgeons recommended the stone basket was more suitable.

CONCLUSIONThe right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoscopic pyeloplasty.

Animals ; Kidney Pelvis ; surgery ; Laparoscopy ; instrumentation ; methods ; Stents ; Swine

Spleen-preservation has recently been emphasized in benign and borderline malignant pancreatic diseases requiring distal pancreatectomy. Reports to suggest that laparoscopic distal pancreatectomy is feasible and safe have been increasingly published. Robotic surgical system has been introduced and is expected to provide unique advantages in laparoscopic surgery. However, robot-assisted pancreatic surgery has not yet been performed by many surgeons. A 45-year-old female patient with abdominal discomfort was found to have pancreatic cyst in the body of the pancreas. Mucinous cystic tumor of the pancreas was the most favourable preoperative diagnosis. She underwent spleen-preserving laparoscopic distal pancreatectomy by using da Vinci surgical robot system. Splenic artery and vein were so tightly adherent to the pancreatic cyst that segmental resection of splenic vessels was required. Postoperative course was uneventful. She was able to come home in 5 days after surgery. Postoperative follow up color doppler ultrasound scan, taken on 2 weeks after surgery, showed minimal fluid collection around surgical field and no evidence of splenic infarction with good preservation of splenic perfusion. Robot-assisted spleen preserving distal pancreatectomy is thought to be feasible and safe. Several unique advantages of robotic system are expected to enhance safer and more precise surgical performance in near future. More experiences are mandatory to confirm real benefit of robot surgery in pancreatic disease.
Female ; Humans ; Laparoscopy/instrumentation/*methods ; Middle Aged ; Pancreatectomy/instrumentation/*methods ; Pancreatic Cyst/*surgery ; *Robotics ; Spleen/pathology/*surgery

OBJECTIVETo investigate the indication and effect of the application of Ligasure vessel sealing instrument in laparoscopic hepatectomy for liver cancer.

METHODSEleven patients with liver cancer undergoing laparoscopic hepatectomy were analyzed for the tumor size and location, operation time, volume of intraoperative bleeding, postoperative hospital stay and short-term clinical outcomes.

RESULTSAll the operations were performed successfully in the 11 cases. All the tumors were less than 7 cm in diameter, locating at the segments II, III, V, VI and VII. The mean operation time was 91 min (80-126 min), and the intraoperative blood loss averaged 82 ml (20-200 ml). The average postoperative hospital stay of the patients was 8 days (7-9 days). No complications were observed in these cases.

CONCLUSIONLigasure vessel sealing instrument in laparoscopic hepatectomy is applicable in cases of perimeter liver cancer. This instrument can decrease the operation time, reduce the intraoperative blood loss and postoperative hospital stay with good safety and minimal invasiveness.

Adult ; Aged ; Female ; Hepatectomy ; instrumentation ; methods ; Humans ; Laparoscopy ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Treatment Outcome

PURPOSE: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. MATERIALS AND METHODS: We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. RESULTS: Mean follow-up was 47.7+/-29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). CONCLUSION: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.
Adult ; Aged ; Carcinoma, Renal Cell/mortality/*surgery ; Female ; Humans ; Kidney Neoplasms/mortality/*surgery ; Laparoscopy/instrumentation/*methods ; Laparotomy/instrumentation/*methods ; Male ; Middle Aged ; Nephrectomy/instrumentation/*methods ; Retrospective Studies ; Treatment Outcome ; Video-Assisted Surgery/instrumentation/*methods

BACKGROUNDLaparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide. Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development. We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.

METHODSAltogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transection laparoscopic Peng's multifunctional operative dissector (LPMOD) was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.

RESULTSLaparoscopic operation was completed in 57 patients. Two patients (3.4%) had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients (3.4%), and there was no perioperative death.

CONCLUSIONLaparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.

Adult ; Aged ; Curettage ; methods ; Female ; Hepatectomy ; adverse effects ; instrumentation ; methods ; Humans ; Laparoscopy ; methods ; Length of Stay ; Male ; Middle Aged ; Suction

PURPOSE: We review the literature and describe our technique for laparoendoscopic single-site orchidopexy using a glove port and rigid instruments. We assessed the feasibility and outcomes of this procedure. MATERIALS AND METHODS: We retrospectively reviewed the case records of all children who had undergone laparoendoscopic single-site orchidopexy by use of a surgical glove port and conventional rigid instruments for a nonpalpable intraabdominal testis between January 2013 and September 2014. RESULTS: Data from a total of 20 patients were collected. The patients' mean age was 18 months. All cases had a nonpalpable unilateral undescended testis. Fourteen patients (70%) had an undescended testis on the right side and six patients (30%) had an undescended testis on the left side. Seventeen patients underwent primary orchidopexy. Three patients underwent single-port laparoscopic Fowler-Stephens orchidopexy for the first and the second stage. Average operating time was 57 minutes (range, 40 to 80 minutes). No patient was lost to follow-up. At follow-up, 2 testes were found to have retracted out of the scrotum and these were successfully dealt with in a second operation. One testis was hypoplastic in the scrotal pouch. There were no signs of umbilical hernia. CONCLUSIONS: Single-port laparoscopic orchidopexy using a glove port and rigid instruments is technically feasible and safe for various nonpalpable intraabdominal testes. However, surgical experience and long-term follow-up are needed to confirm the superiority of this technique.
Cryptorchidism/pathology/*surgery ; Equipment Design ; Feasibility Studies ; Follow-Up Studies ; Gloves, Surgical ; Humans ; Infant ; Laparoscopy/instrumentation/methods ; Male ; Orchiopexy/*instrumentation/methods ; Retrospective Studies

OBJECTIVE: To evaluate the short-term efficacy and cosmetic effect of dual-port laparoscopic distal gastrectomy (DPLDG) for gastric cancer. METHODS: Thirty consecutive patients underwent DPLDG at the Department of General Surgery, Nanfang Hospital from November 2016 to August 2018. INCLUSION CRITERIA: (1) age of 18 to 75 years; (2) primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy; (3) tumor located at middle-low stomach and planned for distal gastrectomy; (4) cT1b-2N0-1M0 at preoperative staging; (5) tumor diameter ≤3 cm; (6) US Eastern Cancer Cooperative Group(ECOG) score 0 to 1 points; (7) American Society of Anesthesiologists grade I to II; (8) perioperative management based on enhanced recovery after surgery (ERAS) principle. EXCLUSION CRITERIA: previous upper abdominal surgery (except laparoscopic cholecystectomy), history of other malignant disease, and body mass index ≥30 kg/m². A self-developed single-incision, multiport, laparoscopic surgery Trocar (Surgaid Medical, Xiamen, China, comprising 3 channels for observation, main surgeon and assistant surgeon) was placed through a 3-4 cm incision under or at the left side of the umbilicus. An additional 5 mm Trocar was inserted under the rib margin of the right clavicle to serve as the secondary operating hole and the position of the drainage tube. The liver was suspended to expose the surgical field clearly. Surgical procedure was as follows: conventional laparoscopic instruments were used. After entering the omental sac, dissection was performed along the transverse colon to the spleen flexure. Left gastroepiploic vessels were identified and then ligated at the root. No.4sb lymph nodes were dissected. The No.4d lymph nodes were dissected along the greater curvature of the stomach. Then the dissection was continued rightward to the hepatic flexure to separate mesogastrium and mesocolon. The right gastroepiploic artery was ligated at the root to allow the removal of No.6 lymph nodes. The duodenal bulb was transacted by liner stapler, the right gastric artery was ligated at the root and the No.5 lymph nodes were removed. Peritoneal trunk, common hepatic artery, splenic artery and left gastric artery and vein in posterior pancreatic space at upper pancreas were separated, then left gastric vessels were ligated, and No.9, No.8a, No.11p and No.7 lymph nodes were dissected. The left side wall of portal vein was exposed and No.12a lymph nodes were removed. No.1 and No.3 lymph nodes were dissected along the lesser curvature. The stomach corpus was transacted by liner stapler at 4-5 cm proximal end of the tumor. Roux-en-Y anastomosis or Billroth II anastomosis was performed in the cavity. A drainage tube was placed near the gastrojejunal anastomosis through the right upper abdomen secondary operating hole. Postoperative short-term efficacy (operation time, blood loss, 5-port conversion rate, open conversion rate, number of retrieved lymph nodes, time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube, postoperative hospital stay, postoperative analgesics use, and postoperative 30-day complication rate) and cosmetic scale (questionnaire: degree of satisfaction with scar, description of scar, grade of scar; total score ranged from the lowest 3 to the highest 24; the higher the better) were evaluated in all 30 patients. RESULTS: No serious complication and death were observed intraoperatively. The mean operative time was (197.8±46.9) minutes. The median blood loss was 30 ml (quartile 31.25 ml). The mean number of retrieved lymph node was 38.7±14.1. Five-port conversion rate was 3.3% (1/30), and no open conversion occurred. Mean time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube and postoperative hospital stay were (45.3±18.9) hours, (87.6±35.6) hours, (101.8±58.0) hours and (6.1±2.1) days, respectively. Twenty-four (80%) of patients had no additional analgesics use. The postoperative complication rate within 30 days was 16.7% (5/30). Postoperative overall cosmetic score was 22.1±1.3, and cosmetic score of 96.7%(29/30) of patients was 18 to 24. CONCLUSION DPLDG is safe and feasible with advantages of faster postoperative recovery, reducing pain and better cosmetic outcomes.
Adenocarcinoma ; pathology ; surgery ; China ; Feasibility Studies ; Gastrectomy ; instrumentation ; methods ; Gastroenterostomy ; Humans ; Laparoscopy ; instrumentation ; methods ; Lymph Node Excision ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Treatment Outcome