Objective To explore the management of Ttube following laparoscopic common bile duct exploration.Methods A total of 420 cases of extrahepatic with or without intrahepatic bile duct stones were given laparoscopic common bile duct exploration with T-tube drainage from July 1997 to October 2004 in this hospital.The common bile duct stones were identified and then a laparoscopic choledochotomy was carried out to remove the stones.After stone clearance,the choledochotomy wound was closed with primary duct suture or with T-tube drainage.Results The primary closure of the bile duct was performed in 27 cases((6.4%)) while the T-tube drainage was conducted in 393 cases(93.6%).The stones were completely removed during the operation in 236 cases(56.2%).Stone removal under choledochoscope was required in 184 cases(43.8%) after operation.The T-tubes were removed in 209 cases after a T-tube cholangiogram at 3~4 postoperative weeks showing no residual stones.Follow-up examinations for 3(months ~ 6) years(mean,47.5 months) in 420 cases revealed 3 cases of recurrence.Conclusions After laparoscopic common bile duct exploration,the T-tube should be removed at 3~4 postoperative weeks in the absence of residual stones on T-tube cholangiogram.However,if residual stones were found on T-tube cholangiogram,a choledochoscopy is needed for stone removal at 6 postoperative weeks after the tubes clamped for 2 weeks.

Objective To summarize the experience on the prevention of severe complications of endoscopic thyroidectomy.Methods Twelve cases of bilateral lesions underwent endoscopic thyroidectomy via precordial approach and 41 cases of unilateral lesions, via subaxillary approach. A subcutaneous channel, with a width of about 5 cm from the incision site to the thyroid, was made by using self-made instruments. The CO 2 pressure was set at 4 mm Hg. By ultrasonic scalpel the lesions were divided and removed. Results There were 41 cases of thyroid adenoma (unilateral, 34 cases; bilateral, 7 cases) and 12 cases of nodular goiter (unilateral, 7 cases; bilateral, 5 cases). Postoperative subcutaneous hematoma occurred in 1 case and was cured by conservative management. No nerve damage or parathyroid complications were observed. Conclusions Application of ultrasonic scalpel and continued low cavity pressure are effective means for preventing complications in endoscopic thyroidectomy.

Objective To sum up the experience of laparoscopic assisted radical resection for colorectal cancer. Methods Radical resection was operated on 40 patients with colorectal cancer under laparoscope. According to the Dukes’ classification, 21 patients were classified as stage A, 16 patients as stage B and 3 patients, stage C.There were 2 cases of cecum cancer, 4 cases of ascending colon cancer, 13 cases of sigmoid colon cancer, and 21 cases of rectum cancer. Results Laparoscopic assisted operations were accomplished in all the 40 patients. The operation time was 110.8?23.5 min and the intraoperative blood loss was 150.4?23.2 ml. The patients began to ambulate 12.2?3.8 hours after the surgery and the time to first passing flatus was 39.3?4.2 hours. Follow- up for 2～72 months (mean, 38.5 months) found no metastasis, local recurrence, and port or incision implantation in all the patients but one,who refused chemotherapy and had a cancer recurrence one year after surgery. Conclusions Laparoscopic radical resection is applicable to colorectal cancer at Dukes’ stage A, B, or C, in which the lymph nodes can be removed as thoroughly as open radical surgery.

Objective To explore the application value of hand-assisted laparoscopic splenectomy and pericardial devascularization in the treatment of liver cirrhosis and portal hypertension. Methods Hand-assisted laparoscopic operations of splenectomy in 10 patients and pericardial devascularization in 13 patients were completed by using the LigaSure device and harmonic scalpel. Results All the operations were completed successfully under laparoscope. Of splenectomy, the operative time was 63?15.5 min and the estimated blood loss was 32.4?21.2 ml. Of pericardial devascularization, the operative time was 115.3?25.5 min and the estimated blood loss was 52.4?24.2 ml. All the patients got out of bed and moved around at 12.2?3.8 h after operation. Conclusions [WTBZ]Hand-assisted laparoscopic splenectomy and pericardial devascularization using the LigaSure device and harmonic scalpel has advantages of high reliability, little blood loss, and quick postoperative recovery. The procedure can be used in the management of portal hypertension and hypersplenism.

Objective To evaluate the feasibility of endoscopic thyroidectomy via an incision under the armpit. Methods A skin incision was made under the armpit and a channel was established to thyroid gland and endoscopic thyroidectomy was performed in 32 cases suffering from unilateral thyroid lesion including 24 cases of solitary adenoma, 5 cases of multiple adenoma, 3 cases of cystic goiter. Results The average operative time was 125 min and the average blood loss was 55 ml. There were not any postoperative complications. Conclusion Endoscopic thyroidectomy is a mini-invasive surgery. The operative field was clear and ultrasonic scalpel is capable of dealing with blood vessels during the procedure.