OBJECTIVETo evaluate the surgical outcomes after transumbilical single-port access laparoscopic surgery for colorectal cancer.

METHODSPatients undergoing transumbilical single-port access laparoscopic radical resection for colorectal cancer at the Zhongshan Hospital of Xiamen University were included.

RESULTSThree patients underwent transumbilical single-port access laparoscopic radical resection for sigmoid colon cancer and 1 for rectal cancer between August 2010 and September 2010. There were no intraoperative or postoperative complications. No conversion was required. The mean operative time was 206 min and the mean estimated blood loss was 75 ml. The mean number of harvested lymph nodes was 21. Patients were ambulatory in the same day of surgery or postoperative day 1. Length of hospital stay ranged from 7 to 10 days.

CONCLUSIONSTransumbilical single-port access laparoscopic surgery is safe for colorectal cancer. Long-term outcomes warrant further investigation.

Adult ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Umbilicus ; surgery

A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous draninage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.
Abdominal Abscess/*etiology/surgery ; Child, Preschool ; Humans ; Infection/*complications ; Ligaments/*pathology/surgery ; Male ; Umbilicus/*pathology

OBJECTIVETo evaluate the one-hole method for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy.

METHODSWe used the one-hole method for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy in the treatment of 15 cases of varicocele, 13 in the left and 2 in the right side, and appraised the treatment results by follow-up 1 month after the surgery.

RESULTSAll the operations succeeded and no complications developed. The average operation time was 28 minutes and the mean hospital stay was 4 days. Symptoms were significantly relieved in all the patients and the scars were inconspicuous at follow-up.

CONCLUSIONThe one-hole method is a novel option for high ligation of the internal spermatic vein by embryonic natural orifice transumbilical laparoscopy in the treatment of varicocele. It is recommendable for its advantages of simple procedure, less pain, few complications, quick recovery, mini-invasiveness and cosmetic acceptability.

Adolescent ; Adult ; Humans ; Laparoscopy ; Ligation ; methods ; Male ; Umbilicus ; surgery ; Varicocele ; surgery ; Young Adult

OBJECTIVETo compare the effect of transumbilical single-site single-port with that of transumbilical single-site double-port laparoscopic varicocelectomy in the treatment of varicocele in adolescents.

METHODSWe randomly assigned 80 varicocele patients aged 10 - 16 years to two groups of equal number to receive transumbilical single-site single-port and single-site double-port laparoscopic varicocelectomy, respectively. We compared the operation time, postoperative hospital stay, incisional pain, complications and satisfaction with the abdominal cosmetic outcomes between the two groups.

RESULTSAll the operations were successfully performed. The double-port group showed a significantly higher score on the Visual Analogue Scale than the single-port group (4.8 +/- 1.4 vs 3.6 +/- 1.1, t = -4.986, P < 0.01), but there were no significant differences between the two groups in the operation time ([29.8 +/- 4.2] vs [31.2 +/- 4.6] min, t = 1.383, P = 0.171), postoperative hospital stay ([1.95 +/- 0.7] vs [1.82 +/- 0.8] d, t = -0.784, P = 0.436), complications (0 vs 0) and scores on the satisfaction with abdominal cosmetic outcomes (4.6 +/- 0.6 vs 4.8 +/- 0.5, t = 1.253, P = 0.214). No recurrence, umbilical hernia, hydrocele and orchiatrophy were found in the two groups of patients at 6 months after operation, and no visible scar was observed on the abdominal surface.

CONCLUSIONWith strict surgical indications, single-site single-port and single-site double-port laparoscopic varicocelectomies have similar clinical effects in the treatment of varicocele, which leave no scar on the abdominal surface. Single-site double-port laparoscopy needs no special instruments and therefore is worthier of wide clinical application.

Adolescent ; Child ; Humans ; Laparoscopy ; methods ; Length of Stay ; Male ; Operative Time ; Umbilicus ; surgery ; Varicocele ; surgery

OBJECTIVETo investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP).

METHODSTwelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed.

RESULTSNo conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery.

CONCLUSIONIt is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.

Anal Canal ; surgery ; Child ; Child, Preschool ; Colon ; surgery ; Female ; Hirschsprung Disease ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Treatment Outcome ; Umbilicus ; surgery

OBJECTIVETo evaluate the safety and efficacy of single-port transumbilical laparoscopic nephrectomy.

METHODSFrom December 2008 to August 2009, we have performed three cases of single-port transumbilical laparoscopic nephrectomy of nonfunctioning renal by Tri-Port system. Among three patients there were two cases of UPJO and one case of upper ureteral obstruction. Involved kidneys were not visualized in IVU and the GFR were not more than 0.90 ml/s. Tri-Port system was inserted transperitoneal through a 2 cm umbilical incision. The flexible grasper, scissors were used in addition to standard laparoscopic equipment. Renal pedicle was divided by Endoscopic Linear Stapling device. Specimens were extracted through the incision.

RESULTSThe first and second case were successful, and the operation time were 85 min and 165 min. The bleeding volume were 50 ml and 100 ml. The discharge time after operation was 3 days and 5 days, respectively. The third case was converted to open surgery because of the edema and adhesion of renal pedicle. At 3 weeks of follow-up, the incisions were hidden in the umbilicus with good cosmetic benefit.

CONCLUSIONSThis new method is technically feasible, which combined with these advantages of less trauma and more cosmetic benefit. However, more special instruments and long learning curving may be needed for those surgeons, who are going to carry out it.

Adult ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Treatment Outcome ; Umbilicus ; surgery

OBJECTIVETo evaluate the clinical efficacy and safety of three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments.

METHODSThirty-two patients undergoing three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments (group A) with 3 ports around the umbilicus were compared with 96 patients (group B) receiving the conventional 4-port routine endoscopic cholecystectomy.

RESULTSAll the procedures were successfully completed without conversion to open laparotomy. In group A, the procedures were completed smoothly in 30 cases while 2 cases required another port (5 mm) punctured below the xyphoid due to severe adhesion around the cyst. The median operating time was 39.7∓5.2 min in group A, significantly longer than that in group B (25.3∓3.3 min, P<0.001), but the patients in group A obtained better cosmetic results (P<0.001); the median blood loss, recovery time of postoperative intestine function, length of postoperative hospital stay, and the rate of use of postoperative painkillers were comparable between the two groups. Bile leakage or other postoperative complications occurred in none of cases in the two groups.

CONCLUSIONIn cases without severe adhesion around the cyst, three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments is a safe and feasible alternative to routine endoscopic cholecystectomy with better cosmetic results.

Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; methods ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Umbilicus ; surgery ; Young Adult

OBJECTIVETo study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy.

METHODSEighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopic cholecystectomy. Some difficulties and countermeasure in operations were analyzed.

RESULTSNine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot's triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopic cholecystectomy and 3 cases to open operation. Other 73 cases were successfully operated with transumbilical single incision laparoscopic cholecystectomy. The success rate was 89.0%. The average operative duration was 48.4 min. The average operative blood loss was 20.8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3 ~ 6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed.

CONCLUSIONSTransumbilical single incision laparoscopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.

Adolescent ; Adult ; Aged ; Cholecystectomy, Laparoscopic ; methods ; Female ; Follow-Up Studies ; Gallbladder Diseases ; surgery ; Humans ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Umbilicus ; surgery ; Young Adult

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new operation technique that utilizes natural orifices of the patient's body with the intention to puncture hollow viscera in order to insert an endoscope into a peritoneal cavity for incisionless surgery. The aim of this study was to evaluate the safety and feasibility of endoscopic cecectomy through the rectum in one dog and the vagina in another dog. METHODS: This study was performed in two beagle dogs for rectal and vaginal approaches. A five-milimeter trocar was inserted into the abdominal cavity by the Hasson method and intra-abdominal pressure was maintained at 5 mmHg with CO2. After pneumoperitoneum was accomplished, the rectum or vagina was incised with a needle knife and a one-channel gastric endoscope was inserted into the abdominal cavity. Counter-traction was performed using a laparoscopic grasper introduced via the 5 mm trocar in the umbilicus. The cecum was dissected from the base by using a needle knife with the aid of laparoscopic counter-traction. The resected cecum was retrieved through the anus or vagina without pouch bag. The incised rectum was closed by using 90-degree endoclips whereas the incised vagina was not repaired. RESULTS: Cecectomies were successfully performed with both transrectal and transvaginal routes. Both cases had no complication and recovered from surgery uneventfully. CONCLUSION: Endoscopic cecectomy with hybrid NOTES are feasible and safe. With the improvement of surgical experiences and further instrumental development, NOTES can be one option for human intestinal surgery.
Abdominal Cavity ; Anal Canal ; Animals ; Cecum ; Chimera ; Dogs ; Endoscopes ; Humans ; Intention ; Models, Animal ; Natural Orifice Endoscopic Surgery ; Needles ; Peritoneal Cavity ; Pneumoperitoneum ; Punctures ; Rectum ; Surgical Instruments ; Umbilicus ; Vagina ; Viscera

OBJECTIVETo evaluate the effectiveness of paraumbilical skin flaps for the repair of the severe burn wounds.

METHODSPedicled, island, or free paraumbilical skin flaps, as well as combined transplantation of several kinds of flaps were used to repair the wounds of 39 patients with severe burns. The largest paraumbilical skin flap was 55 x 27 cm(2) in area, with the end approaching the armpit midline of the axilla on the same side, and extending 10cm from the abdominal midline. The survival, color, elasticity of the flaps, degree of deformity resulted from scar contracture, and the condition of donor area were observed.

RESULTSAll the paraumbilical skin flaps survived, without obvious infection subsequent to complete debridement of the wounds. The flaps exhibited good color and elasticity, without scar contracture after 1 to 46 months in 33 patients. No obvious scar formation was observed in the donor area.

CONCLUSIONParaumbilical skin flap is an ideal one for the early repair of deep burn wounds, because it can cover a large area, and can be transferred in different ways according to the area and the position of the wounds.

Adolescent ; Adult ; Burns ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; Thorax ; Umbilicus ; Wound Healing