With the development of laryngeal microsurgery, the requirements for the flexibility and convenience of surgical instruments are increasing. The research on related instruments has important value for the clinical application of laryngeal microsurgery. We have redesigned a gun-type tube-guide device of laser fiber by comparing the shortcomings of existing laser fiber introducers. The innovation of this design lies in its rotating nut device with adjustable laser angle and pre-bent tip. The corresponding
Humans ; Larynx/surgery* ; Laser Therapy/instrumentation* ; Lasers ; Microsurgery/instrumentation* ; Surgical Instruments

OBJECTIVE: To review the experience with Wang procedure for treatment of pectus excavatum in young children. METHODS: The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. RESULTS: All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. CONCLUSIONS Wang procedure is a good option for treatment of pectus excavatum in young children.
Bone Wires ; Child ; Child, Preschool ; Diaphragm ; Funnel Chest ; surgery ; Humans ; Internal Fixators ; Operative Time ; Orthopedic Procedures ; instrumentation ; methods ; Retrospective Studies ; Thoracic Wall ; Treatment Outcome ; Xiphoid Bone ; surgery

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
Adult ; Aged ; Decompression, Surgical ; instrumentation ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastric Outlet Obstruction ; etiology ; surgery ; Gastroparesis ; etiology ; surgery ; Gastroscopy ; instrumentation ; methods ; Humans ; Intubation, Gastrointestinal ; instrumentation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; etiology ; surgery

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

In maxillofacial surgery, there is a significant need for the design and fabrication of porous scaffolds with customizable bionic structures and mechanical properties suitable for bone tissue engineering. In this paper, we characterize the porous Ti6Al4V implant, which is one of the most promising and attractive biomedical applications due to the similarity of its modulus to human bones. We describe the mechanical properties of this implant, which we suggest is capable of providing important biological functions for bone tissue regeneration. We characterize a novel bionic design and fabrication process for porous implants. A design concept of "reducing dimensions and designing layer by layer" was used to construct layered slice and rod-connected mesh structure (LSRCMS) implants. Porous LSRCMS implants with different parameters and porosities were fabricated by selective laser melting (SLM). Printed samples were evaluated by microstructure characterization, specific mechanical properties were analyzed by mechanical tests, and finite element analysis was used to digitally calculate the stress characteristics of the LSRCMS under loading forces. Our results show that the samples fabricated by SLM had good structure printing quality with reasonable pore sizes. The porosity, pore size, and strut thickness of manufactured samples ranged from (60.95± 0.27)% to (81.23±0.32)%, (480±28) to (685±31) μm, and (263±28) to (265±28) μm, respectively. The compression results show that the Young's modulus and the yield strength ranged from (2.23±0.03) to (6.36±0.06) GPa and (21.36±0.42) to (122.85±3.85) MPa, respectively. We also show that the Young's modulus and yield strength of the LSRCMS samples can be predicted by the Gibson-Ashby model. Further, we prove the structural stability of our novel design by finite element analysis. Our results illustrate that our novel SLM-fabricated porous Ti6Al4V scaffolds based on an LSRCMS are a promising material for bone implants, and are potentially applicable to the field of bone defect repair.
Alloys ; Bionics ; Bone Substitutes/chemistry* ; Bone and Bones/pathology* ; Compressive Strength ; Elastic Modulus ; Finite Element Analysis ; Humans ; Lasers ; Materials Testing ; Maxillofacial Prosthesis Implantation ; Porosity ; Pressure ; Printing, Three-Dimensional ; Prostheses and Implants ; Prosthesis Design ; Stress, Mechanical ; Surgery, Oral/instrumentation* ; Tissue Engineering/methods* ; Titanium/chemistry*

ObjectiveTo explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.

METHODSThis study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.

RESULTSOf the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.

CONCLUSIONSThe F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.

Calculi ; diagnostic imaging ; surgery ; Ejaculatory Ducts ; Endoscopes ; Endoscopy ; instrumentation ; Genital Neoplasms, Male ; Hemospermia ; diagnosis ; therapy ; Holmium ; Humans ; Lasers, Solid-State ; Lithotripsy ; Magnetic Resonance Imaging ; Male ; Natural Orifice Endoscopic Surgery ; instrumentation ; Neoplasm Recurrence, Local ; Postoperative Complications ; Reproducibility of Results ; Seminal Vesicles ; diagnostic imaging ; Urethra

ObjectiveTo investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce.

METHODSFrom September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients.

RESULTSCompared with the controls, the patients in the observation group showed significantly longer operation time (［4.48 ± 1.18］ vs ［7.17 ± 1.42］ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ［19/127］ vs 4.1% ［5/123］, P<0.05) and frenulum misalignment (26.8% ［34/127］ vs 0.8% ［1/123］, P<0.05), higher incidence of postoperative ecchymosis (41.7% ［53/127］ vs 21.1% ［26/123］, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ［18/127］ vs 98.4% ［121/123］, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ［6/127］ vs 1.6% ［2/123］, P = 0.164).

CONCLUSIONSCircumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.

Circumcision, Male ; instrumentation ; Disposable Equipment ; Ecchymosis ; etiology ; Foreskin ; Humans ; Incidence ; Male ; Operative Time ; Penis ; abnormalities ; surgery ; Personal Satisfaction ; Phimosis ; surgery ; Postoperative Complications ; etiology ; Postoperative Period ; Suture Techniques ; instrumentation

INTRODUCTIONOutcomes of bariatric surgery for super obese Asians are not well reported. We aimed to compare short-term outcomes of laparoscopic sleeve gastrectomy (LSG) in Asian patients with body mass index (BMI) <47.5 kg/m to those with BMI •••••• ≥47.5 kg/m.

MATERIALS AND METHODSA total of 272 patients from Singapore university hospital who underwent LSG from 2008 to 2015 with a follow-up of at least 6 months were included in the study. Primary endpoint was weight loss at 1-year and 3-years. Morbid obesity (Group 1, G1) was defined as BMI <47.5 kg/m and super obesity (Group2, G2) was defined as BMI ≥47.5 kg/m.

RESULTSThere were 215 patients in G1 and 57 patients in G2 (mean preoperative weight: 107.3 kg and 146.8 kg; mean follow-up: 27.9 and 26.8 months, respectively). Mean total weight loss at 3-year of 41.9 kg for G2 was significantly higher ( = 0.003) than 27.2 kg for G1. Mean percentage excess weight loss (EWL) did not differ at 3-years. There was no difference in operating time, blood loss, length of stay, 30-day morbidity and readmission. There were no conversions and mortality in both groups. Remission of herpertension ( - 0.001) and dyslipidaemia ( = 0.038) were significantly associated with achieving EWL percentage (%EWL) >50 in G1.

CONCLUSIONLSG is an equally safe and effective operation in Asians with BMI ≥47.5 kg/m2 when compare to patients with BMI <47.5 kg/m in achieving significant weight loss and improvement in comorbidities. Super obese lose more weight but have lower %EWL.

Asian Continental Ancestry Group ; Gastrectomy ; methods ; Humans ; Laparoscopy ; instrumentation ; methods ; Obesity, Morbid ; surgery ; Outcome Assessment (Health Care) ; Patient Safety ; Retrospective Studies ; Singapore

To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups.
 Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time (P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group (P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group (P<0.05), but it decreased more profound (P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. 
 Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
Catheter Ablation ; instrumentation ; methods ; Humans ; Imaging, Three-Dimensional ; instrumentation ; methods ; Operative Time ; Radiation Exposure ; prevention & control ; statistics & numerical data ; Radiography ; statistics & numerical data ; Recurrence ; Tachycardia, Supraventricular ; diagnostic imaging ; surgery ; Treatment Outcome

BACKGROUND: Localization of multiple small lung nodules is the technical difficulty of minimally invasive operation resection. However, there are few clinical studies on the preoperative localization of multiple small lung nodules. This study was designed to evaluate the clinical value of preoperative computed tomography (CT) guided microcoil localization for multiple small lung nodules compared with single small lung nodule before video-assisted thoracoscopic surgery (VATS). METHODS: A retrospective analysis of the clinical data of 235 patients with preoperative pulmonary nodules microcoil localization was performed. According to whether the nodules were single, they were divided into single nodule group (184 cases) and multiple nodules group (51 cases) (multiple nodules group). The single nodule group was positioned under CT-guided conventional methods. The multiple nodules group were CT guided localized by microcoil in batches according to priority before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed. RESULTS: The success rate of localization in multiple nodule groups was 90.2%, there was no significant difference compared with the single nodule group (90.2% vs 94.6%, P=0.205). The occurrence rate of pneumothorax in multiple nodule group and single nodule group was no statistical difference (21.6% vs 14.1%, P=0.179), however, the operation time in the multiple nodule group was significantly longer than the single nodule group [(30.6±6.6) min vs (19.9±7.4) min, P=0.000]. There were no serious complications such as massive hemoptysis, air embolism or hemothorax. There was no conversion to thoracotomy due to failure of localizing the nodules during operation. Sub-lobectomy was the main method of operation. The majority of postoperative pathologies were non-invasive carcinomas. CONCLUSIONS For multiple small lung pulmonary nodules requiring thoracoscopic surgery, according to certain strategies, preoperative CT-guided localized by microcoil in batches according to priority before VATS is safe and effective, and worthy of promotion.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules ; diagnostic imaging ; pathology ; surgery ; Preoperative Period ; Retrospective Studies ; Surgery, Computer-Assisted ; Thoracic Surgery, Video-Assisted ; instrumentation ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden