In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.
Anastomosis, Surgical/trends* ; Colorectal Neoplasms/surgery* ; Digestive System Surgical Procedures/trends* ; Forecasting ; Humans ; Laparoscopy/trends* ; Lymph Node Excision ; Lymphatic Metastasis ; Minimally Invasive Surgical Procedures/trends* ; Suture Techniques/trends*

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.
Bariatric Surgery ; methods ; statistics & numerical data ; trends ; Biliopancreatic Diversion ; statistics & numerical data ; trends ; China ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Endoscopy, Digestive System ; statistics & numerical data ; trends ; Gastrectomy ; statistics & numerical data ; trends ; Gastric Bypass ; statistics & numerical data ; trends ; Humans ; Laparoscopy ; statistics & numerical data ; trends ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Robotic Surgical Procedures ; statistics & numerical data ; trends

There are vast land and lots of people in western China, but the economy developing is relatively slow. However, the minimally invasive surgery was carried out firstly in China. Moreover, the type, number and difficulty of the minimally invasive surgery increased year by year. Especially, in the western area of China, Dr Zhou Zongguang, Yu Peiwu and Zheng Shuguo et al. have performed much pioneering work in laparoscopic surgery for rectal cancer, gastric cancer and laparoscopic liver resection. They led the standard development of minimally invasive in China. In the future, western China should continue to strengthen the standardized training of minimally invasive surgery, make great effort to carry out evidence-based research of minimally invasive surgery, provide evidences of high level of clinical application in minimally invasive surgery. At the same time, we should carry out the robotic and 3D laparoscopic surgery actively, leading the development of minimally invasive surgery more standardized and more widespread in western China.
China ; Digestive System Surgical Procedures ; methods ; trends ; Evidence-Based Medicine ; Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Minimally Invasive Surgical Procedures ; education ; methods ; standards ; trends ; Rectal Neoplasms ; surgery ; Robotic Surgical Procedures ; Stomach Neoplasms ; surgery

OBJECTIVETo summarize the 23-year experience of laparoscopic biliary surgery in General Hospital of PLA and evaluate the application of laparoscopic surgery in the treatment of biliary diseases.

METHODSWe retrospectively analyzed the clinical data of 11 419 consecutive patients with biliary diseases undergoing laparoscopic surgery from April, 1992 and December, 2014. The disease spectrum was compared between patients treated before December 31, 2003 and those treated after the time point.

RESULTSThe 11419 patients receiving laparoscopic surgery accounted for 56.3% of the total patients undergoing biliary surgeries during the 23 years, including 4701 male and 6718 female patients with a mean age of 50.9∓13.2 years (6-93 years). Most (80.83%) of the patients received laparoscopic surgery for gallbladder stones, and 12.53% patients had the operation for gallbladder polyps. The laparoscopic operation rate was 84.81% in patients with gallbladder stones and 34.91% in patients with extrahepatic bile duct stones, but remained low in patients with biliary carcinoma. In laparoscopic operations, laparoscopic cholecystectomy was the most frequent (96.18%) followed by operations for extrahepatic bile duct stones, in which primary suture accounted for 1.38%, traditional T tube drainage for 0.90% and laparoscopic transcystic duct exploration for 0.72%. For malignant tumors, laparoscopic technique was used mainly for the purpose of exploration (0.34%). The application of laparoscopic technique in biliary surgery tended to increase after the year 2004, especially for benign gallbladder diseases and extrahepatic bile duct stones (P<0.05).

CONCLUSIONLaparoscopic technique in biliary surgery is gradually replacing the traditional open operation and becomes the gold standard for the treatment of benign biliary diseases.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; surgery ; Bile Ducts, Extrahepatic ; Child ; Cholecystectomy, Laparoscopic ; Drainage ; Female ; Gallbladder Diseases ; surgery ; Gallstones ; surgery ; Humans ; Laparoscopy ; trends ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Colorectal surgery is rapidly developing in the direction of minimally invasive surgery and functional surgery. New technology and ideas are constantly emerging recently. Laparoscopic colon surgery has already been recommended by NCCN guideline. However, laparoscopic rectal cancer surgery still needs to wait for survival and recurrence rates of long-term follow-up data for verification. In recent years, with the rapid progression of imaging equipment of laparoscope, the new 3D laparoscopic system will process image more quickly, and surgeons can get space depth feeling like open surgery only with a pair of glasses. The new 3D laparoscopic system has many advantages, and can also shorten the learning curve of the beginners. But it does not mean the traditional 2D laparoscopy has been out of date. It is admitted that dialectical view on the development of the technology and equipment is still required. New things also need the accumulation of time and validation, and the deficiency of imaging system remains to be improved. At present, the robotic colorectal cancer surgery is still in its infancy, and its application is relatively common in colon surgery. In respect of robotic rectal cancer surgery, it still lacks of long-term follow-up survival results for verification. To reduce physical and psychological trauma for patients is the goal of the surgeon. Surgeons are experiencing the change from minimally invasion to non-invasion. Natural orifice translumenal endoscopic surgery (NOTES) and natural orifice specimen extraction surgery (NOSES) arise at the historic moment. Among them, transanal total mesorectal excision (taTME) incorporates the concepts of NOTES, anal minimally invasive surgery and total mesorectum excision, guaranteeing the radical cure and no scar of abdomen, but it still needs multicenter, large sample and long-term follow-up clinical data to prove its safety, efficacy and indication. Therefore, surgical procedure is transforming from conventional laparoscopic surgery to the NOTES and NOSES. The surgical principle is the eternal cornerstone to ensure the radical tumor resection and the safety of patients.
Abdomen ; surgery ; Biopsy ; Cicatrix ; Colon ; surgery ; Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; trends ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; trends ; Natural Orifice Endoscopic Surgery ; Robotic Surgical Procedures

The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed.
Cost-Benefit Analysis ; Esophageal Neoplasms/surgery ; Gastrectomy/*methods ; Gynecologic Surgical Procedures/methods ; Humans ; Japan ; Laparoscopy/*methods ; Nephrectomy/*methods ; Otolaryngology/methods ; Prospective Studies ; Prostatectomy/*methods ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/education/*trends ; Stomach Neoplasms/surgery ; Thymectomy/methods ; Thyroid Diseases/surgery

No abstract available.
Humans ; Laparoscopy/methods ; Minimally Invasive Surgical Procedures/*methods ; Periodicals as Topic ; Robotic Surgical Procedures/*methods ; Urolithiasis/diagnosis/therapy ; Urologic Surgical Procedures/*methods ; Urology/trends

Minimally invasive surgery, which has been extensively used to treat gastric adenocarcinoma, is now regarded as one of the standard treatments for early gastric cancer, and its suitability for advanced gastric cancer is being investigated. The use of cutting-edge techniques for minimally invasive surgery enables surgeons to deliver various treatment options to minimize a patient's distress and to maintain oncologic safety. Ongoing multicenter prospective studies aim to validate the efficacy of these surgical techniques and to expand the indications of minimally invasive surgery for the treatment of gastric cancer. In this review, we summarize the current status and issues regarding minimally invasive surgery for the treatment of gastric cancer.
Gastrectomy/*methods/trends ; Humans ; Laparoscopy/*methods/trends ; Multicenter Studies as Topic ; Patient Selection ; Randomized Controlled Trials as Topic ; Republic of Korea ; Robotic Surgical Procedures/*methods/trends ; Sentinel Lymph Node Biopsy/methods/trends ; Stomach Neoplasms/*surgery

Humans ; Laparoscopy ; methods ; trends ; Pancreaticoduodenectomy ; methods

Common Bile Duct ; surgery ; Gallstones ; surgery ; Humans ; Laparoscopy ; methods ; trends