[Show abstract][Hide abstract] ABSTRACT: Background:
Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now.
We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy.
All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200 - 360 minutes. The duration of hospital stay was 3 - 7 days. Follow-up observations lasted 1 - 56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died.
Total laparoscopic choledochal cyst excision is safe and feasible.
No preview · Article · Mar 2013 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: Surgical robotic systems are superior to traditional laparoscopic technologies with regard to generation of 3-dimensional images, and they also offer better instrumentation. Here, we report on our early results for 1-stage robot-assisted laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure.
From March 2009 to July 2009, five consecutive patients underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure assisted by the da Vinci robotic system. Patient demographics, intraoperative findings, postoperative complications, and length of postoperative hospital stay were recorded and analyzed.
No patient required conversion to laparotomy or conventional laparoscopy. The average robotic console time was 176.0±32.1 minutes. One female patient developed postoperative pulmonary infection that was successfully treated medically; the others' postoperative courses were uneventful. The average length of postoperative stay was 5.8±2.5 days. At follow up, all 5 patients were free of recurrent stones.
Robotic-assisted laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure are effective and safe for selected patients. Future experience is needed to further study the efficacy and role of this novel approach.
[Show abstract][Hide abstract] ABSTRACT: Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.
Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.
Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.
Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.
Preview · Article · Apr 2011 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To assess the feasibility and safety of robotic-assisted laparoscopic anatomic hepatectomy.
The development of minimally invasive surgery has led to an increase in the use of laparoscopic hepatectomy. However, laparoscopic hepatectomy remains technically challenging and is not widely developed. Robotic surgery represents a recent evolution in minimally invasive surgery that is being used increasingly for complex minimally invasive surgical procedures. Herein, we report our initial experience with robotic-assisted laparoscopic anatomic hepatectomy in 13 consecutive patients.
Between April and July 2009, 13 consecutive patients underwent robotic-assisted laparoscopic anatomic hepatectomies for benign and malignant hepatic diseases. Major hepatectomies were performed in 9 patients, left lateral sectionectomies in 4 patients. Eight major hepatectomies were for malignant diseases and 5 hepatectomies (1 left hepatectomy and 4 left lateral sectionectomies) were for benign diseases. All the robotic-assisted hepatectomy procedures were performed anatomically with hilum dissection. Prior to starting the parenchymal transaction, vascular control of the portal vessels was carried out whenever possible. These robotic-assisted laparoscopic anatomic hepatectomies were compared with 20 traditional laparoscopic hepatectomies and 32 open resections that were contemporaneous and cohort-matched.
All 13 robotic-assisted laparoscopic anatomic hepatectomies were performed successfully in the manner of pure laparoscopic resection. No conversion to laparotomy or hand-assisted laparoscopic resection occurred. Despite its longer operative time (338 minutes) and higher hospital cost ($12,046), robotic liver surgery compared favorably with traditional laparoscopic hepatectomy and open resection in blood loss (280 vs. 350, 470 mL), transfusion requirement (0 vs. 3 of 20, 4 of 32), use of the Pringle maneuver (0 vs. 3 of 20, 6 of 32) and overall operative complications (7.8% vs. 10%,12.5%). Neither ascites nor transient hepatic decompensation occurred in the robotic group. The surgical margins in all 8 patients with malignant lesions were negative and as yet, no intrahepatic recurrences or metastases have been observed in the robotic group. The mean postoperative stay was shorter with the traditional laparoscopic procedure (5.2 days) than with robotic (6.7 days)or open surgery (9.6 days). Conversions from traditional laparoscopic to open and hand-assisted laparoscopic resection occurred in 2 patients (10.0%) who underwent right hemihepatectomy and left hepatectomy, respectively.
These preliminary results show that robotic-assisted laparoscopic anatomic hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic hepatectomy or open resection. The robotic surgical system may broaden the indications for laparoscopic hepatactomy, and it enabled the surgeon to perform precise laparoscopic liver resection which required hylum dissection, hepatocaval dissection, endoscopic suturing, and microanastamosis. However, more long-term, evidence-based outcomes will be necessary to prove its efficacy, and further research on its cost-effectiveness is still required.
No preview · Article · Dec 2010 · Annals of surgery
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of da Vinci surgical system in the treatment of biliary diseases.
The clinical data of 15 patients with biliary diseases who had undergone operations with da Vinci surgical system from March 2009 to November 2009 at our hospital were retrospectively analyzed.
The operations were successfully performed on all patients. And no case was converted into open laparotomy. The total operative duration was 256 +/- 151 min and the robot operative duration 224 +/- 94 min. No blood transfusion was needed. Postoperative recovery time of bowl movement was 30 +/- 18 hours. And the average postoperative hospital stay was 6 +/- 3 days. Two patients had postoperative complications and were cured by conservative treatment.
Various laparoscopic operations for biliary diseases may be performed with the aid of three-dimensional imaging system and flexible surgical tools of the Da Vinci surgical system. And its superiority is more obvious for complicated biliary diseases.
No preview · Article · May 2010 · Zhonghua yi xue za zhi