This study was supported by a grant from the National R&amp;D Program for Cancer Control, Ministry of Health &amp; Welfare, Republic of Korea (1320270).

伦理学声明:此过程涉及人类受试者曾在亚洲大学医院批准了机构审查委员会（IRB）。 1.准备手术<ol><li>允许软食手术的前一天，什么也没有用嘴巴午夜后在手术前。 注:前和手术过程中不要插入鼻饲管。该协议不使用任何管放气的肚子。替代的是，在胃内气体可通过腹腔镜穿刺针，如果胃鼓起导致腹腔镜手术有限视图吸出。 </li><li>把病人躺在手术台上后，管理代理人上岗（硫喷妥钠，100毫克）。 </li><li>静脉注射肌肉松弛剂的（罗库溴铵，溴化1.0毫克/千克）后，通过口腔插入气管内管。 </li><li>通过气管插管，然后监视第 - 启动麻醉气体（3％七氟烷，2）手术过程中稳定性ê病人。 </li></ol> 2.术前胃镜手术过程<ol><li>放置在反向头低脚高位置的患者，和立在患者的右侧。 </li><li>打10毫米的切口在infraumbilical区，插入第一个套管针进入腹腔。 </li><li>一旦套管针插入时，与套管针连接为二氧化碳气体管以创建15的气腹 - 29毫米汞柱。 </li><li>穿过套管针插入的刚性30°腹腔镜，并探索与腹腔镜系统相连接的监视器上的腹腔。 </li><li>将4个额外的套管（一个12毫米和三个5毫米）的作为工作的端口。在脐的右上侧插入物12 mm套管。将在脐和腹部的两个上端外象限的左上方其他3节5 mm套管。 </li><li>解剖结肠韧带一起向着阴横结肠或脾极超声内镜剪刀。 </li><li>结扎左胃动脉并用腹腔镜夹在根静脉从脾血管始发和使用超声波内窥镜剪刀，胰尾上缘的曝光后切除它们。 </li><li>使用超声波内窥镜剪刀，解剖周围幽门和胰腺的头部peripyloric淋巴结，并在其原籍切除胃网膜右血管。 </li><li>切除十二指肠的第一部分的前，夹紧用腹腔镜钳以防止气体迁移胃镜过程（ 图1）期间，进入小肠十二指肠。 </li></ol> 3.术中胃镜检查<ol><li>移动到病人的头部的左侧进行术胃镜。 </li><li>插入胶状屏蔽术胃镜期间保护牙齿和牙龈。 </li><li>打开老天患者到左侧的胃镜插入的d-。 </li><li>将胃镜插入胃小心通过嘴和食道，以避免伤害到口腔，食道和胃的粘膜。 </li><li>通过胃镜注入气体来定位原发病灶吹进胃部。 注意:大多数胃镜具有特定的按钮的过程期间将气体注入肠道。 </li><li>近似肿瘤的近端边缘和使用标记在胃镜的刻度食管胃结合部之间的距离（ 图2），并进行全胃切除术（如前所述），如果距离太短打捞近端胃10 </li><li>如果全胃切除术是没有必要的，通过胃镜的一个小孔插入内窥镜注射器，并注入2 - 使用的内窥镜注射器在区域2 3立方厘米靛蓝胭脂红的入胃壁 - 3厘米PROX从肿瘤边缘进制，避免内或腔外泄漏（ 图3A）。 <ol><li>插入注射器的针插入胃壁倾斜由针以避免胃壁的穿孔。此外，注入靛蓝胭脂红非常缓慢注射期间识别腔内泄漏。 </li></ol></li><li>染料注射后，通过胃镜抽吸充气气体以使腹腔镜手术更容易。 注意:大多数胃镜具有特定的按钮的过程中抽吸充气气体。 </li></ol> 4.术中胃镜检查程序后， <ol><li>返回到患者的右侧的胃镜过程之后。 </li><li>在腹腔镜下视图，通过由蓝色染料（ 图3B）鉴定浆膜染色确认肿瘤的近侧部分。 </li><li>马克与内窥镜夹切除脏的部分，避免在重新肿瘤介入部裕度（ 图4A）。 注意:我们建议5中执行此过程 - 10分钟手术开始后，由于染料有时会在随后的程序被淘汰。 </li><li>如果染料不能在浆膜进行检测，立即重新注入下胃镜可视的染料。 </li></ol> 5.术中胃镜检查程序后， <ol><li>切除十二指肠，并根据日本治疗指南为淋巴结清扫执行其他的程序。11 </li><li>淋巴结清扫后，在切除距肿瘤边缘，被标记的剪辑指导正确的位置相距至少3 cm近端胃，用2内窥镜缝合。 </li><li>只要远端胃切除，插入检体插入的内窥镜袋，并通过一个2从腹腔撤回 - 3厘米延伸infraumbilical套管针部位。 </li><li>从近端余量来发送所述组织对于病理组织学术评估。 </li><li>在切除胃的近端部分无肿瘤组织的确认后，执行剩余的胃和带体内线性缝合器（ 图4B）的近端空肠之间吻合。 </li></ol>

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	<li>Kim, Y. W., Yoon, H. M., Eom, B. W., Park, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+minimally+invasive+surgery+for+gastric+cancer+in+Korea.">History of minimally invasive surgery for gastric cancer in Korea.</a> J Gastric Cancer. 12, 13-17 (2012).</li><li>Kim, H. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morbidity+and+mortality+of+laparoscopic+gastrectomy+versus+open+gastrectomy+for+gastric+cancer:+an+interim+report--a+phase+III+multicenter,+prospective,+randomized+Trial+(KLASS+Trial).">Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized Trial (KLASS Trial).</a> Ann Surg. 251, 417-420 (2010).</li><li>Kim, M. C., Kim, K. H., Kim, H. H., Jung, G. 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Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+totally+laparoscopic+gastrectomy+less+invasive+than+laparoscopy-assisted+gastrectomy?:+prospective,+multicenter+study.">Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.</a> J Gastrointest Surg. 12, 1015-1021 (2008).</li><li>Hyung, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+tumor+localization+using+laparoscopic+ultrasonography+in+laparoscopic-assisted+gastrectomy.">Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy.</a> Surg Endosc. 19, 1353-1357 (2005).</li><li>Jeong, O., Cho, S. B., Joo, Y. E., Ryu, S. Y., Park, Y. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+technique+for+intraoperative+tumor+localization+during+totally+laparoscopic+distal+gastrectomy:+endoscopic+autologous+blood+tattooing.">Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing.</a> Surg Endosc. 26, 1778-1783 (2012).</li><li>Kim, H. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+portable+abdominal+radiograph+for+tumor+localization:+a+simple+and+accurate+method+for+laparoscopic+gastrectomy.">Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy.</a> Surg Endosc. 25, 958-963 (2011).</li><li>Kim, H. I., Cho, I., Jang, D. S., Hyung, W. 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The authors have no conflicts of interest or financial ties to disclose.

在这个协议中，我们介绍了一个程序，胃镜检查术准确，可靠地识别在胃中的中间三分之一肿瘤的位置。我们能够成功地执行根据术胃镜检查的结果远端胃大部切除术。 迄今为止，各种方法已经被应用，以确定在腹腔镜视图早期胃癌的位置。最常用的方法术前用胃镜的剪裁，和外科医生可以检测到使用腹腔镜超声或便携式X线平片剪辑的位置。7,9术前术前额外胃镜一?...

腹腔镜手术已成为东亚国家，包括韩国，日本早期胃癌治疗的选择。1这种手术的优点已为早期胃癌（EGC）几个临床试验已得到充分证明。2-4大多数在这些试验的过程中通过腹腔镜完成，但在肿瘤部位的鉴定，通过小切口进行胃，包括原发肿瘤和重建术。因此，需要手术小切口打出了"腹腔镜辅助胃切除术"。 然而，最近的外科手术已经发展到最小创伤，改善患者生活术后质量。由于这一概念也得到了腹腔镜手术治疗胃癌的应用，一些有经验的医生的腹腔镜曾试图避免小切口。完全腹腔镜下胃大部切除术（TLG）为gastriç癌症要求所有的程序只使用腹腔镜设备完成后，无需对标本切除吻合的额外小切口。由于痛苦少和恢复速度相对这类手术的结果打开或腹腔镜辅助手术，这需要剖腹探查，医生更喜欢它。但5,6，阻碍TLG胃癌是肿瘤的定位没有直接的可视化触诊或以确定胃切除的面积。 肿瘤缺席的切缘是很重要的，以实现胃癌手术的成功。如果肿瘤累及在胃癌远端胃切除术在切除边缘，需要额外的手术切除，以免留下肿瘤在余下的胃。在开放和腹腔镜辅助的手术，原发肿瘤可以容易地通过触诊或直接可视化通过一个临时胃本地化。但是，由于表面RY肿瘤没有在腹腔镜视图容易地检测，确定切缘为EGC在TLG可能很困难。 几个需要额外的术前胃镜确定切缘的其它方法已经被提出。7-9然而，更多的术前胃镜可能是不方便的患者。我们推出了一个程序，术中胃镜TLG期间直接标记肿瘤在胃的中间三分之一胃癌。 在这个协议中，我们采用患者在术前研究早期胃癌，这是不包括在内镜黏膜下剥离术绝对指征的腹腔镜手术。

<table><tbody><tr><td>Pentothal Sodium</td><td>JW pharmatheutical Co.</td><td>644912100</td><td>It was used as induction asgent</td></tr><tr><td>Rocumeron</td><td>&amp;nbsp;Ilsung pharmatheutical Co.</td><td>655402960</td><td>It was used for general anesthestia as muscle relaxant.</td></tr><tr><td>SevoFRAN</td><td>Hana pharmatheutical Co.</td><td>657801060</td><td>It was used as general anesthetics</td></tr><tr><td>Endoscopy system</td><td>Olympus Corp.</td><td>CLV-260</td><td>It was used for intraoperative GFS</td></tr><tr><td>Laparoscopic surgery system</td><td>Striker Endoscopy</td><td>1488 HD 3-CHIP</td><td>It was a system for laparoscopic surgery</td></tr><tr><td>Ultrasonic scissor</td><td>Johnson and Johnson Medical Corp.</td><td>HAR23</td><td>It was used during tissue dissection</td></tr><tr><td>Laparoscopic clip</td><td>Johnson and Johnson Medical Corp.</td><td>ER420</td><td>It was used for ligation of the vessels.</td></tr><tr><td>Indigo carmine</td><td>Korea United Pharma</td><td>Carmine</td><td>It was injected into the gastric wall</td></tr><tr><td>Linear stapler</td><td>Johnson and Johnson Medical Corp.</td><td>ECHELON FLEX Powered Endopath Stapler</td><td>It was used for resection the stomach</td></tr><tr><td>Gastroscopic injector</td><td>TaeWoong Medical</td><td>Cobra injector</td><td>I was used for gastroscopic injection of blue dye</td></tr></tbody></table>

intraoperative gastroscopy for tumor localization in laparoscopic surgery for gastric adenocarcinoma

确定切缘胃癌，其不暴露于胃的浆膜面，是完全的腹腔镜胃切除（TLG）中的最重要的过程。此协议的目的是介绍一个程序，术中胃镜，要想在胃的中间三分之一TLG过程中直接​​标记肿瘤胃癌。谁在胃的中间三分之一诊断为腺癌的患者在这种情况下系列的患者。手术前，不进行对肿瘤的定位额外胃镜。在全身麻醉下，胃的腹腔镜动员首先执行。后十二指肠的第一部分从胰腺动员并夹紧，外科医生移动到另一侧的胃镜过程。在胃镜的通过口腔进入胃的插入，2 - 3立方厘米靛蓝胭脂红的经由内窥镜注射器施用到胃亩在胃的近端缘SCLE层。在腹腔镜下视图染色浆膜的位置是用来指导远端胃大部切除术，但是，如果肿瘤太靠近胃食管结合进行全胃切除。远端胃切除术后的样品进行采样，确认从切缘肿瘤改造前有足够的长度。在我们的案例系列中，所有患者无瘤利润率，不需要额外的手术。没有涉及到胃镜程序发病率，并为过程具有逐渐下降至约五分钟的时间。对于肿瘤定位术胃镜检查是完全接受腹腔镜胃切除远端胃癌患者准确和耐受性的方法。

20例患者谁接受胃镜检查术中，18行远端胃大部切除术，在通过胃镜发现指导。但是，我们对两名患者进行全胃切除术，因为近端肿瘤边缘过于接近胃食管结合，如术中胃镜检查确定。从肿瘤到近端切除边缘的距离为3.5厘米，2.5厘米这两个患者中，分别为（ 表1）。 总的平均手术时间为远端胃切除术为188分钟。的?...

Watch this Scientific Journal Video about Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma at JoVE.com

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

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12.7K 次观看.  Ajou University, School of Medicine. In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

视频: Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

科研

医学

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

低成本单端口 （LoCoSP） 设备，用于微创性跨侵入性食管切除术中的内脏方法

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

单外科医生、三孔腹腔镜切除术自然孔口标本提取治疗结直肠癌的临床应用

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to the anatomical characteristics of the liver, with intraoperative hemorrhage being a primary concern. Intraoperative blood loss is the leading cause of conversion to open surgery; therefore, effective management of bleeding and hemostasis is crucial for a successful LAH.
The two-surgeon technique is proposed as an alternative to the traditional single-surgeon approach, with potential benefits in reducing intraoperative bleeding during laparoscopic hepatectomy. However, there remains a lack of evidence to determine which mode of the two-surgeon technique yields superior patient outcomes. Besides, to our knowledge, the LAH technique, which involves the use of a cavitron ultrasonic surgical aspirator (CUSA) by the primary surgeon while an ultrasonic dissector by the second surgeon, has been rarely reported before.
Herein, we present a modified, two-surgeon LAH technique, wherein one surgeon employs a CUSA while the other uses an ultrasonic dissector. This technique is combined with a simple extracorporeal Pringle maneuver and low central venous pressure (CVP) approach. In this modified technique, the primary and secondary surgeons utilize a laparoscopic CUSA and an ultrasonic dissectorconcurrently to achieve precise and expeditious hepatectomy. A simple extracorporeal Pringle maneuver, combined with the maintenance of low CVP, is employed to regulate the hepatic inflow and outflow in order to minimize intraoperative bleeding. This approach facilitates the attainment of a dry and clean operative field, which allows for the precise ligation and dissection of blood vessels and bile ducts. The modified LAH procedure is simpler and safer due to its effective control over bleeding as well as the seamless transition between the roles of primary and secondary surgeons. It holds great promise for future clinical applications.

Here, we present a protocol to perform a modified laparoscopic anatomic hepatectomy using improved techniques and instruments.

改良腹腔镜解剖肝切除术:双外科医生技术结合简单的体外普林格尔手法

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to ...

Advancing LRPS: Optimal Techniques for Challenging Liver Resections

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver resections, including less blood loss, reduced wound pain, and shorter hospital stays with a comparable oncological outcome. However, laparoscopic resection of lesions in the right posterior section of the liver is challenging due to difficulties in bleeding control and visualizing the surgical field. In the past, laparoscopic right posterior sectionectomy (LRPS) was still in the exploration phase, with undefined risks in the Second International Consensus Conference on LLR in 2014. However, recent technological advancements and increased surgical experience have shown that LRPS can be safe and feasible. It has been found to reduce hospital stay and blood loss compared to open surgery. This manuscript aims to provide a detailed description of the steps involved in LRPS. The key factors contributing to our success in this challenging procedure include proper liver retraction and exposure, the use of an intrahepatic Glissonian approach for inflow control, a technique called the 'ultrasonic scalpel mimic Cavitron ultrasonic surgical aspirator (CUSA)' for parenchymal transection, early identification of the right hepatic vein, and meticulous bleeding control using bipolar diathermy.

Here, we present a protocol to perform laparoscopic right posterior sectionectomy, focusing on two key aspects: the intrahepatic Glissonian approach for inflow control and a parenchymal transection technique using an ultrasonic surgical aspirator.

腹腔镜右后切除术技术:Glissonian 入路和实质横断技术

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver ...

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the digestive tract, including the abdominal cavity, albeit rarely. In the present case, the tumor was resected endoscopically through the anterior gastric wall. Computed tomography (CT) scan and gastroscopy of a 60-year-old woman revealed submucosal lesions in the gastric body. The possibility of a stromal tumor was considered more likely. The endoscopic surgery was performed under endotracheal anesthesia. After a solution had been injected at the lesion site in the stomach, the entire gastric wall was dissected to expose the tumor. As the lesion was in the abdominal cavity and its base was attached to the abdominal wall, it was accessed using a sterilized PCF colonoscope. A sodium chloride injection was administered at the base. The tumor was then peeled along its boundaries using the hooking and excision knife combined with the precutting knife. Subsequently, the tumor was pulled into the stomach through the incision made in the stomach and then extracted externally through the upper digestive tract using the ERCP spiral mesh basket. After confirming the absence of bleeding at the incision site, the endoscope was returned to the stomach, and the stomach opening was closed using purse-string sutures. The patient recovered satisfactorily following the surgery and was discharged on day 4. Histological examination revealed a low-risk stromal tumor (spindle cell type, &lt;5 mitosis/50 high-power fields [HPF]). Immunohistochemistry revealed positive staining for CD34 and CD117, negative staining for SMA, positive staining for DOG1, and negative staining for S100. Additionally, the expression of ki67 was 3%.

The article introduces the surgical method, endoscopic submucosal dissection (ESD) for the complete removal of intra-abdominal tumors using natural orifice transluminal endoscopic surgery (NOTES). The procedure reaches the stomach by using gastrointestinal endoscopy, creating a controlled perforation for tumor removal, followed by stitching the gastric incision.

Gastrointestinal stromal tumors (GISTs) typically occur in the stomach and proximal small intestine but can also be found in any other part of the ...

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for treating proximal gastric cancer. This technique includes comprehensive laparoscopic resection of the proximal stomach, lymph node dissection, and double-tract anastomosis. By integrating single-port laparoscopic surgery with an auxiliary operating hole, SILT-DT reduces procedural difficulty while facilitating the placement of an abdominal drainage tube. Compared to the traditional five-port laparoscopic gastrectomy, SILT-DT requires fewer ports and results in shorter incision lengths, contributing to reduced postoperative pain and faster recovery. A thorough preoperative evaluation was conducted to ensure procedural success, with factors such as tumor size, stage, location, and patient BMI carefully considered. This comprehensive assessment allowed for optimal patient selection and surgical planning. Postoperative follow-up demonstrated no significant complications, underscoring the safety and efficacy of SILT-DT. This innovative technique offers a promising minimally invasive alternative for managing proximal gastric cancer while maintaining excellent clinical outcomes.

The single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis was initially employed for the radical resection of proximal gastric cancer. This study demonstrated the feasibility of the procedure and laid a foundation for further research.

单切口加单端口腹腔镜近端胃切除术联合双通道吻合术治疗胃癌

Single-incision plus one-port laparoscopic proximal gastrectomy with double-channel anastomosis (SILT-DT) is a minimally invasive surgical approach for ...

Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was approved for in-human use in Europe. Possible applications for this new robotic system are being explored, and standardized approaches are evolving. In lieu of this, a gastric wedge resection and the standardized setup for upper gastrointestinal procedures using this new system are presented here. This safe and feasible robotic procedure is demonstrated in a 69-year-old patient with a gastric tumor. All steps of the surgery are described in a detailed and reproducible manner. The article also details trocar positioning, arm adjustments, and required surgical instruments. Docking time amounted to 13 min, whereas the console time took 115 min. The patient was discharged after 4 days after ensuring an uneventful course. The presented method is also suitable for other surgical purposes, such as fundoplications or hiatoplasties, and ensures both generalizability and reproducibility.

Robotically assisted surgery has become highly popular in recent years. Presented here is the standard care for upper gastrointestinal procedures, including a demonstration of a robotic-assisted gastric wedge resection using a modular robotic device.

外科机器人技术:模块化机器人平台驱动的胃楔形切除术

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was ...

Gastroscope-assisted Trans-Trocar Gastrostomy and Abdominal Exploration

Advanced endoscopic technologies have revolutionized gastrointestinal surgical procedures, transitioning from open or laparoscopic methods to endoscopic interventions. Gastrostomy is a classic clinical technique for patients with swallowing impediments due to obstructions in the cardiac or esophageal regions and has evolved significantly with the establishment of percutaneous endoscopic gastrostomy (PEG). While PEG offers reduced trauma and swift recovery, it falls short of exploratory capabilities and risks damaging adjacent organs. Therefore, we developed an innovative approach-gastroscope-assisted trans-Trocar gastrostomy (GTTG), which not only takes full play to the advantages of PEG with less trauma and faster postoperative recovery but also takes into account the advantages of laparoscopic gastrostomy with a good exploration of the abdominal cavity. This technique is characterized by ease of operation, minimal trauma (including short operation time and no redundant incision), rapid recovery, the ability to explore the abdominal cavity, and avoidance of injury to adjacent organs, which is quite worthy of widespread promotion in clinical settings.

Here, we introduce a novel technique of gastrostomy, which integrates laparoscopic and gastroscopic techniques, offering a streamlined approach with reduced invasiveness, expedited recovery, and the capacity for abdominal exploration while minimizing the risk of adjacent organ injury.

胃镜辅助 Trans-Trocar 胃造口术和腹部探查术

Advanced endoscopic technologies have revolutionized gastrointestinal surgical procedures, transitioning from open or laparoscopic methods to endoscopic ...

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

摘要

探索更多视频

此视频中的章节

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

低成本单端口（LoCoSP）设备，用于微创性跨侵入性食管切除术中的内脏方法

腹腔镜-内镜合作手术治疗胃肠道间质瘤

单外科医生、三孔腹腔镜切除术自然孔口标本提取治疗结直肠癌的临床应用

改良腹腔镜解剖肝切除术:双外科医生技术结合简单的体外普林格尔手法

腹腔镜右后切除术技术:Glissonian 入路和实质横断技术

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

单切口加单端口腹腔镜近端胃切除术联合双通道吻合术治疗胃癌

外科机器人技术:模块化机器人平台驱动的胃楔形切除术

胃镜辅助 Trans-Trocar 胃造口术和腹部探查术

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

摘要

探索更多视频

此视频中的章节

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

低成本单端口 （LoCoSP） 设备，用于微创性跨侵入性食管切除术中的内脏方法

腹腔镜-内镜合作手术治疗胃肠道间质瘤

单外科医生、三孔腹腔镜切除术自然孔口标本提取治疗结直肠癌的临床应用

改良腹腔镜解剖肝切除术:双外科医生技术结合简单的体外普林格尔手法

腹腔镜右后切除术技术:Glissonian 入路和实质横断技术

Transumbilical Endoscopic Resection of Intra-abdominal Mesenchymal Tumor

单切口加单端口腹腔镜近端胃切除术联合双通道吻合术治疗胃癌

外科机器人技术:模块化机器人平台驱动的胃楔形切除术

胃镜辅助 Trans-Trocar 胃造口术和腹部探查术

低成本单端口（LoCoSP）设备，用于微创性跨侵入性食管切除术中的内脏方法