本研究是根据赫尔辛基宣言和当地临床伦理委员会 （2018/09） 进行的。
1. 体格检查
注意:用于诊断 TOS 的激发试验如 图 1 所示。
<ol><li>对于Adson试验（斜角肌试验， 图1A），使患者的肩部向外旋，轻微外展和一点点伸展，并触诊桡动脉搏动。将患者的头部向后伸展并旋转到被测试的肩膀。让患者吸气并屏住呼吸。<ol><li>如果症状再现或桡动脉搏动消失，而症状随着头部向对外侧旋转而消退，则考虑检测阳性。</li>
	</ol></li>
	<li>对于肋锁支具测试（图1B），将患者的手臂向后，在同侧压下并缩回患者的肩胛骨。检查脉搏。如果桡动脉搏动消失或症状再次出现，则认为该检测呈阳性。</li>
	<li>对于过度外展试验（图1C），稍微伸展患者的手臂并触诊桡动脉。将手臂外展 90-180°。阳性测试是指桡动脉脉搏从基线到新位置的降低。</li>
	<li>对于Roos（East）测试（图1D），以坐姿或站姿进行测试。将患者的肩膀外展至 90°，向外旋转，肘部弯曲至 90°。肘部应略微落后于正面平面。让患者张开和合上双手 3 分钟。<ol><li>如果患者感到手臂沉重、缺血性疼痛或无力或手麻木和刺痛，则考虑检测呈阳性。手的变色对测试也很有意义。 注意:手术治疗是 VTOS 病例的首选，而 NTOS 病例的手术治疗是在保守治疗 3 个月后进行的，他们的日常生活、工作生活和睡眠质量没有任何改善。</li>
	</ol></li>
</ol>2. 术前临床和电诊断评估
<ol><li>为了评估手术治疗的临床改善情况，请在体格检查、肌电图检查结果和与日常活动症状以及术前社会和心理症状相关的 QuickDASH（手臂、肩部和手部残疾: <a href="https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf">https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf</a>）问卷中做出临床发现。</li>
	<li>通过测量复合运动动作电位 （CMAP）、感觉神经动作电位 （SNAP） 和神经传导速度 （NCV） 和 F 波潜伏期来确定术前肌电图。使用商用 EMG/NCV/EP 测量系统（例如 Nihon Kohden Neuropack 2）进行记录。</li>
</ol>3.经腋窝第一肋骨切除术
<ol><li>使用标准麻醉诱导方案进行麻醉，其中包括 0.6 mg/kg 罗库溴铵、0.05 mg/kg 咪达唑仑和 1-2 μg/kg 芬太尼。</li>
	<li>给予 6 mg/kg 的噻喷他钠以维持治疗。</li>
</ol>4. 患者体位（图2）
<ol><li>将患者置于侧卧位后，包裹手臂，抬高并悬挂在 90° 外展位。如果需要，每 3-5 分钟减少牵引力，以防止术后并发症。</li>
	<li>使用10%无菌聚维酮碘溶液进行局部灭菌。悬垂手臂、腋窝和胸部。在身体其他部位使用无菌床单以防止污染。</li>
</ol>5. 到达第一根肋骨
<ol><li>手术器械的使用如 图 3 和 材料表所示。</li>
	<li>在腋窝发际线下方横向切开一个切口，从胸大肌向前延伸，背阔肌向后延伸，长度为 5-7 厘米。</li>
	<li>穿过皮肤、皮下组织和筋膜到达前胸壁。</li>
	<li>使用钝性解剖到达第一根肋骨。</li>
</ol>6. 从肌肉和筋膜中释放第一根肋骨
<ol><li>刺穿覆盖在第一肋骨上方的筋膜，并解剖覆盖在肋骨上部的骨膜。使用单极烧灼术和肋骨刮刀钝地从周围肌肉中解剖肋骨的下缘。</li>
	<li>将肋间肌肉分开，直到胸肋交界处的肋锁韧带和肋脊后交界处的角肋骨。</li>
	<li>在第一肋骨的上缘，前斜角肌前方和中斜角肌后方暴露。将弯曲的镊子放在前斜角肌和中斜角肌下方，以在第一肋骨上插入的水平处切割肌肉，在那里它们离神经血管束最远。</li>
</ol>7. 切除第一肋骨或颈肋骨
<ol><li>开始切除胸肋前交界处的第一根肋骨。首先，从其上边缘转动，然后从下边缘转动，使用胸骨上的肋骨切割器将其切除。确保神经血管结构得到保留。</li>
	<li>之后，切除肋骨的后部，并分离位于肋骨角远端的部分;因此完成肋骨切除术。</li>
	<li>将颈肋从周围组织中完全释放后，切除并分离肋骨，直到看到横突的关节面。</li>
</ol>8. 术后时期
<ol><li>在术后，进行胸部 X 线检查以排除并发症，例如胸腔炎。</li>
	<li>在术后第 1 天移除胸腔引流管，如果情况不大。</li>
	<li>使用非甾体抗炎药、麻醉镇痛药和肌肉松弛剂治疗术后疼痛。</li>
	<li>在术后早期，检查手臂在手术侧的运动。术后前两个月继续物理治疗。</li>
	<li>建议患者不要在手术侧进行任何令人筋疲力尽的活动。</li>
</ol>9. 术后临床和电诊断评估
<ol><li>为了评估手术治疗的临床改善，比较体格检查、肌电图检查结果和 QuickDASH（手臂、肩部和手部残疾: <a href="https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf">https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf</a>）问卷中的临床结果，这些问卷与日常活动症状以及术前和术后（3 个月）相关的社会和心理。</li>
	<li>通过测量复合运动动作电位 （CMAP）、感觉神经动作电位 （SNAP）、神经传导速度 （NCV） 和 F 波潜伏期来比较术前和术后肌电图。使用商用 EMG/NCV/EP 测量系统（例如 Nihon Kohden Neuropack 2）进行记录。</li>
	<li>术后进行体格检查，评估疼痛和感觉异常。</li>
</ol>

<ol>
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TFRR 是治疗 TOS9、10、11 最常用的手术技术。TFRR 的优点是它提供了更好的美容效果，在腋窝有一个隐藏的切口，而无需切割肌肉以到达手术区域。它的缺点是工作空间相对狭窄和深。锁骨上入路是动脉 TOS 治疗的首选方法，可降低锁骨下动脉损伤的风险12。锁骨下静脉在静脉 TOS 治疗中常采用锁骨下入路，后外?...

斜角三角臂丛神经、锁骨下动脉或静脉的压迫在临床上称为胸廓出口综合征 （TOS），最初由 Peet 等人描述1。胸廓出口综合征根据潜在病因细分为神经源性 （NTOS）、动脉 TOS 和静脉 TOS1。NTOS患者（93-95%的TOS病例）表现为疼痛、麻木和同侧无力。静脉 TOS 患者 （3-5%） 表现为静脉血栓形成，动脉 TOS 患者 （1-2%） 表现为动脉血栓栓塞事件和缺血。TOS的保守治疗包括药物治疗和物理治疗，是TOS病例的首选。手术治疗方式包括减压手术，并在保守治疗失败后进行2.减压技术包括经腋窝第一肋骨切除术 （TFRR）、锁骨上第一肋骨切除术 （SFRRS）、扁平体切除术（无需通过锁骨上或经腋窝切除第一肋骨）和后入路第一肋骨切除术 （PA-FRR）3。经腋窝第一肋骨切除术是 Roos 等人于 1966 年描述的一种技术，是治疗 TOS 4,5 的有效方法。TFRR 的主要目标是完全切除最后一根颈肋和第一根胸肋骨，并减压下面的神经血管束。
血管 TOS （VTOS） 通过 CT 血管造影、彩色双功 USG 和动脉造影或静脉造影进行诊断，而 NTOS 通过 X 射线、电诊断检查（针脊髓电图）、彩色双功多普勒 USG 和颈部 MRI 进行诊断。术前应咨询物理治疗师和精神科医生，以排除其他疾病。在前斜角肌注射利多卡因缓解症状也是诊断和预测 NTOS 患者手术获益的良好指标6。

<table>
	<tbody>
		<tr>
			<td>Ag Debakey vascular forceps 24 cm, 3.5 mm</td>
			<td>Lawton medizintechnik</td>
			<td>30-0032</td>
			<td>Check the hemorrhage</td>
		</tr>
		<tr>
			<td>Bone chisels curved 13x9.1/2&#39;&#39;</td>
			<td>Aesculap Inc.</td>
			<td>MB-992R</td>
			<td>Dissect the periost of the first rib</td>
		</tr>
		<tr>
			<td>Doyen-stille retractor 24 cm</td>
			<td>Lawton medizintechnik</td>
			<td>20-0650</td>
			<td>Skin- muscle retraction</td>
		</tr>
		<tr>
			<td>Foerster sponge forceps straight</td>
			<td>Lawton medizintechnik</td>
			<td>07-0156</td>
			<td>For swabbing</td>
		</tr>
		<tr>
			<td>Luer stille bone rongeur curved 27 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0703</td>
			<td>Bone punches</td>
		</tr>
		<tr>
			<td>Luer stille rongeur straight 22 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0400</td>
			<td>Rib cutter</td>
		</tr>
		<tr>
			<td>Mayo hegar needle holder 20.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>08-0184</td>
			<td>Suturing</td>
		</tr>
		<tr>
			<td>Metzenbaum scissors curved delicate 23 cm</td>
			<td>Lawton medizintechnik</td>
			<td>05-0665</td>
			<td>Dissection</td>
		</tr>
		<tr>
			<td>Overholt curved forceps delicate 30.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>06-0807</td>
			<td>Split the scalen muscles from the rib</td>
		</tr>
		<tr>
			<td>Roberts art forceps straight 24 cm</td>
			<td>Lawton medizintechnik</td>
			<td>06-0370</td>
			<td>For sponge and remove remain bone</td>
		</tr>
		<tr>
			<td>Roux retractor medium size 15.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>20-0402</td>
			<td>Wound retraction</td>
		</tr>
		<tr>
			<td>Semb rasparotry 22,5 cm, 12mm</td>
			<td>Lawton medizintechnik</td>
			<td>39-0252</td>
			<td>Dissect the muscle of the first rib</td>
		</tr>
		<tr>
			<td>Smith peterson model curved osteotome 13x205 mm</td>
			<td>Lawton medizintechnik</td>
			<td>46-0783</td>
			<td>Dissect the muscle of the first rib</td>
		</tr>
		<tr>
			<td>Stille -giertz rib shears 27 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0200</td>
			<td>First rib cutting</td>
		</tr>
		<tr>
			<td>Stille osteotome 8x205 mm</td>
			<td>Lawton medizintechnik</td>
			<td>46-0248</td>
			<td>Dissect the periost of the first rib</td>
		</tr>
		<tr>
			<td>Wagner rongeur 5.5x210 mm</td>
			<td>Lawton medizintechnik</td>
			<td>53-0703</td>
			<td>Punches</td>
		</tr>
	</tbody>
</table>

transaxillary first rib resection for treatment of the thoracic outlet syndrome

胸廓出口综合征 （TOS） 是一种常见的疾病，会导致生产力显着下降。经腋窝第一肋骨切除术 （TFRR） 方案已用于 TOS 中受困神经血管结构的减压。在其他外科手术中，TFRR 的优点是复发率最低，美容效果更好。TFRR 的缺点是它提供了一个狭窄而深的工作走廊，这使得获得血管控制具有挑战性。

临床结果 本研究共纳入15例患者。3例患者（20%）为男性，12例（80%）为女性。患者平均年龄分别为30.6岁±8.98岁。所有男性参与者和 5 名女性参与者都是体力劳动者。NTOS组最常见的主诉是手臂-前臂疼痛和麻木、握力无力和低水萎缩。在术后临床随访中，询问患者的感觉异常和疼痛严重程度、总体满意度、活动和工作状态。在术前和术后评估QuickDASH评分和EMG值。术前和术后肌电图测?...

Watch this Scientific Journal Video about Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome at JoVE.com

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

在这里，我们提出了第一肋骨经腋窝切除术的方案，用于治疗由臂丛神经、锁骨下静脉和动脉受压引起的胸廓出口综合征。

经腋窝第一肋骨切除术治疗胸廓出口综合征

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol ...

transaxillary-first-rib-resection-for-treatment-thoracic-outlet

Research

JoVE Journal

Medicine

2.7K 次观看.  Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital. 在这里，我们提出了第一肋骨经腋窝切除术的方案，用于治疗由臂丛神经、锁骨下静脉和动脉受压引起的胸廓出口综合征。

视频: Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

科研

医学

Surgical Models of Gastroesophageal Reflux with Mice

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to induce reflux of gastric contents, duodenal contents or mixed contents. Surgical procedures and general principles have been described in detail. A researcher with surgical experience should be able to grasp the technique after a short period of practice. After surgery, most mice can survive and develop reflux esophagitis similar to that in humans. However, it should be noted that histological differences between mouse and human esophagus are the inherent limitations of these surgical models. If used for research on Barrett&#8217;s esophagus and adenocarcinoma, these procedures may need to be combined with genetic modifications.

This article demonstrates surgical procedures of gastroesophageal reflux with mice. These models are useful tools for research on mechanisms and treatment of gastroesophageal reflux disease and potentially Barrett&#8217;s esophagus and esophageal adenocarcinoma.

胃食管反流与小鼠手术模型

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

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 ...

Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, we propose that a concomitant laparoscopic oocyte retrieval for cryopreservation is performed. Oocyte retrieval is pursued at the beginning of the laparoscopy. Right and left 5 mm trocars are positioned, through which a 17 G ovum aspiration needle is used for puncture of the right and left ovaries, respectively. To facilitate exposure of the follicles, the ovaries are mobilized and held with laparoscopic forceps.
When aspirating multiple follicles near each other, the needle tip is retained in the ovary to reduce the number of times that the ovarian cortex is transfixed and due to the inherent risk of bleeding. Subsequent steps are unchanged compared to the Davydov laparoscopic modified technique for vaginoplasty. Prior to surgery, controlled ovarian stimulation is performed with a gonadotropin hormone-releasing hormone (Gn-RH) antagonist protocol, and the concomitant procedure of oocyte retrieval and vaginoplasty is scheduled 36 h after the final follicular maturation trigger. Follicular fluid is collected in the same 10 mL sterile tubes used during transvaginal oocyte retrieval and transferred in a warming block (37 &#176;C) to the assisted reproduction laboratory, where mature (metaphase II) oocytes are vitrified.
In this case, a series of 23 women with MRKH, oocytes were successfully retrieved and cryopreserved in all patients; vaginoplasty was subsequently conducted without modifications, and the inpatient and outpatient postoperative care (day of urinary catheter removal, day of hospital discharge, dilator use, and comfort at follow-up) remained unaffected. One postoperative complication occurred in one patient (fever developing on day 5 post surgery and intraperitoneal fluid detection on transabdominal ultrasound) and resolved after conservative treatment. Rather than performing surgical vaginoplasty and delaying oocyte retrieval in MRKH patients, this approach combines both procedures in a single laparoscopy, thereby minimizing surgical invasiveness and anesthesiologic risks.

A dedicated team can offer Mayer-Rokitansky-Kuster-Hauser patients the option to perform controlled ovarian stimulation and oocyte cryopreservation at the time of laparoscopic vaginoplasty.

阴道成形术中的腹腔镜卵母细胞提取和冷冻保存治疗Mayer-Rokitansky-Kuster-Hauser综合征

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia

Peroral endoscopic myotomy (POEM) is one of the first-line treatment modalities along with pneumatic dilation and Heller myotomy for patients with achalasia. Endoscopists, especially trainees during the learning phase, commonly face difficulty in tissue plane dissection and selective myotomy while working near the esophagogastric junction, with increased risks of inadvertent injury, unexpected bleeding, and inadequate myotomy. To minimize the technical difficulty and improve the safety of POEM, we describe a protocol for using a scissor-type knife for the main steps of POEM, including mucosal incision, submucosal tunneling, myotomy, and hemostasis. The standard techniques used with the scissor-type knife involve grasping the target tissue, and then dissection or coagulation. The confirmation of the cutting line after grasping improves the accuracy and reliability of dissection, which is particularly useful for the selective myotomy of the internal circular muscle. Meanwhile, the scissor-type knife provides enhanced hemostatic capability and enables hemostasis and pre-coagulation without the device exchange for hemostatic forceps. Evaluation of the clinical outcomes in three patients who successfully received POEM using the scissor-type knife revealed no perioperative adverse events. At the 3-month follow-up, all patients achieved clinical success with postoperative Eckardt scores ranging from 0 to 1. In conclusion, the use of a scissor-type knife could minimize the technical difficulty and improve the safety of the POEM procedures, which may be suitable for trainees during the learning phase.

To minimize the technical difficulty and improve the safety of peroral endoscopic myotomy (POEM), we describe a protocol for using a scissor-type knife for the main steps of POEM, including mucosal incision, submucosal tunneling, myotomy, and hemostasis.

在经口内窥镜肌切开术中使用剪刀治疗贲门失弛缓症

Peroral endoscopic myotomy (POEM) is one of the first-line treatment modalities along with pneumatic dilation and Heller myotomy for patients with ...

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, ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

显微镜囊肿切除术治疗诊断为附睾囊肿的患者

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

保留自主呼吸的视频辅助胸腔镜手术的非插管方案

Non-Intubated Video-Assisted Thoracoscopic Surgery

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the lung, and lobectomy. However, there is a high incidence of pulmonary complications arising from general anesthesia with tracheal intubation. Non-intubation with the preservation of voluntary breathing is an alternative to anesthesia. Non-intubation procedures minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and post-operative nausea and vomiting. However, the steps for non-intubation procedures are not detailed in many studies. Here, we present a concise non-intubated protocol for the performance of video-assisted thoracoscopic surgery with preserved autonomic breathing. This article identifies the conditions necessary to convert from non-intubated to intubated anesthesia and also discusses the advantages and limitations of non-intubated anesthesia. In this work, this intervention was performed on 58 patients. In addition, the results of a retrospective study are presented. Compared with intubated general anesthesia, patients in the non-intubated video-assisted thoracic surgery group had lower rates of post-operative pulmonary complications, shorter operative times, less intraoperative blood loss, shorter PACU stays, a lower number of days to chest drain removal, less post-operative drainage, and shorter hospital stays.

作者聚焦: 一种具有多模式镇痛和七氟烷吸入麻醉的非插管视频辅助胸腔镜手术 

Here, we present a non-intubated protocol for performing video-assisted thoracoscopic surgery with preserved autonomic breathing.

非插管视频辅助胸腔镜手术

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the ...