Deep endometriosis （DE） refers to endometriosis lesions that have penetrated≥5 mm in depth. As a special type of endometriosis， intravaginal rectal diaphragm endometriosis has its lesions located in the deep part of the rectovaginal septum， which is difficult to treat and carries a high risk of injury.Laparoscopy has become the preferred treatment method due to its advantages of small trauma， fast recovery，and clear visualization. Understanding the anatomy of the rectovaginal diaphragm is crucial for surgery. The key principles of surgery include fully removing the lesion， reconstructing the pelvic anatomy， and protecting the function of important organs. Preoperative informed consent should be fully provided to patients regarding the risks and benefits of surgery. If necessary， multidisciplinary surgery should be performed. The surgery is complex and requires high surgical skills. Surgical procedures should be tailored according to patients' age，fertility needs， and pain levels， and different instruments and surgical techniques should be used to ensure the successful completion of the surgery.
Non-obstetrical abdominal surgery is required in approximately 1 in 500 pregnant women.Previously， open surgery was preferred during pregnancy. With the development of laparoscopic devices and improved surgical techniques， laparoscopy has been recommended as a safe， minimally invasive approach for abdominal surgery throughout pregnancy. Laparoendoscopic single-site surgery （LESS） is a minimally invasive surgical technique via a single incision， which has been widely used in many fields including gynecologic surgery. Several advantages of LESS over multiport laparoscopy during pregnancy have been indicated， such as the advantages of less incision， good cosmetic effect， less postoperative pain and quick recovery. Several studies have confirmed the safety and feasibility of LESS surgery in pregnancy. Patients with acute abdomen during pregnancy， potentially malignant or malignant adnexal masses， and persistent benign adnexal masses with a tendency to increase in size require surgical treatment， non-emergency surgery is recommended for the second trimester of pregnancy. Based on 38 pregnant women with adnexal masses who underwent LESS surgery， our team summarize the operative skills and precautions of monopole laparoscopy during pregnancy. In conclusion， LESS administered by an experienced physician during pregnancy seems to be a safe and feasible approach.
To investigate the feasibility and safety of remodified overlap using barbed suture（MOBS）in total laparoscopic proximal gastrectomy.
Methods
During Jan. 2022 to May 2023，patients who accepted total laparoscopic proximal gastrectomy by modified MOBS anastomosis in our department were retrospectively collected. Statistical anastomosis time， postoperative recovery and other indicators. We analyzed the time consuming of anastomosis and postoperative recovery indicators.
Results
A total of 25 patients were included in this study. Modified MOBS anastomosis was used in all patients to complete esophagogastrostomy anastomosis. The average time consuming of modified MOBS anastomosis was 10.5±2.6 minutes， and the average postoperative feeding time was 2.3±0.5 days. No anastomotic fistula or anastomotic stenosis occurred after the operation. Minor heartburn discomfort occurred in 1 patient after the operation， and no death or reoperation occurred in perioperative period.
Conclusion
It is feasible and safe to use MOBS anastomosis in total laparoscopic proximal gastrectomy and total gastrectomy.
To report the clinical application of modified prophylactic ileostomy through auxiliary incision in laparoscopic radical resection of middle-to- low rectal cancer.
Methods
A descriptive method was used to analyze the clinical characteristics of middle-to-low rectal cancer patients in our hospital from Nov. 2023 to May 2024. Patietns were arranged to follow laparoscopic rectcal radical surgery plus modified trans-auxiliary prophylactic ileostomy. Inclusion criteria： rectal adenocarcinoma； cTxN+M0/cT3-4N0M0； the lower margin of the tumor is less than 10cm from anal margin. Preoperative localization of the stoma was performed. The localized position of stoma， the surgeon's auxiliary operation hole and the specimen-extraction incision were integrated into one incision. The main outcome measures were stomarelated complications， and the secondary outcome measures were surgical efficacy and safety.
Results
A total of 107 patients were included. The mean age was 58.1±9.5 years， and 69 patients （64.4%） were males. The anastomosis was 3.8±1.5 cm from the anal margin， and the incision length was 4.7±0.7 cm.The median operation time was 120 （94.0-150.0） minutes， and the intraoperative blood loss was 43 （30-50） ml. The mesangial integrity was observed in 98 patients （91. 6%）. Intestinal rupture occurred in 2 patients （1.9%） during operation. Postoperative complications occurred in 31 patients （28.9%）， with 29 patients （27.1%） graded as 1-2 levels by C-D standards. Early stoma-related complications occurred in 16 patients （15. 0%）， 8 （7. 5%） with dermatitis around the stoma， 4 （3. 7%） with incision infection，3 （2.8%） with hemorrhage， and 1 with （0. 9%） ischemic necrosis. Late complications occurred in 4 patients （3. 7%）， 2 （1. 9%） with stoma prolapse， 1 （0. 9%） with retraction and 1 （0. 9%） with parastostomy.
Conclusion
The modified trans-auxiliary prophylactic ileostomy is safe and effective in laparoscopic radical surgery in middle-to-low rectal cancer， with the advantages of simplicity and convenience， and low rates of early and late stoma-related complications.
To analyze the short-term outcomes of open， laparoscopic， and robot assisted liver hemangioma resection surgery in patients with giant liver hemangiomas at our center， and compare the safety and effectiveness of different surgical methods for liver giant hemangioma resection surgery.
Methods
This article collected a total of 176 patients who underwent hepatic hemangioma resection at China-Japan Friendship Hospital from Nov. 2016 to Jun. 2024. After screening according to exclusion criteria， 73 patients were ultimately included in this study. According to the different methods of hepatic vascular tumor resection， the patients were divided into three groups： 11 cases in the robotic elucidation （RE） group， 47 cases in the laparoscopic elucidation （LE） group， and 15 cases in the open elucidation （OE） group.
Result
Compare the differences among the three groups in terms of surgical difficulty， surgical time， surgical bleeding， changes in laboratory indicators， length of hospital stay，complications， and clinical reactions. After statistical analysis， it was found that there was no significant statistical difference in the baseline data of the patients. The average surgical time of the laparoscopic group was 205.15 minutes， significantly lower than that of the open group and the robotic group； The number of cases of allogeneic blood transfusion during the robot group surgery was 0， significantly less than that of the endoscopic group and the open group； The average number of hepatic portal occlusions during the robot group surgery was 1.18， significantly less than that of the endoscopic group and the open group； On the third day after surgery， the mean total bilirubin（TBIL） of the endoscopic group was 16. 76 μmol/L， significantly lower than that of the open group and the robotic group； On the third day after surgery， the mean prothrombin time（PT）of the robot group was 17.25 s， significantly higher than that of the open group and endoscopic group； On the third day after surgery， the mean prothrombin time activity（PTA） of the robot group was 78.45%， significantly lower than that of the open group and endoscopic group； the average postoperative drainage tube removal time in the robot group was 4.27 days， significantly lower than that in the open group and endoscopic group； the average length of hospital stay after surgery in the robot group was 7.36 days，significantly lower than that in the open group and endoscopic group.
Conclusion
Open， laparoscopic， and robotic dissection can all be safely and effectively used for the treatment of hepatic hemangioma. Laparoscopy and robotics can both reduce surgical time， total number of hepatic portal blockades， postoperative drainage tube removal time， and total postoperative hospital stay.
To investigate the safety and long-term efficacy of endoscopic retrograde cholangiopancreatography （ERCP） in the treatment of pancreas divisum.
Methods
A total of 92 patients diagnosed with pancreas divisum in the Department of Gastroenterology， the First Medical Center of PLA General Hospital from Jan. 2010 to Dec. 2023 were retrospectively analyzed， and the inclusion and exclusion criteria were clarified. The clinical data were collected and analyzed， including general condition， operation characteristics， postoperative adverse events and follow-up. The long-term efficacy of endoscopic treatment was evaluated by outpatient follow-up and telephone follow-up.
Results
A total of 76 patients with pancreas divisum who underwent ERCP were enrolled in the study （40 males and 36 females）， with an average age of（40.9±17.5） years. ERCP was successfully performed in 66 of the 76 patients， with a technical success rate of 86.8% （66/76）. The incidence of ERCP-related adverse events was 12.8% （21/164）， including 16 cases of post-ERCP pancreatitis， 4 cases of infection， and 1 case of bleeding. ERCP was performed for 151 times in 66 patients， with a median of 2 times （1-6 times）. During a median follow-up of 110 months （9-160 months）， 53 patients （80. 3%， 53/66） achieved long-term remission.
Conclusion
The endoscopic retrograde cholangiopancreatography （ERCP） demonstrates favorable safety profile and long-term efficacy in the management of pancreas divisum， making it a viable first-line treatment option.
To summarize and analyze the application of the deep learning intraoperative ultrasound（IOUS） main pancreatic duct automatic recognition model in IOUS skill training for surgeons and assisting in the locating of the main pancreatic duct in minimally invasive pancreatic surgery.
Methods
Use the main pancreatic duct automatic recognition model to assist 18 trainees in learning the recognition of IOUS main pancreatic duct images and collect examination data； Prospectively enroll 120 cases of minimally invasive pancreatic surgery that plan to use IOUS to locate the main pancreatic duct. For surgical patients，an automatic main pancreatic duct recognition model was used to assist in locating the main pancreatic duct during the operation. IOUS operation time， main pancreatic duct positioning success rate and baseline data were collected for analysis.
Results
For trainees， model-assisted examination can improve accuracy and answer time （100% vs. 86%，P＜0.05， 6.6 min vs. 14.1 mins， P＜0.05）； Compared with the control group that does not use models， using deep learning model can improve the IOUS operation time （8.8 min vs. 13.6 min， P＜0.05） and localization success rate （96.6% vs. 81.6%，P＜0.05）.
Conclusion
The deep learning IOUS main pancreatic duct automatic recognition model based on deep learning can help surgeons master IOUS skills faster and better， and can improve the speed and success rate of locating main pancreatic duct， assisting in safe and effective minimally invasive pancreatic surgery.
To explore the surgical safety of robotic central pancreatectomy and compare the efficacy of different methods of reconstruction for the distal pancreatic stump.
Methods
Clinical data of 10 patients who underwent robotic central pancreatectomy from Jun. 2018 to Aug. 2022 were retrospectively analyzed to evaluate short-term clinical outcomes and long-term prognosis.The operative time， intraoperative blood loss， postoperative hospital stay， postoperative pancreatic fistula， peritoneal hemorrhage， incidence of peritoneal infection， and long-term abnormal pancreatic secretory function were analyzed.
Results
Among the 10 patients， there were 3 males and 7 females， with an average age of 47.2±11.5 years and an average body mass index（BMI）of 22.5±2.9 kg/m2. The methods of reconstruction of the distal pancreatic stump included pancreaticojejunostomy in 4 cases， pancreatogastric anastomosis in 3 cases， and end-to-end pancreatic anastomosis in 3 cases. The average operation time was 273.0±54.4 minutes， and the average intraoperative blood loss was 120.0±45.8 ml. After the surgery， biochemical leakage occurred in 4 patients，and 3 patients developed Grade B pancreatic fistula. Among them， 1 case combined with gastrointestinal bleeding and abdominal infection （Klebsiella pneumonia） who underwent puncture drainage， while the other 2 cases underwent endoscopic pancreatic duct stent placement. Pathological examination revealed 2 cases of serous cystadenoma， 2 cases of mucinous cystadenoma， 2 cases of pancreatic neuroendocrine tumors， 3 cases of intraductal papillary mucinous neoplasms （IPMN）， and 1 case of renal cell carcinoma metastases. The average length of hospital stay was 14.0±7.7 days. The average follow-up period was 33. 8±14. 3 months. All the 10 patients had distal pancreatic atrophy. None of the patients developed endocrine or exocrine insufficiency.
Conclusion
Robotic central pancreatectomy is safe and feasible. Although there is a relatively high incidence of pancreatic fistula in the early postoperative period，long-term pancreatic exocrine and endocrine functions are not significantly affected，high-quality studies are warranted to verify the conclusion.
To investigate the value of cervical polypectomy via vaginoscopy in pregnant women.
Methods
The pregnant woman with cervical polyps were retrospectively included in Beijing Tiantan Hospital， Capital Medical University from Apr. 2017 to Dec. 2023. A vaginoscopy technique for cervical polypectomy without a speculum， cervical forceps， and anesthesia was applied for surgery group， and conservative management was used for observation group. The rate of spontaneous abortion， preterm birth，preterm rupture of membranes （PROM）， the timing and mode of delivery， and neonatal outcomes were analyzed.
Results
100 pregnant patients with cervical polyps who underwent cervical polypectomy were included into surgery group （n=55） and patients without operation were assigned to observation group （n=45）. At baseline， the rate of vaginal bleeding pre-operation， the length and width of the cervical polyp were higher in surgery group than in observation group. The median interval from vaginal bleeding to polypectomy was 4 weeks and the median time of polypectomy was performed at gestational week 18 . There was no difference on the incidence of spontaneous abortion in two groups （3.6% vs. 4.4%，P＞0.05）. However， a significantly lower frequency of preterm birth （7. 3% vs. 22. 2%，P ＜0. 05） and PROM （20. 0% vs.45.2%，P＜0.05） were observed observation. There was no difference in the timing， mode of delivery， and neonatal outcomes in both groups.
Conclusions
The vaginoscopy for cervical polypectomy without anesthesia may be a feasible management for pregnant women with vaginal bleeding.The cervical polypectomy under vaginoscopy reduced the risk of preterm delivery and PROM in pregnant women with symptomatic cervical polyps.
To review and summarize the laparoscopic surgical treatment for patients with primary liver cancer complicated by portal hypertension at our center， and to discuss the surgical treatment principles for these patients.
Methods
A patient with hepatitis B-related liver cirrhosis， recurrent upper gastrointestinal bleeding， and recent clinical diagnosis of primary liver cancer with portal vein hypertension，admitted to the Department of Hepatobiliary and Liver Transplant Surgery at Nanjing Drum tower Hospital in May 2024， was evaluated through liver function and reserve assessment， gastrointestinal endoscopy， and tumor staging. Based on these evaluations， a surgical treatment plan was formulated.
Results
The patient successfully underwent laparoscopic liver resection combined with total splenectomy and laparoscopic periscardia vascular disconnection. The procedure had minimal blood loss， and there were no postoperative complications such as infection， bleeding， bile leakage， or portal vein thrombosis. Recovery was smooth，and postoperative pathological examination confirmed combined hepatocellular carcinoma and cholangiocarcinoma.
Conclusion For patients with primary liver cancer complicated by portal hypertension，a comprehensive preoperative assessment allows for surgical treatment of both the tumor and complications of portal hypertension could benefit the patient.
To evaluate the efficacy of neoadjuvant immunotherapy combined with chemotherapy and targeted therapy in patients with stage ⅢA lung adenocarcinoma， as well as the feasibility and safety of thoracoscopic minimally invasive surgery.
Methods
A retrospective analysis was conducted on a case of thoracoscopic right lower lobectomy performed in Apr. 2024 at the First Medical Center of the PLA General Hospital. The patient had stage ⅢA lung adenocarcinoma with confirmed pathological response following neoadjuvant chemotherapy， immunotherapy， and targeted therapy.
Results
The surgical procedure was successfully completed， albeit with considerable difficulty. The operation lasted 150 minutes with an estimated blood loss of 50 ml. Postoperative recovery was uneventful， with no complications such as air leakage or atelectasis. The patient was discharged in good condition on postoperative day 5.
Conclusion
Patients with stage ⅢA lung adenocarcinoma harboring EGFR-sensitive mutations demonstrated a clear pathological response following neoadjuvant chemotherapy combined with immunotherapy and targeted therapy. Thoracoscopic surgery is safe and feasible in this context.
Abdominal wall endometriosis （AWE） is a rare form of endometriosis occurring in a specificlocation，primarily seen after cesarean section. In the early stages of the disease， when symptoms are not obvious， a wait-and-see approach with observation is usually adopted. When the lesions cause periodic abdominal wall pain and other discomfort， surgical treatment becomes the main focus. Traditional percutaneous incision surgery can remove single， superficial lesions， but when multiple and larger lesions are present， conventional surgical methods have drawbacks， including larger wound size， higher risk of infection， excessive abdominal wall tissue loss， and abdominal wall weakness. The author's team previously reported a case of single-site laparoscopic resection of abdominal wall endometriosis. Through continuous exploration and improvement， this article reports a case of laparoendoscopic single-site resection of multiple abdominal wall endometriosis lesions at the site of a previous cesarean section scar， aiming to provide a new surgical approach for the treatment of abdominal wall endometriosis using laparoendoscopic single-site techniques.
In the field of gynecology， surgery is an important treatment for gynecological diseases.Due to prolonged use of equipment， doctors are prone to work-related musculoskeletal disorders （WMSDs）.However， many gynecologists have not received ergonomic training and are not aware of the protective role of ergonomics for surgeons， which can easily lead to neglect and lack of understanding on how to handle WMSDs. This article provides a systematic review of the current status of ergonomics in gynecological surgery， with the aim of protecting gynecologists and extending surgical lifespan.
