The caudate lobe is the deepest and most anatomically complex segment of the liver，often referred to as the “last fortress” in liver surgery.Reports on laparoscopic caudate lobectomy （LCL） in China are limited，and standardized surgical protocols have not yet been established.To address this，the Minimally Invasive Surgery Committee of the Chinese Research Hospital Association convened experts in hepatobiliary surgery to conduct an in-depth discussion.Based on clinical experience and a review of relevant literature，the committee proposed recommendations covering the anatomy of the caudate lobe，indications，preoperative preparation and planning，surgical team and learning curve，patient positioning and trocar placement，surgical approaches，as well as intraoperative and postoperative complications and their management.These efforts led to the formulation of the Chinese Expert Consensus on Laparoscopic Caudate Lobectomy （2024 Edition）.The consensus aims to standardize and streamline the application of LCL and provide high-level evidence-based guidance for its clinical implementation.
Laparoscopic partial splenectomy （LPS），a minimally invasive surgical procedure，has gained increasing popularity in the treatment of splenic diseases. With advances in the understanding of splenic function and the widespread adoption of “precision medicine” and “enhanced recovery after surgery（ERAS）” principles，LPS has become the preferred surgical option for benign splenic lesions，selected hematologic disorders，and minor splenic trauma. LPS not only preserves spleen function，but also has advantages such as safety，damagecontrol，mildpain，and fast recovery. Thisconsensus，based on the latest research and clinical practice，outlines the indications，contraindications，surgicaltechniques，and postoperative management of LPS，accompanied by expert recommendations to guide clinical practice. It is intended for patients undergoing LPS and designed for use by surgeons，nurses，and healthcare professionals across all levels of medical institutions.
To explore the method of laparoscopic anatomical liver resection with biliary tree pedicle transaction in the treatment of intrahepatic stones.
Methods
Clinical data of 75 patients who underwent biliary tree pedicle transaction approach for intrahepatic stones from Jan. 2018 to Sep. 2022 at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School were retrospectively analyzed，including 64 cases of laparoscopic anatomical liver resection and 11 cases of robot-assisted surgery.
Results
Among the patients， left hepatectomy was performed in 48 cases （64.0%）， left lateral sectionectomy in 3 cases， right posterior sectionectomy in 7 cases， combined left lateral and right posterior sectionectomy in 4 cases， right hepatectomy in 8 cases， combined caudate lobe resection in 1 case， segmental liver resection in 3 cases； intraoperative diagnosis revealed bile duct cancer at the porta hepatis region in 1 case； 2 cases conversion to open surgery； 6 cases underwent biliary-enteric anastomosis （8.0%）， 24 cases （32.0%）underwent common bile duct exploration. The operation time ranged from 125-525（260 ±75.8） minutes，portal occlusion time ranged from 15-120（46 ±24.9） minutes， target liver pedicle transection time ranged from 5-20 （9.8 ±2.8） minutes， dorsal parenchymal transection time ranged from 1-10 （5.4 ±2.1） minutes， ventral parenchymal transection time ranged from 10-115（40.0 ±24.0） minutes， length of liver cut surface was between 4-17 （9.4 ±2.5） cm and width between 2-8 （5.1 ±1.4） cm. Intraoperative blood loss varied between 50-1 300（325.6 ±302.5） ml； 5（6.7%） cases received blood transfusions；postoperative complications included 5 cases with bile leakage；8 patients with fluid accumulated around surgical site；5 patients underwent ultrasound-guided puncture and drainage；16 cases with postoperative fever， 2 cases with postoperative bleeding，There were no deaths during the perioperative period. Follow-up was conducted for 18-24 months postoperatively， with 2 cases undergoing stone removal through T-tube sinus tract while the remaining patients had no residual stones requiring intervention.
Conclusion
The use of laparoscopic anatomical liver resection with biliary tree pedicle transaction technique for hepatobiliary calculi facilitates surgical procedures and complete removal of lesions in the bile duct tree，reducing residual stones and complications.
To analyze the effect of venous thromboembolism （VTE） after laparoscopic radical gastrectomy for gastric cancer， and provide theoretical basis for the improving nutritional status and preventing perioperative VTE for gastric cancer.
Methods
A retrospective study was conducted to collect clinical data of patients with primary gastric cancer who underwent laparoscopic radical gastrectomy in Union Hospital， Tongji Medical College， Huazhong University of Science and Technology from Jan. 2023 to Mar.2024 and were confirmed by postoperative pathology. Patients were divided into thrombus group （86 cases）and non-thrombus group （131 cases） according to inclusion and exclusion criteria. Preoperative clinical examination data and pathological characteristics of patients in the two groups were compared， and factors with statistical significance in univariate analysis were incorporated into multivariate logistic regression analysis to further evaluate the independent risk factors for postoperative venous thromboembolism in patients cancer. ROC curve was drawn to evaluate the predictive efficiency of the model.
Results
A with gastrictotal of 217 patients with primary gastric cancer were included， including 152 males and 65 females，aged 65.0（57.0， 72.0） years， BMI 22.92（20.33， 25.37） kg/m2. In the thrombus group， there were 6 patients with pulmonary embolism （7.0%）， 23 patients with hypertension （26.7%）， 16 patients（18.6%），21 patients （24.4%） and 49 patients （57.0%） with TNM stage Ⅰ，Ⅱand Ⅲ， respectively，and 16 patients （18.6%） with NRS 2002 score≥2. Unifactorial analysis showed that age， hemoglobin，albumin， BMI， TG， VLDL-C， BUN and CR values were associated with postoperative VTE in gastric cancer patients （P ＜0.05）. Multivariate analysis showed that age ≥60 years old， albumin ＜35 g/L and BMI ＜20 kg/m2 were independent risk factors for venous thromboembolism in gastric cancer patients undergoing laparoscopic surgery （P ＜0.05）. Based on the above independent risk factors， a risk prediction model was constructed and receiver operating characteristic （ROC） curve was drawn. The area under the curve （AUC）of age， albumin， BMI and nomogram were 0.768， 0.741， 0.732 and 0.835， respectively. Conclusion
This study found that preoperative nutritional status can effectively predict the occurrence of postoperative venous thromboembolism in patients with gastric cancer. For high-risk patients ≥60 years of age，albumin ＜35 g/L and BMI ＜20 kg/m2， timely nutritional treatment should be given before surgery to reduce the risk of perioperative venous thromboembolism of gastric cancer.
To evaluate the efficacy and safety of the combined gastroscopy， air， and methylene blue （GAM） leak detection procedure in patients with gastric cancer.
Methods
This prospective randomized clinical trial included 146 patients aged 18-85 years with gastric cancer who were admitted to the Department of Gastrointestinal and Anorectal Hernia Surgery at Nanchong Central Hospital between Sep.2018 and Sep. 2022. Patients confirmed to have no unresectable factors by computed tomography （CT） were randomly assigned to either the intraoperative leak testing （IOLT） group or the no intraoperative leak testing（NIOLT） group. There were 74 patients in the IOLT group and 72 patients in the NIOLT group. The primary endpoint was the incidence of postoperative anastomosis-related complications in the two groups.
Results
In the IOLT group， 6 patients （8.1%） were found to have anastomotic defects intraoperatively，which included anastomotic discontinuity， bleeding， and strictures. The incidence of postoperative anastomotic complications was 0% （0 patients） in the IOLT group versus 6.9% （5 patients） in the NIOLT group （P = 0. 02）. No GAM-related complications were observed. The average operative duration was 283.84 ±95.62 minutes in the IOLT group and 252.75 ±72.64 minutes in the NIOLT group. The IOLT group had an average total operative duration that was 31 minutes longer than the NIOLT group （P=0.03）.
Conclusion
The GAM leak detection procedure can be safely performed during laparoscopic total gastrectomy and effectively reduces the incidence of technical defect-related anastomotic complications in patients undergoing this surgery.
To compare the safety and efficacy of subsegmentectomy （SSE） with lobectomy （LB） in patients with Stage IA1-IA2 lung adenocarcinoma， providing scientific evidence for clinical decision-making.
Methods
This retrospective analysis examines the perioperative and postoperative outcomes of patients with Stage IA1-IA2 lung adenocarcinoma who underwent subsegmental resection （SSE）or lobectomy （LB） at our center from Jan. 2018 to Dec. 2022. Patients were categorized into the lobectomy group and the subsegmentectomy group based on the surgical approach. Propensity score matching （PSM）was employed to match patients according to age， sex， Charlson comorbidity index （CCI）， radiological characteristics of lung tumors， pathological type， and staging.
Results
A total of 192 cases were enrolled，with 96 cases in the SSE group and 96 cases in the LB group respectively， with no significant differences in clinical and pathological characteristics between the two groups （P ＞0.05）. Compared to the SSE group，the LB group demonstrated more lymph nodes removed and more extensive lymphadenectomy （4 groups vs.3 groups， P ＜0.001；7 nodes vs. 4 nodes， P ＜0.001）. Additionally， the LB group had shorter operative times and less intraoperative blood loss （125 minutes vs. 150 minutes， P =0.003； 50 ml vs. 85 ml， P ＜0.001）. The SSE group exhibited shorter postoperative drainage times （2 days vs. 3 days， P ＜0.001），reduced postoperative drainage volume （265 ml vs. 450 ml， P ＜0.001）， and shorter hospital stays （4 days vs. 5 days， P ＜0.001）. However， the incidence of postoperative pneumonia was higher in the SSE group compared to the LB group （8.3% vs. 0%， P =0.004）， while no significant differences were observed in other complications. There were no significant differences in postoperative recurrence rates or oncological outcomes between the two groups.
Conclusion
Precise anatomical subsegmentectomy is a safe and feasible treatment strategy for patients with stage IA1-IA2 lung adenocarcinoma， offering faster postoperative recovery and comparable oncological outcomes to lobectomy. However， further validation through large-scale，prospective randomized controlled trials is necessary.
To explore the feasibility and perioperative considerations of total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery （vNOTES） in patients after cesarean delivery.
Methods
Clinical data of 34 patients who underwent vNOTES total hysterectomy after cesarean section were collected from Jun. 2017 to Jun. 2023 in the First Affiliated Hospital of Shandong First Medical University for retrospective analysis.
Results
Thirty-three cases were successfully completed，and one case was referred to open surgery due to severe local adhesions，and none of 34 cases presented with complications after surgery.
Conclusion
A history of previous cesarean section is not a contraindication to vNOTES total hysterectomy，and the operator should have rich surgical experience，anatomical knowledge and skilled surgical technique， and adequate preoperative evaluation is required.
To investigate the establishment of posterior peritoneal space in transumbilical single-site laparoscopic （TU-LESS） extraperitoneal path lymphadenectomy for staging of endometrial cancer.
Methods
Retroreview of five cases of endometrial cancer patients admitted to the Gynecological Department of the First Affiliated Hospital of Nanjing Medical University from Jan. 2024 to Mar. 2024. In all patients， posterior peritoneal cavity was established by the above procedure and abdominal paraaortic lymph node resection was performed by TU-LESS extraperitoneal approach.
Results
All 5 patients successfully established the extraperitoneal cavity and performed TU-LESS para-aortic lymph node resection. During pelvic lymph node resection， we completed three extraperitoneal route and two peritoneal cavity route surgeries.
Conclusion
TU-LESS extraperitoneal route lymphadenectomy possess the advantages of less trauma and faster rehabilitation. After adjusting the operation， we simplified the construction steps of the extraperitoneal cavity. therefore， the operation was more convenient and the success rate was higher，which was conducive to the promotion of this surgical method.
To investigate the feasibility and safety of transvaginal natural origin transluminal endoscopic surgery（vNOTES）for retroperitoneal sentinel lymph node biopsy（SLNB）in the treatment of early endometrial cancer.
Methods
The clinical data of 8 patients with early endometrial cancer who underwent retroperitoneal sentinel lymph node resection under vNOTES from Sep. 2022 to Feb. 2023 in The Affiliated Women' s and Children' s Hospital， School of Medicine， UESTC were collected. The demographic characteristics，perioperative parameters and surgical prognosis were retrospectively analyzed.
Results
All the 8 patients completed the operation under vNOTES. One patient completed the left retroperitoneal SLNB，and turned to the right intraperitoneal SLNB due to the rupture of the right peritoneum.The other 7 patients successfully underwent bilateral retroperitoneal SLNB，and 3 patients underwent paraaortic lymph node sampling. All 8 patients underwent hysterectomy and bilateral appendectomy under vNOTES.The median operation time was 174（141.8-201.3）minutes，and the median blood loss was 125（62.5-200）ml，except for one patient with intraoperative bleeding of 500 ml and postoperative mild anemia，the other patients had no complications. The median postoperative anal ventilation time was 8. 5（6. 25-12）hours，and the median postoperative hospital stay was 3（3-3.75）days. A total of 58 pelvic SLNs and 6 paraaortic lymph nodes were resected in 8 patients. All the resected lymph nodes were negative by pathological examination.A 48 year old patient was diagnosed as high-grade endometrioid carcinoma after surgery，which involved the deep muscle layer and showed more vascular tumor thrombi. Postoperative adjuvant radiotherapy was used；A 77 year old patient with low-grade endometrioid adenocarcinoma，which infiltrated into the deep muscle wall，did not receive adjuvant therapy after operation.The other six patients were all superficial muscle invasive，and did not receive adjuvant therapy after operation. All the 8 patients were followed up regularly，with a median follow-up time of 24. 5（23-25）months，and no recurrence.
Conclusion
The application of vnotes retroperitoneal SLNB in the comprehensive staging operation of early endometrial cancer may be a new method with safety and faster postoperative recovery.The establishment of retroperitoneal space is the key to the success of the operation，but our number of cases is limited，and we still need more cases to further evaluate the feasibility and safety of this surgical approach.
To compare and analyze the perioperative recovery and long-term postoperative prognostic outcomes between traditional laparoscopic surgery （TL） and transumbilical laparoendoscopic single-site surgery （TU-LESS） in patients with tubal ectopic pregnancy undergoing tubal preservation surgery.
Methods
A retrospective analysis was conducted on the clinical data of patients with tubal ectopic pregnancy who underwent tubal preservation surgery at the Third Affiliated Hospital of Zhengzhou University from Jan. 2019 to May 2024. Postoperative hysterosalpingography （HSG） results and follow-up data regarding subsequent pregnancies were also evaluated.
Results
There were no significant differences in baseline characteristics between the two groups. Compared to the traditional laparoscopic group， the TU-LESS group had a shorter postoperative hospital stay （4 days vs. 5 days， P ＜0.001）， lower pain numerical rating scale （NRS） scores （4 vs. 5， P ＜0.001）， and longer operative time （75.50 minutes vs. 67.00 minutes，P=0.001），all differences being statistically significant. No significant differences were observed in other perioperative indicators. There were also no significant differences between the two groups in terms of tubal patency and subsequent pregnancy outcomes. Furthermore，in the TU-LESS group，patients with tubal ectopic pregnancy masses ＜40 mm had a significantly higher intrauterine pregnancy rate （76.9%vs. 42.9%， P ＜0.001） and a lower non-pregnancy rate （15.4% vs. 57.1%， P ＜0.001） compared to those with masses ≥40 mm.
Conclusion
TU-LESS is a safe and feasible method for treating tubal ectopic pregnancy in patients who require fertility preservation. In terms of perioperative recovery， TU-LESS demonstrates clear advantages， with long-term fertility outcomes comparable to traditional laparoscopic surgery. Additionally， TU-LESS may further improve the likelihood of intrauterine pregnancy in patients with smaller tubal ectopic masses. These findings provide new evidence for the selection of TU-LESS in the management of tubal ectopic pregnancy and highlight the potential for minimally invasive techniques in gynecological surgery.
To investigate the feasibility of laparoscopic radical treatment of hilar cholangiocarcinoma combined with portal vein resection and reconstruction in patients with situs inversus totalis （SIT）.
Methods
We retrospectively analyzed the clinical data of a patient with situs inversus totalis with type Ⅲb hilar cholangiocarcinoma invadede the main portal vein was completed in Nov. 2024 in the Department of Hepatobiliary Surgery， the First Hospital of Hebei Medical University.
Results
The surgical process was smooth.The patient's total operation time was 7 h， including vascular anastomosis for 20 min，and intraoperative bleeding was about 200 ml.After operation the patient was transferred to ICU on the day of operation， and then transferred to the general ward in the next day. The enhanced CT of the epigastric abdomen on the 5th and 7th days after operation showed that the portal vein flow was smooth，no stenosis and thrombus were seen， and the patient was discharged from the hospital on the 14th day after operation.
Conclusions
Laparoscopic radical treatment for type Ⅲb hilar cholangiocarcinoma combined with portal vein resection and reconstruction in patients has a certain degree of safty and feasibility.
