To discuss the efficacy of laparoscopic deep infiltrating endometriosis surgery.

Clinical data of 225 cases who underwent laparoscopic deep infiltrating endometriosis surgery in Chinese PLA General Hospital between Jan. 2008 and Jul. 2018 were analyzed retrospectively. Clinical features, perioperative outcomes, recurrence and natural conception rate were analyzed.

Among the 225 cases, 178 cases(79.1%) had dysmenorrhea, 33 cases (14.7%)had dyspareunia, 1 case(0.4%) had hematochezia, 2 cases (0.9%)had hematuresis, 8 cases (3.6%)had constipation, 6 cases (2.7%)had diarrhea, 42 cases (18.7%)had no symptom. Average blood loss was(94.4±191.6) ml, average operative time was (85.5±51.0) min, average hospital stay was (8.4±4.9) d. Complication rate was 1.3%. Follow up period ranged from 1-144 months(Median follow-up time 57 months ), 24 months recurrence rate was 8.4%, 60 months recurrence rate was 16.4%, overall recurrence rate was 19.6%. Natural conception rate was 67.5%.

Laparoscopic deep infiltrating endometriosis surgery is safe and effective for deep infiltrating endometriosis.

To investigate the causes and management strategies of sigmoid colostomy necrosis after laparoscopic radical resection of rectal cancer.

The clinical data of 2 patients who underwent laparoscopic abdominoperineal resection of rectal cancer from May to Jun. 2020 were retrospectively analyzed. One patient underwent local anesthesia in the early stage of necrosis of the colostomy, then removed the suture around the colostomy and pull the the colon out the abdominal cavity for sigmoid colostomy in situ, the other underwent conservative treatment such as hot compress, dressing change, drainage and cutting of necrotic intestinal wall after intermittent removal of subcutaneous suture line around the colostomy.

The re-ostomy under local anesthesia were well healed, the mucous membrane was ruddy, defecation was smooth, and the patient was discharged 1 week later. The sigmoid colostomy of the conservatively treated patient healed with upper margin mild invagination and stenosis and the patient was discharged on 28 days.

It is a positive and feasible treatment to re-ostomy under local anesthesia in the early stage of sigmoid colostomy necrosis to abdominal wall.

To investigate the safety and feasibility of vaginal delivery after transvaginal natural orifice transluminal endoscopic surgery(V-NOTES).

The clinical data of one case who underwent vaginal delivery after V-NOTES operation in the Affiliated NO.2 People′s Hospital of Nanjing Medical University were retrospectively analyzed and summarized. A 27-year-old female patient with right tubal ectopic pregnancy who accepted right salpingectomy via V-NOTES on Feb. 25, 2019, and recovered well after operation. The incision of posterior vaginal fornix healed well. She underwent vaginal natural delivery on Sep. 9, 2020.

The parturient successfully delivered a healthy male infant of 3 600 g. The mother and child were in good condition, and there was no new laceration at the incision of posterior vaginal fornix. The results of regular follow-up were good.

Under the premise of strictly grasping the indications and contraindications of operation, if the surgeon was skilled in surgical techniques, the vaginal delivery of patients who accepted V-NOTES for gynecological diseases might be safe and feasible.

To summarize the experience of transumbilical laparoendoscopic single-site surgery (TU-LESS) for an accidental endometrial stromal sarcoma, and investigate the safety and feasibility of the therapy for this disease.

The clinical datas of a case of accidental endometrial stromal sarcoma undergoing TU-LESS in the Department of Obstetrics and Gynecology, West China Second Hospital in Feb. 2020 were analyzed retrospectively.

The operations were performed successfully and no intraperitoneal cancer spread were found. Postoperative pathological report suggests low-grade endometrial stromal sarcoma. The patient recovers well and continues to follow up closely. Three months after operation, the patient′s ultrasound, vaginal cuff cytology, tumor markers and hormone examination were normal.

Low-grade endometrial stromal sarcoma is easily misdiagnosed as uterine leiomyoma before operation. In order to improve the prognosis, in addition to early diagnosis, the principle of tumor-free should be strictly observed during operation. TU-LESS, avoiding the use of electric or power morcellators, is safe and feasible for the treatment of minimally invasive treatment of uterine leiomyoma, with the advantages of least invasion, lesser postoperative pain, faster recovery, and better cosmetic result. Therefore, TU-LESS is worth popularizing.

To explore the effect and preventive measures of carbon dioxide pneumoperitoneum on renal function after laparoscopic radical gastrectomy for gastric cancer by analyzing the cases of acute renal failure after laparoscopic gastrectomy.

The clinical manifestations, auxiliary examinations and clinical treatments of 2 patients with acute renal failure after laparoscopic radical resection of gastric cancer were retrospectively analyzed, combined with the review of related literatures. The effects of carbon dioxide pneumoperitoneum on renal function and preventive measures after laparoscopic radical gastrectomy were discussed.

After continuous renal replacement therapy, the renal function was gradually improved.

The clinical incidence of acute renal failure after laparoscopic gastrectomy is low and the treatment experience is rare. Laparoscopic surgery should be carefully selected for patients with renal insufficiency and complicated with basic diseases such as hypertension, diabetes, coronary heart disease and so on.

To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

To explore the clinical manifestations, diagnosis, differential diagnosis and treatment of urachal cyst with infection in children.

The clinical manifestations, imaging features, treatment and pathology of a child with urachal cyst associated with infection and ovarian cyst pedicle torsion were retrospectively analyzed.

Children in the diagnosis was confirmed by laparoscopic exploration, and the lesions were completely removed under the laparoscope.

It is difficult to diagnose urachal cyst with infection in children. For patients with atypical clinical manifestations, it is easy to misdiagnose and missed diagnosis. Diagnostic laparoscopy can reduce the occurrence of misdiagnosis and feasible corresponding minimally invasive surgical treatment.

To explore the feasibility of uniportal VATS complex sleeve lung resection and summarize the surgical techniques and clinical outcomes.

From 2016 to 2019, a total of 167 cases of uniportal thoracoscopic sleeve lung resection were perfomed by one surgical team in Shanghai Pulmonary Hospital. Among them, there are a total of 141 cases of the upper or lower lobe sleeve resections, already analyzed in previous articles.This article aims to analyze the remaining 26 technique-demanding cases. We categorize these operations as "complex sleeve lung resection" . Inclusion criteria are as follows, sleeve lung resection of more than one lobe (bilobar sleeve resection or lobe + segment sleeve resection), sleeve lung resection involving the carina, sleeve segmental resection, right middle sleeve lobectomy. Exclusion criteria includes sleeve lobectomy through thoracotomy, wedge bronchoplasty, upper or lower sleeve lobectomy. The recruited cases are 7 right upper-middle or middle-lower sleeve bilobectomy, 6 left lower lobe + lingular segment sleeve resection, 6 sleeve carinal resection, 4 sleeve segmentectomy, 3 right middle sleeve lobectomy.

There were 15 cases of lung squamous cell carcinoma, 3 cases of lung adenocarcinoma, 4 cases of hamartoma, 1 case of adenoid cystic carcinoma, 1 case of carcinoid tumor, 1 case of malignant lymphoma, and 1 case of extranodal sinus histiocytosis. The average blood loss during the operation was (169 ± 205.94) ml, 50-1 000 ml. The average operation time was (190.3±72.6) min, with interquartile range 150-232.5 min. The average lymph node stations removed were (5.86±0.99), including station7 in all cases. The number of lymph nodes was 6-29, with an average of (14.04 ± 5.41). On operation day, the drainage volume was (265.41 ± 173.98 )ml. The total hospital stay was (10.38 ± 4.87) d, and postoperative hospital stay was (4.96 ± 1.90) d. Sixteen patients with malignant tumors received postoperative chemotherapy (16/19). One case was lost to long-term follow-up. Anastomotic complications occurred in 1cases. Tumor recurrence occurred in 2 case. Bronchoesophageal fistula occurred in 1 patient after radiochemotherapy. One case suffered postoperative chylothorax recovered after reoperation. The postoperative follow-up time was( 15.6 ± 10.7 )months. No perioperative death occurred. Until now, one patient died of distal metastasis 1 year after operation, and other patients still survive.

Uniportal VATS sleeve complex lung resection could be completed with an improvement of minimally invasive surgical techniques, and be beneficial for certain selective patients.

To summarize the experience of laparoscopic pancreaticotailectomy, and investigate the feasibility and clinical value of the therapy for pancreatic tail-mass.

Clinical data of 32 patients who underwent pancreaticotailectomy in the Department Liver and Gallbladder Surgery of Cangzhou People′s Hospital from Jan. 2016 to Dec. 2019 were retrospectively analyzed.Among them, there were 12 males and 20 females, aged 13-75 years, and the average age was (41.3±3.7)years. During the operation, whether to retain the spleen or not was determined according to the features of the tumor, the relationship between the tumor and splenic vessels, and the degree of spleen injury.

Except for one patient who underwent laparotomy due to tumor invasion of transverse colon, the other 31 patients underwent laparoscopic resection.Spleen was retained in 12 cases (8 by Kimura method and 4 by Warshaw method) and 20 by combined splenectomy.The mean operation time was (252±75) min, and the mean intraoperative blood loss was (162±51) ml.Postoperative hospital stay was (11.6±3.2) days.Postoperative pathology: solid pseudopapilloma (10 cases), serous cystadenoma (6 cases), mucinous cystadenoma (4 cases), neuroendocrine tumor (4 cases), pancreatic adenocarcinoma (3 cases), inductal papillary myxoma (3 cases), pancreatic pseudocyst (1 case), and pancreatic tail injury (1 case). Postoperative pancreatic leakage occurred in 10 cases, and they were cured and discharged after adequate drainage and anti-infection treatment.There were 1 case of chylous leakage, 1 case of peritoneal hemorrhage (recovered after conservative treatment with somatostatin and hemostatic agents), and 5 cases of new postoperative diabetes.

Laparoscopic pancreaticotailectomy is safe and effective in the treatment of pancreatic body and tail tumor. Surgeons with extensive experience in laparoscopic surgery can perform them.

To investigate the clinical efficiency and feasibility of laparoscopic sacrocolpopexy (LSC) in the treatment of pelvic organ prolapse(POP) in women.

40 cases of POP were treated with hysterectomy and LSC in Beijing Anzhen Hospital Affiliated to Capital Medical University from Jan.2015 to Dec. 2017.The anatomic and functional recovery was evaluated by POP-Q, the pelvic floor inventory short form 20(PFDI-20), pelvic floor impact questionnaire short form 7(PFIQ-7), and the sexual function questionnaire short form 31(PISQ-31). Age 45-77 years(60.8±1.4)years, pregnancy times 1-4 times, (2.8±0.7)times, delivery times 1-3 times(1.7±0.5)times.

Operation time, 130-330 min, (215.2±7.6) min, intraoperative bleeding 20-300 ml, (82.3±9.2) ml, and postoperative hospitalization 3-19 days, (6.6±0.4)days.All cases were followed up for 8-21 months(mean, 11 months). The overall objectivecure rate was 100% and the satisfaction rate was 100%.

Laparoscopic sacrocolpopexy is an effective treatment for women with POP.This operation has a high cure rate objectively and satisfaction rate.

To explore the causes and countermeasures of basket incarceration in choledochoscopy through T-tube tract lithotripsy.

Retrospective analysis of the data of 12 patients with basket incarceration during biliary tract lithotripsy after bile duct surgery from Jan. 2017 to Dec. 2019 in Hunan Provincial People′s Hospital .And the internal diameter ratio of stone bile duct at incarcerated site, stone properties, treatment methods and treatment outcomes were calculated.

The diameter of stones/diameter of bile duct stenosis measured by preoperative T-tube radiography in 12 patients was all greater than 1.2 cm, and the incarcerated stones were all gallbladder pigment stones.Three patients were successfully netted after being pushed to one side by the basket, three patients were removed after using additional choledochoscopy, and the remaining six patients were removed after cutting the basket. The basket were removed from all cases, and 5 cases of biliary bleeding were rinsed with noradrenaline saline and stopped bleeding.

We need to pay attention to the choledochoscopy through the T-tube sinus tract for basket incarceration, preoperative T-tube angiography stone bile duct diameter ratio can predict the possibility of incarceration, and the lithotripsy is conducive to avoiding forced extraction leading to bleeding, thus ensuring the safety of surgery.

To investigate the feasibility and security of fluorescence method in thoracoscopic anatomical segmentectomy, compared with modified inflation-deflation method.

Department of thoracic surgery of the First Medical Center, Chinese PLA General Hospital from Mar. 2017 to Sep. 2019, we performed thoracoscopic anatomical segmentectomy for 157 patients (fluorescence group, 41 females and 19 males, aging from 36 to 76; modified inflation-deflation group, 62 females and 35 males, aging from 27 to 85). In the fluorescence group, to distinguish intersegmental plane, indocyanine green was injected into peripheral vein after the targeted segmental artery cut off. In the modified inflation-deflation group, after the targeted segmental bronchus cut off, the bilateral ventilation was started, and then unilateral ventilation was restored. The intersegmental plane would be formed after more than 10 minutes. Clinical data of the two groups were collected and analyzed.

Compared with the modified inflation-deflation group, the fluorescence group showed shorter display time and shorter operational time [20 s(8-25)s vs 1 008 s(884-1 200)s, P=0.031, (103.3±7.3)min vs (132.8±10.4)min, P=0.021]. There were no significant differences in bleeding volume, the number of lymph node dissection, drainage time, hospitalization time and morbidity between the two groups (all P>0.05).

Compared with modified inflation-deflation group, it is quicker and more accurate to distinguish intersegmental plane in fluorescence group. It needn′t to inflate and deflate lungs repeatedly. Fluorescence method is safe and efficient.

To investigate the clinicopathological characteristics, diagnosis and differentiated diagnosis, and the regimens of intramural pregnancy (IMP).

A case of IMP was analyzed for the clinical manifestation, auxiliary assesses, clinical therapy, results of biopsy and pathology, with related literatures reviewed.

The patient was diagnosed with IMP in uterine horn and underwent the hysteroscopy combined with laparoscopy, by which the lesion was successfully removed, with the uterine retained.

Due to the difficulty of intramural pregnancy diagnosis and lack of treatment experience, we should consider this disease when the patients had a history of induced abortion or endometriosis, as well as those who had a history of embryo transplantation.

To explore the possibility of ultrasound guided percutaneous transforaminal endoscopic lumbar discectomy (PELD) with no radiation.

The lumbar transverse processes were used as the markers to locate the target level on longitudinal section. A hyperechoic zone on transverse section of lumbar ultrasound was used as the marker to puncture and cannulation of PELD, and the operation was completed.

After operation, the symptoms were relieved obviously. Postoperative MRI showed that the solid tissue of nucleus pulposus in the herniated disc had been completely removed, and the nerve root had been completely released without complications.

This is the first case of zero radiation PELD guided by ultrasound in the world(Report of Novelty Search of Medical and Health Science and Technology No. 2019023; Novelty Search Station of Medical and Health Science and Technology, General Hospital of PLA; Novelty Search Time, March 18th, 2019). It has important value to further reduce the radiation dose of PELD during puncture and intubation under the guidance of ultrasound.

To investigate clinical characteristics and management of internal hernia after laparoscopic gastrectomy.

The clinical data of 27 patients who underwent laparocopic gastrectomy for gastric cancer with Roux-en-Y reconstruction from Jan. 2010 to Jun. 2018 Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University were retrospectively analyzed.

Among the 27 patients with internal hernia, 25 patients underwent laparoscopic total gastrectomy with Roux-en-Y reconstruction, and 2 patients underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction. The main manifestations are severe pain in upper abdomen with nausea and vomiting. The time of onset was 6 days to 5 years after surgery, and 15 cases occurred within 1 year (55.6%). Among them, 23 patients received surgical treatment and 6 died, 4 patients received conservative treatment and 1 died. The total mortality rate was 25.93%.

Internal hernia is a rare and serious complication that is difficult to diagnose. It is necessary to close mesenteric defects to prevent abdominal hernia, during laparoscopic radical gastrectomy for Roux-en-Y anastomosis. Clinically, early surgical treatment is essential when it is suspected.

To improve the safety and efficiency of laparoscopic surgery in children with choledochal cyst through analyzing the technical details during the operating process .

Clinical data of 36 children who were finally diagnosed as choledochal cyst and receiving laparoscopic treatment were analyzed retrospectively, with emphasis on the intraoperative technical details.

Laparoscopic choledochal cyst resection and hepatojejunostomy with Roux-en-Y anastomosis were completed successfully for all patients, The operation time and volume of intraoperative blood loss were (215±35)minutes and (34±22)ml, The indwelling time of nasogastric tube and abdominal drainage tube were (2.4±1.2)d and (6.0±2.2)d, The resumption time of normal diet was (2.8±1.0)d and the postoperative stay was (7.9±1.9)d . The postoperative complication was found in 3 patients(8.3%) and no deaths occurred.

Laparoscopic surgery is a safe and effective method in treating children with choledochal cyst. Several technical details, including proper trocar setting, cyst-strippings and digestive tract reconstructions, can effectively improve the efficiency and safety of the operation.