Single-incision laparoscopic biliary bypass for malignant obstructive jaundice

Transumbilical single-incision laparoscopically assisted ventriculoperitoneal shunting: a minimal invasive technique

OBJECTIVE

Hydrocephalus is not rare in the child. Ventriculoperitoneal shunt (VPS) is still the gold standard in treating non-obstructive hydrocephalus in children. Several approaches have been described and in modern surgery, in which lesser invasive techniques are predominant. This study aims at presenting a minimally invasive technique for the placement of the abdominal part of the catheter.

METHODS

We describe a minimally invasive approach for the placement of the abdominal part of the catheter using a single-incision laparoscopic technique (SILS). Furthermore, considerations about complications, follow-up, and advantages and disadvantages of the above mentioned technique will be discussed.

RESULT

These surgeries were performed successfully without any conversion. The operation time was 60 min, and the abdominal procedure was 11 min. The patient had the oral fluid intake 12 h later with the average hospitalization of 3 days after the surgery. During a 2-month follow-up, favorable cosmetic results were obtained with no relevant complications occurred.

CONCLUSION

Single-incision laparoscopically assisted VPS is feasible and safe in the treatment of hydrocephalus with less invasive and better cosmetic results from the preliminary experience.

Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Background

This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C).

Methods

Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded.

Results

Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence.

Conclusions

Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.