我们要感谢明尼苏达大学的胸肠和前肠外科以及外科系帮助我们进行这项研究。

此处描述的协议和方法已获得批准，并遵循明尼苏达大学机构审查委员会 （IRB） 的道德准则。这里描述的是一名 73 岁女性的再次手术裂管裂孔疝修补术和先前的 Nissen 胃底折叠术的拆除术。患者因腹腔镜食管裂孔疝修补术和 5 年前在室外医院接受过胃底折叠术到诊所就诊，因餐后上腹痛和饱胀感。她还主诉摄入固体食物时出现严重反流和吞咽困难。她的症状在第一次手术后暂时消退，但现在又复发了。值得注意的是，咨询时她的体重指数 （BMI） 为 40。在会诊前无法获得先前的术前检查。患者在重做前肠手术前提供了书面知情同意书。
1. 患者准备和手术设置
<ol><li>术前检查和检查<ol><li>讨论再次手术的可能性，并进行彻底的检查，如上所述：<ol><li>进行食管造影。该患者的食管造影显示中度至重度食管运动障碍（图1）。</li>
			<li>进行内窥镜检查。对于这名患者，上消化道内镜检查未显示狭窄或狭窄，但在后反射镜上显示胃的一部分通过横膈膜向上突出，证实了食管裂孔疝。</li>
			<li>进行腹部计算机断层扫描。该测试还证实了疝出的包裹物（图2）。</li>
			<li>进行无线食管 pH 值测试。结果显示，DeMeester 评分为24,25 分，得分为 38.4，胃酸反流的临界症状关联概率。</li>
			<li>执行高分辨率测压。在该患者中，它表现出非特异性运动障碍。</li>
		</ol></li>
	</ol></li>
	<li>术前规划<ol><li>确保最初的建议包括减轻体重，因此如果需要，应转诊给减肥外科医生。 注意：患者在减肥计划中做得很好，可以将她的体重降低到 32 的 BMI。此时，她仍然出现症状，她的病例在多学科食管手术计划会议上进行了讨论。共识是，测压结果可能是由于反流和疝气引起的，并且使用松散的胃底折叠术再次手术疝修补术是合适的。</li>
	</ol></li>
	<li>麻醉<ol><li>按照机构指南进行麻醉。使用单腔气管插管对患者进行插管，并快速顺序插管，因为存在反流误吸和食管裂孔疝的风险。她有一条用于血流动力学监测的动脉管路。</li>
	</ol></li>
	<li>定位<ol><li>将患者仰卧位，双臂伸出，脚踏板，以利于陡峭的反向特伦德伦堡定位26.胸部和腹部始终为前肠手术做好准备，以便在需要时有足够的时间进入腹部和胸部。</li>
	</ol></li>
	<li>端口放置和对接<ol><li>使用开放的 Hasson 技术27 进入左脐上腔的腹膜腔。在此处插入相机端口。</li>
		<li>在左上象限再插入两个 8 mm 端口，在右上象限插入一个 8 mm 端口。将端口放置在脐部上方约 10 厘米处，并确保端口之间留有手宽空间。</li>
		<li>将辅助端口放在右下象限。将肝牵开器（参见 材料表）插入放置在右上象限最外侧部分的 5 毫米端口。 注：作者倾向于在手术过程中放置左侧胸管，因为疝囊往往与胸膜相连，尤其是在再次手术中。</li>
		<li>在开始解剖之前执行此操作，以最大程度地减少在手术过程中必须断开和重新定位的机会，如果在解剖过程中急性发展的气胸出现显着的血流动力学变化。</li>
		<li>对接机器人（参见 材料表）。</li>
	</ol></li>
</ol>2. 手术程序
<ol><li>减少食管裂孔疝<ol><li>去除肠与腹壁的粘连，并使用机器人双极手术能量装置打开胃肝韧带。</li>
		<li>通过去除粘连和额外的短胃动脉分支来打开小囊。</li>
		<li>在裂孔处使用钝性解剖和电烙术的组合与机器人一起沿圆周解剖疝囊。</li>
		<li>用腹腔镜剪刀仔细解剖肝脏和胃之间的密集粘连（见 材料表）。</li>
	</ol></li>
	<li>删除以前的胃底折叠术。 注意：上一次包裹的部分但不是全部缝合线是可见的。<ol><li>用腹腔镜剪刀进行锐利的解剖，并解开包裹物以完全释放胃。</li>
		<li>小心地留在薄的疤痕组织中，以避免对胃或食道造成损害。</li>
	</ol></li>
	<li>食管动员<ol><li>在纵隔中经裂孔动员食管。通过钝性和尖锐的解剖相结合来做到这一点，并尽量减少在食道附近使用能量。</li>
		<li>接下来，确认腹内食管长度至少为 3 厘米。使用内窥镜检查定位胃食管交界处 （GEJ），并测量从食管裂孔到 GEJ 的食管，以确认足够的长度。</li>
	</ol></li>
	<li>泄漏测试<ol><li>进行内窥镜检查并清楚地观察粘膜，以确保没有受伤。用温水填充上腹部，并吹入食道和胃，以确保没有空气泄漏。</li>
	</ol></li>
	<li>食管裂孔修复<ol><li>使用 0-丝缝合线进行小腿修复，其中两条后小腿缝线和一条前小腿缝合线。</li>
		<li>将 56 Fr bougie（参见 材料表）放入食道，将 bougie 就位后，将抓取器舒适地放入食管裂孔中。这是为了确保大腿修复不会太紧。</li>
	</ol></li>
	<li>尼森胃底折叠术<ol><li>将胃底穿过右侧、食管后方和迷走神经下方。</li>
		<li>将 58 Fr bougie（见 材料表）放入食管。</li>
		<li>用三根 2-0 的蚕丝缝合线在 bougie 上进行松散的胃底折叠术。 注意：内窥镜检查证实了一堆松散的硬币状外观。</li>
	</ol></li>
	<li>胃固定术和 G 管<ol><li>将经皮内窥镜胃造瘘管插入胃中，用作胃固定术和通气管。</li>
	</ol></li>
</ol>3. 后续处理
<ol><li>术后，使用止吐药以最大限度地降低术后恶心和呕吐的风险，因为干呕会破坏疝修补术或导致早期复发。</li>
	<li>最初，胃管保持打开状态，作为通风口以防止胃胀。最后，一旦患者能够耐受液体，在术后第 2 天或第 3 天夹紧它。</li>
	<li>在手术当晚为患者提供冰片。在术后第 1 天，要求患者在胃管保持打开的情况下开始啜饮透明液体。术后第 2 天，开始清流质饮食，如果患者耐受性良好，则夹住胃管。 注意：如果在夹紧时耐受透明液体，则开始全流质饮食。</li>
	<li>最后，指导患者在 1 周后逐渐转向软饮食，并计划在 4 周内进行食管造影的门诊随访，如果不需要大量通气，则计划切除胃管。</li>
</ol>

再次手术食管裂孔疝修复术

<ol>
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T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pseudoachalasia:+a+diagnostic+challenge.+When+to+consider+and+how+to+manage.">Pseudoachalasia: a diagnostic challenge. When to consider and how to manage.</a> Scandinavian Journal of Gastroenterology. 56 (7), 747-752 (2021).</li><li>Felix, V. N., Murayama, K. M., Bonavina, L., Park, M. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Achalasia:+what+to+do+in+the+face+of+failures+of+Heller+myotomy.">Achalasia: what to do in the face of failures of Heller myotomy.</a> Annals of the New York Academy of Sciences. 1481 (1), 236-246 (2020).</li><li>Gorecki, P. J., Hinder, R. A., Libbey, J. S., Bammer, T., Floch, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Redo+laparoscopic+surgery+for+achalasia.">Redo laparoscopic surgery for achalasia.</a> Surgical Endoscopy. 16 (5), 772-776 (2002).</li><li>Markakis, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Belsey+Mark+IV:+an+operation+with+an+enduring+role+in+the+management+of+complicated+hiatal+hernia.">The Belsey Mark IV: an operation with an enduring role in the management of complicated hiatal hernia.</a> BMC surgery. 13, 1-6 (2013).</li><li>Cowgill, S. M., Arnaoutakis, D., Villadolid, D., Rosemurgy, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=34;Redo&amp;#34;+fundoplications:+satisfactory+symptomatic+outcomes+with+higher+cost+of+care.">34;Redo&amp;#34; fundoplications: satisfactory symptomatic outcomes with higher cost of care.</a> Journal of Surgical Research. 143 (1), 183-188 (2007).</li><li>Makris, K. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+short-limb+Roux-en-Y+reconstruction+for+failed+antireflux+surgery:+a+single-center+5-year+experience.">The role of short-limb Roux-en-Y reconstruction for failed antireflux surgery: a single-center 5-year experience.</a> Surgical Endoscopy. 26 (5), 1279-1286 (2012).</li><li>Wendling, M. R., Melvin, W. S., Perry, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+transoral+incisionless+fundoplication+(TIF)+on+subjective+and+objective+GERD+indices:+a+systematic+review+of+the+published+literature.">Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a systematic review of the published literature.</a> Surgical Endoscopy. 27 (10), 3754-3761 (2013).</li><li>Parker, B., Reavis, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benign+Esophageal+Disease.">Benign Esophageal Disease.</a> , 71-89 (2021).</li></ol>

作者没有什么可透露的。

再次手术前肠手术在技术上具有挑战性，但可以通过精心策划和深思熟虑的手术方法安全地进行。彻底的术前评估对于确定症状的病因和指导诊断辅助治疗至关重要。在再次干预之前确定正确的诊断，以确定正确的手术和方法至关重要。例如，在 Nissan 胃底折叠术后接受重做抗反流手术 （ARS） 的患者中，应该了解患者正在经历的主要症状。在那些以胀气症状、疼痛和吞咽困难为主要问题的人中，...

在过去的一个世纪里，对前肠疾病的理解和诊断的改进导致了更好的手术和手术方法的发展。这项创新为前肠外科医生带来了与并发症和再次手术相关的新挑战。从技术角度来看，由于多种因素，包括致密粘连、瘢痕形成、组织平面闭塞和解剖结构改变，手术再干预尤其具有挑战性 1,2,3,4,5。这些重做前肠手术增加了食管穿孔、胃排空延迟和迷走神经损伤发生率较高的患者的发病率 1,6,7,8。裂孔处的网片修复使再次干预进一步复杂化，需要复杂重建的大切除率更高 9,10。先进的内窥镜疗法的出现给前肠外科医生在处理其相关并发症或失败时带来了不断变化的挑战 11,12,13。此外，与主要干预相比，重做前肠手术与连续再手术的成功率和患者满意度恶化有关14,15,16,17。这凸显了在重做手术之前选择患者和准确诊断以获得最佳结果的重要性。
虽然传统上使用开放式方法进行，但腹腔镜方法重做前肠手术是安全有效的14,18。然而，由于与解剖结构和粘连改变相关的更大困难，转为开放手术仍然是一种可能性。随着机器人辅助手术在泌尿科和妇科手术中的出现19,20，与腹腔镜检查相比，其卓越的可视化和灵活性似乎也可能在重做前肠手术中产生一些好处。事实上，新兴研究表明安全性和改善的结果，包括与腹腔镜下方法相比，重新进行前肠手术的转化率更低，住院时间减少21,22,23。
尽管最终由前肠外科医生确定最安全的手术，但本文旨在展示重做前肠手术的方法和技术考虑因素，以便在面对这一挑战时提供一个“框架”。虽然描述了机器人辅助方法，但所描述的原理也可以类似地应用于腹腔镜检查。

<table><tbody><tr><td>Bravo calibration-free reflux testing system</td><td>Medtronic</td><td>FGS-0635</td><td>Wireless esophageal pH testing system</td></tr><tr><td>Cadiere forceps</td><td>IS</td><td>470049</td><td>Used as a grasper</td></tr><tr><td>da Vinci Surgeon Console</td><td>IS</td><td>SS999</td><td>Used to control surgical robot</td></tr><tr><td>da Vinci Vision Cart</td><td>IS</td><td>VS999</td><td>Houses advanced vision and energy technologies to provide communication across the platform components</td></tr><tr><td>da Vinci Xi</td><td>IS</td><td>K131861</td><td>The surgical robot</td></tr><tr><td>da Vinci Xi Endoscope with Camera, 8 mm, 30&amp;deg;</td><td>IS</td><td>470027</td><td>The camera for the da Vinci robot</td></tr><tr><td>Lapro-Flex Articulating Retractors</td><td>Mediflex</td><td>91682</td><td>Used as liver retractor</td></tr><tr><td>Large needle driver</td><td>IS</td><td>470006</td><td>Used as a needle driver</td></tr><tr><td>Maloney Tapered Esophageal Bougie, 56 Fr</td><td>Pilling</td><td>507956</td><td>Esophageal bougie for hiatal repair</td></tr><tr><td>Maloney Tapered Esophageal Bougie, 58 Fr</td><td>Pilling</td><td>507958</td><td>Esophageal bougie for wrap creation</td></tr><tr><td>Mega SutureCut needle driver</td><td>IS</td><td>470309</td><td>Used as a needle driver</td></tr><tr><td>Monolithic FlexArm Plus</td><td>Mediflex</td><td>99045-QC</td><td>Used to hold liver retractor to OR bed</td></tr><tr><td>Round tip scissors</td><td>IS</td><td>470007</td><td>Used for cutting</td></tr><tr><td>Shiley Hi-Lo oral/nasal endotracheal tube cuffed, 8.0 mm</td><td>Covidien</td><td>86113</td><td>Endotracheal tube for intubation</td></tr><tr><td>SynchroSeal</td><td>IS</td><td>480440</td><td>Used for dissecting, vessel sealing, and dividing</td></tr><tr><td>Tip-Up fenestrated grasper</td><td>IS</td><td>470347</td><td>Used as a grasper</td></tr></tbody></table>

technical considerations and approach to redo foregut surgery

多年来，前肠手术技术取得了长足的进步，并且越来越受欢迎。然而，在处理因并发症或手术失败而再次手术时，出现了新的挑战和技术考虑。本研究的重点是处理再次手术前肠手术，特别是重做食管裂孔疝修补术时的技术考虑因素和方法。我们描述了我们的方法，从术前检查到手术的程序步骤。本研究描述了一名既往接受过腹腔镜食管裂孔疝修补术并未出现反流和吞咽困难症状复发的患者进行机器人再手术食管裂孔疝修补术的主要步骤。患者仰卧位，双臂伸出，脚踏板用于陡峭的特伦德伦堡。我们放置了六个套管针，包括一个辅助端口和一个肝脏牵开器端口，以方便可视化和回缩。在对接机器人后，我们使用电烙术和锐器解剖相结合的方式，释放疝囊并减少食管裂孔疝。然后小心地取下先前的胃底折叠术，并通过经裂孔入路结合钝性清扫和锐性清扫来动员食管，直到达到至少 3 cm 的腹内食管长度，然后进行渗漏试验。然后，我们进行小腿修复，通过两根后缝线和一针前缝线重新近似裂孔。最后，在 bougie 上进行重做 Nissen 胃底折叠术，并使用内窥镜检查来确认松散的硬币堆外观。通过强调重做食管裂孔疝修补术的关键步骤，包括术前评估，我们的目标是为前肠外科医生提供一种方法，以最大限度地提高患者的治疗效果。

患者术后病程平安无事。她在 3 天内慢慢进展为全流质饮食，然后在 1 周后指示以流质饮食出院，并指示她转为软饮食。
作为四级转诊中心和大型大学医院，我们经常管理需要再次进行前肠手术的患者。我们过去 5 年的数据显示，43 名接受食管裂孔疝修复术的患者再次接受手术，平均住院时间为 7 天，30 天并发症率为 23%。表1总结了研究结果。大多数已发表的关?...

Watch this Scientific Journal Video about Technical Considerations and Approach to Redo Foregut Surgery at JoVE.com

作者聚焦：再手术前肠手术的最新进展

重做前肠手术与患者发病率增加有关，对外科医生提出了技术挑战。我们描述了在进行重做食管裂孔疝修补术时我们的方法和注意事项，为其他外科医生提供指导并改善患者的治疗效果。

重做前肠手术的技术考虑因素和方法

Foregut surgical techniques have advanced significantly over the years and have become increasingly popular. However, new challenges and technical ...

我们的研究重点是胸外科，特别是前肠再手术。很大一部分是基于手术结果的研究，但我们也强调手术质量的提高，例如使用此协议。在这段视频中，我们讨论了我们的再手术前肠手术方法。在前肠手术中，术中和术前设置的技术不断取得进步。诊断技术的改进，例如 Endoflip 系统和高分辨率测压法，为前肠诊断提供了更准确的信息，而机器人技术和术中监测帮助我们在手术中提供最好的护理。大多数文献在研究前肠再手术时都强调结果，但不一定是手术的方法。我们描述了一种循序渐进的手术方法，同时大致保持一般原则，因此为其他前肠外科医生提供了参考。未来，我们将继续专注于审查其他前肠再手术的结果，目标是制定指南并规范这些病例的管理。

technical-considerations-and-approach-to-redo-foregut-surgery

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

Technical Considerations and Approach to Redo Foregut Surgery

407 次观看.  University of Minnesota. 我们的研究重点是胸外科，特别是前肠再手术。很大一部分是基于手术结果的研究，但我们也强调手术质量的提高，例如使用此协议。在这段视频中，我们讨论了我们的再手术前肠手术方法。在前肠手术中，术中和术前设置的技术不断取得进步。诊断技术的改进，例如 Endoflip 系统和高分辨率测压法，为前肠诊断提供了更准确的信息，而机器人技术和术中监测帮助我们在...

视频: 作者聚焦：再手术前肠手术的最新进展

Roux-en-Y Gastric Bypass Operation in Rats

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality benefit is bariatric surgery1,2. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation3. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation4,5, increased energy expenditure6,7, altered preference for food high in fat and sugar8,9, altered salt and water handling of the kidney10 as well as alterations in gut microbiota11. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating12.
During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail 13-15. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%15. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly.
Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

空肠Roux-en-Y胃搭桥手术大鼠

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality ...

科研

医学

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

We describe a novel esophagogastric anastomotic technique (&ldquo;side-to-side: staple line-on-staple line&rdquo;, STS) for intrathoracic anastomoses designed to create a large diameter anastomosis while simultaneously maintaining conduit blood supply. This technique aims to minimize the incidence of anastomotic leaks and strictures, which is a frequent source of morbidity and occasional mortality after esophagectomy. We analyze the results of this STS technique on 368 patients and compared outcomes to 112 patients who underwent esophagogastric anastomoses using an end-to-end stapler (EEA) over an 8-year time interval at our institution.
The STS technique involves aligning the remaining intrathoracic esophagus over the tip of the lesser curve staple line of a stomach tube, created as a replacement conduit for the esophagus. A linear stapling device cuts through and restaples the conduit staple line to the lateral wall of the esophagus in a side-to-side fashion. The open common lumen is then closed in two layers of sutures.
There was a total of 12 (3.8%) anastomotic leaks in patients who underwent STS esophagogastric anastomosis. Two of eight patients (25%) had anastomotic leaks after esophagectomy for end-stage achalasia as compared to a 2.8% leak rate (10/336) after esophagectomy for other conditions. Eighteen (5.2%) patients required a median of 2 dilatations for anastomotic stricture after STS anastomosis. Supplemental jejunostomy feedings were required in only 11.1% of patients undergoing STS anastomoses following hospital discharge. In contrast, patients undergoing EEA anastomoses demonstrated anastomotic leak and stricture rates of 16.1% and 14.3% respectively (p&lt;0.01). Time analysis of postoperative contrast studies following the STS technique typically demonstrated a straight/uniform diameter conduit with essentially complete contrast emptying into the small bowel within 3 minutes in 88.4% of patients.
The incidence of esophagogastric anastomotic leaks and strictures were extremely low using this novel anastomotic technique. Additionally we believe that based on time and qualitative analyses of postoperative contrast studies, this technique appears to optimize postoperative upper gastrointestinal tract function; however, further comparative studies are needed.

We describe a novel intrathoracic esophagogastric anastomotic technique designed to create a large diameter anastomosis while simultaneously maintaining conduit blood supply to minimize the incidence of anastomotic leaks and strictures. Construction and orientation of the stomach conduit designed to optimize upper gastrointestinal tract function is also described.

静脉造影切除术，旨在最大限度地减少麻醉并发症和优化导管功能

We describe a novel esophagogastric anastomotic technique (&ldquo;side-to-side: staple line-on-staple line&rdquo;, STS) for intrathoracic anastomoses ...

癌症研究

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

低成本单端口 （LoCoSP） 设备，用于微创性跨侵入性食管切除术中的内脏方法

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

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, ...

Robotic Myotomy and Partial Fundoplication for Achalasia

Laparoscopic Heller myotomy is currently considered the standard definitive treatment of achalasia. With the advancements in technology, robotic Heller myotomy has emerged as an alternative approach to traditional laparoscopy due to three-dimensional (3D) visualization, fine motor control, and improved ergonomics provided by the robot. 
Although there is a lack of randomized controlled trials, robotic-assisted Heller myotomy seems to be associated with lower rates of intraoperative perforations compared to the laparoscopic approach. A robotic approach may also improve surgical outcomes by providing a more complete myotomy. 
Here, we describe the detailed steps of robotic myotomy and partial fundoplication for achalasia.

Surgical myotomy with a partial fundoplication may be used in selected patients as a definitive treatment for achalasia. This article provides a step-by-step description of a robotic myotomy and partial fundoplication in a 32-year-old patient with megaesophagus.

机器人肌切开术和部分胃底折叠术治疗贲门失弛缓症

Laparoscopic Heller myotomy is currently considered the standard definitive treatment of achalasia. With the advancements in technology, robotic Heller ...

Surgical Treatment of Gastroparesis

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives.
The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient&#39;s condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.

Gastroparesis is a condition in which the stomach does not empty properly. While it is initially managed with lifestyle modifications and medications, some patients eventually require surgical intervention. This study focuses on the technical considerations and surgical approaches for dealing with gastroparesis patients, which include endoscopic, minimally-invasive, and open surgical techniques.

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are ...

Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment

Hereditary diffuse gastric cancer (HDGC) caused by the CDH1 gene mutation is an inherited cancer syndrome that increases the risk of diffuse gastric cancer and is nearly impossible to detect by screening gastroscopy. The recommended preventative treatment is a total gastrectomy. Robotic surgery facilitates the use of minimally invasive surgical (MIS) techniques for anastomoses and posterior vagus preservation to potentially reduce adverse functional outcomes. An asymptomatic 24 year old male with the CDH1 gene mutation proven by genetic testing and a family history of a brother having a total gastrectomy for HDGC was treated with this technique. This video case report demonstrates the techniques and pitfalls of robotic surgery in terms of the patient positioning and port placement, posterior vagus-preserving dissection, sutured esophagojejunostomy, jejunal pouch formation, and Roux-en-Y reconstruction with a staple-stapled jejunojejunostomy. While these techniques are demonstrated in the case of prophylactic gastrectomy, many of them can be applied to other benign and bariatric foregut and general surgery types.Robotic surgery can facilitate the foregut MIS technique, as described in this case of a vagus-sparing total gastrectomy.

This article focuses on robotic vagus-sparing total gastrectomy. The techniques and pitfalls of vagus preservation, sutured esophagojejunostomy, jejunal pouch formation, and Roux-en-Y reconstruction with a staple-stapled jejunojejunostomy are discussed.

Hereditary diffuse gastric cancer (HDGC) caused by the CDH1 gene mutation is an inherited cancer syndrome that increases the risk of diffuse gastric ...

机器人辅助 Heller 肌切开术治疗贲门失弛缓症

Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia

Achalasia is an esophageal motility disorder. It occurs due to the destruction of nerves in the lower esophageal sphincter (LES), which leads to the failure of the LES to relax. Patients typically complain of dysphagia, chest pain, and regurgitation. They often report drinking liquids with solids intake to help propel food boluses into the stomach. The diagnosis of achalasia is typically confirmed with an esophagogram and a motility study (esophageal manometry). An esophagogram classically shows the bird beak sign with tapering in the distal esophagus. The treatment for achalasia includes both surgical and non-surgical options. Surgical treatment is associated with a lower rate of recurrences, high clinical success rate, and durability of symptom relief. The current gold standard of surgical technique is myotomy, or the dividing of the muscle fibers of the distal esophagus. Surgical myotomy can be accomplished via a laparoscopic or robotic technique; per-oral endoscopic myotomy is a new alternative intervention. Due to the theoretical risk of gastroesophageal reflux following a myotomy, an antireflux procedure is sometimes performed. We reviewed the approach to a robotic heller myotomy for the treatment of achalasia.

作者聚焦:用于治疗贲门失弛缓症的尖端机器人 Heller 肌切开术方案

The protocol presents a robotic approach to Heller myotomy for the treatment of achalasia.

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

Achalasia is an esophageal motility disorder. It occurs due to the destruction of nerves in the lower esophageal sphincter (LES), which leads to the ...

重做前肠手术的技术考虑因素和方法

副本

摘要

探索更多视频

此视频中的章节

空肠Roux-en-Y胃搭桥手术大鼠

静脉造影切除术，旨在最大限度地减少麻醉并发症和优化导管功能

低成本单端口（LoCoSP）设备，用于微创性跨侵入性食管切除术中的内脏方法

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

机器人肌切开术和部分胃底折叠术治疗贲门失弛缓症

Surgical Treatment of Gastroparesis

Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

重做前肠手术的技术考虑因素和方法

副本

摘要

探索更多视频

此视频中的章节

空肠Roux-en-Y胃搭桥手术大鼠

静脉造影切除术，旨在最大限度地减少麻醉并发症和优化导管功能

低成本单端口 （LoCoSP） 设备，用于微创性跨侵入性食管切除术中的内脏方法

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

机器人肌切开术和部分胃底折叠术治疗贲门失弛缓症

Surgical Treatment of Gastroparesis

Robotic Vagus-Sparing Total Gastrectomy for CDH1 Gene Mutation Treatment

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

机器人 Heller 肌切开术促进贲门失弛缓症手术治疗的进步

低成本单端口（LoCoSP）设备，用于微创性跨侵入性食管切除术中的内脏方法