Our team frequently confronts problems such as inadequate exposure and time-consuming adjustment during single-port laparoscopic cholecystectomy.Recently，our team has employed T-shaped shape memory alloy wires in single-port laparoscopic cholecystectomy，which entails penetrating the basal layer of the gallbladder and the mesothelium of the cystic duct to pull the gallbladder at different angles for enhanced exposure.This procedure is denominated the marionette single-port laparoscopic cholecystectomy.With the assistance of this instrument，the operation becomes less arduous，the exposure effect is more pronounced，and in comparison with the conventional single-port laparoscopic liver resection，it adds three 1.1mm port holes.The assistant port heals without leaving scars，and its postoperative aesthetic outcome is comparable to that of conventional single-port laparoscopic surgery，and even the umbilical incision is smaller.This video showcases the marionette single-port laparoscopic cholecystectomy，which is a suitable technique worthy of promotion.

Locally advanced rectal cancer (LARC) is defined as a tumour that has invaded the entire bowel wall and may have spread to adjacent tissues or lymph nodes, but has not yet developed distant metastasis.The goals of treatment for LARC are to reduce local recurrence, improve anal retention, and reduce the risk of distant metastasis.Currently, the standard treatment options for LARC mainly include neoadjuvant radiotherapy (nCRT), total mesorectal excision (TME), and adjuvant chemotherapy.Although nCRT and TME have significantly reduced the rate of local recurrence, distant metastasis and low overall pathological complete remission (pCR) rates remain major challenges.In recent years, immunotherapy, especially immune checkpoint inhibitors (e.g., PD-1/PD-L1 inhibitors), has shown significant promise in cancer treatment.Studies have shown that the combination of immunotherapy and nCRT can significantly increase the pCR rate and clinical complete remission (cCR) rate, and enhance anal retention, especially for microsatellite-stabilised (MSS) patients who are usually insensitive to single immunotherapy.In this paper, we will discuss the issues related to neoadjuvant radiotherapy combined with immunotherapy in locally progressive rectal cancer.

Pancreatic fistula is one of the common complications of pancreatic resection, which not only increases the risk of abdominal infection, bleeding, multiple organ failure and other diseases, but also has a high incidence, which seriously threatens the life safety of patients.Therefore, this article reviews its risk factors and treatment progress, in order to provide reference for the prevention and treatment of postoperative pancreatic fistula.

Laparoscopic liver cancer surgery in China has evolved through four distinct stages：exploratory，growth，promotion，and current maturity.During this mature phase，the technical approaches have become standardized，with surgical indications now closely paralleling those of open hepatectomy.Perioperative safety profiles and long-term oncological outcomes have been rigorously validated through multicenter studies.Present efforts focus on nationwide standardization and addressing persistent challenges such as anatomical complexity and training disparities.This article reviews the evolutionary trajectory of laparoscopic liver resection in China，analyzes its current clinical implementation，and discusses remaining barriers alongside future directions for innovation.

Objective

To observe the clinical application effect of three surgical methods （stent placement+laparoscopic surgery，laparotomy+intraoperative enteric cavity irrigation，stent placement+laparotomy） on patients with colorectal cancer （CRC） complicated with intestinal obstruction （IO），and to analyze the influence on gastrointestinal function indicators and inflammatory indicators of patients.

Methods

The clinical data of 108 patients with CRC complicated with IO in the hospital were retrospectively analyzed from June 2021 to June 2024，and the patients were divided into group A （stent placement+laparoscopic surgery，n=39 cases），group B （laparotomy+intraoperative stent placement，n=34 cases） and group C （stent placement+laparotomy，n=35 cases） according to different surgical methods.SPSS 22.0 software was used for data analysis.Measurement data such as surgical indicators and inflammatory indicators were analyzed by One-WayANOVA of variance.Enumeration data such as complications were analyzed by χ² test.P＜0.05 was considered statistically significant.

Results

There was no significant difference in the operation time among the three groups （P＞0.05）.There were significant differences in the intraoperative blood loss，postoperative exhaust time，time to first get out of bed after surgery，and length of hospital stay among the three groups（P＜0.05）.The intraoperative blood loss in Groups B and C was higher than that in Group A （P＜0.05），and the postoperative exhaust time，time to first get out of bed after surgery，and length of hospital stay in Groups B and C were longer than those in Group A （P＜0.05）.The levels of carbohydrate antigen 125 （CA125） and vascular endothelial growth factor （VEGF） in the three groups decreased significantly 4 weeks after surgery （P＜0.05），but there was no significant difference among the three groups （P＞0.05）.There were significant differences in the levels of lymphocyte - to - monocyte ratio （LMR），motilin，vasoactive intestinal peptide （VIP），tumor necrosis factor - α （TNF - α），and interleukin - 6 （IL- 6） among the three groups after surgery （P＜0.05）.The LMR，motilin，and VIP levels in Groups B and C were lower than those in Group A （P＜0.05），while the levels of TNF - α and IL - 6 were higher than those in Group A （P＜0.05）.There was a significant difference in the total incidence of postoperative complications among the three groups （P＜0.05），and the incidence in Group A was significantly lower than that in Group B （P＜0.05）.

Conclusion

For patients with colorectal cancer complicated by intestinal obstruction，treatment with stent placement + laparoscopic surgery can reduce the patients’ inflammatory response and the impact on gastrointestinal function，thus contributing to postoperative recovery.

Objective

To investigate the effect and survival prognosis of radiofrequency ablation(RFA) combined with thyroid stimulating hormone (TSH) suppression in the treatment of papillary thyroid microcarcinoma (PTMC).

Methods

The medical records of 148 patients with PTMC in the hospital were retrospectively analyzed from April 2020 to April 2023.According to different treatment methods, they were divided into RFA group (RFA combined with TSH suppression therapy, n=76) and resection group (surgical resection combined with TSH suppression therapy, n=72).The data were analyzed by SPSS 24.0 software.Measurement data such as surgical related indicators, lesion volume and thyroid hormone indicators were expressed as (x±s).LSD-t test was used for between-group comparison, and paired sample t test was adopted for within-group comparison.Enumeration data such as lymph node metastasis rate and tumor recurrence rate were expressed as ［cases (%)］ by adopting χ² test.P＜0.05 was considered statistically significant.

Results

The surgical time, intraoperative blood loss, hospital stay and VSS score in RFA group were shorter or less than those in resection group (P＜0.05).The incidence rates of complications in RFA group were lower than those in resection group (P＜0.05).At 1, 3, 6 and 12 months after surgery, the lesion volume in RFA group showed a decreasing trend, and the VRR showed an increasing trend (P＜0.05).TSH level at 30 days after surgery was increased in RFA group (P＜0.05), and the level was lower in RFA group than that in resection group (P＜0.05).The levels of free triiodothyronine (FT3) and free thyroxine (FT4) at 30 days after surgery were declined in both groups (P＜0.05), but the levels in RFA group were higher than those in resection group (P＜0.05).There was no obvious difference in incidence rate of total poor prognosis between both groups (1.3% vs. 4.2%)(P＞0.05).

Conclusion

RFA combined with TSH suppression therapy and surgical resection can achieve good results, but RFA can better reduce intraoperative blood loss, surgical time and hospital stay, avoid high risk of complications and promote rapid absorption of lesions, and it has better long-term prognosis effect and has more minimally invasive advantages.

Surgical repair is the primary method for treating abdominal wall hernias. Laparoscopic hernia repair, based on the concept of minimally invasive surgery, has gradually gained popularity in our country. Modern hernia surgery focuses on restoring abdominal wall function while pursuing less trauma.With the continuous update of new materials, new technology and new operating platform, a variety of surgical methods have been derived on the basis of traditional endoscopic hernia repair. Different operation methods have different theoretical basis, advantages and disadvantages and adaptation range. Strictly grasp the surgical indications, combined with the individual conditions of patients and the experience of surgeons, choose the most reasonable surgical methods, so as to maximize its advantages. It is believed that laparoscopic hernia repair in China will have broad development prospects in the future.

Objective

To investigate the application value of indocyanine green (ICG) imaging technique in the preservation of left colic artery (LCA) during laparoscopic radical resection of rectal cancer.

Method

The data of 80 patients with LCA who underwent laparoscopic radical resection for rectal cancer from April 2022 to January 2024 were retrospectively analyzed and divided into ICG group (n=40 cases) and control group (n=40 cases) according to different operation methods.The ICG group was assisted by indocyanine green development to preserve LCA, while the control group underwent conventional laparoscopic radical resection of rectal cancer to preserve LCA.SPSS26.0 software was used to analyze the data.The perioperative period and other measurement data of the two groups were expressed as (± s), and independent sample t test was used.Postoperative complications and left colic artery retention rate were measured by χ² test.P＜0.05 was considered statistically significant.

Results

The intraoperative blood loss, postoperative bowel sound recovery time and hospital stay in ICG group were lower than those in control group, and the success rate of LCA retention, total lymph nodes and the number of lymph nodes dissection in group 253 were higher than those in control group,with statistical significance (P＜0.05).There were no significant differences in operation time, lymph node metastasis rate and postoperative complication rate between 2 groups (P＞0.05).

Conclusion

Indocyanine green imaging technology can improve the success rate of LCA retention, increase the lymph node clearance rate, reduce the amount of intraoperative blood loss, and has the value of popularization.

Objective

To investigate the safety and efficacy of intravenous indocyanine green navigation surgery in radical gastrectomy.

Methods

Nine patients receiving intravenous indocyanine green guided radical gastrectomy were enrolled.All patients underwent standard D2 lymph node dissection and lymph node sorting.Indocyanine green was injected at 0.5h, 4h and 12h before surgery, respectively.Perioperative indexes, imaging effects of tumor and lymph nodes, the ratio of tumor and lymph nodes to surrounding tissue,the number of lymph nodes sorted at each station and the total number were analyzed.Measurement data with normal distribution were represent as (Mean±SD).

Results

The mean operation time of the included patients was (206.7±33.1) min, the intraoperative blood loss was (161.1±48.6) ml, and the postoperative hospital stay was (10.1±1.8) d.None of the 9 patients had serious complications.The imaging of tumor and lymph nodes could be achieved at all three time points.The highest ratio of tumor to normal gastric mucosal tissue was (2.5±0.4) at 0.5h,and the highest ratio of lymph node to surrounding tissue was (1.9±0.6) at 12h.The total number of lymph nodes was (74.0±29.2).

Conclusions

Intravenous indocyanine green navigation radical gastrectomy is effective.

Laparoscopic hernia surgery has developed rapidly in China for 20 years. Its characteristics of minimal invasive, fast recovery, and low complications have been highly sought after by doctors and patients.The proportion of laparoscopic surgery has also significantly increased, not only in the field of inguinal hernia,but also in other abdominal wall hernias such as incisional hernia, parastomal hernia, and hiatal hernia. The progress in technology and materials, as well as the application of new technologies such as single-incision hernia repair, robotic surgery, and MINIM technique, have led to continuous improvement in the efficacy of laparoscopic hernia surgery. However, there are still many problems, such as mesh related complications,general anesthesia trauma, and new technology learning curve related issues, which restrict the development of laparoscopic hernia surgery. In the future, laparoscopic technology will become the preferred method for most hernia surgeries, and telemedicine and artificial intelligence will provide broader development space for minimally invasive technology.

Objective

To explore the clinical effects of laparoscopic partial hepatectomy (LPH)and laparoscopic common bile duct exploration and stone removal (LCBDE) in the treatment of intrahepatic cholangiolithiasis.

Methods

A total of 88 patients with intrahepatic cholangiolithiasis from April 2014 to March 2020 were retrospectively selected. According to the different surgical methods, they were divided into the LPH group (n=46 cases, undergoing LPH) and the LCBDE group (n=42 cases, undergoing LCBDE).The SPSS27.0 statistical software was used to process the data. Measurement data conforming to the normal distribution were expressed as (). Independent sample t tests were used for comparisons between groups,and paired sample t tests were used for comparisons within groups. Enumeration data were expressed as［ cases(%)］, and χ² tests were performed. P<0.05 was considered to indicate a statistically significant difference.

Results

Compared with the LCBDE group, the patients in the LPH group had a longer operation time and more intraoperative blood loss (P<0.05). The levels of alanine aminotransferase (ALT), aspartate aminotransferase(AST), gamma-glutamyl transpeptidase (γ-GGT), and total bilirubin (TBIL) of the patients in both groups were higher than those before the operation at 1 day and 3 days after the operation (P<0.05), and the above indicators in the LPH group were higher (P<0.05). There was no significant difference in the incidence of postoperative complications between the LPH group and the LCBDE group (P>0.05). Compared with the LCBDE group,the patients in the LPH group had a lower residual stone rate after the operation (P<0.05). After a 36-month follow-up after the operation, there was no significant difference in the recurrence rate between the two groups(P>0.05).

Conclusion

Different minimally invasive surgical methods can achieve good effects in the treatment of intrahepatic cholangiolithiasis. LCBDE has more advantages in terms of minimal invasiveness, but it is inferior to LPH in reducing the intraoperative residual stone rate. Therefore, in clinical practice, individualized treatment plans should be selected according to the actual situation of patients.

For locally advanced rectal cancer, the standard treatment regimen is neoadjuvant chemoradiotherapy followed by total mesorectal excision.With the advent of the immunotherapy era, the synergistic anti-tumor effects of chemoradiotherapy and immunotherapy have been validated in multiple clinical studies.For pMMR/MSS locally advanced rectal cancer, neoadjuvant chemoradiotherapy combined with immunotherapy has further improved the rates of clinical complete response and pathological complete response, and it holds promise for showing advantages in organ preservation and long-term survival.However,the safety concerns associated with the new treatment modality need close attention.Additionally, the evaluation of treatment efficacy, the screening of beneficiary populations, and the combination with other medications warrant further exploration.