The Experimental And Clinical Study Of Fishhook-traction In Laparoendoscopic Single-site Surgery

Part 1Background: Surgery is a invasive treatment.In the treatment of disease It will inevitably take different trauma to the body.Therefore,how to minimize the trauma to achieve a satisfactory therapeutic effect has been the surgeon's goal.Laparoendoscopic surgery is one of minimally invasive surgical techniques which is widely applied in general surgery,gynecology and urinary surgery,It also achieved a good therapeutic effect. With the development of minimally invasive technique, laparoendoscopic single-site surgery (LESS) technology also gradually carried out.Compared to traditional laparoscopic surgery, LESS technology has many advantages, such as: small trauma and good cosmetic effect.the use of LESS is also gradually increasing.But the LESS is also faced with many difficulties.especially auxiliary method of exposing the operative field, still no unified standard.There is no system analysis about the auxiliary method which is more practical and security.This study chose the fishhook-traction auxiliary method, probe into its feasibility in LESS.Objective:To study the feasibility,safety and effectiveness of the fishhook-traction auxiliary method in LESS,summarizes the operation skill of the operation process and provide reference for clinical use.Methods:9 small family pig, male and female not limited, were as the animal models,3 of them only underwent a single-incision laparoscopic Cholecystostomy, the other six sexual underwent single-incision laparoscopic distal pancreatectomy,with the use of fishhook-traction auxiliary method to expose the operative field.The data about operation time,blood loss, mortality, complication rates,was recorded and analysised.Results: In the single-incision laparoscopic distal pancreatectom group,1 case was failed due to blooding uncontrolled.the other 8 cases underwent operations successfully. The mean operation time was 155 minutes (range:102-236 minutes).The mean operation time of the first 2 animals was 177 minutes, the mean operation time of the last 3 cases was 134 minutes, the rapid learning curve.The mean blood loss was 50ml.Experimental animals recovered well postoperatively and no obvious complications, an mean time of the animals began to increase weight was 10.6 days (range:6 to 15 days).Three weeks after execution of experimental animals, did not see serious complications such as pancreatic leakage or abdominal infection.Conclusion:Through animal experiment,it was indicated that fishhook-traction auxiliary method,used in LESS, was easy to use, convenient,minimally invasive, feasibility and practicability.Part 2Objective: To compare security and practicability of the techniques of single-incision laparoscopic cholecystectomy(SILC) and umbilical laparoscopic appendectomy (ULA) via fishhook-traction versus suture-suspension.Methods:Restrospective analysis was performed for a total of 21 patients undergoing umbilical single-incision laparoscopic cholecystectomy and 23 patients undergoing umbilical laparoscopic appendectomy from April 2013 to October 2014.The SILC procedures were of fishhook-traction(n=15) and suture-suspension (n=6), The ULA procedures were of fishhook-traction(n=12) and suture-suspension (n=11).Operative duration,estimated intra-operative blood loss,exposure extent,postoperative pain score,hospital stay after surgery and complcations were compared respectively between two groups.Both groups were matched for age,gender, and diagnoses.Result:ALL procedures were completed by same surgeon.SILC group: Comparison between two showed significant differences in operative duration(mean: (106.7±27.5) vs (137.5±37.0); (t=-2.175, P=0.043)),,exposure extent of Calot's triangle(15 vs 6); insignificant differences in intra-operative blood loss((13.0±4.1) vs (15.8±4.9);t=-1.346, P=0.194),postoperative pain score (3vs3),hospital stay after surgery ((3.4±0.7) vs (4.5±1.8);t=-1.935, P=0.068) and complcations(0 vs 0).Thus the fishhook-traction method was superior to the suture-suspension method. ULA group: Comparison between two showed significant differences in operative duration(mean:(82.5±23.9) vs (107.7±27.1); (t=2.375, P=0.027)), insignificant differences in intra-operative blood loss((14.6±4.5) vs (17.3±7.2);t=-1.085, P=0.290),postoperative pain score (3 vs 3),hospital stay after surgery ((4.0±1.3) vs (4.6±3.1);t=-0.647, P=0.525).Conclusion: Thus the fishhook-traction method was superior to the suture-suspension method.Conclusion The fishhook-traction method of SILC and ULA is safe and effective in clinical practice.