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Introduction: Patients with moderate (grade II) acute cholecystitis patients, as defined by the 2013 Tokyo Guidelines, were retrospectively compared with respect to emergency cholecystectomy (EC) and delayed cholecystectomy (DC) after percutaneous transhepatic gallbladder drainage (PTGBD) to determine the better treatment strategy., Methods: Forty-nine of 103 patients with PTGBD and 47 of 54 patients with EC were assessed for eligibility from January 2013 to January 2017. Patients with the following conditions were included: (i) moderate (grade II) acute cholecystitis diagnosed by the 2013 Tokyo Guidelines; (ii) no common bile duct stones; (iii) no atrophic cholecystitis; (iv) no decompensated liver cirrhosis and massive ascites; (v) no diffuse peritonitis; (vi) surgeons are professors or associate professors; and (vii) PTGBD is not the only procedure for the patient defined by clinicians. The preoperative characteristics and postoperative outcomes were analyzed. PTGBD was performed by experienced interventional radiologists and cholecystectomy was performed by professors or associate professors., Results: Patients in the EC and PTGBD + DC groups had similar demographic, clinical, preoperative laboratory, and imaging characteristics. Both PTGBD and EC resolved the cholecystitis quickly. Compared to the PTGBD + DC group, EC patients had more intraoperative bleeding (101 ± 125 mL versus 33 ± 37 mL, P = .003), longer duration of postoperative abdominal drainage (9.0 ± 12.9 days versus 3.4 ± 2.1 days, P = .041), more patients converted to open cholecystectomy (OC; 19.1% versus 4.1%, P = .021), more OC patients (14.9% versus 0%, P = .005), more patients with gangrenous cholecystitis (40.4% versus 8.2%, P < .001), more cholecystitis patients with perforation (12.8% versus 0%, P = .012), a higher incidence of respiratory failure (14.8% versus 2.0%, P = .029), more admissions to the intensive care unit (ICU) (21.3% versus 2.0%, P = .003), and longer postoperative hospital stays (8.2 ± 3.2 days versus 11.6 ± 4.6 days, P < .001) in the PTGBD + DC group. In addition, there were statistically more OC patients (63.2% versus 14.3%, P = .001) in the nonbiliary surgeon group than the biliary surgeon group., Conclusion(s): In patients with moderate (grade II) acute cholecystitis, PTGBD and EC were highly efficient in resolving cholecystitis. DC patients after PTGBD had better outcomes with a lower rate of OC, less intraoperative bleeding, shorter duration of postoperative abdominal drainage, shorter hospital stays after cholecystectomy, a lower incidence of respiratory failure, fewer admissions to the ICU than EC, and reversed the pathologic process affecting the gallbladder. The total postoperative hospital stay was longer in the PTGBD + DC group.

Purpose: Quadrantectomy with multiple-incision laparoscopic axillary clearance for the treatment of early breast cancer is already well established. With the aim of reducing the axillary scar, we shared our 5 cases to demonstrate the safety and feasibility of quadrantectomy with laparoscopic axillary clearance through a single incision., Patients and Methods: From May 2010 to January 2013, single-incision quadrantectomy and laparoscopic axillary clearance were performed on 5 patients with early breast cancer by using conventional laparoscopic instruments. Surgical techniques and short-term outcomes were summarized and analyzed retrospectively., Results: All the operations were successful with operative duration of 85-120 minutes, intraoperative blood loss of 20-50 mL, and hospital stay of 4-6 days. No intraoperative or postoperative complications were recorded. The incision wound healed uneventfully, with no scar in the axillary fossa., Conclusions: The combination of single-incision quadrantectomy and laparoscopic axillary clearance in the treatment of early breast cancer appears to be a technically safe and feasible alternative to the standard laparoscopic procedure and can be performed using conventional laparoscopic instruments.

Aim: To study the feasibility and efficiency of transumbilical single-incision laparoscopic surgery splenectomy (SILS-Sp) using conventional instruments in consecutive patients and to compare outcomes of the procedure with those of standard multiple-incision laparoscopic splenectomy (MLS)., Patients and Methods: A retrospective review was conducted to evaluate all SILS-Sp procedures performed by a single surgeon between March 2010 and January 2013. Additionally, patients who underwent MLS by other surgeons in the same surgical group during the same period were evaluated to serve as a control group. Demographic data, operative parameters, and postoperative outcomes were assessed., Results: Thirteen patients underwent successful SILS-Sp during the study period without conversion to an open procedure or requiring additional ports. The median operative time was 165 minutes. There was 7.7% morbidity and no mortality in the study group. Median length of stay was 8.8 days. Additionally, 12 patients who underwent MLS were evaluated for comparison. No significant differences were identified in the preoperative patient characteristics between the two groups. For MLS, the median operative time was 158 minutes. There was 8.3% morbidity and no mortality in the group. Median length of stay was 8.3 days. SILS-Sp using conventional instruments was associated with reduced postoperative pain scores, but this did not reach statistical significance. The operative time, conversion rate, and length of stay were equivalent. The mortality, morbidity, and cost were also similar in the two groups. The umbilical incision of the single-incision group can be easily hidden in the umbilical fold with ideal cosmetic result., Conclusions: SILS-Sp is feasible and efficient in an unselected patient population in the hands of an experienced laparoscopic surgeon. The single-incision technique is comparable to standard laparoscopic splenectomy in terms of operative time and perioperative outcomes. Ideal cosmetic effect may be its potential advantage.

Background/aim: Single-incision laparoscopic fundoplication is not widespread because of its technical difficulty. An additional stay suture or retractor is often needed for liver retraction during the procedure. Here, we share our 7 cases to demonstrate the feasibility of transumbilical single-incision laparoscopic fundoplication with a new technique for liver retraction without any stay suture or retractor., Patients and Methods: From March 2010 to October 2011, 3 patients with achalasia underwent a transumbilical single-incision laparoscopic Heller-Dor operation, and 4 patients with hiatus hernia underwent transumbilical single-incision laparoscopic hernioplasty and Nissen fundoplication. The procedures were attempted transumbilically by using three rigid trocars (one was 10 mm, and two were 5 mm) inserted through the 2-cm umbilicus incision. Conventional laparoscopic instruments were used. Adequate retraction of the liver was achieved by binding the lateral left lobe of the liver to the diaphragm with cyanoacrylate., Results: The pneumoperitoneal time was 115-170 minutes, and blood loss was 15-50 mL. There were no intra- or postoperative complications. The hospital stay was under 6 days for all patients. The umbilical incision healed well with satisfactory cosmetic effect., Conclusions: The transumbilical single-incision laparoscopic technique in the treatment of achalaisa and hiatus hernia is feasible for an experienced laparoscope surgeon with excellent cosmetic effect. Cyanoacrylate, when used as described, offers a safe and simple solution to the problem of liver retraction, thus obviating the need for a stay suture or liver retractor.

Purpose: Laparoendoscopic single-site surgery (LESS) has been proposed for several intra-abdominal surgical interventions. However, application of the LESS technique in portal hypertension is still in its infancy. We report in this article a new technique of LESS splenectomy plus pericardial devascularization with conventional laparoscopic instruments in patients with portal hypertension., Patients and Methods: From January 2010 to April 2012, LESS splenectomy plus pericardial devascularization was performed on 5 patients with portal hypertension. Surgical techniques and short-term outcomes were summarized and analyzed retrospectively., Results: All the operations were successful with a mean operative duration of 252 minutes (range, 220-270 minutes), intraoperative blood loss of 290 mL (range, 250-350 mL), and hospital stay of 8.2 days (range, 7-9 days). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect., Conclusions: LESS splenectomy plus pericardial devascularization is feasible when performed by experienced laparoscopic surgeons and may offer safety comparable to that of the conventional laparoscopic operation.

Background: In this article we report our initial clinical experience about umbilical single-incision laparoscopic surgery (SILS) radical gastrectomy with D2 lymph node dissection for early gastric cancer with conventional laparoscopic instruments., Subjects and Methods: Preliminary experiences with umbilical SILS radical gastrectomy in 4 patients with early gastric cancer were described., Results: Umbilical SILS radical gastrectomy with D2 lymph node dissection was performed successfully with conventional laparoscopic instruments in these 4 patients. Average operative time was 280 minutes, and average blood loss was 162 mL. No intraoperative or postoperative complications, such as secondary hemorrhage, anastomotic leakage, or obstruction, were recorded. The patients recovered fully, and the single umbilical scar was well healed., Conclusions: Our initial experience showed that transumbilical SILS radical gastrectomy with D2 lymph node dissection for early gastric cancer is feasible and safe when performed by experienced laparoscopic surgeons.

Purpose: Various techniques for minimally invasive thyroid surgery have been described over the last decade. As interest in single-port access laparoscopic surgery (SPA™) continues to grow, the authors present their technique and short-term outcomes for single-port access transaxillary totally endoscopic thyroidectomy in the management of benign thyroid tumors in a series of 4 patients., Patients and Methods: Four consecutive patients from a prospectively maintained endoscopic thyroidectomy database were analyzed under an institutional review board-approved protocol. Clinical characteristics and short-term outcomes were reviewed., Results: All the patients were young women with no prior neck surgery. A single-port totally endoscopic thyroidectomy was performed for thyroid adenoma in 2 cases and for nodular goiter in 2 cases. Retraction, exposure, and extraction were possible in all cases. The average operating room time was 92.5 minutes. Postoperative pain scores on postoperative day 1 were all 1/10. No patient experienced complications. The median hospital stay was 1.75 days. The mean specimen size was 2.7 cm × 2.375 cm × 2.625 cm. The patients were uniformly pleased with the cosmetic results of the operation., Conclusions: Single-port access transaxillary totally endoscopic partial thyroidectomy appears to be safe and feasible. This technique may provide both an attractive way to reduce injury to the anterior neck tissue and a method for ideal cosmetic effect.

Background: Recent reports have suggested that single-incision laparoscopic cholecystectomy (SILC) is technically feasible. We present our initial retrospective comparative study between SILC and conventional laparoscopic cholecystectomy (CLC) with respect to perioperative outcomes., Methods: The authors reviewed 100 SILC and 100 CLC performed by a single surgeon from May 2009 to July 2010 at the Shengjing Hospital of China Medical University. All the procedures were completed by using the standard trocars and rigid laparoscopic instruments. Demographic data, operating time, estimated blood loss, analgesics requirements, days to oral food intake, and complications were compared., Results: Of the attempted SILC cases, 99 cases (99%) were successfully performed, with 1 case requiring three additional trocars for safe dissection because of existence of accessory bile duct. In the CLC group, all the procedures were successfully completed (three trocars) without conversion to open cholecystectomy. Compared with the CLC group, there was a lower mean estimated blood loss (17.9 ± 15.8 mL versus 27.5 ± 13.9 mL; P = .000) and analgesic requirement (10 versus 23; P = .024) in the SILC group. However, there was no difference between SILC and CLC in operating time (53.5 ± 24.0 minutes versus 49.2 ± 13.8 minutes; P = .163), days to oral food intake (1.8 ± 0.8 days versus 1.8 ± 0.7 days; P = .873), and postoperative complication rate (2% versus 0%; P = .155)., Conclusion: SILC is feasible using the standard trocars and rigid laparoscopic instruments, and it is an effective alternative to CLC in selected patients. However, further clinical studies are necessary to confirm its real benefits.

Background and Aim: The traditional management of open/laparoscopic choledochotomy after common bile duct (CBD) exploration is accomplished by placement of a T-tube, a procedure historically associated with complications and discomfort. In this study, we share in humble our laparoscopic experience of the use of primary closure of CBD, primary closure over pigtail J, and endonasobiliary drainage (ENBD) tubes as easy and effective alternatives to T-tubes., Methods: From April 2006 to March 2009, 27 (16 women) patients with CBD stones underwent laparoscopic choledochotomy at our institute and were engaged in this study by means of T-tube-free approach after bile duct exploration: primary closure, pigtail J tube, and ENBD tube groups. On admission, routine laboratory and imaging workups were performed to confirm choledocholithiasis diagnosis., Results: The mean operative time for primary closure, pigtail J tube, and ENBD tube groups were 95, 100, and 97.5 minutes, respectively. There was no conversion to open surgery nor was intraoperative complication experienced in all the groups. No major biliary complications such as bile leakage or bile peritonitis were seen; however, 1 patient from the pigtail J group experienced premature tube dislodgement and 1 patient from the ENBD tube group was found with a singular CBD retained stone., Conclusions: Laparoscopic primary closure of the CBD and over pigtail J and ENBD tubes are easy and effective alternatives to T-tube placements; these procedures are safe and with great feasibility, they offer faster recovery time for patients and early discharge with lower hospital charge.