| 摘要 |
The minimally invasive surgical technique, like innovative technology, continues to
evolve and be refined. New concepts in the surgery of benign and malignant gastrointestinal
diseases will stimulate GI surgeons to deliver effective treatment in more
minimally invasive procedures.
1. Laparoscopic gastrectomy for malignancy: With growing experience, laparoscopic
gastric resections have become common procedures in certain high-volume
hospitals and have encouraged the use of laparoscopy in the resection of gastric
malignancy. However, the long-term oncologic outcome has not been established
in large series.
2. Laparoscopic resection of colorectal cancer: Laparoscopically assisted colon
resection was first reported in 1991. Since then laparoscopic resection of both
benign and malignant colorectal diseases has been systematically evaluated. The
cornerstone in the treatment of colorectal cancer establishes in surgical colon
resection with a laparoscopic approach. Whereas the short-term outcome of
laparoscopic versus open resection of colorectal malignancy has been evaluated,
the long-term outcome still needs further evidence.
3. Bariatric surgery: The increasing use of bariatric procedures in the treatment of
morbidly obese patients has undergone common practice. In general, restrictive,
mal-absorptive, or combined restrictive and mal-absorptive procedures are the
domain for the surgical treatment of diseased obesity. Both methods are the most
common procedures for weight reduction at present.
4. Laparoscopic liver resection; Laparoscopic hepatectomy could avoid the
disadvantages of open hepatectomy and is beneficial for the patient’s life quality
as a minimally invasive procedure. The indications for the laparoscopic approach
are the tumor of less than 5cm, and it’s location at the left or anterior sector
superficially. The clinical long-term follow-up, either for laparoscopic or
traditional liver resection for hepatocellular carcinoma, has been evaluated, and
has failed to show significant differences between the laparoscopic and traditional
groups.
5. Laparoscopic surgery in liver-donor hepatectomy: The most controversial topic in
liver surgery has been the performance of living donor hepatectomy. The
mortality of this procedure has varied from 0.5 to 1.0% based on reporting and performance of hepatectomy: left lateral section, left hepatectomy or right
hepatectomy.
6. Role of minimally invasive surgery in pancreatic diseases: Laparoscopic
pancreatico-duodenectomy or central pancreatectomy for pancreatic tumor have
been performed in specialized centers of the world. Additionally, studies that
specifically evaluate and compare the oncologic outcomes of laparoscopic and
open pancreatic resections are needed.
In addition, natural orifice transluminal endoscopic surgery (NOTES) has the
potential to redefine minimally invasive surgery. Application in human subjects is
seen in sporadic reports. Rapid development of laparoscopic minimally invasive
surgery and robot surgery will in all probability provide the greatest benefit for
surgical science in the near future. |
