1.1 General information Retrospective 60 patients with stage I ovarian cancer who were hospitalized and diagnosed in Chongqing Ninth People's Hospital、Beijing Ditan Hospital Affiliated to Capital Medical University and Luohu Maternal and Child Health Hospital Shenzhen from February 2012 to May 2020 were selected. The first 29 cases were treated with conventional laparoscopy(control group),next 31 cases were treated with left lower laparoscopic greater omentum resection (observation group). Case selection criteria: ①The patients had no severe medical diseases and can tolerate surgery. ②The maximum diameter of the tumor was less than 12 cm. The Ethics Committee of Chongqing Ninth People's Hospital approved the study. All patients signed informed consent.
Surgical procedures followed: ①The ascites or lavage fluid of pelvic cavity were collected for cytological examination; ②after high ligation of ovarian artery and vein, removal one or both adnexa were put into the specimen bag, and the rapid frozen pathology was carried out. ③The removal uterus was taken out from the vagina. ④pelvic and paraaortic lymph node were taken out from the vagina . ⑤greater omentum below transverse colon was excised. ⑥multi point peritoneal biopsy of paracolonic sulcus and pelvic wall were performed. ⑦appendectomy was performed(for mucinous tumor). ⑧The vaginal stump was sutured under laparoscope. The procedure were performed by conventional four ports (Fig. 1–3).
We took trendelenburg position to remove the greater omentum in control group, the surgeons faced the patient's feet, the laparoscopy was inserted from A point. In the observe group, the patient's position was anti-trendelenburg. Laparoscopic holder standed on the outside of the patient's left thigh, facing the patient's head, the laparoscopy was inserted from D point towardpatient's head. The surgeon standed between patient two legs. When the greater omentum near splenic flexure was resected, noninvasive forcep was put from incision A and ultrasonic scalpel was put from incision B; During the resection of the greater omentum near the liver, ultrasonic scalpel was put through incision A, and noninvasive forceps was put from the incision C (Fig. 4).
1.2.4 observation index The operation time (only removal the greater omentum)、intraoperative blood loss(volume change of negative pressure suction bottle during omentum resection, we did not wash to avoid inaccurate measurement). Intraoperative complications(the injury of stomach, intestine, liver and spleen) and postoperative severe complications (intestinal obstruction、bacteremia、pulmonary embolism、Lymphocyst、respiratory failure and deep venous thrombosis) after omentum resection, hospital stay and postoperative gastrointestinal exhaust time. All patients were followed up every 3 months. The complications and recurrence or death were observed.
1.3 Statistical methods
Spss17.0 statistical software (IBM Corp., New York,NY)was used,the measurement data was expressed by x̄ ± s, independent sample t test, Fisher exact test was used for counting data, and the test level was α = 0.05.