摘要:About this book This book introduces laparoscopic surgeries in liver resection using the technique of curettage and aspiration.Surgical procedures,techniques and special instruments are described in this book.Each step is explained and illustraed with high-quality figures,hand-drawings and videos.This atlas will serve as a stepby-step guide for laparoscopic liver resection.
摘要:Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this plane.None of the bony landmarks can be used during the transoral robotic surgery(TORS)radical tonsillectomy as these landmarks lie lateral to the internal carotid artery(ICA)and external carotid artery(ECA)in transoral approach.Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study.Material and methods:Fifteen cadavers(30 head and neck regions)and 50 CT-Angiogram of neck(100 head and neck regions)were included in the anatomical and radiological study respectively.The vertical midpoint of anterior tonsillar pillar(palatoglossus muscle)was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study.Distance between tonsillar fossa and ECA,distance between tonsillar fossa and ICA,relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied.Results:The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study.The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study.There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa(p value was 0.45 and 0.30 respectively).ECA was located posterolateral to styloglossus in 24 cases(80.0%)and 79 cases(79.0%)in the anatomical and radiological study respectively.ICA was found posterolateral to stylopharyngeus in 21 cases(70.0%)and 69 cases(69.0%)in the anatomical and radiological study respectively.Conclusion:The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS.We propose to divide the parapharyngeal space into two compartments(anterior and posterior)based on the surgical perspective of inside-out anatomy.The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.
摘要:Esophageal cancer is a common cancer with a high case-related mortality worldwide,and radical resection offers the best survival.Initial reports have suggested that esophagus is an ideal organ which could benefit with robotic assistance.However,it remains to be seen whether robotic technology translates into better surgical outcomes and survival for the patients with esophageal cancer.We searched PubMed,Scopus and Google Scholar for English language articles.The search terms included minimally invasive esophagectomy or MIE,robotic-assisted esophagectomy,hybrid esophagectomy,robot-assisted minimal invasive esophagectomy or RAMIE,esophageal cancer,esophageal carcinoma.We review the development of robotic-assisted esophagectomy to focus on the surgical techniques and oncological clearance,and present a brief summary of our experience in this approach.Controlled trials will be required to establish the benefit of robotic-assisted esophagectomy,however the current literature points towards the safety and feasibility of this approach.
摘要:The China STEM Journal Excellence Action Plan is jointly implemented by the China Association for Science and Technology,Ministry of Finance of the People's Republic of China,Ministry of Education of the People's Republic of China,Ministry of Science and Technology of the People's Republic of China,National Press and Publication Administration,Chinese Academy of Sciences,and Chinese Academy of Engineering.This plan aims to build a series of world-class STEM journals.So far,it is the first national support system for STEM journals in China,as well as the largest,most funded and most extensive support project in the STEM journal field in China.
摘要:Objective:During the past three decades,laparoscopy has played a significant role in the management of urological disorders.This study aims to standardize the management of major vascular injury,which is a life-threatening complication in the laparoscopic urological procedures.Methods:A total of 8210 patients with the urological disorder,who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018,were included in this retrospective study.Patients’data of the laparoscopic major vascular injury were collected and analyzed,and the basic principles of the procedure were summarized.Results:A total of 15(0.18%)cases of major vascular injury were found among the 8210 patients,and 2 of them were converted to open surgery.Although the type of laparoscopic surgery,causes,and management of major vascular injury among the patients were diverse,the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear,control bleeding rapidly by clamping and compression,make full preparation for possibly needed liquid resuscitation,and try best to repair under laparoscope.If necessary,converse to open surgery.Conclusion:Although the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low,such injury can result in high morbidity and mortality.It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.
摘要:Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.
摘要:Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic tasks require subjects to reach,grasp and transport a ring through a rollercoaster obstacle using a pair of laparoscopic graspers.The task was performed either bimanually(using both hands)or unimanually(using their preferred hands)in a dyad team.Results:Twelve participants completed all the tasks.The dyad teams recorded significantly greater number of anticipatory movements than individuals who performed the task bimanually(p<0.05).However,there is no significant difference in the task completion time(p=0.701)and the number of errors(p=0.860)recorded between the dyad and the bimanual group.Conclusion:Compared to a single operator,dyad operators performed the task with greater number of anticipatory movements.The increased movement synchronization can help benefit surgical education and team training.
摘要:Objective:To compare 16% carbamide peroxide(CP)with a higher concentration of hydrogen peroxide(HP)for bleaching teeth in office or at-home to erase tetracycline stains on teeth.Materials and methods:In a randomized,self-controlled clinical trial,we assigned eligible subjects to group A with 40% HP compared with 16% CP or group B with 45% CP compared with 16% CP on the split maxillary arch and followed the manufacturers’instructions.Tooth color changes were measured with vita 3D-bleached guide and colorimeter at baseline and three-time assessment.Tooth sensitive intensity was evaluated using numeric rating scales,and oral soft and hard tissue examination was recorded.Patient satisfaction survey was conducted at the last tooth color evaluation.Results:There were 20 subjects enrolled.The color changes by the end of the study were A1(40% HP)=8.22,A2(16% CP)=8.20,B1(45% CP)=11.27,B2(16% CP)=8.26 respectively.All groups experienced significant shade reductions by bleaching,the 45% CP group had significantly greatest color changes compared with the other groups(p=0.03).For tooth sensitivity evaluation,significant differences were observed in 40% HP group(p=0.01),but with mild level.None patients suffered oral soft or hard tissue abnormalities before and after treatment.Patients were more in favor of using 45% CP according to the questionnaire results.Conclusion:The 3 whitening agents were effective and safe for the whitening of tetracycline-stained teeth,the 45% CP agent had quicker whitening efficacy with low tooth sensitivity and positive feedback.Clinical significance:45% of high-concentration CP whitener by at-home using,brought faster and superior efficacy to bleaching tetracycline-stained teeth while had the equal intensity of tooth sensitivity.
摘要:Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.
摘要:Robotic surgery has a series of advantages,including better flexibility,stability and exposure,minimal trauma and less bleeding,as well as quicker recovery.The da Vinci,the most widely applied surgical robot in China,represents the highest level of current surgical robot technology.It was first introduced to Sir Run Run Shaw Hospital,Zhejiang University School of Medicine in 2015.In the past two years,the advantages of robotic surgery have been completely demonstrated.Therefore robotic surgery has gradually become the first choice for patients and surgeons in some disciplines.
摘要:Objective:Port placement is a crucial pre-operative task in robot-assisted minimally invasive surgery.Due to the insufflation process,the abdominal shape is deformed while the internal organs are shifted in position.These changes need to be considered when determining the optimal port locations for the robotic manipulators.However,intra-operative medical image acquisition systems are not always available.In this study,we aim to estimate the shift extent of the abdominal organs in humans by measuring the changed volume and position of the abdominal organs before and after insufflation in three pigs.Methods:A 3D model of the abdomen and abdominal organs was reconstructed from 3D images of the pigs taken by an MRI scanner before and after insufflation.Position shift and shape changes of the abdominal organs after insufflation were determined.The corresponding shift in port location for the robotic manipulators was determined based on the abdominal model.Results:Organ movements as a result of insufflation ranged from 6.37±0.10 cm for the spleen,to 1.64±0.22 cm for the liver.Even a slight planar motion of the target organ(e.g.,1.33±0.06 cm,2.38±0.21 cm in X-Y plane for the left kidney)can shift the access port for the robot manipulator by about 1.6 cm on the abdominal surface.Conclusions:The target organs’motion due to insufflation is a critical factor in determining port locations in robot-assisted minimally invasive surgery.
摘要:Objectives:The Surgical Apgar Score(SAS)can predict the incidence of complications in different surgical fields.However,it is rarely studied in pancreatic cancer.The aim of the present study was to assess the predictive value of the SAS in pancreatic ductal adenocarcinoma(PDAC),and then propose a modified SAS which was more suitable for pancreatic cancer patients.Materials and methods:A prospective cohort study of 160 PDAC patients was concluded.The primary endpoint was 30-day major complications.The SAS was calculated as described.The overall discriminatory power of the score was analyzed using receiver operating characteristic curves and the area under the curve(AUC)with respect to major complications or death.Results:It showed a significant predictive value of SAS in major complications or death in PDAC(p=0.020,AUC=0.606),especially in complication of pneumonia(p=0.022)and pleural effusion(p=0.023).In addition,the SAS exert significant predictive value in distal pancreatectomy group,but it has a weak predictive value for pancreaticoduodenectomy group.On multivariable analyses,occurrence of major postoperative complications was associated with lowest mean arterial pressure,estimated blood loss and operative time.Interestingly,as a characteristic of SAS,lowest heart rate was not involved.The modified SAS we proposed including lowest mean arterial pressure,estimated blood loss and operative time increased AUC from 0.606 to 0.743.Conclusions:The SAS can be a simple,rapid scoring system that effectively predicts major postoperative complications.Besides,the modified SAS we proposed in this study,which included lowest mean arterial pressure,estimated blood loss and operative time,exert a better predictive value in PDAC patients.
摘要:For helping millions of patients to live longer and possess higher quality life,the innovation of novel surgical procedures is very necessary and urgent.This paper introduces a series of innovations of Dr.Xiujun Cai,such as Laparoscopic Peng's multifunctional operative dissector,curettage and aspiration procedure,Cai's associating liver partition with portal vein ligation for staged hepatectomy,sutureless anastomosisetc in minimally invasive field.The paper advocates the pace of medical invention should be accelerated,inspiring hope for better clinical outcomes with less invasive procedures and shorter recovery time.
摘要:Prostate and bladder cancers are one of the cancers occurring worldwide.In addition to radical surgery,the past decade has also focused on targeted therapy of overexpressed cancer proteins that are lethal and critical for cancer cell survival.However,targeted therapy cannot adapt for changing of cancer molecular characteristics and,ultimately,a clone that bypasses the targeted therapy emerges.This can be overcome by immunotherapy.New studies on ablative therapy of cancers show presence of immunomodulatory effect in these modalities.Tumor ablation prime the immune system for further destruction of persistent primary tumor in addition to destruction of concurrent metastatic disease and also reduce recurrence.Ablative therapies can achieve a state of increased antigenicity.Its combination with a novel macrophage targeted therapy may enhance immune priming,trafficking,and/or effector phases;thereby improving clinical outcomes.Tumor associated macrophages or M2 phenotype are now known to mediate this immunosuppressive pro-tumorigenic effect.Alteration of macrophage differentiation may enhance tumor destruction of ablative therapy.This breakthrough in immunotherapy opens up arenas for further robust clinical trials on combinatorial therapies.In the present review,we aim to elucidate the major aspects of immune stimulatory minimal invasive approaches by combining with macrophage directed pathways.
摘要:Paragangliomas are rare neuroendocrine tumors that arise in sympathetic and parasympathetic paraganglion system,derived from neural crest cells.Tympanic paraganglioma is a type of head and neck paraganglioma involving the middle ear cleft.Endoscopic transcanal approach is currently in vogue for the excision of tympanic paragangliomas that is limited to middle ear cleft.We present a series of 3 cases who underwent endoscopic excision of tympanic paraganglioma.
摘要:Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis-McKeown minimally invasive esophagectomy(MIE)has gained interest and known as a minimally invasive surgery for the middle esophageal cancer.However,the safety and operability of McKeown MIE remains to be confirmed clinically.The purpose of this article is to examine the clinical safety and operability of McKeown MIE,and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy.Materials and methods:The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed.Among them,176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE.Patients'demographics and perioperative outcomes were comparable between the two groups.Results:There were no significant differences in terms of operative time,postoperative hospital stay,restore fluid diet time,pathology,tumor node metastasis staging between the two groups.In the McKeown MIE group,the intraoperative blood loss was less than that in the Ivor-Lewis group(116.54±80.99 ml vs 152.78±115.35 ml,p=0.001).The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group(30.04±14.08 vs 27.51±11.34,p=0.039;5.74±4.27 vs 1.80±2.68,p<0.001).There were no significant differences in the incidence of complications.The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group(p=0.013)and no significant difference was found on disease-free survival.Conclusion:McKeown MIE is safe and operational for middle esophageal cancer,which is consistent with the principle of tumor radicalization.
摘要:We are delighted to announce the Best Paper and Best Reviewer 2020 for Laparoscopic,Endoscopic and Robotic Surgery to recognize the outstanding papers and reviewers.1.Best Paper Nominations,chosen from all papers published in 2019 and 2020,were made by the Editorial Office,as follows,in chronological order of publication.
摘要:A recent article published in Surgical Endoscopy entitled“Laparoscopic duodenum-preserving total pancreatic head resection:a novel surgical approach for benign or low-grade malignant tumors”(Surgical Endoscopy 2019;33:633e638)is probably the main reason why Professor Xiujun Cai,Editor-in-Chief of Laparoscopic,Endoscopic and Robotic Surgery sent an email to me on July 8,2019,requesting me to write an Editorial related to this topic.The readers of this journal may wonder why this topic is so important in the eyes of Professor Cai who himself is a world-renowned laparoscopic hepatopancreaticobiliary surgeon?Why is this published article so important in my eyes that I am willing to spend time in my busy daily schedule to write this Editorial?
摘要:Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.
摘要:The surgery of paraventricular cavernoma remains a challenge for the neurosurgeon.Few approaches have been specially described for paraventricular cavernoma in literature.We present a patient with a symptomatic paraventricular cavernoma in the dorsal portion of the right lateral ventricles roof causing ventricular hemorrhage,and review his surgical approaches.This patient underwent a navigationassisted transcortical transventricular approach resulting in a complete resection without any neurologic deficits.The approach allows a safe and effective resection of paraventricular cavernomas.
摘要:Complete and reliable neuromuscular reversal is important to successful anaesthetic recovery in the morbidly obese patient undergoing laparoscopic surgery.Our goal was to determine whether sugammadex,a selective reversal agent is associated with better respiratory recovery than neostigmine following the reversal of anaesthesia-associated neuromuscular blockade by rocuronium in the morbidly obese.Peak Expiratory Flow Rate a surrogate marker for respiratory function,was the primary outcome measured and secondary outcome measures included post-operative nausea and vomiting,pain and head lifting.We found that patients reversed with sugammadex had a significantly higher post-operative PEFR as compared to those reversed with neostigmine and glycopyrrolate group.
摘要:Iatrogenic perforation(IP)is a rare but severe complication of endoscopy,and occurrences grow with the expansion of interventional endoscopy.Apart from symptoms and physical signs,CT scans provide an immediate and comprehensive diagnosis of IP and its severity.The general treatment is broad-spectrum antibiotics,intravenous nutrition,and close monitoring.Endoscopic treatments are considered as the first-line therapy.Endoclips are usually utilized for small perforations,while endoclips with endoloops and over the scope clip system are preferred for large ones.Covered self-expandable metal stents are effective for esophageal perforations.Fibrin glue and band ligation can be attempted,when the location of perforation is difficult for the clip placement.Close observation is required after the procedure.If endoscopic closure fails or deterioration occurs,surgical treatments should be requested.
摘要:Objective:To compare the efficacy of drug-eluting balloons for de novo and in-stent restenosis(ISR)for lesions of the femoropopliteal arteries during 12-month follow-up.Materials and methods:A retrospective analysis of 66 patients was performed.These patients had lower extremity atherosclerosis obliterans and were treated with drug-eluting balloons from June 2016 to June 2017.All the lesions were femoropopliteal,including 47 de novo lesions and 19 ISR lesions.Clinical results were followed up at 6 months and 12 months postoperatively.The primary patency rate,target lesion revascularization,Rutherford classification,ankle-brachial index,amputation rate and mortality were compared between the two groups.Results:All the 66 patients underwent the treatment of femoropopliteal artery lesions with unilateral limbs.The surgical success rates were 100%.No adverse events such as acute ischemia or amputation occurred in the hospital.There was no difference between the two groups'Rutherford classification and the ankle-brachial index at the 6-month follow-up(p>0.05).At the 12-month follow-up,the de novo group's Rutherford classification was lower than the ISR group(p=0.026),and the ankle-brachial index of the ISR group was lower(0.66±0.033 vs 0.52±0.056,p=0.036).There was no difference between the patency rate of the de novo group and the ISR group(93.6%vs 84.2%,p=0.229)at the 6-month follow-up.However,the ISR group patency rate was lower at the 12-month follow-up(63.2%vs 85.1%,p=0.048).As for revascularization there was no significant difference between the two groups at the 6-month follow-up(4.2%vs 10.5%,p=0.334),but a higher rate occurred in the ISR group at the 12-month follow-up(26.3%vs 6.4%,p=0.025).There were no significant differences in the mortality or amputation rate between the two groups(p>0.05).Conclusions:Drug-eluting balloons were effective in treating both de novo lesions and ISR lesions in the atherosclerotic femoropopliteal artery,but the 12-month follow-up results of ISR lesions were less favorable than the de novo lesions.
摘要:Background:The da Vinci robotic-assisted laparoscopic hysterectomy is being widely adopted by healthcare institutions and constitutes the highest percentage of the robotic-assisted surgeries.By now da Vinci robotic-assisted hysterectomy(RAH)is used worldwide,and even so,different aspects of this relatively new surgical technique remain under evaluation.There are contradicting reports in the literature about the superiority of RAH versus conventional laparoscopic hysterectomy(CLH)in terms of patient outcomes and costs.The purpose of this small size study was to contribute to this open question by analyzing patient records in a community hospital with extensive seven years of experience in RAH.The analysis of the data compares the surgical outcomes and patient costs of RAH(n?23)versus CLH(n?23).Method:A retrospective study using the electronic chart review was performed.Results:There were no statistically significant differences between the two groups for estimated blood loss,duration of surgery,length of stay,30-day readmission,and patient costs;however,the average cost of RAH was$3116 less than CLH,if not considering the cost and maintenance of the surgical robot indicating surgical team approaching proficiency and maturity in RAH.A strong correlation between uterus weight,blood loss,duration of surgery,and patient cost within only the RAH group was observed,suggesting a more precise surgical technique.Conclusion:RAH and CLH had similar surgical outcomes.RAH can be a more precise surgical technique,and potentially less costly when the cost and maintenance of the robot are not considered.
摘要:Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has gained interest,as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality.As a result,several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality.ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation.Minimally-invasive surgery,which has known benefits with regards to morbidity and mortality,has also been applied to ALPPS,with promising results regarding safety and feasibility and patient outcomes.Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients.Minimally-invasive ALPPS offers a clear benefit to patients,including reduction of fibrous adhesions,shorter length of hospital stay,and lower morbidity.However,the technical difficulty of the procedure still limits its wide application,even to experienced hepato-pancreato-biliary centres.
摘要:Peer reviewis the driving force of journal development.And scientific reviewers act as gatekeepers who ensure the identification of high quality of published papers.Although,being busy battling against COVID-19,following international reviewers dedicated their considerable time and expertise to review manuscripts for LERS in 2020.The LERS Editorial Office would like to extend sincere gratitude for the reviewer's generous contribution.
摘要:Purpose:Odontogenic maxillary sinusitis(OMS)is frequently encountered in otorhinolaryngologists'clinical practice.Endoscopic sinus surgery(ESS)instead of surgeries in intraoral approach has been widely applied among OMS.However appropriate treatments due to the causes of the OMS as well as the outcome have been less investigated,meanwhile the inherent incidence of OMS may be still on the rise.This study was designed to conclude our systematic treatment within follow-up examination.Materials and methods:In this retrospective study patients confirmed diagnosis of OMS who had systematic follow-up examinations were analyzed.Medical histories of otorhinolaryngologists and dentists were reviewed as well as preoperative examination protocols.Result:Consecutive 29 Patients(10 women,19 men)were included.41.4%(12/29)patients experienced facial pain as the most frequent symptom.69.0%(20/29)patients admitted firstly to otorhinolaryngologists,13 patients were treated with surgical procedure while 7 patients lacking of surgical indication were transferred to dentists.31.0%(9/29)patients were advised by dentist for being suspected of maxillary sinusitis,including 7 patients suffered from sinonasal complications of dental treatment(SCDT).Conventional dental treatment(root planning,root end surgery,extraction)was the most common cause.Follow up for a mean of 15.1(ranges from 6 to 96)months showed 29 patients maintaining open maxillary ostium on endoscopic examination or improving on CT except recurrence in one patient with SCDT.Conclusion:Patients should be inspected by dentists carefully when the patient has symptoms rather than sinusitis-like symptoms,the possibility of OMS should always be considered.Dental examination can help to determine whether a maxillary sinusitis has a dental origin,periodontitis and odontogenic radicular cysts still are the most common causes comparing with iatrogenic factors.Patients treated with ESS showed better tolerance and fewer postsurgical complications.Not all patients with OMS including SDCT need definitely surgery whether ESS or intraoral approach,removing dental focus followed with antibiotics would be optimistic choice.
摘要:Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performance.Materials and methods:A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures:ventral hernia repairs,hysterectomies,lung lobectomies,pancreatectomies,gastric bypass,and prostatectomies.The criteria analyzed to compare these procedures included morbidity rate,readmission rate,mortality rate,cost,length of hospitalization and operative time.These criteria were scaled based on their significance when considering a surgery,such that more important criteria,those that directly impact patient health,are more heavily weighted than less important criteria.Results:The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies.Laparoscopy was preferred for all other procedures.In the case of gastric bypass,laparoscopy was heavily preferred,and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs.Conclusion:The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries.With new technologies,preferences are likely to change in favor of robotic surgery,and this model can be employed to predict the impact of those advancements.
摘要:Objective:Transversus abdominus release(TAR)is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall.Traditionally,TAR has been done with an open technique(oTAR),and the benefits of the newer robotic approach(rTAR)has not been well established in the Australian setting.The aim of this study was to compare the results of oTAR with rTAR to demonstrate its safety and efficacy.Methods:A retrospective review of patients who underwent rTAR and oTAR at two tertiary hospitals was conducted between January 2018 and January 2020 in New South Wales,Australia.Patient demographics,perioperative and postoperative outcomes were compared in both groups.Results:There were 26 patients identified to have undergone TAR(13 rTAR,13 oTAR).Both groups were comparable in regards to age,sex and defect size.oTAR was associated with a higher American Society of Anaesthesiologist score.rTAR was associated with significantly longer average operative time(260.0±78.9 min vs.185.7±64.5 min,p=0.017)but found to have a significantly shorter length of stay(3.6±2.1 d vs.6.9±3.6 d,p=0.007)with a comparable complication rate.Conclusions:rTAR is associated with shorter length of hospital stay with comparable postoperative outcomes when compared to oTAR.We are seeing increasing evidence supporting the safety and benefits of robotics,however larger scale studies are required to fully understand this approach.
摘要:Background:The only definitive treatment for twin-to-twin transfusion syndrome is minimally invasive fetoscopic surgery for the selective coagulation of placental blood vessels.Fetoscopic surgery is a technically challenging operation,mainly due to the poor visibility conditions in the uterine environment.We present the design of an algorithm for the computerized enhancement of fetoscopic video and show that the enhanced video increases the ability of human users to identify blood vessels within fetoscopic video rapidly and accurately.Methods:A computer algorithm for the enhancement of fetoscopic video frames was created.First,optical fiber artifacts were removed via a modification of unsharp masking.Second,image contrast was increased via Contrast Limited Adaptive Histogram Equalization(CLAHE).Third,the effect of contrast enhancements on stationary features was removed by normalizing to a windowed mean of the video frames.Fourth,color information was reincorporated by combining the mean-normalized result with the unnormalized contrast enhanced image using the soft light blending algorithm.Medical trainees(n?16)were recruited into a study to validate the algorithm.Subjects were shown enhanced or unenhanced fetoscopic video frames on a screen and were asked to identify whether a randomly placed marker fell on a blood vessel or on background.The accuracy of their responses was recorded.Results:On the subset of images where subjects had the lowest mean accuracy in identifying the placement of the marker,subjects performed better when viewing video frames enhanced by the computer(accuracy 74.27%;SE 0.97)than when viewing unenhanced video frames(accuracy 63.78%;SE 2.79).This result was statistically significant(p<0.01).Conclusion:Real-time computerized enhancement of fetoscopic video has the potential to ease the readability of video in poor lighting conditions,thus providing a benefit to the surgeon intraoperatively.