BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic s...BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum.The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum.The trans-subxiphoid technique offers excellent exposure of the surgical field,reduces postoperative pain,facilitates specimen retrieval even for large tumors,and potentially improves early surgical outcomes.AIM To evaluate the safety,feasibility,and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.METHODS Between July 2024 and September 2025,12 patients underwent subxiphoid robotic mediastinal resection.The diameter of the operated lesions ranged from 30 mm to 70 mm.A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement,allowing for optical port access.Two operating ports were placed at the sixth intercostal space bilaterally.Carbon dioxide insufflations(8-10 mmHg)enlarged the surgical field,improving visualization of critical anatomical landmarks,such as the internal mammary arteries and phrenic nerves.This approach allowed complete resection of large or invasive tumors,preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.RESULTS The mean operating time was 170.2 minutes,and the median hospital stay was 3.5 days.No major postoperative complications occurred.Two conversions were necessary:One with a lateral robotic approach due to previous abdominal surgery,and one with a sternotomy for tumor invasion of the aortic arch.Histopathological analysis identified nine thymomas and one solitary fibrous tumor.CONCLUSION Subxiphoid robotic approach is a safe,effective technique for extended thymectomy,fulfilling both oncological and myasthenia gravis surgical objectives.展开更多
BACKGROUND Slipping rib syndrome(SRS)is caused by abnormal subluxation of floating ribs,resulting in chronic pain and possible tissue damage.Its prevalence is often overlooked,as it shares symptoms with other musculos...BACKGROUND Slipping rib syndrome(SRS)is caused by abnormal subluxation of floating ribs,resulting in chronic pain and possible tissue damage.Its prevalence is often overlooked,as it shares symptoms with other musculoskeletal conditions,and is more common in young females and athletes.Symptoms include pain along the lower rib margin,aggravated by trunk movements,deep breathing and coughing.Treatment usually starts conservatively with physiotherapy and analgesics.In severe cases,extrapleural rib resection may be required.CASE SUMMARY In April 2023,a 24-year-old woman presented with persistent right hemithorax pain in the eleventh rib for one year.Instrumental examinations,including ultrasonography and magnetic resonance imaging,were negative for abdominal and osteochondral abnormalities.The pain intensity,rated 8/10 on the numeric rating scale(NRS),remained unresponsive to pain therapy.After a careful literature review and discussion with the patient,we opted for a minimally invasive surgical approach.Under general anesthesia,a mini-thoracotomy was performed along the anterior course of the eleventh rib.After exposure,abnormal rib mobility was detected,which led to resection of the medial margin and anchoring to the overlying rib with nonabsorbable sutures.Histological examination revealed no abnormalities.The patient was discharged on the first postoperative day.Pain decreased significantly,reaching 1/10 on the NRS at one month.At 3 months,the patient had mild fluctuating pain(2/10)requiring occasional analgesics but did not interfere with daily activities.CONCLUSION Minimally invasive rib-preserving surgery effectively reduces pain and hospitalization time,offering a valid alternative to conventional rib resection for refractory SRS.展开更多
According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients...According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients are not usually candidates for liver resection.However,many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection,maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function.Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification,and this treatment gives good results in the setting of multinodular,large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis.In this review we explore this controversial topic,and we show through the literature analysis how liver resection may improve the short-and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients.However,other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.展开更多
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms.This disease presents with daily abdominal pain for at least 3 months related to defecation a...Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms.This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool.International surveys about this disease report a global prevalence of about 1.5%.A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea.It is composed of water,electrolytes,and five selected amino acids that function as sodium co-transporters without containing glucose.In recent years,some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis,reporting good results.Recently,a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome.The research was based on a real-life methodology minimizing the disruption of the routine care.One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk.Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction.Based on this data,we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea.It is certainly necessary to plan highquality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea.Probably in the near future all oral rehydration solutions will contain amino acids.展开更多
Artificial intelligence(AI)is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence,such as visual perception,speech recognition,and decision-making.Mach...Artificial intelligence(AI)is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence,such as visual perception,speech recognition,and decision-making.Machine learning and deep learning(DL)are subfields of AI that are able to learn from experience in order to complete tasks.AI and its subfields,in particular DL,have been applied in numerous fields of medicine,especially in the cure of cancer.Computer vision(CV)system has improved diagnostic accuracy both in histopathology analyses and radiology.In surgery,CV has been used to design navigation system and robotic-assisted surgical tools that increased the safety and efficiency of oncological surgery by minimizing human error.By learning the basis of AI,surgeons can take part in this revolution to optimize surgical care of oncologic disease.展开更多
文摘BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum.The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum.The trans-subxiphoid technique offers excellent exposure of the surgical field,reduces postoperative pain,facilitates specimen retrieval even for large tumors,and potentially improves early surgical outcomes.AIM To evaluate the safety,feasibility,and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.METHODS Between July 2024 and September 2025,12 patients underwent subxiphoid robotic mediastinal resection.The diameter of the operated lesions ranged from 30 mm to 70 mm.A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement,allowing for optical port access.Two operating ports were placed at the sixth intercostal space bilaterally.Carbon dioxide insufflations(8-10 mmHg)enlarged the surgical field,improving visualization of critical anatomical landmarks,such as the internal mammary arteries and phrenic nerves.This approach allowed complete resection of large or invasive tumors,preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.RESULTS The mean operating time was 170.2 minutes,and the median hospital stay was 3.5 days.No major postoperative complications occurred.Two conversions were necessary:One with a lateral robotic approach due to previous abdominal surgery,and one with a sternotomy for tumor invasion of the aortic arch.Histopathological analysis identified nine thymomas and one solitary fibrous tumor.CONCLUSION Subxiphoid robotic approach is a safe,effective technique for extended thymectomy,fulfilling both oncological and myasthenia gravis surgical objectives.
文摘BACKGROUND Slipping rib syndrome(SRS)is caused by abnormal subluxation of floating ribs,resulting in chronic pain and possible tissue damage.Its prevalence is often overlooked,as it shares symptoms with other musculoskeletal conditions,and is more common in young females and athletes.Symptoms include pain along the lower rib margin,aggravated by trunk movements,deep breathing and coughing.Treatment usually starts conservatively with physiotherapy and analgesics.In severe cases,extrapleural rib resection may be required.CASE SUMMARY In April 2023,a 24-year-old woman presented with persistent right hemithorax pain in the eleventh rib for one year.Instrumental examinations,including ultrasonography and magnetic resonance imaging,were negative for abdominal and osteochondral abnormalities.The pain intensity,rated 8/10 on the numeric rating scale(NRS),remained unresponsive to pain therapy.After a careful literature review and discussion with the patient,we opted for a minimally invasive surgical approach.Under general anesthesia,a mini-thoracotomy was performed along the anterior course of the eleventh rib.After exposure,abnormal rib mobility was detected,which led to resection of the medial margin and anchoring to the overlying rib with nonabsorbable sutures.Histological examination revealed no abnormalities.The patient was discharged on the first postoperative day.Pain decreased significantly,reaching 1/10 on the NRS at one month.At 3 months,the patient had mild fluctuating pain(2/10)requiring occasional analgesics but did not interfere with daily activities.CONCLUSION Minimally invasive rib-preserving surgery effectively reduces pain and hospitalization time,offering a valid alternative to conventional rib resection for refractory SRS.
文摘According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients are not usually candidates for liver resection.However,many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection,maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function.Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification,and this treatment gives good results in the setting of multinodular,large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis.In this review we explore this controversial topic,and we show through the literature analysis how liver resection may improve the short-and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients.However,other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.
文摘Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms.This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool.International surveys about this disease report a global prevalence of about 1.5%.A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea.It is composed of water,electrolytes,and five selected amino acids that function as sodium co-transporters without containing glucose.In recent years,some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis,reporting good results.Recently,a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome.The research was based on a real-life methodology minimizing the disruption of the routine care.One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk.Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction.Based on this data,we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea.It is certainly necessary to plan highquality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea.Probably in the near future all oral rehydration solutions will contain amino acids.
文摘Artificial intelligence(AI)is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence,such as visual perception,speech recognition,and decision-making.Machine learning and deep learning(DL)are subfields of AI that are able to learn from experience in order to complete tasks.AI and its subfields,in particular DL,have been applied in numerous fields of medicine,especially in the cure of cancer.Computer vision(CV)system has improved diagnostic accuracy both in histopathology analyses and radiology.In surgery,CV has been used to design navigation system and robotic-assisted surgical tools that increased the safety and efficiency of oncological surgery by minimizing human error.By learning the basis of AI,surgeons can take part in this revolution to optimize surgical care of oncologic disease.
