Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in in...Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.展开更多
Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the ki...Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the kidneys,thyroid,soft tissues,and bones.The study by Celik et al presents a series of five clinical cases where hydatid cysts were found in these rare anatomical regions,challenging conventional diagnostic and therapeutic approaches.The paper emphasizes the importance of differential diagnosis,as these cases can mimic other conditions,such as cancer,abscesses,or cysts.Advanced imaging techniques,such as com-puted tomography,magnetic resonance imaging,and ultrasound,play a crucial role in accurate diagnosis and help avoid misdiagnosis.The study demonstrates that early diagnosis and appropriate treatment of echinococosis in atypical localiz-ations are critical for preventing complications like cyst rupture and secondary infections.The use of albendazole and surgical intervention,especially in combi-nation with modern imaging techniques,yields good outcomes in these patients.However,several unanswered questions remain:What are the precise criteria for selecting the optimal treatment method in each case?What is the long-term effect-iveness of different approaches?Do patients with hydatid cysts in atypical lo-cations require additional monitoring and preventive treatment to avoid recu-rrence?Addressing these questions requires further research,and a multidisci-plinary approach involving radiologists,surgeons,and infectious disease spe-cialists is essential to optimize diagnosis and treatment.Early and accurate diagnostic methods based on differential diagnosis play a key role in improving treatment outcomes and reducing morbidity.展开更多
BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no pri...BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation(LDKT).AIM To report the implementation,surgical protocols,and clinical outcomes of the first pediatric LDKT program in Uzbekistan.METHODS This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025.All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy.Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays.Perioperative management was guided by Enhanced Recovery After Surgery Society principles.Primary outcomes included operative metrics,perioperative complications,graft function,biopsyproven rejection,and patient/graft survival.Statistical analysis utilized descriptive statistics,Kaplan–Meier survival estimates,and Fisher’s exact test where applicable.RESULTS Donors included 13 women and 7 men(median age:38 years;range:31–50).Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy.No major intraoperative complications occurred;one donor developed a postoperative wound seroma.All recipients(aged 87–207 months)exhibited immediate graft function,with no delayed graft function observed.Median cold and warm ischemia times were 15 minutes(range:10–138)and 35 minutes(range:18–40),respectively.Median serum creatinine decreased from 198μmol/L on postoperative day 1 to 54μmol/L by day 7.Three rejection episodes were reported,two of which occurred in sensitized recipients.Two graft losses were attributed to late rejection.One patient died from hemorrhagic stroke six months post-transplant.At 24 months,patient and graft survival rates were 95%and 90%,respectively.CONCLUSION The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short-and intermediate-term outcomes,with high graft survival and low complication rates.This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.展开更多
Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these p...Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these procedures carry significant morbidity.The retrospective study by Xu et al provides compelling evidence that endoscopic resection(ER)is a viable,minimally invasive alternative for low-risk esophageal GISTs,demonstrating a high en bloc resection rate(96.9%)and favorable long-term oncologic outcomes,including a 5-year overall survival rate of 100%and disease-free survival of 90.6%.These results challenge the con-ventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients.However,several critical questions remain unanswered:What are the precise selection criteria for ER candidacy?How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes?Could neoadjuvant therapy enhance the feasibility of ER for larger lesions?As endoscopic techniques continue to evolve,interdisciplinary collaboration among gastroenterologists,oncologists,and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes.Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.展开更多
Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which ...Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.展开更多
There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among thes...There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.展开更多
文摘Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.
文摘Hydatid disease,caused by the Echinococcus granulosus parasite,is traditionally associated with liver and lung involvement.However,recent years have seen an increase in cases with atypical localizations,such as the kidneys,thyroid,soft tissues,and bones.The study by Celik et al presents a series of five clinical cases where hydatid cysts were found in these rare anatomical regions,challenging conventional diagnostic and therapeutic approaches.The paper emphasizes the importance of differential diagnosis,as these cases can mimic other conditions,such as cancer,abscesses,or cysts.Advanced imaging techniques,such as com-puted tomography,magnetic resonance imaging,and ultrasound,play a crucial role in accurate diagnosis and help avoid misdiagnosis.The study demonstrates that early diagnosis and appropriate treatment of echinococosis in atypical localiz-ations are critical for preventing complications like cyst rupture and secondary infections.The use of albendazole and surgical intervention,especially in combi-nation with modern imaging techniques,yields good outcomes in these patients.However,several unanswered questions remain:What are the precise criteria for selecting the optimal treatment method in each case?What is the long-term effect-iveness of different approaches?Do patients with hydatid cysts in atypical lo-cations require additional monitoring and preventive treatment to avoid recu-rrence?Addressing these questions requires further research,and a multidisci-plinary approach involving radiologists,surgeons,and infectious disease spe-cialists is essential to optimize diagnosis and treatment.Early and accurate diagnostic methods based on differential diagnosis play a key role in improving treatment outcomes and reducing morbidity.
文摘BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation(LDKT).AIM To report the implementation,surgical protocols,and clinical outcomes of the first pediatric LDKT program in Uzbekistan.METHODS This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025.All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy.Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays.Perioperative management was guided by Enhanced Recovery After Surgery Society principles.Primary outcomes included operative metrics,perioperative complications,graft function,biopsyproven rejection,and patient/graft survival.Statistical analysis utilized descriptive statistics,Kaplan–Meier survival estimates,and Fisher’s exact test where applicable.RESULTS Donors included 13 women and 7 men(median age:38 years;range:31–50).Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy.No major intraoperative complications occurred;one donor developed a postoperative wound seroma.All recipients(aged 87–207 months)exhibited immediate graft function,with no delayed graft function observed.Median cold and warm ischemia times were 15 minutes(range:10–138)and 35 minutes(range:18–40),respectively.Median serum creatinine decreased from 198μmol/L on postoperative day 1 to 54μmol/L by day 7.Three rejection episodes were reported,two of which occurred in sensitized recipients.Two graft losses were attributed to late rejection.One patient died from hemorrhagic stroke six months post-transplant.At 24 months,patient and graft survival rates were 95%and 90%,respectively.CONCLUSION The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short-and intermediate-term outcomes,with high graft survival and low complication rates.This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.
文摘Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these procedures carry significant morbidity.The retrospective study by Xu et al provides compelling evidence that endoscopic resection(ER)is a viable,minimally invasive alternative for low-risk esophageal GISTs,demonstrating a high en bloc resection rate(96.9%)and favorable long-term oncologic outcomes,including a 5-year overall survival rate of 100%and disease-free survival of 90.6%.These results challenge the con-ventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients.However,several critical questions remain unanswered:What are the precise selection criteria for ER candidacy?How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes?Could neoadjuvant therapy enhance the feasibility of ER for larger lesions?As endoscopic techniques continue to evolve,interdisciplinary collaboration among gastroenterologists,oncologists,and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes.Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.
文摘Laparoscopic liver resection in living donors is a relatively novel surgical approach that has the potential to enhance donor safety and facilitate faster recovery.Following an initial development period during which donor safety was not effectively validated,the minimally invasive approach now yields better outcomes,provided that these procedures are performed by experienced surgeons.The key factors include donor selection criteria,the clinical infrastructure,and the learning curve for surgeons.This review outlines the current status of the development of laparoscopic liver resection in living donors and discusses the obstacles to the advancement of this surgical technique.
文摘There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.
