BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the curre...BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.展开更多
BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the t...BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the technique and feasibility of robotic resection of DGISTs.METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively analyzed.The patients were divided into the open surgery group and the robotic surgery group.Pancreatoduodenectomy(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla.Age,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two groups.RESULTS Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 years.Limited resection was performed in 17 patients,and PD was performed in 11 patients.Eleven patients underwent open surgery,and 17 patients underwent robotic surgery.Two patients in the robotic surgery group underwent conversion to open surgery.All the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P<0.05).All the patients survived during the follow-up period,and 4 patients had recurrence and metastasis.No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group(P>0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGISTs,and its therapeutic effect is equivalent to open surgery.展开更多
The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Base...The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.展开更多
Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this...Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.展开更多
Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of ...Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.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
Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards f...Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards for early-stage HCC;however,advances in imaging and minimally invasive techniques have improved patient selection and outcomes.Additionally,the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC.This review highlights the efficacy of agents such as tyrosine kinase inhibitors,alongside emerging options like immune checkpoint inhibitors,which have shown promise in clinical trials.Furthermore,the role of locoregional therapies,including ablation in the setting of combined treatment,transar-terial chemoembolization and transarterial radioembolization with flow catheters,cone-beam computed tomo-graphy and 4D navigation guidance,is examined in the context of bridging therapies for patients awaiting surgical intervention.The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes.Future directions for HCC treatment are discussed,including the potential of novel biomarkers in prognosis and treatment response.This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates.展开更多
In this paper,we comment on the article by Gu et al published in 2024,invest-igating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal t...In this paper,we comment on the article by Gu et al published in 2024,invest-igating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal tumors.Compared with most carcinomas,gastrointestinal stromal tumors are quite common worldwide and have a better prognosis.However,they respond to specific chemotherapies and do not routinely require standard lymphadenectomy.The gastric origin is known to be the most represented.Survival after proven radical surgery is ex-cellent,with recurrences being extremely infrequent.Currently,induction/pe-rioperative chemotherapy for high-risk tumors larger than 5 cm can downstage neoplasia and maintain good survival.Therefore,the standard of care for non-metastatic,resectable tumors is surgical excision(avoiding formal lymphaden-ectomy)with or without chemotherapy.In the case of small-(2 cm)to medium-(5 cm)sized tumors,minimally invasive surgical approaches(laparoscopic or ro-botic)have been advocated,and more recently,a purely endoscopic technique has also been proposed.All these interventions are feasible and effective,although no definitive results have been published to prove the superiority of one over another;however,further investigation of its associated oncologic outcomes is still needed.Unfortunately,rigorous,prospective,randomized controlled trials are challenging to conduct,develop,and receive ethical approval for,whereas the final decision of the surgical route is often related to the availability of instru-mentation and local expertise.展开更多
Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence an...Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 cm.Methods:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between 2002-2020.Results:One hundred RLR and 699 LLR which met study criteria were included.The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(PSM)(73 vs.219).Before PSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median blood.After PSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,P=0.286),transfusion rate rate(19.2%vs.16.9%,P=0.652),median blood loss(200 vs.300 mL,P=0.694),open conversion rate(8.2%vs.11.0%,P=0.519),morbidity(28.8%vs.21.9%,P=0.221),major morbidity(4.1%vs.9.6%,P=0.152),mortality and postoperative length of stay(6 vs.6 days,P=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes.There was no significant difference in perioperative outcomes after RLR or LLR.展开更多
Purpose: Historically the classification of Thoracic Outlet Syndrome (TOS) has been based on symptoms rather than the underlying pathology. Therefore, TOS has been classified into Neurogenic (NTOS), Venous (VTOS or Pa...Purpose: Historically the classification of Thoracic Outlet Syndrome (TOS) has been based on symptoms rather than the underlying pathology. Therefore, TOS has been classified into Neurogenic (NTOS), Venous (VTOS or Paget Schroetter Syndrome) and Arterial (ATOS) subgroups. This classification has resulted in confusion among medical practitioners, difficulty in making the diagnosis, and the poor results with surgical intervention. Methods: The published papers from PubMed on the newer understanding of the pathogenesis and the surgical treatment of TOS were reviewed. Results: More recently TOS has been classified based on the underlying pathologic entity. Based on this classification, patients who are suspected of having TOS should be classified as having 1. Cervical Rib Disease (CRD), or 2. TOS as the result of “Subclavian Vein Compression Syndrome”. This classification has resulted in more accurate diagnosis, better patient selection for surgery, and excellent surgical results. This paper outlines the algorithm for making the appropriate diagnosis in patients who present with neurovascular symptoms of the upper extremity and the selection of the appropriate patients for surgery. Conclusion: Based on the algorithm for surgical decision making, patients with Cervical Rib Disease should undergo cervical exploration and resection of the pathologic entity which results in compression of the brachial plexus or the subclavian artery in the neck. Patients with Thoracic outlet Syndrome who are found to have extrinsic compression of the subclavian vein by a pathologic tubercle at the sternocostal joint on Multiphasic MRA should undergo robotic first rib resection.展开更多
I read the article titled“Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma”,published in JAMA Surgery with great interest(1).This study marks an important milestone in the field of...I read the article titled“Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma”,published in JAMA Surgery with great interest(1).This study marks an important milestone in the field of minimally invasive liver surgery.展开更多
Minimally invasive surgery(MIS)has significantly progressed and emerged as the preferred approach for various gastrointestinal procedures,including gastrectomy,cholecystectomy,and various colorectal surgeries(1).Howev...Minimally invasive surgery(MIS)has significantly progressed and emerged as the preferred approach for various gastrointestinal procedures,including gastrectomy,cholecystectomy,and various colorectal surgeries(1).However,the widespread acceptance of robotic surgery in liver resection has encountered obstacles,attributed to factors such as the lack of appropriate surgical instruments,the intricate learning curve,and safety apprehensions.Nonetheless,the utilization of MIS in liver resection is linked to decreased blood loss,reduced post-operative pain,shorter hospital stays,and lower morbidity rates compared to both open and laparoscopic liver resection procedures(2).展开更多
Aim:Robotic liver resection(RLR)is a new platform for minimally invasive hepatobiliary surgery.Minimally invasive surgery can confer benefits to patients with hepatocellular carcinoma(HCC),which is mostly associated w...Aim:Robotic liver resection(RLR)is a new platform for minimally invasive hepatobiliary surgery.Minimally invasive surgery can confer benefits to patients with hepatocellular carcinoma(HCC),which is mostly associated with underlying chronic liver disease.Despite the inherent functional merits of robotics for surgical techniques,the clinical advantages of hepatectomy are not well defined.Therefore,we reviewed the short-term and longterm surgical results of 57 HCC cases in 46 patients who underwent RLR at our institution.Methods:We evaluated the feasibility and safety of robotic anatomic liver resection for HCC by comparing the results of the anatomic resection(AR)group(n=23)and non-anatomic resection(NAR)group(n=34).Results:Overall(n=57),the liver-specific console time was 487 min,blood loss was 194 g,and there was one open conversion(2%).Postoperative data showed acceptable hepatic functional recovery,with a major complication rate of 11%and no 90-day mortality.Compared to NAR,AR was associated with longer operative and console times,more blood loss,and worse postoperative liver function,thus reflecting the greater extent and complexity of hepatectomies for more advanced-stage tumors than NAR.Nonetheless,major complication rate,mortality rate,length of hospital stay,and R0 resection rate were comparable between groups.Long-term results were comparable to those of previously reported hepatectomies for HCC and were similar between groups.Conclusion:RLR including AR may be a safe and feasible form of hepatectomy for select patients with HCC.展开更多
Liver resection has traditionally been performed using an open approach,but many academic tertiary centers have adopted a minimally invasive surgical(MIS)approach to liver surgery over the past two decades.Laparoscopi...Liver resection has traditionally been performed using an open approach,but many academic tertiary centers have adopted a minimally invasive surgical(MIS)approach to liver surgery over the past two decades.Laparoscopic liver resection(LLR)remains the most common MIS approach to liver surgery worldwide.However,there has been recent increased adoption of robotic liver resection(RLR).The assumptions made in studying MIS liver surgery,according to the International Consortium on Minimally Invasive Liver Surgery(I-MILS)(1),are similar to those for other forms of MIS surgery.There are certain advantages,such as decreased pain,reduced length of stay(LOS),and lower wound infection rates.However,beyond these benefits,the slow adoption of MIS hepatectomies is due to concerns about using MIS approaches for hemorrhage control,achieving adequate R0 surgical resection of malignancies,and the inevitable learning curve associated with performing such complex surgeries.展开更多
Robotic surgery has been a transformative force in minimally invasive thoracic surgery.Robotic surgical technology has impacted surgery of the lung,medi-astinum,esophagus,and the sympathetic chain.However,in one area ...Robotic surgery has been a transformative force in minimally invasive thoracic surgery.Robotic surgical technology has impacted surgery of the lung,medi-astinum,esophagus,and the sympathetic chain.However,in one area of tho racic surgery,surgery for Thoracic Outlet Syndrome,robotics has not only impacted the minimally invasive surgical approach to the resection of the first rib,but it has allowed for a better understanding of the pathogenesis of the disease.Historically,the only consistent aspects of Thoracic Outlet Syndrome(TOS)have been the confusion among medical practitioners,difficulty in making the diagnosis,and poor results with surgical intervention.The present understanding of TOS is that it is the manifestation of a congenital malfor-mation of the first rib where an abnormal boney tubercle at the costo-sternal joint results in compression of the subclavian vein(SV)at its junction with the innominate vein.The compression of the SV leads to a spectrum of diseases,which range from neurologic symptoms resulting from venous congestion of the upper extremity nerves to thrombosis of the SV with prolonged compres sion.Robotic technology allows for the precise removal of the“offending por tion”of the first rib.This technique is associated with the best-reported results in patients with TOS.展开更多
基金National Natural Science Foundation of China,No.81860519.
文摘BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.
文摘BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the technique and feasibility of robotic resection of DGISTs.METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively analyzed.The patients were divided into the open surgery group and the robotic surgery group.Pancreatoduodenectomy(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla.Age,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two groups.RESULTS Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 years.Limited resection was performed in 17 patients,and PD was performed in 11 patients.Eleven patients underwent open surgery,and 17 patients underwent robotic surgery.Two patients in the robotic surgery group underwent conversion to open surgery.All the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P<0.05).All the patients survived during the follow-up period,and 4 patients had recurrence and metastasis.No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group(P>0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGISTs,and its therapeutic effect is equivalent to open surgery.
文摘The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
文摘Laparoscopic rectal surgery has demonstrated its superiority over the open approach,however it still has some technical limitations that lead to the development of robotic platforms.Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one.For this reason a review of all the literature examining robotic surgery for rectal cancer was performed.Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE)using the key words"rectum","rectal","cancer","laparoscopy","robot".After the initial screen of 266 articles,43 papers were selected for review.A total of 3013 patients were included in the review.The most commonly performed intervention was low anterior resection(1450 patients,48.1%),followed by anterior resections(997 patients,33%),ultra-low anterior resections(393 patients,13%)and abdominoperineal resections(173 patients,5.7%).Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function.Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times.This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative,clinical outcomes and incidence of complications.In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide,until now,any significant clinical advantages to the patients.
基金supported by grants from the National Natural Science Foundation of China(No.82072625)Key Research and Development Project of Zhejiang Province(No.2021C03127)+3 种基金National Natural Science Foundation of China(No.81827804)National Natural Science Foundation of China(No.81772546)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases(No.2018E50003)Key Research and Development Project of Zhejiang Province(No.2018C03083).
文摘Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.
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.
文摘Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards for early-stage HCC;however,advances in imaging and minimally invasive techniques have improved patient selection and outcomes.Additionally,the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC.This review highlights the efficacy of agents such as tyrosine kinase inhibitors,alongside emerging options like immune checkpoint inhibitors,which have shown promise in clinical trials.Furthermore,the role of locoregional therapies,including ablation in the setting of combined treatment,transar-terial chemoembolization and transarterial radioembolization with flow catheters,cone-beam computed tomo-graphy and 4D navigation guidance,is examined in the context of bridging therapies for patients awaiting surgical intervention.The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes.Future directions for HCC treatment are discussed,including the potential of novel biomarkers in prognosis and treatment response.This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates.
文摘In this paper,we comment on the article by Gu et al published in 2024,invest-igating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal tumors.Compared with most carcinomas,gastrointestinal stromal tumors are quite common worldwide and have a better prognosis.However,they respond to specific chemotherapies and do not routinely require standard lymphadenectomy.The gastric origin is known to be the most represented.Survival after proven radical surgery is ex-cellent,with recurrences being extremely infrequent.Currently,induction/pe-rioperative chemotherapy for high-risk tumors larger than 5 cm can downstage neoplasia and maintain good survival.Therefore,the standard of care for non-metastatic,resectable tumors is surgical excision(avoiding formal lymphaden-ectomy)with or without chemotherapy.In the case of small-(2 cm)to medium-(5 cm)sized tumors,minimally invasive surgical approaches(laparoscopic or ro-botic)have been advocated,and more recently,a purely endoscopic technique has also been proposed.All these interventions are feasible and effective,although no definitive results have been published to prove the superiority of one over another;however,further investigation of its associated oncologic outcomes is still needed.Unfortunately,rigorous,prospective,randomized controlled trials are challenging to conduct,develop,and receive ethical approval for,whereas the final decision of the surgical route is often related to the availability of instru-mentation and local expertise.
基金Dr.T.P.Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA00878 for this study.
文摘Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 cm.Methods:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between 2002-2020.Results:One hundred RLR and 699 LLR which met study criteria were included.The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(PSM)(73 vs.219).Before PSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median blood.After PSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,P=0.286),transfusion rate rate(19.2%vs.16.9%,P=0.652),median blood loss(200 vs.300 mL,P=0.694),open conversion rate(8.2%vs.11.0%,P=0.519),morbidity(28.8%vs.21.9%,P=0.221),major morbidity(4.1%vs.9.6%,P=0.152),mortality and postoperative length of stay(6 vs.6 days,P=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes.There was no significant difference in perioperative outcomes after RLR or LLR.
文摘Purpose: Historically the classification of Thoracic Outlet Syndrome (TOS) has been based on symptoms rather than the underlying pathology. Therefore, TOS has been classified into Neurogenic (NTOS), Venous (VTOS or Paget Schroetter Syndrome) and Arterial (ATOS) subgroups. This classification has resulted in confusion among medical practitioners, difficulty in making the diagnosis, and the poor results with surgical intervention. Methods: The published papers from PubMed on the newer understanding of the pathogenesis and the surgical treatment of TOS were reviewed. Results: More recently TOS has been classified based on the underlying pathologic entity. Based on this classification, patients who are suspected of having TOS should be classified as having 1. Cervical Rib Disease (CRD), or 2. TOS as the result of “Subclavian Vein Compression Syndrome”. This classification has resulted in more accurate diagnosis, better patient selection for surgery, and excellent surgical results. This paper outlines the algorithm for making the appropriate diagnosis in patients who present with neurovascular symptoms of the upper extremity and the selection of the appropriate patients for surgery. Conclusion: Based on the algorithm for surgical decision making, patients with Cervical Rib Disease should undergo cervical exploration and resection of the pathologic entity which results in compression of the brachial plexus or the subclavian artery in the neck. Patients with Thoracic outlet Syndrome who are found to have extrinsic compression of the subclavian vein by a pathologic tubercle at the sternocostal joint on Multiphasic MRA should undergo robotic first rib resection.
文摘I read the article titled“Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma”,published in JAMA Surgery with great interest(1).This study marks an important milestone in the field of minimally invasive liver surgery.
基金National Research Foundation of Korea(NRF)grant funded by the Korean government(MSIT)(RS-2023-00217123).
文摘Minimally invasive surgery(MIS)has significantly progressed and emerged as the preferred approach for various gastrointestinal procedures,including gastrectomy,cholecystectomy,and various colorectal surgeries(1).However,the widespread acceptance of robotic surgery in liver resection has encountered obstacles,attributed to factors such as the lack of appropriate surgical instruments,the intricate learning curve,and safety apprehensions.Nonetheless,the utilization of MIS in liver resection is linked to decreased blood loss,reduced post-operative pain,shorter hospital stays,and lower morbidity rates compared to both open and laparoscopic liver resection procedures(2).
文摘Aim:Robotic liver resection(RLR)is a new platform for minimally invasive hepatobiliary surgery.Minimally invasive surgery can confer benefits to patients with hepatocellular carcinoma(HCC),which is mostly associated with underlying chronic liver disease.Despite the inherent functional merits of robotics for surgical techniques,the clinical advantages of hepatectomy are not well defined.Therefore,we reviewed the short-term and longterm surgical results of 57 HCC cases in 46 patients who underwent RLR at our institution.Methods:We evaluated the feasibility and safety of robotic anatomic liver resection for HCC by comparing the results of the anatomic resection(AR)group(n=23)and non-anatomic resection(NAR)group(n=34).Results:Overall(n=57),the liver-specific console time was 487 min,blood loss was 194 g,and there was one open conversion(2%).Postoperative data showed acceptable hepatic functional recovery,with a major complication rate of 11%and no 90-day mortality.Compared to NAR,AR was associated with longer operative and console times,more blood loss,and worse postoperative liver function,thus reflecting the greater extent and complexity of hepatectomies for more advanced-stage tumors than NAR.Nonetheless,major complication rate,mortality rate,length of hospital stay,and R0 resection rate were comparable between groups.Long-term results were comparable to those of previously reported hepatectomies for HCC and were similar between groups.Conclusion:RLR including AR may be a safe and feasible form of hepatectomy for select patients with HCC.
文摘Liver resection has traditionally been performed using an open approach,but many academic tertiary centers have adopted a minimally invasive surgical(MIS)approach to liver surgery over the past two decades.Laparoscopic liver resection(LLR)remains the most common MIS approach to liver surgery worldwide.However,there has been recent increased adoption of robotic liver resection(RLR).The assumptions made in studying MIS liver surgery,according to the International Consortium on Minimally Invasive Liver Surgery(I-MILS)(1),are similar to those for other forms of MIS surgery.There are certain advantages,such as decreased pain,reduced length of stay(LOS),and lower wound infection rates.However,beyond these benefits,the slow adoption of MIS hepatectomies is due to concerns about using MIS approaches for hemorrhage control,achieving adequate R0 surgical resection of malignancies,and the inevitable learning curve associated with performing such complex surgeries.
文摘Robotic surgery has been a transformative force in minimally invasive thoracic surgery.Robotic surgical technology has impacted surgery of the lung,medi-astinum,esophagus,and the sympathetic chain.However,in one area of tho racic surgery,surgery for Thoracic Outlet Syndrome,robotics has not only impacted the minimally invasive surgical approach to the resection of the first rib,but it has allowed for a better understanding of the pathogenesis of the disease.Historically,the only consistent aspects of Thoracic Outlet Syndrome(TOS)have been the confusion among medical practitioners,difficulty in making the diagnosis,and poor results with surgical intervention.The present understanding of TOS is that it is the manifestation of a congenital malfor-mation of the first rib where an abnormal boney tubercle at the costo-sternal joint results in compression of the subclavian vein(SV)at its junction with the innominate vein.The compression of the SV leads to a spectrum of diseases,which range from neurologic symptoms resulting from venous congestion of the upper extremity nerves to thrombosis of the SV with prolonged compres sion.Robotic technology allows for the precise removal of the“offending por tion”of the first rib.This technique is associated with the best-reported results in patients with TOS.
