Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently b...Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.展开更多
Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta(PPWPP).Methods:Patien...Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta(PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.展开更多
Gastrointestinal(GI)cancers are highly prevalent and considered a major global health challenge.Their approach has undergone a remarkable transformation over the past years due to the development of new technologies t...Gastrointestinal(GI)cancers are highly prevalent and considered a major global health challenge.Their approach has undergone a remarkable transformation over the past years due to the development of new technologies that enabled better outcomes regarding their diagnosis and management.These include artificial intelligence,robotics,next-generation sequencing and personalized medicine.Nonetheless,the integration of these advances into everyday clinical practice remains complex and challenging as we are still trying to figure out if these innovations tangibly improve oncological outcomes or if the current state of art should remain as the gold standard for the treatment of these patients.Additionally,there are also some issues regarding ethical subjects,data privacy,finances and governance.Precision surgery concept has evolved considerably over the past decades,especially for oncological patients.It aims to customize medical treatments and to operate on those patients who most likely will benefit from a specific surgical procedure.In the future,to improve GI oncological outcomes,a delicate balance between technological advances adoption and evidence-based care should be chased.As we move forward,the question will be to harness the power of innovation while keeping up the highest standards of patient care.展开更多
Gastrointestinal(GI)cancer has a high tumor incidence and mortality rate worldwide.Despite significant improvements in radiotherapy,chemotherapy,and targeted therapy for GI cancer over the last decade,GI cancer is cha...Gastrointestinal(GI)cancer has a high tumor incidence and mortality rate worldwide.Despite significant improvements in radiotherapy,chemotherapy,and targeted therapy for GI cancer over the last decade,GI cancer is characterized by high recurrence rates and a dismal prognosis.There is an urgent need for new diagnostic and therapeutic approaches.Recent technological advances and the accumulation of clinical data are moving toward the use of precision medicine in GI cancer.Here we review the application and status of precision medicine in GI cancer.Analyses of liquid biopsy specimens provide comprehensive real-time data of the tumor-associated changes in an individual GI cancer patient with malignancy.With the introduction of gene panels including next-generation sequencing,it has become possible to identify a variety of mutations and genetic biomarkers in GI cancer.Although the genomic aberration of GI cancer is apparently less actionable compared to other solid tumors,novel informative analyses derived from comprehensive gene profiling may lead to the discovery of precise molecular targeted drugs.These progressions will make it feasible to incorporate clinical,genome-based,and phenotype-based diagnostic and therapeutic approaches and apply them to individual GI cancer patients for precision medicine.展开更多
Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver sur...Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).展开更多
Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innova...Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innovations in the realm of urology,with a strong focus on precision medicine.This platform provides a vibrant space for surgeons,researchers,and medical professionals to share and engage in discussions about surgical techniques,approaches,and procedures that define the forefront of precision urological surgery.展开更多
Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innova...Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innovations in the realm of urology,with a strong focus on precision medicine.This platform provides a vibrant space for surgeons,researchers,and medical professionals to share and engage in discussions about surgical techniques,approaches,and procedures that define the forefront of precision urological surgery.展开更多
Hepatocellular carcinoma(HCC)is globally the sixth most prevalent and the third most fatal malignancy[1].Although radical surgical resection is the optimal treat-ment strategy for HCC,it is not feasible for approximat...Hepatocellular carcinoma(HCC)is globally the sixth most prevalent and the third most fatal malignancy[1].Although radical surgical resection is the optimal treat-ment strategy for HCC,it is not feasible for approximately 80%of HCC patients who present at intermediate or advanced stages[2].Conversion therapy,particularly preoperative transcatheter arterial embolization/chemo-embolization(TAE/TACE),enables unresectable HCC patients to undergo radical resection;this transition from palliative care to curative surgery enhances overall prog-nosis of HCC patients[3].Many treatment guidelines recommend TACE as the first-line conversion therapy for patients with HCC[4];however,its success rate remains low(11.9%-24.0%)[5,6].Traditional manual and three-way tube mixing methods for preparing iodized oil and drug emulsions are limited by the relatively low drug-loading capacity and poor physical stability of the hydro-phobic iodized oil and hydrophilic drug formulations.As a result,the drugs are quickly released into circulation,leading to poor therapeutic effects and severe adverse events[7,8].The alternative method of drug-loaded microsphere embolization is costly and less effective due to microsphere size limitations[9].Therefore,finding ways to improve the success rate of conversion therapy is a major challenge that needs to be urgently addressed.展开更多
To the editor,Skin and soft-tissue defects commonly result from trauma,infection,necrosis or major excisional surgery due to various causes.Flap surgery is the method by which these defects are reconstructed and repai...To the editor,Skin and soft-tissue defects commonly result from trauma,infection,necrosis or major excisional surgery due to various causes.Flap surgery is the method by which these defects are reconstructed and repaired.A major challenge during flap surgery is selecting the appropriate donor site.Vascular supply at donor and recipient sites can vary significantly by individual[1].In our clinical practice,we have found that computedtomography angiography(CTA)not only accurately locates vascular structures but also provides high-throughput data on soft-tissue structures at the recipient and donor sites,which can aid in the selection of an optimal flap[2,3].Therefore,we have developed a new surgical strategy,precise flap surgery based on CTA,to guide optimal flap selection and preparation.展开更多
基金supported by grants from the Beijing Hospitals Authority Youth Program (12022B4010)BTCH Young Talent En-lightenment Program (2024QMRC24)CAMS Innovation Fund for Medical Sciences (2019-I2M-5–056)。
文摘Extracorporeal liver surgery(ELS), also known as liver autotransplantation, is a hybrid(cross-fertilized) surgery incorporating the technical knowledge from extreme liver and transplant liver surgeries, and recently became more embraced and popularized among leading centers. ELS could be summarized into three major categories, namely, ex-situ liver resection and autotransplantation(ELRA), ante-situm liver resection and autotransplantation(ALRA) and auxiliary partial liver autotransplantation(APLA). The successful development of ELS during the past 37 years is definitely inseparable from continuous effort s done by Chinese surgeons and researchers. Especially, the precision liver surgery paradigm has allowed to transform ELS into a modularized, more simplified, and standardized surgery, to upgrade surgical skills, to improve peri-operative outcome and long-term survival, to increase the capability of surgeons to select more complex diseases and to expand the level of medical service to the population. This review highlights the Chinese contributions to the field of ELS, focusing thereby on features of different surgical types, technical innovations, disease selection and surgical indication, patient prognosis and future perspectives.
基金This study was supported by the National Key R&D Program of China(2016YFC1000405)Guangdong Natural Science Foundation(2015A030310115)
文摘Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta(PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.
文摘Gastrointestinal(GI)cancers are highly prevalent and considered a major global health challenge.Their approach has undergone a remarkable transformation over the past years due to the development of new technologies that enabled better outcomes regarding their diagnosis and management.These include artificial intelligence,robotics,next-generation sequencing and personalized medicine.Nonetheless,the integration of these advances into everyday clinical practice remains complex and challenging as we are still trying to figure out if these innovations tangibly improve oncological outcomes or if the current state of art should remain as the gold standard for the treatment of these patients.Additionally,there are also some issues regarding ethical subjects,data privacy,finances and governance.Precision surgery concept has evolved considerably over the past decades,especially for oncological patients.It aims to customize medical treatments and to operate on those patients who most likely will benefit from a specific surgical procedure.In the future,to improve GI oncological outcomes,a delicate balance between technological advances adoption and evidence-based care should be chased.As we move forward,the question will be to harness the power of innovation while keeping up the highest standards of patient care.
基金Supported by KAKENHI(Grant-in-Aid for Scientific Research),No.18H02883
文摘Gastrointestinal(GI)cancer has a high tumor incidence and mortality rate worldwide.Despite significant improvements in radiotherapy,chemotherapy,and targeted therapy for GI cancer over the last decade,GI cancer is characterized by high recurrence rates and a dismal prognosis.There is an urgent need for new diagnostic and therapeutic approaches.Recent technological advances and the accumulation of clinical data are moving toward the use of precision medicine in GI cancer.Here we review the application and status of precision medicine in GI cancer.Analyses of liquid biopsy specimens provide comprehensive real-time data of the tumor-associated changes in an individual GI cancer patient with malignancy.With the introduction of gene panels including next-generation sequencing,it has become possible to identify a variety of mutations and genetic biomarkers in GI cancer.Although the genomic aberration of GI cancer is apparently less actionable compared to other solid tumors,novel informative analyses derived from comprehensive gene profiling may lead to the discovery of precise molecular targeted drugs.These progressions will make it feasible to incorporate clinical,genome-based,and phenotype-based diagnostic and therapeutic approaches and apply them to individual GI cancer patients for precision medicine.
基金supported by the Beijing Research Ward Excellence Program,BRWEP(BRWEP2024W032240108 for Wang S)National Natural Science Foundation of China(No.81972726 and 82273074 for Yang T+2 种基金No.81930119,No.82090050,and No.82090053 for Dong J)Shanghai Health and Hygiene Discipline Leader Project(No.2022XD001 for Yang T)Shanghai Outstanding Academic Leader Program(No.23XD1424900 for Yang T).
文摘Precision liver surgery has advanced significantly with the improvements of technology,and led to a significant decrease in mortality and complication rates.We argued for the necessity of a paradigm shift in liver surgery,and advocated“precision liver resection”as a surgical concept for the first time in 2006.The aim of precision liver surgery involves personalized surgery planning based on individual patient status.The core of the precision liver surgery is to be visualizable,quantifiable,and controllable also known as three essential elements.Since precision paradigm is essential in modern surgery,characterized by multi-objective optimization accommodating therapeutic effectiveness,surgical safety,and minimal invasiveness,it had expanded to different surgery,such as neurosurgery and gastrointestinal surgery.Techniques such as three-dimensional(3D)reconstruction,intraoperative navigation systems,and indocyanine green(ICG)fluorescence imaging facilitate precise identification and removal of liver tumors while preserving healthy liver tissue.These advancements not only promote the certainty,predictability,and controllability in surgical practice,and achieve the balance of these three essential elements.As technological progress continues,precision liver surgery holds the promise of safer and more effective treatments.Precision medicine aims to balance operative risk against survival benefit by removing targeted lesions,protecting liver function,minimizing surgical trauma.The ultimate aim of precision medicine is the maximization of patient benefit(Fig.1).
文摘Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innovations in the realm of urology,with a strong focus on precision medicine.This platform provides a vibrant space for surgeons,researchers,and medical professionals to share and engage in discussions about surgical techniques,approaches,and procedures that define the forefront of precision urological surgery.
文摘Deadline for submission:Submission are welcome throughout the year UroPrecision is excited to announce the launch of our new column,"UroPrecision Cuts,"dedicated to showcasing ground-breaking surgical innovations in the realm of urology,with a strong focus on precision medicine.This platform provides a vibrant space for surgeons,researchers,and medical professionals to share and engage in discussions about surgical techniques,approaches,and procedures that define the forefront of precision urological surgery.
基金National Natural Science Foundation of China,Grant/Award Numbers:81925019,U1705281,U22A20333,82202330Fundamental Research Funds for the Central Universities,Grant/Award Numbers:2020Y4003,20720200019Development Program of China,Grant/Award Number:2017YFA0205201。
文摘Hepatocellular carcinoma(HCC)is globally the sixth most prevalent and the third most fatal malignancy[1].Although radical surgical resection is the optimal treat-ment strategy for HCC,it is not feasible for approximately 80%of HCC patients who present at intermediate or advanced stages[2].Conversion therapy,particularly preoperative transcatheter arterial embolization/chemo-embolization(TAE/TACE),enables unresectable HCC patients to undergo radical resection;this transition from palliative care to curative surgery enhances overall prog-nosis of HCC patients[3].Many treatment guidelines recommend TACE as the first-line conversion therapy for patients with HCC[4];however,its success rate remains low(11.9%-24.0%)[5,6].Traditional manual and three-way tube mixing methods for preparing iodized oil and drug emulsions are limited by the relatively low drug-loading capacity and poor physical stability of the hydro-phobic iodized oil and hydrophilic drug formulations.As a result,the drugs are quickly released into circulation,leading to poor therapeutic effects and severe adverse events[7,8].The alternative method of drug-loaded microsphere embolization is costly and less effective due to microsphere size limitations[9].Therefore,finding ways to improve the success rate of conversion therapy is a major challenge that needs to be urgently addressed.
基金supported by the Basic Research Project of Department of Science and Technology of Yunnan Province(202101AY070001-298,202201AY070001-288,202201 AU070229).
文摘To the editor,Skin and soft-tissue defects commonly result from trauma,infection,necrosis or major excisional surgery due to various causes.Flap surgery is the method by which these defects are reconstructed and repaired.A major challenge during flap surgery is selecting the appropriate donor site.Vascular supply at donor and recipient sites can vary significantly by individual[1].In our clinical practice,we have found that computedtomography angiography(CTA)not only accurately locates vascular structures but also provides high-throughput data on soft-tissue structures at the recipient and donor sites,which can aid in the selection of an optimal flap[2,3].Therefore,we have developed a new surgical strategy,precise flap surgery based on CTA,to guide optimal flap selection and preparation.
