Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid adv...Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.展开更多
Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated th...Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated three-dimensional(3D)models have been proposed as a valuable tool to enhance this understanding.However,a systematic comparison of different display modalities across professional groups has not yet been performed.Methods:In this prospective,monocentric randomized trial,we compared high-resolution twodimensional(2D)CT images of liver malignancies with their corresponding standardized,non-colored 3D virtual and printed models in facilitating anatomical and spatial understanding as well as surgical decision-making.A total of 91 participants,including 40 surgeons,10 radiologists,and 41 students,evaluated six clinical cases(three centrally and three peripherally located liver malignancies).Each participant assessed one central and one peripheral case per display modality,presented in a random order.Results:Compared to 2D CT images,both 3D virtual and printed models significantly improved the identification of tumor location(P<0.001),enhanced the comprehension of spatial relationships with adjacent liver and portal veins(P<0.001 and P=0.019,respectively),and facilitated clinical decisionmaking(P<0.001).No significant difference was observed between virtual and printed models in terms of effectiveness.Within the different groups,surgeons and students,but not radiologists,more accurately identified tumor location and spatial relationships with adjacent liver and portal veins using 3D models.Subjectively,most surgeons and students preferred 3D printed models over virtual models and 2D CT images.Conclusions:This study demonstrated that standardized,non-colored 3D virtual and printed models equally help preoperative anatomical understanding and decision-making,particularly for surgeons and students.By isolating the influence of display modality,our findings clarify prior inconsistent results and support the integration of cost-effective 3D visualization by applying virtual models into surgical planning and education.Preference for printed models despite comparable efficacy highlights the importance of user-centered implementation strategies.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints...BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.展开更多
Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive ca...Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.展开更多
Surgical navigation has evolved significantly through advances in augmented reality,virtual reality,and mixed reality,improving precision and safety across many clinical applications,including neurosurgery,maxillofaci...Surgical navigation has evolved significantly through advances in augmented reality,virtual reality,and mixed reality,improving precision and safety across many clinical applications,including neurosurgery,maxillofacial,spinal,and arthroplasty procedures.By integrating preoperative imaging with real-time intraoperative data,these systems provide dynamic guidance,reduce radiation exposure,and minimize tissue damage.Key challenges persist,including intraoperative registration accuracy,flexible tissue deformation,respiratory compensation,and real-time imaging quality.Emerging solutions include artificial intelligence-driven segmentation,deformation-field modeling,and hybrid registration techniques.Future developments will include lightweight,portable systems,improved non-rigid registration algorithms,and greater clinical adoption.Despite advances in rigid-tissue applications,soft-tissue navigation requires additional innovation to address motion variability and registration reliability,ultimately advancing minimally invasive surgery and precision medicine.展开更多
Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the fi...Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the field of head and neck surgery.With the rapid development of surgical technology,microsurgical reconstruction technology,perioperative management,and multidisciplinary treatment models,surgical treatment has occupied a core position in the comprehensive treatment system of oral and maxillofacial tumors.Based on this,this paper conducts research on the clinical outcomes of surgical treatment for patients with oral and maxillofacial tumors,expounds the optimization strategies of surgical treatment,and analyzes the clinical effects of the optimized surgical treatment,aiming to provide a reference for the clinical treatment of oral and maxillofacial tumors.展开更多
Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55...Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55 sympathetic trunks available in 28 Chinese adult cadavers(18 males and 10 females)were investigated in this study.The thoracic cavity was thoroughly exposed and then sympathetic ganglia and its affiliated rami were observed and measured with microscopic instruments.Results Rami from thoracic nerve 1(T1)intercostal nerve entered the stellate ganglion above the upper border of the second rib in all specimens,The distance between the rami and the upper border of the second rib was(5.1±1.4)mm.The incidence that T2⁃T5 ganglions located at the corresponding intercostal space was 92.7%,85.5%,40.0%and 36.4%,respectively.The rami communicantes were classified into 3 types(type a,b and c)according to the anatomical relationship between the thoracic sympathetic ganglia and the intercostal nerves.The distance from 3 types of rami communicantes to lateral sympathetic trunk at the middle point of relative rib was(10.2±3.4)mm(type a),(9.5±2.6)mm(type b)and(8.4±2.0)mm(type c),respectively.We found that 74.5%superior intercostal artery crossed the neck of the first rib.The distance between the superior intercostal artery and the lateral sympathetic trunk was(3.4±1.3)mm.Conclusion Sympathectomy performed at rib level should be the ideal choice for clinical surgical treatment of palmar or craniofacial hyperhidrosis with less denervation scope to achieve more definite therapeutic effect.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a nov...Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.展开更多
BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct compa...BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.展开更多
Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radi...Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.展开更多
BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonanc...BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.展开更多
BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluat...BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.展开更多
BACKGROUND Appendicitis is a common acute abdominal pain disorder.Laparoscopic appendectomy,a commonly used modality,is associated with less trauma and faster recovery than traditional open appendectomy.However,postop...BACKGROUND Appendicitis is a common acute abdominal pain disorder.Laparoscopic appendectomy,a commonly used modality,is associated with less trauma and faster recovery than traditional open appendectomy.However,postoperative recovery remains an important issue that affects rehabilitation quality and surgical results.AIM To explore the effects of rapid rehabilitation and surgical nursing care on gastrointestinal function recovery and sleep quality among patients undergoing laparoscopic appendectomy.METHODS A total of 120 patients who underwent laparoscopic appendectomy at our hospital between January 2019 and March 2024 and for whom complete clinical data were available were selected.Patients were randomly assigned to two groups(n=60 each)using the random number table method.The control group received routine nursing care,while the experimental group received rapid rehabilitation surgical nursing care;all patients continued to receive nursing care until discharge.The recovery of gastrointestinal function,length of hospital stay,complications,Pittsburgh sleep quality index,and nursing satisfaction were compared between groups.RESULTS Following the implementation of effective nursing measures,the times to bowel sound recovery,first exhaust,first defecation,and first feeding were notably shorter in the study vs control group(P<0.05).Additionally,the duration of the first postoperative activity and the length of hospital stay were significantly shorter in the study vs control group(P<0.05).Furthermore,the study group exhibited better sleep quality than the control group(P<0.05).The postoperative complication rate was significantly lower and the nursing satisfaction rate significantly higher in the study vs control group(P<0.05).CONCLUSION Rapid rehabilitation surgical nursing interventions provided to patients after laparoscopic appendectomy can accelerate their postoperative recovery,reduce the occurrence of complications,and improve their sleep quality and nursing satisfaction.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic...BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.展开更多
BACKGROUND Primary gastrointestinal lymphoma(PGIL)is a relatively uncommon clinical entity,exhibiting distinctive features including occult primary sites,nonspecific clinical presentations,and considerable diagnostic ...BACKGROUND Primary gastrointestinal lymphoma(PGIL)is a relatively uncommon clinical entity,exhibiting distinctive features including occult primary sites,nonspecific clinical presentations,and considerable diagnostic and therapeutic difficulties.Consequently,comprehensive clinical investigations into its clinicopathological characteristics and surgical intervention value are warranted to enhance dia-gnostic and therapeutic proficiency.AIM To investigate the clinicopathological characteristics and surgical significance of PGIL from a surgical perspective,providing a theoretical basis for optimizing diagnostic and therapeutic strategies.METHODS This study included 50 cases of PGIL treated by the General Surgery Department of the Chinese PLA Air Force Medical Center from June 2001 to March 2025.Data were extracted from the Electronic Medical Record system for retrospective analysis.A retrospective analysis was conducted on their epidemiological,clinical manifestations,imaging,pathological features,and treatment outcomes.Descriptive statistics were applied for data summarization,with continuous variables presented as frequencies and percentages.Correlations between variables were assessed using the Spearman rank correlation coefficient.RESULTS All cases had the gastrointestinal tract as the primary site.Abdominal pain was the most common initial symptom(52.0%),with 80.0%of patients experiencing pain during the course of the disease,and 38.0%experiencing hema-tochezia/melena or anemia.Computed tomography diagnosis exhibited a high overall sensitivity(94.3%);the en-doscopic detection rate was 91.5%.Diffuse large B-cell lymphoma was the most common subtype(52.0%).The im-provement rate was higher in the surgery combined with chemotherapy group than in the chemotherapy only group.The incidence of postoperative complications was 26.5%,all occurring in patients with tumors>5 cm.CONCLUSION Diffuse large B-cell lymphoma is the primary PGIL subtype.Imaging and endoscopic biopsy are diagnostic es-sentials.Surgery aids in resection,complication management,and pathologic diagnosis.Multidisciplinary,indi-vidualized strategies are recommended,necessitating further prospective molecular studies.展开更多
Surgical electrodes are frequently associated with disadvantages such as high surface adhesion and severe thermal damage to adjacent normal tissues,which threaten operation quality and patient safety.In this study,by ...Surgical electrodes are frequently associated with disadvantages such as high surface adhesion and severe thermal damage to adjacent normal tissues,which threaten operation quality and patient safety.In this study,by mimicking the micromorphology and bio-anti-adhesion of shark skin,we proposed a strategy that utilized nanoscale aluminium oxide(Al_(2)O_(3))films deposited on bioinspired shark skin(BSS)microstructures to design a composite surface(Al_(2)O_(3)@BSS)and integrated it into both flat sides of the surgical electrodes.Micro/nano-manufacturing of the Al_(2)O_(3)@BSS surface was sequentially accomplished using nanosecond laser texturing,atomic layer deposition,and low-temperature annealing,endowing it with excellent blood-repellent properties.Visualisation experiments revealed that the tensile stress gradient of the blood coagulum with increasing thickness under a thermal field prompted it to separate from the Al_(2)O_(3)@BSS surface,resulting in anti-adhesion.Furthermore,it was observed for the first time that Al_(2)O_(3) films could transiently excite discharge along a dielectric surface(DADS)to ablate tissues while suppressing Joule heat,thereby minimising thermal damage.A combination of ex vivo tissue and living mouse experiments demonstrated that the Al_(2)O_(3)@BSS electrodes exhibited optimal comprehensive performance in terms of anti-adhesion,damage minimisation,and drag reduction.In addition,the Al_(2)O_(3)@BSS electrodes possessed remarkable antibacterial efficacy against E.coli and S.aureus.The proposed strategy can meet the extreme application requirements of surgical electrodes to improve operation quality and offer valuable insights for future studies.展开更多
基金Supported by the Key Special Project of“Cutting-Edge Biotechnology”in the National Key Research and Development Program of China(No.2024YFC3406200)Sanming Project of Medicine in Shenzhen(No.SZSM202411007)Shenzhen Science and Technology Program(No.JCYJ20240813152704006).
文摘Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.
文摘Background:Successful liver resection in oncologic surgery depends on safety,precision,and efficacy,all of which require a thorough understanding of liver anatomy.Contrast-enhanced computed tomography(CT)-generated three-dimensional(3D)models have been proposed as a valuable tool to enhance this understanding.However,a systematic comparison of different display modalities across professional groups has not yet been performed.Methods:In this prospective,monocentric randomized trial,we compared high-resolution twodimensional(2D)CT images of liver malignancies with their corresponding standardized,non-colored 3D virtual and printed models in facilitating anatomical and spatial understanding as well as surgical decision-making.A total of 91 participants,including 40 surgeons,10 radiologists,and 41 students,evaluated six clinical cases(three centrally and three peripherally located liver malignancies).Each participant assessed one central and one peripheral case per display modality,presented in a random order.Results:Compared to 2D CT images,both 3D virtual and printed models significantly improved the identification of tumor location(P<0.001),enhanced the comprehension of spatial relationships with adjacent liver and portal veins(P<0.001 and P=0.019,respectively),and facilitated clinical decisionmaking(P<0.001).No significant difference was observed between virtual and printed models in terms of effectiveness.Within the different groups,surgeons and students,but not radiologists,more accurately identified tumor location and spatial relationships with adjacent liver and portal veins using 3D models.Subjectively,most surgeons and students preferred 3D printed models over virtual models and 2D CT images.Conclusions:This study demonstrated that standardized,non-colored 3D virtual and printed models equally help preoperative anatomical understanding and decision-making,particularly for surgeons and students.By isolating the influence of display modality,our findings clarify prior inconsistent results and support the integration of cost-effective 3D visualization by applying virtual models into surgical planning and education.Preference for printed models despite comparable efficacy highlights the importance of user-centered implementation strategies.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.
文摘Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.
基金Supported by the National Natural Science Foundation of China(NSFC)under Grants 62025104,62422102,62331005,62301034,and U22A2052the Beijing Natural Science Foundation-Daxing Innovation Joint Fund(L256040).
文摘Surgical navigation has evolved significantly through advances in augmented reality,virtual reality,and mixed reality,improving precision and safety across many clinical applications,including neurosurgery,maxillofacial,spinal,and arthroplasty procedures.By integrating preoperative imaging with real-time intraoperative data,these systems provide dynamic guidance,reduce radiation exposure,and minimize tissue damage.Key challenges persist,including intraoperative registration accuracy,flexible tissue deformation,respiratory compensation,and real-time imaging quality.Emerging solutions include artificial intelligence-driven segmentation,deformation-field modeling,and hybrid registration techniques.Future developments will include lightweight,portable systems,improved non-rigid registration algorithms,and greater clinical adoption.Despite advances in rigid-tissue applications,soft-tissue navigation requires additional innovation to address motion variability and registration reliability,ultimately advancing minimally invasive surgery and precision medicine.
文摘Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the field of head and neck surgery.With the rapid development of surgical technology,microsurgical reconstruction technology,perioperative management,and multidisciplinary treatment models,surgical treatment has occupied a core position in the comprehensive treatment system of oral and maxillofacial tumors.Based on this,this paper conducts research on the clinical outcomes of surgical treatment for patients with oral and maxillofacial tumors,expounds the optimization strategies of surgical treatment,and analyzes the clinical effects of the optimized surgical treatment,aiming to provide a reference for the clinical treatment of oral and maxillofacial tumors.
文摘Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55 sympathetic trunks available in 28 Chinese adult cadavers(18 males and 10 females)were investigated in this study.The thoracic cavity was thoroughly exposed and then sympathetic ganglia and its affiliated rami were observed and measured with microscopic instruments.Results Rami from thoracic nerve 1(T1)intercostal nerve entered the stellate ganglion above the upper border of the second rib in all specimens,The distance between the rami and the upper border of the second rib was(5.1±1.4)mm.The incidence that T2⁃T5 ganglions located at the corresponding intercostal space was 92.7%,85.5%,40.0%and 36.4%,respectively.The rami communicantes were classified into 3 types(type a,b and c)according to the anatomical relationship between the thoracic sympathetic ganglia and the intercostal nerves.The distance from 3 types of rami communicantes to lateral sympathetic trunk at the middle point of relative rib was(10.2±3.4)mm(type a),(9.5±2.6)mm(type b)and(8.4±2.0)mm(type c),respectively.We found that 74.5%superior intercostal artery crossed the neck of the first rib.The distance between the superior intercostal artery and the lateral sympathetic trunk was(3.4±1.3)mm.Conclusion Sympathectomy performed at rib level should be the ideal choice for clinical surgical treatment of palmar or craniofacial hyperhidrosis with less denervation scope to achieve more definite therapeutic effect.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
文摘Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.
基金Supported by National Research Foundation of Korea,No.RS-2022-NRO71822Hallym University Medical Center Research Fund(Mighty Hallym,4.0).
文摘BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.
文摘Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.
文摘BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.
文摘BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.
文摘BACKGROUND Appendicitis is a common acute abdominal pain disorder.Laparoscopic appendectomy,a commonly used modality,is associated with less trauma and faster recovery than traditional open appendectomy.However,postoperative recovery remains an important issue that affects rehabilitation quality and surgical results.AIM To explore the effects of rapid rehabilitation and surgical nursing care on gastrointestinal function recovery and sleep quality among patients undergoing laparoscopic appendectomy.METHODS A total of 120 patients who underwent laparoscopic appendectomy at our hospital between January 2019 and March 2024 and for whom complete clinical data were available were selected.Patients were randomly assigned to two groups(n=60 each)using the random number table method.The control group received routine nursing care,while the experimental group received rapid rehabilitation surgical nursing care;all patients continued to receive nursing care until discharge.The recovery of gastrointestinal function,length of hospital stay,complications,Pittsburgh sleep quality index,and nursing satisfaction were compared between groups.RESULTS Following the implementation of effective nursing measures,the times to bowel sound recovery,first exhaust,first defecation,and first feeding were notably shorter in the study vs control group(P<0.05).Additionally,the duration of the first postoperative activity and the length of hospital stay were significantly shorter in the study vs control group(P<0.05).Furthermore,the study group exhibited better sleep quality than the control group(P<0.05).The postoperative complication rate was significantly lower and the nursing satisfaction rate significantly higher in the study vs control group(P<0.05).CONCLUSION Rapid rehabilitation surgical nursing interventions provided to patients after laparoscopic appendectomy can accelerate their postoperative recovery,reduce the occurrence of complications,and improve their sleep quality and nursing satisfaction.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金Supported by Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment,Chinese Academy of Medical Sciences,No.2021RU016.
文摘BACKGROUND Laparoscopic surgery,with the advantage of less trauma,has been predominantly performed to treat pediatric inguinal hernia.However,the traditional three-port laparoscopic surgery remains extremely traumatic for children,whereas singleport laparoscopic surgery causes less damage to children than traditional laparoscopy.However,single-port laparoscopic surgery is more challenging;thus,studies on the effect of its application in pediatric inguinal hernia remain relatively limited.AIM To analyze the association of single-incision laparoscopic herniorrhaphy needle treatment with surgical outcomes,postoperative complications,and serum inflammation in pediatric inguinal hernia.METHODS This retrospective study included 113 pediatric patients with inguinal hernia who underwent surgery at the Children’s Hospital,Capital Institute of Pediatrics,from April 2022 to May 2023.Participants were categorized into the observation group(single-incision laparoscopic herniorrhaphy needle,n=60)and the control group(two-port laparoscopic surgery,n=53).Comparative analyses involved surgical duration,intraoperative blood loss,and length of hospital stay.C-reactive protein(CRP)and white blood cell count(WBC)levels were measured preoperatively and 24 hours postoperatively.Postoperative pain was evaluated with the face,legs,activity,cry,and Consolability scale.Further,the incidence of complications,recurrence,and reoperation rates was assessed.Logistic regression was employed to determine independent risk factors related to poor prognosis.RESULTS The observation group demonstrated significantly reduced intraoperative blood loss and shorter hospitalization compared to the control group(P<0.05).Both groups demonstrated increased CRP and WBC levels postoperatively,but the observation group exhibited significantly lower levels(P<0.05).Further,pain scores at 24 hours postoperatively were significantly lower in the observation group(P<0.05).Additionally,the observation group experienced fewer adverse events,recurrence rates,and reoperations compared to the control group(P<0.05).Logistic regression analysis determined increased postoperative stress markers and surgical technique as independent predictors of recurrence(P<0.05).CONCLUSION Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia exhibits significant efficacy,effectively reduces postoperative complications,ensures a more concealed surgical incision,and promotes faster postoperative recovery than conventional two-port laparoscopy.This approach merits wider application.
基金Supported by the Outstanding Young Talents Program of Air Force Medical Center,People’s Liberation Army,No.22BJQN004Clinical Program of Air Force Medical University,No.Xiaoke2022-07.
文摘BACKGROUND Primary gastrointestinal lymphoma(PGIL)is a relatively uncommon clinical entity,exhibiting distinctive features including occult primary sites,nonspecific clinical presentations,and considerable diagnostic and therapeutic difficulties.Consequently,comprehensive clinical investigations into its clinicopathological characteristics and surgical intervention value are warranted to enhance dia-gnostic and therapeutic proficiency.AIM To investigate the clinicopathological characteristics and surgical significance of PGIL from a surgical perspective,providing a theoretical basis for optimizing diagnostic and therapeutic strategies.METHODS This study included 50 cases of PGIL treated by the General Surgery Department of the Chinese PLA Air Force Medical Center from June 2001 to March 2025.Data were extracted from the Electronic Medical Record system for retrospective analysis.A retrospective analysis was conducted on their epidemiological,clinical manifestations,imaging,pathological features,and treatment outcomes.Descriptive statistics were applied for data summarization,with continuous variables presented as frequencies and percentages.Correlations between variables were assessed using the Spearman rank correlation coefficient.RESULTS All cases had the gastrointestinal tract as the primary site.Abdominal pain was the most common initial symptom(52.0%),with 80.0%of patients experiencing pain during the course of the disease,and 38.0%experiencing hema-tochezia/melena or anemia.Computed tomography diagnosis exhibited a high overall sensitivity(94.3%);the en-doscopic detection rate was 91.5%.Diffuse large B-cell lymphoma was the most common subtype(52.0%).The im-provement rate was higher in the surgery combined with chemotherapy group than in the chemotherapy only group.The incidence of postoperative complications was 26.5%,all occurring in patients with tumors>5 cm.CONCLUSION Diffuse large B-cell lymphoma is the primary PGIL subtype.Imaging and endoscopic biopsy are diagnostic es-sentials.Surgery aids in resection,complication management,and pathologic diagnosis.Multidisciplinary,indi-vidualized strategies are recommended,necessitating further prospective molecular studies.
基金financially supported by the National Natural Science Foundation of China(Grant Nos.52275425,52405473,and 52405472)the Natural Science Foundation of Guangdong Province(Grant No.2024A1515010993)。
文摘Surgical electrodes are frequently associated with disadvantages such as high surface adhesion and severe thermal damage to adjacent normal tissues,which threaten operation quality and patient safety.In this study,by mimicking the micromorphology and bio-anti-adhesion of shark skin,we proposed a strategy that utilized nanoscale aluminium oxide(Al_(2)O_(3))films deposited on bioinspired shark skin(BSS)microstructures to design a composite surface(Al_(2)O_(3)@BSS)and integrated it into both flat sides of the surgical electrodes.Micro/nano-manufacturing of the Al_(2)O_(3)@BSS surface was sequentially accomplished using nanosecond laser texturing,atomic layer deposition,and low-temperature annealing,endowing it with excellent blood-repellent properties.Visualisation experiments revealed that the tensile stress gradient of the blood coagulum with increasing thickness under a thermal field prompted it to separate from the Al_(2)O_(3)@BSS surface,resulting in anti-adhesion.Furthermore,it was observed for the first time that Al_(2)O_(3) films could transiently excite discharge along a dielectric surface(DADS)to ablate tissues while suppressing Joule heat,thereby minimising thermal damage.A combination of ex vivo tissue and living mouse experiments demonstrated that the Al_(2)O_(3)@BSS electrodes exhibited optimal comprehensive performance in terms of anti-adhesion,damage minimisation,and drag reduction.In addition,the Al_(2)O_(3)@BSS electrodes possessed remarkable antibacterial efficacy against E.coli and S.aureus.The proposed strategy can meet the extreme application requirements of surgical electrodes to improve operation quality and offer valuable insights for future studies.
