The minimally invasive approach is the direction of cardiac surgery.With the development of telemanipulation and computer technology,the minimally robotic surgery has become reality.As the one of the most minimally invasive cardiac surgery,the robotic surgical system provides cardiac surgeons with less invasive manner and dexterity manipulation.Robotic cardiac surgery is an evolutionary process and has resulted in a substantial increased attention to surgeons and patients.This review is to introduce the recent clinical application of robotic technology in cardiac surgery.

Objective To investigate the effect of non-restrictive external stent on both cell proliferation of rabbit vein grafts and prevention from hyperplasia of the grafts' neointima. Methods 36 New Zealand white rabbits were randomly divided into two groups, each animal was subjected to a reversed autologous venous graft between external jugular vein and common carotid artery. In stenting group (group S), the vein grafts were surrounded by a 6 mm in diameter non-restrictive stent, and in non-stenting group (group NS), there is no stent to support the vein grafts. The grafts were harvested 1 week (1W), 2 weeks (2W) and 4 weeks (4W) after surgery, respectively. The sections were stained with hematoxylin and eosin stain, ?-smooth muscle actin (?-SMA) and proliferating cell nuclear antigen (PCNA) immunocytochemistry stain. PCNA index was calculated in intima, media and adventitia, respectively. Results (1) HE staining: From 1W to 4W, the hyperplasia of intima and media appeared gradually in both group S and group NS, nevertheless such hyperplasia in group S was lessintense than in group NS. (2) ?-SMA staining: Almost all cells in media were positive, but few cells were positive in intima of both groups at 1W; the thickness of intima of both groups increased gradually, and almost all cells except endothelial cells were positive in intima in both groups, though the thickness of intima of group S was smaller than in group NS at 2W and 4W. (3) PCNA index: the index of intima in both two groups peaked at 2W, and the index of intima in group S was less than in group NS at 2W and 4W, P

0.05; at 14 d,28 d, the thickness and area of the intiam in group S were smaller than those in group NS,P

Fractures of the femoral head (FFH) are mainly seen in young adults,and the majority mechanism is due to dashboard injury in crushing vehicles.FFH can be present with or without posterior dislocation of the hip joint.Except for periarticular pain and hip dysfunction,the typical signs include flexion,adduction and internal rotation of the hip and shortening of involved limb.CT and MRI get their popularity as diagnostic methods for FFH.An emergency open reduction should be indicated in the scenario of failed closed reduction in FFH with posterior dislocation,of FFH with femoral neck fractures,of unmatched head and acetabulum following closed reduction and of deteriorating sciatic nerve damage.Pipkin as well as Brumback classification is still the most popularly used methods,which have great significance for establishment of surgical strategy and prediction of prognosis.More and more clinical evidences show conservative care of FFH should only be indicated for non-displaced fractures or displacement less than 2 mm.These cases must meet the following criteria simultaneously,including stable hip joint,concentric head and acetabulum,no free fractured fragments in the joint space and no labrum entrapment.Operative care is naturally the treatment of choice.Surgical approaches for FFH are hot topics in recent years.In previous control studies to compare Kocher-Langenbeck (K-L) and Smith-Peterson (S-P) approach,it is revealed less operative time,less blood loss and better operative field you can get in S-P approach,however,the incidence of ectopic ossification is higher.Ganz approach,which is characterized by osteotomy of great trochanter,hip capsulotomy and surgical dislocation of the hip,is a novel pattern for operative care of FFH.Ganz approach can show the entire femoral head,while can not damage medial femoral circumflex artery (MFCA) and induce iatrogenic osteonecrosis of the femoral head (ONFH).Various screws are the main implants for the fixation of fractured femoral head.Osteoarthritis and ONFH are two principal complications following FFH,which not only closely associate with severity and mechanism of primary injury,but also correlate with reduction quality and iatrogenic factors.Artificial hip joint replacement is a rational choice for extremely comminuted femoral head and these FFH in the elderly.

Objective To observe the distribution of different ventricular myocardial band segment's in different echocardiogram sectiones. Methods 5 swine hearts, 5 ox hearts and 5 sheep hearts were dissect to the ventricular myocardial band structure by the standard anatomy method. After the demarcation line of each segment of ventricular myocardial band was defined, they were dyed with different colors and then were recovered into the state before dissecting. At last, they were cut open according to different echocardiogram sectiones. Results With relative stabile anatomy methods, all hearts presented to be a unique integrate myocardial band,with two loops, the basic loop and apical loop, and four segments. At different echocardiogram sectiones, the left ventricle is formed by three muscular strata, while the right ventricle is formed by only one muscular strata. Conclusion The distribution of different ventricular myocardial band segments in different echocanliogram sectiones is significantly different.

Studies were carried out on the incidence of SCE and chromosomal aberrations in primary cultured cells of mouse embryo exposed to ~(60)Co-? rays and/or treated with chemical carcinogen——benzopyrene.Result shows in the cultured cells exposed to ~(60)Co-? rays at 50 rads, as compared wtih controls there was no statistically significant change in the frequencies of the appearance of both SCE and chromosomal aberrations, In the cells, however, exposed at 300 rads, the frequencies of SCE and chromosomal aberrations were about 1.3 and 24 times higher than that in the unirradiated controls respectively. In the cultured cells treated with 0.05?g of benzopyrene per millilitre of culture medium, the frequency of SCE were increased by about 1.8 times of that of the control group, while the change of chromosomal aberrations had no statistical significance.From the above results, it was suggested that SCE was proved to be a sensitive indicator for evaluating the effects of chemical carcinogens. There is a remarkable difference existing between the frequencies of SCE and chromosomal aberrations induced by ionizing radiation and chemical carcinogens. The difference seems to have a certain relation to their differences in carcinogenic mechanism and effects on carcinogenesis.It was noted that there are some advantages to utilize primary cultured cells of mouse embryo as target cells.

Objective To summarize the clinical experience of coronary angiography before coronary artery grafting (CABG) with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old (mean age 60 3.5) with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 50% of its calibre was considered positive, and 75% stenosis (including LMCA stenosis more than 50%) was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases (23.4%) had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0.5%, which was significantly lower compared with patients with valve surgery combined with CABG group (4.2%)(P

Objective To summarize the technique and evaluate the effect of anesthesia for off-pump coronary artery bypass surgery (OPCAB). Methods From 1997 through March of 2005, five hundred and forty-three consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 0.05～0.12mg/kg, ketamine 0～0.5mg/kg and fentanyl 5～15?g/?kg. Anesthesia was maintained with isoflurane 0.3%～1.5% and oxygen, combined with propofol 1～3mg/(kg?h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean extubation time was 5.8?1.6h. The ICU stay was 0.5 to 2.0 day. The patients were discharged in 8.0?1.2 days. Two patients met sudden death in the second postoperative day. Conclusion Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.

Objective To introduce experience of harvesting great saphenous vein (GSV) and surgical techniques to avoid infectious complication in coronary artery bypass grafting (CABG). Methods One thousand and one hundred twenty CABG, including 523 conventional CABG (CCABG) and 597 off-pump coronary artery bypass grafting (OPCAB), were performed by the same surgical team. One thousand and fifty GSV were used as the conduit. Left internal mammary artery was routinely anastomosed to left anterior descending artery(LAD), and GSV and/or radial artery to the other target vessels. Preoperative selection of GSV, operative procedure of harvesting, meticulous postoperative supervision and appropriate treatment of the incision, and the control of risk factors as diabetes mellitus, which composed an integral part of periopertive strategies, are critical to avoid infectious complication. Results No infection occurred. Recovery of two patients with diabetes mellitus was complicated by delayed healing of incision. In ten patients there was a slight exudation from the incision, and they healed without infection after the addition of 2~3 interrupted sutures. Healing was not delayed. Swelling of the involved legs occurred in the majority of patients, and numbness along the incision was also documented in some patients, and it usually recovered to normal three months after operation, after being followed-up for 3 months to 2 years. Conclusion Infection can be completely avoided after the planned procedure of harvesting GSV and meticulous perioperative care.

Objective To introduce the strategies of coronary artery bypass grafting (CABG) surgery for elderly patients over 65 years old. Methods Three hundred and ninety four elderly patients were retrospectively studied, 92.4% of whom were complicated with other diseases. Off-pump CABG (OPCAB) was used in 248 cases (62.4%). For the remaining patients with severely compromised cardiac function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested with extrapleural harvesting technique and grafted to left anterior descending artery (LAD) in 96.2% of patients. Saphenous vein or radial artery was utilized for the other coronary arteries. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Perioperative blood sugar level was controlled at 6-10mmol/L by insulin. Results Grafts of per patient were 3.14?0.55 for on-pump CABG and 2.40?0.81 for OPCAB. Three patients died resulting in a mortality of 0.76%. The incidence of complication was 2.28%. The rest recovered uneventfully. Intubation time of OPCAB was significantly shorter than that of CCABG. Patients were discharged within 11.84?4.95 days after operation. Conclusion Good short-term result, namely low incidence of mortality and complication, could be obtained in elderly patients over than 65 years old undertaking CABG.