Robotic assisted surgery system as an advanced technique gains particular attention over the world.We hereby introduce the history of Robotic assisted surgery system, and induce the advantage or existing problems of this technique. We also compared the new technique with traditional surgery and laparoscopic surgery. The future of this novel technique is assessed with the recent development application at home and abroad.

Pancreatic dissection involved in all types of pancreatic surgery.Several aspects of pancreatic dissection remain unknown or undervalued,although it seems easy to manipulate.In this article,how to improve the surgical techniques of pancreatic dissection and improve the efficacies were introduced,which included the following aspects:surgical instruments selection,selection of sharpening dissection or electrosurgical instrument dissection,management of blood vessels and pancreatic duets in the neck and body of pancreas,search of the opening of the pancreatic ducts,methods for the management of the cutting plane of pancreas,managing methods for pancreas with different textures,and regional dissection of pancreas.

With the increasing incidence and high malignancy, pancreatic cancer is still expected to be treated by radical resection. However, because of the unique anatomical and biological features, such as rapid progression, early metas-tasis and direct invasion to the vessels, the resection rate of pan-creatic cancer is still at a lower level. The standard procedures of diagnosis and treatment, including early detection, preopera-tive resectability assessment, and judgement of the resection area based on the tumor staging, benefit the patients and significantly improve the prognosis.

Hilar cholangiocarcinoma is a rare tumor with a poor prognosis.Due to advances in preoperative imaging and enhanced comprehension of tumor biological behavior,surgical management of hilar cholangiocarcinoma has evolved since its original description.Currently,it has been accepted that complete surgical resection provides the only possibility for cure or long-term survival,however,the surgical management of hilar cholangiocarcinoma is extremely challenging because of its anatomical location and vascular proximity.In order to achieve complete resection, several surgical approaches have been investigated and evaluated regarding major hepatic resection,lymph node dissection,vascular resection,extended resection and liver transplantation,however,there are still many disputations. Furthermore,many surgical technical difficulties exist in biliary reconstruction after resection owing to anatomical problems.Focusing on the disputes and problems mentioned above,we herein review and discuss surgical strategies in managing hilar cholangiocarcinoma.

ObjectiveTo summarize the experience in diagnosis and treatment of malignant change in choledochal cyst patients in the past 20 years. MethodsThe clinical data of 16 patients admitted from 1980 to 2000 were analyzed retrospectively. Results9 patients had had a previous internal drainage procedure,12 patients had biliary tract infection, 4 cases presented with abdominal masses. All suffered body weight loss and general malaise. ERCP was performed in 5 cases with no previous operation, in which abnormal pancreatobiliary duct junction was found in 4 patients. Laparotomy plus metastatic lymph node biopsy was performed in 4 patients, choledochotomy with T-tube drainage for 4 patients, cyst excision and pancreatoduodenectomy for 3 cases, partial cyst excision with left lobectomy for 2 patients, cyst excision with Roux-en-Y hepaticojejunostomy for 3 patients. Pathology proved carcinoma was located in cyst wall in most cases.Postoperative survival time ranged from 4 to 31 months with a mean of 12.7 months. ConclusionsThe clinical symptoms of malignant change in congenital choledochal cyst were non-specific. The preoperative diagnosis for canceration was difficult, and the prognosis was poor.Total extrahepatic choledochocele resection should be adopted for the prevention of canceration.Intraoperative frozen section is helpful to confirm diagnosis. Cyst excision with pancreatoduodenectomy is the treatment of choice for carcinoma invading pancreatic head.

Objective To investigate the extent and the relevant factors for local lymph node metastasis of gallbladder carcinoma. Methods Clinicopathologic features of 34 patients with gallbladder carcinoma who underwent radical resection were analyzed retrospectively. Results The overall lymph node metastasis rate was 68%(23/34), with 0(0/3) in T 1 stage, 43%(3/7) in T 2, 85%(11/13) in T 3, and 82%(9/11) in T 4. The metastasis rate was 29%(10/34) in gallbladder lymph nodes, 44%(15/34) in pericholedochal, 18%(6/34) in hepatic hilum, 24%(8/34) alongside proper hepatic artery, 21%(7/34) in periportal vein, 38%(13/34) in retropancreaticoduodenal, and 4/6 in paraaortic region. Conclusions Lymph node metastasis was determined by the depth of invasion of the primary tumor. The extent of surgical dissection was made according to the exploration and result of intraoperative biopsy.

The solid pseudopapillary tumor of pancreas (SPT) is a rare pancreatic tumor with low malignant potential. It primarily affects young women. The clinical characteristic is nonspecific, but the pathological characteristic is distinct. The tumor consists of both cystic and solid component. The typical histopathological appearance of SPT is the pseudopapillary structure with a fibrovascular surrounded by several layers of epithelial cells.Only a few SPTs present invasive behaviors. The tumor cells express a wide range of immunohistochemical markers. The pathogenesis is associated with the Wnt signaling pathway, which is changed by β-catenin, Pl20-catenin, adenomatous polyposis coli gene( APC), the cyclin-dependent kinase inhibitors p21 and p27.

Objective To outline the surgical experience of liver transplantation in children receiving left lateral lobe (segments II, III). Methods From March 1 to September. 1, 2004, 11 cases of pediatric liver transplantation were performed in Medical School of Hannover including 10 cases of split liver transplantation and 1 case of living related liver transplantation, and the clinical data of those cases were collected and analyzed. The average age and weight of these patients was 48.6 months (5-82 months) and 14.3 kg (6.9-23.8 kg) respectively, and 8 children had the previous abdominal surgical history. Results The average weight of the left lateral graft procured was 276.2 g (198-373 g), and the average cold ischemia time, anhepatic phase and operation time was 679 min (183-1290 min), 69 min (44-88 min) and 252 min (155-335 min) respectively. Six children received temporal closure of abdominal wall after liver transplantation. One child developed the perforation of stomach 15 days after operation, and compression of hepatic artery due to limited abdominal capacity occurred in 2 children within 24 h postoperatively. No complications including outflow obstruction of hepatic vein, hepatic artery thrombosis, primary graft nonfunction, graft necrosis and bile leakage from the cutting surface happened. Conclusion The left lateral lobe liver transplantation in children has been widely used with promising results. Resection of ill liver under controlling of inferior vena cava, simultaneous reperfusion of hepatic artery and portal vein and application of temporal abdominal wall closure had unique advantage, and thus, would be worth adopting.

Objective To study the changes of serum liver functions in recurrent hepatitis C ~after liver transplantation.Methods The clinical data of 50 cases of recurrent hepatitis C (~simultaneously negative for serum HBV DNA) after liver transplantation were collected. The relationship between liver function parameters with the HCV RNA genotype, inflammation histological activity, fibrosis stage, steatosis grade and rejection was evaluated. Results ALT, AST and ?-GT were increased in recurrent hepatitis C. Among them, ?-GT was obviously elevated along with the ~aggravation of histological activity (P

ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.