The rise and deep integration of artificial intelligence (AI) technology have led to its irreversible penetration across various industries. Against this backdrop, it is worth discussing how robotic-assisted metabolic and bariatric surgery can leverage its core strengths and capitalize on advancements in AI to achieve technological innovation. This article systematically reviewed the evolution, key advantages, and current limitations of robotic-assisted metabolic and bariatric surgery, explored future directions, and provided insights for subsequent research and clinical practice.

Objective:To investigate the correlation between the plasma trimethylamine oxide (TMAO) level and the disease severity in patients with acute coronary syndrome (ACS).Methods:The clinical data of 200 patients with ACS (ACS group) and 90 chest discomfort patients without obvious coronary artery disease (control group) in Department of Cardiology Medicine, the First People′s Hospital of Tianmen City, Hubei Province, from June 2018 to June 2019 were retrospectively analyzed. The plasma TMAO level were detected by high performance liquid chromatography tandem spectroscopy with stable isotope dilution. Left ventricular ejection fraction (LVEF), left ventricle diameter (LAD), left ventricular posterior wall end-systolic thickness (PWS) and left ventricular posterior wall end-diastolic thickness (LVPWT) were examined by color ultrasound. The diagnostic value of plasma TMAO for ACS was analyzed by receiver operating characteristic (ROC) curve. Correlation was analyzed by Pearson correlation analysis.Results:The TMAO, LAD, PWS and LVPWT in ACS group were significantly higher than those in control group: (6.33 ± 1.31) μmol/L vs. (3.75 ± 1.11) μmol/L, (39.63 ± 8.89) mm vs. (31.90 ± 8.79) mm, (12.88 ± 1.76) mm vs. (7.00 ± 1.27) mm and (13.45 ± 2.51) mm vs. (8.97 ± 2.00) mm, the LVEF was significantly lower than that in control group: (44.63 ± 10.00)% vs. (59.71 ± 11.58)%, and there were statistical differences ( P<0.01). ROC curve analysis result showed that when the optimal cutoff value of plasma TMAO was 4.83 μmol/L, the area under curve (AUC) was 0.942, and its sensitivity and specificity for diagnosing ACS were 87.50% and 88.89%; when the optimal cutoff value of plasma TMAO was 4.66 μmol/L, the AUC was 0.908, and its sensitivity and specificity of early diagnosis of ACS were 88.00% and 83.33%. The correlation analysis result showed that the plasma TMAO had negative correlation with LVEF in patients with ACS ( r=-0.715, P<0.01), and positive correlation with LAD, PWS and LVPWT ( r=0.715, 0.746 and 0.729; P<0.01). Conclusions:The plasma TMAO level in patients with ACS is significantly increased, which is related to the level of heart function. Plasma TMAO can be used as an indicator of early diagnosis and severity assessment of ACS.

Objective: To investigate the forecasting value of serum fibroblast growth factor 23(FGF23) for major adverse cardiovascular adverse events (MACE) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Methods: One hundred and five patients with ACS who underwent PCI in the First People′s Hospital of Tianmen City from June 2017 to June 2019 were enrolled. According to the happening of a MACE event occurs, the patients were divided into the MACE group (32 cases) and the non-MACE group (32 cases). The differences of general data, ultrasound indicators and biochemical indicators of patients between the two groups were compared. Logistic regression analysis was used to analyze independent risk factors for MACE after PCI in patients with ACS. Receiver operating characteristic (ROC) curve analysis was used to predict the predictive value of postoperative MACE in patients with ACS. Results: There were no significant difference in the comparison of general data such as age and gender between the two groups (P>0.05). The Global Registered Risk of Acute Coronary Events (GRACE) score in the MACE group was significantly higher than that in the non-MACE group [(119.18 ± 11.49) scores vs. (111.57 ± 9.31) scores, P<0.05]. Compared with the non-MACE group, the left ventricular end diastolic diameter (LVEDD), brain natriuretic peptide (BNP), C-reactive (CRP), and FGF23 in the MACE group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased [(52.04 ± 3.43) mm vs. (48.57 ± 3.69) mm, (509.48 ± 52.08) ng/L vs. (474.68 ± 89.27) ng/L, (9.61 ± 2.06) mg/L vs. (7.85 ± 0.83) mg/L, (504.73 ± 82.27) ng/L vs. (331.99 ± 81.68) ng/L, (34.77 ± 2.93)% vs. (37.80 ± 3.62)%] (P<0.05). Logistic multivariate regression analysis showed that LVEF, CRP, and FGF23 were independent risk factors for MACE after PCI in patients with ACS (P<0.05). ROC curve analysis showed that AUC of LVEF that predicted for MACE after PCI in patients with ACS was 0.747,and AUC of CRP and FGF23 were 0.772 and 0.944. The AUC of FGF23 was significantly higher than that of LVEF and CRP (Z = 3.867, 2.698, P<0.05). Conclusions Abnormal elevation of serum FGF23 is associated with cardiovascular adverse events after PCI in patients with ACS, which can be used as a serum indicator for early assessment of poor cardiovascular outcomes in patients.

It is difficult to detect micrometastasis of liver cancer with conventional imaging techniques,which leads to high recurrence rate after surgical excision in patients with colorectal cancer liver metastasis.The emergence of indocyanine green fluorescence imaging technology solves this problem.This article reviews the mechanism of this new technology,its clinical application in liver cancer resection and also discussed the advantages and limitations for indocyanine green fluorescence imaging technology.

OBJECTIVETo evaluate the effect of laparoscopic sleeve gastrectomy(LSG) on type 2 diabetes mellitus (T2DM) in patient with a body mass index(BMI) less than 40 kg/m.

METHODSTwenty four obese patients with T2DM and BMI less than 40 kg/mreceived LSG between 1 January 2011 and 1 September 2013 at the Department of General Surgery in Chinese PLA General Hospital. The clinical data and 3-year follow-up outcomes regarding weight loss and remission of diabetes were retrospectively analyzed.

RESULTSThere were 10 males and 14 females with a median age of 40.8(35 to 48) years. The preoperative body weight and BMI was(99.9±15.0) kg and (34.4±2.8) kg/m, respectively. The median duration of type 2 diabetes was 4.3(2 to 15) years. The preoperative fasting blood glucose and glycosylated hemoglobin(HbAlc) was (11.4±1.3) mmol/L and (8.7±0.8)%, respectively. All these patients were preoperatively diagnosed as T2DM by the multidisciplinary experts of the surgical treatment team for obesity and diabetes in our center. All these patients were eligible for surgical treatment through the screening and evaluation by the multidisciplinary joint outpatient service. All the procedures were successfully completed without conversion to laparotomy. There were no severe postoperative complications. The mean fasting blood glucose was (6.4±1.8) mmol/L, (6.1±1.7) mmol/L, (6.0±1.5) mmol/L, (5.9±1.4) mmol/L and (6.0±1.4) mmol/L, respectively, at 6, 9, 12, 24 and 36 months after operation. The mean HbA1c in the same observation intervals was (6.6±1.1)%, (6.2±1.2)%, (6.1±1.2)%, (6.0±1.3)% and (6.1±1.3)%, respectively. The body weight was (89.4±11.4) kg, (86.3±10.6) kg, (83.1±10.2) kg,(80.6±9.8) kg and (81.3±10.1) kg, respectively. The corresponding BMI was (30.8±1.6) kg/m, (29.8±1.5) kg/m, (28.7±1.5) kg/m, (27.8±1.8) kg/mand (28.1±1.8) kg/m, respectively. The %EWL was (36.7±8.7)%, (47.6±12.5)%, (58.8±16.4)%, (67.2±20.3)% and (64.8±21.5)%, respectively. The overall remission rate of diabetes at 6, 9, 12, 24 and 36 months was 50.0%(12/24), 79.2%(19/24), 70.8%(17/24), 66.7%(16/24) and 62.5%(15/24), respectively. The complete remission rate was 33.3%(8/24), 50.0%(12/24), 54.2%(13/24), 45.8%(11/24) and 50.0%(12/24), respectively. For patients with a duration of T2DM shorter than 5 years, the overall remission rate at 9, 12 and 24 months after operation was 10/10, 9/10 and 9/10, respectively, significantly higher than that of patients with a duration of 11-15 years (2/6, 2/6 and 2/6, Fisher's exact tests, P=0.008, 0.036 and 0.036, respectively).

CONCLUSIONThe present study confirms the efficacy of LSG in the treatment of T2DM patients with a BMI less than 40 kg/m.

Adult ; Bariatric Surgery ; methods ; Blood Glucose ; physiology ; Body Mass Index ; Diabetes Mellitus, Type 2 ; surgery ; Female ; Gastrectomy ; Glycated Hemoglobin A ; physiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity ; surgery ; Postoperative Complications ; Remission Induction ; methods ; Retrospective Studies ; Treatment Outcome ; Weight Loss

Objective To investigate the clinical efficacy of combination treatment of Ambroxol,Ipratropium and Budesonide during perioperative period in elderly patients with cardiac adenocarcinoma and chronic obstructive pulmonary disease(COPD).Methods A total of 126 elderly patients aged over 65 years diagnosed as cardiac adenocarcinoma and COPD were selected,and no chemotherapy was given to them before operation.Patients were randomly divided into experimental group(n＝ 62)and control group(n＝ 64).Intravenous infusion of Ambroxol hydrochloride and atomizing inhalation of Ipratropium were given in both groups,and the experimental group received budesonide additionally.The pulmonary function,postoperative pulmonary atelectasis,pulmonary infection,antibiotics application and hospitalization after operation were compared between the two groups.Results The forced expiratory volume at the first second(FEV1),forced vital capacity(FVC)and FEV1/FVC were higher in experimental group than in control group [(1.79 ± 0.52)1 vs.(1.33 ± 0.38)L,(2.44 ±0.43)Lvs.(1.93 ± 0.36)L and(73.91 ± 8.17)％ vs.(62.87 ± 7.23)％,respectively,allP＜0.05].The postoperative pulmonary atelectasis and pulmonary infection were lower in experimental group than in control group(4.8％ vs.15.6％,6.5％ vs.18.8％,respectively,both P＜0.05).The time for antibiotics application after operation had no difference between the two groups[(4.81±1.20) days vs.(5.98 ± 1.17)days,P ＞ 0.05].There was a significant difference in postoperative hospitalization between the two groups [(8.37 ± 0.27) days vs.(11.80 ± 0.33) days,P ＜ 0.05].Conclusions The combination treatment of Ambroxol hydrochloride,Ipratropium and Budesonide during perioperative period achieves better therapeutic effects than does the combination treatment of ambroxol hydrochloride and ipratropium in elderly patients with cardiac adenocarcinoma and COPD.

OBJECTIVETo analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity.

METHODSClinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively.

RESULTSThe mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate(%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8% respectively. There were no severe post operative complications.

CONCLUSIONSLAGBP is associated with high safety and good short-term efficacy.

Body Mass Index ; Gastroplasty ; Humans ; Laparoscopy ; Obesity ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Safety

Objective To analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity. Methods Clinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively. Results The mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate (%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8%respectively. There were no severe post operative complications. Conclusions LAGBP is associated with high safety and good short-term efficacy.

Objective To analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity. Methods Clinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively. Results The mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate (%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8%respectively. There were no severe post operative complications. Conclusions LAGBP is associated with high safety and good short-term efficacy.

Roux-en-Y gastric bypass(RYGB) is a classic procedure for the treatment of type 2 diabetes mellitus (T2DM), but it remains unclear why this procedure works. There might be several mechanisms that RYGB works through to treat T2DM, including calorie restriction and malabsorption, improvement of insulin resistance and β-cell functions, and altered secretion of gastrointestinal hormones. Altered levels of adipokines and serum bile acids might also play a role after RYGB. Future researches should concentrate on the exact mechanism of the altered hormone levels after RYGB, and whether different methods of gastrointestinal tract reconstruction could lead to various hormone levels.
Caloric Restriction ; Diabetes Mellitus, Type 2 ; surgery ; Gastric Bypass ; Gastrointestinal Hormones ; Humans ; Insulin Resistance ; Insulin-Secreting Cells