Robotic surgery is a major trend of mini-invasive surgery,which is still in its infancy in China.The training and education of robotic surgeons is a problem to be solved imperatively.In our clinical practice,we explored the new strategy of training and education for hepatobiliary robotic surgeons by assimilating the essence of traditional surgery education and by drawing lessons from the successful training of robotic surgery in foreign countries.Satisfactory teaching effect was obtaincd.

As a method of choice in the treatment of ampulary carcinoma,pancreaticoduodenectomy often demands open procedure.With the development of minimally invasive techniques,laparoscopic pancreaticoduodenectomy was realized in recent years.Because laparoscopic pancreaticoduodenectomy is high technique-demanding,its popularization is restricted.With flexible robotic arnls and three-dimensional imaging,Da Vinci surgical system has overcome the shortcomings of traditional laparoscope to some extent.In March 2010.a 60-year-old female patient with ampulary carcinoma underwent Da Vinci surgical system-assisted pancreaticoduodenectomy at the Southwest Hospital.The mean operation time and blood loss were 490 minutes and 450 ml respectively,and no blood transfusion was required.Out-of-bed activity began shortly after the operation.The gastric tube was removed and fluid diet was given on postoperative day 3.The patient was discharged on postoperative day 10 without incidence of complications.The Success of this case preliminarily demonstrats that Da Vinci snrgical system-assisted pancreaticoduodenectomy is safe and feasible.

Objective To study the effect of pioglitazone(PIO) on AdipoR1 and cholesterol ester(CE) in foam cells derived from THP-1-derived macrophages.Methods THP-1-derived macrophages were incubated with increasing concentrations of PIO for 24 hours.After co-cultured with low density lipoprotein(LDL),the accumulation of cholesterol in macrophages was measured by fluorescence spectrophotometric method.The lipid peroxide within cells was detected by TBARS method,the foam cells were observed by oil red staining.AdipoR1 levels were determined by Western blot.Results Compared with the ox-LDL group (0 μmol/L),oil red O-positive cells of the PIO protective groups were greatly reduced.TC,CE,MDA of the PIO protective groups were also obviously decreased.TC (53.6 ± 1.2) μg/mg,CE (30.2 ± 3.6) μg/mg,MDA (3.42 ± 0.06) μg/mg of 5 μμ mol/L PIO group were lower than those of 0μmol/L PIO group[(98.2 ± 3.5),(65.5 ± 6.5),(8.50 ± 1.21)] μg/mg (P ＜ 0.05).TC (25.6 ± 1.8) μg/mg,CE (22.5 ± 4.5) μg/mg,MDA (1.90 ± 0.42) μg/mg of 50 μmol/L PIO group.TC (16.8 ± 2.2) μg/mg,CE(5.9 ± 1.4) μg/mg,MDA (0.65 ± 0.05) μg/mg of 100μmol/L PIO group.Concomitantly,PIO significantly increased AdipoR1 protein expresion,AdipoR1 of 5μmol/L PIO group(0.06±0.05) was higher than that of 0μmol/L PIO group(0.03 ±0.07).AdipoR1 of 50μmol/L PIO group(0.11 ±0.07) was higher than that of 5μmol/L PIO group (0.06 ± 0.05).AdipoR1 of 100 μmol/L PIO group (0.40 ± 0.05) was obviously higher than that of 50 μ mol/L PIO group (0.11 ± 0.07).Conclusion PIO inhibited THP-1-derived formation by up-regulation the expression of AdipoR1,which may play an important role in the development and progression of atherosclerosis.

Pi.Au-Pt alloy does not resist the growth and adhesion of the bacteria, but Au-Pd does.

Objective:To evaluate the accuracy of Cerec Bluecam and Cerec Omnicam with 3D printed resin models.Methods:A metal master model including 4 cylindrical metal preparations on the model base,respectively simulating the maxillary canine and the first molar preparations,was prepared.The right canine and the right first molar were respectively marked as A and B,and the left as C and D.The master model was scanned respectively by Cerec Bluecam and Cerec Omnicam for 10 times,10 digital models were genera-ted in Bluecam group and Omnnicam group respectively.Resin models were obtained by a 3D printer based on the digital models,the distance of AB,AC,BD and the diameter(d)of A were respectively measured.Statistical analysis was conducted by SPSS 13.0 soft-ware.Results:The distance of AB,AC,BD of master model and Bluecam group showed significant difference(P <0.05),but d did not(P >0.05);the distance of AC,BD of master model and Omnicam group showed significant difference(P <0.05),but d did not (P >0.05).All the distances of the Bluecam group and Omnicam group showed significant difference(P <0.05).Conclusion:The scanning accuracy of Cerec Bluecam is higher than that of Cerec Omnicam in a single preparation scanning.When the scanning area ex-tending,the scanning accuracy of Cerec Omnicam is higher than that of Cerec Bluecam.

Objective To investigate the clinical efficacy of laparoscopic hepatectomy and summarize its experiences.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 2 048 patients who underwent laparoscopic hepatectomy in the Southwest Hospital of the Third Military Medical University from March 2007 to October 2016 were collected.The resectability of lesions and liver functional reserve were preoperatively evaluated,and then laparoscopic hepatectomy was conducted.Observation indicators:(1)surgical and intraoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the patients' postoperative survival up to June 2017.Measurement data with normal distribution were represented as (x)±s.Count data were evaluated by the percentage.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and intraoperative situations:all the 2 048patients received successful laparoscopic hepatectomy,including 1 985 undergoing traditional laparoscopic hepatectomy and 63 undergoing Da Vinci robot-assisted and laparoscopic hepatectomy.Non-anatomical and anatomical hepatectomies were respectively applied to 1 052 and 996 patients.The rate of conversion to open surgery of 2 048 patients was 6.738％ (138/2 048).Operation time,volume of intraoperative blood loss and rate of intraoperative blood transfusion in 2 048 patients were (225±27)minutes,(455± 152)mL and 5.615％ (115/2 048),respectively.The incidence of postoperative complications was 11.816％ (242/2 048),42.149％ (102/242) of postoperative complications included reactive pleural effusion and effusion in the resection margin,and other postoperative complications included peritoneal effusion,pulmonary infection,abdominal infection,bile leakage,bleeding,incision liquefied,thrombus and acute liver injury.The incidence of postoperative severe complications was 0.488％ (10/2 048),including 6 with intraperitoneal bleeding,1 with acute respiratory distress syndrome,1with cardiac failure,1 with hepatic failure and 1 with renal failure.Of 242 patients with postoperative complications,6 with intraperitoneal bleeding received reoperations and were improved,1 died of extensive thrombus of portal vein system induced liver failure,and 235 were improved by conservative treatment.Duration of hospital stay in 2 048 patients was (10.7± 1.0)days.(2) Follow-up situations:912 of 1 070 patients with malignant liver tumors were followed up for 8-120 months,with a median time of 51 months.The 1-,3-and 5-year overall survival rates and 1-,3-and 5-year tumor-free survival rates in 912 patients with malignant liver tumors and follow-up were 94.1％,82.2％,53.6％ and 82.3％,61.3％,32.8％,respectively.Conclusions Laparoscopic hepatectomy is safe and feasible,with definite effects.In the premise of breakthroughs of technical bottlenecks in the bleeding control and exposure of special liver segment,the indications for laparoscopie hepatectomy have been expanded and there is no restricted area.

ObjectiveTo investigate the efficacy of laparoscopic hepatectomy for regional hepatolithiasis.MethodsThe clinical data of 81 patients with regional hepatolithiasis who received laparoscopic hepatectomy at the Southwest Hospital from March 2007 to March 2011 were retrospectively analyzed.Based on the classification of the Guideline for the diagnosis and treatment of hepatolithiasis 2007 version and indications for open surgery,hepatic lobes with calculi,biliary stricture or dilated bile ducts were resected laparoscopically after preoperative examination.Bile ducts of the remnant hepatic lobes were explored using fiber choledochoscope or electronic choledochoscope for the prevention of residual stones. Results Laparoscopic hepatectomy was successfully performed on 72 patients,and the other 9 patients were converted to open surgery. Left lateral lobectomy ( segments Ⅱ,Ⅲ ) was performed on 20 patients,left hemihepatectomy ( segments Ⅱ,Ⅲ,Ⅳ ) on 30 patients,right posterior lobectomy ( segments Ⅵ,Ⅶ ) on 11 patients,right anterior lobectomy ( segments Ⅴ,Ⅷ ) on 6patients,right hemihepateetomy (segments Ⅴ,Ⅵ,Ⅶ,Ⅷ ) on 9 patients,hepatic Ⅲ segmentectomy on 2 patients and hepatic Ⅵ segmentectomy on 3 patients.Gallbladders were resected,and intermittent portal triad clamping was performed on 15 patients.Hepateetomy combined with biliary exploration and stone removal was performed on 57 patients.The mean operation time and operative blood loss were (328 ± 80)minutes and (451 ±288) ml,respectively.No operative mortality was observed.Sixteen patients had postoperative complications,including pulmonary infection in 2 patients,pleural effusion in 4 patients,encapsulated effusion in the resection margin in 6 patients,abdominal infection and abscess in 2 patients and wound infection in 2 patients.Of the 16patients with complications,9 were cured by medicine,6 by pleural or abdominal drainage and 1 by wound debridement.The mean duration of hospital stay was ( 13 + 6)days.The intraoperative stone clearance rate was 96％ (69/72),and the residual stone in 3 patients were removed by choledochoscopy.Sixty-nine patients were followed up for 7-55 months,7 patients had symptoms of cholangitis and 2 patients had common bile duct stone recurrence.ConclusionsLaparoscopie hepatectomy is sate and effective for regional hepatolithiasis.Accurate positioning of the stones and lesions pre- and intra-operatively,reasonable designing of the parenchymal transection plane,and anatomical liver resection are the key points for achiving good therapeutic effects.

Objective To investigate the indications, techniques and results of laparoscopic hepatectomy. Methods The clinical data and follow-up results of 463 patients who received laparoscopic hepatectomy at our institute were retrospectively analyzed. Results From March 1, 2007 to March 31, 2011, 463 cases of laparoscopic hepatectomy were successfully carried out. Of the 463 patients,165 were with primary liver cancer, 29 with metastatic liver cancer, 143 with hepatic hemangioma, 81with hepatolithiasis and 45 with other benign liver diseases (including hepatic angiomyolipoma, hepatocellular adenoma, focal nodular hyperplasia and chronic liver abscess). The surgical approaches included laparoscopic left lateral lobectomy (93 cases), left hepatectomy (71 cases), extended left hepatectomy (4 cases), right hepatectomy (29 cases), right posterior lobectomy (24 cases), hepatectomy of segment Ⅵ (56 cases), extended right hepatectomy (2 cases), central hepatectomy (8 cases) and hepatectomy of segments Ⅶ/Ⅷ, Ⅳa, caudate lobe and the junction of segment Ⅵ and Ⅶ (41 case).Nonanntomic and wedge resection were performed on 121 patients, and combined resection on 14 patients. The mean operation time, blood loss, length of hospital stay and incidence of postoperative complications were (244.71 ± 105. 07) minutes, (460. 26±425.81) ml, (15.51 ±4.36) days and 9.29%, respectively. And no operative death occurred. In the 194 cases with malignant liver lesions,185 cases were followed up for 2 to 50 months. The 1 year and 3 year overall and disease free survival rate were 90. 8% and 87.9% , 84.2% and 73. 7% respectively. Conclusions As a means of minimally invasive surgical approach, laparoscopic hepatectomy can be selectively adopted for the treatment of all kinds of liver diseases which located at different parts of the liver, with the advantages of smaller trauma, quick recovery and cosmetic benefits. The short-term results of laparoscopic hepatectomy is superior to and its long-term results is equal to that of open surgery. Benign liver diseases, small hepatocellular carcinoma and metastatic liver cancer are the good indications for laparoscopic hepatectomy.

Objective To investigate the value of laparoscopy in the treatment of liver cancer.Methods The clinical data of 128 liver cancer patients who received laparoscopic surgery at Southwest Hospital from March 2007 to October 2009 were retrospectively analyzed.Of all patients,116 were with primary liver cancer,and 12 with metastatic liver cancer.There were 107 patients who received laparoscopie bepatectomy,15 received laparoscopic radiofrequency ablation(RFA)and 6 received laparoscopic ligation of the right branch of portal vein.Results Of the 107 patients who received laparoscopic bepatectomy,7 were converted to open surgery,and 5 were converted to hand-assisted laparoscopic hepatectomy.Anatomical hepatectomy was performed on 88 patients,including left lateral lobectomy on 21,left hemihepatectomy on 15,extended left hemihepatectomy on 2,medial lobectomy on 1,right hemihepatectomy on 11,right posterior lobeetomy on 9 and hepatic segmentectomy on 29.Combined hepatic resection was performed on 4 patients,and nonanatomical hepatectomy on 15.The mean oporatire time and blood loss were(228±92)minutes and(393±213)ml,with no operative mortality.The mean postoperative hospital stay was(8±4)days,and the incidence of complications was 15%(16/107).A total of 126 patients were followed up for 1-42 months,12 patients with laparoscopic hepatectomy died within 16 months,with the mean survival time of(118±7)weeks and the mean tumor free survival time of(105±7)weeks;2 patients with laparoscopic RFA died within 11 months:2 patients with laparoseopie ligation of the right branch of portal vein received two-stage radical resection.Conclusion Laparoscopic surgery is safe and feasible with the advantages of minimal operative trauma and quick recovery of patients when it is applied to the treatment of liver cancer.

Objective To investigate the clinical efficacy of laparoscopic hepatectomy for the treatment of large hepatocellular carcinoma (HCC).Methods From January 2009 to January 2011,84 patients with large hepatocellular carcinoma received laparoscopic hepatectomy at the Southwest Hospital,and their clinical data were retrospectively analyzed.Lesions were located at the left lobe in 12 cases,left lateral lobe in 9 cases,right lobe in 3 cases,right posterior lobe in 11 cases,right anterior lobe in 11 cases,segment Ⅴ in 8 cases,segment Ⅵ in 6 cases,segment Ⅶ in 6 cases,segment Ⅴ/Ⅵ in 8 cases,segment Ⅶ/Ⅷ in 4 cases,segment Ⅳ in 5 cases and segment Ⅰ in 1 case.According to the results of preoperative ultrasonography,the tumor diameter ranged between 5.1-6.0 cm in46 cases,6.1-7.0 cm in 12 cases,7.1-8.0 cm in9 cases,8.1-9.0 cm in7 cases,9.1-10.0 cm in 10 cases.Anatomical or non-anatomical hepatectomy was performed according to the results of preoperative assessment and operative exploration.Abdominal imaging examination and serologic examination were done once every 3 months at postoperative year 1,once every 4 months at postoperative year 2,once every 6 months at postoperative year 3.The follow-up ended in January 2014.The survival rate was calculated by Kaplan-Meier method.Results Eight patients were converted to laparotomy,and the rate of conversion to laparotomy was 9.5％ (8/84).Seventy-six patients received laparoscopic hepatectomy,including 30 patients received anatomical hepatectomy and 54 received non-anatomical hepatectomy.The operation time,volume of blood loss,perioperative blood transfusion rate,tumor diameter,resection margin,time for gastriontestinal function recovery,duration of postoperative hospital stay,incidence of postoperative complications were (240 ± 132) minutes,(432 ± 340) mL,10.7％ (9/84),(6.5±1.5)cm,(1.6±0.9)cm,(3.0±0.5)days,(11 ±3)days and 19.0％(16/84),respectively.All thepatients were comfirmed with HCC including 18 cases of high differentiated HCC,57 cases of moderate differentiated HCC and 9 cases of low differentiated HCC.One patient died perioperatively.Eighty-three patients were followed up for 2-48 months,the median follow-up time was 24 months,and the overall 1-and 3-year survival rates and the 1-and 3-year tumor-free survival rates were 91％,80％,70％ and 56％,respectively.Conclusion Laparoscopic hcpatcctomy is safe and feasible for selected patients with large hepatocellular carcinoma.