OBJECTIVETo evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system.

METHODSWe conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSNone of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group.

CONCLUSIONIn selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

Adolescent ; Adult ; Aged ; Female ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Mitral Valve ; surgery ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Insufficiency ; surgery ; Retrospective Studies ; Robotics ; methods ; Surgery, Computer-Assisted ; methods ; Young Adult

OBJECTIVETo investigate the diagnosis and treatment of malignant fibrous histiocytoma of the retroperitoneum (MFHR).

METHODSThe clinicopathological features, treatment and prognosis of 31 patients with MFHR were retrospectively analyzed.

RESULTSThe mean age of the patients was 52.7 +/- 14.1 years. Male:Female = 22:9. The primary symptoms were abdominal mass and pain. The average diameter of tumor was 15 cm. The histopathologic types of the tumor were inflammatory, storiform-pleomorphic, myxoid and giant cell in 16, 10, 4 and 1 cases. The overall survival rate of 1-, 3- and 5-year was 61.3% +/- 9.8%, 31.6% +/- 11.3% and 21.1% +/- 11.4% with a median survival time of 17.0 +/- 6.3 months. Complete resection of the tumor was the major prognostic factor. Postoperative radiotherapy of 20 - 45 Gy was able to prolong the median survival from 12.1 +/- 11.6 months of surgery alone to 26.4 +/- 22.0 months of surgery plus postoperative radiotherapy though without statistical significance (P = 0.051). Postoperative CHOP chemotherapy was not shown to be beneficial.

CONCLUSIONChemotherapy remains the important method of cure. The survival in patients with MFHR might be improved by complete resection combined with chemotherapy or/and radiotherapy.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Chemotherapy, Adjuvant ; Cyclophosphamide ; administration & dosage ; Doxorubicin ; administration & dosage ; Female ; Follow-Up Studies ; Histiocytoma, Benign Fibrous ; secondary ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pancreatectomy ; Postoperative Period ; Prednisone ; administration & dosage ; Prognosis ; Radiotherapy, Adjuvant ; Retroperitoneal Neoplasms ; pathology ; surgery ; therapy ; Retrospective Studies ; Splenectomy ; Survival Rate ; Vincristine ; administration & dosage

OBJECTIVETo evaluate the beneficial effect of intraperitoneally applied mitomycin bound to activated carbon particles (MMC-CH) in the prevention and treatment of intraabdominal recurrence after curative surgery for gastric cancer.

METHODSOne hundred and twenty-four patients with radically resected gastric cancer infiltrating the serosal surface were randomly divided into group receiving 50 mg mitomycin bound to a solution of 375 mg carbon adsorbent intraperitoneally before closure of the abdominal wound (n = 62) and a control group (n = 62). The patients with MMC-CH and the control group were received systemic chemotherapy 3 months or 3 weeks after operation respectively. The postoperative recurrence-free survival was evaluated to analyze the benefits of this treatment.

RESULTSAfter observation for 8 months (range, 2 - 65). The 3-, 5-year postoperative recurrence-free survival rates were significantly higher in the MMC-CH group (70.16%, 44.51%) than in the control group (27.09%, 14.45%), P < 0.01.

CONCLUSIONAdjuvant intraperitoneal chemotherapy of gastric cancer by mitomycin bound to activated carbon particles is effected by an increased postoperative recurrence-free survival rate.

Antibiotics, Antineoplastic ; administration & dosage ; Antineoplastic Agents ; administration & dosage ; therapeutic use ; Charcoal ; administration & dosage ; Chemotherapy, Cancer, Regional Perfusion ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Neoplasm Recurrence, Local ; prevention & control ; Peritoneal Cavity ; Prognosis ; Prospective Studies ; Stomach Neoplasms ; drug therapy ; pathology ; Survival Analysis ; Treatment Outcome

OBJECTIVETo analyze a large cohort of patients with rectal cancer within a cancer center to determine the prognostic factors by univariate and multivariate analyses.

METHODSA total of 952 patients with rectal cancer were treated surgically during a period of 10 years. R0, R1 and R2 operations were carried out in 741 patients (77.8%), 75 patients (7.9%) and 136 patients (14.3%), respectively. There were more Miles operation (53.5%) than lower abdominal resection (LAR, 33.7%).

RESULTSThe operation mortality was 0.3%, 418 patients were dead within 108 months postoperatively due to recurrence or metastases to liver, lung and bone in 53, 39 and 12 patients. The overall mean survival time for all patients was 73.52 +/- 1.70 months and the overall 3-, 5-and 10-year survival rates were 67.6%, 55.4% and 38.2%. The overall 3-, 5- and 10-year survival rates for patients treated by radical operation were 81.4%, 70.3%, 48.8%, respectively. Kaplan-Meier estimate showed that patient gender, age, radicality of resection, histological type, liver and pulmonary metastasis and TNM stage were the predictors of survival. Multivariate analysis showed statistically significant correlation with radicality of operation, histological type, depth of tumor invasion, lymphatic invasion, TNM stage, liver and pulmonary metastasis.

CONCLUSIONFor survival, statistically significant differences among prognostic factors in relation to radicality of resection, lymphatic invasion, TNM stage, depth of tumor invasion, histological type, liver and pulmonary metastasis are found.

Adenocarcinoma ; mortality ; secondary ; surgery ; Adult ; Age Factors ; Aged ; Female ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Rectal Neoplasms ; mortality ; pathology ; surgery ; Sex Factors ; Survival Rate

OBJECTIVETo determine the safety and efficacy of robotic mitral valve repair using da Vinci S Surgical system. Method From January 2007 to April 2011, over 400 cases of robotic cardiac surgery have been performed, in which 60 patients with isolated mitral valve insufficiency underwent robotic mitral valve repair, including 42 male and 18 female patients with a mean age of (44 ± 13) years (ranging from 14 to 70 years). Forty-eight patients were in NYHA class I-II and 12 patients in class III. Fourteen patients were concomitant with atrial fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSAll patients had successful valve repair including quadrangular resections, sliding plasties and chordal replacement. There was no conversion to median sternotomy. The mean cardiopulmonary bypass and arrested heart time were (132 ± 30) min and (88 ± 22) min. One patient had hemolysis after operation, and required mitral valve replacement. Echocardiographic follow-up revealed trace to mild regurgitation in 2 patients with a mean of (16 ± 9) months.

CONCLUSIONRobotic mitral valve repair is safe and efficacious in the patients with isolated mitral valve insufficiency.

Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Robotics ; methods ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate determinants of long-term survival for carcinoma of ampulla of Vater treated by local resection.

METHODSThe clinical and pathological data of 38 such patients treated by local resection from 1983 to 2003 were retrospectively analyzed. According to UICC staging system, there were T1 30, T2 7 and T3 1. Lymph nodes were involved in 4 during operation which was present in primary lesions larger than 2 cm across. All patients were treated by local resection. At first, external palpation was carried out to ascertain accessibility. Then with the duodenum opened, direct exploration was carried out. On deciding for resection, the common bile duct was probe explored which guided the circumferential ring resection 1 cm, away from the tumor, including all layers of duodenum, ampula and partial bile and terminal pancreatic ducts and the posterial wall of duodenum was completed in steps. Meticulous care was taken not to suture the pancreatic duct and endotheliation was ensured at the mouth of common bile duct and duodenum. The basal tissue was frozen sectioned to ensure negative stumps. The gall bladder of 6 patients was also resected. SPSS 10.0 software was used in data processing, log-rank test used in univariate analysis and Cox equation for multivariate analysis and Kaplan-Meirer method for the survival rates.

RESULTSThirty-eight patients received local resection giving an operative mortality of 0% and morbidity of 13.2%. The 1-, 5- and 10-year survival rate was 83.5%, 51.4%, and 38.9%, respectively, with a median survival of 3.35 years. Up to now, 13 patients have survived for more than five years and 2 patients beyond ten years. The tumour size, tumour grading, lymph node status and UICC stage were significant prognostic factors in univariate analysis. However, only lymph node status was a statistically independent predictor of prognosis in multivariate analysis.

CONCLUSIONLocal excision is safe giving low morbidity and good survival in carefully selected cases. Preferably it is indicated only in high risk patients with a pT1 and well differentiated ampullary cancer smaller than 1 cm in diameter.

Adenocarcinoma ; surgery ; Adult ; Aged ; Ampulla of Vater ; surgery ; Common Bile Duct Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Survival Analysis

OBJECTIVETo summary the first 14 cases undergoing internal mammary artery (IMA) harvest using da Vinci S system and minimally invasive direct coronary artery bypass grafting (MIDCAB) on beating heart.

METHODSThe average age of patients was (60.4 +/- 10.1) years old. One case was female and 13 male. All the patients had a history of angina. The coronary angiography showed severe stenosis of anterior descending branch in all patients, of which 2 cases had diagonal and circumflex branch stenosis. Four case had myocardial infraction history. All the patients had good lung function and had no medical history of pleurisy. Without sternotomy, the camera cannula was placed in the left, 3 cm lateral to nipple in the 4th intercostal space (ICS). Da Vinci instrument arms were inserted through two 1 cm trocar incisions. The right instrument generally was positioned 4 to 6 cm cephalad to camera cannula in the 2nd or 3rd ICS. The left instrument arm was positioned 4 to 6 cm caudal to the camera cannula in the 5th or 6th ICS. Arm trocar sites were maintained 6 cm apart at chest entry. The internal mammary artery was harvested in routine methods. Thirteen cases underwent left internal mammary artery harvest, one case underwent right internal mammary artery harvest, one case underwent double internal mammary harvest. MIDCAB was performed on beating heart in 14 cases and 1 case accepted the totally endoscopic coronary artery bypass (TECAB).

RESULTSAll cases were accomplished successfully without complications. The average time of ICU was 20 hours. Robotic surgery had less draining than the conventional coronary bypass.

CONCLUSIONSTotally robotic internal mammary artery harvest and beating heart coronary artery bypass is less invasive, more precise, safe and efficient.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; methods ; Female ; Humans ; Male ; Mammary Arteries ; surgery ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Robotics ; Treatment Outcome

OBJECTIVETo develop a quantitative PCR method for detecting hookworm infection and quantification.

METHODSA real-time PCR method was designed based on the intergenic region II of ribosomal DNA of the hookworm Necator americanus. The detection limit of this method was compared with the microscopy-based Kato-Katz method. The real-time PCR method was used to conduct an epidemiological survey of hookworm infection in southern Fujian Province of China.

RESULTSThe real-time PCR method was specific for detecting Necator americanus infection, and was more sensitive than conventional PCR or microscopy-based method. A preliminary survey for hookworm infection in villages of Fujian Province confirmed the high prevalence of hookworm infections in the resident populations. In addition, the infection rate in women was significantly higher than that of in men.

CONCLUSIONSA real-time PCR method is designed, which has increased detection sensitivity for more accurate epidemiological studies of hookworm infections, especially when intensity of the infection needs to be considered.

Animals ; China ; epidemiology ; DNA, Helminth ; genetics ; Female ; Humans ; Male ; Microscopy ; Necator americanus ; genetics ; isolation & purification ; Necatoriasis ; diagnosis ; epidemiology ; genetics ; Nucleic Acid Amplification Techniques ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Sentinel Surveillance ; Sequence Analysis, DNA ; Sex Distribution

OBJECTIVETo summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China.

METHODSFifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography.

RESULTSAll patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical conversion and surgical death. Fifty-three patients received ITA to LAD grafts and 3 patients received double coronary artery bypass grafts as well. Ten cases received stent placement in separate session. The CT scan and angiography revealed patent grafts in all patients. There were no post-operative complications. All patients were discharged from hospital.

CONCLUSIONSAs a new advanced approach of revascularization, robotic ITA harvesting and coronary anastomoses can be safely performed with the da Vinci S system. The procedure is minimally invasive and can offer enhanced ability to control precise and stable operative manipulations.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Robotics

OBJECTIVETo investigate the gene expression of transforming growth factor-beta(1) (TGF-beta(1)) in lung tissues of silica-treated mice.

METHODSThe experimental mice were divided into control and silica group. 0.2 g/kg body weight of silica was injected intratracheally in silica group. Samples of lung tissue were collected 1, 3, 5, 7, 14 and 28 d after injection. RT-PCR method was used to analyze the gene expression of TGF-beta(1) in lung tissue of silica-treated mice.

RESULTSThe expression of TGF-beta(1) gene in lung tissue elevated from the 3rd day (1.20 +/- 0.15) and the peak value was on the 7th day (1.74 +/- 0.19). Then the expression decreased from the 14th to 28th day. But there was still higher than control until the 28th day.

CONCLUSIONTGF-beta(1) may play an important role in silica-induced pulmonary fibrosis.

Animals ; Gene Expression Regulation ; drug effects ; Lung ; drug effects ; metabolism ; pathology ; Male ; Mice ; Pulmonary Fibrosis ; etiology ; pathology ; Reverse Transcriptase Polymerase Chain Reaction ; methods ; Silicon Dioxide ; pharmacology ; toxicity ; Time Factors ; Transforming Growth Factor beta ; genetics