Objective:To explore the technical key points and vital improvements of single-port robotic prepectoral breast reconstruction.Methods:A retrospective analysis was conducted on the case data of 10 patients with breast cancer who underwent single-port robotic prepectoral breast reconstruction performed in the Department of Breast Surgery, Beijing Chao-Yang Hospital, Capital Medical University from January to March 2025. Technical key points and vital improvements were summarized.Results:All 10 patients underwent surgery using the da Vinci Xi system. During the postoperative follow-up period of (3±1) months, no cases of flap or nipple-areola complex necrosis occurred, with no instances of implant loss. The patients experienced neither severe perioperative nor late postoperative complications, and all were satisfied with the aesthetic outcomes. In single-port robotic prepectoral breast reconstruction, several technical modifications were implemented, including posterior space liposuction, electrocautery-assisted flap dissection, and single-port Trocar connection to robotic arms. These refinements enabled clear intraoperative visualization of the circummammary ligaments, allowing for breast reconstruction to be completed within the fascial anatomical planes.Conclusion:The single-port robotic prepectoral breast reconstruction, achieved through technical refinements including posterior space liposuction, electrocautery-assisted flap dissection, and single-port Trocar connection to robotic arms, demonstrates excellent procedural feasibility and is expected to enable precise glandular resection while achieving favorable breast contour outcomes.

Objective:To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction, who were admitted to Tianjin hospital between May 2013 and January 2023, including 5 males and 15 females, aged 61-84 years [(72.2±7.3)years]. According to Letournel and Judet classification, 13 patients had anterior column fracture, 5 anterior column fracture combined with posterior transverse fracture and 2 two-column fracture. All the patients underwent open reduction and internal fixation through an anterior approach. Of them, 11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum (plate plus raft screw group) and 9 with the screws only (screw only group). The operative time, intraoperative blood loss, and intraoperative fluoroscopy times were compared between the two groups. The quality of fracture reduction was evaluated with the Matta′s radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D′Aubigné and Postel scoring system at 3 months after surgery and at the last follow-up as well as the excellent and good rate at te last follow-up. The occurrence of postoperative complications was observed.Results:All the patients were followed up for 6-18 months [(13.1±3.1)months]. There were no significant differences in the operative time, intraoperative blood loss or intraoperative fluoroscopy times between the two groups ( P>0.05). According to the Matta′s radiographic criteria at 3 days after surgery, patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group, compared to 5 and 4 respectively in the screw only group ( P>0.05). The values of Merle D′Aubigné and Postel score at 3 months after surgery and at the last follow-up were (14.0±2.4)points and (15.8±2.2)points in the plate plus raft screw group, which were higher than those in the screw only group [(11.0±2.6)points and (13.0±3.1)points] ( P<0.01). The values of Merle D′Aubigné and Postel score at the last follow-up of both groups were further enhanced from those at 3 months after surgery ( P<0.01). At the last follow-up, 3 patients were rated excellent, 6 good, 1 fair and 1 poor in the plate plus raft screw group, with an excellent and good rate of 81.8%, while in the screw only group, 3 were rated good, 2 fair and 4 poor, with an excellent and good rate of 33.3% ( P<0.05). One patient in the plate plus raft screw group and 5 in the screw only group had displacement of the dome impaction fragment combined with traumatic arthritis after surgery ( P<0.05). Conclusion:For acetabular fractures combined with dome impaction in the aged patients, the horizontal plate plus raft screw above the acetabulum can effectively improve the function restoration of the hip joint and reduce the occurrence of the displacement of the dome impaction fragment and traumatic arthritis after surgery compared to the fixation with screws only.

Objective To analyze the curative effect of unilateral biportal endoscopy (UBE) transforaminal lumbar interbody fusion (TLIF) and its influences on the recovery of lumbar function in lumbar spinal stenosis (LSS).Methods 70 patients with secondary LSS were retrospectively analyzed between September 2021 and September 2023.According to different surgical methods,they were divided into UBE-TLIF group (39 cases) and TLIF group (31 cases).The occurrence of postoperative complications during follow-up,surgical indexes (operation time,postoperative leaving bed time,and hospitalization time),hemoglobin level before surgery and 3 and 7 d after surgery,improvement rate of dural sac cross-sectional area (DSCA) at 3 d after surgery,the visual analogue scale (VAS) and Oswestry disability index (ODI) at different time points were compared between the two groups.Results The operation time,postoperative leaving bed time and hospitalization time in UBE-TLIF group were shorter than those in TLIF group,the differences were statistically significant (P<0.05).At 3 d after surgery,improvement rate of DSCA in UBE-TLIF group was higher than that in TLIF group,the difference was statistically significant (P<0.05).At the 3 d and 7 d after surgery,hemoglobin level was decreased in both groups,which was higher in UBE-TLIF group than TLIF group,the difference was statistically significant (P<0.05).At 3 d,1 month and 3 months after surgery,VAS and ODI in both groups were decreased than those before the surgery,which were lower in UBE-TLIF group than TLIF group,the differences were statistically significant (P<0.05).The incidence of postoperative complications in UBE-TLIF group was lower than that in TLIF group (7.69％ vs 25.81％),the difference was statistically significant (P<0.05).Conclusion The curative effect of UBE-TLIF is better in patients with secondary LSS,which can significantly relieve pain,achieve full lumbar decompression and promote the recovery of lumbar function.It is worthy clinical application.

Objective To analyze the curative effect of unilateral biportal endoscopy (UBE) transforaminal lumbar interbody fusion (TLIF) and its influences on the recovery of lumbar function in lumbar spinal stenosis (LSS).Methods 70 patients with secondary LSS were retrospectively analyzed between September 2021 and September 2023.According to different surgical methods,they were divided into UBE-TLIF group (39 cases) and TLIF group (31 cases).The occurrence of postoperative complications during follow-up,surgical indexes (operation time,postoperative leaving bed time,and hospitalization time),hemoglobin level before surgery and 3 and 7 d after surgery,improvement rate of dural sac cross-sectional area (DSCA) at 3 d after surgery,the visual analogue scale (VAS) and Oswestry disability index (ODI) at different time points were compared between the two groups.Results The operation time,postoperative leaving bed time and hospitalization time in UBE-TLIF group were shorter than those in TLIF group,the differences were statistically significant (P<0.05).At 3 d after surgery,improvement rate of DSCA in UBE-TLIF group was higher than that in TLIF group,the difference was statistically significant (P<0.05).At the 3 d and 7 d after surgery,hemoglobin level was decreased in both groups,which was higher in UBE-TLIF group than TLIF group,the difference was statistically significant (P<0.05).At 3 d,1 month and 3 months after surgery,VAS and ODI in both groups were decreased than those before the surgery,which were lower in UBE-TLIF group than TLIF group,the differences were statistically significant (P<0.05).The incidence of postoperative complications in UBE-TLIF group was lower than that in TLIF group (7.69％ vs 25.81％),the difference was statistically significant (P<0.05).Conclusion The curative effect of UBE-TLIF is better in patients with secondary LSS,which can significantly relieve pain,achieve full lumbar decompression and promote the recovery of lumbar function.It is worthy clinical application.

Objective:To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods:A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021. There were 9 males and 4 females, aged 49.1±8.5 years (range, 25-65 years), 9 cases of vehicle accidents, 2 cases of falling injuries, 2 cases of impact injuries, 7 cases of combined posterior hip dislocations, and 1 case of sciatic nerve injury. Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column. Use robot navigation for percutaneous anterior column screw fixation, and record the time of inserting anterior column screws, incision length, and complications. The quality of fracture reduction was evaluated using Matta imaging, and the degree of ectopic ossification was evaluated using Brooker classification. The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3, 6 months after surgery and at the last follow-up.Results:All 13 patients successfully completed the surgery. The insertion time of the anterior column screw was 19.4±4.0 min (range, 17-23 min), and the incision length was 8.0±1.4 mm (range, 6-10 mm). Postoperative imaging examination showed that all anterior column screws were located within the bone canal, with a screw length of 108.3±11.2 mm (range, 90-130 mm), and no complications such as nerve or vascular injury or incision infection occurred. All 13 patients were followed up for a period of 12-36 months, with an average of 18.6 months; All fractures healed, with a healing time of 2-6 months, average 3.4 months. According to the Matta imaging evaluation method, 11 of 13 patients had anatomical reduction of fractures, and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column. The anatomical reduction rate was 84%. At postoperative 3, 6 months and the last follow-up, the modified Postel Merle D'Aobigne scores were 13.4±1.1, 15.8±1.5, and 17.0±1.7, respectively, with statistically significant differences ( F=7.78, P=0.007). The difference between the last follow-up and postoperative 3 months was statistically significant ( P=0.002), and there was no statistically significant difference compared to postoperative 6 months ( P=0.222). At the last follow-up, 8 cases were excellent, 4 cases were good, and 1 case was fair, with an excellent and good rate of 92%. There was no occurrence of ectopic ossification, traumatic arthritis, or necrosis of the femoral head. Conclusion:Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective, and is worthy of clinical promotion.

Objective:To evaluate the clinical outcome of Robot-assisted sacroiliac screw fixation in the treatment of fragility fracture of the sacrum in the elderly.Methods:From March 2016 to June 2022, a retrospective analysis was performed on 30 patients with fragility fractures of the sacrum in the elderly who accepted robot-assisted sacroiliac screw to treat fragility fractures of the sacrum in our hospital. There were 12 males and 18 females with average age 71.03±8.25 years (range, 60-89 years). According to the classification of fragility fractures of the pelvis (FFP) in the elderly, there were 22 patients with FFP II, 2 patients with FFP III, and 6 patients with FFP IV. Surgical planning was based on the average CT value of S 1 channel and whether there is a transsacral screw channel. Robot-assisted sacroiliac screw fixation was performed during surgery. The pain of pre-operation and post-operation was evaluated using the visual analogue scale (VAS), the position of sacroiliac screws was evaluated by Gras grading, and the degree of functional recovery after surgery was evaluated using the Majeed function score. Results:All 30 patients successfully completed the operation. The mean operation time was 27.00±6.68 min (range, 18-35 min), the mean fluoroscopy times were 27.13±5.16 (range, 18-34), and the mean blood loss was 30.53±6.61 ml (range, 23-38 ml). All patients were followed up, and the mean follow-up time was 19.03±7.8 months (range, 8-25 months). The VAS was 5(5, 6), 4(3, 4), 3(2, 3), 0(0, 1) points before surgery, 1 week, 2 months and 6 months after surgery, respectively, and the difference was statistically significant ( H=103.26, P<0.001). After the surgery of 2 months, 6 months and the last follow-up time, the Majeed function scores were 88(83, 90), 91(87, 92), 92(90, 93) points, respectively, and the difference was statistically significant ( H=19.59, P<0.001). Screw position was evaluated according to Gras grading at 3 days after surgery, including 28 cases of level I, 2 cases of level II, and no screw penetrated the cortical bone or entered the sacral canal or sacral foramen. No vascular or nerve injury occured during the operation. 28 patients with FFS met the fracture healing criteria, and the healing time was 4.54±1.57 months (range, 3-7 months). Two patients had bone nonunion, one of whom underwent anterior ring plate removal due to infection of the pelvic anterior wound, and one month later, pelvic CT scan revealed loosening of the sacroiliac screw; the other one is considered to be related to too early weight bearing. Conclusion:For fragility fractures of the sacrum in elderly, Robot-assisted sacroiliac screw is an effective minimally invasive treatment, with high accuracy of screw placement, effective pain reduction, improved fracture healing rate, and achieve the satisfactory clinical efficacy.

Objective:To investigate the clinical outcomes of fragility fractures of the pelvis (FFP) treated with robot-assisted screws, minimally reduction according to the pelvic osseous pathways.Methods:A retrospective analysis was performed on the data of 50 elderly patients with FFP treated by the Department of Trauma and Pelvic Trauma of Tianjin Hospital from March 2016 to October 2021, and the 50 patients with FFP were divided into robotic-assisted screw fixation group (robot group) and open reduction steel plate fixation group (open group) according to the fixation method. There were 30 patients in the Robot group, 6 males and 24 females, average age 75.03±7.32 years (range, 60-90 years). According to Rommens and Hofmann FFP classification, there were 4 cases of IIc type, 8 cases of IIIa type, 1 case of IIIb type, 12 cases of IIIc type, 3 cases of IVa type, 2 cases of IVb type. There were 20 patients in the open group, 5 males and 15 females, average age 71.90±5.51 years (range, 62-85 years). According to Rommens and Hofmann FFP classification, there were 2 cases of IIc type, 6 cases of IIIa type, 9 cases of IIIc type, 3 cases of IVa type. The two groups were compared with age, pelvic fracture classification, operation time, intraoperative blood loss, fracture reduction quality, visual analogue scale (VAS), Majeed score, and wound healing or not.Results:All patients were followed up for 12.72 months (range, 6-24 months). In the robot group, the operation time was 50.17±19.32 min (range, 30-120 min), and intraoperative blood loss was 55.50±28.60 ml (range, 10-150 ml); in the open group, the operation time was 92.25±27.55 min (range, 60-180 min), and intraoperative blood loss was 217.50±67.20 ml (range, 150-400 ml), there were statistical differences ( t=6.36, P<0.001; t=11.72, P<0.001). According to Mears and Velyvis imaging evaluation criteria, in the robot group, anatomical reduction were achieved in 10 cases, satifactory reduction were achieved in 20 cases; in the open group, anatomical reduction were achieved in 14 cases, satifactory reduction were achieved in 6 cases, there were statistical differences (χ 2=6.46, P=0.011). In the robot group, VAS for pelvic pain was 7.33±1.32 points (range, 4-9 points) before operation, 4.13±1.07 points (range, 3-8 points) one week after surgery, and 2.30±0.84 points (range, 1-5 points) at the last follow-up; in the open group, VAS for pelvic pain was 7.45±1.23 points (range, 5-9 points) before operation, 5.25±1.25 points (range, 3-8 points) one week after surgery, and 2.80±1.24 points (range, 1-6 points) at the last follow-up, the difference between the two groups was statistically significant ( F=162.18, P<0.001; F=70.18, P<0.001), the difference between the two groups was statistically significant 1 week after surgery ( t=3.37, P=0.001), and there was no statistically significant difference between the two groups before surgery and the last follow-up ( P>0.05). The Majeed score was 82.10±4.80 (range, 65-95) in the robot group, 77.60±5.40 (range, 70-93) in the open group at the last follow-up, there were statistical differences ( t=3.09, P=0.003). There was no wound complication in the robot group, there were 4 cases with wound infection or rupture in the open group. One LC-II screw loosen in the robot group, which needed reoperation with cement, there was also 1 screw of plate loosening in the open group with no reoperation. Conclusion:Robot-assisted screws fixation with minimally reduction based pelvic osseous pathways shows satisfactory clinical outcomes, satisfactory reduction, effective pain relief, and fewer postoperative complications in treatment of elderly FFP.

Objective:To investigate the clinical outcomes of unstable pelvic fractures in adolescents treated with robot-assisted posterior pelvic channel screw.Methods:From October 2016 to October 2020, 14 adolescent patients with unstable pelvic fractures were retrospectively analyzed. There were 8 males and 6 females, average age of 14.57±1.69 years (range, 12-17 years). Pelvic fracture classification: according to Tile classification, 2 cases of B1, 3 cases of B2, 1 case of B3, 2 cases of C1, 5 cases of C2, 1 case of type C3. According to Torode-Zieg classification, 2 cases of type IIIb, 12 cases of type IV. According to Young-Burgess classification, 1 case of APC II, 1 case of APC III, 2 cases of LC I, 2 cases of LC III, 8 cases of VS type. The diameter of the sacroiliac screw channel, operation time, intraoperative blood loss, fracture reduction quality, pelvic asymmetry, pain visual analogue scale (VAS), Majeed score, screw placement accuracy, postoperative complications were analyzed. The pelvic asymmetry and VAS at presurgery, one week after surgery and the last follow-up were statistically analyzed.Results:There were 8 cases of robot-assisted sacroiliac screw placement and 6 cases of robot-assisted triangular fixation. All patients were followed up for 24.85±10.26 months (range, 12-51 months). The average height of S 1 sacroiliac screw channel was 14.85±3.59 mm (range, 8-22 mm). The average width was 13.78±2.64 mm (range, 9-19 mm). The average height of S 2 sacroiliac screw channel was 14.07±3.08 mm (range, 8-21 mm), and the average width was 12.64±2.84 mm (range, 7-19 mm). The operation time was 63.57±21.61 min (range, 20-120 min), and the intraoperative blood loss was 65.71±41.83 ml (range, 20-200 ml). According to Mears and Velyvis imaging evaluation criteria, 7 cases were anatomically reduced, 6 cases were satisfactory, and 1 case was unsatisfactory, and the satisfactory reduction rate was 93% (13/14). The pelvic asymmetry was 18.14±6.07 mm (range, 9-33 mm) before surgery, while one week after surgery, it was 5.43±2.44 mm (range, 3-13 mm), and it was 4.64±2.27 mm (range, 3-12 mm) in the last follow-up. One week after surgery, the last follow-up, and preoperative pelvic asymmetry was statistically different ( F=50.21, P<0.001); As for VAS for pelvic pain, the score was 6.93±1.21 points (range, 5-9 points) preoperative, 3.93±0.99 points (range, 3-6 points) one week after surgery, and 1.21±0.97 points (range, 0-3 points) at the last follow-up. There was statistical difference between 1 week after operation, the last follow-up and preoperative VAS ( F=100.89, P<0.001). The Majeed score was 86.14±7.35 points (range, 70-95 points), and the excellent and good rate was 93%(13/14). All the robot-assisted screws were located in the bone, the screw placement accuracy was 100%. No postoperative complications such as wound infection occurred, and only 1 patient complained of discomfort because of the nail tail. Conclusion:For unstable pelvic fractures in adolescents, robot-assisted pelvic posterior channel screws shows satisfactory postoperative clinical effects, which is minimally invasive, with fewer postoperative complications.

Objective:To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection.Methods:Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery, the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results:There were 67 patients in the final analysis, The median follow-up duration was 14 months (range: 1-60 months). Firty three patients (79.1%) had tumor recurrence, 52 patients (77.6%) died, Among them, 49 patients (73.1%) died from tumor recurrence. The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%, 19.6%, 16.8% and 53.7%, 32.4%, 20.8%. respectively. The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion ( χ2=5.916, P=0.015). CA19-9≥1 000 U/ml was the only independent risk factor for the disease-free survival. CA19-9≥1 000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival. Conclusion:For ICC patients with single tumor, when the tumor diameter is less than 5 cm and has no microvascular invasion, surgical resection is recommended, and a satisfactory prognosis could be achieved.

T cell immunoglobulin and ITIM domain (TIGIT) is a novel immune checkpoint that has been considered as a target in cancer immunotherapy. Current available bioassays for measuring the biological activity of therapeutic antibodies targeting TIGIT are restricted to mechanistic investigations because donor primary T cells are highly variable. Here, we designed a reporter gene assay comprising two cell lines, namely, CHO-CD112-CD3 scFv, which stably expresses CD112 (PVRL2, nectin-2) and a membrane-bound anti-CD3 single-chain fragment variable (scFv) as the target cell, and Jurkat-NFAT-TIGIT, which stably expresses TIGIT as well as the nuclear factor of activated T-cells (NFAT) response element-controlled luciferase gene, as the effector cell. The anti-CD3 scFv situated on the target cells activates Jurkat-NFAT-TIGIT cells through binding and crosslinking CD3 molecules of the effector cell, whereas interactions between CD112 and TIGIT prevent activation. The presence of anti-TIGIT mAbs disrupts their interaction, which in turn reverses the inactivation and luciferase expression. Optimization and validation studies have demonstrated that this assay is superior in terms of specificity, accuracy, linearity, and precision. In summary, this reliable and effective reporter gene assay may potentially be utilized in lot release control, stability assays, screening, and development of novel TIGIT-targeted therapeutic antibodies.