The article reported a case of 5G remote robot-assisted sleeve gastrectomy completed on December 14,2023,by using the Minimally Invasive Tumai Laparoscopic Surgical Robotic System(MT-1000)and a 5G signal network system in a dual-master-knife mode.The patient's platform was located in the operating room of the Gansu Provincial People's Hospital(GSPH),and the main manipulator's table was located in the operating room of the Lanzhou New District Branch of the Gansu Provincial People's Hospital(straight-line distance between the two being 75.6 km).The total duration of the surgery was 120 min,including 30 min of loading time and 90 min of robotic operation time.The average intraoperative network delay was(55.16±25.33)ms,and the packet loss rate was 0.01％-0.1％.No adverse network events such as network interruption occurred,and the surgery was completed successfully.

Objective To summarize the experience of performing selective laparoscopic appendectomy in re-admission children who had been given conservative treatment for acute appendicitis complicated with peri-appendiceal abscess.Methods From September 2019 to July 2024,22 patients with acute appendicitis complicated with peri-appendiceal abscess underwent three port laparoscopic appendectomy after receiving conservative treatment for 6-14 weeks.Their age ranged 5-14 years old,with an average of 8.5 years old.A 5 mm trocar and a 30° laparoscope were inserted through a midline umbilical incision,and 5 mm trocars and forceps were placed at the suprapubic area,lateral to the left rectus abdominis,and 3-5 cm below the umbilicus.Adequate adhesiolysis was performed,including detaching the omentum from the pelvic sidewall,separating the ileocecal region from the omentum,and freeing the appendix from the lateral peritoneum and the mesenteric tissue of the terminal ileum to expose the affected appendix.The mesoappendix and the base of the appendix were then ligated and transected.Results The operations in all the 22 cases were successful.The surgical time ranged 50-150 min(mean,75.5±10.0 min).The patients were able to mobilize independently at 6-8 h postoperatively,resumed passing gas and consumed clear liquids within 1-1.5 d.The postoperative hospital stay was 3-6 d,with an average of 4 d.Pathological reports indicated chronic appendicitis with necrotizing perforation.Follow-ups lasted for 2-13 months(mean,6 months),with no reports of abdominal pain,fever,incision infection,adhesive intestinal obstruction,residual appendicitis,or pelvic abscess.Conclusions For children with acute appendicitis complicated with peri-appendiceal abscess who have received conservative treatment,effective adhesiolysis within the abdominal and pelvic cavities during selective laparoscopic appendectomy is crucial,which is also the primary reason for a relatively prolonged surgical time.Adhesions are primarily located between the omentum and pelvic sidewall,between the ileocecal region and omentum,and between the appendix and lateral peritoneum as well as the mesentery of the terminal ileum.Adequate adhesiolysis followed by appendectomy can effectively alleviate symptoms such as abdominal pain.

Objective To explore the application effect of ultrasound-assisted localization in spinal anesthesia for elderly patients with hip fractures.Methods A total of 114 elderly patients undergoing hip fracture surgery with spinal anesthesia in our hospital from September 2022 to June 2024 were enrolled.The random number table method was applied to allocate participants into two groups:surface anatomical landmark localization group and ultrasound-assisted localization group,with 57 patients in each group.Both groups of patients underwent spinal anesthesia via the paramedian approach for puncture.The first-attempt puncture success rate,success rate of the initial puncture site,number of skin punctures,number of adjusted epidural needle direction,positioning time of the puncture point,puncture time(puncture success time,anesthesia time,and total time),adverse events during the puncture process(nerve hypersensitivity and accidental puncture of the dura mater),spinal anesthesia related complications(back pain,headache,and nerve injury),patient satisfaction and hospital stay were observed and compared between the two groups.The quality of early postoperative recovery was evaluated by using the 15-Item Quality of Recovery(QOR-15)scale at 24 h after surgery.Results The first-attempt puncture success rate in the ultrasound-assisted localization group was 71.9％(41/57),which was significantly higher than that in the surface anatomical landmark localization group[28.1％(16/57),x2=21.930,P=0.000].The success rate of the initial puncture site in the ultrasound-assisted localization group was 87.7％(50/57),which was significantly higher than that in the surface anatomical landmark localization group[54.4％(31/57),x2=15.396,P=0.000].The number of skin punctures and adjusted epidural needle direction in the ultrasound-assisted localization group were 1(1,1)and 0(0,1)times,while in the surface anatomical landmark localization group were 2(1,3)and 3(0,5)times,with statistically significant differences(all P=0.000).The puncture positioning time in the ultrasound-assisted localization group was 2.2(1.7,3.2)min,which was significantly longer than that in the surface anatomical landmark localization group[0.8(0.5,1.2)min,Z=-8.418,P=0.000].The puncture success time,anesthesia time,and total time of the ultrasound-assisted localization group were 1.9(1.7,2.3),4.9(4.3,5.3),and 7.1(6.3,8.7)min,while of the surface anatomical landmark localization group were 5.1(2.3,8.0),7.9(5.7,11.0),and 8.6(6.6,12.0)min,with statistically significant differences(all P＜0.05).There were no statistically significant differences in the incidence of nerve hypersensitivity during operation(3.5％vs.7.0％,x2=0.176,P=0.675),accidental puncture of the dura mater by epidural needles(0％vs.3.5％,P=0.496),postoperative headache(0％vs.3.5％,P=0.496),and back pain(1.8％vs.10.5％,x2=2.435,P=0.119)between the two groups.Both groups of patients showed no symptoms of nerve injury after surgery.There were no statistically significant differences in QOR-15 scores at 24 h postoperatively[119(115,124)points vs.116(112,121)points,Z=-1.858,P=0.063]and length of hospital stay[10.0(9.0,12.5)dvs.10.0(8.0,13.0)d,Z=-0.043,P=0.966]between the two groups.The satisfaction of patients in the ultrasound-assisted localization group was significantly higher than that in the surface anatomical landmark localization group(P=0.004).Conclusion Application of ultrasound-guided localization in spinal anesthesia for elderly patients with hip fractures significantly improves the first-attempt puncture and initial puncture site success rates,reduces skin puncture attempts and adjustments of the epidural needle direction,shortens time of anesthetic procedure,and enhances patient satisfaction,making it highly recommendable for clinical use.

Objective To compare the effectiveness between ultrasound-guided paravertebral block(PVB)and general anesthesia in percutaneous nephrolithotomy(PCNL).Methods Clinical data of 284 patients who underwent PCNL in our hospital from January 2023 to March 2024 were collected.These were 78 cases of PVB(PVB group)and 206 cases of general anesthesia(general anesthesia group).A total of 61 cases in each of the two groups were matched with propensity score,and the operative time,intraoperative fluid infusion volume,postoperative haemoglobin changes,postoperative visual analogue scale(VAS),hospital stay,hospital costs,and incidence of postoperative complications were compared.Results The operations were completed in both groups of patients successfully,with stable vital signs during the operation and no intraoperative anesthetic complications such as bradycardia,respiratory depression,or hypotension.There were significant differences between the two groups in heart rate(HR)before the start of surgery[(66.5±10.4)beats/min vs.(77.5±11.7)beats/min,t=-5.471,P=0.000],HR at the end of surgery[(60.5±8.4)beats/min vs.(71.0±12.3)beats/min,t=-5.472,P=0.000],mean arterial pressure(MAP)before the start of surgery[(97.2±11.9)mm Hg vs.(103.1±12.3)mm Hg,t=-2.694,P=0.008],MAP at the end of surgery[(85.2±8.8)mm Hg vs.(94.3±11.6)mm Hg,t=-4.892,P=0.000],pulse oxygen saturation(SpO2)before the start of surgery[(99.0±1.1)％vs.(99.6±0.6)％,t=-3.347,P=0.001]and SpO2 at the end of surgery[(99.2±1.1)％vs.(99.8±0.4)％,t=-4.122,P=0.000].The operative time was significantly shorter in the PVB group than that in the general anesthesia group[55.0(41.5,75.5)min vs.95.0(65.0,130.0)min,Z=-5.173,P=0.000].The postoperative haemoglobin changes[5(2,11)g/L vs.8(4,11)g/L,Z=-2.099,P=0.036],postoperative VAS score[1(1,1)points vs.1(1,2)points,Z=-3.342,P=0.001],postoperative hospital stay[3(2,3)dvs.4(3,6)d,Z=-6.016,P=0.000]and hospital costs[(14 499.4±2141.0)yuan vs.(19 634.2±3846.8)yuan,t=-9.109,P=0.000]were statistically lower in the PVB group than those in the general anesthesia group.Comparison of intraoperative fluid infusion volume[600(600,600)ml vs.600(600,1100)ml,Z=-1.800,P=0.072],postoperative venting time[1(1,1)d vs.1(1,1)d,Z=-1.045,P=0.296],and phase Ⅰ stone removal rate[88.5％(54/61)vs.82.0％(50/61),x2=1.043,P=0.307]showed no significant differences between the two groups.The incidence of postoperative complications in the PVB group was significantly lower than that in the general anesthesia group[6.6％(4/61)vs.19.7％(12/61),x2=4.604,P=0.032].Conclusion Ultrasound-guided PVB in PCNL maintains stable intraoperative vital signs,reduces operative time and bleeding,alleviates postoperative pain,reduces postoperative complications and postoperative hospital stay,and saves medical costs,having a good safety and efficacy.

Objective To evaluate the recovery of bladder and rectal functions after Querleu-Morrow type C1 laparoscopic nerve-sparing radical hysterectomy(LNSRH)and laparoscopic radical hysterectomy(LRH)in the management of early-stage cervical cancer,and summarize the experience of identifying and preserving pelvic autonomic nerves.Methods We retrospectively analyzed data from 200 patients undergoing LNSRH and 160 patients undergoing LRH for early cervical cancer between September 2009 and September 2023 in two hospitals.The postoperative recovery of bladder and rectal functions was compared between the two groups.Results The LNSRH group exhibited a significantly shorter hospital stay[(9.3±2.2)dvs.(11.0±2.4)d,t=-7.688,P＜0.001]and earlier removal of urinary catheters[(7.9±1.2)d vs.(15.7±2.6)d,t=-39.023,P＜0.001]as compared to the LRH group.Additionally,there was a lower incidence of urinary retention(5 cases vs.23 cases,x2=17.475,P＜0.001)and fewer symptoms of bladder dysfunction,such as nocturia,dysuria,urinary incontinence,and urgency(6 cases vs.30 cases,x2=24.500,P＜0.001)in the LNSRH group.Moreover,the time to recovery of intestinal function postoperatively was significantly reduced[(24.7±7.1)h vs.(32.4±4.4)h,t=-13.165,P＜0.001]in the LNSRH group.Conclusion LNSRH appears to significantly enhance the recovery of bladder and rectal functions and reduces the duration of hospital stay as compared to conventional LRH.

Objective To explore the therapeutic effect of orthopedic robot assisted percutaneous cannulated screw internal fixation in the treatment of Tilt pelvic fractures.Methods A retrospective analysis was made on clinical data of 21 cases of Tilt pelvic fractures treated with"Tianji"orthopedic surgical robot combined with 3D C-arm fluoroscopy assisted percutaneous cannulated screw internal fixation from January 2020 to October 2023.The Tile classification included 11 cases of type B2.1,3 cases of type B2.2,2 cases of type B2.3,and 5 cases of type B3.Results The percutaneous insertion of cannulated screw was safe in all the 21 cases,with a total of 71 screws inserted,including 21 S1 screws,21 S2 screws,21 pubic branch screws(14 anterograde screws and 7 retrograde screws),4 LC-Ⅱ screws,and 4 modified LC-Ⅱ screws.The insertion time of a single screw was(31.1±10.8)min,the fluoroscopy time of a single screw was(5.9±1.7)min,the surgical time was(100.7±16.2)min,and the bleeding volume was(11.2±4.2)ml.According to the Matta criteria,8 cases had excellent fracture reduction quality,11 cases were good,and 2 cases were fair,with an excellent and good rate of 90.5％(19/21).According to the Gras classification,the quality of screw placement was excellent in 65 cases and good in 6 cases,with an excellent and good rate of 100％(71/71).The 21 cases were followed up for 4-18(mean,10.7±8.4)months.The bone healing was achieved in all the cases,with a fracture healing time of(12.7±1.8)weeks.At the last follow-up,according to the Majeed scoring system,7 cases were rated as excellent pelvic function,11 cases as good,and 3 cases as fair,with an excellent and good rate of 85.7％(18/21).Two cases of lateral femoral cutaneous nerve injury and two cases of intermuscular vein thrombosis were cured.Conclusion The use of orthopedic robot assisted percutaneous cannulated screw fixation for the treatment of Tilt pelvic fractures has satisfactory therapeutic effects,with accurate screw placement and no need for adjustment.

Objective To evaluate the technical feasibility and safety of video-assisted thoracoscopic surgery(VATS)without chest tube placement for infants with congenital pulmonary airway malformation(CPAM).Methods Clinical data of 145 infants with CPAM treated by VATS from May 2019 to August 2022 were retrospectively analyzed.Six cases had a chest tube placement at the end of the surgery,while 139 cases did not.Among them,there were 99 segmental lobectomies,36 lobectomies,and 4 lobectomies and segmental lobectomies.Clinical efficacy and postoperative complications were observed.Results All the 145 patients underwent resection by VATS without conversion to thoracotomy.There was no mortality during the perioperative period.In the 139 cases without chest tube placement at the end of surgery,the operation time was(42.0±16.6)min,and the intraoperative blood loss was(2.7±2.0)ml.The were 6 cases who were given indwelling drainage tube for pneumothorax or pleural effusion after surgery,the rate of re-catheterization being 4.3％.The remaining 133 cases had chest X-ray review on the third day after routine surgery.Among them,8 cases had mild pneumothorax(lung compression＜20％)on the surgical side,which did not require further treatment.Before discharge,chest X-ray re-examination showed that pneumothorax was basically absorbed.All the patients were discharged with uneventful recovery,and the hospital stay was(6.6±1.3)d.Conclusion VATS without chest tube placement is a safe and feasible surgical procedure for some selective infants with congenital pulmonary airway malformation.

Objective To explore the value of frozen section(FS)in the selection of surgical modalities for patients with Bethesda Ⅵ thyroid nodules.Methods Clinical data of 287 cases of 306 Bethesda Ⅵ thyroid nodules in our department from January 2022 to April 2024 were reviewed.The proportion of changes in patients'expected surgical methods caused by FS,the sensitivity,missed diagnosis rate,and diagnostic accuracy of fine needle aspiration(FNA)and FS,as well as the utilization rate of FS and the preference of surgeons,were observed.Results The utilization rate of FS was 62.4％(191/306),and the difference in utilization rate of FS among 8 surgeons was statistically significant(x2=36.722,P=0.000).FS changed the expected surgical plan in 4.7％(9/191)of patients with nodules,which was finally proved by paraffin pathology to be inappropriate.The missed diagnosis rate of FNA was significantly lower than that of FS(0.0％vs.4.7％,P=0.000),and the sensitivity(100.0％vs.95.3％)and diagnostic accuracy(100.0％vs.95.3％)of FNA were significantly higher than that of FS(P=0.000 and 0.000).Conclusion It is not recommended to use FS to reconfirm the malignant outcome of FNA for Bethesda Ⅵ thyroid nodules,as FS may mislead surgical decisions in some patients.

Objective To evaluate the efficacy and safety of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of obstructive hydronephrosis at ureteropelvic junction in infants≤6 months old.Methods Clinical data of 44 infants with ureteropelvic junction obstruction(UPJO)and hydronephrosis treated by RALP from January 2021 to December 2023 were analyzed retrospectively.The average age was(72.3±49.7)d(range,5 d-6 months old),and the average weight was(5.7±1.6)kg(range,2.9-8.5 kg).Preoperative ultrasonography showed that the anteroposterior diameter was(30.2±9.5)mm and the thinnest part of the renal parenchyma was(2.6±1.2)mm.By using the da Vinci Xi robotic operating system,the narrow segment of the ureteropelvic junction was fully exposed,the renal pelvis and ureter were trimmed with scissors,and the ureter was anastomosed with 6-0 single strands.Results All the 44 operations were completed successfully without conversion to traditional laparoscopic or open surgery.No intraoperative complications occurred.The operation time was 105-245 min(mean,179.8 min),and the intraoperative blood loss was 2-10 ml(mean,4.9 ml).Re-examinations of ultrasonography at 6 months after removal of double J tube showed that the anteroposterior diameter was(10.5±6.3)mm,which was significantly decreased than that before operation(paired t test,t=19.985,P=0.000),and the thinnest part of the renal parenchyma was(6.8±1.7)mm,which was significantly increased than that before operation(paired t test,t=18.420,P=0.000).The patients were followed up for 6-12 months after removal of double J tube.There were no complications such as anastomotic stricture,urine leakage,or recurrence of obstruction.Conclusion RALP is safe and effective in the treatment of UPJO and hydronephrosis in infants younger than 6 months old.

Objective To explore the feasibility of video-assisted thoracoscopic surgery(VATS)in the treatment of congenital pulmonary airway malformation(CPAM)or pulmonary isolation complicated with ipsilateral mediastinal bronchogenic cyst in children.Methods From July 2019 to July 2024,VATS was carried out to treat CPAM or pulmonary isolation with ipsilateral mediastinal bronchogenic cyst in 7 children.A three-hole thoracoscopic surgery via lateral thoracic approach was performed.The patients were placed in a healthy lateral position.The observation hole was located at the intersection of the subscapular line and the 5th intercostal space,and the operating hole was established according to the surgical requirements in combination with the lumboscopic diamond rule.A 5 mm trocar was used for all three holes.The pressure of CO2 pneumothorax was 4 mm Hg and the flow rate was 2 L/min,which was adjusted at any time according to the intraoperative conditions of the children.The operation was mainly designed for lung operation.The pulmonary operation was conducted firstly,and then the bronchogenic cyst was treated.If necessary,block resection was applied to avoid serious complications of trachea.Results All the operations were performed under thoracoscopy without conversion to open surgery.The operation time was 37-191 min(median,101 min).The intraoperative bleeding volume was 1-15 ml(median,5 ml).One case was not given a closed chest drainage tube placed,and the other 6 cases were placed a closed chest drainage for 1-5 d(median,3d).Postoperative pathology showed 5 cases of CPAM combined with bronchogenic cysts,including 4 cases of type 2(bronchiole type)and 1 case of type 3(bronchiole/alveolar type),and 2 cases of extralobular pulmonary isolation combined with bronchogenic cysts.All the 7 cases were followed up for 6-57 months(median,27 months),and chest CT showed no recurrence of lesions.Conclusions CPAM or pulmonary isolation may be accompanied by bronchogenic cysts.Preoperative imaging examination should correspond to surgical observation,and careful exploration should be conducted to avoid missed diagnosis.VATS is safe and feasible for treating CPAM or pulmonary isolation with ipsilateral mediastinal bronchogenic cysts.