Objective To explore the feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis. Methods The clinical data of patients with primary palmar hyperhidrosis who underwent high-definition thoracoscopic sympathicotomy in Taikang Xianlin Drum Tower Hospital from June to July 2023 were retrospectively analyzed. Intraoperative visualization rates and anatomical variations of sympathetic ganglia were recorded, and the consistency between white-light thoracoscopy and near-infrared fluorescence imaging was compared. Additionally, surgical videos from previous fluorescence-guided procedures were reviewed. Results Finally 100 patients were collected, including 54 females and 46 males, with an average age of (21.92±6.56) years. All patients underwent endoscopic thoracic sympathicotomy at R3 level. The overall intraoperative ganglion visualization rate was 92.5% (740/800), with G2-G5 rates of 95.5% (191/200), 94.0% (188/200), 94.0% (188/200), and 86.5% (173/200), respectively. Ganglion variations occurred in 32.0% (237/740), predominantly at G3 (29.8%) and G4 (42.6%). In 5 indocyanine green-enhanced patients, the concordance rate between white-light and near-infrared fluorescence imaging was 100.0% (38/38). Video analysis of 14 near-infrared fluorescence-guided surgeries demonstrated a 99.1% (107/108) consistency rate. Postoperative palmar hyperhidrosis improvement reached 100.0% (100/100) with no Horner’s syndrome. Conclusion With the wide clinical application of high-definition thoracoscopy, accurate thoracic sympathicotomy has the feasibility of clinical application.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

Objective:To explore the clinical application value of artificial intelligence models in identifying bleeding events and hemorrhagic points during laparoscopic pancreatic surgery.Methods:This single-center retrospective cohort study collected surgical videos of 25 patients undergoing laparoscopic pancreatic surgery at the Department of General Surgery, Peking Union Medical College Hospital from January 2022 to December 2024. Videos within 5 seconds before and after representative bleeding events were captured at 30 frames/s, with 11 666 hemorrhagic-related video frames annotated. Two algorithm models were developed: a pigment-based model and a pigment+optical flow-based model for classification and target recognition of bleeding frames. The training and test sets for the pigment-based algorithm contained 4 692 hemorrhagic and 4 309 non-hemorrhagic frames, while those for the pigment+optical flow model included 1 339 hemorrhagic and 1 326 non-hemorrhagic frames. Performance evaluation was conducted using overlap thresholds, with accuracy and recall rates as key metrics.Results:The pigment-based model achieved 93.8% accuracy (134/143) and 43.3% recall (134/310) in hemorrhagic frame classification. At an overlap threshold of 0.3, the pigment-based model showed 84.1% accuracy (433/515) and 85.4% recall (433/507) in target recognition. When the threshold was increased to 0.5, the pigment+optical flow model demonstrated 88.1% accuracy (354/402) and 89.2% recall (354/397) in hemorrhagic target recognition.Conclusions:It is difficult to distinguish active bleeding from old bleeding completely by pigment information alone. The spatio-temporal features can be effectively extracted by combining pigment and optical flow information, and the bleeding can be accurately identified and located, which has potential clinical application value.

Objective:To analyze the safety and therapeutic efficacy of laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic total pancreatectomy (LTP) in the treatment of pancreatic cancer.Methods:Clinical data of 87 patients with pancreatic head and neck cancer who underwent LPD or LTP in the Department of General Surgery at Peking Union Medical College Hospital from December 2018 to August 2023 were retrospectively analyzed. The surgical approach, operative time, intraoperative blood loss volume, conversion rate to open surgery, perioperative mortality, re-operative rate, rate of major postoperative complications, postoperative hospital stay, number of lymph nodes harvested, tumor pathological stage, R 0 resection rate, initiation of postoperative chemotherapy and survival outcomes were recorded. The follow-up period extended until September 2023. Results:Among the 87 patients, 78(89.7%) underwent LPD and 9(10.3%) underwent LTP. PV-SMV vascular resection and reconstruction was performed in 16 cases (18.4%), and 11 cases totally underwent laparoscopy. Five cases (5.7%) required conversion to open surgery. The mean operative time was 279.8±74.0 minutes, and the mean intraoperative blood loss volume was 520.1±743.2 ml. The overall length of hospital stay was 15.9±6.3 days, with a mean postoperative hospital stay of 11.5±6.0 days. The rate of major postoperative complications was 19.5%, including 4 cases (4.6%) of postoperative bile leakage, 6 cases (6.9%) of postoperative gastric emptying disorders, and 3 cases (3.4%) of postoperative bleeding. There was one case (1.1%) with secondary surgery and one case (1.1%) with perioperative death. Among LPD patients, 5 cases (6.4%) had postoperative grade B or higher pancreatic fistula. Advanced age (≥70 years) did not increase the incidence of perioperative complications. All patients achieved R 0 resection. The mean number of lymph nodes harvested was 25.9±11.4. The median time to initiation of postoperative chemotherapy was 2.13±1.43 months. The median overall survival was 16 months. Conclusions:In a high-volume center for pancreatic diseases, LPD and LTP are safe and feasible for the treatment of pancreatic cancer, which could achieve satisfactory anti-tumor efficacy and improve patients' prognosis.

Objective:To analyze the clinical characteristics of invasive intervention-related intestinal fistula in patients with acute pancreatitis (AP).Methods:We retrospectively analyzed the clinical data of 177 moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) patients who received invasive intervention in Peking Union Medical College Hospital from January 2003 to December 2022. Patients were divided into fistula group and non-fistula group based on the presence or absence of fistula after or during receiving invasive interventions. The age, gender, etiology, systemic inflammatory response syndrome(SIRS), impairment of organ function, revised Atlanta classification, bedside index of severity of acute pancreatitis(BISAP), Balthazar CT classification, extra-pancreatic involvement and secondary infection of local complications, indications, timing and modalities of invasive interventions, length of hospitalization, length of intensive care and outcomes were recorded. The differences on clinical characteristics were compared between the two groups.Results:Intestinal fistulae were found in 21(11.9%) cases during or after invasive intervention, including 8 during or after percutaneous drainage and 13 during or after surgeries. 51 cases received endoscopic drainage or debridement and no intestinal fistula occurred after endoscopic management. Compared to patients without fistula, the median age was younger in the fistula group (36 vs 45 years, P=0.014), and the occurrence of SIRS (95.2% vs 59.6%, P=0.001), extra-pancreatic invasion (100.0% vs 67.3%, P=0.002), and secondary infection (71.4% vs 36.5%, P=0.002) were higher. Patients with fistula had a longer median length of hospitalization (71 vs 40 days, P=0.016) and intensive care (8 vs 0 days, P=0.002). All patients in the fistula group had peri-pancreatic, abdominal and retroperitoneal involvement seen on imaging or intraoperatively. The intestinal fistulae mainly occurred in the colon ( n=13, 61.9%) and the duodenum ( n=6, 28.6%). The confirmed diagnosis of fistulae was based on transfistula imaging ( n=11) or digestive tract imaging ( n=5). Among 13 cases with colonic fistulae, nonsurgical treatment was preferred in 9 cases, and surgeries of fistula repairmen or proximal ostomy were preferred in 4 cases. Among 8 cases with non-colonic fistulae, nonsurgical treatment was preferred in 7 cases, and only 1 case repaired the fistula immediately during the intraoperative detection. Conclusions:Intestinal fistula is an important complication of severe AP, and it is closely associated with invasive interventions. Improved invasive intervention strategies may help prevent intestinal fistula formation; timely and effective management of intestinal fistula may help avoid complications and shorten hospitalization.

To investigate the differences in postoperative short-term complications and long-term prognosis of pancreatic cancer(PC) patients after total pancreatectomy(TP) and pancreaticoduodenectomy(PD).

A young man with a history of thrombocytopenia for seven years presented with splenomegaly and fever and rapidly evolved to disseminated intravascular coagulation (DIC) and hemorrhagic shock. Spontaneous rupture of the spleen was diagnosed. The critical patient underwent an emergency splenectomy. Pathological examination revealed splenic peliosis, an extremely rare disease with unknown etiology and pathogenesis. Despite the high mortality rate due to spontaneous splenic rupture with DIC, the patient was successfully treated and the details of the case are presented in this report.

Objective:To analyze the ultrasound characteristics of small bowel volvulus among adults and to investigate the value of ultrasound in the diagnosis of small bowel volvulus.Methods:Totally 34 adults with small bowel volvulus confirmed by clinical diagnosis or surgery and who underwent ultrasound examination at Peking Union Medical College Hospital from August 2017 to October 2022 were enrolled, including 19 males and 15 females, aged (55.0±21.8) years (range: 19 to 94 years). The clinical characteristics, CT images and ultrasound images of the patients were retrospectively reviewed, and the ultra, sound features of small bowel volvulus and its diagnostic efficacy were analyzed.Results:Abdominal pain was the typical clinical symptom of all patients. Other symptoms included 21 cases of abdominal distension, 19 cases of nausea and vomiting, and 13 cases of cessation of passage of stool or flatus. Eight patients had signs of peritonitis and 22 patients had abnormal bowel sounds. Twenty patients had a history of abdominal surgery. Twenty-seven patients underwent surgery for intestinal obstruction, and the remaining 7 patients improved after conservative treatment. All cases were evaluated by ultrasound, 11 cases showed a “whirl sign” and were diagnosed as small bowel volvulus, the diagnostic accuracy rate was 32.4% (11/34), ultrasound simultaneously diagnosed intestinal obstruction in 21 cases, 17 cases of abdominal effusion, 4 cases of intestinal wall thickening, 2 cases of abdominal mass, 1 case of intussusception, 1 case of right sided inguinal hernia. CT and ultrasound had a consistent positive discovery in 88.2% (30/34) of all the patients.Conclusion:Ultrasound is valuable in the diagnosis of small bowel volvulus and the evaluation of complications.

Objective:To analyze the ultrasound characteristics of small bowel volvulus among adults and to investigate the value of ultrasound in the diagnosis of small bowel volvulus.Methods:Totally 34 adults with small bowel volvulus confirmed by clinical diagnosis or surgery and who underwent ultrasound examination at Peking Union Medical College Hospital from August 2017 to October 2022 were enrolled, including 19 males and 15 females, aged (55.0±21.8) years (range: 19 to 94 years). The clinical characteristics, CT images and ultrasound images of the patients were retrospectively reviewed, and the ultra, sound features of small bowel volvulus and its diagnostic efficacy were analyzed.Results:Abdominal pain was the typical clinical symptom of all patients. Other symptoms included 21 cases of abdominal distension, 19 cases of nausea and vomiting, and 13 cases of cessation of passage of stool or flatus. Eight patients had signs of peritonitis and 22 patients had abnormal bowel sounds. Twenty patients had a history of abdominal surgery. Twenty-seven patients underwent surgery for intestinal obstruction, and the remaining 7 patients improved after conservative treatment. All cases were evaluated by ultrasound, 11 cases showed a “whirl sign” and were diagnosed as small bowel volvulus, the diagnostic accuracy rate was 32.4% (11/34), ultrasound simultaneously diagnosed intestinal obstruction in 21 cases, 17 cases of abdominal effusion, 4 cases of intestinal wall thickening, 2 cases of abdominal mass, 1 case of intussusception, 1 case of right sided inguinal hernia. CT and ultrasound had a consistent positive discovery in 88.2% (30/34) of all the patients.Conclusion:Ultrasound is valuable in the diagnosis of small bowel volvulus and the evaluation of complications.

Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve (RLN) in videos of endoscopic thyroidectomy (ETE) via breast approach.Methods:Videos of ETE via breast approach in Peking Union Medical College Hospital from Feb. 2020 to Aug. 2021 were collected. Videos containing RLN were selected, and the outline of RLN was marked by two thyroid surgeons. Then data were divided into a training set and a test set in a ratio of 5:1 and classified into the high and low difficulty group according to a senior thyroid surgeon’s opinion. Those pictures were input to D-LinkNet model. Precision, sensitivity and mean dice index was calculated.Results:A total of 46 videos including 153, 520 frames of pictures were included in this study. 131,039 frames of 39 videos were in the training set and 22,481 frames of 7 videos were in the test set. When the intersection over union threshold was 0.1, the sensitivity and precision was 92.9%/72.8% and 47.6%/54.9% in high and low recognition group, respectively. When the intersection over union threshold was 0.5, the sensitivity and precision turned to 85.8%/67.2% and 37.6%/43.5% in high and low difficulty group, respectively. Mean Dice index was 0.781 and 0.663 in high and low difficulty group, respectively.Conclusions:RLN recognition based on deep learning is feasible and has potential application value in ETE, which may help surgeons reduce the risk of accidental injury of RLN and improve the safety of thyroidectomy.