Objective    To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods    The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results    All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion    Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

【Objective】 To compare the anesthestic effects of ultrasound-guided retrolaminal block （RLB） and local anesthesia during posterior approach vertebral surgery. 【Methods】 Forty patients （ASA physical status Ⅰ or Ⅱ） scheduled for transforaminal lumbar spine endoscopic surgery were recruited and randomly divided into two groups （n=20）： RLB group and local anesthesia group （Group C）. RLB group received the ultrasound-guided retrolaminar block using parasagittal in plane method by an anesthesiologist while Group C received layer-by-layer local infiltration anesthesia according to the operation location； 0.5% ropivacaine of 20 mL was used in the two groups. We recorded visual analogue score （VAS） and Ramsay sedation score at admission （T0）， during skin incision （T1）， puncture （T2）， foraminoplasty （T3）， nerve root decompression （T4） and suture （T5）. We also recorded remedial analgesia rate， scores of the patients’ satisfaction and the intraoperative occurrence of side effects （respiratory depression， tachycardia and hypertension）. The patients were followed up. Their functional status was assessed by the Oswestry Disability Index （ODI） score before surgery and three months after surgery. 【Results】 Compared with Group C， RLB group had significantly decreased visual analogue score at T2-4 and lower remedial analgesia rate （P<0.05）. The patients’ satisfaction was higher in group RLB than in Group C （P<0.05）. The intraoperative occurrence of hypertension and tachycardia were significantly lower in RLB group than in Group C （P<0.05）. ODI score was significantly decreased three months after surgery in both groups （P<0.05）， but it did not differ significantly between the two groups （P>0.05）. 【Conclusion】 Ultrasound-guided RLB can provide satisfactory analgesia with greater safety when trasforaminal endoscopic surgery is used.

Objective    To evaluate the feasibility and clinical value of robot-assisted lung segmentectomy through anterior approach. Methods    We retrospectively analyzed the clinical data of 77 patients who underwent robotic lung segmentectomy through anterior approach in our hospital between June 2018 to October 2019. There were 22 males and 55 females, aged 53 (30-71) years. Patients' symptoms, general conditions, preoperative imaging data, distribution of resected lung segments, operation time, bleeding volume, number of lymph node dissected, postoperative duration of chest tube insertion, drainage volume, postoperative hospital stay, postoperative complications, perioperative death and other indicators were analyzed. Results    All operations were successfully completed. There was no conversion to thoracotomy, serious complications or perioperative death. The postoperative pathology revealed early lung cancer in 48 patients, and benign tumors in 29 patients. The mean clinical parameters were following: the robot Docking time 1-30 (M=4) min, the operation time 30-170 (M=76) min, the blood loss 20-400 (M=30) mL, the drainage tube time 2-15 (M=4) days, the drainage fluid volume 200-3 980 (M=780) mL and the postoperative hospital time 3-19 (M=7) days. Conclusion    Robotic lung segmentectomy through anterior approach is a safe and convenient operation method for pulmonary nodules.

Objective    To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach. Methods    We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed. Results    One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died. Conclusion    Robot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.

Objective    To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy. Methods    A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups. Results    All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups. Conclusion    3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.

Objective    To investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment. Methods    A total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized. Results    There was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments. Conclusion    Da Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.

Objective:To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital, Army Medical University, and comparison analysis the clinical application value for early-stage lung cancer.Methods:A retrospective cohort study was conducted to continuously enroll 190 patients, 100 who received robotic(33 males and 67 females, median age of 51 years)and 90 who received VATS(34 males and 56 females, median age of 54 years), who underwent segmentectomy between June 2018 and October 2019. Perioperative outcomes(the operation time, intraoperative blood loss, postoperative thoracic drainage volume and time, pain score, complications, postoperative hospital stay and survival and mortality) were compared.Results:All the patients successfully completed the surgery and recovered from hospital, with no perioperative death.The baseline characteristics(sex, age, clinical symptoms, smoking status, underlying disease, tumor size, pathological type) and type of segmentectomy were comparable. There was significant difference in operative time[120(interquartile range, IQR 60-225)min vs. 155( IQR 75-330)min, P<0.001], blood loss[30( IQR 20-400) ml vs. 100( IQR 20-1 600) ml, P<0.001] between the robotic and VATS groups, respectively. But there was no significant difference in postoperative thoracic drainagevolume[4( IQR 1-15) days vs. 4( IQR 2-29) days, P=0.547], postoperative thoracic time[755( IQR 200-3 980)ml vs. 815( IQR 280-3 920)ml, P=0.902], pain score[2.33( IQR 0.88-4.75) points vs. 3.13( IQR 0.95-5.29)points, P=0.199], complications[7.4%(14/190) vs. 6.3%(12/190), P=0.303], postoperative hospital stay[7( IQR 3-19) days vs. 6( IQR 4-21) days, P=0.405] , number of lymph nodes[(4.83±3.18) vs.(6.15±4.1), P=0.255] between the robotic and VATS groups, respectively. The follow-up time was 6.5( IQR 1-26) months in the two groups, without recurrence, metastasis or death. Conclusion:Robotic lung segmentectomy is safe and feasible. This approach might lead to a better in operative time and blood loss. The short-term efficacy is similar with thoracoscopy, and the long-term efficacy needs further follow-up time.

ObjectiveTo study the metabolite features of acute necrotizing pancreatitis (ANP) and chronic pancreatitis (CP) in rats.MethodsA total of 22 Wistar rats were divided into ANP group (n =7 ),CP group (n =6) and the control group (n =9).ANP model was induced peritoneous injection of 20％ Larginine,and the rats were sacrificed 12 hours later.CP model was induced by intravenously injection of DBTC (8 mg/kg body weight),and the rats were sacrificed after 2 months.The rats in the control group received same amount of saline.Serum amylase was determined and pancreatic tissues were pathologically examined.Metabolic changes of pancreatic tissues in vitro were studied by high resolution magic angle spinning nuclear magnetic resonance (MAS NMR ),and analyzed by using principal components analysis (PCA).Characteristic metabolites of ANP and CP were compared. Results Compared with the control group,increased leucine,iso-leucine and valine levels were observed in ANP group,however,the opposite trends were observed in CP group.Phosphocholine,glycerophosphocholine,choline levels were increased and fatty acids,lactate,betaine,glycine levels were decreased in both ANP and CP groups.The lipid content in CP group were significantly higher than that in ANP group and the increased taurine was only observed in CP group. Conclusions There were obvious metabolic features in pancreatic tissue in rats with pancreatitis disorders,and the increased taurine could be used as biomarker to discriminate ANP and CP.

Objective To investigate and determine the apparent diffusion coefficient (ADC) values in different anatomical regions of normal pancreas.Methods A total of 383 volunteers with normal pancreas were included in this study.Single-shot echo planar imaging diffusion weighted imaging (SSEP-DWI; b value =0,500 s/mm2) was employed to determine the ADCs in the head,neck,body and tail parts of the pancreas.Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon signed rank tests.Results The ADCs in the head,neck,body and tail parts of the pancreas was (1.52 ± 0.29) × 10-3,( 1.64 ± 0.34) ×10-3,(1.67±0.35) × 10-3,(1.58 ±0.31) × 10-3 mm2/s,the Kruskal-Wallis test results showed a significant difference of mean ADCs among the different anatomical regions (chi square =44.8748,P ＜0.0001 ).Wilcoxon signed rank test results showed the mean ADCs differed remarkably between the head and neck ( P ＜ 0.0001 ),head and body ( P ＜ 0.0001 ),head and tail ( P =0.0008 ),neck and tail (P =0.0062 ),body and tail (P ＜0.0001),respectively.The mean ADCs between the neck and body was not significantly different (P =0.1181 ).Conclusions The mean ADC values of normal pancreas vary significantly within different anatomical regions,which can serve as a guide for DW1 and ADC in clinical application and research of pancreatic diseases.

OBJECTIVE: To investigate the advantages and disadvantages between two surgical approaches of trans scalp coronary incision (TCI) and functional endoscopic sinus surgery (FESS) by which front-ethmoid-orbital masses being resected. METHOD: Thirty-four cases of front-ethmoid-orbital mass from 1995-2006 were retrospectively studied, among which lesions of 18 cases resected by FESS, lesions of 16 cases via TCI. The follow-up time varied from 2 to 4 years. RESULT: Five of 18 cases by FESS had residual dizziness or nasal pain, one case recurred 2 years after the operation. None of TCI cases experienced recurrence, whereas dizziness presented in 3 cases, regional dull sensation of the operative scalp in 12 cases. CONCLUSION FESS and TCI approach has its own benefits and shortcomings thus has its indications respectively.
Adolescent ; Adult ; Aged ; Cysts ; surgery ; Endoscopy ; Ethmoid Sinus ; surgery ; Female ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Orbit ; surgery ; Paranasal Sinus Diseases ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Retrospective Studies ; Scalp ; surgery ; Young Adult