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Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.
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Objective@#To assess the feasibility and validity of the establishment of a modified channel for extraperitoneal robot-assisted laparoscopic radical prostatectomy (RARP) through single incision.@*METHODS@#From November 2020 to January 2021, 35 cases of localized PCa were treated by extraperitoneal RARP through single incision in our center. All the operations were performed by the same surgeon, none via the multichannel port for the establishment of the channel. We recorded and analyzed the intra- and postoperative parameters, operation cost, complications, pathological findings and follow-up data.@*RESULTS@#All the operations were successfully completed, without conversion to open surgery or additional channels, or serious postoperative complications, the time for establishing the extraperitoneal space averaging 25.4 (20.0－45.0) min, the operation time 67.3 (35.0－125.0) min, intraoperative blood loss 75.5 (60.0－150.0) ml, time to first postoperative anal exhaust 26 (8－48) h, and postoperative hospital stay 7.89 (7－10) d. Postoperative pathology showed adenocarcinoma in all the cases, with Gleason score (GS) 3+3 in 9 (25.7%), GS 3+4 in 9 (25.7%), GS 4+3 in 8 (22.9%), and GS ≥ 8 in 9 (25.7%) of the cases, 23 (65.7%) in the Subject(s)
Humans
, Male
, Blood Loss, Surgical
, Laparoscopy
, Prostatectomy
, Robotic Surgical Procedures
, Robotics
ABSTRACT
Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration
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BACKGROUND: Kyphosis in ankylosing spondylitis is sagittal or coronal imbalance, but there is a lack of study on its orthopedic biomechanics, and biomechanics is of great significance for the reconstruction of spinal stability after orthopedic surgery.OBJECTIVE: To establish a three-dimensional (3D) finite element model of kyphosis in ankylosing spondylitis treated by osteotomy on software, and to analyze its biomechanical properties, thus providing theoretical basis for clinical practice.METHODS: A 3D finite element model of kyphosis in ankylosing spondylitis was established based on CT data, and the predetermined angle of the osteotomy at L2 was measured. Afterwards, vertebral column decancellation and vertebral column resection were stimulated, and then the biomechanical parameters were analyzed. RESULTS AND CONCLUSION: (1) The 3D finite element models of kyphosis in ankylosing spondylitis treated by vertebral column decancellation or vertebral column resection at L3 were established successfully. (2) The stress on the screw and contact at each segment in the vertebral column decancellation group was significantly higher than that in the vertebral column resection group except for S1. (3) To conclude, both two methods can reconstruct the sagittal balance,but vertebral column decancellation exhibits significantly higher stress on the screw. Indeed, the incidence of internal fixation failure and complications in vertebral column decancellation is higher than that in vertebral column resection at the same segment and angle.
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Objective To design and manufacture a multifunctional cushion for venous thrombosis prevention of lower extremities, which can be also applied to the low extremities needing raising. Methods The cushion was made of anti-rust, low-weight, undeformable and easy-to-clean stainless material, which was composed of a pad and a massage apparatus. The pad had its height regulable from 16 to 30 cm and telescopic inclination from 30 to 70° to adapt the cushion to sizes of patients. There were 6 independent air chambers and tubular circulating pipes around the blanket wrapping the chambers so that extremity massage and temperature-controlled heating could be executed based on setting up pressure, time and temperature of the electromagnetic air and water pumps. Results The cushion simulated the functions of the muscle pump, which formed step-by-step-increasing pressure changes by driving the chambers to be inflated and discharged continuously to execute extremity massage, temperature-controlled heating etc. Conclusion The cushion gains advantages in flexible composition, patient comfort etc, solves the problems in fixing angle and height, constant time for pump inflation and discharge as well as temperature-controlled heating, and thus is worthy promoting clinically.
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<p><b>OBJECTIVE</b>To compare the apical microleakage of Vitapex (calcium hydroxide based paste) with that of AH-plus and zinc oxide eugenol sealer when used with laterally condensed gutta percha obturation technique.</p><p><b>METHODS</b>One hundred single rooted human anterior teeth were instrumented and randomly divided into three experimental groups (A, B, C) of 30 teeth each and two control groups (D, E) of 5 teeth each. Group A was filled with laterally condensed gutta-percha using Vitapex as sealer. Group B was filled with laterally condensed gutta-percha using AH-plus as sealer. Group C was filled with laterally condensed gutta-percha using zinc oxide eugenol as sealer. Group D was the positive control. Group E was the negative control, which were coated with nail polish to entire root surface. Teeth were then suspended in 2% methylene blue. After this, teeth were demineralized dehydrated and cleared. Linear dye penetration was determined under stereomicroscope with calibrated eye piece.</p><p><b>RESULTS</b>The mean dye penetration for group A, B, C were respectively (0.57 +/- 0.56) mm, (0.79 +/- 0.96) mm and (1.07 +/- 1.12) mm. Group D demonstrated maximum dye penetration. Group E showed no dye penetration. There was no statistically significant difference between group B and group C (P > 0.05). However, there was statistically significant difference between group A and group B, C (P < 0.01).</p><p><b>CONCLUSION</b>This study showed that Vitapex used as endodontic sealer material are better than AH-plus sealer and zinc oxide eugenol sealer.</p>
Subject(s)
Humans , Calcium Hydroxide , Dental Leakage , Dental Pulp Cavity , Gutta-Percha , Molar , Root Canal Filling Materials , Root Canal Obturation , Silicones , Zinc Oxide-Eugenol CementABSTRACT
Ultrasound therapy is a new type of therapy technology, there are hyperthermia and high intensity focused ultrasound surgery (HIFUS). Compared with a single frequency system, mutiple frequency system has an additional function to combine power patterns of different frequencies. This function increases the availability of power patterns to treat tumors of various shapes and depths. Therefore, we have in this article proposed a system with the ability to drive ultrasonic phased arrays of multiple resonant frequencies for ultrasound hyperthermia and HIFUS. The results show that this system is able to (1) drive multi-element applicators or phased arrays of a single resonant frequency through the multichannel power amplifiers, (2) concurrently drive transducer with different resonant frequencies, (3) adjust the relative phase and output power of each channel for the scanning ultrasonic focus, and (4) operate each channel with good output stability.