A single-team experience with robotic pancreatic surgery in 1010 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.</p><p><b>METHODS</b>The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.</p><p><b>RESULTS</b>The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.</p><p><b>CONCLUSION</b>This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.</p>

Roles of acoustic radiation force impulse and two-dimensional shearwave elastography in grading liver fibrosis in rabbits / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the difference between acoustic radiation force impulse (ARFI) and two-dimensional shearwave elastography (2D-SWE) in grading liver fibrosis (LF).</p><p><b>METHODS</b>Sixty New Zealand rabbits were divided into control group (n=10; without any treatment) and LF group (n=50; treated with CCl4 to induce LF at different degrees). Liver stiffness (LS) were measured in all the animals using ARFI and 2D-SWE, and liver tissues in the same sites were collected for pathological analysis. Spearman's rank-correlation coefficient was used for analysis between LF and LS,and the receiver operating characteristic curve was constructed to analyze the difference of the diagnostic performance of the two techniques.</p><p><b>RESULTS</b>Data were obtained from 37 animals, among which 14 sites was at F0,11 sites at F1,12 sites at F3,and 22 sites at F4.All the LS measurements were successfully performed.A significant correlation between LS and ARFI results (r=0.802,P<0.01)as well as a significant correlation between LF and 2D-SWE results (r=0.892, P<0.01)were found. The receiver operating characteristic curves were successfully constructed. The area under the curve for diagnosing LF higher than F0, F1, F2 and F3 were 0.809,0.916,0.938, and 0.934, respectively, for ARFI, and those were 0.917,0.935,0.976, and 0.974, respectively,for 2D-SWE.</p><p><b>CONCLUSION</b>ARFI and 2D-SWE can accurately grade LF,and 2D-SWE has a better diagnostic performance than ARFI.</p>

Liver stiffness measured by acoustic radiation force impulse imaging in assessing hepatic functional reserve in patients with space-occupying lesions in the liver / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the value of liver stiffness measured by acoustic radiation force impulse imaging(ARFI) in assessing hepatic functional reserve in patients with space-occupying lesions in the liver.</p><p><b>METHODS</b>Sixty-three patients with space-occupying lesions in the liver were enrolled. Liver stiffness (LS) measurements with ARFI and indocyanine green(ICG) retention test were performed in the same day, and plasma clearance rate of indocyanine green(ICG-K), ICG retention at 15 minutes(ICGR15) as well as 10 effective values of LS were recorded. The correlation between Child-Pugh score, ICGR15, ICG-K, and LS were evaluated.</p><p><b>RESULTS</b>The LS measurements with ARFI failed in one patient. A strong correlation between LS and ICGR15(r=0.789, P<0.01) and an inverse correlation between LS and ICG-K(r=-0.738, P<0.01) were observed. Besides, there was a significant correlation between LS measurements and Child-Pugh score(r=0.929, P<0.01) . The LS significantly differed among patients with Child-Pugh class A, B, and C(P<0.01) .</p><p><b>CONCLUSION</b>ARFI is a simple, feasible and non-invasive method for assessing hepatic functional reserve in patients with space-occupying lesions in the liver.</p>