Study of Individual Characteristic Abdominal Wall Thickness Based on Magnetic Anchored Surgical Instruments / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Magnetic anchored surgical instruments (MASI), relying on magnetic force, can break through the limitations of the single port approach in dexterity. Individual characteristic abdominal wall thickness (ICAWT) deeply influences magnetic force that determines the safety of MASI. The purpose of this study was to research the abdominal wall characteristics in MASI applied environment to find ICAWT, and then construct an artful method to predict ICAWT, resulting in better safety and feasibility for MASI.</p><p><b>METHODS</b>For MASI, ICAWT is referred to the thickness of thickest point in the applied environment. We determined ICAWT through finding the thickest point in computed tomography scans. We also investigated the traits of abdominal wall thickness to discover the factor that can be used to predict ICAWT.</p><p><b>RESULTS</b>Abdominal wall at C point in the middle third lumbar vertebra plane (L3) is the thickest during chosen points. Fat layer thickness plays a more important role in abdominal wall thickness than muscle layer thickness. "BMI-ICAWT" curve was obtained based on abdominal wall thickness of C point in L3 plane, and the expression was as follow: f(x) = P1 × x 2 + P2 × x + P3, where P1 = 0.03916 (0.01776, 0.06056), P2 = 1.098 (0.03197, 2.164), P3 = -18.52 (-31.64, -5.412), R-square: 0.99.</p><p><b>CONCLUSIONS</b>Abdominal wall thickness of C point at L3 could be regarded as ICAWT. BMI could be a reliable predictor of ICAWT. In the light of "BMI-ICAWT" curve, we may conveniently predict ICAWT by BMI, resulting a better safety and feasibility for MASI.</p>

Early removal of the chest tube after lobectomies: a prospective randomized control study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases.</p><p><b>METHODS</b>A prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients (n = 70) were randomized into two groups; early removal group (removal of chest tube when drainage less than 300 ml/24 h, n = 41) and traditional management group (removal of chest tube when drainage less than 100 ml/24 h, n = 29). Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital.</p><p><b>RESULTS</b>There were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups (Z = -2.059, P = 0.039). Patients undergoing early removal management had a shorter Chest tube duration (44 hours vs. 67 hours, Z = -2.914, P = 0.004) and a shorter postoperative hospital stay (5.0 days vs. 6.0 days, Z = -3.882, P = 0.000). Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital.</p><p><b>CONCLUSIONS</b>Compared to the traditional management group (drainage ≤ 100 ml/24 h), early removal of chest tube after lobectomy (drainage ≤ 300 ml/24 h) is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.</p>

Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy for esophageal cancer: initial experience from China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Minimally invasive Ivor Lewis esophagectomy was usually performed with either hand-sewn or circular stapler anastomosis through a small thoracotomy or using a side-to-side stapler anastomotic technique. This study aimed to present our initial results of Ivor Lewis esophagectomy using a circular-stapled anastomosis with transoral anvil technique.</p><p><b>METHODS</b>Six patients with esophageal cancer underwent minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular-stapled end-to-end anastomosis. The abdominal portion was operated on laparoscopically, and the thoracic portion was done using thoracoscopic techniques. A 25 mm anvil connected to a 90 cm long delivery tube was introduced transorally to the esophageal stump in a tilted position, the anvil head was then connected to circular stapler. The anastomosis was completed under direct thoracoscopic view.</p><p><b>RESULTS</b>A total of six patients in this report successfully underwent total laparoscopic and thoracoscopic Ivor Lewis esophagectomy with a circular-stapled anastomosis using a transoral anvil. They were five male and one female patients, and had a mean age of 55 years (range, 38-69 years). The thoracic and abdominal operations were successfully performed without any intraoperative complications or conversion to laparotomy or thoracotomy. The passage of the anvil head was technically easy and successful in all six cases. The mean overall operative time was (260 ± 42) minutes (range, 220-300 minutes), and the mean estimated blood loss was (520 ± 160) ml (range, 130-800 ml). Patients resumed a liquid oral diet on postoperative day seven. The median length of hospital stay was 17 days (range, 9-25 days). The postoperative pathological diagnosis was esophageal squamous cell carcinoma in five patients and esophageal small cell carcinoma in one patient. Tumors were staged as T(2)N(0)M(0) in three cases, T(2)N(1)M(0) in one case, and T(3)N(0)M(0) in two cases. During the mean follow-up of 2.5 months (range, 2-4 months), there were no intraoperative technical failure of the anastomosis or major postoperative complications such as leak or stricture.</p><p><b>CONCLUSIONS</b>The initial results of this small series suggest that minimally invasive Ivor Lewis esophagectomy for malignant esophageal tumor is technically feasible. However, further multi-center prospective studies and thorough evaluation are needed to evaluate the long-term results.</p>

Completely minimally invasive Ivor Lewis esophagectomy: the preliminary experience of circular-stapled anastomosis with the trans-oral anvil / 中华外科杂志

<p><b>OBJECTIVE</b>to present the preliminary results of minimally invasive Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil technique.</p><p><b>METHODS</b>six patients with esophageal cancer received minimally invasive Ivor Lewis oesophagectomy from April 2010 to June 2010. There were 5 males and 1 female with mean age of 55 years (ranging 38 to 69 years). The lesion located in cardiac in 1 case, in lower third of the esophagus in 4 cases and in middle third in 1 case. The abdominal portion was operated laparoscopically. The thoracic portion was done using thoracoscopic techniques. The esophago-gastric anastomosis was created using a 25 mm anvil passed trans-orally and connected to a 90 cm long polyvinyl chloride delivery tube through an opening in the esophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler) inserted into the gastric conduit.</p><p><b>RESULTS</b>six patients with esophageal squamous cell cancer (n = 5) and small-cell cancer (n = 1) underwent an Ivor Lewis esophagectomy. All the operation was successfully performed without intra-operative technical failures of the anastomosis. There was no severe postoperative complications. The mean operation time was 380 min. The mean blood loss was 300 ml. pTNM staging: T2N0M0 in 3 cases, T2N1M0 in 1 case and T3N0M0 in 2 cases.</p><p><b>CONCLUSIONS</b>the circular-stapled anastomosis with the trans-oral anvil is an efficient and safe technique for esophago-gastric anastomosis.</p>

Stereotactic localization and visualization of the subthalamic nucleus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The subthalamic nucleus (STN) is widely recognized as one of the most important and commonly targeted nuclei in stereotactic and functional neurosurgery. The success of STN surgery depends on accuracy in target determination. Construction of a digitalized atlas of STN based on stereotactic MRI will play an instrumental role in the accuracy of anatomical localization. The aim of this study was to investigate the three-dimensional (3D) target location of STN in stereotactic space and construct a digitalized atlas of STN to accomplish the visualization of the STN on stereotactic MRI, thus providing clinical guidance on the precise anatomical localization of STN.</p><p><b>METHODS</b>One hundred and twenty healthy people volunteered to be scanned by 1.5 Tesla MRI scanning with 1-mm-thick slice in the standard stereotactic space between 2005 and 2006. One adult male was selected for 3D reconstruction of STN. The process of 3D reconstruction included identification, manual segmentation, extraction, conservation and reconstruction.</p><p><b>RESULTS</b>There was a significant correlation between the coordinates and age (P < 0.05). The volume of left STN was significantly larger than the right STN, and there was a significant negative correlation between volume and age (P < 0.05). The surface of the STN nucleus after 3D reconstruction appeared smooth, natural and realistic. The morphological feature of STN on the individual brain could be visualized directly in 3D. The 3D reconstructed STN could be rotated, zoomed and displayed at any direction in the stereotactic space. The anteroposterior diameter of the STN nucleus was longer than the vertical and transverse diameters in 3D space. The 3D reconstruction of STN manifested typical structure of the "dual lens".</p><p><b>CONCLUSIONS</b>The visualization of individual brain atlas based on stereotactic MRI is feasible. However, software for automated segmentation, extraction and registration of MR images need to be further developed.</p>

Comparison of changes in early pulmonary function and hemodynamic between unilateral and bilateral lung volume reduction for chronic obstructive pulmonary disease / 中华外科杂志

<p><b>OBJECTIVE</b>To compare changes in early pulmonary function and hemodynamics between unilateral and bilateral lung volume reduction (LVRS) for severe chronic obstructive pulmonary disease (COPD).</p><p><b>METHODS</b>Eighty-six patients with severe COPD underwent LVRS, 61 underwent unilateral LVRS and 25 underwent lateral LVRS. The results of lung function (FEV(1), RV, TLC), arterial blood gas analysis (PaO(2), PaCO(2)) and color Doppler echocardiography (CO, CI, EF, PAP) were evaluated preoperatively and 3, 6 months postoperatively.</p><p><b>RESULTS</b>Six patients died. FEV(1), RV and TLC were improved significantly after (P < 0.05). PaO(2) increased (P < 0.05) and PaCO(2) decreased postoperatively (P < 0.05). According to the Doppler echocardiography there were no statistic difference in cardia functions (CO, CI, EF, PAP) between unilateral and bilateral LVRS preoperatively and 3, 6 months postoperatively.</p><p><b>CONCLUSIONS</b>Unilateral and bilateral LVRS is safe and effective in the treatment of patients with severe COPD, the pulmonary function significantly improved postoperatively, but the results of bilateral LVRS is better than unilateral. Both unilateral and bilateral LVRS showed no significant deterioration in hemodynamics, there were no significant difference between preoperatively and postoperatively.</p>

Study on an actuation system for matrix control of the active catheter in a minimally-invasive intervention surgery / 中国医疗器械杂志

As it is impossible for an active catheter with a very small space to accommodate overmany lead wires in minimally-invasive surgery, a matrix network system is presented, in this paper, to control SMA actuators using minimum lead wires. Pulse current is adjusted by pulse width modulation (PWM) signals from the single-chip processor. In addition, multiple SMA actuators' cooperation helps the active catheter to succeed in guiding motion.