Day-surgery unit-based training of laparoscopic cholecystectomy: experience and technical data / 中华肝胆外科杂志

Objective:To evaluate the day-surgery unit-based training of laparoscopic cholecystectomy (LC).Methods:Perioperative data of 438 patients (187 males and 251 females) with a median age of 54 (aged 17 to 91) years undergoing LC during January 2019 to April 2021 in the day-surgery unit of Chinese PLA General Hospital were retrospectively collected and subdivided according to the training methods of surgeons [Group A( n=260): conventional training vs. Group B ( n=178): protocoled stepwise training]. The protocoled stepwise training consists of the rotation in open biliary surgery unit, the stimulator-based laparoscopic training, and the stepwise procedural tutoring. The conventional training features the traditional surgical practice following senior surgeons. The technical data involving operation time, blood loss, the percentages of intraoperative decision-making by senior surgeons and the handing-over of procedure to senior surgeons, etc. were statistically analyzed. Results:The operation time was shortened in Group B [(55±30) min vs. (61±33) min], with significantly decreased percentages of intraoperative decision-making by senior surgeons [7.9% (14/178)vs. 16.9%(44/260), P<0.05] and the handing-over of procedure to senior surgeons [3.4%(6/178) vs. 11.2%(29/260), P<0.05]. Conclusion:Based on the protocoled stepwise training and the consecutive, high-volumed and standardized procedures, the laparoscopic technical proficiency and competency of the trainee surgeons have been improved.

Open versus laparoscopic hepatic resection for hepatocellular carcinoma: a systematic review and meta-analysis.

BACKGROUND: Several studies have been conducted comparing laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC), however, the optimal therapeutic approach has not been established. Therefore, we conducted a systematic review and meta-analysis of studies comparing LLR versus OLR for HCC. METHODS: MEDLINE and Cochrane Central Register of Controlled Trials database were systematically searched for relevant studies. RESULTS: Fifty-one studies were identified including a total of 6812 patients (2786 patients underwent LLR and 4026 patients were subjected to OLR). Blood transfusion rate, hospital stay in days, 30-days mortality rate and morbidity were significantly lower in LLR comparing with OLR (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.30-0.69; P = 0.001; I2 = 55.83%), (MD - 3.87; 95% CI - 4.86 to - 2.89; P = 0.001; I2 = 87.35%), (OR 0.32; 95% CI 0.16-0.66; P = 0.001; I2 = 0%), and (OR 0.42; 95% CI 0.34-0.52; P = 0.001; I2 = 39.64), respectively. There was no significant difference between LLR and OLR regarding the operative time in minutes, resection margin in centimeter and R0 resection (MD 18.29; 95% CI - 1.58 to 38.15; p = 0.07; I2 = 91.73%), (MD 0.04; 95% CI - 0.06 to 0.14; P = 0.41; I2 = 48.03%) and (OR 1.31; 95% CI 0.98-1.76; P = 0.07; I2 = 0%), respectively. The 1-year overall survival (1-OS) and 5-OS rates were significantly higher in LLR comparing with OLR (OR 1.45; 95% CI 1.06-1.99; P = 0.02; I2 = 25.59%) and (OR 1.36; 95% CI 1.07-1.72; P = 0.01; I2 = 14.88%), respectively. CONCLUSION: LLR is superior to OLR regarding intraoperative blood loss, blood transfusion rate, hospital stay in days, 30-days mortality and morbidity, however, randomized controlled trials are needed to identify the superiority of either strategy.

Illuminate hepatobiliary and pancreatic surgery using optical molecular imaging methods / 中华肝胆外科杂志

Since the concept of molecular imaging was put forward in 1999,optical molecular imaging techniques have been widely applied in the field of biomedical and clinical research.Its unique application value is especially shown in hepatobiliary surgery,such as in liver tumor imaging,anatomical liver resection,liver transplant angiography,cholangiography,and bile or pancreatic leakage prevention.Optical molecular imaging technique "lights up" targeted areas in surgical operations and provides convenience in carrying out precision operation.This paper reviewed the advantages of optical molecular imaging technology in clinical research and discussed its limitations in translational surgery,and put forward possible directions in improvement for the future.

Application value of fusion indocyanine green fluorescence imaging in the laparoscopic anatomical liver resection / 中华消化外科杂志

Objective To investigate the application value of fusion indocyanine green fluorescence imaging (FIGFI) in the laparoscopic anatomical liver resection (ALR).Methods The retrospective crosssectional study was conducted.The clinical data of 21 patients who underwent laparoscopic ALR using FIGFI in the Chinese People's Liberation Army General Hospital between December 2015 and February 2017 were collected.Indocyanine green (ICG) staining included positive staining and negative staining.Observation indicators:(1) intraoperative situations:surgical procedures,extent of liver resection,methods and results of ICG staining,operation time,volume of intraoperative blood loss,cases with blood transfusion;(2) postoperative situations:postoperative complications,duration of postoperative hospital stay,postoperative pathological examination;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as average (range).Results (1) Intraoperative situations:of 21 patients,20 underwent successful laparoscopic ALR and 1 had conversion to open surgery.The positive and negative stainings of ICG were respectively applied to 5 and 16 patients.Seventeen patients had successful staining and 4 had failed staining.Average operation time,average volume of intraoperative blood loss and cases with blood transfusion were respectively 268 minutes (range,120-360 minutes),388 mL (range,100-800 mL) and 3.(2) Postoperative situations:5 patients had postoperative complications,including 3 with Clavien-Dindo classification Ⅰ and 2 with Clavien-Dindo classification Ⅱ.Average duration of postoperative hospital stay of 21 patients was 9.3 days (range,6.0-14.0 days).Sixteen patients with malignant tumor had negative surgical margins.(3) Follow-up situations:all the 21 patients were followed up for 1.0-14.0 months,with a median time of 3.3 months.During follow-up,all the patients survived,and 1 patient had tumor recurrence.Conclusion The FIGFI is safe and feasible in the laparoscopic ALR,with a good short-term outcome.