Robotic single-incision left hemihepatectomy for intrahepatic bile duct stones by Da Vinci single-site surgical system: A case report with video

Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.

Repeated laparoscopic liver resection using ICG fluorescent imaging for recurrent liver cancer

Objective:Liver cancer is very common in China,with cumulative five-year tumor recurrence rate after a microscopically margin-negative resection of hepatocellular carcinoma up to 70%.Postoperative recurrent hepatocellular carcinoma presents a challenge for surgeons because of the complexity of postoperative adhesion and the difficulty in of recognizing recurrent lesions.This study aims to introduce a method using an indocyanine green(ICG)fluorescent imaging technique to do repeated laparoscopic liver resection.Method:Patients received repeated laparoscopic liver resection using ICG fluorescent imaging between January 2017 and December 2019 in the Department of General Surgery of Sir Run Run Shaw Hospital were analyzed retrospectively.Basic information,intraoperative information,complications,and followup time were collected and analyzed.Results:Totally,35 patients with a median age of 59 years(ranged 38-82 years)were included.All of the patients received minimally invasive surgery.One case was performed robotically,and only two cases were converted to open surgery due to severe adhesion.The median operating time was 174 minutes,and the median blood loss during surgery was 100 mL.The median hospital stay after surgery was 5 days,with a range of 3e55 days.In total,32(91.4%)patients showed staining by ICG fluorescent imaging,and lesions were visible on fluorescent camera.The median follow-up time was 19.7 months,with a range of 1e40.2 months.The median relapse-free survival time was 18.5 months.Conclusion:Repeated laparoscopic liver resection using ICG fluorescent imaging is a safe and promising approach in the treatment of recurrent liver tumors in selected patients.

UBQLN1 mediates sorafenib resistance through regulating mitochondrial biogenesis and ROS homeostasis by targeting PGCip in hepatocellular carcinoma

The treatment for hepatocellular carcinoma(HCC)is promising in recent years,but still facing critical challenges.The first targeted therapy,sorafenib,prolonged the overall survival by months.However,resistance often occurs,largely limits its efficacy.Sorafenib was found to target the electron transport chain complexes,which results in the generation of reactive oxygen species(ROS).To maintain sorafenib resistance and further facilitate tumor progression,cancer cells develop strategies to overcome excessive ROS production and obtain resistance to oxidative stress-induced cell death.In the present study,we investigated the roles of ROS in sorafenib resistance,and found suppressed ROS levels and reductive redox states in sorafenib-resistant HCC cells.Mitochondria in sorafenib-resistant cells maintained greater functional and morphological integrity under the treatment of sorafenib.However,cellular oxygen consumption rate and mitochondria DNA content analyses revealed fewer numbers of mitochondria in sorafenib-resistant cells.Further investigation attributed this finding to decreased mitochondrial biogenesis,likely caused by the accelerated degradation of peroxisome proliferator-activated receptor y coactivator ip(PGC1P).Mechanistic dissection showed that upregulated UBQLN1 induced PGCip degradation in a ubiquitination-independent manner to attenuate mitochondrial biogenesis and ROS production in sorafenib-resistant cells under sorafenib treatment.Furthermore,clinical investigations further indicated that the patients with higher UBQLN1 levels experienced worse recurrence-free survival.In conclusion,we propose a novel mechanism involving mitochondrial biogenesis and ROS homeostasis in sorafenib resistance,which may offer new therapeutic targets and strategies for HCC patients.