Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical v...Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations.Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.展开更多
By using function one direction S-rough sets （function one direction singular rough sets）, the concept of one direction rough law is proposed, where one direction rough law is the law pair { w（x）-, w（x） - } comp...By using function one direction S-rough sets （function one direction singular rough sets）, the concept of one direction rough law is proposed, where one direction rough law is the law pair { w（x）-, w（x） - } composed by w（x）- and w（x）-, ffthe attribute set {a_ , a-} of function one direction S-rough sets changes, then one direction rough law { w（x）_, w（x）- } will change, too. By employing ellipse curves, the concept of one direction rough law security is presented, the security theorem of one direction rough law is proposed and the applications are given. One direction rough law security, which is generated by the intersection and penetration between function one direction S-rough sets and ellipse curves, is a new applied research direction of function S-rough sets.展开更多
文摘Laparoscopic cholecystectomy(LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety(CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations.Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC:(1) consideration that a high level of experience alone is not enough;(2) recognition of the plateau involving the common hepatic duct and hepatic hilum;(3) blunt dissection until CVS exposure;(4) Calot's triangle clearance in the overhead view;(5) Calot's triangle clearance in the view from underneath;(6) dissection of the posterior right side of Calot's triangle;(7) removal of the gallbladder body; and(8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.
基金Natural Science Foundation of Fujian Province of China( No.2009J01293)Open Project of Brain-like Key Laboratory Research of Fujian Province of China (No. BLISSOS20101015)
文摘By using function one direction S-rough sets （function one direction singular rough sets）, the concept of one direction rough law is proposed, where one direction rough law is the law pair { w（x）-, w（x） - } composed by w（x）- and w（x）-, ffthe attribute set {a_ , a-} of function one direction S-rough sets changes, then one direction rough law { w（x）_, w（x）- } will change, too. By employing ellipse curves, the concept of one direction rough law security is presented, the security theorem of one direction rough law is proposed and the applications are given. One direction rough law security, which is generated by the intersection and penetration between function one direction S-rough sets and ellipse curves, is a new applied research direction of function S-rough sets.
