Efficacy and prognostic analysis of carbon nanotracers combined with the da Vinci robot in the treatment of esophageal cancer

BACKGROUND Traditional methods cannot clearly visualize esophageal cancer(EC)tumor contours and metastases,which limits the clinical application of da Vinci robotassisted surgery.AIM To investigate the efficacy of the da Vinci robot in combination with nanocarbon lymph node tracers in radical surgery of EC.METHODS In total,104 patients with early-stage EC who were admitted to Liuzhou worker's Hospital from January 2020 to June 2023 were enrolled.The patients were assigned to an observation group(n=52),which underwent da Vinci robot-assisted minimally invasive esophagectomy(RAMIE)with the intraoperative use of nanocarbon tracers,and a control group(n=52),which underwent traditional surgery treatment.The operation time,intraoperative blood loss,postoperative drainage tube indwelling time,hospital stay,number of lymph nodes dissected,incidence of complications,and long-term curative effects were comparatively analyzed.The postoperative stress response C-reactive protein(CRP),cortisol,epinephrine(E)and inflammatory response interleukin(IL)-6,IL-8,IL-10,and tumor necrosis factor-alpha(TNF-α)were evaluated.RESULTS Compared with the control group,the observation group had significantly lower postoperative CRP,cortisol,and E levels(P<0.05)with a milder inflammatory response,as indicated by lower IL-6,IL-10,and TNF-αlevels(P<0.05).Patients who underwent RAMIE had less intraoperative blood loss and shorter operation times and hospital stays than those who underwent traditional surgery.The average number of dissected lymph nodes,time of lymph node dissection,and mean smallest lymph node diameter were all significantly lower in the observation group(P<0.05).The rate of postoperative complications was 5.77%in the observation group,significantly lower than the 15.38%observed in the control group.Furthermore,the lymphatic metastasis rate,reoperation rate,and 12-and 24-month cumulative mortality in the observation group were 1.92%,0%,0%,and 0%,respectively,all of which were significantly lower than those in the control group(P<0.05).CONCLUSION The treatment of EC using the da Vinci robot combined with nanocarbon lymph node tracers can achieve good surgical outcomes and demonstrates promising clinical applications.

Comparison of da Vinci 5 with previous versions of da Vinci and Sina:A review

Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review article,we discuss four models of robotic systems to determine their advantages:the Sina flex system from Iran and the da Vinci Xi,SP,and 5 systems from the USA.We compared aspects such as architecture,instruments,visualizations,clinical use,and costs.Our findings suggest that the da Vinci robot,which was introduced earlier than the Sina system,utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities,including three-dimensional optical,tomographic,and fluorescence imaging.It is well established and widely utilized in various surgical procedures.Conversely,the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard,with optional three-dimensional and fluorescence imaging upgrades available.Despite its affordability,the Sina flex system is relatively new and has not yet been clinically tested.Additionally,the Sina flex system is more user-friendly.

Da Vinci机器人手术系统在子宫内膜癌淋巴结切除术中的应用价值

目的:探讨Da Vinci机器人手术系统在子宫内膜癌淋巴结切除术中的安全性、可行性及术中清扫淋巴结情况。方法:回顾分析2018年1月至2022年3月济宁医学院附属医院妇科收治的83例子宫内膜癌患者的临床资料,分为RAS组(41例)和CLS组(42例)。比较两组患者的一般情况、手术时间、术中出血量、有无术中损伤、术后排气时间、应用抗生素时间、盆腔引流管留置时间、留置导尿时间、术后是否应用止痛药物、术后是否腹胀、术中清扫淋巴结数及阳性数、LNR等。结果:两组患者的手术时间、术中清扫淋巴结数、术中清扫淋巴结阳性数、LNR、手术方式、肿瘤肌层浸润及脉管浸润情况比较,差异均有统计学意义(P<0.05)。多元回归分析结果显示,两组患者的术中清扫淋巴结阳性数、LNR比较,差异均有统计学意义(P<0.05)。结论:相较于传统腹腔镜手术,Da Vinci机器人手术系统术中清扫淋巴结数、淋巴结转移数较多。

Successful treatment of esophageal metastasis from hepatocellular carcinoma using the da Vinci robotic surgical system

A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma(HCC) presented with progressive dysphagia.He had undergone liver transplantation for HCC three and a half years prevously.At presentation,his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus,causing a luminal stricture.We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system.Recovery was uneventful and he was been doing well 2 mo after surgery.α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively.During the follow-up period,he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.

Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis:A case report and review of literature

BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.

Anesthetic Implications of Robotically Assisted Surgery with the Da Vinci Xi Surgical Robot

Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduction of the da Vinci Xi robot related to positioning operating room equipment, patient access and chance for unintended patient contact are described.

Robotic rectal cancer surgery:Results from a European multicentre case series of 240 resections and comparative analysis between cases performed with the da Vinci Si and Xi systems

Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous systems(da Vinci S&Si)have arguably slowed down its wholesale adoption.The latest robotic platform,the da Vinci Xi,addresses these limitations.This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems.Materials and methods:All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases.The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed.Results:A total of 240 patients were identified(124 Si,116 Xi).Median operation-time and length-of-stay were 260 minutes and 6 days respectively.Conversion and 30-day mortality rates were 0.The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group(230 vs 300 min,p=0.000)but length-of-stay,lymph node yield and circumferential resection margin favoured the Xi group(7 vs 5 days,p=0.010;17 vs 21,p=0.000;92.7%vs 99.1%,p=0.020).Conclusion:Single-docking fully-robotic rectal cancer surgery is safe,feasible and can lead to good shortterm outcomes,making it a good alternative to laparoscopic rectal cancer surgery.The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.

Managerial perspectives of scaling up robotic-assisted surgery in healthcare systems:A systematic literature review

Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.

Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi:A case report

BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

第三代da Vinci Si手术机器人系统在妇科单孔腹腔镜手术中的初步应用

目的探讨da Vinci Si手术机器人系统在妇科单孔腹腔镜手术中的初步应用效果。方法选择2018年5月27日至6月20日在海军军医大学(第二军医大学)长征医院妇产科住院、拟行妇科手术的患者5例,应用第三代da Vinci Si手术机器人系统和LagiportTM多通道单孔腹腔镜手术穿刺器实施单孔机器人腹腔镜手术。其中宫颈高级别上皮内瘤变(宫颈锥切术后提示微浸润不除外)患者1例,行全子宫切除术+前哨淋巴结切除术;宫颈浸润癌Ⅰa1期患者1例,行全子宫切除术+双附件切除术+前哨淋巴结切除术;子宫内膜癌Ⅰa1期患者1例,行全子宫切除术+双附件切除术+前哨淋巴结切除术;子宫内膜异位症Ⅳ期患者1例,行广泛肠粘连松解术+单侧附件切除术;宫颈浸润癌Ⅱa1期患者1例,行广泛子宫切除术+双附件切除术+盆腔淋巴结清扫术。结果5例患者手术均顺利完成,未增加辅助孔操作。5例患者的手术时间分别为174、110、90、125、300 min,术中出血量分别约为110、80、100、210、150 mL。5例患者均未出现围手术期并发症。结论利用第三代da Vinci Si机器人手术系统进行妇科单孔腹腔镜手术具备一定的可行性。

喉返神经监测仪在da Vinci机器人甲状腺癌手术中的应用

目的探讨喉返神经监测技术在da Vinci机器人甲状腺癌手术中的安全性及有效性。方法采用前瞻性研究方法,对济南军区总医院甲状腺乳腺外科2016年11月~2017年12月行da Vinci机器人甲状腺癌手术的患者随机分配,神经监测组80例患者(观察组),87例患者未使用神经监测仪(对照组)。对两组患者的喉返神经(recurrent laryngeal nerve,RLN)显露时间、手术时间、喉返神经损伤率(永久性/暂时性)、术中出血量、术后总引流量、住院费用以及术后6个月随访噪音障碍指数(voice handicap index,VHI)进行对比分析。结果两组患者RLN损伤率(永久性/暂时性)、术中出血量、术后总引流量以及术后6个月随访VHI等差异均无统计学意义(P均>0.05)。两组患者住院费用、RLN显露时间及手术时间差异均有统计学意义(P均<0.05)。结论用探测夹直接连接3臂金属杆监测RLN功能,对术中快速寻找和保护RLN有重要价值,节省手术时间。

da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症

目的探讨daVinci机器人辅助先天性巨结肠Soave拖出术的可行性。方法2015年5～8月行daVinci机器人辅助巨结肠Soave拖出术3例。采用四孔技术，调整患儿体位和trocar位置后，完成daVinci机器人与患儿的对接。肠壁浆肌层活检明确病变范围，单级电凝或超声刀游离直肠、乙状结肠系膜。解除机器人与患儿的对接，转至会阴部操作。电凝分离直肠黏膜达腹膜返折水平，采用改进的Soave技术进行吻合。结果移行区1例位于直肠，1例位于直肠乙状结肠交界处，1例位于乙状结肠上段。手术时间分别为160、170、200min，无术中并发症。住院时间分别为7、7、14d。3例分别随访35、65、88d，1例患儿因吻合口轻度狭窄需每日扩肛，持续1个月后好转，无小肠结肠炎表现。结论daVinci机器人手术系统可安全地应用于婴幼儿巨结肠Soave拖出手术，更清晰地显示系膜血管和盆腔细微的组织结构，操作灵巧，有效避免副损伤。

da Vinci外科手术系统在胰腺肿瘤外科应用的优势及现状

由于胰腺的解剖复杂,比邻重要的大血管,腹腔镜胰腺手术发展缓慢。da Vinci外科手术系统（da Vinci surgical system,DVSS）的3D视野,使术者视野恢复到开放手术,放大10~15倍使术者进入显微手术,7个自由度的Endo-wrist使术者分离、解剖、缝合、吻合极为精准,因而在以复杂著称的胰腺手术中迅速开展。国内外的临床研究显示：DVSS可安全地应用于所有胰腺手术,技术上可行,临床效果与腹腔镜和开腹手术相似。本文对DVSS在胰腺肿瘤外科应用的优势及其现状进行文献总结,相信机器人辅助胰腺手术治疗胰腺肿瘤会有广阔的发展前景。

da Vinci Si机器人治疗男性乳房发育症的临床研究

目的：探讨da Vinci Si外科手术系统治疗男性乳房发育症的安全性及可行性。方法：2014年1月至2015年12月行da Vinci Si机器人手术治疗男性乳房发育症患者4例。取距离双乳乳腺腺体边缘2 cm的4点、6点、8点位做长约5 mm、8 mm、5 mm切口,双乳6点位切口作为da Vinci Si手术系统镜头入路,4点、右8点位接da Vinci Si手术系统1、2臂,1臂接超声刀,2臂接抓钳。术中止血及腺体切除均采用超声刀,标本于摄像臂切口取出,术毕于术区留置负压引流管并关闭手术切口。结果：4例均成功完成机器人男性乳房发育症皮下腺体切除术,无中转开放或腔镜手术及手术并发症发生,术中出血量20~30 ml,手术时间120~148 min,建立皮下隧道用时10~15 min（单侧）。结论：应用da Vinci Si外科手术系统行男性乳房发育症皮下腺体切除术安全、可行,手术美容效果较好。

daVinciS手术机器人胸腺瘤切除3例

目的:总结da Vinci S手术机器人胸腺瘤切除术的临床经验。方法:自2009年5月～2009年10月解放军第二炮兵总医院用da Vinci S手术机器人切除胸腺瘤3例,根据胸腺瘤体偏向一侧作为手术入路一侧。患者仰卧位,将术侧胸部及肩部垫高30度。双腔气管插管,手术对侧肺单肺通气,从患者头侧偏向非术侧约30度将床旁机械臂车推至手术台旁合适位置,选定术侧胸壁腋前线至腋中线间第6肋间作为内窥镜成像系统入口,戳孔放入戳卡,并于其左右侧各一拳的距离(约在锁骨中线外第3肋间和第5肋间或第6肋间)插入左右机械手臂。于内窥镜戳孔与左操作孔之间向后加一个辅助孔。切除瘤体和全部胸腺,并清除其周围脂肪组织,胸腺周围小血管均用电凝止血,胸腺静脉用钛夹夹闭,标本用取物袋取出。结果:所有3例患者均手术成功,无手术死亡及主要并发症。无中转开胸,未加小切口。均完整切除瘤体和胸腺,并清除胸腺周围脂肪组织。手术时间80～240min(平均136.7min)。术后16～49h(平均28.7h)时拔除气管插管,术中估计出血量30～100mL(平均63.3mL),术后24h胸管引流量为100～250mL(平均160mL),围术期均未输血。1例左侧进胸者一过性膈神经麻痹,出院时复查恢复正常。术后病理按WHO分型,2例为B1型胸腺瘤,1例为B2型。结论:本研究报告的用da Vinci S手术机器人进行胸腺瘤切除术及周围脂肪组织清除是可行的,早期效果满意。

基于DaVinci技术的嵌入式Web视频监控系统的设计

提出一种基于Da Vinci技术的嵌入式Web视频监控系统设计方案,该方案利用TI高速双核信号处理器TMS320DM6467和嵌入式Linux操作系统为平台,完成视频信号的H.264编码、传输和存储,并在此基础上搭建嵌入式Web服务器,用户在浏览器中登录Web服务器后可以进行实时监控;还提出一种基于率失真优化方法的改进型码率控制算法,使用该算法可明显提高视频流的编码速率及改善编码质量.实验结果表明:使用该算法所得平均码率误差比JVT-G012算法低1.2%,而信噪比PSNR提高了1.16 d B.本系统具有很强的实时性、交互性、视频质量高等优点,可广泛应用于远程视频监控.

再论翻译中的模糊特性——从The Da Vinci Code的翻译选例

本文探讨模糊法则的翻译应用价值,旨在为模糊语言的分析提供一个可以参考的模板。文章首先从模糊语言学(包括模糊语义学和模糊语用学)、模糊美学、模糊逻辑学、模糊数学、模糊修辞学五个维度,对"模糊"概念的界定进行回顾和分析,并提出翻译学中最宜采取的解释。然后,文章以The Da Vinci Code为个案,从语言时空、文化时空、修辞时空层面切入,探索文本中模糊语言所表现出的形式特点以及翻译处理所采取的对策。

视差梯度对da Vinci立体视的影响

NAKAYAMA和SHIMOJO提出了一种新形式的基于遮挡几何学恢复深度的da Vinci立体视.尽管对该研究中采用的立体图中的单眼性条棒的深度来源提出质疑,COOK和GILLAM通过构建一种新颖的侵入构型,发现所有观察者都不能观察到双眼性融合所预期的3-D弯曲表面,从而肯定了某种da Vinci立体视的存在.通过将原始侵入构型在垂直方向上进行拉伸,以减小构型的视差梯度,发现所有观察者都能够观察到容易识别的3-D表面,从而证明侵入构型的深度还是基于融合性立体视.

从The Da Vinci Code两译本看翻译规范与译者思维的互动

本文以The Da Vinci Code大陆和台湾的两个中译本的描述研究为例,来验证译者的翻译策略是否遵循或违背规范。从描述研究中得出结论,翻译过程是一个极为动态多变的过程。对翻译规范与译者思维互动的研究,正是为了更动态的还原多变的翻译过程,从而对翻译实践提供借鉴与帮助。

Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer: Report of the first case in Hong Kong and China with an updated literature review

Telerobotic surgery is the most advanced development in the field of minimally invasive surgery. The da Vinci surgical system, which is currently the most widely used telerobotic device, was approved by the Food and Drug Administration of the United States of America for clinical use in all abdominal operations in July 2000. The first da Vinci surgical system in China was installed in November 2005 at our institution. We herein report the first telerobotic-assisted laparoscopic abdominoperineal resection using the 3-arm da Vinci surgical system for low rectal cancer in Hong Kong and China, which was performed in August 2006. The operative time and blood loss were 240 min and 200 mL, respectively. There was no complication, and the patient was discharged on postoperative day five. An updated review of published literature on telerobotic-assisted colorectal surgery is included in this report, with special emphasis on its advantages and limitations.