Robot-assisted oncologic pelvic surgery with Hugo™robot-assisted surgery system:A single-center experience

Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,USA).Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported.The primary endpoint of the study was to report the surgical setting of Hugo™RAS system to perform RARP and RARC.The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes.Results Seventeen patients underwent RARP with a transperitoneal approach,and three with an extraperitoneal approach;and one patient underwent RARC with intracorporeal ileal conduit.No intraoperative complications occurred.Median docking and console time were 12(interquartile range[IQR]7-16)min and 185(IQR 177-192)min for transperitoneal RARP,15(IQR 12-17)min and 170(IQR 162-185)min for extraperitoneal RARP.No intraoperative complications occurred.One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment(Clavien-Dindo Grade 2).In case of transperitoneal RARP,two minor complications occurred(one pelvic hematoma and one urinary tract infection;both Clavien-Dindo Grade 2).Conclusion Hugo™RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery.We showed the feasibility of RARP both intra-and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.

Clinical Observation of Disposal Uterine Cavity Observation and Suction Surgery System on Terminating Pregnancy in Very Early Pregnancy

Objective: To compare the clinical effects of uterine cavity observation and suction surgery system with ultrasound guided induced abortion in very early pregnancy induced abortion surgery. Method: Select 80 patients who requested termination of pregnancy due to early pregnancy from August 2022 to April 2023, and analyze the data. 40 patients who underwent ultrasound-guided induced abortion to terminate pregnancy were included in the control group, and 40 patients who underwent uterine cavity observation surgery to terminate pregnancy were included in the observation group. Compare the surgical time, number of times the straw enters the uterine cavity, incidence of complications, and menstrual recovery time between the two groups. Results: There was no statistically significant difference in the surgical time between the observation group and the control group, but the number of times negative pressure straws entered the uterine cavity and the incidence of surgical complications in the observation group were significantly lower than those in the control group (P Conclusion: Applying the uterine cavity observation and suction surgical system to terminate pregnancy in very early pregnancy has the advantages of minimal damage to the uterus and low incidence of surgical complications, greatly protecting the patient’s fertility.

Application of a novel computer-assisted surgery system in percutaneous nephrolithotomy:A controlled study

BACKGROUND Most complex renal stones are managed primarily with percutaneous nephrolithotomy(PCNL).However,PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures.Novel techniques are required to assist in planning and navigation.AIM To apply and evaluate the Hisense computer-assisted surgery(CAS)system in PCNL.METHODS A total of 60 patients with complex renal stones were included.Thirty patients in the CAS group had three-dimensional(3 D)virtual models constructed with the CAS system.The model assisted in planning and navigating in the CAS system.Thirty patients in the control group planned and navigated as standard PCNL,without the application of the CAS system.Success rate of one attempt,operation time,initial stone-free rate,decrease in hemoglobin,and complications were collected and analyzed.RESULTS There were no statistically significant differences in the baseline characteristics or planning characteristics.The success rate of one puncturing attempt(90%vs 67%,P=0.028)and the initial stone-free rate(87%vs 63%,P=0.037)were significantly higher in the CAS group.However,there were no statistically significant differences in the operation time(89.20±29.60 min vs 92.33±33.08 min,P=0.859)or in the decrease in hemoglobin(11.07±8.32 g/L vs 9.03±11.72 g/L,P=0.300)between the CAS group and the control group.No statistically significant differences in the incidence of complications(Clavien-Dindo grade≥2)were found.CONCLUSION Compared with standard PCNL,CAS-assisted PCNL had advantages in terms of the puncturing success rate and stone-free rate.The Hisense CAS System was recommended to assist in preoperative planning and intraoperative navigation for an intuitive,precise and convenient PCNL.

A New Computer Assisted Orthopaedic Surgery System:WATO

Background:The traditional manual orthopaedic technology heavily relies on a surgeon's experience,so it certainly increases the instability of the surgery.Therefore,computer assisted orthopaedic surgery(CAOS) is becoming a hot research topic for its high accuracy and stability.We developed a new CAOS system WATO,which is mainly designed for total knee replacement(TKR).Methods:WATO system provides the interactive software for a surgeon's preoperative planning.Based on its two infrared cameras,infrared markers and infrared probe,WATO system gives a simple surgical positioning procedure of femur and tibia without additional surgery for the placement of fiducial markers.According to the reference alignment axis from positioning procedure,a surgeon can move the robot of WATO system to do accurate bone resection.Safety checking is also considered in WATO system.Results:Extensive experiments were conducted on phantoms and cadaver bones to verify the accuracy and stability of WATO system.Experimental results showed that TKR using WATO system had better performance compared with traditional and navigated TKR.Conclusion:WATO system shows its superiority in TKR,and has a broad application prospect in the future.We will develop its new functions for other orthopaedic surgery such as total hip replacement(THR).Current disadvantages such as bigger skin incision have to be resolved in the future.

Solid pseudopapillary tumor of the pancreas:A systematic review of clinical,surgical and oncological characteristics of 1384 patients underwent pancreatic surgery

Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear pathogenesis.They account for less than 2%of exocrine pancreatic neoplasms.This study aimed to perform a systematic review of the main clinical,surgical and oncological characteristics of pancreatic SPTs.Data sources:MEDLINE/PubMed,Web of Science and Scopus databases were systematically searched for the main clinical,surgical and oncological characteristics of pancreatic SPTs up to April 2021,in accordance with the preferred reporting items for systematic reviews and meta-analyses(PRISMA)standards.Primary endpoints were to analyze treatments and oncological outcomes.Results:A total of 823 studies were recorded,86 studies underwent full-text reviews and 28 met inclusion criteria.Overall,1384 patients underwent pancreatic surgery.Mean age was 30 years and 1181 patients(85.3%)were female.The most common clinical presentation was non-specific abdominal pain(52.6%of cases).Mean overall survival was 98.1%.Mean recurrence rate was 2.8%.Mean follow-up was 4.2 years.Conclusions:Pancreatic SPTs are rare,and predominantly affect young women with unclear pathogenesis.Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.

Impact of frailty on short-term postoperative outcomes in patients undergoing colorectal cancer surgery:A systematic review and meta-analysis

BACKGROUND Colorectal cancer is a major global health challenge that predominantly affects older people.Surgical management,despite advancements,requires careful consideration of preoperative patient status for optimal outcomes.AIM To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.METHODS A literature search was conducted using PubMed,EMBASE and Scopus databases for observational studies in adult patients aged≥18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis.Only studies that conducted frailty assessment using recognized frailty assess-ment tools and had a comparator group,comprising nonfrail patients,were included.Pooled effect sizes were reported as weighted mean difference or relative risk(RR)with 95%confidence intervals(CIs).RESULTS A total of 24 studies were included.Compared with nonfrail patients,frailty was associated with an increased risk of mortality at 30 d(RR:1.99,95%CI:1.47-2.69),at 90 d(RR:4.76,95%CI:1.56-14.6)and at 1 year(RR:5.73,95%CI:2.74-12.0)of follow up.Frail patients had an increased risk of any complications(RR:1.81,95%CI:1.57-2.10)as well as major complications(Clavien-Dindo classification grade≥III)(RR:2.87,95%CI:1.65-4.99)compared with the control group.The risk of reoperation(RR:1.18,95%CI:1.07-1.31),readmission(RR:1.70,95%CI:1.36-2.12),need for blood transfusion(RR:1.67,95%CI:1.52-1.85),wound complications(RR:1.49,95%CI:1.11-1.99),delirium(RR:4.60,95%CI:2.31-9.16),risk of prolonged hospitalization(RR:2.09,95%CI:1.22-3.60)and discharge to a skilled nursing facility or rehabilitation center(RR:3.19,95%CI:2.0-5.08)was all higher in frail patients.CONCLUSION Frailty in colorectal cancer surgery patients was associated with more complications,longer hospital stays,higher reoperation risk,and increased mortality.Integrating frailty assessment appears crucial for tailored surgical management.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

First experience in laparoscopic surgery in low and middle income countries: A systematic review

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Bariatric surgery reduces colorectal cancer incidence in obese individuals:Systematic review and meta-analysis

BACKGROUND Colorectal cancer ranks third in global cancer prevalence and stands as the second leading cause of cancer-related mortalities.With obesity recognized as a pivotal risk factor for colorectal cancer,the potential protective role of bariatric surgery,especially laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy,has garnered attention.AIM To investigate the Roux-en-Y gastric bypass(RYGB)vs sleeve gastrectomy(SG)effect on colorectal cancer incidence in obese individuals.METHODS A systematic review and meta-analysis of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Seventeen studies with a total of 12497322 patients were included.The primary outcome was the relative risk(RR)of developing colorectal cancer in obese patients who underwent weight loss surgery compared to those who did not.Secondary outcomes included determining the RR for colon and rectal cancer separately and subgroup analyses by gender and type of weight loss surgery.RESULTS The meta-analysis revealed a 54%reduction in colorectal cancer risk in morbidly obese patients who underwent bariatric surgery compared to those who did not.A significant 46%reduction in colorectal cancer risk was observed among female patients.However,no significant differences were found in the meta-analysis for various types of bariatric surgery,such as SG and RYGB.CONCLUSION This meta-analysis reveals weight loss surgery,regardless of type,reduces colorectal cancer risk,especially in women,as indicated by RR and hazard ratio assessments.Further validation is essential.

Recent evidence for subcutaneous drains to prevent surgical site infections after abdominal surgery:A systematic review and metaanalysis

BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.

Comparison between upfront surgery and neoadjuvant chemotherapy in patients with locally advanced gastric cancer:A systematic review

BACKGROUND Gastric cancer(GC)is a major health concern worldwide.Surgical resection and chemotherapy is the mainstay treatment for gastric carcinoma,however,the optimal approach remains unclear and should be different in each individual.Chemotherapy can be administered both pre-and postoperatively,but a multidisciplinary approach is preferred when possible.This is particularly relevant for locally advanced GC(LAGC),as neoadjuvant chemotherapy(NAT)could potentially lead to tumor downsizing thus allowing for a complete resection with curative intent.Even though the recent progress has been impressive,European and International guidelines are still controversial,thus attenuating the need for a more standardized approach in the management of locally advanced cancer.AIM To investigate the effects of NAT on the overall survival(OS),the disease-free survival(DFS),the morbidity and the mortality of patients with LAGC in comparison to upfront surgery(US).METHODS For this systematic review,a literature search was conducted between November and February 2023 in PubMed,Cochrane Library and clinicaltrials.gov for studies including patients with LAGC.Two independent reviewers conducted the research and extracted the data according to predetermined inclusion and exclusion criteria.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to form the search strategy and the study protocol has been registered in the International Prospective Register of Systematic Reviews.RESULTS Eighteen studies with 4839 patients with LAGC in total were included in our systematic review.Patients were separated into two groups;one receiving NAT before the gastrectomy(NAT group)and the other undergoing upfront surgery(US group).The OS ranged from 41.6%to 74.2%in the NAT group and from 30.9%to 74%in the US group.The DFS was also longer in the NAT group and reached up to 80%in certain patients.The complications related to the chemotherapy or the surgery ranged from 6.4%to 38.1%in the NAT group and from 5%to 40.5%in the US group.Even though in most of the studies the morbidity was lower in the NAT group,a general conclusion could not be drawn as it seems to depend on multiple factors.Finally,regarding the mortality,the reported rate was higher and up to 5.3%in the US group.CONCLUSION NAT could be beneficial for patients with LAGC as it leads to better OS and DFS than the US approach with the same or even lower complication rates.However,patients with different clinicopathological features respond differently to chemotherapy,therefore currently the treatment plan should be individualized in order to achieve optimal results.

Effects of an Omaha System-based follow-up regimen on self-care and quality of life in gastrointestinal surgery patients

BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.

New classification system for radical rectal cancer surgery based on membrane anatomy

BACKGROUND Total mesorectal excision along the“holy plane”is the only radical surgery for rectal cancer,regardless of tumor size,localization or even tumor stage.However,according to the concept of membrane anatomy,multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection.AIM To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery.METHODS A three-dimensional template of the member anatomy of the pelvis was established,and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation.Then,we suggested a new and simple classification system for rectal cancer surgery.For simplification,the classification was based only on the lateral extent of resection.RESULTS The fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces(medial,middle and lateral),and blood vessels and nerves are precisely positioned in the fascia or space.Three types of radical surgery for rectal cancer are described,as are a few subtypes that consider nerve preservation.The surgical planes of the proposed radical surgeries(types A,B and C)correspond exactly to the medial,middle,and lateral spaces,respectively.CONCLUSION Three types of radical surgery can be precisely defined based on membrane anatomy,including nerve-sparing procedures.Our classification system may offer an optimal tool for tailoring rectal cancer surgery.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates

Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.

Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Optimization of tracheoesophageal fistula model established with Tshaped magnet system based on magnetic compression technique

BACKGROUND The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula(TEF),but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control.We designed a Tshaped magnet system to overcome these problems and verified its effectiveness via animal experiments.AIM To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs.METHODS Twelve beagles were randomly assigned to groups in which magnets of the Tshaped scheme(study group,n=6)or normal magnets(control group,n=6)were implanted into the trachea and esophagus separately under gastroscopy.Operation time,operation success rate,and accidental injury were recorded.After operation,the presence and timing of cough and the time of magnet shedding were observed.Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing,and gross specimens of TEFs were obtained.Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery,and gross specimens were obtained.Fistula size was measured in all animals,and then harvested fistula specimens were examined by hematoxylin and eosin(HE)and Masson trichrome staining.RESULTS The operation success rate was 100%for both groups.Operation time did not differ between the study group(5.25 min±1.29 min)and the control group(4.75 min±1.70 min;P=0.331).No bleeding,perforation,or unplanned magnet attraction occurred in any animal during the operation.In the early postoperative period,all dogs ate freely and were generally in good condition.Dogs in the control group had severe cough after drinking water at 6-9 d after surgery.X-ray indicated that the magnets had entered the stomach,and gastroscopy showed TEF formation.Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm±1.29 mm(range,3.52-6.56 mm).HE and Masson trichrome staining showed scar tissue formation and hierarchical structural disorder at the fistulas.Dogs in the study group did not exhibit obvious coughing after surgery.X-ray examination 2 wk after surgery indicated fixed magnet positioning,and gastroscopy showed no change in magnet positioning.The magnets were removed using a snare under endoscopy,and TEF was observed.Gross specimens showed well-formed fistulas with a diameter of 6.11 mm±0.16 mm(range,5.92-6.36 mm),which exceeded that in the control group(P<0.001).Scar formation was observed on the internal surface of fistulas by HE and Masson trichrome staining,and the structure was more regular than that in the control group.CONCLUSION Use of the modified T-shaped magnet scheme is safe and feasible for establishing TEF and can achieve a more stable and uniform fistula size compared with ordinary magnets.Most importantly,this model offers better controllability,which improves the flexibility of follow-up studies.

Systematic bibliometric analysis of research hotspots and trends on the application of premium IOLs in the past 2 decades

AIM:To analysis of research hotspots and trends on the application of premium intraocular lens(PIOLs)in the past 2 decades.METHODS:The literature search was performed on the Web of Science and included PIOLs studies published between January 2000 and December 2022.The retrieved literature was collated and analyzed by R-tool’s Bibliometrix package,CitNetExplorer,CiteSpace and other software.RESULTS:A total of 1801 articles about PIOLs were obtained,most of which were published in Spain and the United States.The organization that published the most articles was the University of Valencia in Spain.Alió JL,and Montés-Micó R,from Spain were the most influential authors in this field.The Journal of Cataract and Refractive Surgery and Journal of Refractive Surgery were the core journals for this field;the top 10 cited articles mainly focus on postoperative satisfaction with multifocal intraocular lens(IOLs)and postoperative results of toric IOLs.Through the keyword analysis,we found that trifocal IOLs,astigmatism and extended depth of focus(EDoF)IOLs are the most discussed topics at present,and the importance of astigmatism and the clinical application of the new generation of PIOLs are the emerging research trends.CONCLUSION:Bibliometric analysis can effectively help to identify multilevel concerns in PIOLs research and the prevailing research trends in the realm of PIOLs encompass the adoption of EDoF IOLs,trifocal IOLs,and their respective Toric models.