Minimally Invasive Surgery Professional Committee of the Chinese Research Hospital Association The, Intelligent Medicine Professional Committee of the Chinese Research Hospital Association The
To standardize and promote the clinical application of pancreatic duct(repair) surgery for benign and borderline/low-grade malignant pancreatic tumors, thereby improving surgical outcomes and reducing complications, this expert consensus was formulated.
Methods
Organized by the Minimally Invasive Surgery Committee and Intelligent Medicine Committee of the Chinese Research Hospital Association, domestic pancreatic surgery experts discussed key topics including pancreatic duct anatomy, repair concepts, surgical indications, preoperative evaluation, intraoperative techniques, and postoperative management, integrating literature evidence and clinical experience.
Results
The consensus delineates core techniques of pancreatic duct repair surgery, such as main pancreatic duct repair, end-toend pancreatic anastomosis, main pancreatic duct replacement, and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) local resection. It emphasizes preoperative multimodal imaging evaluation,intraoperative ultrasound guidance, and minimally invasive approaches. Recommendations include selecting repair strategies based on duct injury severity, standardized use of pancreatic stents, and postoperative pancreatic fistula prevention protocols.
Conclusion
Pancreatic duct (repair) surgery restores duct continuity, avoids traditional gastrointestinal reconstruction, and significantly reduces postoperative complications. It represents a major advancement in organ-preserving pancreatic surgery. Further studies are needed to validate long-term efficacy and refine technical details.
Minimally Invasive Surgery Professional Committee of the Chinese Research Hospital Association The, Intelligent Medicine Professional Committee of the Chinese Research Hospital Association The
To standardize robotic radical resection for perihilar cholangiocarcinoma and improve perioperative safety and long-term survival of patients, this expert consensus is formulated.
Methods
The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. This expert consensus was drafted based on literature and practice,followed by several rounds of voting, feedback, discussion and revision.
Results
Eleven recommendations were put forward covering six aspects of this operation including preoperative evaluation and surgical planning, indications and contraindications, perioperative safety and efficacy, feasibility of cases requiring vascular reconstruction, survival and recurrence, as well as learning curve.
Conclusion
After thorough evaluation and comprehensive planning, it is safe and eligible for surgical centers with adequate experience in robotic hepatobiliary and pancreatic surgery to carry out this operation. The advantages of robotic approach over other approaches in terms of complications, prognosis and learning curve, still need to be supported and clarified by evidence with higher quality obtained via more application and practice.
Minimally Invasive Surgery Professional Committee of the Chinese Research Hospital Association The, Intelligent Medicine Professional Committee of the Chinese Research Hospital Association The
To standardize robotic radical resection for gallbladder cancer thereby reducing postoperative complications and improving patient prognosis, this expert consensus is formulated.
Methods
The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. Based on literature and practice, this expert consensus was drafted,followed by several rounds of voting, feedback, discussion and revision.
Results
Fourteen recommendations were put forward in five aspects of this operation including preoperative evaluation and surgical planning,indications and contraindications, perioperative safety and efficacy, survival and recurrence as well as learning curve.
Conclusion
It is safe and effective for surgical centers with adequate experience in minimally invasive surgery to carry out robotic radical resection for gallbladder cancer following thorough evaluating and surgical planning. The advantages of robotic approach over other surgical approaches in terms of efficacy, prognosis and learning curve, still need to be confirmed and revealed by studies with higher quality.
Hysteroscopy is considered the gold standard for the diagnosis and therapy of various genital tract lesions, especially intrauterine diseases. With the innovation of no energy hysteroscopic techniques and products, no energy hysteroscopic surgery has been widely applied in vaginal, cervical and uterine cavity lesions in recent years. To address the evolving needs of clinical diagnosis, treatment, and development, the expert group has formulated recommendations based on extension literature review and clinical experience, as well as considering the current status of no energy hysteroscopic technology in China.These recommendations include the entry criteria for hysteroscopic no energy hysteroscopic surgery,indications and contraindications, preoperative preparation, key points of operation, intraoperative monitoring, postoperative management, and complications management. It also provides the classification of no energy hysteroscopic surgery and their applications in genital tract lesions. It is anticipated that these recommendations will assist the application of no energy hysteroscopic technology in clinical practice.
To compare the therapeutic effect of robot-assisted and traditional open surgery in caudate lobectomy.
Methods
A total of 77 patients with hepatocellular carcinoma in the caudate lobe who underwent robotic or open resection in the First Medical Center of Chinese PLA General Hospital from May 2010 to May 2024 were retrospectively enrolled, 61 males and 16 females. There were 50 patients in the open group and 27 patients in the robotic group, with an average age of 58.03±9.64 years.Demographic data, perioperative outcomes and differences in survival outcomes were collected. Propensity scoring match (PSM) was used to balance the baseline data. After PSM, 28 patients were included in the laparotomy group and 18 patients were included in the robot group. The differences in perioperative and prognostic indicators between the two groups were compared after matching.
Results
There were no significant differences in baseline data between the two groups. After PSM, the median (inter quartile range,IQR) operation time and blood loss were 117.50 (107.00, 185.00) min and 50.00 (20.00, 100.00) ml in the robot group, respectively. The postoperative hospital stay was 5.00 (4.00, 6.00) days. There was no conversion to open surgery and no serious postoperative complications. In the open surgery group, the median operation time was 180.50(160.75, 240.00) min, the blood loss was 300.00 (100.00, 425.00) ml, the postoperative hospital stay was 8.50 (7.00, 11.00) d, and 2 patients (7.14%) had severe ascites. Then abdominal puncture and drainage were performed under ultrasound guidance. However, the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798), the overall survival (OS) was (55 months vs.60 months, P=0.974), and the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798) in the two groups. The difference was not statistically significant. Multivariate Cox analysis showed that AFP>400 μg/L (P=0.008), tumor diameter >5 cm (P=0.020), multiple tumors (P=0.010), and poor tumor differentiation (P=0.009) were independent risk factors for RFS. microvascular invasion (MVI)and poor tumor differentiation were independent influencing factors for OS (P<0.05).
Conclusion
Robot-assisted caudate lobectomy is superior to open surgery in terms of operation time, blood loss and postoperative hospital stay. There was no significant difference in RFS and OS between the two surgical methods. Robotic hepatic caudate lobectomy is a safe, effective and minimally invasive procedure.
To compare the perioperative efficacy of da Vinci robot and laparoscopic partial hepatectomy in the treatment of hepatic tumors.
Method
Retrospective analysis was conducted on a cohort of 184 patients with hepatic tumors who underwent partial hepatectomy at the Department of Hepatobiliary Pacreatic Surgery and the Second Department of Hepatobiliary Surgery, Guangzhou First People's Hospital, between Jan. 2021 and Jun. 2023. This cohort comprised two groups: the robot group (n=52) consisting of patients who underwent robotic-assisted partial hepatectomy, and the laparoscope group(n=132) comprising patients who underwent laparoscopic partial hepatectomy. The perioperative status of the robot group was assessed, and a comparison of surgical-related indicators and postoperative complications between the two groups was conducted using propensity score matching.
Results
The average operative time for the robotic surgery group at our center was 177 (145-243.8) minutes. After completing 20 cases,surgeons can begin to navigate the learning curve, with operation time progressively stabilizing. Upon accumulating 42 cases, they can gradually transition into the proficiency phase. After propensity score matching, there were no statistically significant differences in baseline variables such as age, gender, and tumor location between the robotic surgery group and the laparoscopic surgery group (P>0.05). Compared to the laparoscopic surgery group, the robotic surgery group demonstrated significantly shorter operative time for right partial hepatectomy (P=0.0002) and reduced intraoperative blood loss (P=0.006). However,there were no statistically significant differences observed in postoperative hospital stay, postoperative complication rate, postoperative blood transfusion, and duration of antibiotic use (P>0.05).
Conclusion
Laparoscopic and robotic partial hepatectomy with the da Vinci robot are both safe and effective for the treatment of hepatic tumors. Robotic partial hepatectomy for right-sided hepatic tumors has a shorter operation time and less blood loss than laparoscopic partial hepatectomy.
To summarize the application experience of robotic resection of hepatic hemangioma and evaluate the safety of the surgery.
Methods
The clinical and pathological data of patients who underwent robotic resection of hepatic hemangioma from Aug. 2016 to Dec. 2024 was retrospectively analyzed. Patients were divided into <10 cm and ≥10 cm groups based on tumor size, and further divided into single and multiple groups based on the number of hemangioma. Da Vinci robot combined with intraoperative ultrasound were used to complete the hepatic hemangioma resection surgery.
Results
Among the 129 patients, there were 33 males and 96 females with an average age of 48 years. The average diameter of hemangioma was 8.6±2.4 cm, with 91 cases in the <10 cm group and 38 cases in the ≥10 cm group and 94 cases in the single lesion group and 35 cases in the multiple lesion group. Robotic resection surgery was completed in all the patients, and there were no patients who were converted to open surgery. The average surgical time was 97 (79.5-135.0) min, with an average intraoperative blood loss of 50 (20-100) ml.There were 8 cases of intraoperative blood transfusion, 2 cases of postoperative bile leakage, and an average hospital stay of 5 days. There were statistically significant differences (P<0.05) in the average surgical time, number of hepatic portal blockades, average intraoperative bleeding, and average postoperative hospital stay among patients with different tumor sizes. There were also statistically significant differences (P<0.05)in the average surgical time, number of hepatic portal blockades, and average intraoperative bleeding among patients with different tumor arrays.
Conclusions
The application of robotic resection of hepatic hemangioma, especially those located in complex areas, is safe and effective.
To compare the perioperative outcomes, pathological characteristics, and lymph node dissection (LND) efficacy between robotic and open surgeries for intrahepatic cholangiocarcinoma (ICC) to evaluate the safety and feasibility of robotic-assisted LND.
Methods
This study retrospectively collected clinical data from 148 patients who underwent radical resection for intrahepatic cholangiocarcinoma with lymphadenectomy at the First Medical Center of Chinese PLA General Hospital between Jan. 2018 and Oct. 2023. Patients were stratified into robotic (n=42) and open surgery (n=106)groups. Propensity score matching (PSM) was applied to eliminate baseline confounding factors.Perioperative parameters, patholog-ical features, and LND outcomes were compared between groups.
Results
After propensity score matching, 35 patients in the robotic group and 33 in the open surgery group were included, with balanced baseline characteristics. The robotic group demonstrated significantly shorter operative time compared to the open surgery group (165.00 min vs. 190.00 min; Z=-2.33, P=0.020),along with reduced blood loss (50.00 ml vs. 200.00 ml; Z=-5.78, P<0.001), shorter drainage tube retention (5.00 days vs. 8.00 days; Z=-4.40, P<0.001),and decreased postoperative hospitalization duration (7.00 days vs. 11.00 days; Z=-4.75, P<0.001). However, no significant differences were observed between groups regarding Number of Pringlemaneuvers(P=0.603) or duration (P=0.519).Postoperative complication characteristics, rates showed no statistical discrepancy (χ2=1.010,P=0.663).Pathological includ-ing tumor multiplicity, differentiation grade, vascular invasion, satellite nodules, neural invasion,and microvascular invasion, were comparable between groups (all P>0.05).LND outcomes also revealed equivalence, with similar total harvested lymph nodes (4.00 vs. 5.00; Z=-1.19, P=0.236) and positive lymph node counts (1.00 vs. 1.00; Z=-0.89, P=0.375).
Conclusions
Robotic lymphadenectomy demonstrates non-inferior efficacy to open surgery with reduced intraoperative trauma.
To explore the feasibility of non-intubated uniportal video-assisted thoracic surgery(NI UVATS) sleeve lobectomy and summarize the surgical techniques and clinical outcomes.
Methods
From Mar. 2019 to Jul. 2023, a total of 18 non-intubated uniportal VATS sleeve lobectomy were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital.
Results
All 18 patients successfully underwent radical resection and bronchial anastomosis. No patient was converted to thoracotomy during the entire operation.The 18 cases comprised lung squamous cell carcinoma (n=13), lung adenocarcinoma (n=2), adenoid cystic carcinoma (n=1), andcarcinoid tumor(n=2). The average operation time was 118.33±19.17 minutes. The average number of lymph node stations removed was 5.71±1.69, including station seven in all cases, and the median number of lymph nodes removed was 13.24±5.88.On the day of surgery, the drainage volume was 324.71±155.17 ml. The mean postoperative hospital stay was 4.22±1.48 days.Eight of the 15 patients diagnosed with malignancy received postoperative chemotherapy. One year after the operation, two patients experienced tumor metastasis. These two patients received postoperative chemotherapy combined with immunotherapy and achieved good tumor control.1.5 years after the operation,a local recurrence in a patient with a squamous cell carcinoma. The postoperative follow-up time was 25.7±10.7 months. The mortality was zero.
Conclusions
Non-intubated uniportal VATS sleeve resections on selected patients are feasible procedures in hands of experienced uniportal VATS surgeons,teamed up with experienced anesthetists.
To explore the causes of falciform ligament cyst and the advantages of laparoscopy in the management of abdominal complications after ventriculoperitoneal shunt in infantile hydrocephalus.
Methods
A retrospective analysis and literature review were conducted on the clinical data of four infantile hydrocephalus cases who developed falciform ligament cysts following ventriculoperitoneal shunt surgery at Capital Center for Children's Health, Capital Medical University between Sep. 2017 and Sep. 2022.
Results
After confirming the abdominal complications by ultrasound and CT, the fascia of the falciform ligament was dissected and cerebrospinal fluid was removed. Afterwards, the distal catheter was placed into the peritoneal cavity to keep it unobstructed. Postoperatively, all four infantile patients showed significant clinical improvement, with a noticeable reduction in lateral ventricular size compared to preoperative measurement.
Conclusion
The development of falciform ligament cyst is not only related to the physiological and anatomical characteristics of infants, but also to the abdominal incision of distal catheter placement. Laparoscopy is able to safely and effectively diagnose and treat abdominal complications.
To report a case of severe intravenous leiomyomatosis (IVL) managed through robotic surgery and multidisciplinary collaboration.
Methods
In Aug. 2023, a patient with intravenous leiomyomatosis was admitted to the First Medical Center of Chinese PLA General Hospital. The patient presented with multiple uterine leiomyomas and a markedly enlarged uterine corpus. The IVL lesion involved the left parametrium and pelvic floor vasculature, with tumor thrombus extending upward along the left ovarian vein, left renal vein, inferior vena cava, and terminating in the right atrium. A multidisciplinary consultation was convened, involving departments of gynecology, urology, cardiothoracic surgery,ultrasound, radiology, anesthesiology, and other relevant specialties. The lesion was completely resected through robotic surgery and multidisciplinary collaboration. The operative duration was 356 minutes, with an estimated blood loss of 500 ml.
Results
The patient experienced no severe complications during the perioperative period and had an uneventful recovery. She was discharged in improved condition 12 days postoperatively and remained free of recurrence and long-term complications during a 1-year follow-up period.
Conclusion
This case highlights the successful management of IVL through robotic surgery and multidisciplinary collaboration, achieving complete resection of the lesion in a single surgical stage.Minimally invasive surgery, particularly leveraging the advantages of the robotic surgical system and high-level multidisciplinary collaboration, has enabled the effective treatment of such complex and challenging cases.
