Surgical Robotics: An Introduction

Surgical robots assisting surgeons during operations are being used in selected medical fields like neurosurgery, orthopaedics and endoscopy. In an introductory part, the authors present a workflow for robot assisted surgery, which includes the steps: image data acquisition, image processing, surgical planning and the actual robot assisted intraoperative transposition. Each step of the workflow comprises different computer aided methods and apparatuses, which are presented in this paper. The following part focuses on different mechanical set-ups and various application fields for surgical robots. They include neurosurgery, orthopaedic surgery, radiosurgery and radiotherapy, prostatectomy, endoscopy, laparoscopy, cardiac surgery and craniofacial surgery.     

Predicting Acute Renal Failure after Cardiac Surgery: Validation and Re‐definition of a Risk‐Stratification Algorithm

Background:  Acute renal failure (ARF) after cardiac surgery is associated with significant morbidity and mortality, irrespective of the need for dialysis. Previous studies have attempted to identify predictors of ARF and develop risk stratification algorithms. This study aims to validate the algorithm in an independent cohort of patients that includes a significant proportion of female and black patients and compares two different definitions of renal outcome.
Methods:  A large single center cardiac surgery database was examined (n, 24,660; 1993–2000) which included 29.9% females and 3.7% black patients. Post‐operative ARF was defined as: a) ARF requiring dialysis, b) > 50% reduction in creatinine clearance relative to baseline or requiring dialysis. Clinical variables related to baseline renal function and cardiovascular disease were used in recursive partitioning analysis for both outcome definitions. Chi‐square goodness of fit analysis was performed to validate the algorithm.
Results:  The frequency of post‐operative ARF requiring dialysis ranged between 0.5 and 15.5% based on the risk categories with the area under the receiver operating characteristic (ROC) curve of 0.78. Using the more inclusive definition of ARF, the frequency was significantly higher ranging from 2.6 to 25%(P < 0.001) with an area under ROC curve of 0.65.
Conclusions:  The renal risk stratification algorithm is valid in predicting post‐operative ARF in an independent cohort of patients, well represented by differences in gender and race. Since the need for dialysis remains subjective, a more objective and inclusive definition of ARF may help in identifying a larger number of patients 'at‐risk'.     

A New Role for Psychology: Comment.

Letter comments that, about four years ago, Irving S. Cooper, a neurosurgeon in New York City, developed a new type of brain surgery designed to alleviate the tremor and rigidity associated with Parkinson's Disease. As Cooper's work and research progressed, it soon became evident that a significant factor in the selection of appropriate candidates was the patient's psychological and mental condition. Thus it was decided to add a clinical psychologist to the team of professional and rehabilitation people carrying out preoperative evaluation. So far as the letter's author knows, St, Barnabas Hospital is the only setting in this country in which psychologists work so closely with a Department of Neurologic Surgery in both a clinical and research role. The author feels it is significant to report this development which opens up a broad new area for which psychological services are utilized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

准分子激光角膜手术研究

叙述了角膜手术对激光特性的要求，对准分子激光放切术（ＲＫ）和准分子激光消融术（ＰＲＫ）进行了实验研究。     

YQ400A／B—Ⅰ型激光美容仪结合手术切除祛除纹身112例疗效观察

目的:观察YQ400A/B-I型激光美容仪结合手术祛除文身的疗效。方法:选择文身面积在5×5cm2以上的患者采用YQ400A/B-I型激光美容仪治疗2次至3次后对残留的文身色素进行手术切除,以彻底消除文身色素及其文身图案。结果:本组112例患者经治疗后总有效率达96.43%,无效率为3.57%。无明显并发症产生。结论:YQ400A/B-I型激光美容仪结合手术切除祛除文身的疗效肯定,互补了单纯激光或手术在治疗中的不足,是一种很好的祛除文身的治疗方法。     

高分子及其他物质在预防术后粘连的研究进展

粘连是腹部手术常伴的并发症,也是引起肠梗阻、不育、腹痛、骨盆疼痛的主要原因。本文汇总了近年来预防粘连的技术及疗效,并最终确定对病人最有益的预防方法。     

术前2h饮用碳水化合物对老年胃肠道手术患者胃容量及反流误吸风险的影响:前瞻性随机对照研究

目的应用床旁超声技术观察术前2 h饮用碳水化合物对老年胃肠道手术患者麻醉前胃容量的影响,并评估患者发生反流误吸的风险。方法前瞻性选取2017年12月至2018年10月,在四川省人民医院行胃肠道手术的老年患者(>65岁),随机分为试验组和对照组。试验组常规禁食8 h,术前2 h口服200 ml碳水化合物;对照组要求术前禁食8 h,禁饮4 h。麻醉前采用床旁超声技术测量45°半坐位及右侧卧位胃窦部头尾径及前后径,分别计算两种体位下的胃窦部横截面积(cross-sectional area,CSA)、胃容量(gastric volume,GV)及胃容量与体重比(GV/weight,GV/W)。采用GV超声半定量3分评估法及GV/W分级法评估患者发生反流误吸的风险。结果共纳入69例符合入选和排除标准的患者,其中试验组33例,对照组36例。两组基线资料、手术类别及美国麻醉医师学会分级无统计学差异(P均>0. 05)。半坐位下,试验组和对照组的GV/W分别为(0. 57±0. 23) ml/kg和(0. 44±0. 21) ml/kg;右侧卧位下,试验组和对照组的CSA分别为(578. 8±71. 5) mm2和(513. 3±53. 2) mm2,GV分别为(21. 2±11. 1) ml和(12. 9±6. 8) ml,GV/W分别为(0. 36±0. 17) ml/kg和(0. 20±0. 11) ml/kg,上述指标两组间均存在统计学差异(P均<0. 05)。GV超声半定量评分:试验组0分17例(51. 5%,17/33),1分15例(45. 5%,15/33),2分1例(3. 0%,1/33),对照组0分25例(69. 4%,25/36),1分11例(30. 6%,11/36),2分0例(0,0/33),两组评分构成比无统计学差异(P>0. 05)。反流误吸风险评估:试验组极低风险者占比81. 8%(27/33)、低风险18. 2%(6/33)、高风险0 (0/33),对照组极低风险者占比94. 4%(34/36)、低风险5. 6%(2/36)、高风险0 (0/33),两组间构成比亦无统计学差异(P>0. 05)。结论老年胃肠道手术患者术前2 h饮用200 ml碳水化合物虽可以增加麻醉前胃容量,但并不增加反流误吸的风险。     

临床腋窝淋巴结阳性老年三阴性乳腺癌局部治疗策略

因老年乳腺癌患者多伴发基础疾病,在选择局部治疗方案时,除应考虑原发肿瘤本身因素外,还需评估患者重要器官功能及其对治疗的耐受能力。三阴性乳腺癌与其他亚型乳腺癌相比,主要表现为侵袭性强、预后不佳;而临床腋窝淋巴结阳性的老年三阴性乳腺癌患者,局部治疗的选择则更为棘手,对于此类特殊群体,尚需探索更为合理的个体化治疗方案。     

The use of three-dimensional ultrasound imaging in breast biopsy and prostate therapy

Minimally invasive techniques are rapidly replacing traditional practices because they result in improved benefits for patients, health care providers, payers, employers and hospitals. While two-dimensional (2D) imaging has been used to guide interventional procedures for many decades, the use of three-dimensional (3D) imaging of the anatomy has the potential to provide more accurate and less variable interventional guidance and monitoring options. Although 3D magnetic resonance imaging (MRI), computed tomography (CT) and angiography are important modalities, the development of 3D ultrasound imaging techniques that are capable of acquiring B-mode, color Doppler and power Doppler images, has allowed the development of image-guided therapy and surgery approaches that are making breast biopsy and prostate therapy more accurate and less variable. The use of 3D ultrasound has the potential to provide inexpensive and near real-time views of the anatomy and pathology enabling minimally invasive interventional procedures. In this paper we present the principles and advantages of 3D ultrasound imaging, review some of the implementations techniques, and present new applications in image-guided prostate therapy and breast biopsy.     

基于云模型BBO算法的医院管理资源调度研究

手术资源的合理调度对提高医疗资源的利用和工作效率具有重要意义。为提高手术资源的利用率和工作效率,建立医院手术室资源协调调度模型。为提高BBO算法收敛速度和避免陷入局部最优,将云模型引入BBO,提出一种基于CMBBO的医院手术资源调度模型。研究结果表明,CMBBO可以有效提高手术资源使用效率、手术服务能力,降低手术等候时间。