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We report a bending-insensitive multi-core fiber (MCF) for lensless endoscopy imaging with modified fiber geometry that enables optimal light coupling in and out of the individual cores. In a previously reported bending insensitive MCF (twisted MCF), the cores are twisted along the length of the MCF allowing for the development of flexible thin imaging endoscopes with potential applications in dynamic and freely moving experiments. However, for such twisted MCFs the cores are seen to have an optimum coupling angle which is proportional to their radial distance from the center of the MCF. This brings coupling complexity and potentially degrades the endoscope imaging capabilities. In this study, we demonstrate that by introducing a small section (1 cm) at two ends of the MCF, where all the cores are straight and parallel to the optical axis one can rectify the above coupling and output light issues of the twisted MCF, enabling the development of bend-insensitive lensless endoscopes.
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BACKGROUND: The diffusion of laparoscopic radical surgery for hydatid liver echinococcosis remains limited. There are no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed. METHODS: HPB center (Center 1) and general surgery hospital in an endemic area (Center 2) participated in a retrospective study. Radical surgery included total, subtotal pericystectomy, and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. RESULTS: The total number of patients who underwent surgery for liver hydatid cysts was 213. Laparoscopic cystectomy was performed in 106 (50%) patients. This number included 47 radical laparoscopic cystectomy (Center 1). Conservative laparoscopic procedures were used in 59 patients (Center 2). Finally, twenty-seven pairs of patients were matched. Immediate outcomes were better for radical treatment in terms of severe morbidity, length of hospital stay, and time of abdominal drainage before and after PSM. The mean follow-up length was 23 (4-66) and 29 (6-66) months and the recurrence rate was 2% and 5% in groups of radical and conservative treatment respectively. No differences were found in 1-, 3-, and 5-year disease free survival. After second PSM for recurrence, 20 pairs were matched with no relapse of disease. CONCLUSION: Laparoscopic radical surgery leads to the better immediate outcomes and can be recommended as the preferred treatment option in a specialized HPB center. Conservative option is justified in general hospitals in endemic area for selected uncomplicated cysts.
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Equinococosis Hepática , Laparoscopía , Equinococosis Hepática/etiología , Equinococosis Hepática/cirugía , Humanos , Laparoscopía/métodos , Recurrencia Local de Neoplasia/cirugía , Recurrencia , Estudios RetrospectivosRESUMEN
In this Letter, we report a high-efficiency, miniaturized, ultra-fast coherent beam, combined with 3D-printed micro-optics directly on the tip of a multicore fiber bundle. The highly compact device footprint (180 µm in diameter) facilitates its incorporation into a minimally invasive ultra-thin nonlinear endoscope to perform two-photon imaging.
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Endoscopios , Endoscopía , Endoscopía Gastrointestinal , Óptica y Fotónica , Fotones , Impresión TridimensionalRESUMEN
The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian Pancreatic Club using the Delphi method. Its goal was to consolidate the opinions of national experts on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is ensured by the participation of leading gastroenterologists and surgeons.
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Insuficiencia Pancreática Exocrina , Enfermedades Pancreáticas , Consenso , Insuficiencia Pancreática Exocrina/etiología , Humanos , Enfermedades Pancreáticas/cirugía , Federación de RusiaRESUMEN
BACKGROUND: No prospective randomized trials comparing transection techniques for the liver parenchyma transection during laparoscopic liver resection have been performed. The aim of the study was to compare the immediate outcomes of hydro-jet dissection with ultrasonic surgical aspirator in laparoscopic liver parenchyma transection in a prospective randomized single-center study. METHODS: Consecutive patients with liver benign and malignant tumors presenting to a single center from May 2017 to May 2020 were enrolled in the study. The primary endpoint was the intraoperative estimated blood loss. The secondary endpoints included duration of parenchymal transection, morbidity, and overall hospital stay. RESULTS: A total of 68 patients were enrolled in the study, with 34 patients in each group. There were no differences between groups in the difficulty of resection (according to IWATE criteria and IMM score) and other basic surgical parameters. No differences were found in all primary and secondary endpoints except the expenditure. The cost of equipment was significantly higher in the group of ultrasonic aspirator. CONCLUSION: Despite the wider use of the ultrasonic aspirator in laparoscopic liver surgery, hydro-jet and ultrasonic surgical aspirators have shown similar efficacy and safety for transection of the liver parenchyma during laparoscopic resection.
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Laparoscopía , Neoplasias Hepáticas , Pérdida de Sangre Quirúrgica/prevención & control , Disección , Hepatectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Hígado/diagnóstico por imagen , Hígado/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Estudios Prospectivos , UltrasonidoRESUMEN
BACKGROUND: Estimation of physiologic ability and surgical stress system (E-PASS) has been shown to be effective in predicting morbidity after surgery for perihilar cholangiocarcinoma (PHCC). Nevertheless, E-PASS does not include an assessment of the disease specific risk factors. The aim of the study was to estimate the combined impact of E-PASS and specific preoperative factors on major morbidity for PHCC patients. METHODS: A retrospective analysis of a prospectively collected data was performed. Severe morbidity according to complication comprehensive index was defined as ≥40 points. A value of comprehensive risk score (CRS) ≥1 was taken as critical. RESULTS: Multivariate analysis of perioperative data from 122 patients revealed significant impact of five factors (CRS ≥1, future liver remnant volume <50%, T4 stage, moderate and severe cholangitis, INR) on the risk of severe morbidity after resection. The AUC for the combination of these factors was classified as good predictive value (0.810, 95% CI 0.729-0.891) and poor predictive value (0.673, 95% CI 0.573-0.773) for CRS alone (p = 0.040). CONCLUSION: A combination of E-PASS with disease specific risk factors is a reliable predictive model for major morbidity for patients undergoing radical surgery for PHCC.
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Neoplasias de los Conductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares , Colangiocarcinoma/cirugía , Hepatectomía/efectos adversos , Humanos , Tumor de Klatskin/cirugía , Hígado , Morbilidad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: There is no comparative analysis of the learning curves for robot-assisted and laparoscopic liver resection. We aimed to compare learning curves in complex robotic and conventional laparoscopic liver resections with regards to estimation of the difficulty index score. METHODS: The results of 131 consecutive liver resections were analyzed retrospectively (40 robot-assisted and 91 laparoscopic). The learning curve evaluation was based on calculation of procedures number before significant change of the difficulty index for minimally invasive liver resection or the rate of posterosuperior segments resection. Groups of early and late experience were compared in every type of approach (robot-assisted and laparoscopic). RESULTS: Significant increase of difficulty index (from 5.0 [3.0-7.7] to 7.3 [4.3-10.2]) of robotic procedures required 16 procedures. It was necessary to perform 29 laparoscopic resections in order to significantly increase the rate of laparoscopic posterosuperior segments resection but without significant increase of difficulty index. The implementation of minimally invasive liver resection started with the robotic approach. CONCLUSION: The learning curve for robot-assisted liver resections is shorter in comparison with laparoscopic resections. The inclusion of robot-assisted resections in a minimally invasive liver surgery program may be useful to rapidly increase the complexity of laparoscopic liver resections.