Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been prov...Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.展开更多
The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the y...The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.展开更多
With the accelerated aging society in China,the incidence of biliary surgical diseases in the elderly has increased significantly.The clinical characteristics of these patients indicate that improving treatment outcom...With the accelerated aging society in China,the incidence of biliary surgical diseases in the elderly has increased significantly.The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention.How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention.This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects:(1)higher morbidity associated with an aging society,(2)prevention and control of pre-operative risks,(3)extending the indications of laparoscopic surgery,(4)urgent standardization of minimally invasive surgery,(5)precise technological progress in hepatobiliary surgery,and(6)guarantee of peri-operative safety.It is of great significance to fully understand the focus of controversy,actively make use of its favorable factors,and effectively avoid its unfavorable factors,for further improving the therapeutic effects of geriatric biliary surgical diseases,and thus benefits the vast older patients with biliary surgical diseases.Accordingly,a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.展开更多
文摘Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.
文摘The beginnings of laparoscopic liver resection(LLR)were at the start of the 1990s,with the initial reports being published in 1991 and 1992.These were followed by reports of left lateral sectionectomy in 1996.In the years following,the procedures of LLR were expanded to hemi-hepatectomy,sectionectomy,segmentectomy and partial resection of posterosuperior segments,as well as the parenchymal preserving limited anatomical resection and modified anatomical(extended and/or combining limited)resection procedures.This expanded range of LLR procedures,mimicking the expansion of open liver resection in the past,was related to advances in both technology(instrumentation)and technical skill with conceptual changes.During this period of remarkable development,two international consensus conferences were held(2008 in Louisville,KY,United States,and 2014 in Morioka,Japan),providing up-to-date summarizations of the status and perspective of LLR.The advantages of LLR have become clear,and include reduced intraoperative bleeding,shorter hospital stay,and-especially for cirrhotic patients-lower incidence of complications(e.g.,postoperative ascites and liver failure).In this paper,we review and discuss the developments of LLR in operative procedures(extent and style of liver resections)during the first quarter century since its inception,from the aspect of relationships with technological/technical developments with conceptual changes.
基金Beijing Municipal Science&Technology Commission(No.Z171100000417056)Key Support Project of Guo Zhong Health Care of China General Technology Group(No.SGTYHT/21-JS-223)
文摘With the accelerated aging society in China,the incidence of biliary surgical diseases in the elderly has increased significantly.The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention.How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention.This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects:(1)higher morbidity associated with an aging society,(2)prevention and control of pre-operative risks,(3)extending the indications of laparoscopic surgery,(4)urgent standardization of minimally invasive surgery,(5)precise technological progress in hepatobiliary surgery,and(6)guarantee of peri-operative safety.It is of great significance to fully understand the focus of controversy,actively make use of its favorable factors,and effectively avoid its unfavorable factors,for further improving the therapeutic effects of geriatric biliary surgical diseases,and thus benefits the vast older patients with biliary surgical diseases.Accordingly,a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
