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Robotic pancreaticoduodenectomy after the learning curve-a new hope

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 489-491页

作者： Philip C.müller beat P.müller-stich Thilo Hackert Felix Nickel Swiss HPB and Transplantation Center Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland Department of General Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany

First,we would like to congratulate Liu et al.for their successful multicenter study including 1,032 patients undergoing robotic pancreaticoduodenectomy(RPD)and 1,154 open pancreaticoduodenectomy(OPD)in seven high volume centers in China over an 8 year period(1).To ensure the best possible outcomes of both techniques,RPD was performed by five surgeons from three centers after overcoming the individual learning curve that was defined as having performed>40 RPD.On the other hand,OPD was performed by 9 surgeons from 6 centers after reaching the individual learning curve,defined as an experience of>60 OPD.

关键词： centers learning after

Combined non-alcoholic fatty liver disease and type 2 diabetes in severely obese patients-medium term effects of sleeve gastrectomy versus Roux-en-Y-gastric bypass on disease markers

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 795-807页

作者： Franck Billmann Sherehan El Shishtawi Tom Bruckner mostafa ElSheikh beat peter muller-stich Adrian Billeter Department of Surgery University Hospital of HeidelbergHeidelbergGermany Institut für medizinische Biometrie und Informatik Universität HeidelbergHeidelbergGermany Department of General Surgery El-Gharbia GovenorateTantaEl gash St.Medical CampusThe Faculty of MedicineTantaEgypt

Background:We aimed to evaluate the medium-term efficacy of sleeve gastrectomy(SG)vs.Roux-en-Y gastric bypass(RYGB)on remission of non-alcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2Dm).methods:We identified severely obese patients[body mass index(BmI)>35 kg/m^(2)]with NAFLD(as defined by the Longitudinal Assessment of Bariatric Surgery Study)and T2Dm(as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology)who underwent SG or RYGB in a single university surgical centre.The cohorts were match-paired and data were analysed after at least 3 years of follow up.The key outcomes measured were:(I)the improvement of liver function tests and NAFLD markers;(II)glycemic control and insulin resistance.Results:Ninety-six patients were investigated;44(45.8%)were women.The mean pre-operative BmI was 45.2 kg/m2 in the SG and 42.0 kg/m^(2) in the RYGB group.SG and RYGB both significantly reduced serum liver enzyme concentrations.NAFLD markers resolved 2 years after SG in all patients.In contrast,only 78%and 80%of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively.Both procedures resulted in comparable rates of remission of T2Dm.Conclusions:Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2Dm based on the rates of remission of markers of these co-morbidities.However,our results need to be confirmed in prospective trials.Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.

关键词： Bariatric surgery morbid obesity complications non-alcoholic fatty liver disease(NAFLD) type 2 diabetes mellitus(T2Dm) gastric bypass sleeve gastrectomy(SG) transaminases

Comparative effectiveness of medical treatment vs.metabolic surgery for histologically proven non-alcoholic steatohepatitis and fibrosis:a matched network meta-analysis

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Hepatobiliary Surgery and Nutrition 2022年第5期11卷 696-708,I0008-I0011页

作者： Adrian T.Billeter beatrice Reiners Svenja E.Seide Pascal Probst Eva Kalkum Christian Rupp beat P.müller-stich Department of General Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany Institute of medical Biometry and Informatics University of HeidelbergHeidelbergGermany The Study Center of the German Surgical Society(SDGC) HeidelbergGermany Department of Gastroenterology and Hepatology University of HeidelbergHeidelbergGermany

Background:Non-alcoholic steatohepatitis(NASH)comprises a major healthcare problem affecting up to 30%of patients with obesity and the associated risk for cardiovascular and liver-related mortality.Several new drugs for NASH-treatment are currently investigated.No study thus far directly compared surgical and non-surgical therapies for NASH.This network meta-analysis compares for the first time the effectiveness of different therapies for NASH using a novel statistical approach.methods:The study was conducted according to the PRISmA guidelines for network meta-analysis.Pubmed,CENTRAL and Web of Science were searched without restriction of time or language using a validated search strategy.Studies investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were selected.Patients with liver cirrhosis were excluded.Risk of bias was assessed with ROB-2 and ROBINS-I-tools.A novel method for population-adjusted indirect comparison to include and compare single-arm trials was applied.main outcomes were NASH-resolution and improvement of fibrosis.Results:Out of 7,913 studies,twelve randomized non-surgical studies and twelve non-randomized surgical trials were included.NASH-resolution after non-surgical intervention was 29%[95%confidence interval(CI):23-40%]and 79%(95%CI:72-88%)after surgery.The network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication[odds ratio(OR)=2.68;95%CI:1.44-4.97]while drug treatment was superior to placebo(OR=2.24;95%CI:1.55-3.24).Surgery(OR=2.18;95%CI:1.34-3.56)and medication(OR=1.79;95%CI:1.39-2.31)were equally effective to treat fibrosis compared to placebo without difference between them.The results did not change when only new drugs specifically developed for the treatment of NASH were included.Conclusions:metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of fibrosis.Trials directly comparing surgery with medication must b

关键词： Non-alcoholic fatty liver disease(NAFLD) non-alcoholic steatohepatitis(NASH) metabolic surgery fatty liver

Learning robotic distal pancreatectomy: the force awakens

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胰腺病学杂志(英文) 2022年第3期05卷 132-133页

作者： müller Philip C. müller-stich beat P. Hackert Thilo Nickel Felix Swiss HPB and Transplantation Center Department of Surgery and Transplantation 3. University Hospital Zurich 4. Zurich 5. Switzerland Department of General Visceral and Transplantation Surgery 8. Heidelberg University Hospital 9. Heidelberg 10. Germany

Training and learning curves in minimally invasive pancreatic surgery:from simulation to mastery

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Journal of Pancreatology 2020年第2期3卷 101-110页

作者： Haney Caelán m. Karadza Emir Limen Eldridge F. de Santibanes martin Kinny-Köster Benedict müller Philip C. Bintintan Vasile V. Kulu Yakub Hackert Thilo müller-stich beat-peter Nickel Felix Department of General Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany Department of Surgery Hospital Italiano de Buenos AiresBuenos AiresArgentina Department of Surgery Clinic Beau-SiteBernSwitzerland Department of Surgery University Hospital Cluj NapocaCluj NapocaRomania

Background:minimally invasive pancreatic surgery(mIPS)has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community.With increasing awareness of both the public and the surgical community on patient safety,optimization of training has gained importance.For implementation of mIPS we propose 3 training phases.The first phase focuses on developing basic skills and procedure specific skills with the help of simulation,biotissue drills,video libraries,live case observations,and training courses.The second phase consists of index procedures,fellowships,and proctoring programs to ensure patient safety during the first procedures.During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality.Case selection,skills assessment,feedback,and mentoring are important methods to optimize this phase.The residual learning curve can reach up to 100 cases depending on the surgeons’previous experience,selection of cases,and definition of the parameters used to assess the learning curve.Adequate training and high procedural volume are key to implementing mIPS safely.

关键词： Laparoscopic surgery minimally invasive surgery Robotic surgery Training

A narrative review on endopancreatic interventions: an innovative access to the pancreas

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Journal of Pancreatology 2021年第2期4卷 90-98页

作者： michael C.Frey Benjamin Eigl Daniel C.Steinemann Thilo Hackert Fabian Rossler Felix Nickel beat P.muller-stich Kaspar Z’graggen Philip C.muller Department of Surgery Kantonsspital BadenBaden CAScination AG Bern Department of Surgery Clarunis University Hospital BaselBaselSwitzerland Department of General Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany Department of Visceral and Transplant Surgery University Hospital ZurichZurich Department of Surgery Hirslanden Klinik Beau-SiteBernSwitzerland

The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas.Endoscopically this access is already regularly used,mainly for diagnostic and even for certain therapeutic purposes.With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms,intrapancreatic strictures and removal of pancreatic duct stones.However,the endopancreatic access can equally be applied for surgical interventions.The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access.Endopancreatic surgery stands for a further development of the endoscopic technique:a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control.While the orientation and localization of target structures using this minimally invasive approach is difficult,the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.

关键词： Computer-assisted surgery Endopancreatic surgery Image-guided surgery minimally invasive pancreatic surgery Pancreatic surgery

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更智能的电梯传感器

中国电梯 2006年第15期17卷 33-37页

作者： beat Decoi Daniel Lippuner peter Nebiker 郑晓峰（译）瑞士瑞电士公司瑞电士（上海）传感器有限公司

今天，新兴的照相传感技术已可被运用在电梯技术中，从而提升了电梯的效率，安全和舒适。对于电梯效率最优化而言，轿厢面积被占用的百分比是一个关键数据。但是，现有的称重装置只能测出轿厢中的重量，却无法识别轿厢面积被占用的百分... 详细信息

今天，新兴的照相传感技术已可被运用在电梯技术中，从而提升了电梯的效率，安全和舒适。对于电梯效率最优化而言，轿厢面积被占用的百分比是一个关键数据。但是，现有的称重装置只能测出轿厢中的重量，却无法识别轿厢面积被占用的百分比。基于安全考虑，轿厢中的任何人或物都应被检测到。但是，现有的漫反射型传感器却无法实现，因为它无法检测到静止不动的物体。本文介绍的是基于新兴的CmOS照相技术研发的视觉传感器系统，对于该型传感器的分类使用，将解决上述问题，并使电梯更加舒适。对于该传感器的技术细节将在下文中，根据不同的应用事例做详细描述。

关键词：电梯效率舒适的概念安全视觉系统照相机

Effects of a Drums Alive®Intervention versus Hand-Foot Coordination Training on motor, Cognitive and motivational Parameters in Seniors

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Advances in Aging Research 2022年第3期11卷 51-77页

作者： Carrie Ekins peter R. Wright Guenter Schlee Dean Owens Drums Alive® UG Kutzenhausen Germany Department of Sport Health Sciences & Social Work Oxford Brookes University Oxford UK Department of movement Science Chemnitz University of Technology Chemnitz Germany Embry-Riddle Aeronautical University Daytona Beach FL USA

This study was conducted to compare the effects of two different interventions on the physiological, cognitive, and motivational parameters in seniors;and, how they would be accepted as alternative forms of exercise in the senior population. The facilitators recruited 26 randomly selected participants from two senior care facilities in Chemnitz, Germany who were required to complete two 45-minute exercise periods a week for 30 days. The first group completed the Drums Alive intervention which included a multi-dimensional approach using music, movement, drumming choreographies, games, and activities. The second intervention group completed a series of Hand-Foot Coordination exercises that used beat-keeping patterns on various parts of the body. Each intervention group had three divisions of participants, i.e. “healthy” to define those with no diagnosed malady, “dementia” for those with varying degrees of diagnosed dementia, and, “wheelchair” and those requiring a wheelchair for movement. The pre- and post-testing measurements consisted of age, heart rate, blood pressure, rate of perceived exertion (RPE), bar-drop test, chair-raise test, 6-minute walk test, memory, concentration, balance, reaction, coordination, and cognitive flexibility. In addition, to measure the level of motivation, i.e. fun, the participants used a tool that was developed by the Psychology Department of the Chemnitz University. The results demonstrated that both interventions were suitable alternates for senior-focused conventional sports offerings, however, the Drums Alive intervention outperformed the Hand-Foot Coordination intervention in a majority of the measured domains by an overall average of 9.45 percent. Of note, the data, vis a vis motivation, demonstrated a 38.4 percent increase for Drums Alive vice a 13.3 percent increase for Hand-Foot Coordination, suggesting the Drums Alive intervention offered more effective protocols that could inspire seniors to make this a part of an overall health and wellness plan to improve their quality

关键词： motivation Cognition Physicality Quality of Life

Compensatory Strategies and Prevention of musculoskeletal Disorders in music Conductors

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Compensatory Strategies and Prevention of Musculoskeletal Di...