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Artificial Intelligence and Computer Vision during surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

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Surgical Science 2024年第3期15卷 169-181页

作者： Savvas Hirides Petros Hirides Kouloufakou Kalliopi Constantinos Hirides Department of surgery Medical School University of Nicosia Nicosia Cyprus Department of Laparoscopic & robotic surgery Athens Medical Center Athens Greece Department of Laparoscopic & robotic surgery IASO Maternity & Gynecology Clinic Athens Greece

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.

关键词： Artificial Intelligence surgery Image Recognition Autonomous surgery

Pathophysiology of severe gallstone pancreatitis:A new paradigm

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World Journal of Gastroenterology 2024年第7期30卷 614-623页

作者： Masatoshi Isogai Department of surgery Nawa HospitalOgaki 503-0893GifuJapan

Severe gallstone pancreatitis(GSP)refractory to maximum conservative therapy has wide clinical variations,and its pathophysiology remains *** Editorial aimed to investigate the pathophysiology of severe disease based on Opie’s theories of obstruction,the common channel,and duodenal reflux and describe its *** GSP might be a hybrid disease with pathology polarized between acute cholangitis with mild pancreatitis(biliary type)and necrotizing pancreatitis uncomplicated with biliary tract disease(pancreatic type),in which hepatobiliary and pancreatic lesion severity is inversely related to the presence or absence of impacted ampullary *** GSP is caused by stones that are persistently impacted at the ampulla with biliopancreatic obstruction(biliary type),and probably,stones that are either temporarily lodged at the duodenal orifice or passed into the duodenum,thereby permitting reflux of bile or possible duodenal contents into the pancreas(pancreas type).When the status of the stones and the presence or absence of impacted ampullary stones with biliopancreatic obstruction are determined,the clinical course and outcome can be *** represent the main cause of acute pancreatitis globally,and clinicians are expected to encounter GSP more *** of the etiology and pathogenesis of severe disease is mandatory.

关键词： Gallstone pancreatitis Biliary pancreatitis Gallstone hepatitis Acute cholangitis Necrotizing pancreatitis Pathophysiology

Immunotherapy for esophageal cancer:Where are we now and where can we go

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World Journal of Gastroenterology 2024年第19期30卷 2496-2501页

作者： Yoshiaki Shoji Kazuo Koyanagi Kohei Kanamori Kohei Tajima Mika Ogimi Yamato Ninomiya Miho Yamamoto Akihito Kazuno Kazuhito Nabeshima Takayuki Nishi Masaki Mori Department of Gastroenterological surgery Tokai University School of MedicineKanagawa 259-1193Japan

Immune checkpoint inhibitor therapy has dramatically improved patient prognosis,and thereby transformed the treatment in various cancer types including esophageal squamous cell carcinoma(ESCC)in the past *** antibodies that selectively inhibit programmed cell death-1(PD-1)activity has now become standard of care in the treatment of ESCC in metastatic settings,and has a high expectation to provide clinical benefit during perioperative ***,anti-cytotoxic T-lymphocyte–associated protein 4(CTLA-4)monoclonal antibody has also been approved in the treatment of recurrent/metastatic ESCC in combination with anti-PD-1 *** understanding of the existing evidence of immune-based treatments for ESCC,as well as recent clinical trials on various combinations with chemotherapy for different clinical settings including neoadjuvant,adjuvant,and metastatic diseases,may provide future prospects of ESCC treatment for better patient outcomes.

关键词： Esophageal cancer Immunotherapy Immune checkpoint inhibitor Programmed cell death-1 Anti-cytotoxic T-lymphocyte-associated protein 4 Neoadjuvant therapy Adjuvant therapy Clinical trials Combination therapy

MicroRNA-329-3p inhibits the Wnt/β-catenin pathway and proliferation of osteosarcoma cells by targeting transcription factor 7-like 1

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Oncology Research 2024年第3期32卷 463-476页

作者： Hur SUN MASANORI KAWANO TATSUYA IWASAKI ICHRO ITONAGA YUTA KUBOTA HROSHI TSUMURA KAZUHRO TANAKA Department of Orthopaedic surgery Faculty of MedicineOita UniversityOita879-5503Japan

An important factor in the emergence and progre sion of osteosarcoma(OS)is the dysregulated expression of microRNAs(miRNAs).Transcription factor 7-like 1(TCF7LI),a member of the T cell factor/lymphoid enhancer factor(TCF/LEF)transcription factor family,interacts with the Wnt signaling pathway regulator β-catenin and acts as a DNA-specific binding *** study sought to elucidate the impact of the interaction between miR 3293p and TCF7L1 *** growth and apoptosis of OS and analyze the regulatory expression relationship between miRNA and mRNA in osteosarcoma cells using a variety of ***329-3p was significantly downregulated,while TCF7L1 was considerably up-regulated in all examined OS cell ***,a clinical comparison study was performed using the TCGA ***,the regulatory relationship between miR-329-3p and TCF7L1 on the proliferation and apoptosis of OS cells was verified through in vitro and in vivo *** miR 329-3p was transfected into the OS cell line,the expression of TCF7L1 decreased,the proliferation of OS cells was inhibited,the cytoskeleton disintegrated,and the nucleus condensed to fom apoptotic *** expression of proteins that indicate apoptosis increased *** cell cycle was arrested in the G0/G1 phase,and the G1/S transition was *** introduction of miR 3293p also inhibited downstream Cyclin D1 of the Wnt *** experiments indicated that the overexpression of miR-329-3p signi ficanly inhibited the growth of OS xenografts in nude mice,and the expression of TCF7L1 and C-Myc in tumor tssues *** 329-3p was significantly reduced in OS cells and played a suppressive role in tumorigenesis and proliferation by targeting TCF7L1 both in vitro and in *** cell cycle arrest and pathway inhibition were observed upon the regulation of TCF7LI by miR *** these results,it can be inferred that miR.3293p exerts anticancer efects in osteosarcom

关键词： MiR-329-3p TCF7L1 Wnt/β-catenin pathway Osteosarcoma Proliferation

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of *** use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative ***,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after *** To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after *** The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively *** were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower *** factors,including demographic data and perioperative D-dimer values,were compared between the two *** operating characteristic curve analysis was performed to determine the D-dimer cutoff *** and multivariate analyses were performed using logistic regression analysis to identify significant *** In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE *** the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after *** Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

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World Journal of Pediatric surgery 2024年第1期7卷 20-25页

作者： Yuichiro Miyake Hiroyuki Koga Shuko Nojiri Shunsuke Yamada Takanori Ochi Go Miyano Geoffrey J Lane Atsuyuki Yamataka Tadaharu Okazaki Department of Pediatric General and Urogenital surgery Juntendo University School of MedicineBunkyo-kuTokyoJapan Department of Medical Technology Innovation Center Juntendo UniversityBunkyo-ku TokyoJapan Department of Pediatric surgery Juntendo University Urayasu HospitalUrayasuChibaJapan

Background Following on from an earlier study published in 2008 about left pulmonary artery(LPA)flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia(CDH)and the ratio of LPA to right pulmonary artery(RPA)diameters being a simple and reliable indicator for commencing nitric oxide(NO)therapy,the ratio of LPA:RPA diameters(PA ratio orPAR)was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH *** Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to *** obtained retrospectively for subject demographics,clinical course,LPA/RPA diameters,and PAR were compared between survivors and *** value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic(ROC)curve *** Of 65 subjects,there were 54 survivors(82.3%)and 11 non-survivors(17.7%);7 of 11 non-survivors died before surgical repair could be *** PAR for survivors(0.851±0.152)was significantly higher than for non-survivors(0.672±0.108)(p=0.0003).Mean PAR for non-survivors was not affected by surgical *** of survivors were:LPA≥2 mm(n=52 of 54;mean PAR=0.866±0.146)and RPA≥3mm(n=46 of 54;mean PAR=0.857±0.152).Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean *** curve cut-off for PAR was *** with high PAR(≥0.762)required high-frequency oscillatory ventilation/NO less than subjects with low PAR(<0.762)(p=0.0244 and p=0.0485,respectively)and subjects with high PAR stabilized significantly earlier than subjects with low PAR(1.71±0.68 days vs 3.20±0.87 days)(p<0.0001).Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH.

关键词： hernia congenital diameters

Bicuspidization Using the Open-Sleeve Technique for Congenital Aortic Stenosis during Infancy

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Congenital Heart Disease 2024年第2期19卷 177-183页

作者： Toshi Maeda Hiroki Ito Keiichi Hirose Kisaburo Sakamoto Departments of Cardiovascular surgery Mt.Fuji Shizuoka Children’s HospitalShizuoka420-8660Japan

Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile ***,surgical repair is challenging because of the narrow surgical *** performed bicuspidization using the open-sleeve technique for cAS with a unicuspid aortic valve in two ***,the patients were doing well without reintervention for the aortic valve for 8 and 6 years,*** aortic annular diameter increased along with somatic *** for neonates or infancy can be performed safely using the open-sleeve technique as its midterm results have been satisfactory.

关键词： Aortic valve repair infant bicuspidization open-sleeve technique

Evaluation of mitral chordae tendineae length using four-dimensional computed

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World Journal of Cardiology 2024年第5期16卷 274-281页

作者： Takuya Mori Satoshi Matsushita Terumasa Morita Abulaiti Abudurezake Junji Mochizuki Atsushi Amano Department of Cardiovascular surgery Juntendo University Faculty of MedicineTokyo 113-8421Japan Department of Cardiovascular surgery JACCT Japan Animal Cardiovascular Care TeamOsaka 533-0033Japan Department of Radiology Minamino Cardiovascular HospitalTokyo 192-0918Japan

BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral *** precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this ***,preoperative assessment of CL is critical for surgical planning and ***-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection *** To investigate the behavior and length of mitral chordae tendineae during systole using *** Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic *** length of the primary chordae tendineae was measured from early systole to early diastole using the 3D *** primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,*** behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was *** In all cases,the mitral anterior leaflet chordae tendineae could be *** most cases,the cA and cP chordae tendineae could be measured *** mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,***(max)was significantly *** correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),*** cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to *** cP,CL reached a plateau at 15%and remaine

关键词： Mitral valve Chordae tendineae Computed tomography Four-dimensional Cardiac cycle

Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy

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World Journal of Gastroenterology 2024年第14期30卷 2006-2017页

作者： Kazuhiro Takahashi Masahiko Gosho Yoshihiro Miyazaki Hiromitsu Nakahashi Osamu Shimomura Kinji Furuya Manami Doi Yohei Owada Koichi Ogawa Yusuke Ohara Yoshimasa Akashi Tsuyoshi Enomoto Shinji Hashimoto Tatsuya Oda Department of Gastrointestinal and Hepatobiliary-Pancreatic surgery University of TsukubaTsukuba 3058-575IbarakiJapan Department of Biostatistics University of TsukubaTsukuba 3058-575IbarakiJapan

BACKGROUND The success of liver resection relies on the ability of the remnant liver to *** of the knowledge regarding the pathophysiological basis of liver regeneration comes from rodent studies,and data on humans are ***,there is limited knowledge about the preoperative factors that influence postoperative *** To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver *** A total of 268 patients who received partial hepatectomy were *** were grouped into right hepatectomy/trisegmentectomy(RH/Tri),left hepa-tectomy(LH),segmentectomy(Seg),and subsegmentectomy/nonanatomical hepatectomy(Sub/Non)*** regeneration index(RI)and late rege-neration rate were defined as(postoperative liver volume)/[total functional liver volume(TFLV)]×100 and(RI at 6-months-RI at 3-months)/RI at 6-months,*** lower 25th percentile of RI and the higher 25th percentile of late regeneration rate in each group were defined as“low regeneration”and“delayed regeneration”.“Restoration to the original size”was defined as regeneration of the liver volume by more than 90%of the TFLV at 12 months *** The numbers of patients in the RH/Tri,LH,Seg,and Sub/Non groups were 41,53,99 and 75,*** RI plateaued at 3 months in the LH,Seg,and Sub/Non groups,whereas the RI increased until 12 months in the RH/Tri *** to our multivariate analysis,the preoperative albumin-bilirubin(ALBI)score was an independent factor for low regeneration at 3 months[odds ratio(OR)95%CI=2.80(1.17-6.69),P=0.02;per 1.0 up]and 12 months[OR=2.27(1.01-5.09),P=0.04;per 1.0 up].Multivariate analysis revealed that only liver resection percentage[OR=1.03(1.00-1.05),P=0.04]was associated with delayed ***,multivariate analysis demonstrated that the preoperative ALBI score[OR=2.63(1.00-1.05),P=0.02;per 1.

关键词： Liver regeneration Albumin-bilirubin score Liver resection percentage Partial hepatectomy Human Regeneration index