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Robotic and laparoscopic surgery of the pancreas: an historical review. 胰腺机器人和腹腔镜手术:历史回顾。
Pub Date : 2019-01-30 eCollection Date: 2019-01-01 DOI: 10.1186/s42490-019-0001-4
Alan Kawarai Lefor

Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.

胰腺外科是一个相对较新的领域,手术系列是近50年来才出现的。胰腺手术在技术上具有挑战性。1987年,随着腹腔镜胆囊切除术的引入,整个普外科领域发生了根本性的变化。微创手术技术迅速在世界范围内应用于胆囊手术,然后应用于其他腹部手术。这些技术经常用于胰腺手术,包括远端胰腺切除术和胰十二指肠切除术。从开放手术到腹腔镜手术再到机器人手术的进展已经发生在许多手术中,包括肾上腺切除术、甲状腺切除术、结肠切除术、前列腺切除术、胃切除术等。显示机器人手术对患者有益的数据很少,尽管胰腺腹腔镜和机器人手术在主要手术和肿瘤预后方面并不逊色。当腹腔镜首次用于恶性肿瘤患者时,存在严重的担忧,机器人手术已用于许多良性和恶性疾病,没有明显的预后恶化。胰腺恶性肿瘤的机器人手术已被广泛接受并扩展到更多的中心。卓越中心的重要性,外科医生的经验,由一个编纂的掌握为基础的培训计划和国际注册的支持是广泛接受的。与开放手术相比,机器人胰腺手术的失血量和住院时间略有减少。主要的肿瘤预后似乎得到了保留,一些研究显示更高的R0切除率和无肿瘤边缘。胰腺病变的患者应该找一个他们信任的外科医生,而不需要关心他们切除的手术方法。与腹腔镜胆囊切除术带来的狂热形成鲜明对比的是,胰腺机器人手术的发展是以循序渐进的方法为特征的,这种方法可以识别出需要改进的领域,其中许多领域位于工程和医疗实践的交叉点。机器人手术的改进依赖于工程师和临床医生之间的合作。
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引用次数: 23
Models of tendon development and injury. 肌腱发育和损伤模型。
Pub Date : 2019-01-01 Epub Date: 2019-11-29 DOI: 10.1186/s42490-019-0029-5
Sophia K Theodossiou, Nathan R Schiele

Tendons link muscle to bone and transfer forces necessary for normal movement. Tendon injuries can be debilitating and their intrinsic healing potential is limited. These challenges have motivated the development of model systems to study the factors that regulate tendon formation and tendon injury. Recent advances in understanding of embryonic and postnatal tendon formation have inspired approaches that aimed to mimic key aspects of tendon development. Model systems have also been developed to explore factors that regulate tendon injury and healing. We highlight current model systems that explore developmentally inspired cellular, mechanical, and biochemical factors in tendon formation and tenogenic stem cell differentiation. Next, we discuss in vivo, in vitro, ex vivo, and computational models of tendon injury that examine how mechanical loading and biochemical factors contribute to tendon pathologies and healing. These tendon development and injury models show promise for identifying the factors guiding tendon formation and tendon pathologies, and will ultimately improve regenerative tissue engineering strategies and clinical outcomes.

肌腱连接肌肉和骨骼,传递正常运动所必需的力量。肌腱损伤会使人虚弱,其内在的愈合潜力有限。这些挑战促使了模型系统的发展,以研究调节肌腱形成和肌腱损伤的因素。最近对胚胎和出生后肌腱形成的理解的进展激发了旨在模仿肌腱发育关键方面的方法。模型系统也被开发来探索调节肌腱损伤和愈合的因素。我们强调当前的模型系统,探索在肌腱形成和肌腱干细胞分化中受发育启发的细胞、机械和生化因素。接下来,我们将讨论肌腱损伤的体内、体外、离体和计算模型,以研究机械负荷和生化因素如何促进肌腱病理和愈合。这些肌腱发育和损伤模型有望确定指导肌腱形成和肌腱病理的因素,并最终改善再生组织工程策略和临床结果。
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引用次数: 17
In vitro tissue-engineered adipose constructs for modeling disease. 体外组织工程脂肪构建模型疾病。
Pub Date : 2019-01-01 Epub Date: 2019-10-29 DOI: 10.1186/s42490-019-0027-7
Connor S Murphy, Lucy Liaw, Michaela R Reagan

Background: Adipose tissue is a vital tissue in mammals that functions to insulate our bodies, regulate our internal thermostat, protect our organs, store energy (and burn energy, in the case of beige and brown fat), and provide endocrine signals to other organs in the body. Tissue engineering of adipose and other soft tissues may prove essential for people who have lost this tissue from trauma or disease.

Main text: In this review, we discuss the applications of tissue-engineered adipose tissue specifically for disease modeling applications. We provide a basic background to adipose depots and describe three-dimensional (3D) in vitro adipose models for obesity, diabetes, and cancer research applications.

Conclusions: The approaches to engineering 3D adipose models are diverse in terms of scaffold type (hydrogel-based, silk-based and scaffold-free), species of origin (H. sapiens and M. musculus) and cell types used, which allows researchers to choose a model that best fits their application, whether it is optimization of adipocyte differentiation or studying the interaction of adipocytes and other cell types like endothelial cells. In vitro 3D adipose tissue models support discoveries into the mechanisms of adipose-related diseases and thus support the development of novel anti-cancer or anti-obesity/diabetes therapies.

背景:脂肪组织是哺乳动物的重要组织,其功能是隔离我们的身体,调节我们的内部恒温器,保护我们的器官,储存能量(在米色和棕色脂肪的情况下燃烧能量),并向身体其他器官提供内分泌信号。脂肪和其他软组织的组织工程对于那些因创伤或疾病而失去这些组织的人来说可能是必不可少的。在这篇综述中,我们讨论了组织工程脂肪组织在疾病建模方面的应用。我们提供了一个基本的背景脂肪仓库和描述三维(3D)体外脂肪模型的肥胖,糖尿病和癌症的研究应用。结论:在支架类型(水凝胶基、丝基和无支架)、起源物种(智人和肌肉鼠)和使用的细胞类型方面,脂肪3D模型的工程方法多种多样,这使得研究人员可以选择最适合其应用的模型,无论是优化脂肪细胞分化还是研究脂肪细胞与内皮细胞等其他细胞类型的相互作用。体外3D脂肪组织模型支持发现脂肪相关疾病的机制,从而支持新型抗癌或抗肥胖/糖尿病疗法的发展。
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引用次数: 0
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