A. Lelchuk, Michael Nicoara, Sharique Nazir, Shin-TSo Liu, K. Bain
Mucinous tumors of the appendix and ovary/fallopian tubes can have similar presentations. Most commonly, these tumors are asymptomatic and found incidentally during surgery. When symptomatic, these pathologies can present with lower abdominal pain, a palpable abdominal mass, nausea/vomiting, fevers, or leukocytosis. It is uncommon for these tumors to be confused with one another with the increased use and sensitivity of preoperative imaging modalities. We present the case of a paratubal cyst (PTC) being misidentified as an appendiceal mucocele on preoperative CT scan.
{"title":"Hydatid cyst of Morgagni—the case of a misidentified paratubal cyst as an appendiceal mucocele","authors":"A. Lelchuk, Michael Nicoara, Sharique Nazir, Shin-TSo Liu, K. Bain","doi":"10.21037/ls.2019.09.03","DOIUrl":"https://doi.org/10.21037/ls.2019.09.03","url":null,"abstract":"Mucinous tumors of the appendix and ovary/fallopian tubes can have similar presentations. Most commonly, these tumors are asymptomatic and found incidentally during surgery. When symptomatic, these pathologies can present with lower abdominal pain, a palpable abdominal mass, nausea/vomiting, fevers, or leukocytosis. It is uncommon for these tumors to be confused with one another with the increased use and sensitivity of preoperative imaging modalities. We present the case of a paratubal cyst (PTC) being misidentified as an appendiceal mucocele on preoperative CT scan.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2019.09.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47329705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Complete removal of the adrenal gland has been the standard approach in the surgical treatment of tumors for decades. There, however, is bigger role emerging for organ sparing adrenalectomy especially in the era of minimal invasive surgery. Initially proposed for bilateral tumors in hereditary diseases and in tumors in a solitary gland, partial adrenalectomy gained also popularity in the treatment of spontaneous unilateral small masses. Various surgical techniques have been described so far with promising surgical and functional outcomes with increased quality of life compared to total adrenalectomy. Steroid replacement can be avoided in most cases even in bilateral disease and successful normalization of pathological preoperative endocrine levels were reported in various kinds of adenoma. Therefore, minimal invasive partial adrenalectomy, which seems to be still underused, is a valid treatment option for small hormonal active adrenal tumors whenever surgically possible.
{"title":"Cortical sparing adrenalectomy in sporadic and bilateral tumors","authors":"D. Colleselli, G. Janetschek","doi":"10.21037/ls.2019.08.02","DOIUrl":"https://doi.org/10.21037/ls.2019.08.02","url":null,"abstract":"Complete removal of the adrenal gland has been the standard approach in the surgical treatment of tumors for decades. There, however, is bigger role emerging for organ sparing adrenalectomy especially in the era of minimal invasive surgery. Initially proposed for bilateral tumors in hereditary diseases and in tumors in a solitary gland, partial adrenalectomy gained also popularity in the treatment of spontaneous unilateral small masses. Various surgical techniques have been described so far with promising surgical and functional outcomes with increased quality of life compared to total adrenalectomy. Steroid replacement can be avoided in most cases even in bilateral disease and successful normalization of pathological preoperative endocrine levels were reported in various kinds of adenoma. Therefore, minimal invasive partial adrenalectomy, which seems to be still underused, is a valid treatment option for small hormonal active adrenal tumors whenever surgically possible.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2019.08.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47763644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatic adenoma (HA) is a rare benign disease. Only selected patients require a liver resection: all male patients; female patients with a progressively enlarging nodule or HA >5 cm or β-catenin mutated tumors (especially if β-catenin mutated HA exon 3); symptomatic patients. We performed a review of the literature to analyze the indications and the results of a laparoscopic resection in patients with HA. The number of minimally invasive resections performed for HA reported in the literature has progressively increased in the most recent years. Laparoscopic resection of HA is safe and feasible and carries the same advantages of minimally invasive liver surgery for other diseases. The minimally invasive approach is standard for HA requiring limited resection of antero-lateral segments or left lateral sectionectomy. Laparoscopic complex resections for HA have been reported, but they are still under evaluation and should be reserved to high-volume centers with adequate expertise. A three-step decisional process should be respected. The surgeon should evaluate: firstly, if the patient needs surgery; secondly, which resection is appropriate; thirdly, if a laparoscopic approach is suitable in his/her center. The possibility to perform a laparoscopic resection for HA should not widen indications or modify surgical strategy. Furthermore, the surgeon’s awareness of his/her expertise and learning curve and that of the entire teams’ capabilities is paramount to increase patient safety and optimize outcomes.
{"title":"Hepatic adenoma: indications for minimally invasive resection","authors":"L. Viganó, A. Elamin, G. Costa","doi":"10.21037/ls.2019.08.03","DOIUrl":"https://doi.org/10.21037/ls.2019.08.03","url":null,"abstract":"Hepatic adenoma (HA) is a rare benign disease. Only selected patients require a liver resection: all male patients; female patients with a progressively enlarging nodule or HA >5 cm or β-catenin mutated tumors (especially if β-catenin mutated HA exon 3); symptomatic patients. We performed a review of the literature to analyze the indications and the results of a laparoscopic resection in patients with HA. The number of minimally invasive resections performed for HA reported in the literature has progressively increased in the most recent years. Laparoscopic resection of HA is safe and feasible and carries the same advantages of minimally invasive liver surgery for other diseases. The minimally invasive approach is standard for HA requiring limited resection of antero-lateral segments or left lateral sectionectomy. Laparoscopic complex resections for HA have been reported, but they are still under evaluation and should be reserved to high-volume centers with adequate expertise. A three-step decisional process should be respected. The surgeon should evaluate: firstly, if the patient needs surgery; secondly, which resection is appropriate; thirdly, if a laparoscopic approach is suitable in his/her center. The possibility to perform a laparoscopic resection for HA should not widen indications or modify surgical strategy. Furthermore, the surgeon’s awareness of his/her expertise and learning curve and that of the entire teams’ capabilities is paramount to increase patient safety and optimize outcomes.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2019.08.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43319290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neoplasms occur more frequently in individuals with obesity and may go unnoticed during the workup for a bariatric procedure in part because there are no guidelines to screen patients for intra-abdominal malignancy before bariatric surgery, and because obesity can mask even very large abnormal masses on physical exam. Many reports in the literature describe a variety of masses being discovered incidentally during bariatric procedures. Liposarcomas are soft tissue neoplasms with striking potential to grow to gigantic proportions. These tumors often present as a disfiguring mass palpable to physician and patient alike. We present a case in which a giant mass measuring 41 cm and 10.2 kg was undetected in an individual with obesity and was incidentally found during bariatric surgery. To our knowledge this is the first case in the literature of a giant liposarcoma being initially discovered during a bariatric procedure. We discuss management considerations for the bariatric surgeon who incidentally discovers a giant retroperitoneal mass at the time of gastric bypass.
{"title":"Giant retroperitoneal liposarcoma incidentally discovered during bariatric surgery","authors":"H. Calderon, D. Yarbrough, Erika La Vella","doi":"10.21037/LS.2019.07.08","DOIUrl":"https://doi.org/10.21037/LS.2019.07.08","url":null,"abstract":"Neoplasms occur more frequently in individuals with obesity and may go unnoticed during the workup for a bariatric procedure in part because there are no guidelines to screen patients for intra-abdominal malignancy before bariatric surgery, and because obesity can mask even very large abnormal masses on physical exam. Many reports in the literature describe a variety of masses being discovered incidentally during bariatric procedures. Liposarcomas are soft tissue neoplasms with striking potential to grow to gigantic proportions. These tumors often present as a disfiguring mass palpable to physician and patient alike. We present a case in which a giant mass measuring 41 cm and 10.2 kg was undetected in an individual with obesity and was incidentally found during bariatric surgery. To our knowledge this is the first case in the literature of a giant liposarcoma being initially discovered during a bariatric procedure. We discuss management considerations for the bariatric surgeon who incidentally discovers a giant retroperitoneal mass at the time of gastric bypass.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/LS.2019.07.08","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43159550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left paraduodenal hernias are congenital internal hernias caused by the failure of the mesenteric and parietal peritoneum fusion with midgut malrotation. We present a case of a 22-year-old woman who presented with acute abdominal pain and was found to have a left paraduodenal hernia on CT. She underwent a laparoscopic reduction and primary repair of the defect. She presented two weeks later with acute abdominal pain and emesis and was taken emergently to the operating room after a CT showed a high-grade obstruction at the site of the prior hernia defect. In a laparoscopic converted to open exploration, several of the prior hernia closure’s sutures were removed and the bowel was released. This case highlights the importance of a perfect hernia closure, tight enough to prevent a recurrence but not too tight to cause an obstruction.
{"title":"A balancing act: obstruction following laparoscopic closure of a congenital paraduodenal hernia","authors":"Marisa E. Pulcrano, Lan Vu, Matthew C. Lin","doi":"10.21037/LS.2019.07.05","DOIUrl":"https://doi.org/10.21037/LS.2019.07.05","url":null,"abstract":"Left paraduodenal hernias are congenital internal hernias caused by the failure of the mesenteric and parietal peritoneum fusion with midgut malrotation. We present a case of a 22-year-old woman who presented with acute abdominal pain and was found to have a left paraduodenal hernia on CT. She underwent a laparoscopic reduction and primary repair of the defect. She presented two weeks later with acute abdominal pain and emesis and was taken emergently to the operating room after a CT showed a high-grade obstruction at the site of the prior hernia defect. In a laparoscopic converted to open exploration, several of the prior hernia closure’s sutures were removed and the bowel was released. This case highlights the importance of a perfect hernia closure, tight enough to prevent a recurrence but not too tight to cause an obstruction.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/LS.2019.07.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45188018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minimally invasive liver surgery is undergoing exponential growth (1). Since its first application (2), laparoscopic surgery has been increasingly used to address benign and malignant liver lesions ranging from minor resections to major hepatectomies. First randomized controlled trials clearly demonstrate medical and economic advantages over conventional open surgical techniques, in selected groups of patients (3).
{"title":"Minimally invasive liver surgery: a field is maturing","authors":"E. Sucher, R. Sucher","doi":"10.21037/LS.2019.08.01","DOIUrl":"https://doi.org/10.21037/LS.2019.08.01","url":null,"abstract":"Minimally invasive liver surgery is undergoing exponential growth (1). Since its first application (2), laparoscopic surgery has been increasingly used to address benign and malignant liver lesions ranging from minor resections to major hepatectomies. First randomized controlled trials clearly demonstrate medical and economic advantages over conventional open surgical techniques, in selected groups of patients (3).","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49156701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bilateral adrenalectomy is an exceedingly rare operation. Less than 1% of patients undergoing adrenal surgery will need a bilateral procedure. As the vast majority of surgeons offering adrenal surgery have a minimal annual workload of under 4–6 cases per year it is imperative to centralise the care of the small number of patients who need bilateral adrenalectomy. This paper reviews the indications for the procedure and comments on its technical feasibility.
{"title":"Bilateral adrenalectomy—simultaneous or delayed?","authors":"R. Mihai","doi":"10.21037/ls.2019.06.03","DOIUrl":"https://doi.org/10.21037/ls.2019.06.03","url":null,"abstract":"Bilateral adrenalectomy is an exceedingly rare operation. Less than 1% of patients undergoing adrenal surgery will need a bilateral procedure. As the vast majority of surgeons offering adrenal surgery have a minimal annual workload of under 4–6 cases per year it is imperative to centralise the care of the small number of patients who need bilateral adrenalectomy. This paper reviews the indications for the procedure and comments on its technical feasibility.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/ls.2019.06.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47799134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Cesar, M. Valadão, Eduardo Linhares, J. P. Jesus, F. Lott, Bernardo Lindenberg Braga Nóbrega, F. Campos, G. Guitmann, E. Lustosa, A. Iglesias
Background: Minimally invasive surgery of the pelvis is technically demanding, limiting its application. Previous studies have reported the potential advantages of robotic-assisted surgery (RAS) for pelvic malignancies. These advantages might facilitate the surgeons to advance effortlessly along the learning phase. However, there are limited studies evaluating the learning curve (LC) and none have compared different surgical specialties. The objective of this study is to evaluate and compare the robotic LC of different oncological pelvic specialties. Methods: This retrospective study evaluates consecutive patients operated on by a robotic platform between January 2012 and June 2016 by urological, gynecological and rectal surgeons. Pre-operative and intraoperative parameters including docking time (DT), surgeon console time (SCT) and total operative time (TOT) were analyzed by linear regression and cumulative sum (CUSUM) methods. Body mass index (BMI), conversion rate (CR) to open surgery and estimated blood loss (EBL) were also studied in order to determine if there is a correlation with the LC. Results: Three hundred and forty-three RAS and seven surgeons were included in the analysis, 103 RAS for rectal cancer were performed by 3 rectal surgeons, 55 RAS for endometrial cancer and 58 RAS for cervical cancer were performed by 2 surgeons and 127 RAS prostatectomies were performed by 2 urologists. For most surgeons, the CUSUM graphs exhibited a 3 phases LC with turning points reflecting competency and proficiency. Urological surgeons had the most well-defined LC followed by the gynecologists. All surgeons were able to master docking with few cases. Rectal surgeons were not able to show a 3 phase LC for SCT and TOT. There was a clear inverse correlation between BMI and DT, patients with higher BMI had a shorter DT and patients with lower BMI showed increased DT. EBL had no statistical correlation with the LC and the CR was low (2%). Conclusions: Analysis of our data suggests that the LC for each respective robotic operative step, surgeon and specialty is unique. Urological and gynecological RAS might have a less steep LC compared to RAS for rectal cancer. Therefore, robotic proctoring and training for rectal cancer should be more diligent. Prospective multicenter study with different methods of LC analysis is necessary to validate our results.
{"title":"Cumulative sum analysis of the robotic learning curve in the surgical management of malignant pelvic neoplasms","authors":"D. Cesar, M. Valadão, Eduardo Linhares, J. P. Jesus, F. Lott, Bernardo Lindenberg Braga Nóbrega, F. Campos, G. Guitmann, E. Lustosa, A. Iglesias","doi":"10.21037/LS.2019.07.07","DOIUrl":"https://doi.org/10.21037/LS.2019.07.07","url":null,"abstract":"Background: Minimally invasive surgery of the pelvis is technically demanding, limiting its application. Previous studies have reported the potential advantages of robotic-assisted surgery (RAS) for pelvic malignancies. These advantages might facilitate the surgeons to advance effortlessly along the learning phase. However, there are limited studies evaluating the learning curve (LC) and none have compared different surgical specialties. The objective of this study is to evaluate and compare the robotic LC of different oncological pelvic specialties. \u0000 Methods: This retrospective study evaluates consecutive patients operated on by a robotic platform between January 2012 and June 2016 by urological, gynecological and rectal surgeons. Pre-operative and intraoperative parameters including docking time (DT), surgeon console time (SCT) and total operative time (TOT) were analyzed by linear regression and cumulative sum (CUSUM) methods. Body mass index (BMI), conversion rate (CR) to open surgery and estimated blood loss (EBL) were also studied in order to determine if there is a correlation with the LC. \u0000 Results: Three hundred and forty-three RAS and seven surgeons were included in the analysis, 103 RAS for rectal cancer were performed by 3 rectal surgeons, 55 RAS for endometrial cancer and 58 RAS for cervical cancer were performed by 2 surgeons and 127 RAS prostatectomies were performed by 2 urologists. For most surgeons, the CUSUM graphs exhibited a 3 phases LC with turning points reflecting competency and proficiency. Urological surgeons had the most well-defined LC followed by the gynecologists. All surgeons were able to master docking with few cases. Rectal surgeons were not able to show a 3 phase LC for SCT and TOT. There was a clear inverse correlation between BMI and DT, patients with higher BMI had a shorter DT and patients with lower BMI showed increased DT. EBL had no statistical correlation with the LC and the CR was low (2%). \u0000 Conclusions: Analysis of our data suggests that the LC for each respective robotic operative step, surgeon and specialty is unique. Urological and gynecological RAS might have a less steep LC compared to RAS for rectal cancer. Therefore, robotic proctoring and training for rectal cancer should be more diligent. Prospective multicenter study with different methods of LC analysis is necessary to validate our results.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/LS.2019.07.07","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41837357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The distal pancreatectomy (DP) with or without splenectomy, has to be considered the standard of care for the treatment of benign, borderline, and malignant lesions of the pancreatic body and tail.
{"title":"The impact of minimally invasive surgery and robot-assisted surgery on distal pancreatic resection: a snapshot on literature review and future technical innovations","authors":"A. Rocca, Andrea Scacchi, G. Ceccarelli","doi":"10.21037/LS.2019.07.01","DOIUrl":"https://doi.org/10.21037/LS.2019.07.01","url":null,"abstract":"The distal pancreatectomy (DP) with or without splenectomy, has to be considered the standard of care for the treatment of benign, borderline, and malignant lesions of the pancreatic body and tail.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/LS.2019.07.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47820376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatobiliary surgery is among the last frontiers in terms of the advancement and wide acceptance of minimally invasive approaches; particularly with liver resections (1). Given the difficulty of these operations when performed via laparotomy in regard to exposure, hemostasis and adequate oncologic resection; it is understandable why laparoscopic liver resection (LLR) was initially viewed with a healthy dose of skepticism.
{"title":"Laparoscopic liver resection in cirrhosis: the challenge of the posterosuperior segments","authors":"Auriel T. August, B. Visser","doi":"10.21037/LS.2019.07.04","DOIUrl":"https://doi.org/10.21037/LS.2019.07.04","url":null,"abstract":"Hepatobiliary surgery is among the last frontiers in terms of the advancement and wide acceptance of minimally invasive approaches; particularly with liver resections (1). Given the difficulty of these operations when performed via laparotomy in regard to exposure, hemostasis and adequate oncologic resection; it is understandable why laparoscopic liver resection (LLR) was initially viewed with a healthy dose of skepticism.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46147141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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