RESUMO
Worldwide use of robotic-assisted hepatectomy has increased dramatically over the past two decades. The role of robotic liver surgery is still controversial, especially with respect to its long-term oncological outcomes in treating early-stage hepatocellular carcinoma (HCC). The Glissonean approach is a fundamental technique for anatomical resection using open and laparoscopic liver surgery. To our knowledge, there have been few reports on purely robotic anatomical segmentectomy 7 for HCC using the Glissonean approach have been described. The present study describes the technical details and surgical outcomes of totally robotic segmentectomy 7 using the Glissonean approach. Fourteen patients with HCC limited to segment 7 underwent segmentectomy 7 from January 2019 through April 2023 in our hospital. The surgical techniques, peri-operative, and oncological outcomes were analyzed. Purely robotic anatomical segmentectomy 7 using the Glissonean approach was safe and feasible with the technology described herein in all of the 14 patients. The peri-operative and oncological outcomes were better and/or comparable with those of other similar hepatic resections using open approach and/or laparoscopic approach. The median follow-up time was 18 months. Intrahepatic recurrence occurred in 2 (14.3%) patient within one year following surgery. The 3-year overall survival rate was 81%. Although technically challenging, the purely robotic segmentectomy 7 could be performed safely and simultaneously with oncological radicality using the Glissonean approach.
RESUMO
Mineral resource bases have dual properties, e.g., mineral resources and environmental pollution. The latter could be classified into natural and anthropogenic pollution based on identifying the spatial distribution characteristics and sources of heavy metals in the soil. The Hongqi vanadium titano-magnetite mineral resources base in Luanping County, Luanhe watershed, was taken as the research object. The geo-accumulation index (Igeo), Nemerow comprehensive pollution index (PN), and potential ecological risk (Ei) were utilized to assess the soil heavy metal pollution characteristics, and redundancy analysis (RDA) and positive determinate matrix factorization (PMF) were employed to identify sources of the soil heavy metals. The results revealed that the mean contents of Cr, Cu, and Ni in the parent material of medium-basic hornblende metamorphic rock and medium-basic gneisses metamorphic rock were 1-2 times that in other parent materials in the concentrated area of mineral resources. However, the mean contents of Pb and As were lower. Fluvial alluvial-proluvial parent materials had the highest mean content of Hg, and the mean content of Cd was higher in the parent materials of medium-basic gneisses metamorphic rocks, acid rhyolite volcanic rocks, and fluvial alluvial-proluvial facies. The Igeodecreased in the following order:Cd>Cu>Pb>Ni>Zn>Cr>Hg>As. PN ranged from 0.61 to 18.99, and the sample proportion of moderate and severe pollution reached 10.00% and 8.08% respectively. Pishowed that the contents of Cu, Cd, Cr, and Ni were relatively higher in the parent material of intermediate-basic hornblende metamorphic rocks and intermediate-basic gneiss metamorphic rocks. Ei decreased in the order of Hg(58.06)>Cd(39.72)>As(10.98)>Cu(6.56) >Pb(5.60)>Ni(5.43)>Cr(2.01)>Zn(1.10). Samples whose RI was lower than 150 accounted for 84.27%, showing that the research area was predominantly at a slight potential ecological risk level. The sources of soil heavy metals were dominated by parent material weathering, followed by the mixed sources of agricultural activities and transportation, the exploitation of mining, and fossil burning, which accounted for 41.44%, 31.83%, 22.01%, and 4.73%, respectively. The risks of heavy metal pollution in the mineral resource base were characterized as multi-source instead of the single source from the mining industry. These research results provide the scientific basis for regional green mining development and eco-environmental protection.