In this systematic review, we aimed to clarify the useful anatomic structures and assess available surgical techniques and strategies required to safely perform minimally invasive anatomic liver resection (MIALR), with a particular focus on the hepatic veins (HVs). Methods: A systematic review was conducted using MEDLINE/PubMed for English articles and Ichushi databases for Japanese articles through September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 3372 studies were obtained, and 59 were selected and reviewed.Due to the limited number of published comparative studies and case series, the degree of evidence from our review was low. Thirty-two articles examined the anatomic landmarks and crucial structures for approaching HVs. Regarding the direction
The Brisbane 2000 Terminology for Liver Anatomy and Resections, based on Couinaud’s segments, did not address how to identify segmental borders and anatomic territories of less than one segment. Smaller anatomic resections including segmentectomies and subsegmentectomies, have not been well defined. The advent of minimally invasive liver resection has enhanced the possibilities of more precise resection due to a magnified view and reduced bleeding, and minimally invasive anatomic liver resection (MIALR) is becoming popular gradually. Therefore, there is a need for updating the Brisbane 2000 system, including anatomic segmentectomy or less. An online "Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (PAM‐HBP Surgery Consensus)" was hosted on February 23, 2021.
The Steering Committee invited 34 international experts from around the world. The Expert Committee (EC) selected 12 questions and two future research topics in the terminology session. The EC created seven tentative definitions and five recommendations based on the experts’ opinions and the literature review performed by the Research Committee. Two Delphi Rounds finalized those definitions and recommendations.
This paper presents seven definitions and five recommendations regarding anatomic segmentectomy or less. In addition, two future research topics are discussed.
The PAM‐HBP Surgery Consensus has presented the Tokyo 2020 Terminology for Liver Anatomy and Resections. The terminology has added definitions of liver anatomy and resections that were not defined in the Brisbane 2000 system.
The current unprecedented coronavirus 2019 (COVID-19) crisis has accelerated and enhanced e-learning solutions. During the so-called transition phase, efforts were made to reorganize surgical services, reschedule elective surgical procedures, surgical research, academic education, and careers to optimize results. The intention to switch to e-learning medical education is not a new concern. However, the current crisis triggered an alarm to accelerate the transition. Efforts to consider e-learning as a teaching and training method for medical education have proven to be efficient. For image-guided therapies, the challenge requires more effort since surgical skills training is combined with image interpretation training, thus the challenge is to cover quality educational content with a balanced combination of blended courses (online/onsite). Several e-resources are currently available in the surgical scenario; however, further efforts to enhance the current system are required by accelerating the creation of new learning solutions to optimize complex surgical education needs in the current disrupted environment.
Acute pancreatitis is the third most common gastrointestinal disorder
requiring hospitalization in the United States, with annual costs exceeding
$2 billions. Severe necrotizing pancreatitis is a life-threatening
complication developed in approximately 20% of patients. Its mortality rate
range from 15% in patients with sterile necrosis to up 30% in case of
infected one associated with multi-organ failure. Less invasive treatment
techniques are increasingly being used. These techniques can be performed in
a so-called step-up approach.
To present the technique for videoscopic assisted retroperitoneal debridement
(Vard technique) with covered metallic stent in necrotizing pancreatitis.
A guide wire was inserted through the previous catheter that was removed in
the next step. Afterwards, the tract was dilated over the guide wire. Then,
a partially covered metallic stent was deployed. A 30 degrees laparoscopic
camera was inserted and the necrosis removed with forceps through the
expanded stent under direct vision. Finally, the stent was removed and a new
catheter left in place.
This technique was used in a 31-year-old man with acute pain in the upper
abdomen and diagnosed as acute biliary pancreatitis with infected necrosis.
He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial
recovery, a left lateral VARD was performed (incomplete by fixed and
adherent tissue) at 8th week. As the patient´s inflammatory
response was reactivated, a second VARD attempt was performed in three weeks
later. Afterwards, patient showed complete clinical and imaging resolution.
Videoassisted retroperitoneal necrosectomy using partially covered metallic
stent is a feasible technique for necrotizing pancreatitis.
The concept of minimally invasive anatomic liver resection (MIALR) is gaining popularity. However, specific technical skills need to be acquired to safely perform MIALR. The “Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (PAM‐HBP Surgery Consensus)” was developed as a special program during the 32nd meeting of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery (JSHBPS).
Thirty‐four international experts gathered online for the consensus. A Research Committee performed a comprehensive literature review, classifying studies according to the Scottish Intercollegiate Guidelines Network method. Based on the literature review and experts’ opinions, tentative recommendations were drafted and circulated among experts using online Delphi Rounds. Finally, formulated recommendations were presented online in the Expert Consensus Meeting of the JSHBPS on February 23rd, 2021. The final recommendations were validated and finalized by the 2nd Delphi Round in May 2021.
Seven clinical questions were selected, and 22 recommendations were formulated. All recommendations reached more than 85% consensus among experts at the final Delphi Round.
The Expert Consensus Meeting for safely performing MIALR has presented a set of clinical guidelines based on available literature and experts’ opinions. We expect these guidelines to have a favorable effect on the safe implementation and development of MIALR.
In this work, a Spanish corpus that was developed, within the EMPATHIC project 1 framework, is presented. It was designed for building a dialogue system capable of talking to elderly people and promoting healthy habits, through a coaching model. The corpus, that comprises audio, video an text channels, was acquired by using a Wizard of Oz strategy. It was annotated in terms of different labels according to the different models that are needed in a dialogue system, including an emotion based annotation that will be used to generate empathetic system reactions. The annotation at different levels along with the employed procedure are described and analysed.1 http://www.empathic-project.eu/
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