Background Laparoscopic liver resection has not been widely used because of intraoperative bleeding. This problem should be solved with instruments and techniques that require a short learning curve. Materials and methods The aim of this work was to present the technique used in our center to perform laparoscopic liver resection using the 'curettage and aspiration' technique with laparoscopic Peng's multifunctional operational dissectors and regional occlusion of inflow and outflow. We retrospectively analyzed patients who underwent a laparoscopic liver resection from August 1998 to August 2012, and collected the conversion rate, operating time, blood loss, hospitalization, bile leakage rate, bleeding rate, and other complications on a yearly basis and in total.We used SPSS software to analyze whether there was a significant difference, and summarized the learning curve of laparoscopic liver resection with various procedures. Results We performed 365 cases of laparoscopic liver resection, including left hemihepatectomy, left lateral lobectomy, segmental hepatectomy, non-anatomic liver resection, right hemihepatectomy, and caudate lobectomy. The diseases included liver cancer, hepatolithiasis, liver hemangioma, focal nodular hyperplasia, liver abscess, and metastatic hepatic carcinoma. In total, 63 cases (17.20 %) were converted to open surgery because of severe adhesions, bleeding, or anatomical limitation. Mean blood loss was 370.6 ± 404.0 ml; mean operating time was 150.8 ± 73.0 min; and mean postoperation hospitalization was 9.2 ± 5.3 days. There were four cases (1.32 %) with the complication of bile leakage and two cases of hemorrhage (0.66 %). No intraoperative or postoperative deaths occurred. After finishing 15-30, 43, 35, and 28 cases of laparoscopic left hemihepatectomy, left lateral hepatectomy, non-anatomic liver resection, and segmentectomy, respectively, the average operating time, blood loss, and hospitalization were almost the same as the overall mean results. Conclusion The technique used in our center is a safe, fast, and effective approach to laparoscopic liver resection. Our 14 years of experience demonstrates that this technique can prevent postoperative bleeding and bile leakage. A surgeon can master the skill of laparoscopic left hemihepatectomy, left lateral hepatectomy, non-anatomic liver resection, and segmentectomy after *15-30, 43, 35, and 28 case procedures, respectively.
are the base on which any RTO system is built. A number of researchers have investigated the design and interaction of these two subsystems, particularly with respect to plant/model mismatch. The Two-Phase approach (Chen and Joseph, 1987) is the most widely used method for model updating and modelbased optimization in RTO. In this approach the optimization problem and parameter estimation problem are solved separately. Although this Two-Phase approach attempts to solve the RTO problem by updating the imperfect model, it will not necessarily converge to the correct optimum (Durbeck, 1965;Biegler et al., 1985;Forbes et al., 1994). To address this issue, methods have been proposed to deal explicitly with plant/model mismatch. These methods fall into two distinct classes: (1) those that modify the RTO problem directly; and (2) those that use adaptive control ideas modifi ed to suit RTO applications.This paper provides a comprehensive performance analysis approach for Real-Time Optimization (RTO) technologies, which incorporates systematic approaches to estimating bounds on the convergence behaviour and performance effects of on-line experiments used by a given RTO approach. The performance analysis method is illustrated by an investigation of the conventional two-phase approach and representative techniques drawn from the three main classes of perturbation-based RTO methods which attempt to directly compensate for plant/model mismatch through adaptation. The proposed approach is applied to two simulation-based case studies: a heat exchanger system and a continuous bioreactor.On présente dans cet article une méthode complète d'analyse de performance pour les technologies d'optimisation en temps réel (RTO), qui comporte des approches systématiques pour l'estimation des bornes de convergence et les effets de performance sur des expériences en ligne utilisées dans une approche RTO donnée. L'analyse de performance est illustrée par une étude de l'approche conventionnelle à deux phases et des techniques représentatives issues des trois catégories principales de méthodes RTO basées sur des perturbations et qui tentent de compenser directement l'incompatibilité usine/modèle par l'adaptation. La méthode proposée est appliquée à deux études de cas basées sur des simulations : un système d'échangeur de chaleur et un bioréacteur continu.
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