Journal of Robotic Surgery最新文献

{"title":"Barriers and recommendations for the implementation of robot-assisted minimally invasive surgery in Africa.","authors":"Adebayo Feranmi Falola, Shivangi Singh, Upamanyu Das, Ayotemi Oluwagbemi, Rhoda Etta, Ademola Adeyeye","doi":"10.1007/s11701-024-02163-7","DOIUrl":"10.1007/s11701-024-02163-7","url":null,"abstract":"<p><p>Robotic surgery offers several advantages to the African setting, including shorter hospital stays, faster return to work, and increased overall productivity. However, its adoption has been limited by several factors. This review aims to present the barriers to implementation, and recommendations for integrating robotic surgery into the African healthcare system. Use of robotic surgery in Africa is primarily limited to Egypt and South Africa. Barriers faced by other countries were categorized into economic, infrastructural, systemic, and training-related. They include limited healthcare budgets, initial costs of robotic systems, patients' inability to afford robotic procedures, out-of-pocket healthcare financing, inadequate power supply, limited internet connectivity, poor healthcare leadership, and insufficient surgeon training facilities. Public-private partnerships, provision of loans and subsidies, introduction of cheaper robotic systems, and local manufacturing of robotic equipment will serve as cost-effective innovations. It is also important to improve healthcare financing and strengthen healthcare leadership across Africa. To address the lack of surgeon training facilities, remote assistance for surgeon training can be used to create a mentor-mentee relationship between robotic surgeons in any part of the world and surgical trainees in Africa to facilitate knowledge transfer. Prior investment in electricity and network infrastructure is however necessary. Establishment of fellowships to provide early exposure to robotic surgery should also be explored. AI-integrated robotic surgery can also enhance precision and safety, and provide tailored training tools for surgeons. Similar barriers to the adoption of surgical robotics are faced across Africa. By implementing the provided recommendations, robotic surgery can still be widely adopted in African settings, despite the delay.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"16"},"PeriodicalIF":2.2,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A simple technique to improve docking time in robotic surgery.","authors":"Yoav Mintz, Ram Elazary, Brigitte Helou, Ronit Brodie, Gad Marom","doi":"10.1007/s11701-024-02179-z","DOIUrl":"https://doi.org/10.1007/s11701-024-02179-z","url":null,"abstract":"<p><p>The docking process is a crucial step in robotic surgery, which determines the technical capability of moving the robotic arms during surgery and affects the performance of surgery. Robotic companies, therefore, provide setup guides recommending the trocar placement, arm carts, and operating table positioning for each procedure or body quadrant, to facilitate this process. This process takes time and although improves with experience, reported docking times range from 4 to 29 min. The final step of docking the robot is sometimes challenging and includes the insertion of the robotic instruments into the surgical field which involve patient safety. We implemented a simple new technique for safe insertion of robotic instruments and overcome the challenge of manipulating the camera arm for visualizing the trocars and advancing of the robotic instruments into the surgical field. This technique utilizes simple laparoscopic skills of laparoscopic instrument insertion. Docking times were recorded in ten consecutive patients undergoing robotic surgeries with the Hugo RAS™ and compared to our prospectively collected data registry prior to this technique. The new technique reduced the average docking time by 3.5 min and resulted in improvement of 45% in docking time. Integrating trivial laparoscopic skills into the docking process may simplify and reduce the docking time in robotic surgery.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"14"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of sarcopenia on postoperative complications and survival outcomes after robotic colorectal cancer surgery: a study based on single-center propensity score matching.","authors":"Yayan Fu, Shuai Zhao, Chenkai Zhang, Jie Wang, Ruiqi Li, Yifan Cheng, Jiajie Zhou, Wei Wang, Liuhua Wang, Jun Ren, Dong Tang, Daorong Wang","doi":"10.1007/s11701-024-02133-z","DOIUrl":"https://doi.org/10.1007/s11701-024-02133-z","url":null,"abstract":"<p><p>Sarcopenia is more common in elderly individuals and is often associated with functional limitations, which can affect postoperative clinical efficacy and mortality rates in cancer surgery. Yet, the precise effects of sarcopenia on individuals receiving robotic colorectal cancer surgery (RCRC) remain insufficiently explored. Our objective was to evaluate the value of preoperative skeletal muscle status on patients receiving RCRC about postoperative complications and long-term prognosis. Data were gathered retrospectively for patients with well-defined conditions. Clinical records of patients who underwent RCRC at a single center between January 2019 and September 2022 were analyzed. Sarcopenia was defined using preoperative computed tomography (CT) body composition analysis of the L3 vertebral level muscle index with cutoff values of < 29 cm²/m² for females and < 36 cm²/m² for males. In this retrospective study, 432 patients were sequentially sampled, and 127 pairs were formed through propensity score matching to contrast sarcopenic and non-sarcopenic patients. Relative to the non-sarcopenia group (NSCA), the sarcopenia group (SCA) showed increased rates of complications after matching (P = 0.045), especially in cases of wound and pulmonary infections (P = 0.0408). Compared to the NSCA group, the SCA group exhibited reduced rates of 3-year overall survival (OS) and disease-free survival (DFS) (P = 0.048, 0.036). Additionally, the SCA group experienced extended hospitalizations (P = 0.04) and heightened inflammatory indices before and after surgery (P = 0.028, 0.049). Sarcopenia before surgery in RCRC patients correlates with heightened post-surgery complications and lower rates of short-term survival. Conducting sarcopenia screenings before surgery could assist in evaluating risks and developing post-surgery management approaches for these patients.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"13"},"PeriodicalIF":2.2,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From gaming to surgery: the influence of digital natives on robotic skills development.","authors":"Dominik Imre Szabó, András Vereczkei, András Papp","doi":"10.1007/s11701-024-02178-0","DOIUrl":"10.1007/s11701-024-02178-0","url":null,"abstract":"<p><p>Our study investigates the potential correlation between generational differences, like age and previous experience with digital innovations, such as video games and smartphones, and the performance on the Da Vinci Skills Simulator, the cornerstone of robotic surgery training. Thirty participants were involved from three age groups: Generation Alpha, Generation Z, and Generation X. None had prior robotic surgical experience. Participants performed the Wrist Articulation 1 task on the Da Vinci Skills Simulator after two practice rounds. Analysis of performance metrics and statistical tests were conducted to assess the differences between groups. Additionally, participants had completed a survey on their habits related to video gaming, smartphone, and computer usage. A trend was observed where performance declined with age, meaning that Generation Alpha performed the most successfully compared to the other generations, although the difference was not statistically significant (p = 0.51). However, significant differences were found in Glass Movement (GM) by Generation Z showing superior precision, making less errors (p = 0.019). The study found no correlation between simulator performance and early or frequent exposure to smartphones or video games. Interestingly, frequent two-thumb typing on smartphones correlated with better performance in the GM metric (p = 0.006). Generation Z demonstrated greater precision in handling the simulator, reflecting that robotic surgery training might be best to be started at the beginning of residency programs. Young doctors using two-thumb typing develop robotic surgery skills faster. Further studies are needed to determine whether this quicker learning would also lead to better skills later on.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"12"},"PeriodicalIF":2.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic radical prostatectomy (RALP) with pre-existing inflatable penile prosthesis (IPP): technical innovations to improve safety and outcomes.","authors":"Shirin Razdan, Ali Fathollahi, Sanjay Razdan","doi":"10.1007/s11701-024-02128-w","DOIUrl":"https://doi.org/10.1007/s11701-024-02128-w","url":null,"abstract":"<p><p>Robotic-assisted laparoscopic radical prostatectomy (RALP) is the gold standard surgical approach for treatment of prostate cancer. Prostate cancer is often comorbid with erectile dysfunction (ED), and a small subgroup of men undergoing RALP have an indwelling inflatable penile prosthesis (IPP). In men with IPPs, we perform two techniques at the time of RALP to preserve the pelvic reservoir. In the No Touch Technique, we leave the pseudocapsule of the reservoir intact, electing to dissect the pelvic sidewall and lateral prostatic attachments away from the pseudocapsule. In the Safe Mobilization Technique, we sharply open the pseudocapsule overlying the reservoir and relocate the reservoir out of the pelvis. We retrospectively analyzed 155 cases (Group IPP) from a cohort of 1000 men who underwent RALP. These cases were compared to a randomly selected control group comprising 455 men with PCa who underwent RALP without prior IPP placement (Group NoIPP). We compared perioperative and functional outcomes. The overall incidence of positive surgical margins (PSM) did not significantly differ between the groups (14% in Group IPP and 12% in Group NoIPP, p = 0.4). Furthermore, there was no statistically significant difference in the incidence of PSM at the bladder neck between Group IPP (5.3%) and Group NoIPP (3.4%), p = 0.1. Binomial logistic regression analysis did not find prior IPP placement to be a significant predictor of continence at 3 and 6 months or for BCR. All patients in Group IPP were able to successfully cycle their devices postoperatively and there were no reported device infections. The No Touch Technique and Safe Mobilization Technique are easy to perform and safe adjunct procedures at the time of RALP in men with pre-existing IPP.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"11"},"PeriodicalIF":2.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of enhanced recovery after surgery concept in perioperative radical prostatectomy for prostate cancer.","authors":"Chengshuai Wu, Xinying Jiang, Yunfeng Shi, Zhong Lv","doi":"10.1007/s11701-024-02170-8","DOIUrl":"10.1007/s11701-024-02170-8","url":null,"abstract":"<p><p>Radical prostatectomy (RP) is the main treatment for early-stage localized prostate cancer. With the improvement of medical technology, radical prostatectomy is mainly performed under laparoscopy or robot assistance. With the continuous deepening of the Enhanced Recovery After Surgery (ERAS) concept in clinical practice, patients have increasingly high requirements for postoperative recovery. The ERAS concept is of great significance in the perioperative period and has been used in many surgical fields due to its ability to improve prognosis. ERAS has not yet been widely applied in urology and the research progress of other disciplines in ERAS has promoted its development in radical prostatectomy. This review summarizes the key elements of ERAS in the perioperative period of RP, aiming to demonstrate the superiority of ERAS and provide new references and inspirations for urologists.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"9"},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient reported health related quality of life outcomes after viable cryopreserved umbilical tissue placement directly over spared neurovascular bundles after robotic assisted radical prostatectomy.","authors":"Aidan Kennedy, Mit Shah, Alex Geisenhoff, Samantha Kraemer, Chirag Dave, Sabir Meah, Anna Johnson, Fiona Sun, Sugandh Shetty, Brian Seifman, Jason Hafron","doi":"10.1007/s11701-024-02101-7","DOIUrl":"https://doi.org/10.1007/s11701-024-02101-7","url":null,"abstract":"<p><p>Incontinence and sexual dysfunction remain common side effects from robotic-assisted radical prostatectomy (RARP) despite nerve sparing (NS) and bladder neck reconstruction techniques. Placing growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA-approved for surgery. The objective is to determine if vCUT use in NS-RARP accelerates return of continence and sexual function. A retrospective cohort of 176 patients undergoing NS-RARPs with and without vCUT from 2015 to 2020 was identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence at 3, 6, and 12 months, postoperatively was evaluated using MUSIC patient-reported outcomes (PRO), a validated questionnaire assessing urinary and sexual quality of life at baseline and post-treatment. A distinct cohort of 65 patients undergoing NS-RARP with and without vCUT was assessed for erections firm enough for intercourse at 12 and 24 months post-operatively using MUSIC-PRO. The association between vCUT use and social continence at 3 months was assessed via multivariable logistic regression. A descriptive analysis among patients with quality erections prior to surgery assessed the association between vCUT use and erection quality. Continence was achieved by 3 months post-op in 86% (99/115) of vCUT patients versus 74% (45/61) in non-vCUT patients (p = 0.044). In a multivariable analysis, although not reaching conventional statistical significance, vCUT patients were more likely to achieve continence than non-vCUT patients (OR = 2.21, p = 0.073). At 24 months post-op, 32% of vCUT patients reported good sexual function versus 33% in non-vCUT patients (p = 0.9). vCUT use during NS-RARP is associated with quicker return to social urinary continence. However, no differences were seen in return of potency. Further studies with longer follow-up and larger sample sizes may further evaluate effectiveness of vCUT in accelerating return of postoperative continence and potency.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"10"},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative perioperative outcomes of intravenous indocyanine green during robot-assisted cystectomy: a meta-analysis and systematic review.","authors":"Gen Fan, Yinyu Wu, Junji Wang, Yu Wang, Yushui Chen, Ke Hu, Tielong Tang","doi":"10.1007/s11701-024-02171-7","DOIUrl":"10.1007/s11701-024-02171-7","url":null,"abstract":"<p><p>This study aimed to evaluate the clinical utility of intravenous indocyanine green (ICG) in the context of robot-assisted cystectomy (RAC) through a systematic review and meta-analysis. The primary focus was to compare postoperative complications and perioperative outcomes between the ICG cohort and the non-ICG cohort. The primary outcome indicators were the incidence of ureteroenteric strictures and the number of strictures anastomoses. A comprehensive search was performed across multiple databases, including PubMed, Embase, the Cochrane Library, and Web of Science, to identify pertinent studies that evaluate the application of ICG in RAC. The analysis of dichotomous variables was performed using relative risk (RR), while weighted mean difference (WMD) was utilized for comprehensive assessment of continuous variables. A total of 4 studies encompassing 732 patients were included in the analysis, comprising 311 patients who received ICG and 421 patients who did not. The baseline characteristics were found to be comparable between the two cohorts. The meta-analysis indicated that the occurrence of 90-day severe complications was markedly lower in the ICG cohort versus the non-ICG cohort (RR = 0.63, 95% CI 0.44-0.90, P = 0.011). In addition, the length of ureteral resection was longer in the ICG cohort compared to the non-ICG cohort (WMD = 0.25, 95% CI 0.01-0.49, P = 0.039), with notably significant results for right-side procedures (WMD = 0.54, 95% CI 0.28-0.80, P < 0.001). Nevertheless, no substantial differences observed between the two cohorts regarding the occurrence of ureteroenteric stricture, numbers of strictures at anastomoses, operative time (OT), length of hospitalization (LOS), or lymph node positivity. Compared with the non-ICG cohort, the ICG cohort had comparable efficacy and was able to reduce the incidence of 90-day severe complications. The use of intravenous ICG showed promising clinical applicability during RAC; however, additional long-term studies are necessary to substantiate its effectiveness.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"7"},"PeriodicalIF":2.2,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted simple prostatectomy for men with benign prostatic hyperplasia and bothersome LUTS-a retrospective cohort study.","authors":"Peter Stapleton, Andrew Fuller, Raj Singh-Rai, Richard Wells, Emily Bak","doi":"10.1007/s11701-024-02168-2","DOIUrl":"https://doi.org/10.1007/s11701-024-02168-2","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BPH is a common urological pathology that affects 2480 per 100,000 men worldwide. With a rising population and increased age expectancy, the prevalence of benign prostatic hyperplasia (BPH) is increasing (Awedew et al. in Lancet Healthy Longev 3(11), 2022). There are many surgical management options for BPH with LUTS, including open simple prostatectomy (OSP), holmium laser enucleation of the prostate (HoLEP), transurethral resection of prostate (TURP), and transurethral electro vaporization of the prostate (TUVP) (Cho et al. in Int Neurourol J 24(1), 2020). However, these options often have a steep learning curve and increasing complexity with larger prostates. Robot-assisted simple prostatectomy (RASP) offers an alternative approach for large and very large glands for those already trained in robotic-assisted radical prostatectomy (RARP), particularly as robotic surgery continues to increase in popularity and is steadily becoming the standard of care in the management of prostate disease (Madersbacher et al. in Gerontology 65(5), 2019). The aim of this study was to demonstrate the surgical outcomes for men undergoing RASP for bothersome LUTs and/or acute urinary retention (AUR) secondary to BPH. A retrospective study was performed which included 105 patients who underwent RASP for the treatment of BPH causing lower urinary tract symptoms or acute urinary retention. This study reviews the pre-operative, (age, PSA, weight, prostate size) operative (duration, histology, estimated blood loss and hospital length of stay) and post-operative (duration of indwelling catheter, trial of void outcome, complications and post-operative PSA) outcomes, to evaluate the effectiveness of RASP for the management of BPH with LUTS. Data were analyzed using standard descriptive measures and multivariate logistic regression for comparison of continuous variables, significance was set to a CI of 95%. The median age of patients was 75 years (IQR 70-78) with a median prostate size of 135.5 cc (IQR 112.25-162.25). Patient demographic and pre-operative LUTS assessments are summarized in Table 1. Median operative time was 60 min (IQR 50-80), estimated blood loss was 350 ml (IQR 200-563), specimen weight was 98.5 g (IQR 69.5-120). Prostate size on imaging directly impacted operative duration (CI 0.07-0.2, p =  &lt; 0.001). Eleven (10.5%) of the patients involved in the review had a post-operative complication, two (1.9%) considered major complications Clavien-Dindo grade ≥ 3. There was a statistically increased risk of complications associated with advanced age and prostate size (p = 0.043 and p = 0.001). This study, although limited by its retrospective nature, demonstrates the safety and utility of robotic simple prostatectomy in the context of large and very large prostate volumes. In particular, it offers a safe alternative for men with large prostates who otherwise may not be suitable for endoscopic management. Further prospective and randomized control trials are n","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"8"},"PeriodicalIF":2.2,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Body mass index influence on short-term perioperative results in robotic-assisted laparoscopic partial nephrectomy: a comprehensive systematic review and meta-analysis.","authors":"Xiao-Bin Chen, Qiu-Lin Du, Ping-Yu Zhu","doi":"10.1007/s11701-024-02160-w","DOIUrl":"https://doi.org/10.1007/s11701-024-02160-w","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"5"},"PeriodicalIF":2.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}