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Back W, Rho J, Kim K, Yong HS, Jeon OH, Choi BH, Kim HK, Park JH. An injectable fluorescent and iodinated hydrogel for preoperative localization and dual image-guided surgery of pulmonary nodules. Biomater Sci 2024; 12:2943-2950. [PMID: 38651530 DOI: 10.1039/d4bm00035h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The widespread use of video-assisted thoracoscopic surgery (VATS) has triggered the rapid expansion in the field of computed tomography (CT)-guided preoperative localization and near-infrared (NIR) fluorescence image-guided surgery. However, its broader application has been hindered by the absence of ideal imaging contrasts that are biocompatible, minimally invasive, highly resolvable, and perfectly localized within the diseased tissue. To achieve this goal, we synthesize a dextran-based fluorescent and iodinated hydrogel, which can be injected into the tissue and imaged with both CT and NIR fluorescence modalities. By finely tuning the physical parameters such as gelation time and composition of iodinated oil (X-ray contrast agent) and indocyanine green (ICG, NIR fluorescence dye), we optimize the hydrogel for prolonged localization at the injected site without losing the dual-imaging capability. We validate the effectiveness of the developed injectable dual-imaging platform by performing image-guided resection of pulmonary nodules on tumor-bearing rabbits, which are preoperatively localized with the hydrogel. The injectable dual-imaging marker, therefore, can emerge as a powerful tool for surgical guidance.
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Affiliation(s)
- Woojin Back
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
| | - Jiyun Rho
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea.
- Department of Biomedical Sciences, College of Medicine Korea University, Seoul, Republic of Korea
| | - Kyungsu Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea.
- Department of Biomedical Sciences, College of Medicine Korea University, Seoul, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea
| | - Ok Hwa Jeon
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea.
- Department of Biomedical Sciences, College of Medicine Korea University, Seoul, Republic of Korea
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea.
- Department of Biomedical Sciences, College of Medicine Korea University, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine Korea University, Seoul, Republic of Korea.
- Department of Biomedical Sciences, College of Medicine Korea University, Seoul, Republic of Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
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Sato T, Kitani I. A novel Foley catheter made of high-intensity near-infrared fluorescent silicone rubber for image-guided surgery of lower rectal cancer. Photodiagnosis Photodyn Ther 2024; 45:103976. [PMID: 38224726 DOI: 10.1016/j.pdpdt.2024.103976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Urethral injury occurs in 1-6 % of male cases during minimally invasive surgery of lower rectal cancer. A Foley catheter emitting near-infrared (NIR) fluorescence of sufficient intensity has been expected to locate the urethra during image-guided surgery. Although it has been difficult to impart NIR fluorescent properties to biocompatible thermosetting polymers, we have recently succeeded in developing a NIR fluorescent compound for silicone rubber and a NIR fluorescent Foley catheter (HICARL). Here, we evaluated its NIR fluorescence properties and visibility performance using porcine anorectal isolation specimens. METHODS The HICARL catheter was made of a mixture of solid silicone rubber and a NIR fluorescent compound that emits fluorescence with a wavelength of 820-880 nm, while a conventional transparent Foley catheter was made of solid silicone rubber only. As a standard for comparison of the intensity of NIR fluorescence, a transparent Foley catheter the lumen of which was filled with a mixture of indocyanine green (ICG) and human plasma was used. As a comparison to assess the visibility performance of the HICARL catheter, a transparent Foley catheter into which a commercially available NIR fluorescent polyurethane ureteral catheter (NIRC) was placed was used. RESULTS A NIR fluorescence quantitative imaging analysis revealed that the Foley-NIRC catheter and the HICARL catheter emitted 3.42 ± 0.42 and 6.43 ± 0.07 times more fluorescence than the Foley-ICG catheter, respectively. The location of the HICARL catheter placed in the anorectum with a wall thickness of 3.8 ± 0.1 mm was clearly delineated in its entirety by NIR fluorescence, while that of the Foley-NIRC catheter was faintly or only partially visible. CONCLUSIONS The HICARL catheter emitting NIR fluorescence of sufficient intensity is a promising and easy-to-use tool for urethral visualization during image-guided surgery of lower rectal cancer.
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Affiliation(s)
- Takayuki Sato
- Department of Cardiovascular Control, Kochi Medical School, Oko, Nankoku 783-8505, Japan.
| | - Ichiro Kitani
- R&D Marketing Department, Mizuho Corporation, 3-30-13, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Misaki N, Tatakawa K, Chang SS, Go T, Yokomise H. Constant-rate intravenous infusion of indocyanine green leading to high fluorescence intensity in infrared thoracoscopic segmentectomy. JTCVS Tech 2020; 3:319-324. [PMID: 34317916 PMCID: PMC8302929 DOI: 10.1016/j.xjtc.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives The purpose of this study was to determine whether or not fluorescence could be increased by administering indocyanine green at a constant rate, thus stabilizing its blood concentration. Methods In 20 consecutive patients undergoing segmentectomy, the dominant pulmonary arteries were ligated, blocking blood in the target segment. Fluorescence intensity was then observed using different indocyanine green administration methods under infrared thoracoscopy. Intravenous administration of indocyanine green, via a syringe pump at a rate of 12.5 mg/min, was defined as the constant rate group. The bolus group was defined by a 5-mg indocyanine green rapid intravenous injection. The fluorescence intensity was compared at the time of maximum fluorescence and 2 minutes after fluorescence initiation. Results At maximum staining, the fluorescence intensity of the normal blood flow area was brighter in the constant rate group (median, 184.2; interquartile range, 170.2-200.1) compared with the bolus group (median, 122.3; interquartile range, 87.3-144.7; P = .0003). The fluorescence of the normal blood flow was retained even after 2 minutes. There was no difference in the fluorescence intensity of the ischemic segments. Conclusions The constant rate method showed brighter and better fluorescence than the bolus injection, without an increase in the dose. The contrast between adjacent segments was clear, facilitating the differentiation of the areas.
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Affiliation(s)
- Noriyuki Misaki
- Department of General Thoracic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa Prefecture, Japan
- Department of General Thoracic Breast and Endocrinological Surgery, Kagawa University, Takamatsu City, Kagawa Prefecture, Japan
- Address for reprints: Noriyuki Misaki, MD, Department of General Thoracic Surgery, Takamatsu Municipal Hospital, 847-1 Bushozan-cho Kou, Takamatsu City, Kagawa Prefecture, Japan.
| | - Kiichi Tatakawa
- Department of General Thoracic Surgery, Takamatsu Municipal Hospital, Takamatsu City, Kagawa Prefecture, Japan
| | - Sung Soo Chang
- Department of General Thoracic Breast and Endocrinological Surgery, Kagawa University, Takamatsu City, Kagawa Prefecture, Japan
| | - Tetsuhiko Go
- Department of General Thoracic Breast and Endocrinological Surgery, Kagawa University, Takamatsu City, Kagawa Prefecture, Japan
| | - Hiroyasu Yokomise
- Department of General Thoracic Breast and Endocrinological Surgery, Kagawa University, Takamatsu City, Kagawa Prefecture, Japan
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Gregor A, Ujiie H, Yasufuku K. Sentinel lymph node biopsy for lung cancer. Gen Thorac Cardiovasc Surg 2020; 68:1061-1078. [PMID: 32661834 DOI: 10.1007/s11748-020-01432-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Sentinel lymph node biopsy is a technique to identify the first lymph node (or nodes) draining a tumor. The underlying principle is that as the first site of cancer spread, evaluation of the sentinel node will be most predictive for wider nodal involvement. The introduction of sentinel node biopsy revolutionized the surgical management of cutaneous melanoma and breast cancer, becoming a key component in the management of such patients. For over 20 years, thoracic surgeons have similarly worked to apply this technique to lung cancer but have thus far not had the same impact on lung surgery. In this review, we will summarize the ongoing discussions on the role of sentinel node biopsy in lung cancer, the methods for identifying the sentinel node, and the techniques for evaluating the sentinel node specimen. We will also highlight some of the pressing questions investigators should consider when designing a trial for sentinel node mapping. This will clarify the current status of sentinel node biopsy in lung cancer and thus highlight important future directions for research.
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Affiliation(s)
- Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada. .,Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, West-7, North-15, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Shirata C, Kawaguchi Y, Kobayashi K, Kobayashi Y, Arita J, Akamatsu N, Kaneko J, Sakamoto Y, Kokudo N, Hasegawa K. Usefulness of indocyanine green-fluorescence imaging for real-time visualization of pancreas neuroendocrine tumor and cystic neoplasm. J Surg Oncol 2018; 118:1012-1020. [DOI: 10.1002/jso.25231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Kosuke Kobayashi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yuta Kobayashi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
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Caso R, Jones GD, Jones DR. Sentinel lymph node mapping in lung cancer: a step forward? J Thorac Dis 2018; 10:S3254-S3256. [PMID: 30370130 DOI: 10.21037/jtd.2018.08.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Raul Caso
- Department of Surgery, Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gregory D Jones
- Department of Surgery, Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Department of Surgery, Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ujiie H, Effat A, Yasufuku K. Image-guided thoracic surgery in the hybrid operation room. J Vis Surg 2017; 3:148. [PMID: 29302424 DOI: 10.21037/jovs.2017.09.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/15/2017] [Indexed: 11/06/2022]
Abstract
There has been an increase in the use of image-guided technology to facilitate minimally invasive therapy. The next generation of minimally invasive therapy is focused on advancement and translation of novel image-guided technologies in therapeutic interventions, including surgery, interventional pulmonology, radiation therapy, and interventional laser therapy. To establish the efficacy of different minimally invasive therapies, we have developed a hybrid operating room, known as the guided therapeutics operating room (GTx OR) at the Toronto General Hospital. The GTx OR is equipped with multi-modality image-guidance systems, which features a dual source-dual energy computed tomography (CT) scanner, a robotic cone-beam CT (CBCT)/fluoroscopy, high-performance endobronchial ultrasound system, endoscopic surgery system, near-infrared (NIR) fluorescence imaging system, and navigation tracking systems. The novel multimodality image-guidance systems allow physicians to quickly, and accurately image patients while they are on the operating table. This yield improved outcomes since physicians are able to use image guidance during their procedures, and carry out innovative multi-modality therapeutics. Multiple preclinical translational studies pertaining to innovative minimally invasive technology is being developed in our guided therapeutics laboratory (GTx Lab). The GTx Lab is equipped with similar technology, and multimodality image-guidance systems as the GTx OR, and acts as an appropriate platform for translation of research into human clinical trials. Through the GTx Lab, we are able to perform basic research, such as the development of image-guided technologies, preclinical model testing, as well as preclinical imaging, and then translate that research into the GTx OR. This OR allows for the utilization of new technologies in cancer therapy, including molecular imaging, and other innovative imaging modalities, and therefore enables a better quality of life for patients, both during and after the procedure. In this article, we describe capabilities of the GTx systems, and discuss the first-in-human technologies used, and evaluated in GTx OR.
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Affiliation(s)
- Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Effat
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Abbas A, Kadakia S, Ambur V, Muro K, Kaiser L. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg 2017; 153:1581-1590. [DOI: 10.1016/j.jtcvs.2016.12.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/11/2016] [Accepted: 12/03/2016] [Indexed: 02/07/2023]
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Hachey KJ, Digesu CS, Armstrong KW, Gilmore DM, Khullar OV, Whang B, Tsukada H, Colson YL. A novel technique for tumor localization and targeted lymphatic mapping in early-stage lung cancer. J Thorac Cardiovasc Surg 2017; 154:1110-1118. [PMID: 28274559 DOI: 10.1016/j.jtcvs.2016.12.058] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate safety and feasibility of navigational bronchoscopy (NB)-guided near-infrared (NIR) localization of small, ill-defined lung lesions and sentinel lymph nodes (SLN) for accurate staging in patients with non-small cell lung cancer (NSCLC). METHODS Patients with known or suspected stage I NSCLC were enrolled in a prospective pilot trial for lesion localization and SLN mapping via NB-guided NIR marking. Successful localization, SLN detection rates, histopathologic status of SLN versus overall nodes, and concordance to initial clinical stage were measured. Ex vivo confirmation of NIR+ SLNs and adverse events were recorded. RESULTS Twelve patients underwent NB-guided marking with indocyanine green of lung lesions ranging in size from 0.4 to 2.2 cm and located 0.1 to 3 cm from the pleural surface. An NIR+ "tattoo" was identified in all cases. Ten patients were diagnosed with NSCLC and 9 SLNs were identified in 8 of the 10 patients, resulting in an 80% SLN detection rate. SLN pathologic status was 100% sensitive and specific for overall nodal status with no false-negative results. Despite previous nodal sampling, one patient was found to have metastatic disease in the SLN alone, a 12.5% rate of disease upstaging with NIR SLN mapping. SLN were detectable for up to 3 hours, allowing time for obtaining a tissue diagnosis and surgical resection. There were no adverse events associated with NB-labeling or indocyanine green dye itself. CONCLUSIONS NB-guided NIR lesion localization and SLN identification was safe and feasible. This minimally invasive image-guided technique may permit the accurate localization and nodal staging of early stage lung cancers.
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Affiliation(s)
- Krista J Hachey
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | | | - Denis M Gilmore
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Onkar V Khullar
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Brian Whang
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Hisashi Tsukada
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Yolonda L Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass.
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He J, Yang L, Yi W, Fan W, Wen Y, Miao X, Xiong L. Combination of Fluorescence-Guided Surgery With Photodynamic Therapy for the Treatment of Cancer. Mol Imaging 2017; 16:1536012117722911. [PMID: 28849712 PMCID: PMC5580848 DOI: 10.1177/1536012117722911] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/07/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022] Open
Abstract
Specific visualization of body parts is needed during surgery. Fluorescence-guided surgery (FGS) uses a fluorescence contrast agent for in vivo tumor imaging to detect and identify both malignant and normal tissues. There are several advantages and clinical benefits of FGS over other conventional medical imaging modalities, such as its safety, effectiveness, and suitability for real-time imaging in the operating room. Recent advancements in contrast agents and intraoperative fluorescence imaging devices have led to a greater potential for intraoperative fluorescence imaging in clinical applications. Photodynamic therapy (PDT) is an alternative modality to treat tumors, which uses a light-sensitive drug (photosensitizers) and special light to destroy the targeted tissues. In this review, we discuss the fluorescent contrast agents, some newly developed imaging devices, and the successful clinical application of FGS. Additionally, we present the combined strategy of FGS with PDT to further improve the therapeutic effect for patients with cancer. Taken together, this review provides a unique perspective and summarization of FGS.
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Affiliation(s)
- Jun He
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Leping Yang
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenjun Yi
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wentao Fan
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yu Wen
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiongying Miao
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Xiong
- General Surgery Department, Second Xiangya Hospital, Central South University, Changsha, China
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