The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.
A tuned liquid column damper (TLCD) system provides the same level of vibration suppression as a conventional tuned mass damper (TMD) system but with several advantages. A new hybrid control system is presented through judicious combination of a passive supplementary damping system with a semi-active TLCD system. The new model utilizes the advantages of both passive and semi-active control systems, thereby improving the overall performance, reliability, and operability of the control system during normal operations as well as a power or computer failure. The robust wavelet-hybrid feedback least mean square (LMS) control algorithm developed recently by the authors is used to find optimal values of the control parameters. The effectiveness and robustness of the proposed hybrid damper-TLCD system in reducing the vibrations under various seismic excitations are evaluated through numerical simulations performed for an eight-story frame using three different simulated earthquake ground accelerations. It is found that the new model is effective in significantly reducing the response of the structure under various seismic excitations.
Hepatocellular carcinoma patients with BDTT achieved relatively favorable long-term results after resection; therefore extensive surgery should be recommended when complete resection is anticipated.
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