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Background: There is no optimal reconstruction method after proximal gastrectomy. The valvuloplastic esophagogastrostomy can reduce postoperative reflux esophagitis, but it is technically complex with a long operation time. The gastric tube anastomosis is technically simple, but the incidences of reflux esophagitis and anastomotic stricture are higher. Methods: We have devised a modified valvuloplastic esophagogastrostomy after laparoscopy-assisted proximal gastrectomy (LAPG), the arch-bridge anastomosis. After reviewing our prospectively maintained gastric cancer database, 43 patients who underwent LAPG from November 2021 to April 2023 were included in this cohort study, with 25 patients received the arch-bridge anastomosis and 18 patients received gastric tube anastomosis. The short-term outcomes were compared between the two groups to evaluate the efficacy of the arch-bridge anastomosis. Reporting was consistent with the STROCSS 2021 guideline. Results: The median operation time was 180 min in the arch-bridge group, significantly shorter than the gastric tube group (p= 0.003). In the arch-bridge group, none of the 25 patients experienced anastomotic leakage, while one patient (4%) experienced anastomotic stricture requiring endoscopic balloon dilation. The postoperative length of stay was shorter in the arch-bridge group (9 vs. 11, p= 0.034). None of the patients in the arch-bridge group experienced gastroesophageal reflux and used proton pump inhibitor (PPI), while four (22.2%) patients in the gastric tube group used PPI (p= 0.025). The incidence of reflux esophagitis (Los Angeles grade B or more severe) by endoscopy was lower in the arch-bridge group (0% vs. 25.0%). Conclusion: The arch-bridge anastomosis is a safe, time-saving, and feasible reconstruction method. It can reduce postoperative reflux and anastomotic stricture incidences in a selected cohort of patients undergoing laparoscopy-assisted proximal gastrectomy. Graphical abstract:

We report the laser-diode pumped multi-gigahertz (GHz) self-mode-locked alexandrite femtosecond (fs) lasers for the first time, to the best of our knowledge. Using a simple linear cavity, stable mode-locked laser was achieved with a repetition rate of 3.6 GHz and a pulse width of 237 fs. Additionally, the second-harmonic mode-locked pulse was realized with a repetition rate of 7.5 GHz and a pulse width of 201 fs based on the Fabry–Perot effect generated in the laser cavity. It was observed that this laser possesses advantages of high repetition rate and short pulse width that enable the development of promising applications in modern ultrafast photonics.

Purpose: Automatic surgical skill assessment is an emerging field beneficial to both efficiency and quality of surgical education and practice. Prior works largely evaluate skills on elementary tasks performed in the simulation laboratory, which cannot fully reflect the variety of intraoperative circumstances in the real operating room. In this paper, we attempt to fill this gap by expanding surgical skill assessment onto a clinical dataset including fifty-seven in vivo surgeries. Methods: To tackle the workflow and device constraints in the clinical setting, we propose a robust and non-interruptive surrogate for surgical skills, namely the clearness of operating field (COF), which shows strong correlation with overall skills and high inter-annotator consistency on our clinical data. Then, an automatic model based on neural networks is developed to regress surgical skills through the surrogate of COF using only video as input. Results: The automatic model achieves 0.595 Spearman’s correlation with the ground truth of overall technical skill, which even exceeds the human performance of junior surgeons. Moreover, an exploratory study is conducted to validate the skill predictions against the clinical outcomes of patients. Conclusion: Our results demonstrate that the surrogate of COF is promising and the approach is potentially applicable to clinical practice.

We demonstrate the Kerr-lens mode-locked Pr^3+:LuLiF_4 (Pr:LLF) laser pumped by a blue laser diode (LD). By theoretical calculation of the group velocity dispersion in the laser gain, the compensation was employed for the realization of the continuous-wave mode-locked laser at the wavelength of 604 nm with the pulse width of 1.1 ps which, to the best of our knowledge, is the shortest pulse width in the Pr^3+ ion doped crystal lasers pumped with LDs. It can be believed that the present Pr:LLF laser should provide some inspiration for the development of the blue LD pumped visible lasers, especially in the mode-locking laser operation.