Surgery of the alimentary tract for benign and malignant disease with the novel robotic platform HUGOTM RAS. A first world report of safety and feasibility

Introduction

As robotic surgery increases its reach, novel platforms are being released. We present the first 17 consecutive cases of alimentary tract surgery performed with the Hugo^TM RAS (Medtronic).

Methods

patients were selected to undergo surgery from February through April 2023. Exclusion criteria were age <16 years, BMI>60, ASA IV.

Results

17 patients underwent ileocaecal resection for Chrons disease (2 M and 1 F) and pseudo-obstruction of the terminal ileum (1 M), cholecystectomy (3 M and 5 F), subtotal gastrectomy with D2 lymphadenectomy (1 F), sleeve gastrectomy (1 F), hiatal hernia repair with Nissen fundoplication (1 M), right hemicolectomy (1 M) and sigmoidectomy (1 M). No conversion to an open approach or any arm collisions requiring corrective actions were reported.

Conclusions

Our preliminary experience with the Hugo^TM RAS point to safety and feasibility for a rather wide spectrum of surgical procedures of the alimentary tract.     

Postoperative impairment of cognitive function in old mice: a possible role for neuroinflammation mediated by HMGB1, S100B,and RAGE

Background

Postoperative cognitive dysfunction, a common complication after surgery in elderly patients, is an increasing and largely underestimated problem without a defined etiology. Neuroinflammation plays an important role in the pathogenesis of postoperative cognitive dysfunction. The present study sought to investigate the role of neuroinflammation mediated by high-mobility group box 1 (HMGB1), S100B, and the receptor for advanced glycation end product (RAGE) in cognitive dysfunction after partial hepatectomy in aged mice.

Materials and methods

Old C57BL/6 mice were randomly divided into three groups: normal control (n = 18), anesthetic (n = 66), and surgery (n = 66). The mice in the surgery or anesthetic group received isoflurane anesthesia for either partial hepatectomy or no surgery, respectively. Cognitive function was subsequently assessed using a Y-maze. HMGB1, S100B, RAGE, interleukin-1β, and nuclear factor-kappaB p65 levels were measured at 12 h and 1, 3, and 7 d after surgery. Immunofluorescence double labeling was performed to study the colocalization between RAGE and its ligands, HMGB1 and S100B.

Results

The mice’s learning and memory abilities were significantly impaired at 1 and 3 d and 2 and 4 d after surgery, respectively. The expression of HMGB1, S100B, RAGE, and nuclear factor-kappaB p65 had increased significantly at 12 h and 1 and 3 d after surgery. The interleukin-1β level was significantly increased at 1 and 3 d after surgery. The interaction of HMGB1 or S100B with RAGE was confirmed at 1 d after surgery.

Conclusions

These data suggest that HMGB1, S100B, and RAGE signaling modulate the hippocampal inflammatory response and might play key roles in surgery-induced cognitive decline.     

Emergency Surgery in Patients Who Have Undergone Recent Radiotherapy is Associated With Increased Complications and Mortality: Review of 536 Patients

Background  

There is a paucity of data regarding patients undergoing emergency surgery following radiotherapy. This study examines the morbidity and mortality of patients having emergent surgery ≤90 days after irradiation.     

A pilot study for one-stop endoscopic total extraperitoneal inguinal hernia repair

Background  

One-stop surgery was developed for patients to undergo surgical evaluation, anesthesia, surgery, and discharge all within 1 day. This study aimed to assess the feasibility, patient satisfaction, and potential of one-stop endoscopic total extraperitoneal (TEP) inguinal hernia surgery.     

Laparoscopic Pylorus-Preserving Pancreatic Head Resection and Hybrid Open Reconstruction via Pancreatogastrostomy

Introduction  

Laparoscopic pancreatic surgery is ambitious and should only be performed in institutions with expert knowledge in pancreatic surgery.     

A multicenter survey on profile of care for hip fracture: predictors of mortality and disability

Summary  

Because delay in time to surgery beyond 24–48 h has been observed in many studies to be associated with adverse outcomes, a survey in nine centers in Italy was undertaken to examine the impact of time to surgery on mortality and disability at 6 months after hospitalization.     

Management of tracheobronchial foreign bodies-experience of cardiothoracic department of cardiology institute

Background  

We report our experience of 3 years in the management of tracheobronchial foreign bodies in our department of cardiothoracic surgery.     

Thoracoscopy in the management of congenital lung diseases in infancy

Background  

This study aimed to compare the results of thoracoscopic surgery for congenital lung diseases between infants younger than 6 months and those older than 6 months at the time of surgery in terms of operation duration, surgical complications, chest tube duration, and hospital stay.     

Antidepressant Drug Therapy Does Not Affect Weight Loss One Year after Gastric Bypass Surgery

Background  

Preliminary data suggest that patients with actively treated depression should expect the same outcomes after surgery. The objective of this study was to compare weight loss 12 months after gastric bypass surgery in patients taking antidepressants before surgery (AD) versus those who were not (non-AD).     

Bariatric Surgery Outcomes in the Elderly: An ACS NSQIP Study

Introduction  

Mortality and complications following bariatric surgery occur at acceptable rates, but its safety in the elderly population is unknown. We hypothesized that short-term operative outcomes in bariatric surgery patients ≥65 years would be comparable to younger persons.     

Early Effects of Gastric Banding (LGB) and of Biliopancreatic Diversion (BPD) on Insulin Sensitivity and on Glucose and Insulin Response after OGTT

Background  

Bariatric surgery improves glucose metabolism.     

Anesthesia for Bariatric Surgery

Background  

Bariatric surgery has a lot of problems in anesthesia. We retrospectively compared anesthesia for bariatric surgery in yellow race with that in normal weight patients.     

Intraoperative transoesophageal echocardiography (ITEE) in mitral valve surgery

Background  

Patients undergoing mitral valve surgery were assessed for morphology and function by Transoesophageal Echocardiography (TEE) at surgery over a 5 year period.     

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy

Background  

Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.     

Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis

Background  

Single incision laparoscopic surgery (SILS) may further reduce the trauma of surgery leading to reduced port site complications and postoperative pain. The improved cosmetic result also may lead to improved patient satisfaction with surgery.     

From ancient to contemporary times: a concise history of incisional hernia repair

Purpose  

This historical review explores the origins of incisional hernia surgery.     

Risk factors in patient safety: minimally invasive surgery versus conventional surgery

Background  

This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS).     

Adjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial

Purpose  

To identify the effects of adding two different doses of dexamethasone on the duration and quality of interscalene block in patients undergoing shoulder surgery in ambulatory surgery settings.     

A randomized trial of automated intermittent ropivacaine administration vs. continuous infusion in an interscalene catheter

Background

Ultrasound‐guided interscalene nerve block with ropivacaine as local anesthetic agent given as boluses or continuous infusion is the preferred pain management after major shoulder surgery. The use of automated intermittent boluses has been shown to be superior to continuous infusion in sciatic and epidural nerve block. Hypothesis: Automated intermittent boluses reduce pain after major shoulder surgery.

Methods

Seventy patients aged 18–75 years, scheduled for major shoulder surgery under general anesthesia with interscalene nerve block were included in this randomized controlled trial. Patients were allocated to either automated intermittent boluses with 16 mg ropivacaine every 2 h combined with patient‐controlled administration or to a conventional regimen of continuous infusion of 8 mg/h (4 ml/h) of ropivacaine combined with patient controlled administration (2 ml, lockout time 30 min). Pain (Visual Analog Scale, VAS) was assessed every 8 h postoperatively.

Results

Fifty‐seven patients completed the study, 29 in the continuous infusion group and 28 in the automated intermittent bolus group. Shoulder arthroplasty was performed in 49 (86%) of the cases. There were no significant differences in VAS score from 8 to 48 h post‐operatively. No significant difference in opioid usage was observed. The automated intermittent bolus group reported significantly less force on coughing and more hoarseness. A significantly lower volume of ropivacaine was used in the automated intermittent bolus group.

Conclusion

Automated intermittent boluses did not reduce pain or rescue opioid consumption compared with continuous infusion of ropivacaine. The automated intermittent bolus group had significantly less force on coughing and more hoarseness.     

Which factors determine subjective improvement following pelvic organ prolapse 1?year after surgery?

Introduction and hypothesis  

The factors influencing a patient’s subjective improvement 1 year after pelvic organ prolapse (POP) surgery were studied.