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1.
Julia Torabi Juan P. Rocca Krystina Choinski Katherine Lorenzen Camille Yongue Michelle L. Lubetzsky Melvon E. Herbert Attasit Chokechanachaisakul Maria Ajaimy Layla Kamal Enver Akalin Milan Kinkhabwala Jay A. Graham 《Clinical transplantation》2018,32(1)
Background
We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.Methods
This is an observational retrospective cohort of 26 recipients who received either a locally procured (n = 16) or an imported pancreas graft (n = 10) at our center between January 2014 and May 2017. Wait list times of this cohort were compared to UNOS Region 9 (New York State and Western Vermont). Hospital financial data were also reviewed to analyze the cost‐effectiveness of this strategy.Results
Imported pancreas grafts had significantly increased cold ischemia times (CIT) and peak lipase (PL) levels compared to locally procured grafts (CIT 827 vs 497 minutes; P = .001, PL 563 vs 157 u/L; P = .023, respectively). There were no differences in graft or patient survival. The median wait time was significantly lower for simultaneous kidney‐pancreas transplants at our center (518 days, n = 21) compared to Region 9 (1001 days, n = 65) P = .038. Despite financial concerns, the cost of transport for imported grafts was offset by lower standard acquisition costs.Conclusions
Imported pancreas grafts may be a cost‐effective strategy to increase organ utilization and shorten wait times in regions with longer waiting times. 相似文献2.
Juan D. San Juan Abie H. Mendelsohn 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(4):e2510
Background
Transoral robotic surgery (TORS) using the Single-Port system (SPS) relies on electrocautery, limiting its applications in the upper aerodigestive tract. We evaluated the feasibility of a CO2 delivery system for the SPS.Methods
Otolaryngology residents performed a cutting exercise using a handheld CO2 laser and participated in a cadaveric oropharyngeal dissection using the SPS with monopolar cautery (SP + EC) and CO2 laser (SP + CO2). Residents completed the System Usability Scale (SUS) questionnaire to evaluate these techniques.Results
The same laser fiber was used for all combined dissections. The handheld CO2 laser, SP + EC, and SP + CO2 demonstrated similar SUS scores. On individual domain scores, SP + CO2 received less favorable ratings compared to the handheld CO2 laser for complexity, integration, and cumbersome experience (p < 0.05). On subgroup stratification, less TORS experience was associated with worse SUS scores.Conclusion
SP-guided CO2 laser delivery is a viable alternative to electrocautery in robotic surgery, and should be considered when performing TORS. 相似文献3.
Antonio Gangemi Paolo Bernante Matteo Rottoli Federica Pasquali Gilberto Poggioli 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(4):e2544
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 HugoTM 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 HugoTM RAS point to safety and feasibility for a rather wide spectrum of surgical procedures of the alimentary tract. 相似文献4.
Qiangqiang Liu Ziyu Mao Junjie Wang Changquan Wang Wenze Chen Wenzhen Chen Xiaolai Ye Chencheng Zhang Yong Lu Jiwen Xu 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(2):e2479
Background
We aimed to evaluate the accuracy and safety of a novel self-tapping bone fiducial as a registration technique for stereoelectroencephalography (SEEG) implantation.Methods
Each patient was installed with five bone fiducial markers. All procedures were performed using the same Sinovation robot system. The accuracy was determined by calculating the target point error (TPE) and the entry point error (EPE) of electrodes.Results
Fourteen patients underwent SEEG implantation surgery; and the average installation time of the markers per patient was 86.1 s. In the operating theatre, the average registration time was 206.6 s, and the average registration error was 0.18 mm. The average TPE of 174 electrodes was 1.98 mm and the average EPE was 0.88 mm.Conclusion
Our study provided a bone fiducial marker installation and registration technique that was convenient and fast, highly accurate in registration, and highly tolerated by patients. 相似文献5.
Junmo An Andrew G. Webb Dipan J. Shah Karen Chin Nikolaos V. Tsekos 《The international journal of medical robotics + computer assisted surgery : MRCAS》2018,14(1)
Background
A method for the identification of semi‐active fiducial magnetic resonance (MR) markers is presented based on selectively optically tuning and detuning them.Methods
Four inductively coupled solenoid coils with photoresistors were connected to light sources. A microcontroller timed the optical tuning/detuning of coils and image collection. The markers were tested on an MR manipulator linking the microcontroller to the manipulator control to visibly select the marker subset according to the actuated joint.Results
In closed‐loop control, the average and maximum were 0.76° ± 0.41° and 1.18° errors for a rotational joint, and 0.87 mm ± 0.26 mm and 1.13 mm for the prismatic joint.Conclusions
This technique is suitable for MR‐compatible actuated devices that use semi‐active MR‐compatible markers. 相似文献6.
A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis
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Thomas Ind Alex Laios Matthew Hacking Marielle Nobbenhuis 《The international journal of medical robotics + computer assisted surgery : MRCAS》2017,13(4)
7.
Navid Ahmadi MD MPhil Nima Ahmadi MBBS MS FRACS Praveen Ravindran MBBS FRACS Tae Jun Kim BMed GDipSurgSkills FRACS Christopher M. Byrne MBBS FRACS Christopher J. Young MBBS FRACS 《ANZ journal of surgery》2023,93(9):2161-2165
Background
Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis.Method
A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018.Result
A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001).Conclusion
Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications. 相似文献8.
Rashmitha Dachepally Alvaro Donaire Garcia Wei Liu Christine Flechler William J. Hanna 《Paediatric anaesthesia》2023,33(6):460-465
Background
Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.Aim
The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.Methods
This single-center retrospective cohort study included children 0–18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018–06/01/2021.Results
One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45–3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28–3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18–0.85] p = .017).Conclusion
In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions. 相似文献9.
W. Mauritz I. Wilbacher J. Leitgeb M. Majdan I. Janciak A. Brazinova M. Rusnak 《European journal of trauma and emergency surgery》2011,37(4):387-395
Goal
To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma. 相似文献10.
Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi‐port laparoscopy
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M. Carvello E. J. de Groof A. de Buck van Overstraeten M. Sacchi A. M. Wolthuis C. J. Buskens A. D'Hoore W. A. Bemelman A. Spinelli 《Colorectal disease》2018,20(1):53-58
Aim
Single port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi‐port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP laparoscopic ICR for CD.Method
This was a retrospective study of patients undergoing SP or MP ICR for CD in three tertiary referral centres from February 1999 to October 2014. Baseline characteristics (age, sex, body mass index and indication for surgery) were compared. Primary end‐points were postoperative pain scores, analgesia requirements and short‐term postoperative outcomes.Results
SP ICR (n = 101) and MP ICR (n = 156) patients were included in the study. Visual analogue scale scores were significantly lower after SP ICR on postoperative day 1 (P = 0.016) and day 2 (P = 0.04). Analgesia requirements were significantly reduced on postoperative day 2 in the SP group compared with the MP group (P = 0.007). Duration of surgery, conversion to open surgery and stoma rates were comparable between the two groups. Surgery was more complex in terms of additional procedures when MP was adopted (P = 0.001). There were no differences in postoperative complication rates, postoperative food intake, length of stay and readmissions.Conclusion
These data suggest that in comparison to standard laparoscopic surgery SP ICR might be less painful and patients might require less opioid analgesia. 相似文献11.
Javier C. Lendoire Gabriel Raffin Jorge Grondona Ricardo Bracco Rodolfo Russi Victoria Ardiles Gabriel Gondolesi Jorge Defelitto Eduardo de Santiba?es Oscar Imventarza 《Journal of gastrointestinal surgery》2011,15(10):1814-1819
Background
Caroli's disease (CD) management is still controversial. 相似文献12.
Christian Hatzfeld Sarah Dorsch Carsten Neupert Mario Kupnik 《The international journal of medical robotics + computer assisted surgery : MRCAS》2018,14(1)
Background
Impairment of haptic perception by surgical gloves could reduce requirements on haptic systems for surgery. While grip forces and manipulation capabilities were not impaired in previous studies, no data is available for perception thresholds.Methods
Absolute and differential thresholds (20 dB above threshold) of 24 subjects were measured for frequencies of 25 and 250 Hz with a Ψ‐method. Effects of wearing a surgical glove, moisture on the contact surface and subject's experience with gloves were incorporated in a full‐factorial experimental design.Results
Absolute thresholds of 12.8 dB and ?29.6 dB (means for 25 and 250 Hz, respectively) and differential thresholds of ?12.6 dB and ?9.5 dB agree with previous studies. A relevant effect of the frequency on absolute thresholds was found. Comparisons of glove‐ and no‐glove‐conditions did not reveal a significant mean difference.Conclusions
Wearing a single surgical glove does not affect absolute and differential haptic perception thresholds. 相似文献13.
Purpose
We hypothesized that a high dose of dexmedetomidine (1 μg/kg/h) could reduce postoperative analgesic requirements of patients. 相似文献14.
Introduction and hypothesis
The aim of this study was to assess complications and short-term results (3 months and 1 year) from a single-incision mid-urethral tape for stress urinary incontinence. 相似文献15.
Reducing blood loss in open radical retropubic prostatectomy with prophylactic periprostatic sutures
Gustavo F. Carvalhal Christopher R. Griffin Donghui Kan Stacy Loeb William J. Catalona 《BJU international》2010,105(12):1650-1653
Study Type – Therapy (case series)Level of Evidence 4
OBJECTIVE
To determine whether the placement of small‐calibre, rapidly absorbed prophylactic periprostatic sutures before the mobilization of the prostate could reduce blood loss during open retropubic radical prostatectomy (RRP).PATIENTS AND METHODS
In 2007, during open RRP, we began placing prophylactic haemostatic sutures of 4‐0 and 3‐0 plain catgut in the anterior portions of the distal neurovascular bundles (NVBs) and lateral to the proximal NVBs and prostate pedicles before initiating the nerve‐sparing dissection and mobilizing the prostate gland. To evaluate whether this reduced intraoperative blood loss, we compared estimated blood loss (EBL), non‐autologous transfusion rates, and postoperative haemoglobin (Hb) levels between 100 consecutive patients treated immediately before and 100 consecutive patients treated immediately after the adoption of the prophylactic periprostatic suture technique.RESULTS
Before the use of prophylactic haemostatic sutures, the mean intraoperative blood loss was 1285 mL, and one patient (1%) received an intraoperative non‐autologous transfusion. After the adoption of prophylactic sutures, the mean EBL was 700 mL (P < 0.001), and there were no transfusions. The mean Hb concentration the morning after RRP was 10.9 g/dL before and 11.8 g/dL after the initiation of prophylactic haemostatic sutures (P < 0.001).CONCLUSION
Prophylactic periprostatic haemostatic sutures significantly reduce intraoperative blood loss during open RRP. 相似文献16.
Background
Outcomes between laparoscopic (LAPR) and open abdominoperineal resections (OAPR) are poorly described. 相似文献17.
Botulinum toxin injection vs topical nitrates for chronic anal fissure: an updated systematic review and meta‐analysis of randomized controlled trials
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Aim
Chronic anal fissures (CAFs) are frequently encountered in coloproctology clinics. Chemical sphincterotomy with pharmacological agents is recommended as first‐line therapy. Topical nitrates (TN) heal CAF effectively but recurrences are common. An alternative treatment modality is injection of botulinum toxin (BT) into the anal sphincter. We aimed to perform an updated systematic review and meta‐analysis to compare the effectiveness of BT and TN in the management of CAF.Method
PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until March 2017. All randomized controlled trials (RCTs) that reported direct comparisons of BT and TN were included. Two independent reviewers performed methodological assessment and data extraction. Random effects models were used to calculate pooled effect size estimates.Results
Six RCTs describing 393 patients (194 BT, 199 TN) were included. There was significant heterogeneity among the trials. On random effects analysis there were no significant differences in incomplete fissure healing (OR = 0.47, 95% CI 0.13–1.68, P = 0.24) or recurrence (OR = 0.70, 95% CI 0.39–1.25, P = 0.22) between BT and TN, respectively. BT was associated with a higher rate of transient anal incontinence (OR = 2.53, 95% CI 0.98–6.57, P = 0.06) but significantly fewer total side effects (OR = 0.12, 95% CI 0.02–0.63, P = 0.01) and headache (OR = 0.10, 95% CI 0.02–0.60, P = 0.01) compared with TN.Conclusion
BT is associated with fewer side effects than TN but there is no difference in fissure healing or recurrence. Patients need to be warned regarding the risk of transient anal incontinence associated with BT. 相似文献18.
Stephanie J. Brown Susan Donath Christine MacArthur Ellie A. McDonald Ann H. Krastev 《International urogynecology journal》2010,21(2):193-202
Introduction
Few studies have examined associations of prepregnancy urinary incontinence (UI). 相似文献19.
Introduction
We investigated complications after pancreaticoduodenectomy (PD) with pancreaticogastrostomy (PG) reconstruction more than 12 months postoperatively. 相似文献20.
A randomized trial of automated intermittent ropivacaine administration vs. continuous infusion in an interscalene catheter
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J. Oxlund A. H. Clausen S. Venø M. D. Nielsen M. Pall T. Strøm P. Toft 《Acta anaesthesiologica Scandinavica》2018,62(1):85-93