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.     

Evaluation and application of CO2 laser fiber delivery for single port transoral robotic surgery

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.     

Laparoscopic and Open Abdominoperineal Resection for Cancer: How Patient Selection and Complications Differ by Approach

Background  

Outcomes between laparoscopic (LAPR) and open abdominoperineal resections (OAPR) are poorly described.     

Dysphagia and Gastroesophageal Junction Resistance to Flow Following Partial and Total Fundoplication

Background  

Esophageal peristalsis and basal gastroesophageal junction (GEJ) pressure correlate poorly with dysphagia.     

The accuracy of a novel self-tapping bone fiducial marker for frameless robot-assisted stereo-electro-encephalography implantation and registration techniques

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.     

One-year outcome and course of recovery after severe traumatic brain injury

Goal  

To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma.     

Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors

Introduction  

Few studies have examined associations of prepregnancy urinary incontinence (UI).     

Clinical features and outcomes of 98 children and adults with dense deposit disease

Background  

Dense deposit disease (DDD) is an ultra-rare renal disease.     

Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature

Background  

Advances in operative techniques and technology have facilitated laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD).     

Carpal tunnel syndrome and the use of computer mouse and keyboard: A systematic review

Background  

This review examines evidence for an association between computer work and carpal tunnel syndrome (CTS).     

Mortality and renal prognosis in isolated metformin-associated lactic acidosis treated with continuous renal replacement therapy and citrate-calcium-anticoagulation

Introduction

Use of metformin increases plasma lactate concentration and may lead to metformin-associated lactic acidosis (MALA). Previous studies have suggested severe MALA to have a mortality of 17%-21%, but have included patients with other coincident conditions such as sepsis. The treatment of choice is continuous renal replacement therapy (CRRT), which has been performed using heparin analogues or no anticoagulation in former studies.

Materials and Methods

Patients admitted to the Intensive Care Unit of Turku University Hospital Finland with lactic acidosis without any other recognizable etiology than concomitant metformin treatment who required CRRT between years 2010 and 2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Data extracted included patient demographics, comorbidities, and clinical parameters at 6-hour intervals about 72 hours from admission. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after MALA.

Results

A total of 23 patients with isolated MALA were included in the study. Median (IQR) pH was 6.88 (6.81-7.07) and lactate 16.1 (11.9-23.0) mmol/L on admission. Median (IQR) duration of CRRT was 62 (41-70) hours. Seven patients (30%) required mechanical ventilation with a mean duration of 6.0 ± 3.0 days. 90-day mortality was 4.3% and 1-year mortality 13.0%. Creatinine (P = .02) and eGFR (P = .03) remained significantly altered at 1 year of follow-up compared to baseline.

Conclusions

MALA can be treated effectively and safely with CRRT and citrate-calcium-anticoagulation, usually required for 2-3 days. Mortality of patients with MALA treated with CRRT is low when other conditions inducing lactic acidosis are excluded. MALA episode may be associated with long-lasting kidney injury.

     

Complications in primary and completed thyroidectomy

Purpose  

To compare the rates of postsurgical complications following a primary and completed thyroidectomy for multinodular goiter (MNG).     

Retropubic and transobturator midurethral slings: a decision analysis to compare outcomes including efficacy and complications

Introduction and hypothesis  

The objective of this paper is to compare retropubic (RP) and transobturator (TO) midurethral slings using decision analysis techniques.     

Erratum to: Chronic Kidney Disease Japan Cohort study: baseline characteristics and factors associated with causative diseases and renal function

Background  

Prevalence of chronic kidney disease (CKD) is estimated to be 13.3 million in Japan, but patient characteristics during the predialysis period (CKD stages 3–5) are not well studied.     

Remodeling of adjacent spinal alignments following cervical arthroplasty and anterior discectomy and fusion

Objective  

To evaluate the effects of cervical artificial disc replacement (ADR) and anterior discectomy and fusion (ACDF) on adjacent spinal alignments.     

Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review

Background  

This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome).     

Neck Pain and Disability Scale and Neck Disability Index: validity of Dutch language versions

Purpose  

To investigate the validity of the Neck Pain and Disability Scale Dutch Language Version (NPAD-DLV) and the Neck Disability Index (NDI)-DLV.     

Preoperative Diabetes Mellitus and Long-Term Survival After Resection of Pancreatic Adenocarcinoma

Purpose  

To assess clinicopathologic features and postresection survival of diabetes mellitus (DM)-associated pancreatic ductal adenocarcinoma (PDAC).     

Breakout Session: Gender Disparities in Knee Osteoarthritis and TKA

Background  

Biologically derived (sex-based) and behaviorally influenced (gender-based) disparities exist in knee osteoarthritis and treatment with TKA.