Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms

Background

Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches.

Methods

The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System.

Results

The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3 %), 131 (78.9 %), and 136 (81.9 %) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m², and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8 %), three SIRC cases (1.8 %), and two SPIDER cases (1.2 %).

Conclusions

The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.     

Head and neck keloid: treatment by core excision and delayed intralesional injection of steroid.

PURPOSE: This report aims to describe a technique used by the author for the management of head and neck keloid. PATIENTS AND METHODS: This is a clinical review of patients presenting with new and recurrent keloid of the head and neck to the Maxillofacial Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. The surgical technique involved the intralesional excision of the bulk of the keloid. Primary closure of the ensuring defect was achieved at operation. At the time of suture removal between 10 and 14 days postoperative, 40 mg triamcinolone was injected into the residual lesion. The injection was repeated on 2 more occasions at monthly intervals. All patients were followed up for at least 2 years. RESULTS: Eighteen patients were successfully treated with no sign of recurrence in any of them. The main complication was hypo-pigmentation at the site of the original lesion. CONCLUSION: The technique was found to be effective for the treatment of moderately sized new and recurrent keloid scars of the head and neck and is therefore recommended.     

Two pairs of phenylpropanoid enantiomers from the leaves of Eucommia ulmoides

Abstract

Two pairs of phenylpropanoid enantiomers, (+)-(7S,8S)-alatusol D (1a), (?)-(7R,8R)-alatusol D (1b), (?)-(7S,8R)-alatusol D (2a) and (+)-(7R,8S)-alatusol D (2b) were isolated from the leaves of Eucommia ulmoides Oliver. Among them, 1a and 2b were firstly obtained by chiral enantiomeric resolution. Their structures were elucidated based on extensive spectroscopic analysis and the induced CD (ICD) spectrum caused by adding Mo₂(AcO)₄ in DMSO. All compounds were tested on Hep G2 tumor cell lines. However, none of the compounds showed potential cytotoxic activity against Hep G2 in vitro.     

Developing Priorities for Addressing Surgical Conditions Globally: Furthering the Link Between Surgery and Public Health Policy

Background  

Efforts to promote wider access to surgical services globally would be aided by developing consensus among clinicians, the public health policy community, and other stakeholders as to which surgical conditions warrant the most focused attention and investment. This would add value to other, ongoing efforts, especially in helping to define unmet need and effective coverage.     

Haematological values from a Gambian cohort--possible reference range for a West African population

The objective of this study was to establish haematological reference ranges for the West African subregion using a Gambian cohort. We analysed full blood counts from 1279 subjects aged > or =1 year. Anthropometric and body composition measurements were performed. Haematological mean values, medians and 90% reference values were calculated and related to malnutrition in children and thinness and/or obesity in adults. Haemoglobin (Hb) and mean corpuscular volume (MCV) significantly increased with age (P < 0.00001). There were gender-related changes in Hb from 15 years of age (P = 0.001) and for MCV only in adults (P = 0.0002). Hb was significantly reduced in underweight and stunted children (P = 0.0001 and 0.0002, respectively) but was unaffected by thinness or obesity in adults. White blood cell (WBC) and platelet counts were highest under 5 years and declined significantly with age (P < 0.0001 and 0.0001). While, there were no gender-related differences with WBC, there were higher WBC counts in underweight (P = 0.0001) and stunted (P < 0.0001) children. Adult females had significantly higher mean platelet counts compared with males (P = 0.006). The mean and median values of haematological parameters in The Gambia are similar to other standards but the 90% reference range for each parameter encompasses lower values when compared with Western standards.     

In vitro antimicrobial activity of aromatic diamidines and diimidazolines related to pentamidine

Geometric isomers of pentamidine analogues were screened for antimicrobial activity in vitro. cis isomers demonstrated good antibacterial activity compared to their trans counterparts. Both isomers were moderately active against opportunistic pathogens that afflict AIDS patients with minimum inhibitory concentrations in the range of 3.12-12.5 microg/mL.     

Structure-transfection activity studies of novel cationic cholesterol-based amphiphiles

Inclusion of DOPE in lipoplex formulations has hampered the establishment of a correlation between cationic lipid structure, biological specificity, and transfection activity, simply because the presence of a helper lipid not only alters the physicochemical properties of the lipoplex but also modifies cell surface specific interactions during the process of transfection. To this end, four cationic cholesterol-based derivatives were synthesized by systematically varying the methylation of the polar headgroup, after which the physicochemical properties, in the absence of DOPE and serum, were correlated with their transfection activity and interaction with cell membranes. It was found that only the primary and secondary amine derivatives, AC-Chol and MC-Chol, respectively, are able to mediate in vitro cell transfection. These results were consistent with fusion experiments and cell internalization studies which illustrated that although cell surface binding occurs for all of the cationic lipids, only the active analogues were able to gain entry into the cytosol. Given the minute differences in the physical properties of these cationic derivatives, we speculate that the biological specificity of the active cationic derivatives either triggers endocytotic pathways leading to eventual endosomal fusion allowing cytoplasmic access to the packaged DNA or other endocytotic pathways that avoid lysosomal degradation.