RESUMEN
Robotic surgery is on its way to revolutionizing traditional surgical procedures, offering precise and minimally invasive techniques hypothesized to shorten recovery times and improve patient outcomes. While there have been multiple publications on robotic systems' medical and procedural achievements, more emphasis should be put on the surgeon's experience, especially in comparison with laparoscopic surgery. The present report aims to systematically examine the stress impact on surgeons by comparing the robotic Senhance Surgical System (Asensus Surgical, Durham, North Carolina, U.S.A) to laparoscopic surgery. The well-established "SURG-TLX" survey is used to measure distinct stress entities. The "SURG-TLX" survey is a modified version of the NASA-TLX, validated for surgery by M. Willson. Based on a comprehensive database from six centers encompassing various disciplines and surgical procedures, our analysis indicates significantly reduced "overall stress" levels for robotic (cockpit) compared to laparoscopic surgeons. Exploring the "SURG-TLX" stress dimensions further between methods (robotic vs. laparoscopic) and surgeon position (laparoscopic, (robotic) bedside, or (robotic) cockpit) resulted in significantly more Mental (p.value < 0.015), less Physical Demands (p.value < 0.001) and less Distraction (p.value < 0.009) for robotic surgery, especially regarding the robotic cockpit surgeons. This finding suggests that robotic surgery with the Senhance Surgical System contributes to a favorable stress profile for surgeons, potentially enhancing their overall well-being and performance.
Asunto(s)
Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Cirujanos , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Gastroesophageal reflux disease requiring an operative solution is common. Minimally invasive surgery to generate an anti-reflux barrier at the distal esophagus following the principle of the "floppy Nissen" technique has become the gold standard. Advanced robotic-assisted systems may deliver more consisted outcomes. METHODS: This registry study analyzed safety and efficacy of the Senhance® surgical system in the surgical treatment of reflux disease and procedural proficiency. Data from 237 consecutive patients operated in a single center were evaluated. Historic standard laparoscopies from the same center were analyzed to compare robotic surgery learning curve effects. RESULTS: Using the Senhance® Surgical System, during the first 50 patients there was a significant decrease in surgery time which was maintained over the duration of study, pointing to the surgical staff's system-specific learning. After this phase, procedural times were comparable between the robotic-assisted and traditional laparoscopic surgery. The effect of learning was greater than for standard laparoscopy. For 237 patients, there were four conversions to laparoscopic surgery. Two serious adverse events were recorded, both cardiac in nature and not related to the use of the robot. CONCLUSIONS: Robotic fundoplication was swiftly implemented in a non-university hospital with 65 surgical beds. The operating time was no longer than in standard laparoscopy, the procedure was more standardized than open or laparoscopic surgery and hospitalization times may have been sustainably shortened. The autonomy at the system's digital platform (cockpit) to conduct robotic fundoplications is a big step forward in surgery.
Asunto(s)
Reflujo Gastroesofágico , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Fundoplicación/métodos , Curva de Aprendizaje , Reflujo Gastroesofágico/cirugía , Laparoscopía/métodos , Sistema de Registros , Resultado del TratamientoRESUMEN
The Senhance Robotic System™ (Asensus Surgical, Durham, NC, USA) has been used in abdominal surgery since 2016, and provides an eye-tracker for camera movement and haptic tactile feedback. Safety aspects are very important in robotic surgery, such as regarding the presence of system malfunctions and surgical outcomes. The data for robotic function in gastrointestinal surgical procedures in 530 patients (colorectal surgery, fundoplication, others) were prospectively listed in the TRUST registry after informed patient consent in three German gastrointestinal surgery centers (center A, N = 46 patients; center B, N = 457; center C, N =27). Adverse events were noted in 14.3% (76/530 patients) of the overall surgeries, with an equal distribution among the procedures. Robotic malfunctions, such as console/camera/arm malfunctions, collisions, or limited motion, were experienced in 5.5 % (29/530 patients), with some differences among the centers (A, 0.0%; B, 4.2%; C, 37%). These differences were explained in terms of team experience and case load. In conclusion, the Senhance™ Robotic System can be safely applied to routine abdominal surgery procedures.
RESUMEN
BACKGROUND: Reflux esophagitis (RE) and Barrett's esophagus (BE) are predisposing factors for development of esophageal adenocarcinoma (EAC), the solid tumor with the fastest rising incidence in the Western world. This RE-BE-EAC cascade involves multiple host factors and consequently multiple genes. Polymorphisms in the 3' region of myosin IXB (Myo9B) are associated with chronic inflammatory gastrointestinal disorders like celiac disease and ulcerative colitis, assuming that variation in Myo9B influences the intestinal permeability. AIM: To determine esophageal expression and the genetic variation of the Myo9B gene in the RE-BE-EAC cascade. METHODS: DNA from 886 Caucasian participants (198 non-reflux controls, 305 RE, 254 BE, 129 EAC) was collected for the determination of the Myo9B gene polymorphism (rs2305764). Esophageal Myo9B expression was determined on biopsies from normal, RE, BE and EAC epithelium. RESULTS: Genotype G/G was more common in BE (p = 0.032) and EAC (p = 0.046), but not in RE (p = 0.126) compared with the control group. Cytoplasmic Myo9B expression was determined in RE, BE and EAC, but most prominent in epithelial cells of BE and EAC. CONCLUSIONS: Genetic variation of Myo9B may play a role in the etiology of BE and EAC by increasing the permeability of the epithelial barrier.
Asunto(s)
Adenocarcinoma/genética , Esófago de Barrett/genética , Neoplasias Esofágicas/genética , Esofagitis Péptica/genética , Miosinas/genética , Lesiones Precancerosas/genética , Adenocarcinoma/metabolismo , Adulto , Anciano , Esófago de Barrett/metabolismo , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Intervalos de Confianza , Neoplasias Esofágicas/metabolismo , Esofagitis Péptica/metabolismo , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Miosinas/metabolismo , Oportunidad Relativa , Polimorfismo de Nucleótido Simple , Lesiones Precancerosas/metabolismoRESUMEN
OBJECTIVE: Esophageal cancer development is a sequence that starts with reflux esophagitis (RE), followed by Barrett's esophagitis (BE), dysplasia, and finally esophageal adenocarcinoma (EAC). Tumor necrosis factor (TNF) is a potent anti-neoplastic agent, hence DNA polymorphisms that reduce TNF levels potentially enhance the development of BE and EAC. The aim of the study was to determine the impact of TNF gene variation on the RE-BE-EAC cascade. METHODS: DNA from 887 Caucasian participants (197 controls, 305 RE, 257 BE, 128 EAC) was tested for the gene polymorphism TNF-ß NcoI, and TNF production was determined by TNF-α specific immunohistochemistry on esophageal biopsies from these BE (n = 31) and EAC (n = 4) patients. RESULTS: As compared with healthy controls, the TNF-ß NcoI A/A genotype was significantly more prevalent in BE (p = 0.04) and EAC patients (p = 0.02), but not in RE patients (p = 0.1). While TNF-α protein levels were invariably high in esophageal biopsies from EAC patients, most esophageal BE samples showed low to moderate TNF levels. CONCLUSIONS: Chronic inflammation, like in BE, markedly increase the risk of malignant transformation. In this study, the significantly higher frequency of the TNF-ß NcoI A/A genotype and the local TNF expression indicate that the pro-inflammatory cytokine TNF plays a role in the development of BE and EAC.
Asunto(s)
Adenocarcinoma/genética , Esófago de Barrett/genética , Desoxirribonucleasas de Localización Especificada Tipo II/genética , Neoplasias Esofágicas/genética , Linfotoxina-alfa/genética , Polimorfismo de Nucleótido Simple , Factor de Necrosis Tumoral alfa/genética , Adenocarcinoma/metabolismo , Adulto , Anciano , Esófago de Barrett/metabolismo , Estudios de Casos y Controles , Transformación Celular Neoplásica/genética , Transformación Celular Neoplásica/metabolismo , Estudios de Cohortes , Neoplasias Esofágicas/metabolismo , Femenino , Expresión Génica , Genotipo , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SexualesRESUMEN
Reflux esophagitis (RO) and Barrett's esophagus (BO) can cause esophageal adenocarcinoma (OAC). The esophageal mucosa in the RO-BO-OAC cascade is chronically exposed to gastro-esophageal reflux. Epidermal growth factor (EGF) has an important role in the protection and repair of mucosal damage, and non-physiologic levels are associated with gastrointestinal tumors. The aim is to determine the functional effect of EGF gene polymorphisms on RO, BO and OAC development. A cohort of 871 unrelated Dutch Caucasians consisted of 198 healthy controls, 298 RO patients, 246 BO patients and 129 OAC patients. The frequency of the EGF-production-associated 5'UTR A+61G polymorphism was determined in these four groups. EGF immunohistochemistry was performed on BO biopsies. EGF expression was significantly lower in the G/G genotype compared with the A/G (P=0.008) and A/A (P=0.002) group. The G/G genotype was significantly more prevalent in RO (odds ratios (OR)=2.6; 95% confidence intervals (95% CI): 1.3-5.2), BO (OR=3.0; 95% CI: 1.5-6.2) and OAC (OR=4.1; 95% CI: 1.8-9.7) than in controls. The G allele is associated with reduced EGF expression and increased risk for RO, BO and OAC development. This indicates that reduced mucosal protection resulting from genetically decreased EGF expression enhances esophageal tumor development.
Asunto(s)
Adenocarcinoma/genética , Esófago de Barrett/genética , Factor de Crecimiento Epidérmico/genética , Neoplasias Esofágicas/genética , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido Simple/genética , Adenocarcinoma/patología , Esófago de Barrett/patología , Estudios de Cohortes , Receptores ErbB/genética , Neoplasias Esofágicas/patología , Esofagitis Péptica/genética , Femenino , Humanos , Inmunohistoquímica , Modelos Logísticos , Masculino , Persona de Mediana Edad , Caracteres SexualesRESUMEN
BACKGROUND: The continuous exposure of esophageal epithelium to refluxate may induce ectopic expression of bile-responsive genes and contribute to the development of Barrett's esophagus (BE) and esophageal adenocarcinoma. In normal physiology of the gut and liver, the nuclear receptor Pregnane × Receptor (PXR) is an important factor in the detoxification of xenobiotics and bile acid homeostasis. This study aimed to investigate the expression and genetic variation of PXR in reflux esophagitis (RE), Barrett's esophagus (BE) and esophageal adenocarcinoma. METHODS: PXR mRNA levels and protein expression were determined in biopsies from patients with adenocarcinoma, BE, or RE, and healthy controls. Esophageal cell lines were stimulated with lithocholic acid and rifampicin. PXR polymorphisms 25385C/T, 7635A/G, and 8055C/T were genotyped in 249 BE patients, 233 RE patients, and 201 controls matched for age and gender. RESULTS: PXR mRNA levels were significantly higher in adenocarcinoma tissue and columnar Barrett's epithelium, compared to squamous epithelium of these BE patients (P<0.001), and RE patients (P=0.003). Immunohistochemical staining of PXR showed predominantly cytoplasmic expression in BE tissue, whereas nuclear expression was found in adenocarcinoma tissue. In cell lines, stimulation with lithocholic acid did not increase PXR mRNA levels, but did induce nuclear translocation of PXR protein. Genotyping of the PXR 7635A/G polymorphism revealed that the G allele was significantly more prevalent in BE than in RE or controls (P=0.037). CONCLUSIONS: PXR expresses in BE and adenocarcinoma tissue, and showed nuclear localization in adenocarcinoma tissue. Upon stimulation with lithocholic acid, PXR translocates to the nuclei of OE19 adenocarcinoma cells. Together with the observed association of a PXR polymorphism and BE, this data implies that PXR may have a function in prediction and treatment of esophageal disease.
Asunto(s)
Adenocarcinoma/genética , Esófago de Barrett/genética , Neoplasias Esofágicas/genética , Polimorfismo de Nucleótido Simple , Receptores de Esteroides/genética , Adenocarcinoma/patología , Adulto , Anciano , Esófago de Barrett/patología , Estudios de Casos y Controles , Línea Celular Tumoral , Núcleo Celular/metabolismo , Citoplasma/genética , Neoplasias Esofágicas/patología , Esofagitis Péptica/genética , Esofagitis Péptica/patología , Esófago/patología , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Receptor X de Pregnano , ARN Mensajero/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Translocación Genética , Adulto JovenRESUMEN
In this case report, we present an 83-year-old man with a ruptured para-anastomotic aneurysm who underwent a stent graft in spite of his condition of acute shock. Our patient presented at the emergency room (ER) with acute abdominal pain. Shortly after arrival, he collapsed because of a ruptured para-anastomotic aneurysm after the previous aorto-bi-iliac aneurysm repair in 1984. He was charged with a cardiac history that made him unsuitable for surgery. We chose for resuscitation followed by inflation of an aortic balloon that made the patient hemodynamically stable. He then underwent iliac stent grafting and was discharged from the hospital at 22 days after the procedure. The mortality rate of patients with a ruptured para-anastomotic aortic aneurysm arriving at hospital ranges from 32% to 70%. Endovascular stent placement for ruptured iliac aneurysmal arteries can be a safe treatment in selected patients.
Asunto(s)
Aneurisma Roto/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma Ilíaco/cirugía , Dolor Abdominal/etiología , Anciano de 80 o más Años , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/etiología , Aneurisma Roto/fisiopatología , Oclusión con Balón , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Reanimación Cardiopulmonar , Procedimientos Endovasculares/instrumentación , Hemodinámica , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Aneurisma Ilíaco/etiología , Aneurisma Ilíaco/fisiopatología , Masculino , Reoperación , Choque/etiología , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Barrett's esophagus (BE) affects approximately 2% of the Western population and progresses to esophageal adenocarcinoma (EAC) in 0.5% of these patients each year. In BE, the stratified epithelium is replaced by an intestinal-type epithelium owing to chronic gastroduodenal reflux. Since self-renewal of intestinal crypts is driven by Notch signaling, we investigated whether this pathway was active in the proliferative crypts of BE. Immunohistochemistry confirmed the presence of an intact and activated Notch signaling pathway in metaplastic BE epithelium, but not in the normal human esophagus. Similar observations were made in two well-known human Barrett's-derived EAC cell lines, OE33 and SKGT-5. We then sought to investigate the effects of Notch inhibition by systemic treatment with a gamma-secretase inhibitor in a well-validated rodent model for BE. As we have shown previously in normal intestinal epithelium, Notch inhibition converted the proliferative Barrett's epithelial cells into terminally differentiated goblet cells, whereas the squamous epithelium remained intact. These data imply that local application of gamma-secretase inhibitors may present a simple therapeutic strategy for this increasingly common pre-malignant condition.