RESUMEN
This case demonstrated the feasibility of robotic-assisted exploratory laparoscopy in a hemodynamically stable trauma patient and abdominal wall repair with a favorable outcome. The patient presented with a stab wound at the left middle posterior flank. A computer tomography scan of the abdomen and pelvis demonstrated penetrating soft tissue injury to the left lateral abdominal wall with herniation of the omentum. A robotic-assisted laparoscopic approach was implemented to evaluate for visceral injury and to repair the abdominal wall. Diagnostic laparoscopy ruled out visceral and diaphragmatic injuries, and robotic primary tissue repair of the abdominal wall was performed. The patient was discharged home the following day. Laparoscopy for hemodynamically stable trauma patients has shown the benefit of decreased morbidity and decreased hospital stay compared to laparotomy. In turn, the robotic surgical approach has all the benefits of laparoscopy while bringing additional benefits of improved surgical dexterity, visualization, range of motion, and ergonomics.
RESUMEN
The objective of our study was to compare length of stay and wound complications after hybrid robotic transversus abdominis release (hrTAR) vs. robotic transversus abdominis release (rTAR) Two cohorts of patients undergoing robotic (rTAR) and hybrid robotic (hrTAR) performed by two surgeons at a single institution were analyzed. Mean length of stay (LOS) and incidence of surgical site occurrences (SSO) were compared. 57 patients undergoing rTAR and 25 patients undergoing hrTAR were analyzed. The hrTAR group had larger mean hernia dimensions and a larger proportion of men but otherwise the patient cohorts were similar. LOS was not statistically different between rTAR and hrTAR (2.8 vs 3.7 days p = 0.06). We found no difference in incidence of surgical site occurrences between the two groups (7.0% vs 4.0% p = 0.52). Hybrid robotic assisted TAR allows for repair of complex ventral hernias with similar lengths of stay and wound morbidity to pure robotic repairs.
Asunto(s)
Músculos Abdominales/cirugía , Hernia Ventral/cirugía , Herniorrafia/métodos , Tiempo de Internación/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/métodos , Dehiscencia de la Herida Operatoria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A fluorescently labeled 20-residue polyglutamic acid (polyE) peptide 20 amino acid length polyglutamic acid (E(20)) was used to study structural changes which occur in E(20) as it co-aggregates with other unlabeled polyE peptides. Resonance energy transfer (RET) was performed using an o-aminobenzamide donor at the N-terminus and 3-nitrotyrosine acceptor at the C-terminus of E(20). PolyE aggregates were not defined as amyloid, as they were nonfibrillar and did not bind congo red. Circular dichroism measurements indicate that polyE aggregation involves a transition from alpha-helical monomers to aggregated beta-sheets. Soluble oligomers are also produced along with aggregates in the reaction, as determined through size exclusion chromatography. Time-resolved and steady-state RET measurements reveal four dominant E(20) conformations: (1) a partially collapsed conformation (24 A donor-acceptor distance) in monomers, (2) an extended conformation in soluble oligomers (>29 A donor-acceptor distance), (3) a minor partially collapsed conformation (22 A donor-acceptor distance) in aggregates, and (4) a major highly collapsed conformation (13 A donor-acceptor distance) in aggregates. These findings demonstrate the use of RET as a means of determining angstrom-level structural details of soluble oligomer and aggregated states of proteins.