Emergency robotic colorectal surgery during COVID-19 pandemic: A retrospective case series study.

Objective: While interest in elective robotic surgery is growing, use in emergency setting remains limited due to challenges posed by sicker patients, advanced pathology and logistical issues. During the COVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from the bedside and reducing the number of directly exposed medical staff. The objective of this study was to report patient outcomes and initial learning experience of emergency robotic colorectal surgery during the COVID-19 pandemic. Methods: A case series study was conducted, including patients undergoing emergency robotic colorectal surgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK. Patient data were collected from an ethics approved prospective database. Patient demographics, operative time, conversions and postoperative complications were recorded. In addition, readmissions, length of stay and short-term oncological outcomes were analyzed. Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had robotic complete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease in emergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was 249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given a temporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality. Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectal surgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncological cases and avoidance of diverting stoma.

Emergency robotic colorectal surgery during COVID-19 pandemic: A retrospective case series study

Objective While interest in elective robotic surgery is growing, use in emergency setting remains limited due to challenges posed by sicker patients, advanced pathology and logistical issues. During the COVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from the bedside and reducing the number of directly exposed medical staff. The objective of this study was to report patient outcomes and initial learning experience of emergency robotic colorectal surgery during the COVID-19 pandemic. Methods A case series study was conducted, including patients undergoing emergency robotic colorectal surgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK. Patient data were collected from an ethics approved prospective database. Patient demographics, operative time, conversions and postoperative complications were recorded. In addition, readmissions, length of stay and short-term oncological outcomes were analyzed. Results Ten patients with median age 64 y (range, 36 – 83 y) were included. Four patients had robotic complete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease in emergency setting. All were R0 with a mean lymph node harvest of 54 ±13. Mean operative time was 249 ± 117 min, the median length of stay was 9.4 d (range, 5—22 d). Only one patient was given a temporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality. Conclusions Provided an experienced team and peri-operative planning, emergency robotic colorectal surgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncological cases and avoidance of diverting stoma.

A coordinated national UK liver transplant program response, prioritizing waitlist recipients with the highest need, provided excellent outcomes during the first wave of the COVID-19 pandemic.

INTRODUCTION: Healthcare provision has been severely affected by COVID-19, with specific challenges in organ transplantation. Here, we describe the coordinated response to, and outcomes during the first wave, across all UK liver transplant (LT) centers. METHODS: Several policy changes affecting the liver transplant processes were agreed upon. These included donor age restrictions and changes to offering. A "high-urgency" (HU) category was established, prioritizing only those with UKELD > 60, HCC reaching transplant criteria, and others likely to die within 90 days. Outcomes were compared with the same period in 2018 and 2019. RESULTS: The retrieval rate for deceased donor livers (71% vs. 54%; P < .0001) and conversion from offer to completed transplant (63% vs. 48%; P < .0001) was significantly higher. Pediatric LT activity was maintained; there was a significant reduction in adult (42%) and total (36%) LT. Almost all adult LT were super-urgent (n = 15) or HU (n = 133). We successfully prioritized those with highest illness severity with no reduction in 90-day patient (P = .89) or graft survival (P = .98). There was a small (5% compared with 3%; P = .0015) increase in deaths or removals from the waitlist, mainly amongst HU cohort. CONCLUSIONS: We successfully prioritized LT recipients in highest need, maintaining excellent outcomes, and waitlist mortality was only marginally increased.

A coordinated national response maintained a safe and effective UK liver transplant program during the first year of the COVID-19 pandemic

P091 Figure 1Number of livers from UK deceased doners offered, retrieved and transplanted, 4 February 2020 to 5 April 2021[Figure omitted. See PDF]DiscussionA sophisticated national response has maintained a safe and effective UK LT program throughout the first year of COVID. We adapted our resources, implementing phased donor restrictions and a new category for recipient prioritisation. Patients benefitted from collaborative working, enabling those in most need to be transferred and transplanted in protected centres. Consequently, we mitigated against a significant fall in LT activity. Our collaborative response serves as an as exemplar for other specialist healthcare services.

The efficacy of distance psychoanalysis: A qualitative study

This study examines the use and efficacy of already established synchronic distance technologies in psychoanalysis. With a growing facility of technological use, especially amongst the younger generation, and with ever-increasing demands that such services being provided - be they from physical, emotional, or psychological limitations of clients or be they from pandemic concerns such as the current coronavirus COVID-19 crisis, which has created the new normal of social distancing - use of distance technology in psychoanalytic treatment offers a necessary growth edge for the practice. This study was qualitative in nature and attempted to capture the lived experience of psychoanalysts who have integrated distance technologies ranging from cell phones to videoconferencing into their practices. The goal of this study was to discern whether distance sessions are as effective as in-person, traditional sessions, or whether something critical gets lost when analyst is not in the room with analysand.Literature was reviewed that relates to the significance of the technological movement not only within the psychological community but also within the psychoanalytic community. In it, key terms within psychoanalysis were spelled out and explored. The growing need for psychoanalysis in a rapidly changing world was discussed. Clinical issues were extrapolated. Seven central themes of psychoanalysis were garnered.Six psychoanalysts were recruited from Southern California. Semi-structured interviews were conducted, recorded, and transcribed. The interviews focused on the seven central themes relative to the use of distance technology as taken from the literature review: the psychoanalytic frame, the working alliance, interpretations, free association, transference and countertransference, ethical concerns, and overall effectiveness. There was a twofold analysis of data. First, emergent themes from each of the main themes were brought to light and committed to a table. Second, experiential meaning units were lifted directly from portions of the interviews that appear in the results section, Chapter 4, of this project and that best exemplified the lived experience of conducting psychoanalytic sessions via distance technology. They were also committed to a table. In the end, the majority of participants in the research project found distance technology highly useful and highly therapeutic. (PsycInfo Database Record (c) 2020 APA, all rights reserved)