Cost is not a drawback to perform laparoscopic appendectomy in an academic hospital.

Appendectomy is the most frequently performed emergent surgical procedure in western countries. There is still controversy about which alternative is clinically and economically superior: open or laparoscopic appendectomy (LA). Our aim was to determine clinical outcomes and cost of both procedures in our academic institution. A retrospective comparative study was performed including patients undergoing appendectomy from January to December 2011. Demographic data, operating room occupancy time, hospital length of stay, complications, and economic data were obtained. A total of 116 appendectomies were performed along the time of study, 23.27% laparoscopic and 76.72% open. Groups were similar in terms of demographics and intraoperative findings. Operating room occupancy time was longer in laparoscopic group and hospital stay was shorter. No significant differences were found respecting to postoperative complications rate. Cost minimization analysis showed that LA saved 1561.08&OV0556; per patient. In our teaching setting, LA may have clinical and economic advantages over open appendectomy.

Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados / Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes

Introducción El sistema Da Vinci (Intuitive Surgical®) es un telemanipulador quirúrgico que proporciona numerosas ventajas técnicas al abordaje laparoscópico convencional (visión tridimensional, posición ergonómica, precisión en los movimientos, instrumental multiarticular, etc.) y que se viene utilizando en diversas especialidades en todo el mundo desde el año 2000. El primer hospital público español que incorporó esta tecnología robótica fue el Hospital Clínico San Carlos (HCSC) de Madrid en julio de 2006.IntroducciónPresentamos la organización multidisciplinaria y los resultados asistenciales, docentes e investigadores del programa de cirugía robótica (PCR) desarrollado en el HCSC. Material y método Con una dirección común y un equipo común de instrumentistas, se incorporaron progresivamente al PCR los servicios de Cirugía General, Urología y Ginecología, con procedimientos variados y de complejidad creciente. Se programaron numerosas actividades docentes y de difusión tanto intrahospitalarias como extrahospitalarias para dar a conocer el PCR. Resultados Entre julio de 2006 y julio de 2008 se intervinieron 306 pacientes en el ámbito del PCR-HCSC: 169 en Cirugía General, 107 en Urología y 30 en Ginecología. Los resultados demostraron la factibilidad de los procedimientos y su corta curva de aprendizaje. La actividad docente realizada incluyó a residentes y especialistas interesados en la tecnología robótica. Conclusión La incorporación estructurada y gradual de la cirugía robótica mediante el PCR-HCSC ha permitido facilitar el aprendizaje, compartir la infraestructura diseñada, coordinar las actividades de difusión y la colaboración multidisciplinaria. Esta experiencia inicial ha demostrado la eficacia de una organización adecuada y un equipo motivado (AU)

Background Da Vinci system (Intuitive Surgical®) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006.BackgroundWe present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. Material and methods Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. Results Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. Conclusion The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team (AU)

[Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes]. / Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados.

BACKGROUND: Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS: Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS: Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION: The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

Estado actual de la cirugía robótica digestiva a la luz de la medicina basada en la evidencia / Current state of digestive system robotic surgery in the light of evidence based medicine

La introducción de la asistencia robótica a la cirugía mínimamente invasiva ha tenido una aceptación desigual en los diferentes ámbitos de la cirugía digestiva. En la actualidad se están produciendo continuamente publicaciones sobre técnicas y resultados del abordaje robótico que no siempre aportan un criterio objetivo y cuyo valor, tras un análisis basado en la evidencia científica, en ocasiones puede resultar cuestionable. Con el fin de arrojar luz sobre los conocimientos actuales en cirugía robótica digestiva y llevar a cabo una puesta al día de las posibilidades de este abordaje, en esta revisión de conjunto los autores revisan la abundante literatura producida sobre los diversos procedimientos de la cirugía robótica digestiva y suman a ella el testimonio de su propia experiencia (AU)

The incorporation of robotics in minimally invasive surgery has had mixed reception in the different fields of digestive surgery. Nowadays we are exposed to a continuous stream of publications on robotic approach techniques and outcomes, which do not always provide objective criteria and whose value, through scientific evidence analysis, is sometimes arguable. With the aim of shedding light on current knowledge on digestive robotic surgery and giving an update of its possibilities, the authors analyse the abundant literature available on the different digestive robotic surgery procedures, and sum up their own experience (AU)

The FTO obesity gene. Genotyping and gene expression analysis in morbidly obese patients.

BACKGROUND: Obesity has emerged as one of the most serious public health concerns in the twenty-first century. the fat mass and obesity associated gene (FTO) has been found to contribute to the risk of obesity in humans. Our aims in this study were to investigate the association of rs9939609 single nucleotide polymorphism (SNP) of the FTO gene with different obesity-related parameters, to assess the FTO gene expression in subcutaneous and visceral adipose tissues from morbidly obese and its correlations with other adipocytokine gene expressions. METHODS: The association between the rs9939609 FTO gene variant and obesity related parameters in 75 obese/morbidly obese adult patients and 180 subjects with body mass index (BMI) < 30 kg/m(2) (control group) was examined. Gene expression analyses: subcutaneous adipose tissue samples were obtained from 52 morbidly obese and five subjects with BMI < 30 kg/m(2). Visceral adipose tissue was also obtained from 35 morbidly obese patients. Weight, height, BMI, SBP, DBP, fasting glucose, lipid profile, proinsulin, insulin, leptin, and adiponectin (RIA) of patients were also obtained. Insulin resistance by HOMA(IR). rs9939609 of FTO genotyping using allele discrimination in real-time PCR. Genomic study of RNA extraction of adipose tissue and real-time PCR (RT-PCR) of adipocytokines and a housekeeping gene were quantified using TaqMan probes. Relative quantification was calculated using the DeltaDelta Ct formula. RESULTS: The minor-(A) allele frequency of rs9939609 FTO gene in the whole population was 0.39. A strong association between this A allele and obesity was found, even after age-sex adjustment (p = 0.013). We found higher levels of FTO mRNA in subcutaneous adipose tissue from morbidly obese than in the control group (p = 0.021). FTO gene expression was lower in visceral than in subcutaneous adipose depot. However, this finding did not reach the level of statistical significance. A negative correlation between subcutaneous FTO gene expression and serum triglyceride levels and a positive correlation with leptin, perilipin, and visfatin gene expressions was found. In the visceral adipose tissue, these positive correlations were statistically significant only for perilipin. CONCLUSIONS: Our results show: (1) A strong association between rs9939609 SNP of the FTO gene variant and obesity in Spanish morbidly obese adult patients; (2) positive correlations between FTO mRNA and leptin, perilipin, and visfatin gene expressions in subcutaneous adipose tissue; (3) FTO and perilipin gene expressions were positively correlated in visceral fat depot. Overall these results may suggest a role of FTO in the regulation of lipolysis as well as in total body fat rather in fat distribution patterns.