Is Robotic-Assisted Surgery Better?

The surgical platform for robotic-assisted surgery has enabled many surgeons to join a popular trend in minimally invasive surgery, which offers prospective benefits to patients (eg, shorter hospital stays, earlier recovery, and less pain) and operational benefits to surgeons. Surgeons without minimally invasive surgical training typically acquired during fellowship training are generally able to perform complex procedures with the robotic platform due to its ergonomic suturing instrumentation, tremor stabilization, 3D visualization, and 4-arm control by a single surgeon. Prospective benefits, however, must be balanced against prospective risks. This article explores the multitude of factors that persuade both surgeons and patients to choose robotic surgery over open surgery or conventional laparoscopy and explores whether evidence exists to support its use despite sometimes conflicting research.

Outcomes of laparoscopic modified Cellan-Jones repair versus open repair for perforated peptic ulcer at a community hospital.

INTRODUCTION: Minimally invasive or open Graham Patch repair remains the gold standard approach for management of perforated peptic ulcers (PPU). Herein, we report outcomes of laparoscopic technique and compare it with open approach at a community hospital. METHODS: Retrospective observational study conducted comparing laparoscopic modified Cellan-Jones repair (mCJR) versus the standard open repair of PPU. Patients aged 18-90 years during 2016-2021 were offered either a minimally invasive or open approach depending on surgeon laparoscopic capability, and were compared in terms of demographics, co-morbidities, intra-operative details, and short-term outcomes. RESULTS: A total of 49 patients were included (46.9% males, mean age 52.9 years, mean BMI 25.0, ASA ≥ III 75.5%, 75.5% smokers, 26.5% current NSAIDs use, and 71.4% alcohol drinkers). Duodenum was the most common perforation site (57.1%), and majority of ulcers were 1-2 cm (72.9%). Laparoscopic approach was performed in 16 consecutive patients (32.7%) by a single surgeon, with no conversions. Preoperative characteristics were similar for both groups. Compared to open approach, laparoscopic group were taken to operation immediately (< 4 h) (87.5% vs. 15.2%, p < 0.001), had lower estimated blood loss (11.8 ml vs. 73.8 ml, p = 0.063), and longer operative time (117.1 min vs. 85.6 min, p = 0.010). Postoperatively, nasogastric tube was removed earlier in laparoscopic group (POD1-2, 87.5% vs. 24.2%, p = 0.001), with earlier resumption of diet (POD1-2, 62.6% vs. 9.1%, p = 0.002), less narcotic usage (< 3 days, 58.3% vs. 6.1%, p < 0.001), earlier return of bowel function (POD1-2, 43.8% vs. 9.1%, p = 0.003) and shorter length of stay (LOS) (3.7 days vs. 16.1 days, p < 0.001). Both in-house mortality and morbidity rates were lower in the laparoscopic group, but not statistically significant [(0% vs. 6.1%, p = 0.347) and (12.5% vs. 39.4%, p = 0.500), respectively]. CONCLUSION: Laparoscopic mCJR is a feasible method for repair of PPU, and it is associated with shorter LOS, and less narcotics usage in comparison to the open repair approach.

Biochar addition for enhanced cucumber fruit quality under deficit irrigation / Adição de biochar para melhorar a qualidade de frutos do pepino sob irrigação em déficit

In the recent years, biochar has been used as an organic soil amendment. Therefore, this study was undertaken in April 2016 to July 2017 to examine the effect of different biochar addition (BA) rates and deficit irrigation (DI) on quality characteristics of cucumber under greenhouse conditions over two consecutive growing seasons. The BA treatments were B0 (0-ton ha-1), B1 (10-ton ha-1and B2 (20-ton ha-1), while the DI treatments were 1.0 (W1), 0.60 (W2) and 0.40 (W3) of the reference evapotranspiration (ET0). The results obtained elaborated that the combination of B2W1 gave the maximum values of fruit weight (g), fruit water content (%), fruit dry biomass (g) and pH in the both seasons. On the other hand, W2 and W3 increased significantly titratable acidity (TA %) and total soluble solid (TSS %). It was possible to conclude that BA with DI might be a novel approach to improve both crop yield and fruit quality.

Nos últimos anos, o biochar tem sido utilizado como uma alteração do solo orgânico. Desta maneira, este estudo foi realizado entre os períodos de Abril de 2016 a Julho de 2017 para investigar o efeito de diferentes taxas de alteração de biochar e irrigação por déficit (DI) nas características de qualidade do pepino em casa de vegetação durante duas safras consecutivas. Os tratamentos BA foram B0 (0 ton ha-1), B1 (10 ton ha-1 e B2 (20 ton ha-1), juntamente com três lâminas de irrigação em déficit W1, W2 e W3 correspondentes 100%, 60% e 40% da ET0, respectivamente. Os resultados obtidos mostraram que a combinação de B2W1 forneceu os valores máximos de peso dos frutos (g), teor de água dos frutos (%), biomassa seca dos frutos (g) e pH nas duas safras. Por outro lado, W2 e W3 aumentaram significativamente a acidez titulável (TA%) e o sólido solúvel total (TSS%). Foi possível concluir que a alteração de biochar com DI pode ser uma nova abordagem para melhorar tanto a produtividade como a qualidade dos frutos.

Near infrared perfusion assessment of gastric conduit during minimally invasive Ivor Lewis esophagectomy.

INTRODUCTION: Anastomotic leak and conduit necrosis are devastating complications following Ivor Lewis esophagectomy. Near infrared imaging (NIR) using IndoCyanine Green allows for real time tissue perfusion assessment which may reduce anastomotic leak during minimally invasive Ivor Lewis esophagectomy (MIE). METHODS: Forty consecutive MIE were performed by a single surgeon at a tertiary referral center. The first 20 were assessed for gastric conduit perfusion by clinical criteria (Group 1). The second 20 were also assessed using NIR laparoscopic system (Group 2). RESULTS: Comparing Group 1 to Group 2, no significant differences were found in overall complication rate, readmission or reoperation rate. NIR resulted in resection of the non perfused proximal portion of the conduit in 30% (6/20). Two patients in group 2 group developed anastomotic leak (2/20) compared to 0 in Group 1 (p = 0.49). Graft necrosis led to one mortality in Group 1, while there were 0 mortalities in Group 2. (p = 1.0). CONCLUSION: Although NIR plays a role in assessment of tissue perfusion, in our study its use did not result in reduction of anastomotic leak rate.

The role of supplemental irrigation to crop water use under rainwater harvesting / O papel da irrigação suplementar na redução do uso da água através da captação de águas pluviais

Sorghum is an important food and dominant multi-purpose cereal crop in Sudan. Its production influenced by plant available soil water content at planting and growing season rainfall. Series of field experiments were carried-out to study the sorghum water use potentiality using different water harvesting techniques (WHT) and supplemental irrigation (SI). Soil moisture content (SMC), grain yield and water use efficiency (WUE) of sorghum were calculated during the years of 2012 and 2013. The results showed that the WHT and SI affected the SMC, growth and productivity parameters of sorghum. The results were also indicated that, the tied-ridging with SI (T1w) produced the highest values of SMC, sorghum productivity and WUE (10.59%, 3850 kg ha-1, and 0.71 kg m-3 in season 2012, respectively. Whereas in season 2013 the values were 11%, 4760 kg ha-1and 0.86 kg m-3 with the same arrangement mentioned above. Conclusively, the WUE could be promoted by implementing WHT as water stewardship. Nevertheless SI should consider as pivot factor that compensate the shortage in the rainwater.

O sorgo é um alimento importante e uma cultura de cereais multi-propósito dominante no Sudão. Sua produção é influenciada pelo teor de água disponível no solo da planta na plantação e na precipitação da estação de crescimento. Foram realizadas séries de experimentos de campo para estudar a potencialidade do uso da água do sorgo usando diferentes técnicas de colheita de água (WHT - water harvesting techniques) e irrigação suplementar (SI - supplemental irrigation). O teor de umidade do solo (SMC - Soil moisture content), o rendimento de grãos e a eficiência do uso da água (WUE - water use efficiency) de sorgo foram calculados nos anos de 2012 e 2013. Os resultados mostraram que o WHT e SI afetaram os parâmetros SMC, crescimento e produtividade do sorgo. Os resultados também foram indicados que o empate com SI (T1w) produziu os maiores valores de SMC, produtividade de sorgo e WUE (10,59%, 3850 kg ha-1 e 0,71 kg m-3 na temporada 2012, respectivamente). Enquanto que na temporada 2013, os valores foram de 11%, 4760 kg ha-1 e 0,86 kg m-3 com o mesmo arranjo mencionado acima. Conclusivamente, a WUE poderia ser promovida pela implementação de WHT como gerenciamento de água. No entanto, a SI deve considerar como fator de pivô que compense a escassez na água da chuva.

Water harvesting techniques and supplemental irrigation impact on sorghum production.

BACKGROUND: In general, rain-fed agriculture is practised in many areas in western Sudan. Therefore, it is imperative to adopt appropriate rainwater harvesting and reuse technique(s) by promoting soil and water management research to sustain crop productivity. Sorghum (Sorghum bicolor L.) is a primary stable crop of Sudan. Extensive field experiments were conducted to study the effect of water harvesting techniques (WHTs) and supplemental irrigation (SI) on infiltration rate (IR), soil moisture content (SMC), growth and productivity of sorghum during two rainy seasons (2012 and 2013). RESULTS: The results showed that the WHTs and SI affected the soil physical properties, growth and productivity parameters of sorghum. The results indicated that the tied-ridging with SI (TRwSI) produced the highest values of accumulative IR, SMC and sorghum productivity (115 mm, 13% and 4000 kg h(-1) , in season 2012, respectively, whereas in season 2013 the values were 145 mm, 10% and 5000 kg h(-1) , for accumulative IR, SMC and sorghum productivity, respectively. Basin with SI (BwSI) ranked second, next to TRwSI in the both seasons. CONCLUSION: Hence, water harvesting and SI are expected to play a significant role in terms of sustainable agricultural and socio-economic development in western Sudan and similar areas.

Salutary effect of calcium channel blockade following hypoxic and septic insult.

BACKGROUND: Intestinal ischemia and reperfusion is a major problem associated with a high morbidity and mortality following trauma and hemorrhagic shock. Apoptosis is the major mode of cell death following reperfusion. The cytoskeleton damage precedes the apoptotic final microscopic features. Calcium plays a central role in apoptosis. Therefore, we studied whether verapamil could preserve the function of the cytoskeleton in an in vitro intestinal model following hypoxia-reoxygenation (H/R). Our goal was to assess mainly the cytoskeleton functions, which includes IgA transport and the cell monolayer barrier integrity. METHODS: Confluent HT29 intestinal monolayers grown in a two-chamber cell culture system were held under hypoxic (5% CO2) conditions for 90 minutes followed by normoxia (21% O2) (H/R). Cell subsets were exposed to lipopolysaccharide (10 µg/mL) before H/R. Verapamil (8 µM) was added to HT29 cell subsets after H/R treatment. Dimeric IgA was added to the basal compartment, and apical media were sampled at intervals to quantitate IgA transcytosis using enzyme-linked immunosorbent assay. HT29 cells held under normoxic conditions served as controls. HT29 permeability to FD4 was assessed at the end of each experiment. In a separate experiment, HT29 cells were stained for F actin using rhodamine-labeled phalloidin. RESULTS: Intestinal monolayer permeability was increased following treatment with H/R and/or lipopolysaccharide. Verapamil treatment prevented increased permeability in HT29 cells and led to an increase in IgA transport. Disruption of actin microfilaments was demonstrated following H/R insult but was abrogated by the addition of verapamil following H/R insult. CONCLUSION: Reperfusion can lead to both physical and immune derangement of epithelial cell barrier function. Verapamil may be important in preserving gut barrier function. Additional studies including in vivo confirmation in animal shock models are needed to validate these findings.

Stress hormone epinephrine increases IgA transport across respiratory epithelial surfaces.

BACKGROUND: Secretory immunoglobulin A (sIgA) is the principle antibody produced at the respiratory surface. Respiratory sIgA levels are increased early after injury in both human and laboratory animals; the mechanisms are uncertain. Stress hormones, including epinephrine (Epi) and norepinephrine (NE), increase early after injury. In addition, respiratory epithelial cells are known to be responsive to ß2-agonists. We therefore studied the effect of Epi, NE, and albuterol on IgA transport in vitro. STUDY DESIGN: Calu-3 respiratory epithelial cell monolayers grown in a 2-chamber cell culture system were treated for 24 hours with Epi, NE, or albuterol (10(-6)M). Dimeric IgA was added to the basal chamber of Calu-3 cells and IgA transcellular transport was indexed by recovery of SIgA in the apical chamber by enzyme-linked immunosorbent assay. In separate experiments, Klebsiella pneumoniae (10(5) colony-forming units/mL) was added to the apical chamber of treated Calu-3 cell monolayers and bacterial passage across Calu-3 cells was determined by bacterial recovery from basal chamber media. Calu-3 cells not treated with Epi, NE, or albuterol served as control. Cell monolayer integrity was confirmed by transepithelial electrical resistance. RESULTS: Calu-3 cells treated with Epi led to a significant increase in sIgA transport, this was associated with an increase in polyimmunoglobulin receptor expression. Calu-3 cells treated with NE or albuterol showed no statistical difference compared with control. Only cells treated with Epi led to a significant increase in pro-inflammatory cytokine expression and decrease in bacterial passage. CONCLUSIONS: Epinephrine is likely an early upstream signal in the enhanced IgA response at respiratory surfaces after injury.

Estrogen modulation of pneumonia? An immunoglobulin A effect.

BACKGROUND: Laboratory and clinical studies demonstrated a salutary effect of estradiol (E2) on pneumonia and other infectious complications after trauma, while dihydrotestosterone (DHT) failed to show a similar effect. Secretory immunoglobulin A is the principle antibody in the respiratory and other mucosal secretions. Immunoglobulin A (IgA) production and transport into the mucosal secretion is regulated by Toll-like receptor 4 (TLR-4). In addition, E2 may influence immune regulatory cells via TLR-4. We hypothesized that the protective effect of E2 on the development of pneumonia may be related to modulation of IgA transport into respiratory secretions. METHODS: Calu-3 respiratory epithelial cell monolayers were established in a two-chamber cell culture system. Calu-3 cells were then treated with either E2 or DHT for 3 days for maximal cell stimulation. Dimeric IgA was added to the basal chamber of Calu-3 cells, and IgA transcellular transport was indexed by recovery of secretory immunoglobulin A in the apical chamber media. In separate experiments, Klebsiella pneumonia (10(5) CFU/mL) was added to the apical chamber of treated Calu-3 cell monolayers, and bacterial passage across Calu-3 cells was determined by bacterial recovery from the basal chamber. Calu-3 cells not treated with E2 or DHT served as control. RESULTS: Calu-3 cells pretreated with E2 significantly increased IgA transport, and this effect was augmented in a dose-dependent fashion. Only cells pretreated with E2 significantly decreased bacterial passage, and this effect was exhibited in a dose- and time-dependent fashion. E2 led to a significant increase in TLR-4 expression. CONCLUSION: The protective effect of E2 against pneumonia may be related to augmented transport of IgA into the respiratory mucosal secretions.