ABSTRACT
BACKGROUND: Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. MATERIALS AND METHODS: Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. RESULTS: Sixty-one patients underwent RA-PEHR with mesh, 72% were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57% of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26%, III 64%, and IV 13%. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6% and 23%, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66%) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42% of patients and only 23% of patients were symptomatic. CONCLUSIONS: This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.
Subject(s)
Hernia, Hiatal/surgery , Herniorrhaphy/methods , Laparoscopy/methods , Robotic Surgical Procedures/methods , Aged , Feasibility Studies , Female , Follow-Up Studies , Hernia, Hiatal/classification , Herniorrhaphy/adverse effects , Humans , Laparoscopy/adverse effects , Learning Curve , Length of Stay , Male , Middle Aged , Operative Time , Recurrence , Retrospective Studies , Robotic Surgical Procedures/adverse effectsABSTRACT
Tetracycline depends on divalent metal ions for its biological function, but its multiple ionization states, conformations, and tautomers at varying solution conditions complicate its ion-binding equilibria, and the stoichiometry of the biologically relevant Ca2+ or Mg2+ complexes has not been clear. Isothermal titration calorimetry was used in the present work to study Ca2+ and Mg2+ binding to tetracycline. The two metal ions bind with distinct stoichiometries, one Ca2+ per tetracycline and one Mg2+ per two tetracyclines, and with differing dependence on solution conditions, indicating that these two ions bind TC differently. An endothermic process accompanies ion binding that is proposed to reflect conformational changes in tetracycline. The results identify conditions that limit the distribution of species and may facilitate structural study.
