The success rate of robotic natural orifice intracorporeal anastomosis and transrectal extraction (NICE procedure) in a large cohort of consecutive unselected patients.

BACKGROUND: The Robotic NICE procedure is a total intracorporeal natural orifice approach in which specimen extraction and anastomosis is accomplished without an abdominal wall incision other than the port sites themselves. We aim to present the success rate of the NICE procedure in a large cohort of unselected consecutive patients presenting with colorectal disease using a stepwise and reproducible robotic approach. METHODS: Consecutive patients who presented with benign or malignant disease requiring left-sided colorectal resection and anastomosis between May 2018 and June 2021 were evaluated. Data abstracted included demographic, clinical data, disease features, intervention data, and outcomes data. The main outcome was success rate of Intracorporeal anastomosis (ICA), transrectal extraction of specimen (TRSE), and conversion rate. RESULTS: A total of 306 patients underwent NICE procedure. Diverticulitis was the main diagnosis (64%) followed by colorectal neoplasm (27%). Median operative time was 219 min, and the median estimated blood loss was 50 ml. ICA was achieved in all cases (100%). TRSE was successfully achieved in 95.4% of cases. In 14 patients (4.6%), an abdominal incision was required due to inability to extract a bulky specimen through the rectum. There overall postoperative complications rate was 12.4%. Eight patients (2.6%) experienced postoperative ileus. There were no superficial or deep surgical site infection (SSI). Eleven patients (3.6%) developed organ SSI space including 5 patients with intra-abdominal abscess and 4 patients with anastomotic leak. There was one mortality (0.3%) due to toxic megacolon from resistant Clostridium difficile. The 30-day reoperation rate was 2.9% (n = 9) including six patients presenting with organ space SSI and three patients with postoperative obstruction at the diverting loop ileostomy site. CONCLUSION: The NICE procedure is associated with a very high success rate for both intracorporeal anastomosis and transrectal specimen extraction in a large cohort of unselected patients.

Quantifying the decisional satisfaction to accept or reject the Human Papillomavirus (HPV) vaccine: a preference for cervical cancer prevention.

OBJECTIVE: Only a portion of the US population is willing to consider HPV vaccination to date. The primary aim of this study is to determine the decisional satisfaction associated with HPV vaccination. STUDY DESIGN: This is a prospective survey conducted at an urban college where women 18-26 years old completed a decisional satisfaction survey about their HPV vaccine experience. RESULTS: Regardless of the decision to accept or reject HPV vaccination, the decisional satisfaction was very high (mean 5-item score = 21.2 (SD 3.8)). Women without HPV vaccination were decisionally neutral significantly more often than those already vaccinated; 22% were decisionally neutral for the option to accept HPV vaccination at that visit. Cervical cancer prevention was preferred significantly more often than genital wart prevention in all analyses. CONCLUSIONS: Targeting those who are decisionally neutral about HPV vaccination may result in a higher uptake of HPV vaccination.

Quiet eye gaze behavior of expert, and near-expert, baseball plate umpires.

The quiet eye gaze behavior of 4 near-expert and 4 expert baseball umpires who called balls and strikes in simulated pitch-hit situations was assessed with a mobile eye cornea tracker system. Statistical analyses of the umpires' gaze behavior (fixation/pursuit tracking, saccades, and blinks)--onset, duration, offset, and frequency--were performed between and within 4 stages (pitcher's preparation, pitcher's delivery, ball in flight, and umpire call) by umpire's skill level. The results indicated that the quiet eye of expert umpires at onset of the pitcher's release point occurred earlier and was longer in duration than near-expert umpires. Expert expert umpires. The area outside the pitcher's ball release point may be the key environment cue for the behind-the-plate umpire.

Does a preoperative bowel preparation reduce bowel morbidity and length of stay after scoliosis surgery? A randomized prospective study.

BACKGROUND: Constipation is a common problem after surgery for adolescent idiopathic scoliosis (AIS), with bowel morbidity being reported as high as 78%. The purpose of this study was to determine if a preoperative bowel preparation reduces the incidence of bowel morbidity after surgery for AIS. METHODS: This is an IRB-approved randomized, prospective study of 60 consecutive patients who underwent surgery for AIS. After consent to participate was signed by the patients' family, patients were randomized to either a preoperative bowel preparation (group A) or no bowel preparation (group B). Bowel morbidity data were then collected and compared postoperatively. RESULTS: Complete data were available for 27 patients in group A and 28 in group B. Postoperatively, we found that group A had less weight gain (P<0.09), fewer postoperative bowel medications (P<0.023), and a shorter time to first bowel movement (P<0.03) when compared with group B. Two patients in group B had persistent constipation after discharge, one requiring readmission to the hospital. One patient in group B developed a postoperative wound infection. There were no adverse events in group A postoperatively. CONCLUSIONS: This study did show a modest reduction in some aspects of bowel morbidity when patients had a preoperative bowel preparation before scoliosis surgery. However, these differences did not reach statistical significance. Therefore, we do not recommend routine preoperative bowel preparations for AIS patients. LEVEL OF EVIDENCE: Level II.

Visual gaze behavior of near-expert and expert fast pitch softball umpires calling a pitch.

The purpose of this study was to examine the difference in visual gaze behavior between near expert (NE) and expert (E) umpires in a simulated pitch-hit situation in fast pitch softball. An Applied Science Laboratory mobile eye tracker was worn by 4 NE and 4 E fast pitch umpires and recorded their visual gaze behavior while following pitches (internal view). A digital camera located behind the pitcher recorded the external view of the pitcher, hitter, catcher, and umpire actions for each pitch. The internal and external video clips of 10 representative pitches--5 balls and 5 strikes--were synchronized and displayed in a split screen and were then coded for statistical analyses using Quiet eye solution software. Analysis of variance and multivariate analysis of variance statistical analyses of the umpires' gaze behavior during onset, duration, offset, and frequency (fixation/pursuit tracking, saccades, and blinks) were conducted between and within the 5 stages (pitcher's preparation, delivery and release, ball in flight, and umpire call) by umpire's skill level. Significant differences (p < 0.05) observed for combined gaze behavior frequency, type of gaze by phase, quiet eye duration and onset, and ball duration tracking indicated that E umpires' visual control was more stable and economical than NE umpires. Quiet eye significant results indicated that E umpires had an earlier onset (mean = 50.0 ± 13.9% vs. 56 ± 9.5%) and longer duration (mean = 15.1 ± 11.3% vs. 9.3 ± 6.5%) of the pitcher's release area than NE umpires. These findings suggest that gaze behavior of expert fast pitch umpires was more economical, fixated earlier and for a longer period of time on the area where the ball would be released, and was able to track the ball earlier and for a longer period of time.

Can infection associated with rib distraction techniques be managed without implant removal?

STUDY DESIGN: Retrospective clinical cohort study of infections in patients treated using rib distraction techniques. OBJECTIVE: To determine if patients with early onset spinal deformity, who develop infection around their rib distraction implant, can be successfully managed without implant removal. SUMMARY OF BACKGROUND DATA: Vertical Expandable Prosthetic Titanium Rib (VEPTR) has gained wide acceptance for the management of progressive complex spinal deformity in children. Many children in this population have significant comorbidities and low body mass index putting them at high risk for infection. Typically, the protocol for treating all but early infection recommends implant removal. The purpose of this study is to determine if a VEPTR infection can be managed effectively without implant removal. METHODS: This is an institutional review board-approved retrospective review of medical records of all patients who had VEPTR procedures and developed infections at PCMC from 2002 to 2008. RESULTS: Ninety-seven patients underwent 678 VEPTR procedures. Nineteen infections developed in 16 patients, with a 2% overall rate of infection per procedure. The average body mass index (16.2) and absolute neutrophil count (8.2) were predictably low for this population. The diagnosis was varied. Infection was associated with initial implantation (31%), expansion (47%), exchange (5%), and revision (21%). Seventeen of 19 infections followed a wound dehiscence. Thirteen infections were classified as superficial and six deep. All patients were treated with initial irrigation and debridement (I&D) and intravenous antibiotics. The average duration of intravenous therapy was 58 days, followed by oral suppressive therapy for 34 days (2-126). Three patients required more than one debridement to control the infection (range, 2-4 I&D). No patient has required VEPTR removal to resolve the infection. CONCLUSION: These data suggest that infections involving VEPTR instrumentation without fusion procedures can be effectively managed without implant removal. Nutrition and improved soft tissue management may be significant in reducing the incidence of infection in this patient population.

Does expansion thoracoplasty improve the volume of the convex lung in a windswept thorax?

BACKGROUND: Expansion thoracoplasty using the Vertical Expandable Prosthetic Titanium Rib increases the measured height and volume of the concave hemi thorax, but the effect on the convex, non-instrumented lung is unknown. The purpose of this study was to measure changes in lung volume and density in the convex lung after expansion thoracoplasty. METHODS: The volume and density of the lungs was measured in 12 children with congenital scoliosis and fused ribs before and after concave expansion thoracoplasty using serial computed tomography scans. RESULTS: There were 8 boys and 4 girls with an average age of 6.4 years at initial implant. The average length of follow-up was 17.5 months. All patients showed increased total lung volumes by an average of 250 cc (range 24 to 795 cc). The volume of the concave lung increased by an average of 55% and the lung density decreased by an average of 6%. The volume of the convex lung increased by an average of 60%, and the density decreased by an average of 7%. Nine of 12 patients showed improvement in density of the convex lung. DISCUSSION: These findings suggest that concave expansion thoracoplasty increases overall lung volume in children with congenital scoliosis and fused ribs as measured by computed tomography scan. In addition, expansion thoracoplasty seems to have a beneficial effect on the convex, non-operated hemi thorax. Decreases in measured lung density suggest improved aeration of the lung, which may prove to be beneficial to overall pulmonary function. LEVEL OF EVIDENCE: Level 4 therapeutic studies: case series.