Learning Curve Analysis for Robotic-assisted Harvest of Deep Inferior Epigastric Perforator Flap.

The deep inferior epigastric perforator (DIEP) flap is the preferred method for autologous breast reconstruction after mastectomy, but risks the development of hernia, bulge, and decreased core strength. Robotic harvest of DIEP vessels may limit abdominal wall morbidity through smaller fascial incisions and preservation of motor nerves. This study shows the expected learning curve (LC) for robotic harvest and compares the LC between a general surgeon (GS) and a plastic surgeon (PS).

Transabdominal Robotic Harvest of Bilateral DIEP Pedicles in Breast Reconstruction: Technique and Interdisciplinary Approach.

Background:  The deep inferior epigastric artery perforator (DIEP) flap is the gold standard for autologous breast reconstruction. However, the conventional procedure's anterior sheath division, from perforating vessels to the pedicle origin, risks weakening the abdominal wall's primary strength layer. Employing the da Vinci Xi Surgical System with indocyanine green dye and near-infrared fluorescence imaging, we refined a robotic technique for bilateral DIEP flap harvest.

A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.

Background:  Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.

Indocyanine Green-Guided Near-Infrared Fluorescence Enhances Vascular Anatomy in Robot-Assisted DIEP Flap Harvest.

Indocyanine green-guided near-infrared fluorescence imaging has gained clinical acceptance lately. This technology can be particularly advantageous in the case of robotic flap harvest. This article presents a new approach to deep epigastric pedicle dissection using indocyanine green-guided near-infrared fluorescence in the setting of robot-assisted deep inferior epigastric perforator flaps.

Soft-Tissue Reconstruction after Composite Vertebrectomy and Chest Wall Resection for Spinal Tumors.

Background: Oncologic resections involving both the spine and chest wall commonly require immediate soft-tissue reconstruction. The authors hypothesized that reconstructions of composite resections involving both the thoracic spine and chest wall would have a higher complication rate than reconstructions for resections limited to the thoracic spine alone.

Methods: The authors performed a retrospective analysis of all consecutive patients who underwent a thoracic vertebrectomy and soft-tissue reconstruction from 2002 to 2017.

Bilateral Breast Reduction Without Opioid Analgesics: A Comparative Study.

Background: Breast reduction has traditionally been performed under general anesthesia with adjunct opioid use. However, opioids are associated with a wide variety of adverse effects, including nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction.

Objectives: This study compares bilateral breast reduction using a multimodal opioid-free pain management regimen vs traditional general anesthesia with adjunct opioids.

Tissue Monitoring with Three-Wavelength Light Emitting Diode-Based Near-Infrared Spectroscopy.

 Flap monitoring with near-infrared spectroscopy (NIRS) facilitates early detection of vascular compromise. However, standard NIRS devices that employ two wavelengths of light to assess tissue oxygenation (StO) are susceptible to artifact from background noise and demonstrate significant variability in the clinical setting. As the number of wavelengths detected by a NIRS device is increased, the precision of StO measurements can be improved and additional chromophores other than oxyhemoglobin and deoxyhemoglobin can be measured.

Calvarial Regeneration With Use of Acellular Dermal Matrix in Aplasia Cutis Congenita.

Aplasia cutis congenital (ACC) is a rare congenital anomaly, most commonly affecting the scalp, with a variable penetrance ranging from a small (<2 cm) area of missing skin to large defects characterized by absent skin, subcutaneous tissue, calvarium, and dura. Calvarial reconstruction in ACC can be challenging. Due to exposed neurologic structures, in large defects, ACC has a high mortality rate.

Muscle-sparing blepharoplasty: a prospective left-right comparative study.

Background: Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision.

Single-incision laparoscopic cholecystectomy at community hospitals in Honolulu, Hawai'i: a case series.

This study aims to demonstrate the feasibility of implementing single-incision laparoscopic cholecystectomy in a community hospital setting. Minimally invasive surgical approaches for cholecystectomy achieve equivalent outcomes to the open surgical approach with less post-operative pain, improved cosmesis, shorter hospital stays, and decreased complications. Surgeons are attempting to reduce incisional trauma further by decreasing the number of incisions.

Treatment of median arcuate ligament syndrome via traditional and robotic techniques.

Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. This is the second ever report of this approach.

Prescription drug cost reduction in Native Hawaiians after laparoscopic Roux-en-y gastric bypass.

Objective: Native Hawaiians (NH) represent a unique population where socioeconomic factors have contributed to higher incidence rates of obesity and related comorbidities than in the general population resulting in substantial prescription medication costs. Studies demonstrate that laparoscopic Roux-en-y gastric bypass (LRYGB) surgery results in significant weight loss, improvement of comorbidities, and decreased costs for prescription medications in Caucasians. This study aimed to analyze the effects of LRYGB surgery on Native Hawaiians and their prescription drug costs.

Novel technique for preoperative localization of colorectal tumors for laparoscopic resection.

Minimally invasive surgery for resection of colon tumors is being utilized with increasing frequency making accurate preoperative tumor localization essential to proper surgical planning and patient positioning. Traditional endoscopic localization techniques such as lesion distancing from the anal verge are adequate in the majority of patients. Patients with a significantly tortuous and redundant colon, however, are at increased risk for ambiguous and incorrect lesion localization.

Dry eye syndrome due to botulinum toxin type-A injection: guideline for prevention.

Dry eye syndrome is a potential complication of botulinum toxin type-A injection (BTX-A) into the lateral canthal rhytids (crow's feet). The early manifestations of this syndrome are subtle and are rarely reported to the treating physician. A guideline for early detection of dry-eye state is proposed, in order to avoid more troublesome adverse effects that may develop with repeated injections of BTX-A into the crow's feet region.

Subcutaneous emphysema, pneumopericardium, pneumomediastinum and pneumoretroperitoneum secondary to sigmoid perforation: a case report.

A 50-year-old woman presented with chronic epigastric abdominal pain and constipation. She underwent diagnostic upper and lower endoscopy for further evaluation. Several hours following the procedure, she developed chest and subcutaneous emphysema of her upper chest, neck, and face.

Case report and management of suspected acute appendicitis in pregnancy.

Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman.

Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections.

Background: Perfusion through the right axillary artery is an alternative to aortic or femoral artery cannulation during surgery for ascending aortic dissections. The results of this strategy, particularly beyond the immediate postoperative period, are not well described.

Methods: Eighty-three patients (median age, 58 years) with acute or subacute ascending aortic dissection underwent surgical repair with right axillary artery perfusion through an interposition Dacron graft.

Splenic rupture: a case of massive hemoperitoneum following therapeutic colonoscopy.

Colonoscopies are usually regarded as safe procedures with low complication rates and are recommended for anyone over the age of fifty for colon cancer screening. Splenic rupture is a rare complication of colonoscopy with few reported cases in the English literature. We present the only reported case of such a complication in the state of Hawai'i and the 44th reported case in the English literature.