Rise of the robots: implementing robotic surgery into the acute care surgery practice.

Objectives: Acute Care Surgery (ACS) admissions and procedures are substantially increasing. ACS disproportionally accounts for a majority of morbidity and mortality among surgical patients. Minimally invasive techniques are associated with improved outcomes and shorter hospital length of stay within the ACS population.

Multisociety research collaboration: timing of cholecystectomy following cholecystostomy drainage for acute cholecystitis.

Background: Patients with acute cholecystitis (AC) presenting with unfavorable systemic or local conditions are often managed with percutaneous cholecystostomy (PC) as a temporary measure. The clinical outcomes of interval cholecystectomy following PC remain unclear. The aim of the study was to identify the association between the timing of cholecystectomy following PC for AC and perioperative complication rates at interval cholecystectomy.

Robotic median arcuate ligament release: management algorithm and clinical outcomes from a large minimally invasive series.

Background: Median arcuate ligament syndrome (MALS) is a rare and debilitating condition that remains difficult to diagnose. Proper patient selection remains key to achieving favorable outcomes for those undergoing MALR. The robotic technique facilitates a minimally invasive MALR approach given the fine precision of the instrumentation and stability of visualization.

The use of advanced robotic simulation labs to advance and assess senior resident robotic skills and operating room leadership competency: a pilot study.

Background: General surgery has the fastest growing robotic operative volume in the United States, but most robotic curricula are focused on basic psychomotor skills. There are limited curricula focused on advanced robotic technical and related non-technical skills. We describe a novel pilot curriculum for robotic hiatal hernia repair developed for senior surgical residents to provide training and standardized assessment of higher-order robotic technical and leadership skills.

Impact of COVID-19 on common non-elective general surgery diagnoses.

Background: During the COVID-19 pandemic, public health and hospital policies were enacted to decrease virus transmission and increase hospital capacity. Our aim was to understand the association between COVID-19 positivity rates and patient presentation with EGS diagnoses during the COVID pandemic compared to historical controls.

Methods: In this cohort study, we identified patients ≥ 18 years who presented to an urgent care, freestanding ED, or acute care hospital in a regional health system with selected EGS diagnoses during the pandemic (March 17, 2020 to February 17, 2021) and compared them to a pre-pandemic cohort (March 17, 2019 to February 17, 2020).

Technique and Outcomes in Laparoscopic Repair of Morgagni Hernia in Adults.

Morgagni hernias (MHs) are rare anteromedial congenital diaphragmatic hernias. This study describes the effectiveness of a laparoscopic approach for these defects. A prospectively collected institutional database at a tertiary referral center was queried for patients (≥18 years) with MHs.

Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes.

Background: The majority of laparoscopic paraesophageal hernia (PEH) repairs are performed electively. We aimed to investigate the frequency of non-elective laparoscopic (MIS) PEH repair and compare 30-day outcomes to elective MIS repairs and non-elective open repairs. We hypothesized that an increasing percentage of non-elective PEH repairs would be performed laparoscopically and that this population would have improved outcomes compared to non-elective open PEH counterparts.

Surgery Resident Time Consumed by the Electronic Health Record.

Objective: Time spent on the Electronic Health Record (EHR) influences surgical residents' clinical availability. Objective data assessing EHR usage among surgical residents are lacking and necessary.

Design/participants: Active EHR usage data for 70 surgical residents were collected from April 2015 through April 2016.

Trends and Outcomes in the Operative Management of Traumatic Vascular Injuries: A Comparison of Open Endovascular Approaches.

Controversy exists in vascular trauma regarding the best method of treatment-open versus endovascular techniques. Little has been published on this complex topic. Patients from 2005 to 2013 at a Level I trauma center with vascular injuries were identified via a prospectively trauma registry.

A novel variant of the cleidocervicalis muscle with clinical implications for nerve compression/entrapment.

Purpose: The cleidocervicalis muscle occurs in approximately 1-3 % of the population that may be confused with pathological neck masses. We describe a novel variant of the muscle and its clinical implications.

Methods: This is a case report of a cleidocervicalis muscle variant identified during routine cadaveric dissection.

Rational design of cyclopropane-based chiral PHOX ligands for intermolecular asymmetric Heck reaction.

A novel class of chiral phosphanyl-oxazoline (PHOX) ligands with a conformationally rigid cyclopropyl backbone was synthesized and tested in the intermolecular asymmetric Heck reaction. Mechanistic modelling and crystallographic studies were used to predict the optimal ligand structure and helped to design a very efficient and highly selective catalytic system. Employment of the optimized ligands in the asymmetric arylation of cyclic olefins allowed for achieving high enantioselectivities and significantly suppressing product isomerization.

Highly diastereoselective formal nucleophilic substitution of bromocyclopropanes.

A highly diastereoselective formal nucleophilic substitution of bromocyclopropanes with oxygen- and nitrogen-based nucleophiles was demonstrated. The reaction proceeds via a base-assisted dehydrohalogenation producing a cyclopropene intermediate, which subsequently undergoes addition of a pronucleophile across the strained double bond. Very high chemoselectivity toward addition of primary and secondary alkoxides, as well as N-nucleophiles, in the presence of tert-butoxide base was observed, whereas phenoxides did not undergo addition under these reaction conditions.

Rhodium-catalyzed hydroformylation of cyclopropenes.

The first catalytic diastereo- and enantioselective hydroformylation of cyclopropenes was demonstrated. The reaction proceeds efficiently under very mild conditions and low catalyst loadings providing high yields of cyclopropylcarboxaldehydes. This novel methodology represents a convenient, atom-economic approach toward optically active cyclopropylcarboxaldehydes from readily available prochiral cyclopropenes.

Palladium-catalyzed hydrophosphorylation and hydrophosphinylation of cyclopropenes.

Novel transition-metal-catalyzed addition of P-H entities across the cyclopropene double bond has been developed. This transformation allows for mild and efficient preparation of phosphorus-containing cyclopropanes in good yields and high degrees of diastereoselectivity.