Prolonged non-operative management of clostridium difficile colitis is associated with increased mortality, complications, and cost.

Background: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI).

Methods: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded.

No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis.

Background: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications.

Methods: The 2011-2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded.

Emergent cholecystectomy is superior to percutaneous cholecystostomy tube placement in critically ill patients with emergent calculous cholecystitis.

Background: The role of percutaneous cholecystostomy (PC) is undefined in patients with multiple comorbidities presenting with emergent calculous cholecystitis (CC). This study compared outcomes between PC, laparoscopic (LC), and open cholecystectomy (OC).

Methods: The Vizient UHC database was queried for high-risk patients with CC who underwent PC, LC, OC, or laparoscopic converted to open cholecystectomy (CONV).

Sleeve gastrectomy and anti-reflux procedures.

Background: Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem.

Adaptive Virtual Reality Training to Optimize Military Medical Skills Acquisition and Retention.

The Department of Defense has pursued the integration of virtual reality simulation into medical training and applications to fulfill the need to train 100,000 military health care personnel annually. Medical personnel transitions, both when entering an operational area and returning to the civilian theater, are characterized by the need to rapidly reacquire skills that are essential but have decayed through disuse or infrequent use. Improved efficiency in reacquiring such skills is critical to avoid the likelihood of mistakes that may result in mortality and morbidity.

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair.

Purpose: Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs.

Design and Analysis of a Novel Articulated Drive Mechanism for Multifunctional NOTES Robot.

This paper presents a novel articulated drive mechanism (ADM) for a multifunctional natural orifice transluminal endoscopic surgery (NOTES) robotic manipulator. It consists mainly of three major components including a snakelike linkage, motor housing, and an arm connector. The ADM can articulate into complex shapes for improved access to surgical targets.

Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh.

Introduction: Paraesophageal hernia (PEH) repair has a high radiologic recurrence rate, even with the use of biologic mesh as a prosthetic buttress to reinforce the primary crural repair. This review was done to evaluate outcomes after PEH repair with mesh.

Methods: A retrospective analysis was done of all patients who underwent PEH repair with mesh at our institution between December 2004 and March 2013.

How does robotic anti-reflux surgery compare with traditional open and laparoscopic techniques: a cost and outcomes analysis.

Background: Conventional laparoscopic fundoplications (CLF) have been the gold standard for Nissen fundoplications (NFs) for two decades. The advent of a robotic approach for fundoplication procedures creates a potential alternative. Thus, we used a national database to examine perioperative outcomes with respect to open, laparoscopic, and robotic approaches.

Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study.

Background: Morbidity and mortality are very high for critically ill patients who develop acute acalculous cholecystitis (AAC). The aim of this study was to compare outcomes in extremely ill patients with AAC treated with percutaneous cholecystostomy (PC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC), which were also analyzed together in the LC-plus-OC (LO) group.

Methods: Discharge data from the University HealthSystem Consortium database were accessed using International Classification of Diseases codes.

Survey of minimally invasive general surgery fellows training in robotic surgery.

Minimally invasive surgery fellowships offer experience in robotic surgery, the nature of which is poorly defined. The objective of this survey was to determine the current status and opportunities for robotic surgery training available to fellows training in the United States and Canada. Sixty-five minimally invasive surgery fellows, attending a fundamentals of fellowship conference, were asked to complete a questionnaire regarding their demographics and experiences with robotic surgery and training.

Do you need a computed tomographic scan to evaluate suspected appendicitis in young men: an administrative database review.

Background: The purpose of this study was to evaluate the impact of computed tomographic (CT) scans of the abdomen on clinical outcomes and costs in young male patients presenting with suspected appendicitis.

Methods: Discharge data from the University HealthSystem Consortium was accessed for all male patients between 18 and 55 years of age from October 2007 to June 2011.

Results: Of a total of 13,228 patients who met the inclusion criteria, 11,340 (85%) were assessed using a CT scan of the abdomen, whereas 1,888 (15%) did not undergo CT evaluation.

Review of surgical robotics user interface: what is the best way to control robotic surgery?

Background: As surgical robots begin to occupy a larger place in operating rooms around the world, continued innovation is necessary to improve our outcomes.

Methods: A comprehensive review of current surgical robotic user interfaces was performed to describe the modern surgical platforms, identify the benefits, and address the issues of feedback and limitations of visualization.

Results: Most robots currently used in surgery employ a master/slave relationship, with the surgeon seated at a work-console, manipulating the master system and visualizing the operation on a video screen.

Not all biologics are equal!

Background: Although the efficacy of various biologic meshes in the abdominal reconstruction of complex ventral hernia has been shown, the performance profile of various biologic mesh scaffolds in terms of hernia-specific outcomes such as recurrence, mesh explantation, and mesh infections has not been examined.

Aim: To evaluate the clinical outcomes of patients who underwent complex ventral hernia repair with bioprosthetic material.

Methods: This study is a retrospective analysis of the use of bioprosthetic material in complex ventral hernia at an academic institution from January 2002 to December 2007.

In vivo miniature robots for natural orifice surgery: State of the art and future perspectives.

Natural orifice translumenal endoscopic surgery (NOTES) is the integration of laparoscopic minimally invasive surgery techniques with endoscopic technology. Despite the advances in NOTES technology, the approach presents several unique instrumentation and technique-specific challenges. Current flexible endoscopy platforms for NOTES have several drawbacks including limited stability, triangulation and dexterity, and lack of adequate visualization, suggesting the need for new and improved instrumentation for this approach.

Safety, efficacy, and cost-effectiveness of common laparoscopic procedures.

Background: Laparoscopic surgery has been shown to offer superior surgical outcomes for most abdominal surgical procedures. However, there is hardly any evidence on surgical outcomes with patient risk stratification. This study aimed to compare outcomes of common laparoscopic and open surgical procedures for varying illness severity.

Tool guidance using a compact robotic assistant.

Surgical robots in popular clinical use are generally large machines, which limits their practical use to some extent. This study aims to investigate the potential of a small, table-mounted robot for tool guidance in minimally invasive surgery (MIS). In particular, its multipurpose use for guidance of various tools was investigated.