Upper extremity surface electromyography signal changes after laparoscopic training

Introduction: Objective measures of laparoscopic skill in training are lacking. Aim: To evaluate the changes in the surface electromyography (sEMG) signal during laparoscopic training, and to link them to intracorporeal knot tying. Material and methods: Ten right-handed medical students (6 female), aged 25 ±0.98, without training in laparoscopy, were enrolled in the study. With no additional training, they tied intracorporeal single knots for 15 min. Then underwent laparoscopic training and redid the knot tying exercise. During both events, sEMG was recorded from 8 measurement points on the upper extremities and neck bilaterally. We analyzed changes in sEMG resulting from training and tried to find sEMG predictive parameters for higher technical competence defined by the number of knots tied after the training. Results: The average number of knots increased after the training. Significant decreases in activity after the training were visible for the non-dominant hand deltoid and trapezius muscles. Dominant and non-dominant hands had different activation patterns. Differences largely disappeared after the training. All muscles, except for the dominant forearm and non-dominant thenar, produced a negative correlation between their activities and the number of tied knots. The strongest anticorrelation occurred for the non-dominant deltoid (r = –0.863, p < 0.05). Relatively strong relationships were identified in the case of the non-dominant trapezius and forearm muscles (r = –0.587, r = –0.504). Conclusions: At least for some muscle groups there is a change in activation patterns after laparoscopic training. Proximal muscle groups tend to become more relaxed and the distal ones become more active. Changes in the non-dominant hand are more pronounced than in the dominant hand

The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Perioperacijske promjene subpopulacija limfocita u bolesnika operiranih zbog kolorektalnog karcinoma

Surgical procedure has immense impact on the immune balance. However, little is known about perioperative changes in T regulatory and Th17 lymphocyte subpopulations in patients undergoing colorectal resection. Patients with resectable colon cancer were enrolled in the study. Blood samples were obtained on two occasions, i.e. before the procedure and two days after the surgery. We also recruited a control group of young, healthy individuals. Lymphocyte subpopulations were analyzed with the use of flow cytometry. Investigated subpopulations consisted of total lymphocyte count, CD4+, CD8+, T regulatory Foxp3+ (Tregs), Th17 lymphocytes and white blood cell (WBC) count. There were significant differences in immune cell levels before and after the surgery. Reduction was recorded in the CD4+, CD8+, Tregs and total lymphocyte counts (p=0.002, p=0.01, p=0.008 and p=0.001, respectively). Increase was observed in total WBC and Th17 cells, however, Th17 lymphocytes did not reach statistical significance (p=0.01 and p=0.5, respectively). In conclusion, surgical intervention caused changes in all lymphocyte subpopulations investigated in patients undergoing surgery for colorectal cancer. However, it seemed to be an effect of perioperative trauma. Further studies are needed to investigate the impact of surgical intervention on lymphocyte subpopulations.Kirurški zahvat ima golem učinak na ravnotežu imunog sustava. Međutim, malo se zna o perioperacijskim promjenama u subpopulacijama T regulatornih i Th17 limfocita u bolesnika podvrgnutih resekciji kolorektuma. U istraživanje su bili uključeni bolesnici s resektabilnim karcinomom kolona. Uzorci krvi prikupljeni su dva puta: prije zahvata i dva dana nakon operacije. Uključena je bila i kontrolna skupina sastavljena od mladih i zdravih osoba. Subpopulacije limfocita analizirane su protočnom citometrijom. Istraživane su sljedeće subpopulacije: ukupan broj limfocita, CD4+, CD8+, T regulatorni Foxp3+ (Tregs), Th17 i bijela krvna slika. Utvrđene su značajne razlike u razinama imuno stanica prije i nakon operacije. Snižene razine zabilježene su za CD4+, CD8+, Tregs i ukupni broj limfocita (p=0,002, p=0,01, p=0,008 odnosno p=0,001). Povišenje je zapaženo za bijelu krvnu sliku i Th17 stanice, međutim, Th17 limfociti nisu postigli statističku značajnost (p=0,01 odnosno p=0,5). Zaključujemo da je kirurški zahvat uzrokovao promjene u svim istraživanim subpopulacijama limfocita kod bolesnika podvrgnutih operaciji kolorektalnog karcinoma. Međutim, čini se da je to bio učinak perioperacijske traume. Potrebna su daljnja istraživanja kako bi se ispitao utjecaj kirurškog zahvata na subpopulacije limfocita

Enhanced recovery after surgery (ERAS) programs for esophagectomy

A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS’s effectiveness in esophageal surgery