Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy

BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer

Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

Background:Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences.A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses.A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines.Methods and analysis:a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up.The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC)The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers.Ethics:This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevantlaws/regulations.Trial registration number:NCT0275108

Induction of anaesthesia with ketamine during an acute crisis of hereditary coproporphyria

An appendectomy operation was undertaken in a 29-year-old patient with signs of an acute crisis of hereditary coproporphyria. Anaesthetic induction with ketamine 75 mg IV was uneventful. The safety of ketamine in patients with oproporphyria is discussed. © 1987 Canadian Anesthesiologists.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Traitement des éventrations médianes volumineuses par autoplastie aponévrotique et prothèse retromusculaire. À propos de 40 observations

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

VALEUR DE L'ECHOGRAPHIE POUR LA MESURE DES VOLUMES DE LA GLANDE THYROIDE ET DE SES LESIONS

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

FISTULE JEJUNALE ENTEROCUTANEE COMPLICATION TARDIVE D'UNE PROTHESE SYNTHETIQUE DANS LA CHIRURGIE PARIETALE

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Traitement des éventrations médianes volumineuses par autoplastie aponévrotique et prothèse retromusculaire. À propos de 40 observations

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Retroperitoneal liposarcoma: A propos of 3 cases and a review of the literature

info:eu-repo/semantics/publishe

Spontaneous rupture of the esophagus after coronary artery bypass

SCOPUS: ar.jinfo:eu-repo/semantics/publishe