7 research outputs found
Awake Da Vinci robotic partial nephrectomy: First case report ever in a situation of need
We report a unique case of a robotic partial nephrectomy performed under continuous spinal anesthesia (CSA). A 63-year-old woman, active smoker with mild obesity and previous right pneumonectomy, was diagnosed with a growing 5.5-cm renal right cystic tumor. Being at high risk for general anesthesia, a loco-regional approach was indicated. Therefore, after multidisciplinary discussion, a robotic-assisted partial nephrectomy under CSA was considered mandatory. After T4-T5 sensory and motor block, retroperitoneoscopic robot-assisted surgery was successfully performed. Postoperative period was uneventful, with optimal pain control. This unique case demonstrates the feasibility of robotic surgery under CSA, for imperative indications
Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors
BackgroundPre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive.MethodsA monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003-2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP ResultsUnivariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p50 years old donor.ConclusionsOur findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure
Outcome of liver transplantation with grafts from brain-dead donors treated with dual hypothermic oxygenated machine perfusion, with particular reference to elderly donors
Prompted by the utilization of extended criteria donors, dual hypothermic oxygenated machine perfusion (DâHOPE) was introduced in liver transplantation to improve preservation. When donors after neurological determination of death (DBD) are used, DâHOPE effect on graft outcomes is unclear. To assess DâHOPE value in this setting and to identify ideal scenarios for its use, data on primary adult liver transplant recipients from January 2014 to April 2021 were analyzed using inverse probability of treatment weighting, comparing outcomes of DâHOPEâtreated grafts (n = 121) with those preserved by static cold storage (n = 723). Endâischemic DâHOPE was systematically applied since November 2017 based on donor and recipient characteristics and transplant logistics. DâHOPE use was associated with a significant reduction of early allograft failure (OR: 0.24; 0.83; p = .024), grade â„3 complications (OR: 0.57; p = .046), comprehensive complication index (â7.20 points; p = .003), and improved patient and graft survival. These results were confirmed in the subset of elderly donors (>75âyearâold). Although DâHOPE did not reduce the incidence of biliary complications, its use was associated with a reduced severity of ischemic cholangiopathy. In conclusion, DâHOPE improves postoperative outcomes and reduces early allograft loss in extended criteria DBD grafts
Monitoring of Cardiac Output Using a New Smartphone Application (Capstesia) vs. Vigileo FloTrac System
(1) Background: We tested Capstesia against a reference system, Vigileo FloTrac, in patients undergoing major vascular surgery procedures. (2) Methods: Twenty-two adult patients (236 data pairs) were enrolled. Cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and related indexed parameters from the two monitoring systems were collected and compared at eleven time points during surgery. Intraclass correlation coefficients with 95% confidence intervals (CIs) and BlandâAltman plots with percentages of error were used. (3) Results: The interclass correlation coefficients for CO, SV, and SVR were 0.527 (95%CI 0.387 to 0.634), 0.580 (95%CI 0.454 to 0.676), and 0.609 (95%CI 0.495 to 0.698), respectively. In the BlandâAltman analysis, bias (and limits of agreement) of CO was 0.33 L minâ1 (â2.44; 3.10), resulting in a percentage error of 61.91% for CO. For SV, it was 5.02 mL (â36.42; 46.45), with 57.19% of error. Finally, the bias (and limit of agreement) of SVR was â75.99 dyne sec cmâ5 (â870.04; 718.06), resulting in an error of 69.94%. (4) Conclusions: Although promising, cost-effective, and easy to use, the moderate level of agreement with Vigileo and the high level of error make Capstesia unsuitable for use in the intraoperative setting of vascular surgery. Critical errors in acquisition or digitalization of the snap might have a strong impact on the accuracy and performance. Further standardization of the acquisition technique and improvements in the processing algorithm are needed
Monitoring of Cardiac Output Using a New Smartphone Application (Capstesia) vs. Vigileo FloTrac System
(1) Background: We tested Capstesia against a reference system, Vigileo FloTrac, in patients undergoing major vascular surgery procedures. (2) Methods: Twenty-two adult patients (236 data pairs) were enrolled. Cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and related indexed parameters from the two monitoring systems were collected and compared at eleven time points during surgery. Intraclass correlation coefficients with 95% confidence intervals (CIs) and BlandâAltman plots with percentages of error were used. (3) Results: The interclass correlation coefficients for CO, SV, and SVR were 0.527 (95%CI 0.387 to 0.634), 0.580 (95%CI 0.454 to 0.676), and 0.609 (95%CI 0.495 to 0.698), respectively. In the BlandâAltman analysis, bias (and limits of agreement) of CO was 0.33 L minâ1 (â2.44; 3.10), resulting in a percentage error of 61.91% for CO. For SV, it was 5.02 mL (â36.42; 46.45), with 57.19% of error. Finally, the bias (and limit of agreement) of SVR was â75.99 dyne sec cmâ5 (â870.04; 718.06), resulting in an error of 69.94%. (4) Conclusions: Although promising, cost-effective, and easy to use, the moderate level of agreement with Vigileo and the high level of error make Capstesia unsuitable for use in the intraoperative setting of vascular surgery. Critical errors in acquisition or digitalization of the snap might have a strong impact on the accuracy and performance. Further standardization of the acquisition technique and improvements in the processing algorithm are needed