Robotic suture of a large caval injury caused by endo-GIA stapler malfunction during laparoscopic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein

P rimary endo-GIA stapler malfunction occurred during robotic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein, in an obese woman diagnosed with single liver metastasis from a previous carcinoid tumour. Haemorrhage was soon controlled by clamping the vena cava below the injury using two wristed forceps angled at 90°. With the two instruments locked in the holding position the ensuing operative strategy was discussed between surgeon and anaesthesia teams. Using the third robotic arm the caval injury was repaired laparoscopically with interrupted polypropylene sutures. The patient was transfused with two units of packed red blood cells, recovered uneventfully, and was discharged on post-operative day five. We conclude that even the most advanced technologies can fail and that surgeons should be fully aware of the consequences of these malfunctions and be prepared for repair. From this point of view, the da Vinci surgical system seems to have some advantages over classical laparoscopic methods including the ability to lock the wristed instruments in the holding position, the use of three arms by the same operating surgeon, and the extreme facilitation of intracorporeal suturing and knot-tying in deep and narrow spaces, extremely difficult if not impossible with conventional laparoscopic instruments

Oesophageal involvement is correlated with interstital lung involvement (ILD) in SSc patients

Background: Systemic sclerosis (SSc), also known as scleroderma, is a systemic disease on unknown etiology. The severity and type of organ involvement may vary widely, but oesophageal function is altered in the vast majority of SSc patients

Oesophageal involvement is correlated with interstital lung involvement (ILD) in SSc patients

Evaluation of the relationship between esophageal involvement and interstital lung involvement in scleroderma patient

Gallium scanning in the diagnosis of thoracic neoplasms

J. Nucl. Med. All. Sci

"Non-invasive" portable laser ablation sampling for lead isotope analysis of archaeological silver: A comparison with bulk and In situ laser ablation techniques

The main factor restricting lead isotope analysis of metals from museum collections is the requirement for physical material. Hence, there are major incentives for developing minimally invasive methods for lead isotope analysis that are accurate and precise enough to reveal historical information about artefacts and their origin. Portable laser ablation (pLA), collecting microscopic samples on Teflon filters, has four key benefits. It produces no visual impact to the artefacts, does not require transport of artefacts to laboratory facilities, there are no artefact size restrictions, and samples are processed under clean laboratory conditions allowing Pb purification prior to measurement by solution MC-ICPMS. To validate the efficacy of the pLA technique on silver, nine matrixed-matched commercial, in-house and archaeological reference materials were sampled and analysed multiple times (9-10). The pLA mean analyses (±2SD) were all consistent with inter-laboratory bulk analyses. The digestion of sample filters produces precisions that are consistently more than five-times better than in situ nsLA-MC-ICPMS and are the same order of magnitude expected for bulk samples processed in different laboratories. This journal i

Robotic renal transplantation: First European case

A kidney from a 56-year-old mother was transplanted to her 37-year-old daughter laparoscopically using the daVinci HDSi surgical system. The kidney was introduced into the abdomen through a 7-cm suprapubic incision used also for the uretero-vescical anastomosis. Vascular anastomoses were carried out through a total of three additional ports. Surgery lasted 154 min, including 51 min of warm ischemia of the graft. Urine production started immediately after graft reperfusion. Renal function remains optimal at the longest follow-up of 3 months. The technique employed in this case is discussed in comparison with the only other two contemporary experiences, both from the USA. Furthermore, possible advantages and disadvantages of robotics in kidney transplantation are discussed extensively. We conclude that the daVinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Further experience is needed, but it is likely that solid organ transplantation will not remain immune to robotics. © 2010 The Authors. Transplant International © 2010 European Society for Organ Transplantation

Robotic renal transplantation: first European case

A kidney from a 56-year-old mother was transplanted to her 37-year-old daughter laparoscopically using the daVinci HDSi surgical system. The kidney was introduced into the abdomen through a 7-cm suprapubic incision used also for the uretero-vescical anastomosis. Vascular anastomoses were carried out through a total of three additional ports. Surgery lasted 154 min, including 51 min of warm ischemia of the graft. Urine production started immediately after graft reperfusion. Renal function remains optimal at the longest follow-up of 3 months. The technique employed in this case is discussed in comparison with the only other two contemporary experiences, both from the USA. Furthermore, possible advantages and disadvantages of robotics in kidney transplantation are discussed extensively. We conclude that the daVinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Further experience is needed, but it is likely that solid organ transplantation will not remain immune to robotics