Laparoscopic appendectomy as a teaching procedure: experiences with 1197 patients in a community hospital

Purpose: Since laparoscopic procedures have become more common, resident surgeons have to learn complex laparoscopic skills at an early stage of their career. The aim of this study was to compare the short-term clinical outcome parameters of laparoscopic appendectomy (LA) performed by resident surgeons (RS) or attending surgeons (AS). Methods: A total of 1197 LA and 57 open appendectomies were performed in a Swiss community hospital between 1999 and 2009. RS performed 684 operations. Parameters including the duration of the operation and hospital stay, intraoperative complications, surgical reinterventions, and a 30-day morbidity and mortality were observed. Results: The mean age of the patients was 35.6±18.17years. The duration of the operation was longer (61.34±25.73min [RS] vs. 53.65±29.89 [AS]min; p=0.0001), but the hospital stay was shorter, in patients treated by RS (3.92±2.61days [RS] vs. 4.87±3.23 [AS]days; p=0.0001). The rate of intraoperative complications was not significantly different between the two groups (1.02% [RS] vs. 0.8% [AS]; p=0.6). The need for surgical reintervention (0.6% [RS] vs. 2.5% [AS]; p=0.005) and the 30-day morbidity were higher in patients treated by AS (3.7% [AS] vs. 1.8% [RS]; p=0.04). There was no postoperative mortality. Conclusions: Under appropriate supervision, surgical residents are able to perform LA with results comparable to those of experienced surgeon

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Purpose: Standardized surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) performed by resident surgeons (RS) and attending surgeons (AS). Methods: In this retrospective review of prospectively collected data 1,747 LC were performed in a community hospital between 1999 and 2009. Seven hundred seventy operations were performed by RS. Parameters analysed included the duration of operation and length of hospital stay, intraoperative complications, 30-day morbidity and mortality. Results: Duration of operation was 88 (25-245) min for RS vs. 75 (30-190) min by AS (p = 0.001). Elective operations were shorter when performed by AS (70 (30-190) [AS] vs. 85 (25-240) [RS] min, p = 0.001). Length of hospital stay was shorter in patients treated by RS (4 (1-49) days [RS] vs. 5 (1-83) days [AS], p = 0.1). Intraoperative complications showed no differences between the groups (1.0% [RS] vs. 1.3% [AS], p = 0.6), whereas 30-day morbidity was lower in patients treated by RS (3.8% [RS] vs. 6.2% [AS], p = 0.02). Overall mortality was 0.6% and independent of surgical expertise (0.5% [RS] vs. 0.8% [AS], p = 0.5). Conclusions: Provided adequate training, supervision and patient selection, surgical residents are able to perform LC with results comparable to those of experienced surgeon

Langerhans cell histiocytosis as differential diagnosis of a mediastinal tumor

We describe the case of a 55-year-old man who presented with parasternal swelling. The chest CT scan showed a large tumor of the chest wall infiltrating the subcutaneous tissue. To assume histologic diagnosis an open biopsy was performed. Between the myofibrils a coarse, white tumor with infiltrative growth was noted. Histopathologic examination revealed expanded atrophic skeletal muscle that was infiltrated by histiocytic cells. Numerous eosinophilic granulocytes and lymphocytes CD20 and CD3 positive could be detected and immunohistochemical staining was also positive for S-100 proteins and CD1a. Histologic findings were characteristic of Langerhans cell histiocytosis (LCH). To the best of our knowledge a LCH originating from the mediastinum in an adult as presented has not been previously describe

Functional integration of natural killer cells in a microfluidically perfused liver on-a-chip model.

OBJECTIVE The liver acts as an innate immunity-dominant organ and natural killer (NK) cells, are the main lymphocyte population in the human liver. NK cells are in close interaction with other immune cells, acting as the first line of defense against pathogens, infections, and injury. A previously developed, three-dimensional, perfused liver-on-a-chip comprised of human cells was used to integrate NK cells, representing pivotal immune cells during liver injury and regeneration. The objective of this study was to integrate functional NK cells in an in vitro model of the human liver and assess utilization of the model for NK cell-dependent studies of liver inflammation. RESULTS NK cells from human blood and liver specimen were isolated by Percoll separation with subsequent magnetic cell separation (MACS), yielding highly purified blood and liver derived NK cells. After stimulation with toll-like-receptor (TLR) agonists (lipopolysaccharides, Pam3CSK4), isolated NK cells showed increased interferon (IFN)-gamma secretion. To study the role of NK cells in a complex hepatic environment, these cells were integrated in the vascular compartment of a microfluidically supported liver-on-a-chip model in close interaction with endothelial and resident macrophages. Successful, functional integration of NK cells was verified by immunofluorescence staining (NKp46), flow cytometry analysis and TLR agonist-dependent secretion of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha. Lastly, we observed that inflammatory activation of NK cells in the liver-on-a-chip led to a loss of vascular barrier integrity. Overall, our data shows the first successful, functional integration of NK cells in a liver-on-a-chip model that can be utilized to investigate NK cell-dependent effects on liver inflammation in vitro

Impact of the first COVID-19 shutdown on traumatological patient volumes in Switzerland

Background The coronavirus has caused a worldwide pandemic with serious impacts on our healthcare systems. Many countries experienced a decline in traumatological patient volume. The aim of this study is to evaluate the impact of the first lockdown on traumatological patient volume in Switzerland. Methods We retrospectively used a prospective national quality measurement database. We compared the period of the first lockdown in Switzerland from March 17 to April 26, 2020 to the same period in the years 2018 and 2019. Included were all adult patients with any S-code (trauma) according to the International Classification of Diseases. Results In total, we assessed 3874 patients (1779 in the year 2018, 1303 in the year 2019, and 792 in the year 2020) with a mean age of 61 ± 21 years. The patients during the lockdown period had significantly more injuries to the hip and forearm, had more comorbidities, and were more likely to have statutory insurance. During the lockdown period, more thromboembolism prophylaxis or anticoagulation was applied, and more patients needed antibiotic treatment. Conclusions The present study demonstrated a 40–55% reduction in patient volume during the lockdown period in Switzerland compared to the previous years. The in-hospital mortality and complication rate during the lockdown period remained stable. This study suggests that in-hospital care for trauma patients in Switzerland was not substantially affected by the first lockdown

Additional surgical procedure is a risk factor for surgical site infections after laparoscopic cholecystectomy

Purpose: Surgical site infections (SSI) are associated with increased costs and length of hospital stay, readmission rates, and mortality. The aim of this study was to identify risk factors for SSI in patients undergoing laparoscopic cholecystectomy. Methods: Analysis of 35,432 laparoscopic cholecystectomies of a prospective multicenter database was performed. Risk factors for SSI were identified among demographic data, preoperative patients' history, and operative data using multivariate analysis. Results: SSIs after laparoscopic cholecystectomy were seen in 0.8% (n = 291) of the patients. Multivariate analysis identified the following parameters as risk factors for SSI: additional surgical procedure (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.2-7.5), age over 55years (OR 2.4 [1.8-3.2]), conversion to open procedure (OR 2.6 [1.9-3.6]), postoperative hematoma (OR 1.9 [1.2-3.1]), duration of operation >60min (OR 2.5 [1.7-3.6], cystic stump insufficiency (OR 12.5 [4.2-37.2]), gallbladder perforation (OR 6.2 [2.4-16.1]), gallbladder empyema (OR 1.7 [1.1-2.7]), and surgical revision (OR 15.7 [10.4-23.7]. SSIs were associated with a significantly prolonged hospital stay (p 60min, age >55years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for SSI after laparoscopic cholecystectomy

Paediatric thyroid surgery is safe - experiences at a tertiary surgical centre.

PRINCIPLES Thyroidectomy in children is rare and mostly performed because of thyroid neoplasms. The aim of this study based on prospective data acquisition was to evaluate whether thyroid surgery in children can be performed as safely as in adults when undertaken by a team of adult endocrine surgeons and paediatric surgeons. METHODS Between 2002 and 2012, 36 patients younger than 18 years underwent surgery for thyroid gland pathologies. All surgical procedures were performed by an experienced endocrine surgeon and a paediatric surgeon. Baseline demographic data, surgical procedure, duration of operation, length of hospital stay, and postoperative morbidity and mortality were analysed. RESULTS The median age of all patients was 13 years (range 2-17 years), with predominantly female gender (n = 30, 83%). The majority of operations were performed because of benign thyroid disease (n = 27, 75%) and only a minority because of malignancy or genetic abnormality with predisposition for malignant transformation (MEN) (n = 9, 25%). Total thyroidectomy was performed in the majority of the patients (n = 24, 67%). The median duration of the surgical procedure was 153 minutes (range 90-310 minutes). The median hospital stay was 5 days (3-1 days). One patient developed persistent hypoparathyroidism after neck dissection due to cancer. One persistent and two temporary recurrent nerve palsies occurred. CONCLUSION This study demonstrated that paediatric thyroidectomy is safe as performed by this team of endocrine and paediatric surgeons, with acceptable morbidity even when total thyroidectomy was performed in the case of benign disease

Liking and description of pasta sauces with varying mealworm content

Entomophagy is directly connected with culture, explaining why it is commonly rejected in Western countries. Due to increased meat consumption in recent years with its associated negative impacts on health and sustainability, the development of products based on alternative protein sources has become urgent. The larval form of Tenebrio molitor (mealworm) has the potential to substitute meat as it requires less resources and produces less emissions compared to other forms of meat production. Therefore, in this project we have aimed to develop pasta sauces with differing mealworm contents based on a common meat sauce and to test the acceptance with 91 consumers in Austria. Three sauces (100% mealworm, 50% mealworm and 50% meat, 100% meat) were developed and tested using a 9-point hedonic scale for acceptance, and the CATA (Check-All-That-Apply) method was integrated to also receive descriptive information. The analysis of the liking data revealed that the liking for the hybrid sauce with meat and mealworm content was comparable to the meat sauce (6.9 ± 1.8. vs. 6.5 ± 1.8, p > 0.05). Less liked was the sauce with the highest mealworm content (5.7 ± 1.8, p < 0.05). The CATA analysis demonstrated the strongest positive effects on the mean in terms of how much the products were liked for the attribute "fleshy" (0.8). On the other hand, the attributes "brownish" (-0.9) or "mushy" (-1.0) had the strongest negative effects on the mean of the liking of products. We have seen that meat cannot be substituted by mealworm immediately and completely. The results suggest a stepwise substitution and the further adaptation of products regarding the (negative and positive effecting) attributes to increase consumer acceptance