Dacron or ePTFE for Femoro-popliteal above-knee bypass grafting:short and long-term results of a multicentre randomised trial

AbstractObjectivesTo compare expanded polytetrafluoroethylene (ePTFE) prosthesis and collagen-impregnated knitted polyester (Dacron) for above-knee (AK) femoro-popliteal bypass grafts.DesignA prospective multicentre randomised clinical trial.Patients and MethodsBetween 1992 and 1996, 228 AK femoro-popliteal bypass grafts were randomly allocated to either an ePTFE (n=114) or a Dacron (n=114) vascular graft (6mm in diameter). Patients were eligible for inclusion if presenting with disabling claudication, rest pain or tissue loss.Follow-up was performed and included clinical examination and duplex ultrasonography at all scheduled intervals. All patients were treated with warfarin.The main end-point of this study was primary patency of the bypass graft at 2, 5 and 10 years after implantation. Secondary end-points were mortality, primary assisted patency and secondary patency. Cumulative patency rates were calculated with life-table analysis and with log-rank test.ResultsAfter 5 years, the primary, primary assisted and secondary patency rates were 36% (confidence interval (CI): 26–46%), 46% (CI: 36–56%) and 51% (CI: 41–61%) for ePTFE and 52% (CI: 42–62%) (p=0.04), 66% (CI: 56–76%) (p=0.01) and 70% (CI: 60–80%) (p=0.01) for Dacron, respectively. After ten years these rates were respectively 28% (CI:18-38%), 31% (CI:19-43%) and 35% (CI: 23-47%) for ePTFE and 28% (CI: 18-38%), 49% (CI: 37-61%) and 49% (CI: 37-61%) for Dacron.ConclusionDuring prolonged follow-up (10 years), Dacron femoro-popliteal bypass grafts have superior patency compared to those of ePTFE grafts. Dacron is the graft material of choice if the saphenous vein is not available

Quality of life temporarily improved in patients in whom the diagnosis chronic mesenteric ischemia wasn’t confirmed after multidisciplinary evaluation in a tertiary referral centre

Objectives: Chronic Mesenteric Ischemia (CMI) is a disease in which abdominal symptoms are caused by insufficient mesenteric blood supply. Treatment results in improved quality of life (QoL). To put these results into perspective, the QoL of patients with symptoms potentially complying with CMI but without confirmation of the diagnosis was studied from six months up to four years.Methods: Between May and July 2020 follow-up questionnaires were sent to 144 patients that were suspected of CMI but in whom the diagnosis was not confirmed after a thorough multidisciplinary evaluation in a CMI expert centre. The baseline QoL was measured at first presentation. Three cohorts were included: 50 patients with a follow-up of six months, 45 patients with a follow-up of two years, and 49 patients with a follow-up of four years were invited to participate. The QoL was measured on a 100 points Visual Analogue Scale (VAS). A minimal clinically important difference of 7.5 was used as non-inferiority threshold.Results: The response rates were 34/50 (68%), 33/45 (73%), and 34/49 (69%). QoL improved in the six months group, with a mean change of 19 in VAS score (95% CI 11-27), in which baseline QoL was inferior to the QoL at follow-up (lower bound 95% CI above >7.5 threshold). The change in QoL was inconclusive in the other two groups, respectively 15 (95% CI 6-24) and 3 (95% CI -6-13). Furthermore, there was no significant change in QoL between patients without mesenteric stenosis and with one or two vessel stenosis (P=0.36) and between patients with occlusive stenosis and anatomic Median Arcuate Ligament Syndrome (MALS) (P=0.53).Conclusion: The QoL of patients suspected for CMI was clinically significantly improved after six months without additional treatment. However, this improvement faded completely after four years

Open surgery in VR: Inguinal hernia repair according to Lichtenstein

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and\ud autonomous simulation platform which can be used for training and assessment of\ud medical students and for continuing education of physicians. A workstation\ud consisting of two haptic devices and a 3D vision system is part of the VREST\ud platform. Another part of the platform is a generic software environment in which lessons can be built by the teacher and performed by their students. Using the platform one can see, feel and decide as in reality. With the assessment tool the progress and skills of the students can be supervised. The first lesson build on the VREST platform is an inguinal hernia repair according to Lichtenstein. This is an open surgery procedure. The VREST platform is used prior to the first operating room surgery of the resident. Interactive models and case dependant feedback is used to enlarge the residents’ cognition. This should reduce the training time in the operating room

Validation of open-surgery VR trainer

VREST (Virtual Reality Educational Surgical Tools) is developing a universal and\ud autonomous simulation platform which can be used for training and assessment of\ud medical students and for continuing education of physicians. With the VREST -\ud Virtual Lichtenstein Trainer, simulating the open surgery procedure of the inguinal hernia repair according to Lichtenstein, the validation of the simulator is ongoing. Part of this trajectory is the evaluation of the transfer of training of the virtual incision making. One group of students trained incision making on the VREST platform where the control group did not. In an experiment both groups has to perform several incision tasks on a manikin. The results are not available yet but will be presented at the MMVR14 conference

Robot-assisted and fluorescence-guided remnant-cholecystectomy: a prospective dual-center cohort study

Background: Abdominal symptoms after cholecystectomy may be caused by gallstones in a remnant gallbladder or a long cystic duct stump. Resection of a remnant gallbladder or cystic duct stump is associated with an increased risk of conversion and bile duct or vascular injuries. We prospectively investigated the additional value of robotic assistance and fluorescent bile duct illumination in redo biliary surgery.Methods: In this prospective two-centre observational cohort study, 28 patients were included with an indication for redo biliary surgery because of remnant stones in a remnant gallbladder or long cystic duct stump. Surgery was performed with the da Vinci X & REG; and Xi & REG; robotic system. The biliary tract was visualised in the fluorescence Firefly & REG; mode shortly after intravenous injection of indocyanine green.Results: There were no conversions or perioperative complications, especially no vascular or bile duct injuries. Fluorescence-based illumination of the extrahepatic bile ducts was successful in all cases. Symptoms were resolved in 27 of 28 patients. Ten patients were treated in day care and 13 patients were discharged the day after surgery.Conclusion: Robot-assisted fluorescence-guided surgery for remnant gallbladder or cystic duct stump resection is safe, effective and can be done in day-care setting.Surgical oncolog