Robotic Splenic Flexure and Transverse Colon Resections

Since the 1990s, laparoscopic technique has become a standard approach for several surgical procedures in the field of colorectal surgery. Laparoscopic approach to splenic flexure and transverse colon cancer, however, is still a matter of debate and considered challenging for both anatomical and technical aspects. The relationship with the spleen and the absence of a consensus on the extent of surgery for splenic flexure cancer are two of several aspects that make splenic flexure surgery mostly debated. Robotic technique has overcome some pitfalls of laparoscopy, thanks to its stability of vision, tremor filtering, and fine movements of the robotic arms that can help in better identifying and managing both vascular structures and side organs, thus avoiding splenic and pancreatic injuries. In addition, robotic system can allow a better fashioning of the intracorporeal anastomosis, and the advent of fluorescence is useful to guide dissection and to evaluate the vascularization of the colon. Herein we discuss a standardized approach for robotic splenic flexure resection and transverse colon

Short-term Clinical Outcomes of a European Training Programme for Robotic Colorectal Surgery

Background Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery—EARCS). Methods Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. Results Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. Conclusions Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm

A Single Centre Retrospective Evaluation of Laparoscopic Rectal Resection with TME for Rectal Cancer: 5-Year Cancer-Specific Survival

Laparoscopic colon resection has established its role as a minimally invasive approach to colorectal diseases. Better long-term survival rate is suggested to be achievable with this approach in colon cancer patients, whereas some doubts were raised about its safety in rectal cancer. Here we report on our single centre experience of rectal laparoscopic resections for cancer focusing on short- and long-term oncological outcomes. In the last 13 years, 248 patients underwent minimally invasive approach for rectal cancer at our centre. We focused on 99 stage I, II, and III patients with a minimum follow-up period of 5 years. Of them 43 had a middle and 56 lower rectal tumor. Laparoscopic anterior rectal resection was performed in 71 patients whereas laparoscopic abdomino-perineal resection in 28. The overall mortality rate was 1%; the overall morbidity rate was 29%. The 5-year disease-free survival rate was 69.7%, The 5-year overall survival rate was 78.8%

ISO -LWS two-colour diagram of young stellar objects

We present a [60-100] versus [100-170]μm two-colour diagram for a sample of 61 young stellar objects (YSOs) observed with the Long Wavelength Spectrometer (LWS) on-board the Infrared Space Observatory (ISO). The sample consists of 17 Class 0 sources, 15 Class I, nine Bright Class I (Lbol>104Lsolar) and 20 Class II (14 Herbig Ae/Be stars and six T Tauri stars). We find that each class occupies a well-defined region in our diagram with colour temperatures increasing from Class 0 to Class II. Therefore the [60-100] versus [100-170] two-colour diagram is a powerful and simple tool to derive from future (e.g. with the Herschel Space Observatory) photometric surveys the evolutionary status of YSOs. The advantage over other tools already developed is that photometry at other wavelengths is not required: three flux measurements are enough to derive the evolutionary status of a source. As an example we use the colours of the YSO IRAS 18148-0440 to classify it as Class I. The main limitation of this work is the low spatial resolution of the LWS which, for some objects, causes a high uncertainty in the measured fluxes due to background emission or to source confusion inside the LWS beam

Strong H_2O and high-J CO emission towards the Class 0 protostar L1448-mm

The spectrum of the Class 0 source L1448-mm has been measured over the wavelength range extending from 6 to 190 mu m with the Long Wavelength Spectrometer (LWS) and the Short Wavelength Spectrometer (SWS) on the Infrared Space Observatory (ISO). The far infrared spectrum is dominated by strong emission from gaseous H_2O and from CO transitions with rotational quantum numbers J >= 14; in addition, the H_2 pure rotational lines S(3), S(4) and S(5), the OH fundamental line at 119 mu m, as well as emission from [O I] 63 mu m and [C Ii] 158 mu m are also observed. The strong CO and water emission can be consistently explained as originating in a warm gas component at T ~ 700-1400 K and n_H_2 ~ (3-50) 10(4 ) cm(-3) , which fills about 0.2-2% of the ~ 75\arcsec LWS field of view (corresponding, assuming a single emitting region, to a physical size of about (3-12)\arcsec or (0.5-2) 10(-2) pc at d = 300 pc). We derive an H_2O/CO abundance ratio ~ 5, which, assuming a standard CO/H_2 abundance of 10(-4) , corresponds to H_2O/H_2 ~ 5 10(-4) . This value implies that water is enhanced by about a factor ~ 10(3) with respect to its expected abundance in the ambient gas. This is consistent with models of warm shocked regions which predict that most of the free atomic oxygen will be rapidly converted into water once the temperature of the post-shocked gas exceeds ~ 300 K. The relatively high density and compact size inferred for this emission may suggest an origin in the shocked region along the molecular jet traced by SiO and EHV CO millimeter line emission. Further support is given by the fact that the observed enhancement in H_2O can be explained by shock conditions similar to those expected to produce the abundant SiO observed in the region. L1448-mm shows the largest water abundance so far observed by ISO amongst young sources displaying outflow activity; we argue that the occurrence of multiple shocks over a relatively short interval of time, like that evidenced in the surroundings of L1448-mm, could have contributed to enrich the molecular jet with a high H_2O column density. Based on observations with ISO, an ESA project with instruments funded by ESA Member States (especially the PI countries: France, Germany, the Netherlands and the United Kingdom) with the participation of ISAS and NAS

Robotic surgery in emergency setting : 2021 WSES position paper

Background Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery. Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus. Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.Peer reviewe

Training curriculum in minimally invasive emergency digestive surgery : 2022 WSES position paper

Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.Peer reviewe

VizieR Online Data Catalog: Catalog of dense cores in Aquila from Herschel (Konyves+, 2015)

Based on Herschel Gould Belt survey (Andre et al., 2010A&A...518L.102A) observations of the Aquila cloud complex, and using the multi-scale, multi-wavelength source extraction algorithm getsources (Men'shchikov et al., 2012A&A...542A..81M), we identified a total of 749 dense cores, including 685 starless cores and 64 protostellar cores. The observed properties of all dense cores are given in tablea1.dat, and their derived properties are listed in tablea2.dat. (4 data files)

The Influence of Fluorescence Imaging on the Location of Bowel Transection during Robotic Left-Sided Colorectal Surgery

Background Hypoperfusion is an important risk factor for anastomotic leakage in colorectal surgery. This study was designed to evaluate the impact of fluorescence imaging on visualization of perfusion and subsequent change of transection line during left-sided robotic colorectal resections. Methods Patients scheduled for robotic left-sided colon or rectal resections were enrolled in this prospective, multicenter study. Resections were performed as per each surgeon’s preference. After complete colorectal mobilization, ligation of blood vessels, and distal transection of the bowel, the mesocolon was completely divided to the planned proximal or distal transection line, which was marked in white light. Indocyanine green was injected intravenously and the transection location(s) and/or distal rectal stump, if applicable, were re-assessed in fluorescent imaging mode. Imaging information, perioperative, and early postoperative outcomes were recorded. An independent video review of the surgeries was performed. Results Data for 40 patients (20 female/20 male) with a mean age of 63.9 years and a mean body mass index of 27.6 kg/m2 were analyzed. Fluorescence imaging resulted in a change of the proximal transection location in 40 % (16/40) of patients. There was one change in the distal transection location in a patient with benign disease. The use of fluorescence imaging took an average of 5.1 min of the mean overall operative room time of 232 min. Two patients (5 %) with a change in transection line developed an anastomotic leak at postoperative days 15 and 40. Conclusion Fluorescence imaging provides additional information during determination of transection location in left-sided colorectal procedures. This results in a significant change of transection location, particularly at the proximal transection site. Further research needs to be conducted with larger patient cohorts and in comparative design to determine actual effect on anastomotic leak rate