Robot-assisted Transplant Ureteral Repair after Robot-assisted Kidney Transplant

Objective: To use a video to describe steps of robotic-assisted transplant ureteral repair (RATUR) for treating transplant ureteral stricture (TUS) in a patient who had undergone robot assisted kidney transplant (RAKT). Method: We recorded and edited the operation of a patient who experienced TUS by distal obstruction due to a calcification after RAKT and underwent RATUR in 2020. Results: We present a case of a 65-year-old male who developed graft dysfunction. He was found to have a short intrinsic obstruction of the distal transplant ureter due to a calcification that formed around the suture line at the ureteroneocystostomy. The video covers the steps of the operation which include positioning, placement of the ports, orientation, dissection of the paravesicle space, identification and dissection of the ureter, stent placement, reconstruction and post-operative course. We try to include tips and tricks that could be useful in other similar robotic cases. Conclusion: Open surgical repair of the transplant ureter is the standard of care for transplant ureteral stenosis. However, it requires the morbidity of a large surgical incision. Robotic assisted transplant ureteral repair can be done successfully while limiting convalescence from an open reoperation

Ex-vivo ureteroscopy for the treatment of nephrolithiasis in a deceased donor kidney prior to transplantation

Background: There are over 100,000 adult patients awaiting renal transplantation in the United States, with less than 25% who undergo eventual transplantation [1]. This disparity has motivated providers to seek ways to increase the number of kidneys available for transplantation. Historically, the presence of kidney stones in a renal allograft was a relative contraindication for renal transplantation [2]. Ex-vivo ureteroscopy, or, “back-table ureteroscopy”, is a technique which has been employed as a potential solution to increase the total number of available kidneys which were initially deemed ineligible [3,4]. Objective: To demonstrate our step by step technique for ex-vivo ureteroscopy and to demonstrate its safety and efficacy as a method of stone removal prior to transplantation. Methods: Following procurement and back table preparation of the donor kidney by the transplant surgery team, the kidney was replaced in an ice bath for ex-vivo ureteroscopy. A combination of holmium laser lithotripsy and stone basketing were used to extract the stone. Following complete removal of the renal calculus, the renal allograft was reprepared and the renal transplantation was carried forth in the standard fashion by the transplant surgery team. Results: The total operative time for the ex-vivo ureteroscopy was 70 min. No intra-operative complications were identified during ex-vivo ureteroscopy or during allograft transplantation. Six months following transplantation, the patients renal function remains normal. Conclusions: Ex-Vivo ureteroscopy can be a safe and effective treatment for the management of renal stones prior to transplantation. This method can be used with existing resources to increase the number of donor kidneys available for transplantation each year

Robotic-Assisted Versus Open Techniques for Living Donor Kidney Transplant Recipients: A Comparison Using Propensity Score Analysis

Background: Following the rapid advancements in minimally invasive urology, living donor robotic-assisted kidney transplantation (RAKT) has developed into a feasible alternative to open kidney transplantation (OKT). The procedure has been performed in multiple international programs, but a relative dearth of experience exists in the US. In this investigation, we compare RAKT to OKT using a propensity score analysis, to elucidate the safety and feasibility of RAKT as a suitable alternative to OKT. Methods: A retrospective review of 101 living kidney transplants (36 RAKT, 65 OKT), which occurred between January 2016 and June 2018, was conducted. Selection for RAKT was based on Robot availability. Recipient and donor demographic variable were collected, in addition to perioperative parameters. A propensity score analysis was conducted, matching for recipient age, gender, body mass index, race, pre-operative dialysis, preoperative serum creatinine, panel reactive antibody, and donor age. Primary outcomes assessed included perioperative factors such as estimated blood loss (EBL), cold ischemic time (CIT), warm ischemic time (WIT), operative time, as well as several patient outcomes including, length of stay, narcotics consumed on postoperative days one and two, and change in serum creatinine (SCr) at five time points (day 3, day 7, day 14, 6 months, and 1 year). Final analysis included 35 patients in each group. Results: Recipients’ (N=101) mean age was 49 years (range 19-74), with RAKT recipients slightly younger than OKT recipients (46 vs 51 years). 61 recipients were male and 62 white (29 Black, 10 other). Average recipient BMI was 29 (range 20-40), with equivalent BMIs in RAKT and OKT subsets. Following propensity score analysis, RAKT recipients demonstrated significantly greater WIT (49 vs 38 minutes, p\u3c0.001) and less EBL (62.5 vs 150 mL, p\u3c0.001). However, total operative time and overall length of stay were not significantly different in the groups. Postoperative narcotics consumed on postoperative days one and two were similar between the groups (31.8 vs 32.3 morphine equivalents). Additionally, SCr was evaluated at days 3, 7, and 14 as well as 6 months and 1 year, without significant differences between the groups. Conclusion: RAKT offers an important minimally invasive alternative to OKT, with a short learning curve, and similar graft and patient outcomes. Notably, this study compares RAKT to OKT with a heterogeneous study population, using propensity scoring. The largest limitation of this study is a small sample size. Interestingly, despite the significantly longer WIT in RAKT, we found an equivalence of SCr between groups in the early and intermediate postoperative period. Although the small sample size limits our ability to detect differences in graft and patient outcomes, trends demonstrate shorter lengths of stay, shorter operative times, and smaller amounts of blood loss for RAKT recipients. Additionally, trends demonstrate fewer narcotics administered by the second postoperative day. Similar to the advent of laparoscopic technology in living donor nephrectomy, early findings in RAKT demonstrate a safe and reasonable alternative for living donor kidney transplantation in various populations.https://scholarlycommons.henryford.com/merf2019clinres/1052/thumbnail.jp

Robotic-assisted Versus Open Technique for Living Donor Kidney Transplantation: A Comparison Using Propensity Score Matching for Intention to Treat

Living donor robotic-assisted kidney transplantation (RAKT) is an alternative to open kidney transplantation (OKT), but experience with this technique is limited in the United States. METHODS: A retrospective review of living donor kidney transplants performed between 2016 and 2018 compared RAKT with OKT with regard to recipient, donor, and perioperative parameters. A 1:1 propensity score matching was performed on recipient/donor age, sex, body mass index, race, preoperative dialysis, and calculated panel reactive antibodies. RESULTS: Outcomes of patient survival, graft survival, and postoperative complications were assessed for 139 transplants (47 RAKT and 92 OKT). Propensity score analysis (47:47) showed that RAKT recipients had longer warm ischemic times (49 versus 40 min; P \u3c 0.001) and less blood loss (100 versus 150 mL; P = 0.005). Operative time and length of stay were similar between groups. Postoperative serum creatinine was similar during a 2-y follow-up. Post hoc analysis excluding 4 open conversions showed lower operative time with RAKT (297 versus 320 min; P = 0.04) and lower 30-d (4.7% versus 23.4%; P = 0.02) and 90-d (7% versus 27.7%; P = 0.01) Clavien-Dindo grade ≥3 complications. CONCLUSIONS: Our findings suggest that RAKT is a safe alternative to OKT

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend.

Objectives The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 minute application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend. Design Pre and post-intervention. Setting University movement analysis laboratory. Participants Eleven healthy male participants. Main Outcome Measures Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee. Results Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P=.035) and coronal (P=.011) planes during the descent phase of a small knee bend following cryotherapy. Conclusion In conclusion a twenty minute application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury

The Evolution of Bat Vestibular Systems in the Face of Potential Antagonistic Selection Pressures for Flight and Echolocation

PMCID: PMC3634842This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Efficacy of a 3 month training program on the jump-landing technique in jump-landing sports. Design of a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>With the relatively high rate of injuries to the lower extremity due to jump-landing movement patterns and the accompanied high costs, there is need for determining potential preventive programs. A program on the intervention of jump-landing technique is possibly an important preventative measure since it appeared to reduce the incidence of lower extremity injuries. In real life situations, amateur sports lack the infrastructure and funds to have a sports physician or therapist permanently supervising such a program. Therefore the current prevention program is designed so that it could be implemented by coaches alone.</p> <p>Objective</p> <p>The objective of this randomized controlled trial is to evaluate the effect of a coach supervised intervention program targeting jump-landing technique on the incidence of lower extremity injuries.</p> <p>Methods</p> <p>Of the 110 Flemish teams of the elite division, 24 teams are included and equally randomized to two study groups. An equal selection of female and male teams with allocation to intervention and control group is obtained. The program is a modification of other prevention programs previously proven to be effective. All exercises in the current program are adjusted so that a more progressive development in the exercise is presented. Both the control and intervention group continue with their normal training routine, while the intervention group carries out the program on jump-landing technique. The full intervention program has a duration of three months and is performed 2 times a week during warm-up (5-10 min). Injuries are registered during the entire season.</p> <p>Discussion</p> <p>The results of this study can give valuable information on the effect of a coach supervised intervention program on jump-landing technique and injury occurrence. Results will become available in 2011.</p> <p>Trial registration</p> <p>Trial registration number: NTR2560</p

Functional Implications of Ubiquitous Semicircular Canal Non-Orthogonality in Mammals

The ‘canonical model’ of semicircular canal orientation in mammals assumes that 1) the three ipsilateral canals of an inner ear exist in orthogonal planes (i.e., orthogonality), 2) corresponding left and right canal pairs have equivalent angles (i.e., angle symmetry), and 3) contralateral synergistic canals occupy parallel planes (i.e., coplanarity). However, descriptions of vestibular anatomy that quantify semicircular canal orientation in single species often diverge substantially from this model. Data for primates further suggest that semicircular canal orthogonality varies predictably with the angular head velocities encountered in locomotion. These observations raise the possibility that orthogonality, symmetry, and coplanarity are misleading descriptors of semicircular canal orientation in mammals, and that deviations from these norms could have significant functional consequences. Here we critically assess the canonical model of semicircular canal orientation using high-resolution X-ray computed tomography scans of 39 mammal species. We find that substantial deviations from orthogonality, angle symmetry, and coplanarity are the rule for the mammals in our comparative sample. Furthermore, the degree to which the semicircular canals of a given species deviate from orthogonality is negatively correlated with estimated vestibular sensitivity. We conclude that the available comparative morphometric data do not support the canonical model and that its overemphasis as a heuristic generalization obscures a large amount of functionally relevant variation in semicircular canal orientation between species.Funding for this research was provided by grants NSFIIS-0208675 (http://www.nsf.gov/cise/iis/hcc_pgm.jsp), and EAR-0948842 (http://www.nsf.gov/awards/award_visualiz​ation.jsp?org=EAR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Geological SciencesAnthropologyEmail: [email protected]