Robotic double-loop reconstruction method following total gastrectomy

Minimally invasive surgery for gastric cancer is a challenge. The reconstructive time is a particular issue and researchers have adopted a large variety of solutions and produced heterogeneous data. The reconstructive phase can be divided into two major categories based on the approach adopted: the execution of extracorporeal versus intracorporeal anastomosis. In turn, the surgical team can perform the latter with laparoscopic or robotic assistance. However, the question is, how should a robotic esophagojejunal anastomosis be performed after total gastrectomy? Most articles in the literature have reported the execution of mechanical anastomoses [1] [2] [3] [4] [5] [6], especially with circular staplers via the creation of a manual purse-string around the anvil. Other solutions have described the use of the Orvil or the overlap technique. Only three authors have reported intracorporeal sutures with a completely robotic-sewn anastomosis [7] [8] [9]. A new robotic technique (the Parisi technique) was developed and adopted at St. Mary’s Hospital, Terni, Italy. A double-loop reconstruction method with an intracorporeal robot-sewn anastomosis is performe

Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults

Background Total thyroidectomy (TT) and subtotal thyroidectomy (ST) are worldwide treatment options for multinodular non-toxic goitre in adults. Near TT, defined as a postoperative thyroid remnant less than 1 mL, is supposed to be a similarly effective but safer option than TT. ST has been shown to be marginally safer than TT, but it may leave an undetected thyroid cancer in place. Objectives The objective was to assess the effects of total or near-total thyroidectomy compared to subtotal thyroidectomy for multinodular non-toxic goitre. Search methods We searched the Cochrane Library, MEDLINE, PubMed, EMBASE, as well as the ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was 18 June 2015 for all databases. No language restrictions were applied. Selection criteria Two review authors independently scanned the abstract, title or both sections of every record retrieved to identify randomised controlled trials (RCTs) on thyroidectomy for multinodular non-toxic goitre for further assessment. Data collection and analysis Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality utilising the GRADE instrument. We calculated the odds ratio (OR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. A random-effects model was used for pooling data. Main results We examined 1430 records, scrutinized 14 full-text publications and included four RCTs. Altogether 1305 participants entered the four trials, 543 participants were randomised to TT and 762 participants to ST. A total of 98% and 97% of participants finished the trials in the TT and ST groups, respectively. Two trials had a duration of follow-up between 12 and 39 months and two trials a follow-up of 5 and 10 years, respectively. Risk of bias across studies was mainly unknown for selection, performance and detection bias. Attrition bias was generally low and reporting bias high for some outcomes. In the short-term postoperative period no deaths were reported for both TT and ST groups. However, longer-term data on all-cause mortality were not reported (1284 participants; 4 trials; moderate quality evidence). Goiter recurrence was lower in the TT group compared to ST. Goiters recurred in 0.2% (1/425) of the TT group compared to 8.4% (53/632) of the ST group (OR 0.05 (95% CI 0.01 to 0.21); P < 0.0001; 1057 participants; 3 trials; moderate quality evidence). Re-intervention due to goitre recurrence was lower in the TT group compared to ST. Re-intervention was necessary in 0.5% (1/191) of TT patients compared to 0.8% (3/379)of ST patients (OR 0.66 (95% CI 0.07 to 6.38); P = 0.72; 570 participants; 1 trial; low quality evidence). The incidence of permanent recurrent laryngeal nerve palsy was lower for ST compared with TT. Permanent recurrent laryngeal nerve palsy occurred in 0.8% (6/741) of ST patients compared to 0.7% (4/543) of TT patients (OR 1.28, (95% CI 0.38 to 4.36); P = 0.69; 1275 participants; 4 trials; low quality evidence). The incidence of permanent hypoparathyroidism was lower for ST compared with TT. Permanent hypoparathyroidism occurred in 0.1% (1/741) of ST patients compared to 0.6% (3/543) of TT patients (OR 3.09 (95% CI 0.45 to 21.36); P = 0.25; 1275 participants: 4 trials; low quality evidence). The incidence of thyroid cancer was lower for ST compared with TT. Thyroid cancer occurred in 6.1% (41/669) of ST patients compared to 7.3% (34/465)of TT patients (OR 1.32 (95% CI 0.81 to 2.15); P = 0.27; 1134 participants; 3 trials; low quality evidence). No data on health-related quality of life or socioeconomic effects were reported in the included studies. Authors' conclusions The body of evidence on TT compared with ST is limited. Goiter recurrence is reduced following TT. The effects on other key outcomes such as re-interventions due to goitre recurrence, adverse events and thyroid cancer incidence are uncertain. New long-term RCTs with additional data such as surgeons level of experience, treatment volume of surgical centres and details on techniques used are needed

Monitoring of membrane processes with fluorescence molecular probes

This work discusses the use of molecular probes that change their fluorescence response in the presence of different local environmental conditions. In particular, probes able to respond to temperature and to oxygen concentration were identified and used to report the value of these parameters at a molecular scale. The development of a stable, reproducible and sensitive molecular probing system was then applied to monitor oxygen concentration at the surface of different membrane materials and also in order to obtain oxygen concentration profiles inside dense membranes. Ultimately, a temperature sensitive probe was used to measure temperature at membrane surfaces making possible its measurement locally. This technique was applied with success to experimentally measure temperature polarization in membrane distillation processes, on-line, in a non-invasive mode. Future developments of molecular probing will be also presented and discussed

Laparoscopic peritoneal lavage. Our experience and review of the literature

NTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage

BDP/formoterol MART asthma exacerbation benefit increases with blood eosinophil level

A number of studies have evaluated the effectiveness of a “Maintenance And Reliever Therapy” (MART) regimen combining in a single inhaler the rapid-acting, long-acting β2-agonist (LABA) formoterol fumarate (FF) with an inhaled corticosteroid (ICS) in asthma. Such a regimen is now established for the treatment of moderate-to-severe asthma in adolescents and adults in many guidelines. Furthermore, rescue short-acting β2-agonists (SABAs) are no longer recommended as sole therapy even for patients with mild asthma, and an ICS/FF combination used as needed is the preferred reliever therapy