Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group

Background: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention: RAKT with regional hypothermia. Outcome measurements and statistical analysis: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra-or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved

MRI of the Post‐Operative Meniscus and ACL Graft

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145335/1/cpmia2302.pd

Robot-assisted Kidney Transplantation: The European Experience.

BACKGROUND: Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT). OBJECTIVE: To evaluate perioperative and early postoperative RAKT outcomes. DESIGN, SETTING AND PARTICIPANTS: This was a multicenter prospective observational study of 120 patients who underwent RAKT, predominantly with a living donor kidney, in eight European institutions between July 2015 and May 2017, with minimum follow-up of 1 mo. The robot-assisted surgical steps were transperitoneal dissection of the external iliac vessels, venous/arterial anastomosis, graft retroperitonealization, and ureterovesical anastomosis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive analysis of surgical data and their correlations with functional outcomes. RESULTS AND LIMITATIONS: The median operative and vascular suture time was 250 and 38min, respectively. The median estimated blood loss was 150ml. No major intraoperative complications occurred, although two patients needed open conversion. The median postoperative estimated glomerular filtration rate was 21.2, 45.0, 52.6, and 58.0ml/min on postoperative day 1, 3, 7, and 30, respectively. Both early and late graft function were not related to overall operating time or rewarming time. Five cases of delayed graft function (4.2%) were reported. One case (0.8%) of wound infection, three cases (2.5%) of ileus, and four cases of bleeding (3.3%; three of which required blood transfusion), managed conservatively, were observed. One case (0.8%) of deep venous thrombosis, one case (0.8%) of lymphocele, and three cases (2.5%) of transplantectomy due to massive arterial thrombosis were recorded. In five cases (4.2%), surgical exploration was performed for intraperitoneal hematoma. Limitations of the study include selection bias, the lack of an open control group, and failure to report on patient cosmetic satisfaction. CONCLUSIONS: When performed by surgeons with robotic and KT experience, RAKT is safe and reproducible in selected cases and yields excellent graft function. PATIENT SUMMARY: We present the largest reported series on robot-assisted kidney transplantation. Use of a robotic technique can yield low complication rates, rapid recovery, and excellent graft function. Further investigations need to confirm our promising data

Testing of crop Models for Accurate Predictions of Evapotranspiration and crop Water Use

All crop models, whether site-specific or global-gridded and regardless of crop, simulate daily crop transpiration and soil evaporation during the crop life cycle, resulting in seasonal crop water use. Modelers use several methods for predicting daily potential evapotranspiration (ET), including FAO-56, Penman-Monteith, Priestley-Taylor, Hargreaves, full energy balance, and transpiration water efficiency. They use extinction equations to partition energy to soil evaporation or transpiration, depending on leaf area index. Most models simulate soil water balance and soil-root water supply for transpiration, and limit transpiration if water uptake is insufficient, and thereafter reduce dry matter production. Comparisons among multiple crop and global gridded models in the Agricultural Model Intercomparison and Improvement Project (AgMIP) show surprisingly large differences in simulated ET and crop water use for the same climatic conditions. Model intercomparisons alone are not enough to know which approaches are correct. There is an urgent need to test these models against field-observed data on ET and crop water use. It is important to test various ET modules/equations in a model platform where other aspects such as soil water balance and rooting are held constant, to avoid compensation caused by other parts of models. The CSM-CROPGRO model in DSSAT already has ET equations for Priestley-Taylor, Penman-FAO-24, Penman-Monteith-FAO-56, and an hourly energy balance approach. In this work, we added transpiration-efficiency modules to DSSAT and AgMaize models and tested the various ET equations against available data on ET, soil water balance, and season-long crop water use of soybean, fababean, maize, and other crops where runoff and deep percolation were known or zero. The different ET modules created considerable differences in predicted ET, growth, and yield

Integrating Economic Analysis Wiith Biophysical Simulation: Appraising Blackland Corn Production.

60 p

Dairy-CropSyst: Gaseous emissions and nutrient fate modeling tool

Dairy confined animal feeding operations (CAFO) are required to implement nutrient management plans for minimizing the risk of water resource degradation and report gaseous emissions when exceeding certain threshold values. Although tools exist to aid in completing such tasks, few integrate the impact of on-farm manure treatment unit operations such as anaerobic digestion, solids separation, and nutrient recovery. Furthermore, existing tools do not estimate the nutrient value of recovered products and effluent leaving the dairy system or the nutrient fate after effluent is applied to crop fields. Dairy-CropSyst is a decision support tool for researchers and CAFO managers aimed at evaluating the effects of different manure treatment unit operations on gaseous emission and nutrient fate in dairy systems. The model tracks nutrients through the dairy system, including inorganic and organic forms of carbon, nitrogen, and phosphorus. This is accomplished by integrating established transformation and emission equations, performance parameters of manure treatments from industrial data and literature, and using a cropping system model for the land application evaluation. Predicted and observed emission values for greenhouse gases (GHG) and ammonia from different dairy unit operations were found in good agreement. The use of Dairy-CropSyst has the potential to assist the dairy industry in decision making on manure management treatment strategies and as a tool for reporting GHG and ammonia emissions

2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries - a case series

<p>Abstract</p> <p>Background</p> <p>Screw fixation of pelvic ring fractures is a common, but demanding procedure and navigation techniques were introduced to increase the precision of screw placement. The purpose of this case series was the evaluation of screw misplacement rate and functional outcome of percutaneous screw fixation of pelvic ring disruptions using a 2D navigation system.</p> <p>Methods</p> <p>Between August 2004 and December 2007, 44 of 442 patients with pelvic injuries were included for closed reduction and percutaneous screw fixation of disrupted pelvic ring lesions using an optoelectronic 2D-fluoroscopic based navigation system. Operating and fluoroscopy time were measured, as well as peri- and postoperative complications documented. Screw position was assessed by postoperative CT scans. Quality of live was evaluated by SF 36-questionnaire in 40 of 44 patients at mean follow up 15.5 ± 1.2 month.</p> <p>Results</p> <p>56 iliosacral- and 29 ramus pubic-screws were inserted (mean operation time per screw 62 ± 4 minutes, mean fluoroscopy time per screw 123 ± 12 seconds). In post-operative CT-scans the screw position was assessed and graded as follows: I. secure positioning, completely in the cancellous bone (80%); II. secure positioning, but contacting cortical bone structures (14%); III. malplaced positioning, penetrating the cortical bone (6%). The malplacements predominantly occurred in bilateral overlapping screw fixation. No wound infection or iatrogenic neurovascular damage were observed. Four re-operations were performed, two of them due to implant-misplacement and two of them due to implant-failure.</p> <p>Conclusion</p> <p>2D-fluoroscopic navigation is a safe tool providing high accuracy of percutaneous screw placement for pelvic ring fractures, but in cases of a bilateral iliosacral screw fixation an increased risk for screw misplacement was observed. If additional ramus pubic screw fixations are performed, the retrograde inserted screws have to pass the iliopubic eminence to prevent an axial screw loosening.</p