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In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.

The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.

Die chirurgische Behandlung parastomaler Hernien gilt als komplex und ist bekanntermaßen komplikationsträchtig. In der Vergangenheit wurden diese Hernien durch die Relokation des Stomas oder Nahtverfahren der Austrittstelle versorgt. In den letzten Jahren wurden verschiedene netzbasierte Techniken vorgeschlagen, die heute in der minimal-invasiven Chirurgie eingesetzt werden. Mit der Verbreitung der roboterassistierten Hernienchirurgie wurden die Netzverfahren weiterentwickelt und die Ergebnisse für die Patienten erheblich verbessert. In diesem Beitrag wird ein Überblick über die verfügbaren Techniken der roboterassistierten Versorgung parastomaler Hernien präsentiert. Es werden technische Überlegungen und erste Ergebnisse des roboterassistierten modifizierten Sugarbaker-Verfahrens, der roboterassistierten Pauli-Technik und der Verwendung des trichterförmigen Netzes IPST vorgestellt. Darüber hinaus werden die Herausforderungen bei der roboterassistierten Versorgung parastomaler Hernien am Ileum-Conduit diskutiert. Die Operationstechniken werden durch Foto- und Videomaterial veranschaulicht.

Background:Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary:This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages:Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.

Peripheral percutaneous transluminal angioplasty is fraught with a substantial risk of restenosis and reintervention. A drug-eluting balloon (DEB) based on a novel coating was compared with uncoated balloons in patients undergoing femoro-popliteal percutaneous transluminal angioplasty.

Objective: To evaluate the multitude of new synthetic absorbable sutures (both monofilament and multifilament) in comparison with older materials with regard to capillarity and bacterial transport.Methods: Sutures of United States Pharmacopoeia (USP) 4-0 thickness were arranged in a three-chamber system under sterile conditions. Either a colorant (liquid transport evaluation) or bacteria (bacterial transport evaluation) were added to the contamination chamber, and movement of colorant or bacteria was evaluated for as long as 30 days.Results: None of the monofilament sutures transported colorant or bacteria. Colorant transport was found on the pseudomonofilament and multifilament sutures between the first and the fifth day. Escherichia coli were transported on the majority of the multifilament sutures, although no transport was found on silk or polyester sutures. Bacterial transport was most often evident in tests using the motile Proteus mirabilis.Conclusions: All multifilament and pseudomonofilament suture designs allowed transport of colorants and bacteria to some degree. The movement of fluids and bacteria did not depend on the absorptive capacity of the sutures, coating, or the presence of an open suture end.

The Comparison of Balloon versus Rotational Angioplasty (COBRA) study is a prospective, randomized study to compare short‐ and long‐term effects of PTCA and high speed PTCRA (or rotablation) in patients with complex coronary stenoses. Patients with angiographically defined complex coronary stenoses (> 70% diameter reduction) are included in the study. The trial has recruited 501 patients who will have detailed follow‐up for 6 months. The primary end points are: (1) procedural success, defined as angiographically proven residual stenoses < 50% and stenosis reduction of ± 20% in absence of new myocardial infarction, emergency CABG, or death; (2) 6‐month restenosis in the treated segment; and (3) major cardiac events during the follow‐up period. Additionally, improved exercise tolerance will be scored. The final results of the study are expected by late 1997.

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio‐Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio‐Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheterization and after closure of the puncture site with Angio‐Seal. Mean arterial and venous blood flow of the superficial femoral artery and vein were calculated. Statistical evaluation was performed using the one‐sample Wilcoxon test. In group A there was a significant reduction of blood flow volume in both the femoral artery, from a mean of 119 mL/min before puncture to 78 mL/min with pressure dressing, and the femoral vein, from 114 mL/min before puncture to 82 mL/min with pressure dressing (P < 0.0001). After removal of pressure dressing the blood flow rose to 119 mL/min in the femoral artery and 116 mL/min in the femoral vein. In group B there was no change in flow volume before and after catheterization (femoral artery: 117 vs 118 mL/min, femoral vein 119 vs 120 mL/min, P = ns). We conclude that the use of pressure dressing after cardiac catheterization caused a significant reduction in arterial and venous blood flow (about 30%) during immobilization. The new Angio‐Seal closure device did not affect arterial or venous flow.

Zusammenfassung: In diesem Aufsatz wird ein stochastisches Optimierungsverfahren vorgestellt, das die Lsung beliebiger Optimierungsprobleme ohne Kenntnis des Gradienten der Gtefunktion erlaubt. Das Verfahren ist eine Weiterentwicklung der mehrgliedrigen Evolutionsstrategie dahingehend, da die implizit in der Objektmenge enthaltene Gradienteninformation ausgenutzt wird. Anhand von Testrechnungen wird nachgewiesen, da die Konvergenzsicherheit sehr hoch ist.

Background Stent length serves as a predictor of restenosis in use of bare metal stents (BMS). This has been demonstrated in a feasibility study that used a single short BMS implant (<9 mm) in a high proportion of lesions; the study observed a low rate of restenosis.Methods We performed a pilot prospective study to investigate in a series of consecutive patients the immediate and long-term effects of implantation of either 1) a single short BMS for all lesions with low probability of restenosis or 2) a drug-eluting stent (DES) for all other lesions.Results The 200 patients studied had 236 coronary artery lesions that were treated with short BMS in 168/236 patients (71.2%) and with DES in 68/236 patients (28.8%). Angiographic success was achieved in 230/236 lesions (97.5%) and procedural success in 194/200 patients (97.0%). Restenosis occurred in 15/153 lesions (9.8%) after short BMS, in 3/62 lesions (4.8%) after DES, and in 18/215 of all lesions (8.4%) angiographically controlled after six to eight months. Target vessel revascularization was performed in 16/218 lesion (7.4%).Conclusion Most of the coronary artery lesions in this small group of consecutive patients were treated sufficiently with a single BMS implant. This differential approach of treating suitable lesions in medium- to large-sized vessels with a single short BMS device and treating all other lesions with a DES implant resulted in a low incidence of restenosis.