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Background: Advancement in surgery has shifted numerous procedures to a same-day discharge (SDD) setting. In this study, we evaluated factors related to SDD after robotic transversus abdominis release (rTAR). Materials and Methods: A retrospective analysis of a prospectively maintained hernia databank was performed. Patients who underwent rTAR for incisional hernias were assigned to either the SDD group (length of stay [LOS] <1) or the inpatient group (LOS ≥1 day). Pre-, intra-, and postoperative variables were compared. Predictors of SDD were explored through a logistic regression, and a mediation analysis was performed to assess their effect on the LOS. Results: Out of the 167 patients included, 53 patients were discharged the same day. Age, American Society of Anesthesiologists score, history of coronary artery disease, and wound infection were significantly higher in the inpatient group. Overall, median LOS was 1 (0-2). Postoperative complications did not differ between SDD and inpatient groups except for Clavien-Dindo Grade-II (1 versus 14, respectively; P = .039). Thirty-day readmission rates were comparable (P = .229). A binary logistic regression to predict factors associated with SDD rTAR showed statistical significance in age, operative time, mesh area, and history of wound infection. Mediation analysis showed that mesh size indirectly affected the LOS through the operative time (a = 0.54; b = 0.46; P < .001). An age >46-year-old, an operative time beyond 217 minutes, and a mesh size >475 cm2 increased the probability of an inpatient stay (area-under-the-receiver operating characteristic curves: 0.69, 0.81, and 0.82, respectively). Conclusion: The pre- and intraoperative factors associated with SDD rTAR were age, history of wound infection, operative time, and mesh area. Further studies are needed to investigate the appropriateness of discharge decisions while balancing patients' benefits, resource utilization, and costs. [ABSTRACT FROM AUTHOR]

Purpose: This is the first study to investigate clinical outcomes after robotic emergent inguinal hernia repair (rEIHR). Methods: Data were retrospectively analyzed from patients who underwent rEIHR from 2013 to 2020. Any patients who underwent concomitant nonabdominal wall procedures were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCI®) scoring systems. Results: Out of 616 patients who underwent inguinal herniorrhaphy throughout the study period, 23 rEIHRs were identified among 19 patients. The median Acute Physiology and Chronic Health Evaluation-II score was 6, and the average skin-to-skin time was 75.9 minutes. The average length of stay (LOS) was 1.4 days. During the mean follow-up period of 31.7 months, a total of three complications (CD-grades I, II, and IVa) in two patients were observed. The median CCI score was 0 (max = 43.3). Conclusion: rEIHR is a feasible option for surgeons to utilize, with a short LOS and low complication rate, given the sufficient experience and support as well as the appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background. There are no studies on the role of robotics in emergency ventral hernia repair (EVHR). We aimed to compare outcomes of robotic EVHR (REVHR) and open (OEVHR). Methods. We performed a retrospective study of EVHRs performed between 2013 and 2019. Patients who underwent ventral hernia repair in an elective setting and patients who had concomitant non-abdominal wall procedures were excluded. Pre-, intra-, and postoperative variables were compared. Univariate and multivariate analyses were performed. Results. In all, 43 patients underwent OEVHR as compared to 35 patients who underwent REVHR. The patients in both groups were similar in terms of hernia etiology as well as Acute Physiology and Chronic Health Evaluation (APACHE-II) and the Sequential Organ Failure Assessment (SOFA) scores. Mean operative times for the robotic group were almost 2-fold compared with those of the open group (139 minutes vs 70 minutes, respectively; P <.001). Median length of stay (LOS) did not differ between the groups (3 days for both groups; P =.488). Major complications (P =.001), morbidity scores (P =.006), surgical site events (SSEs) (P =.045), and procedural interventions (P =.020) were found higher in the open group. No differences in freedom of recurrence were found (P =.662). Multivariate logistic regression analysis showed that open repair was associated with a 4-fold risk for the development of complications as compared to robotic repair (P =.025; odds ratio (OR) = 4, 95% confidence interval (CI) = 1.193-13.444). Conclusion. Compared to OEVHR, REVHR resulted in longer operative times and lower morbidity, including SSEs and related interventions. However, neither LOS nor recurrence differed between the groups. [ABSTRACT FROM AUTHOR]

Aim: A sigmoidectomy is the most definitive surgical treatment for recurrent diverticulitis. While it is usually accomplished via transabdominal specimen extraction and stapled anastomosis, the robotic platform can facilitate novel approaches and techniques. This is the first report of the initial experience using robotic sigmoidectomy with natural orifice specimen extraction and hand‐sewn anastomosis (NOSHA). Method: A prospectively maintained database of NOSHA procedures performed between 2018 and 2020 was retrospectively examined. The technique was described and variables across preoperative, intra‐operative and postoperative timeframes were presented. The Clavien‐Dindo classification system was used to describe postoperative complications. Results: Sixteen patients with recurrent diverticulitis treated with NOSHA were included in this study. Transanal specimen extraction and an intracorporeal hand‐sewn anastomosis were achieved in all patients. However, two (12.8%) patients required specimen debulking prior to extraction. The mean operating time was 171.7 min, and patients had a return of bowel function within an average period of 35.2 h. The mean hospital length of stay was 2.9 days. In total, two (12.8%) complications were seen: one postoperative ileus managed conservatively and one readmission for abdominal pain which resolved without intervention. No anastomotic leaks or reoperations were observed. Conclusion: Robotic NOSHA appears to be a viable technique for the surgical management of diverticulitis. Further studies are needed to establish its utility for various diseases and its reproducibility across clinical practices. [ABSTRACT FROM AUTHOR]

Background: Robotic Rives-Stoppa ventral hernia repair (rRS-VHR) is a minimally invasive technique that incorporates extraperitoneal mesh placement, using either transabdominal or totally extraperitoneal access. An understanding of its learning curve and technical challenges may guide and encourage its adoption. We aim at evaluating the rRS-VHR learning curve based on operative times while accounting for adverse outcomes. Materials and Methods: We conducted a retrospective analysis of patients undergoing rRS repair for centrally located ventral and incisional hernias. A single surgeon operative time-based cumulative sum (CUSUM) analysis learning curve was created, and a composite outcome was used for risk-adjusted CUSUM (RA-CUSUM). Results: Eighty-one patients undergoing rRS-VHR were included. A learning curve was created by using skin-to-skin times. Accordingly, patients were grouped into three phases. The mean skin-to-skin time was 72.2 minutes, and there was a significant decrease in skin-to-skin times throughout the learning curve (Phase-I: 86.4 minutes versus Phase-III: 63.8 minutes; P = .001), with a gradual decrease after 29 cases. Eleven patients experienced adverse composite outcomes, which were used to create a RA-CUSUM graph. Results showed the highest adverse outcome rates in Phase-II, with a gradual decrease in risk-adjusted operative times after 51 cases. Conclusions: Consistently decreasing operative times and adverse outcome rates in rRS-VHR was observed after the completion of 29 and 51 cases, respectively. Future studies that provide group learning curves for this procedure can deliver more generalizable results in terms of its performance rates. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive abdominal wall reconstruction, utilizing transversus abdominis release (TAR), has been described and shown to be beneficial for ventral hernia repair (VHR). Limited literature is available surrounding the hybrid robotic TAR (h-rTAR) approach, which combines robotic dissection and component separation with open fascial defect closure and mesh deployment. In this study, we describe our h-rTAR technique and present our center's postoperative and patient-reported outcomes (PROs). Methods: h-rTAR VHRs performed between 2013 and 2018 were examined. The h-rTAR technique was described. Patient characteristics and operative variables were analyzed. Perioperative results were presented according to European Hernia Society (EHS) classifications. Pre- and post-operative hernia-specific quality-of-life (QoL) assessments were conducted. Results: Twenty patients who underwent an h-rTAR were included in this study. All hernias were incisional. A bilateral TAR needed in 90% of patients. The average hospital stay was 1.8 days. Two patients experienced medical complications and 5 patients experienced surgical site events. None of the patients experienced a hernia recurrence throughout a mean postoperative follow-up period of 319 days. PROs showed improvement in all domains, especially cosmetic. Conclusion: The h-rTAR technique combines the benefits of robotic and open techniques when used for large incisional VHR with improvement in patient-reported QoL. [ABSTRACT FROM AUTHOR]

Imaging studies suggested that the RFB had been present for a few days causing an obstruction; there were no signs of bowel perforation. Rectal foreign body (RFB) insertion is a rare referral to the surgeon on call. Nonsurgical removal of the RFB in the ED, with the patient under conscious sedation, failed. [Extracted from the article]

Perforated diverticulitis remains a challenging emergency, with its management widely debated. Although a laparoscopic approach reduces the risk of both procedures, studies showed that sigmoidectomy with primary anastomosis in perforated diverticulitis is preferable to a Hartmann's [3,4]. Robotic natural orifice intracorporeal anastomosis and extraction sigmoidectomy for Hinchey Class IV diverticulitis - A video vignette. [Extracted from the article]

2021; 35 (6): 3205 - 13. https://doi.org/10.1007/s00464-021-08350-z 3 Kudsi OY, Gokcal F, Bou-Ayash N, Chudner A. Robotic sigmoidectomy for diverticulitis - natural orifice extraction with stapleless hand-sewn intracorporeal anastomosis. The COVID pandemic affected hospital bed occupancy and surgeons are optimizing treatments to allow same-day discharge for elective cases such as sigmoidectomy for uncomplicated diverticulitis. Refractory recurrent uncomplicated diverticulitis is managed surgically [1]. [Extracted from the article]

Association of Timing of colostomy reversal with outcomes following Hartmann procedure for diverticulitis. Staged robotic colostomy reversal and Botox followed by hybrid TAR - A video vignette Parastomal hernia is an independent risk factor for incisional hernia in patients with end colostomy. [Extracted from the article]

Accessory breast tissue is a remnant persisting after normal embryological development of the breast. Although accessory breasts may be asymptomatic, they can cause discomfort during menstruation, anxiety, cosmetic problems, pain, or restriction of arm movement. The data of all patients who presented with axillary accessory breasts between January 2000 and September 2008 were recruited from a computer database. Medical charts, outpatient records, operative notes, and pathology reports were reviewed. A total of 29 patients underwent surgical treatment of axillary accessory breasts in the Department of Breast Surgery and Department of Plastic, Reconstructive and Aesthetic Surgery. The ages of the patients at the time of surgery ranged from 19 to 54 years. The mean age was 28.8 years. All patients were female. Sixteen patients had unilateral accessory breast and 13 patients had bilateral accessory breasts. Fourteen patients had breast hypertrophy. Twenty-one patients had excision, five patients had liposuction, and three patients had both. Axillary accessory breasts can be satisfactorily treated with excision, liposuction, or both. In patients with concomitant macromastia, reduction mammaplasty and removal of accessory breasts can be performed at the same time with no additional morbidity. [ABSTRACT FROM AUTHOR]

Introduction: We assessed whether postoperative day-1 (POD-1) complete blood count (CBC) test parameters, including red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), could identify patients with gastric leaks after laparoscopic sleeve gastrectomy (LSG)., Methods: Patients with postoperative gastric leaks (n=36) and patients with no complications who were selected by age-sex-BMI matching (n=254) were included in the study. The levels of RDW, MPW, PCT, PLR, and NLR were compared between groups in univariate analyses. Receiver operating characteristic (ROC) curve analysis was run for CBC parameters with a P-value<0.05 in univariate analyses. The area under the curve (AUC) was evaluated, and a cutoff value was determined. Sensitivity, specificity, likelihood ratio (LR), positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated., Results: The level of PCT was significantly lower, while levels of PLR and NLR were significantly higher in patients with postoperative gastric leaks as compared with those without (P<0.05). The AUC of both PCT and PLR was <0.750, while the AUC of NLR was 0.911. NLR cutoff at 3.6 yielded 80% sensitivity, 92% specificity, and an LR of 10. In the study cohort, PPV of 59%, NPV of 97%, and an accuracy of 90% were found., Conclusions: Our results suggest that NLR at POD-1, with a cutoff value of 3.6, is a useful indicator of postoperative gastric leak who underwent LSG. We recommend the use of this easily calculated parameter in clinical practice., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: To estimate the average treatment effect on the treated (ATT) and to assess the clinical outcomes in two different types of mesh in robotic Rives-Stoppa (rRS) ventral hernia repair (VHR)., Methods: A retrospective analysis of a robotic VHR database between February 1, 2013 and May 31, 2022. Patients who underwent a rRS VHR were included in this study and separated into two groups depending on the mesh used: Synecor TM Preperitoneal Biomaterial (Synecor TM Pre) and Bard™ Soft. Through propensity score and inverse-probability-treatment-weighting, the ATT was estimated for two scenarios; the first with the treated target having used the Synecor TM Pre, the second having used the Bard™ Soft mesh. Adjusted linear regression models, including lingering imbalanced variables, were used for both the primary outcome of the Comprehensive Complication Index (CCI®), and the secondary outcome of the hospital cost., Results: A total of 186 patients who underwent rRS were separated into the two groups (Synecor TM Pre mesh, n = 85; Bard™ Soft mesh, n = 101). Adjusted linear regression models for the CCI showed no statistical difference between both groups (p > 0.05), whereas ATT on hospital cost was significantly higher ( p < 0.001) in the Synecor TM Pre group in both scenarios [(95% confidence interval) = 3882 (2352, 5413) and -5185 (-8213, -2157), respectively]., Conclusion: Both mesh materials provided excellent outcomes with no difference in complications or recurrence rates. However, hospital cost was found to be higher in the hybrid mesh group. Long-term follow-up is needed to fully assess the performance of both mesh types in rRS., (© 2022 by SLS, Society of Laparoscopic & Robotic Surgeons.)

Background: Cumulative sum (CUSUM) learning curves (LCs) are useful to analyze individual performance and to evaluate the acquisition of new skills and the evolution of those skills as experience is accumulated. The purpose of this study is to present a CUSUM LC based on the operative times of robotic intraperitoneal onlay mesh (rIPOM) ventral hernia repair (VHR) and identify differences observed throughout its phases., Materials and Methods: Patients who underwent rIPOM repair for elective, midline, and primary hernias were included. All procedures were performed exclusively by one surgeon within a 5-year period. CUSUM and risk-adjusted CUSUM were used to visualize the LC of rIPOM-VHR, based on operative times and complications. Once groups were obtained, univariate comparisons were performed., Results: Of the 90 rIPOM repairs, 25, 40, and 25 patients were allocated using a CUSUM analysis to the early, middle, and late phases, respectively. In terms of skin-to-skin times, the middle phase has a mean duration of 23 minutes shorter than the early phase (P<0.001), and the late phase has a mean duration 34 minutes shorter than the early phase (P<0.001). A steep decrease in off-console time was observed, with a 10-minute difference from early to middle phases. A consistent and gradual decrease in operative times was observed after completion of 36 cases, and a risk-adjusted CUSUM revealed improving outcomes after 55 cases., Conclusions: This study demonstrates and elucidates interval improvement in operative efficiency in rIPOM-VHR. Consistently decreasing operative times and simultaneous accumulated complication rates were observed after the completion of 55 cases., Competing Interests: O.Y.K. has received a teaching course and consultancy fees from Intuitive Surgical and W.L. Gore outside the submitted work. The remaining authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Short-term outcomes of robotic intraperitoneal onlay mesh(rIPOM) versus robotic totally extraperitoneal retromuscular mesh(rTEP-RM) ventral hernia repair were compared., Methods: A retrospective review of prospectively collected data of patients was conducted. A one-to-one propensity score matching(PSM) analysis was performed to achieve two well-balanced groups in terms of preoperative variables. A univariate and multivariate analysis were conducted to determine factors influencing post-operative outcomes., Results: Of 291 rIPOM and rTEP-RM procedures, 68 patients were assigned to each group after PSM. Operative times were longer for the rTEP-RM group. Adhesiolysis was more frequently required in rIPOM. The rTEP-RM allowed for a greater mesh-to-defect ratio. The rate of overall perioperative complications, Clavien-Dindo grades, and surgical site events were higher for the rIPOM group than the rTEP-RM group. The Comprehensive Complication Index® morbidity scores were lower in favor of rTEP-RM group. Adhesiolysis, rIPOM, and craniocaudal defect size were predictors for post-operative complications., Conclusion: Robotic TEP-RM repair has better early postoperative outcomes for ventral hernias, suggesting that it may be preferable over robotic IPOM repair. Further studies with longer follow-up are needed., Competing Interests: Declaration of competing interest Drs. Gokcal and Chang have no conflicts of interest or financial ties to disclose. Dr. Kudsi has received a teaching course and/or consultancy fees from Intuitive Surgical, Bard-Davol and W.L. Gore outside the submitted work., (Copyright © 2020 Elsevier Inc. All rights reserved.)