Search

Background: Available reports of surgeon efficiency when transitioning from laparoscopic to robotic-assisted (RA) inguinal hernia repair (IHR) are retrospective or describe single-center experience. The purpose of this study is to provide a prospective, multi-surgeon, multi-center assessment of surgeon efficiency when transitioning from Lap-IHR to RA-IHR., Methods: General surgeons with Lap-IHR experience (≥300 Lap-IHRs prior to the study) but with no robotic experience (no RA cases one year prior to the study) consented to participate in this prospective, observational pilot study of their surgical efficiency as they adopted RA-IHR. Efficiency was measured through procedure durations, including skin-to-skin time and time to establish critical view of the myopectineal orifice (MPO). Rates of conversions, and adverse events (AEs) through 30 days post RA-IHR procedure were also reported. Outcomes with 95% confidence intervals (95% CI) describe surgeons' collective and individual unilateral and bilateral early, middle, and late-phase cases, with each surgeon contributing 25 consecutive cases at each phase., Results: Four surgeons consented to enroll in the study and provided 75 consecutive, prospective RA-IHR cases. Collectively, the surgeons reached relative skin-to-skin time efficiencies for their unilateral repairs in the mid-phase of their prospective cases. For RA-IHR bilateral procedures, skin-to-skin time efficiency was reached in the late-phase cases. Surgeons' skin-to-skin efficiency times varied relative to their retrospective Lap-IHRs. Possible confounders included practice patterns, referrals, proctoring periods, and-for one surgeon-Covid interruptions. One conversion from RA-IHR to open resulted from severe adhesions present after prior prostatectomy. AEs varied broadly from surgeon to surgeon., Conclusions: The four surgeons improved their skin-to-skin efficiencies., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.) more...

Background: Single-incision laparoscopic surgery (SILS) is a well-described technique for many general surgical procedures. The SILS techniques applied to cholecystectomy vary, and reporting has been sparse. Because most cholecystectomies are outpatient procedures performed by busy, practicing general surgeons, the authors report their initial experience adopting this technique., Methods: From March, 2008 to January, 2009, SILS was performed for 100 consecutive outpatients needing cholecystectomy. All the patients underwent a single-incision, multiport laparoscopic (SIMPL) technique using existing instrumentation. The patients were followed postoperatively for at least 6 months., Results: Of the 100 patients, 98 underwent SIMPL cholecystectomy and 2 required conversion to the standard laparoscopic technique because of bleeding from the cystic artery. No major postoperative complications occurred, including infections and hernias., Conclusions: The findings show SIMPL cholecystectomy to be safe in the outpatient setting. It is an excellent alternative to traditional three- or four-port cholecystectomy for the ideal candidate with a lower body mass index (BMI), early disease, and no previous abdominal surgery. The authors' initial outpatient experience shows that it can be performed using existing instrumentation without increasing costs by a reproducible technique that can be adopted by any practicing general surgeon. more...

Superior vena cava (SVC) syndrome can result from benign causes such as temporary hemodialysis catheters placed into the central veins. The indications for open, surgical revascularization are rare and usually reserved for patients whose symptoms are refractory to anticoagulation and endovascular treatment. The current report documents the case of a 54-year-old woman with recurrent SVC syndrome secondary to long-term indwelling central venous catheters for total parenteral nutrition. She presented to the vascular service with moderate head/neck edema and persistent headaches despite chronic anticoagulation and multiple previous endovascular attempts including both angioplasty and stenting. An internal jugular-SVC bypass was performed using autogenous superficial femoral vein (SFV), which resulted in the resolution of her symptoms and a patent graft 12 months postoperatively. Autogenous SFV is an ideal conduit for central vein revascularization secondary to its size, relative ease associated with harvesting, and handling characteristics. It may be the ideal conduit for revascularization in patients with SVC syndrome secondary to benign causes because of their favorable life expectancy, although documentation of long-term graft patency is necessary. more...

We present an endoscopic approach for the reconstruction of pectus excavatum with a custom silicone implant. The procedure incorporates endoscopic techniques to facilitate dissection of an extensive subcutaneous pocket through a 6-cm Chevron skin incision 8 cm below the level of the xiphoid. The incision is designed based on the size, shape, and flexibility of the custom implant and the configuration of the chest wall deformity. A superiorly based rectus abdominis anterior fascial sheath flap then is elevated up to the caudal-most margin of the implant, creating a sling below the implant, thus stabilizing its position and preventing direct communication with the overlying skin incision. In our patient, the endoscope permitted insertion of the custom implant while minimizing the length of incision. The cosmetic result using a minimally invasive approach to assist with the dissection was acceptable, and the morbidity and scarring were minimized. more...

Pneumothorax (PTX) in patients with penetrating thoracic trauma is routinely ruled out with serial chest radiographs (CXRs). This study examined the efficacy of a shortened time period between initial and follow-up radiographs. Patients with penetrating torso injuries treated at a Level-1 trauma center received a CXR during their initial evaluation. If no pneumothorax or hemothorax was noted, and the patient did not require immediate admission to the Intensive Care Unit or operating room, a repeat chest film was taken at 3 and 6 h. Findings were treated as clinically indicated, and patients were discharged home if the last radiograph revealed no evidence of pathology. Over a 15-month period, 116 patients were evaluated for penetrating thoracic injuries (93 stabbings, 23 gunshot wounds) and had no pneumothorax detected on initial CXR. Two patients had pneumothorax detectable only by computed tomography. One patient had a normal initial CXR, but developed a PTX on the 3-h film, requiring tube thoracostomy. No patients developed a PTX on the 6-h study that was not present on the initial or 3-h CXR. In conclusion, extending the time between initial and final CXRs to 6 h in patients with penetrating thoracic trauma provided no additional information that was not available on the 3-h film. more...

Facial clefts remain one of the most common congenital anomalies encountered by plastic surgeons. Over the last few decades, surgical results have continued to improve due to the interdisciplinary approach to this complex clinical problem. more...