bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic inguinal hernia repair (rTAPP) – A series of 300 cases
Authors: Ramser M , Baur J , Dietz U 
Published: May 2021

Abstract

Objective
While inguinal hernia repair using mesh is the recommended standard for most patients, minimal invasive techniques experienced a prolonged process until broad acceptance and sufficient expertise. Lately, a reluctance towards the integration of robotic hernia repair as a standard procedure is observed in Europe compared to the US. Nevertheless, robotic technology is a powerful tool for increasing quality in standardized procedures. We present a large case series of inguinal hernias repaired by robotic surgery.

Methods
All consecutive patients receiving a robotic inguinal hernia repair with a transabdominal approach (rTAPP) in the first 18 months (May 2018 up to October 2019) after introduction of the DaVinci Xi system at our institution were included in this study.

Results
Overall, 302 groin hernias in 225 patients were operated in the defined period. 77 patients presented with bilateral hernias. Mean age of patients was 58.7 years, 87.6% were men. Mean BMI 25.5kg/m2.
Nearly half of all operations were teaching operations making use of the available double consoles. While in the first 6 months only 20.0% of operations were teaching procedures, the rate increased to 60.3% in the last 6 months of the observation period.
While overall 35.6% of procedures were performed as day-surgery, the rate varied over the course of the study with 35.6% in the first 6 months, 46.0% in the second and 33.3% in the last 6 months.
Operation time was 82.6min. (range 40-186) with 72min. (range 40-186) for unilateral repairs and 101.3min. (range 52-169) for bilateral repairs. Further subgroup analysis showed that in bilateral repairs in primary hernias teaching vs. no-teaching operations differed only marginally in time (108.9min., range 66-149 vs. 91.6min., range 52-159).
Follow-up data was available for 93.8% of patients. There were no cases of recurrence; two patients experienced postoperative pain lasting more than 30 days. Seroma was observed in 8.9%, haematoma in 4.4% cases. Urinary retention occurred in 3.6% of patients, PE in 0.4%, DVT in 0.4%, epididymitis in 3.1%.

Conclusion
Robotic inguinal hernia repair is an outstanding and safe procedure. The operative accuracy of the system is impressive. The availability of two consoles makes it an ideal teaching tool, allowing to train residents in inguinal hernia repair, in a high standard of safety and with good outcomes.
Damage-control surgery in patients with non-traumatic abdominal emergencies: A meta-analysis
Authors: Haltmeier T , Falke M , Quaile O , Candinas D , Schnüriger B 
Published: May 2021

Abstract

Objective
After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies.

Methods
Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI).

Results
Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively).

Conclusion
This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.
IBM WATSON Trauma Pathway Explorer outperforms the TRISS score to predict early death after polytrauma
Authors: Niggli C , Pape H -C , Mica L 
Published: May 2021

Abstract

Objective
In recent years, several big data-based artificial intelligence (AI) systems have found its way in health care, one of which we present here: The IBM WATSON Trauma Pathway Explorer, a visual analytics tool to predict early death in polytrauma patients. The aim of this study was to compare the predictive performance of the Trauma Pathway Explorer for early in-hospital mortality with an established trauma scoring system, the Trauma Revised Injury Severity Score (TRISS).

Methods
A retrospective comparative accuracy study in a level I trauma center including patients with an Injury Severity Score (ISS) ≥16 and age ≥16 was performed. The compared outcome was early death within 72 hours since admission of the patient. The area under the receiver operating characteristic curve (AUC) was used to measure discrimination. Hosmer-Lemeshow statistics was calculated to analyse calibration of the two predictive models. The Brier score assessed the overall performance of the two models.

Results
The cohort included 107 polytrauma patients with a death rate of 10.3% at 72 hours since patient admission. The Trauma Pathway Explorer and TRISS showed similar AUCs to predict early death (AUC 0.90, 95% CI 0.79-0.99 vs. AUC 0.88, 95% 0.77-0.97; p = 0.75). The calibration of the Trauma Pathway Explorer was superior to that of TRISS (chi-squared 8.19, Hosmer-Lemeshow p = 0.42 vs. chi-squared 31.93, Hosmer-Lemeshow p &lt; 0.05). The Trauma Pathway Explorer had a lower Brier score than TRISS (0.06 vs. 0.11).

Conclusion
The IBM WATSON Trauma Pathway Explorer showed equal results in discrimination as TRISS but outperformed in calibration. In addition to being able to provide a prediction of early death, this visual analytics tool for polytrauma patients can also show the quantitative flow of patient sub-cohorts through different events, such as coagulopathy, hemorrhagic shock class, surgical strategy and the above-mentioned outcome. Here, we can present an accurate and valid alternative to TRISS for predicting early death in polytrauma patients.
Temporary extracorporeal femoro-femoral crossover bypass to treat critical limb ischemia due to occlusive femoral transaortic microaxial left ventricular assist device – a novel technique and case series
Authors: Richarz S , Siegemund M , D`Amico R , Bachofen B , Döbele T , Gürke L , Mujagic E 
Published: May 2021

Abstract

Objective
The Impella transaortic microaxial left ventricular assist device (MLVAD) bears the risk of severe ipsilateral limb ischemia due to it´s percutaneous insertion through the common femoral artery (CFA). As long as the MLVAD is required for cardio-circulatory support, treatment options are limited. Therefore, we developed a temporary extracorporeal femoro-femoral crossover bypass to restore and maintain perfusion of the affected leg.

Methods
From October 2018, we treated all patients with severe limb ischemia due to the MLAVD with a femoro-femoral crossover bypass. For comparison, a consecutive cohort of patients undergoing placement of the MLAVD between January 2011 and July 2019 was identified.
For those patients who experienced limb ischemia after Impella placement, data on age, gender, BMI and diabetes, underlying cardiac condition, duration of Impella pump in place, limb complications, limb salvage procedure, need for additional surgical procedure on the affected limb (e.g. fasciotomy) were recorded.
The primary outcome is the feasibility and safety of our percutaneously established extracorporeal femoro-femoral crossover bypass. As secondary outcomes, we report overall 30 day mortality and limb salvage rates.

Results
Between January 2011 and July 2019, 25 of 245 (10.3%) patients developed a severe ipsilateral limb ischemia following the MLVAD placement.
Until October 2018, 20 patients were treated conventionally (C-cohort) and since October 2018, five (consecutive) patients have been treated by an extracorporeal femoro-femoral cross over bypass (BP-Cohort).
Following the BP-procedure, an immediate improvement of the perfusion was seen in all patients. The bypass remained in place during a median of 5 days. Limb salvage was documented in 100% of our patients and 30 days mortality was 60% in both groups.

Conclusion
This is the first case series reporting on this novel technique. We demonstrated that the percutaneous creation of an extracorporeal femoro-femoral crossover bypass is feasible, safe and effective and should therefore be promoted in the future.
First experience with percutaneous arteriovenous fistula creation using the Ellipsys® vascular access system
Authors: Isaak A , Mallios A , Gürke L , Wolff T 
Published: May 2021

Abstract

Objective
Percutaneous creation of arteriovenous fistulae (pAVF) has been developed as an alternative to the creation of an upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. To our knowledge, the technique has not been used in Switzerland before.

Methods
Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and July 2020 at two vascular surgery centres.

Results
Seven patients underwent pAVF creation with the Ellipsys® vascular access system under regional anaesthesia for maximum vasodilation. The procedures were performed entirely under sonographic control without the use of fluoroscopy. The cephalic or basilic vein was punctured and the puncture needle advanced under sonographic control through the cubital perforator vein into the proximal radial artery. The Ellipsys® catheter was advanced over a guidewire and activated to create the fistula between the proximal radial artery and the perforator vein. The fistula was further dilated with a 5mm PTA balloon. We achieved technical success in 6 patients. In one patient with small and spastic vessels, the needle could not be advanced into the radial artery. A conventional upper arm cephalic fistula was created during the same procedure. In three patients primary maturation was achieved and the cephalic vein or distal basilic vein could be punctured for dialysis without any adjunct procedures. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). One patient required superficialisation of the basilic vein and one patient transposition of the arterialised brachial vein. Maturation was achieved in six pAVF after a mean of 158 days with a mean fistula flow of 920 ml/ min.

Conclusion
We achieved high technical success and maturation rates in our first patients undergoing pAVF creation with the Ellipsys® system. Prerequisites are suitable anatomy of the cubital perforator vein and good skills in sonography and endovascular techniques. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.
Nicotinamide Adenine Dinucleotide (NAD+) improves lung function in rat lung ex-vivo lung perfusion model
Authors: Ehrsam J P , Arni S , Chen J , Rodriguez Cetina Biefer H , Opitz I , Inci I 
Published: May 2021

Abstract

Objective
Ischemia-reperfusion injury compromises short- and long-term outcome after lung transplantation. The scarce existing data on the natural co-enzyme NAD+ suggest an antagonistic effect on hypoxia induced vasoconstriction, removal capacity on reactive oxygen species, and anti-inflammatory effects. We therefore investigated the impact of NAD+ on ischemic rat lungs during ex-vivo lung perfusion (EVLP).

Methods
Lungs were retrieved from 12 outbred Sprague Dawley male rats and exposed to 14 hours of cold ischemic storage. All lungs were then perfused in a rat EVLP system for 4 hours. Lung grafts were injected after 1, 2 and 3 hours with 2000 uM NAD + (N = 6) or placebo (N = 6) in the perfusate in proximity of the pulmonary artery. EVLP physiology and biochemistry were monitored.

Results
During the 4 hours of EVLP, the lung function increased significantly in the NAD+ group when compared to the placebo group. We monitored a higher vascular flow (p = 0.018), a lower mean pulmonary pressure (p = 0.007) and increased oxygenation capacity (p = 0.003). Lung compliance and weight were comparable. Tissue inflammation measured by myeloperoxidase was significantly lower in the NAD+ group (p = 0.015). In the perfusate, we observed in the NAD+ group significantly lower levels of pro-inflammatory interleukin-18 (p = 0.033) and a trend towards high levels of anti-inflammatory interleukin-10 (p = 0.080) and low levels of pro-inflammatory interleukin-12 (p = 0.146).

Conclusion
Findings from this preliminary study demonstrated that NAD+ is a promising agent with both anti-inflammatory properties and the ability to improve ischemic lung function. This observation should be validated in a large animal model.
Hydrogen sulfide (H2S) reduces oxygen and ATP consumption in the isolated perfused pig kidney
Authors: Agius T , Songeon J , Klauser A , Nastasi A , Ruttiman R , Meier R P H , Buhler L , Allagnat F , Corpataux J -M , Lazeyras F , Longchamp A 
Published: May 2021

Abstract

Objective
Organ donation after circulatory death [DCD] has the potential to reduce the shortage of kidneys available for transplantation. However, many DCD grafts are discarded because of long warm ischemia times. Strategies reducing oxygen demand may minimize damages caused by ischemia/reperfusion injury. Ex-vivo, Hydrogen sulfide (H2S) reduces oxygen and ATP consumption of the isolated perfused kidney, reduces inflammation and improves renal function following ischemia reperfusion injury in rodents. However, the benefits and applicability of H2S in clinically relevant model remain unknown.

Methods
To mimic DCD, pig kidneys underwent 0 or 60 min of warm ischemia, before oxygenated hypothermic machine perfusion (HMP). NaHS (100µM), an H2S donor, was added to the perfusion media or injected as an intra-arterial bolus before warm ischemia. After 2 hours of HMP, kidneys were transplanted and reperfused for 1 hour before harvest. Kidney function was assesses before, after and during ex vivo perfusion by measuring energy metabolites, Gadolinium elimination by pMRI and histopathological scoring.

Results
Warm ischemia (60 min) induced significant histological damages, delayed cortical and medullary Gadolinium elimination (perfusion), and reduced ATP levels, but not its precursors (AMP). As expected, ATP levels and kidney perfusion both inversely correlated with the severity of kidney histological injury. NaHS reduced metabolism during warm ischemia, and seemed to increase kidney ATP levels and viability after reperfusion.

Conclusion
Our preliminary data suggest that the H2S donor NaHS reduces kidney metabolism and protects from warm ischemia. Further experiments will identify the best administration protocol and the clinical relevance of H2S supplementation in the context of organ preservation.
Maternal metabolic syndrome induces liver injury and promotes tumor growth in the offspring
Authors: Moeckli B , Delaune V , Peloso A , Orci L , Slits F , Gex Q , Lacotte S , Toso C 
Published: May 2021

Abstract

Objective
Obesity is a growing disease entity affecting a third of women of reproductive age. Epidemiological studies show that children of obese mothers suffer from obesity, long-term morbidity and an increased rate of childhood cancers. However, the mechanisms of disease transmission remain unknown. The aim of this study is to test this hypothesis in a mouse model and shed light on the involved mechanisms of vertical transmission.

Methods
Female mice were fed a high fat or standard diet (HFD/SD) for 16 weeks before being mated with mice fed a normal diet. Corresponding diet was continued until weaning, all offspring were thereafter fed a SD. Metabolic profile, weight gain, liver enzymes and the gut microbiota profile were assessed in the offspring (n = 24). Additional groups of offspring (n = 48) were injected with a carcinogen (diethylnitrosamine) at week two, tumor characteristics were assessed by computed tomography scan at week 36.

Results
Mothers fed HFD developed obesity and non-alcoholic fatty liver disease (NAFLD). Female offspring of mothers fed HFD gained significantly more weight (+33.7%, p = 0.001), had increased alanine transaminase levels (62 vs 18 IU/L, p = 0.003) and a significantly altered liver histology exemplified by an increased NAFLD activity score (3.8 vs 0.6, p = 0.016). Expression levels of several candidate genes were studied of which FGF21 showed the largest differential expression between HFD and SD offspring (9 vs 1 2^ΔΔCT, p = &lt;0.001). However, epigenetic analysis of FGF21 in the liver revealed no changes in methylation level between HFD and SD offspring. Furthermore, offspring of HFD mothers had a distinctly altered gut microbiome with lower proportions of Bacteroides caccae, Bacteroidales and Parasutterella excrementihominis. Interestingly, the proportion of female offspring developing tumors was significantly higher in offspring of HFD mothers (83 vs 44%, p = 0.011), the average total tumor volume was larger (234 vs 3.5mm3, p = 0.022) and the offspring developed more tumors (3.5 vs 0.6, p = 0.010).

Conclusion
Maternal obesity promotes liver tumor growth in the offspring, alters metabolic patterns and induces liver suffering in the progeny in a sex-dependent manner. The gut microbiome seems to play a role in this transmission of disease. Yet further research is needed to determine the vectors of transmission and evaluate preventive interventions in obese mothers.
The use of single incision laparoscopic surgery techniques and natural orifice transluminal endoscopic surgery – a nationwide survey
Authors: Fahrner R , Mazzola F , Adamina M 
Published: May 2021

Abstract

Objective
Since the first report of transgastric peritoneoscopic surgery in 2004, minimal invasive surgery (MIS) including conventional laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single incision laparoscopic surgery (SILS), and robotic surgery have gained traction in general and visceral surgery. While laparoscopic surgery is now the gold standard in many institutions, other MIS approaches lag behind in spite of the enthusiasm of few promoters.
The present study investigates the current role of NOTES and SILS in Switzerland.

Methods
All Swiss surgical departments where queried. Heads of department were asked to complete a detailed questionnaire regarding the use of NOTES and SILS techniques, reminders were sent twice.

Results
Of 93 departments queried, 63 (68%) answered the survey and most were public hospitals (92%). One third of general surgery departments and 46% of visceral surgery departments had the highest accreditation level A and V1, respectively.
While up to 27% of the responding hospitals had performed NOTES in the past, only about 9% still use the technique today. Since January 2019, only two departments performed NOTES cholecystectomy, one department NOTES colectomy and three departments NOTES total mesorectal excision.
The main reasons for not performing NOTES anymore were lack of perceived benefits, higher costs, increased morbidity in routine procedures, no patient demand, and the lack of surgical expertise.
A similar picture was found regarding the use of SILS, with 37% of hospitals having past experience with SILS and only 13% still performing SILS procedures. Yet, significantly more institutions performed a broader range of SILS procedures today:
SILS appendectomy (n = 2), SILS cholecystectomy (n = 4), SILS thyroidectomy (n = 1), SILS small bowel resection (n = 2), SILS colonic resection (n = 5), and SILS rectal resection (n = 2). The main reasons for not performing routinely SILS were similar to the rationale against NOTES.

Conclusion
Due to technical limitations and lack of perceptible benefits, NOTES and SILS are less frequently performed nowadays than they were in the past. Only a minority of departments are still performing NOTES and SILS, including cholecystectomies, appendectomies, thyroidectomies, and bowel resections. Whether the rise in use of robotic techniques correlates with the decrease of NOTES and SILS needs further investigation.
Real-time clipper tip visibility detection using computer vision
Authors: Aspart F , Lindström Bolmgren J , Lavanchy J L , Beldi G , Woods M S , Padoy N , Hosgor E 
Published: May 2021

Abstract

Objective
Laparoscopic cholecystectomy is one of the most common laparoscopic procedures. The critical phase of this intervention consists in dissecting the hepatocystic triangle and clipping the cystic artery and duct. Poor visibility of the clipper tips can result in unintentional clipping of neighboring tissues (“past-pointing”) or improper enclosing of the artery or duct, leading to hemorrhage or bile leaks. To improve patient safety during this clipping phase, we propose real-time intraoperative feedback to alert a surgeon when departing from safe behavior, i.e., losing visibility of the clipper tip. This is achieved using a deep learning model which classifies the clipper tip visibility in each frame.

Methods
We tailored a dataset for our application by selecting frames containing a clipper that were selected from 300 laparoscopic cholecystectomy videos. These 122k frames were annotated with binary labels: clipper tip visible/invisible. A frame was labelled as tip visible when the tips of both clipper jaws were visible. Frames in which the clipper tip was occluded (e.g. by tissue) or frames with poor image quality (e.g., bad contrast, blurriness/smoke) were labelled as tip invisible. Frames from 29 videos were set aside for a test set; the remaining frames were used for training/validation (80%, 20% resp.).
Using a 5-fold cross-validation scheme, convolutional neural networks (Resnet50 architecture) were trained to classify the clipper tip visibility in each frame. Finally, 5 neural networks trained in the cross-validation were ensembled into a single model by averaging their predictions.

Results
On the test set, the ensembled model achieved an AUROC of 0.906 and a specificity of 64.5% at 95% sensitivity. Looking at per video performance, the median specificity across videos raised to 76.6% (at 95% sensitivity). That is, the model would correctly detect 95% of the clipper tip not visible cases; in the majority of the interventions, 7 out of 10 warnings would be justified.

Conclusion
We propose a novel safety feedback which warns on poor visibility of the clipper while clipping the cystic duct or artery. While being accurate, our technical solution runs in real-time, a requirement for intraoperative use. We believe this feedback can raise surgeons’ attentiveness when departing from safe visibility during this critical phase of laparoscopic cholecystectomy.