Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Diafragma Pélvico/cirugía , Prolapso Rectal/cirugía , Recto/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Humanos , Diafragma Pélvico/patología , Perineo/patología , Perineo/cirugía , Prolapso Rectal/diagnóstico , Prolapso Rectal/etiología , Prolapso Rectal/patología , Recto/patología , Mallas QuirúrgicasRESUMEN
This review aims to provide succinct insight into the past, present and near-future of right colon resection. The history of right colon resection as well as the evolution of a laparoscopic approach are described. Standardization of the surgical technique, indications for medial-to-lateral and lateral-to medial mobilization, D2 and D3 lymphadenectomy, iso-peristaltic and antiperistaltic anastomotic configurations, intracorporeal and extracorporeal anastomosis, totally stapled and stapled handsewn techniques, laparoscopic and robotic suturing, mucosa eversion and inversion, and specimen extraction sites are discussed. In addition, totally intracorporeal robotic right colectomy for cancer is described. This review concludes that, whether it is hindered or assisted, gasless or "con gas", multiple- or single-port, extra- or intracorporeal, iso- or anti-peristaltic, right colon resection is still evolving.
Asunto(s)
Neoplasias del Colon , Laparoscopía , Anastomosis Quirúrgica , Colectomía , Colon/cirugía , Neoplasias del Colon/cirugía , HumanosRESUMEN
BACKGROUND: The educational environment is a crucial metric of medical education that affects the course participants' motivation, achievement, happiness and success. The aim of this study was to evaluate the educational environment of a cadaver course in robotic colorectal surgery by comparing the perceptions of the participating residents to those of the participating surgeons. METHODS: This was a cross-sectional study carried out in 2017. Participants from the U.S. and Europe attended a course using eight fresh frozen cadaver torsos with no prior abdominal surgery. After course completion, participants anonymously completed 50-item Dundee Ready Educational Environment Measure (DREEM) questionnaires to evaluate five components of the educational environment: perception of learning, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception. Internal consistency of the questionnaire was assessed using Cronbach's alpha coefficient. Mean scores were compared using an independent samples t-test. RESULTS: Twenty of 24 participants completed the DREEM questionnaire, consisting of 9 residents and 11 surgeons (12 from the U.S., 8 from Europe). The internal consistency of the questionnaire was excellent (alpha=0.97). The mean total score was excellent for both residents and surgeons, and the difference between the groups was not significant (154.1±25.8 vs. 168.1±18.9, p=0.197). Perception of learning was significantly better among surgeons ("teaching highly thought of") than among residents ("a more positive perception") (40.5±3.6 vs. 35.7±5.6, p=0.04). CONCLUSIONS: This study suggests that the residents' perception of learning may have been negatively influenced by the participation of surgeons in the same cadaver station.
Asunto(s)
Cirugía Colorrectal/educación , Evaluación de Programas y Proyectos de Salud , Procedimientos Quirúrgicos Robotizados/educación , Actitud del Personal de Salud , Cadáver , Estudios Transversales , Evaluación Educacional , Humanos , Internado y Residencia , Cirujanos/educación , Encuestas y CuestionariosAsunto(s)
Toma de Decisiones Clínicas , Colectomía/métodos , Tratamiento Conservador/métodos , Diverticulitis/diagnóstico por imagen , Diverticulitis/terapia , Procedimientos Quirúrgicos Electivos/métodos , Progresión de la Enfermedad , Diverticulitis/fisiopatología , Divertículo del Colon/diagnóstico por imagen , Divertículo del Colon/fisiopatología , Divertículo del Colon/cirugía , Femenino , Humanos , Masculino , Pronóstico , Recurrencia , Reoperación/métodos , Reoperación/estadística & datos numéricos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Between June 2010 and December 2012, one surgeon performed 100 consecutive robotically assisted laparoscopic cholecystectomies without any conversions to an open technique. To our knowledge, this is the largest single-surgeon series of robotic cholecystectomies in the literature and, because of the zero percent conversion rate, also provides evidence that robotic cholecystectomies have a clinical advantage over traditional laparoscopic cholecystectomies.
RESUMEN
A method for the determination of mercury via UV photoreduction has been investigated. Mercury vapor was generated by the reduction of mercury species in an acetic acid solution using UV radiation. Detection of the volatile mercury was accomplished by atomic absorption spectrometry. An optimized system was found to provide a detection limit (defined as the concentration giving a signal equal to three times the standard deviation of the blank) of 2.1mugL(-1) with a precision of 2.9% relative standard deviation (n=8) for a 500mugL(-1) mercury standard. The effect of various metal ions on the mercury signal was investigated and the method validated with a NRCC certified dogfish liver material (DOLT-3) using the method of standard additions. A reaction pathway is hypothesized for UV photoreduction.