Is the use of ultra-low insufflation pressure safe and feasible in robot assisted radical prostatectomy.

OBJECTIVE: Current innovations in minimally invasive surgery include using ultra-low insufflation pressure with the aim of improving peri-operative and short-term clinical outcomes. Despite an exponential increase in the use of robotic technology, there remains limited literature supporting the use of ultra-low pressure during robotic surgery. We performed a feasibility study of ultra-low-pressure robot-assisted laparoscopic radical prostatectomy (RARP). MATERIAL AND METHODS: Prospective data related to standard pressure (15 mm Hg) RARP (Group 1) and ultra-low-pressure (6 mm Hg) RARP (Group 2) were collected and compared to assess the peri-operative and short-term outcomes. RESULTS: Outcome data of 112 consecutive patients (56 in each group) were collected. Mean age, pre-operative prostate specific antigen, body mass index, and performance status were similar in both groups. Mean console time was shorter in ultra-low-pressure RARP group (125 minutes) than in standard pressure RARP group (138 minutes) (p=0.016). Furthermore, there was no significant difference in console time or estimated blood loss between these 2 groups for patients with RARP and lymph node dissection. No patients from either group required conversion to an open procedure or received a peri-operative blood transfusion. None of the patients in either group developed post-operative complications or needed readmission. CONCLUSION: Our study has demonstrated that ultra-low-pressure RARP is a practical and safe option, and it supports the routine practice of ultra-low-pressure RARP with slow adaptation in other complex robotic surgeries, such as robotic cystectomy for bladder cancer.

Aortopexy for Life-Threatening Airway Obstruction Following Division of Double Aortic Arch.

Symptoms of airway compression secondary to double aortic arch are relieved by division of one of the two aortic arches. However, in some cases inherent tracheomalacia and other factors may result in persistence of symptoms. We report one such occurrence in our experience and describe the use of aortopexy as a curative procedure to tackle this problem.

Gastric outlet obstruction secondary to orbera intragastric balloon.

Intragastric balloons are used as a temporary restrictive method in obesity to induce weight loss. They are typically recommended when patients have mild obesity and have failed traditional first line treatments of diet, exercise and behaviour modification. We report a case of a 45-year-old female who presented with nausea, vomiting and abdominal pain two weeks following an uncomplicated insertion of an intragastric balloon. Following investigation, she was found to have a gastric outlet obstruction which required endoscopic removal of the balloon. While a rare occurrence, gastric outlet obstruction as seen in this case, highlights the importance of early recognition in order to proceed with swift diagnosis and intervention in order to prevent significant morbidity such as ischaemia and perforation.

A confirmed case of sugammadex-induced anaphylaxis in a UK hospital.

We report the first published case of confirmed anaphylaxis to sugammadex in a UK hospital. The patient was given a bolus of sugammadex at the end of surgery. Four minutes later, he developed hypotension and a widespread erythematous rash. Multiple epinephrine boluses were administered and a continuous intravenous infusion of epinephrine commenced. The patient later reported auditory awareness, which occurred while the diagnosis of anaphylaxis was being made and initial treatment initiated. Serial serum tryptase levels were consistent with a type I hypersensitivity reaction. Skin prick and intradermal testing were performed 6 months later confirming allergy to sugammadex. This case restates the potential for hypersensitivity reactions to develop following the administration of sugammadex and makes clinicians aware that such reactions may require prolonged treatment with intravenous infusions of epinephrine. Finally, this case highlights the importance of maintaining or re-establishing anaesthesia while managing the emergent situation in order to avoid unintentional awareness.

Risk of tumor transmission after thoracic allograft transplantation from adult donors with central nervous system neoplasm-A UNOS database study.

BACKGROUND: We analyzed the UNOS database to better define the risk of transmission of central nervous system (CNS) tumors from donors to adult recipients of thoracic organs. METHODS: Data were procured from the Standard Transplant Analysis and Research dataset files. Donors with CNS tumors were identified, and recipients from these donors comprised the study group (Group I). The remaining recipients of organs from donors who did not have CNS tumors formed the control group (Group II). Incidence of recipient CNS tumors, donor-related malignancies, and overall survival were calculated and compared in addition to multivariable logistic regression. RESULTS: A cohort of 58 314 adult thoracic organ recipients were included, of which 337 received organs from donors who had documented CNS tumors (Group I). None of these recipients developed CNS tumors at a median follow-up of 72 months (IR: 30-130 months). Although overall mortality in terms of the percentage was higher in Group I than Group II (163/320=51% vs 22 123/52 691=42%), Kaplan-Meier curves indicate no significant difference in the time to death between the two groups (P=.92). CONCLUSIONS: There is little risk of transmission of the common nonaggressive CNS tumors to recipients of thoracic organs.

Optimal Timing of Pulmonary Banding for Newborns with Single Ventricle Physiology and Unrestricted Pulmonary Blood Flow.

The aim of this study was to determine the optimal timing of pulmonary artery band (PAB) placement in neonates with single ventricle physiology, unrestricted pulmonary blood flow, and no systemic outflow tract obstruction. Retrospective chart review of all patients who underwent isolated PAB for single ventricle physiology between January 2005 and December 2014 was carried out. The influence of age at the time of PAB on operative mortality, the need for reoperation to adjust the PAB, the preparedness of the pulmonary vascular bed prior to the second-stage bidirectional cavopulmonary shunt (BCPS), and the outcomes following BCPS were studied. The study cohort included 54 subjects (34 males). The median age at the time of PAB was 18 days. The overall mortality following PAB was 4 % (2/54). Reoperation for PAB adjustment was 7 % (4/54). Younger age at the time of PAB was not associated with mortality or increased risk of reoperation. There was a mild positive correlation between the age at PAB and the mean pulmonary artery pressure prior to BCPS. There was also a weak positive correlation between the age at PAB and the duration of ventilation following BCPS. Age at the time of PAB did not influence pulmonary vascular resistance (PVR) prior to BCPS or the mortality and hospital stay following BCPS. PAB can be done safely and effectively soon after birth in neonates with single ventricle physiology, increased pulmonary blood flow, and no potential or actual systemic outflow tract obstruction. It may not be necessary to wait for a few weeks after birth for the neonatal PVR to fall before placing a PAB.

Attraction and mortality of Bactrocera dorsalis (Diptera: Tephritidae) to STATIC Spinosad ME weathered under operational conditions in California and Florida: a reduced-risk male annihilation treatment.

Studies were conducted in 2013-2014 to quantify attraction, feeding, and mortality of male oriental fruit flies, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae), to STATIC Spinosad ME a reduced-risk male annihilation treatment (MAT) formulation consisting of an amorphous polymer matrix in combination with methyl eugenol (ME) and spinosad compared with the standard treatment of Min-U-Gel mixed with ME and naled (Dibrom). Our approach used a behavioral methodology for evaluation of slow-acting reduced-risk insecticides. ME treatments were weathered for 1, 7, 14, 21, and 28 d under operational conditions in California and Florida and shipped to Hawaii for bioassays. In field tests using bucket traps to attract and capture wild males, and in toxicity studies conducted in 1-m(3) cages using released males of controlled ages, STATIC Spinosad ME performed equally as well to the standard formulation of Min-U-Gel ME with naled for material aged up to 28 d in both California and Florida. In laboratory feeding tests in which individual males were exposed for 5 min to the different ME treatments, mortality induced by STATIC Spinosad ME recorded at 24 h did not differ from mortality caused by Min-U-Gel ME with naled at 1, 7, 14, and 21 d in California and was equal to or higher for all weathered time periods in Florida during two trials. Spinosad has low contact toxicity, and when mixed with an attractant and slow release matrix, offers a reduced-risk alternative for eradication of B. dorsalis and related ME attracted species, without many of the potential negative effects to humans and nontargets associated with broad-spectrum contact insecticides such as naled.