Assessing robotic-assisted surgery versus open approach in penetrating Crohn's disease: advantages and outcomes in ileocolic resection.

INTRODUCTION: Penetrating Crohn's disease (CD) often necessitates surgical intervention, with the open approach traditionally favored. Robotic-assisted surgery offers potential benefits but remains understudied in this complex patient population. Additionally, the lack of standardized surgical complexity scoring in CD hinders research and comparisons. METHODS: We retrospectively analyzed adult patients with penetrating CD who underwent either robotic-assisted ileocolic resection (RICR) or open ileocolic resection (OICR) at our institution from January 2007 to December 2021. We assessed endpoints, including length of stay, complications, readmissions, reoperations, and other perioperative outcomes. RESULTS: RICR demonstrated safety outcomes comparable to OICR. Importantly, RICR patients experienced significantly reduced estimated blood loss (p < 0.0001), shorter hospital stays (median 4.5 days versus 6.9 days; p = 0.01), lower surgical site infection rates (0% versus 15.4%; p = 0.01), and decreased 30-day readmission rates (0% versus 15.4%; p = 0.01). Linear regression analysis revealed the need for additional strictureplasties (coefficient: 84.8; p = 0.008), colonic resections (coefficient: 41.7; p = 0.008), and estimated blood loss (coefficient: 0.07; p = 0.002) independently correlated with longer operative times). CONCLUSION: Robotic-assisted surgery appears to be a safe and potentially beneficial alternative for the surgical management of penetrating CD, offering advantages in perioperative outcomes reducing length of stay, blood loss, surgical site infection rates, and readmission rates. Further validation with larger cohorts is warranted.

Robotic resection of presacral tumors.

BACKGROUND: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors. METHODS: This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates. RESULTS: Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant). CONCLUSIONS: Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.

Managed care and public health.

Both public health and managed care organizations share an interest in ensuring the health status of a defined population. We explore the existing and potential relationships between managed care organizations and public health in several major public health areas, specifically clinical preventive services, prevention-oriented social and political policies, and core public health functions. The latter include health information, health education, personal health services provision, work force and research, community partnerships, and evaluation of health care. We believe there is much potential to improve the population's health through the collaboration of these two sectors of the health care system.

A survey of state health department compliance with the recommendations of the Institute of Medicine report, The Future of Public Health.

We repeated a survey of state health agencies (SHAs) designed to ascertain the extent that the recommendations of the Institute of Medicine's report, The Future of Public Health, have been implemented. This survey was originally done in 1989 and we repeated the same survey in 1996. While there has been progress in some of the recommendations, such as a separate department of health, agreed-upon public health duties, outreach, infrastructure, and scope of responsibilities, there continue to be problems with the implementation of some of the recommendations. For example, the proportion of agencies reporting that the core public health function of policy development is extant has actually declined since 1989. There continue to be problems, with developing linkages of public health with environmental health and mental health, with strengthening the public health infrastructure, and with expansion of the scope of public health responsibilities. We encourage the continued monitoring of the implementation of the IOM recommendations.

Compliance with the recommendations of the Institute of medicine report, The Future of Public Health: a survey of local health departments.

In 1989 a survey of state health officials was conducted to ascertain the extent that the recommendations of the 1988 Institute of Medicine's report, The Future of Public Health, were in place. We applied a similar survey in 1996 to assess the level of implementation of the IOM recommendations at the local health department level. Agreement with the specific IOM recommendations at the local level was, in almost all cases, greater than 90%. However, when one views the extent of these recommendations in place, nearly half fall below 50%. While there have been improvements in areas such as education of the public and outreach towards legislators and voluntary health organizations, our results show that there are still major short-comings when it comes to implementing the recommendations. Lack of resources at the local level appears to be the predominant cause of the low level of implementation, with restricted authority and lack of support also contributing to the problem. We feel the IOM recommendations can provide a strong foundation for our public health system, and hope these results help serve as a benchmark for further study.