Current Trends in the Utilization of a Robotic Approach in the Field of Bariatric Surgery.

PURPOSE: The utilization rate of robotic surgery for bariatric procedures is not well-described. Our study identified the proportion of metabolic and bariatric surgery (MBS) procedures in the United States between 2015 and 2020 performed using a robotic (R-) or laparoscopic (L-) approach. MATERIALS AND METHODS: A descriptive analysis of the 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant User Data File (PUF) datasets was performed. The primary outcome was (1) surgical cases performed annually and (2) proportion of cases performed using a R- or L- approach. Analysis was done separately for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional bariatric surgery (RBS). Statistical analysis consisted of means and proportions, fold difference, annual slope, and Student's t tests or chi-square tests as appropriate, with statistical significance set to p < .05. RESULTS: A total of 1,135, 214 procedures were captured between 2015 and 2020. R-RYGB increased from 2554 to 6198 (6.8% to 16.7%), R-SG increased from 5229 to 17,063 (6.0% to 17.2%), R-RBS increased from 993 to 3386 (4.7% to 17.4%), and R-BPD-DS increased from 221 to 393 (22.0% to 28.4%). The greatest annual increase was observed among R-RBS and R-SG (3.70-fold difference; slope 2.4% per year and 2.87-fold difference; slope 2.2% per year, respectively). CONCLUSION: There is a nationwide increase in the utilization of a R- approach in bariatric surgery. There are concerns related to the potential increase in healthcare expenditures related to robotics. Further studies are needed to establish key performance indicators along with guidelines for training, adoption and utilization of a R- approach.

Knowledge of erectile dysfunction and pelvic floor disorders among young adults: a cross-sectional study.

INTRODUCTION: The prevalence of pelvic floor disorders (PFD) in aging women is comparable to the prevalence of erectile dysfunction (ED) in aging men. The objective of this study was to assess young adults' familiarity with the definition, prevalence, etiology, and treatment of PFD and ED. MATERIALS AND METHODS: Women and men aged 18-40 years completed a validated survey (Prolapse and Incontinence Knowledge Quiz) to assess knowledge of urinary incontinence (UI) and pelvic organ prolapse (POP). Both groups completed a similar questionnaire created to assess knowledge of ED. Participants were asked to estimate the prevalence of these conditions and to identify their source(s) of knowledge. RESULTS: Of 377 respondents, 65% were female and 35% were male. Respondents underestimated the prevalence of these disorders and were significantly worse at estimating the prevalence of PFD than ED. Men and women had significantly less knowledge of POP (67% +/- 32, compared to ED (83% +/- 20) and UI (82% +/- 22), p < 0.001). Men and women did not differ in their knowledge about UI and POP, but men had significantly more knowledge about ED than women (87% +/- 18 versus 81% +/- 21, p = 0.008). Higher education level and increased age were associated with better knowledge of PFD and ED. CONCLUSIONS: Despite high education levels, young adults in our study had a worse understanding of POP compared to UI or ED. Women knew more about ED than about POP, a condition that may affect them during their lifetime.

Magnetic resonance enterography: the test of choice in diagnosing intestinal "zebras".

Small bowel tumors and other rare intestinal disorders are often exceedingly difficult to identify. Even cutting-edge technologies, such as push enteroscopy and capsule endoscopy, can fail to determine the cause of a patient's symptoms. At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient. In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies. With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as "zebras."

BRCA2 is epistatic to the RAD51 paralogs in response to DNA damage.

Homologous recombination plays an important role in the high-fidelity repair of DNA double-strand breaks. A central player in this process, RAD51, polymerizes onto single-stranded DNA and searches for homology in a duplex donor DNA molecule, usually the sister chromatid. Homologous recombination is a highly regulated event in mammalian cells: some proteins have direct enzymatic functions, others mediate or overcome rate-limiting steps in the process, and still others signal cell cycle arrest to allow repair to occur. While the human BRCA2 protein has a clear role in delivering and loading RAD51 onto single-stranded DNA generated after resection of the DNA break, the mechanistic functions of the RAD51 paralogs remain unclear. In this study, we sought to determine the genetic interactions between BRCA2 and the RAD51 paralogs during DNA DSB repair. We utilized siRNA-mediated knockdown of these proteins in human cells to assess their impact on the DNA damage response. The results indicate that loss of BRCA2 alone imparts a more severe phenotype than the loss of any individual RAD51 paralog and that BRCA2 is epistatic to each of the four paralogs tested.