Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects?

We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.

Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal.

Robotic Transversus Abdominis Release (TAR): is it possible to offer minimally invasive surgery for abdominal wall complex defects? / Transversus Abdominis Release (TAR) Robótico: é possível oferecer cirurgia minimamente invasiva para os defeitos complexos da parede abdominal?

ABSTRACT We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.

RESUMO Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal.

Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality(AU)