Operative efficiency: a comparative analysis of Versius and da Vinci robotic systems in abdominal surgery.

Robotic-assisted surgery has gained momentum in the pursuit of improved minimally invasive procedures. The adoption of new robotic platforms, such as the Versius, raises concerns about safety, efficacy, and learning curves. This study compares the Versius to the well-established da Vinci in terms of operative time and patient population. Retrospective data collection was conducted on patient data from inguinal hernia surgery, ventral hernia surgery, and cholecystectomies performed between February 2022 and March 2023 at the American Hospital of Dubai. Only experienced cases were included, ensuring proficiency with robotic technology. Versius had longer procedure times in inguinal and ventral hernia surgeries but not in cholecystectomy. No intraoperative complications were observed in either system. This study demonstrates that Versius can provide comparable outcomes to the da Vinci in abdominal surgery, with no observed intraoperative complications.

Femorocele: A rare clinical entity - A case report.

INTRODUCTION AND IMPORTANCE: A femoral hernia is a protrusion of the peritoneum through a defect in the femoral ring into the femoral canal. A rare form of a femoral hernia is a femorocele, which requires a highly skilled physician for accurate diagnosis and management. Clinical examination is the gold standard for diagnosis, with a CT used to confirm clinical suspicion. Once diagnosed, the only curative option is surgery. This case report provides evidence for the use of robotics to treat a femorocele. CASE PRESENTATION: A 23-year-old female with a two-year history of a non-reducible fluid-filled swelling in the right groin presented to the surgical clinic. Upon clinical suspicion and CT imaging, a femorocele was diagnosed. The surgeon opted for a femoral hernia repair using the da Vinci surgical system. Peritoneal connection with the hernia sac was noted, confirming the diagnosis. The content of the cystic mass was reduced; further to that, the omental content was also reduced and the hernia was repaired. The patient tolerated the procedure with no complications. CLINICAL DISCUSSION: This case highlights the use of robotics to treat a rare clinical entity. Robotics was used for this case as it provided exceptional ergonomics, three-dimensional visualization, and wristed movements. CONCLUSION: A femorocele is a rare form of a femoral hernia that requires accurate diagnosis and proper management. In this case, we demonstrated the possibility of using robotics as a viable option for treatment of a femorocele.

Implementation of robotic surgery in Dubai: a focus on outcomes.

The rapid acceptance of robotic surgery in gallbladder, inguinal, and ventral hernia surgery has led to the growth of robotic surgery programs around the world. As this is new technology, implementation of such programs needs to be done safely, with a focus on patient outcomes. We herein describe the implementation of a new robotic surgery program in a major hospital in the Middle East. A laparoendoscopic surgeon led the program after training and proctoring. Competency based credentialing were created and put in place. To confirm safety of the program, all laparoscopic and robotic cholecystectomy and hernia operations were followed, and perioperative data analyzed. Out of the 304 patients included in this study, 157 were performed using the robotic approach. In the cholecystectomy group (n = 103) the single site approach offered shorter operative times (P < 0.05). Both the single site robotic and the robotic assisted approaches resulted in less pain (P < 0.05). In the inguinal hernia group (n = 146) the laparoscopic approach offered shorter operative times (P < 0.05), but the robotic approach was associated with less pain (P < 0.05). In the ventral hernia group (n = 55), the open approach offered the best operative times, but the robotic approach was associated with the least amount of pain (P < 0.05). This is the first report of the implementation of a robotic program in the MENA region where the primary measure of success is outcomes. We show that monitoring cholecystectomy, inguinal or ventral hernia data can confirm the quality of the program before expansion and moving forward to more complex procedures.

Initial experience with a novel robotic surgical system in abdominal surgery.

The emergence of robotics in surgery has led to a recent boom in the acceptance of such technology. This technology has been rapidly adopted in various fields, with the most prominent being general surgery. The number of abdominal procedures being performed using robotics has increased to around 15.1% as potential advantages continue to be highlighted. We herein report the use of the Versius surgical robotic system for use in common abdominal procedures. Three experienced robotic surgeons first gained experience and became familiar with the robotic system through both online modules and cadaveric training sessions. The initial cases performed using the Versius robotic system at a single center were included in this study. Data reported included demographics as well as perioperative data. Fifty-five procedures were performed using the Versius robotic system. Procedures included various hernia repairs (n = 30), gallbladder surgery (n = 22), as well as appendix surgery (n = 3). Appendectomy had the fastest OR times at 35.81 ± 21.84, while the slowest OR times were seen in the BIH group with an average time of 95.2 ± 24. No complications or conversions were observed throughout this entire series. This is the first report to demonstrate the usage of the Versius robotic surgical system for use in abdominal surgery. Our initial data confirm that regardless of patient demographics, the system is safe to use in such procedures; however, further larger scale studies are required to assess its clinical utility.

Treatment of an unusual case of Meckel's diverticulum with a new robotic platform.

INTRODUCTION AND IMPORTANCE: Meckel's diverticulum (MD) is a common congenital anomaly of the digestive tract that affects around 4 % of the population. Although it is relatively common, diagnosis still remains very challenging; it requires an astute clinician with a high clinical index of suspicion to achieve the diagnosis. Once a diagnosis is reached, treatment is almost always surgical. This case report provides evidence of the effectiveness of a new robotic surgical system for resection of MD in the elderly. CASE PRESENTATION: 61 year old male presented to the emergency room with recurrent hematochezia. After multiple diagnostic techniques, he was finally diagnosed with MD using Meckel's scan. After diagnosis, surgical resection using the Cambridge Medical Robotics (CMR) Versius robotic system was performed, which yielded good results. CLINICAL DISCUSSION: This case highlights the use of a new robotic system for the treatment of Meckel's Diverticulum. CONCLUSION: Our initial experience with the CMR Versius surgical system in small bowel resection was successful; however, further studies are needed to demonstrate the safety and efficacy of such a system.

Changing Professional Behaviors in the Digital World Using the Medical Education e-Professionalism (MEeP) Framework-A Mixed Methods Multicentre Study.

Background: There is increasing evidence on the exponential use of technology-based social media in medical field that has led to a proliferation of unprofessional behaviors in digital realm. Educating, training, and changing the behaviors of healthcare professionals are essential elements to restrain the rising unprofessional incidents. Therefore, this research was designed to determine the impact of an interventional workshop on the medical and dental students in improving their professional behaviors in the digital world using the newly developed medical Education e-Professionalism (MEeP) framework. Methods: We adopted the Theory of Planned Behavior (TPB) as a benchmark reference which explores constructs intertwined with the mission-based MEeP framework; values (whistleblowing-raising concerns), behaviors (being responsible in the digital world) and identity (reflective practice in the digital world). A multicentre 3-phased mixed-method study was conducted using a pre-workshop survey, an online interventional workshop, and a post-workshop survey. SPSS and NVivo were the tools used for the data analysis. Results: A total of 130 students registered for workshop out of which 120 completed the pre-workshop survey, 62 joined the workshop and 59 completed the workshop and post-workshop survey. From the whistleblowing - raising concern perspective, we found that attitudes and perceived behavioral control had a significant relationship. While for responsible in digital world category, attitude and perceived behavioral control had a significant bearing on the intentions. Third, for reflective practice, attitude and subjective norms significantly enhanced the intention of participants. A multi layered thematic analysis yielded four overarching themes of attitudes, subjective norms, perceived behavioral control and intentions. Most students showed positive attitudes of being reflective, self-directed, and humane. Students realized the subjective norms had made them conscientious, self-aware and conformative. While perceived behavioural control manifested as identity and Intentions were heavily reliant on self-actualization. Conclusion: Our mixed method study found that the interventional workshop using MEeP framework significantly improved attitudes, subjective norms, perceived behavioral control, and intentions. This study provides valuable evidence of MEeP framework evaluation using the theoretical underpinning of TPB by reporting positive changes in professional values, behaviors, and identities of undergraduate medical and dental students.

One-step synthesis and deposition of ZnFe2O4 related composite films via SPPS route for photodegradation application.

Binary spinel-type metal oxides (AB2O4) related materials, including ferrites (AFe2O4), are attractive photocatalysts thanks to their excellent visible light response for the photodegradation of organic pollutants. Currently, these materials are synthesized via conventional chemical routes suffering from long preparation duration and multistep. Moreover, the photocatalysts are obtained as nano-powders from conventional chemical routes would introduce another drawback for their recycling and reuse. From an industrial perspective, it is desirable to develop an efficient and facile synthesis process to produce photocatalysts in a non-dispersible form. Herein, we demonstrate that the solution precursor plasma spray (SPPS) process is a single-step method for depositing photocatalytically active zinc ferrite-based films within several minutes. The influence of the precursor ratio on the microstructures and phase compositions of the ZnFe2O4 films was investigated by XRD and Raman analyses. In addition, two optimized ZnFe2O4 films were prepared by increasing the ZnO loading and tailoring injection pattern of the precursor solution. The surface morphologies and optical bandgap were also determined by SEM and UV-visible spectroscopy. The photocatalytic activities of the ZnFe2O4 films were evaluated through the degradation of the Orange II dye and of tetracycline hydrochloride under UV or visible light irradiation. The results show that compositional ratios and composition distribution of the ZnFe2O4 films prepared via SPPS played a key role on the photocatalytic activity. The SPPS route was demonstrated to be a promising method for the synthesis and the deposition of metal oxide (i.e. perovskite type and spinel type) films within a single-step for functional applications.

Oxygen-defective ZnO films with various nanostructures prepared via a rapid one-step process and corresponding photocatalytic degradation applications.

The deposition of oxygen-defective ZnO films exhibiting varied nanostructures via Solution Precursor Plasma Spray (SPPS) route, a one-step, minute-scaled duration and large scale method, is reported. The in situ formation of oxygen vacancies in ZnO films was confirmed by UV-Visible, Raman and photoluminescence (PL) spectroscopy and the as-prepared samples exhibit a bandgap as low as 3.02 eV. Density functional theory (DFT) simulation demonstrates that the polarization of ZnO is enhanced by the created oxygen vacancies, leading to substantially improved photocatalytic activity. The comparative experiments also revealed that forming and preserving appropriate ZnO precursor clusters inside the plasma plume is requisite for obtaining propitious ZnO nanostructures, which was followed by the in situ transfer and growth of the clusters on the preheated substrate. The ZnO-NRs films fully degrade the aqueous Orange II dye solutions within 120 min and maintain a quasi-intact activity (95.8% retention) after five test runs, which highlight their good stability. The oxygen vacancies and the narrowing of the bandgap also enable a visible light-driven photodegradation activity with conversions as high as 54.1%. In summary, this work not only reveals that the photocatalytic activity of SPPS-deposited ZnO films benefit from oxygen vacancies and well nanostructures, but also suggests that the SPPS route is of high potential for preparing metal oxides films destined to functional applications.

CdSe nanorod/TiO2 nanoparticle heterojunctions with enhanced solar- and visible-light photocatalytic activity.

CdSe nanorods (NRs) with an average length of ≈120 nm were prepared by a solvothermal process and associated to TiO2 nanoparticles (Aeroxide® P25) by annealing at 300 °C for 1 h. The content of CdSe NRs in CdSe/TiO2 composites was varied from 0.5 to 5 wt %. The CdSe/TiO2 heterostructured materials were characterized by XRD, TEM, SEM, XPS, UV-visible spectroscopy and Raman spectroscopy. TEM images and XRD patterns show that CdSe NRs with wurtzite structure are associated to TiO2 particles. The UV-visible spectra demonstrate that the narrow bandgap of CdSe NRs serves to increase the photoresponse of CdSe/TiO2 composites until ≈725 nm. The CdSe (2 wt %)/TiO2 composite exhibits the highest photocatalytic activity for the degradation of rhodamine B in aqueous solution under simulated sunlight or visible light irradiation. The enhancement in photocatalytic activity likely originates from CdSe sensitization of TiO2 and the heterojunction between these materials which facilitates electron transfer from CdSe to TiO2. Due to its high stability (up to ten reuses without any significant loss in activity), the CdSe/TiO2 heterostructured catalysts show high potential for real water decontamination.

Trace amounts of Cu²âº ions influence ROS production and cytotoxicity of ZnO quantum dots.

3-Aminopropyltrimethoxysilane (APTMS) was used as ligand to prepare ZnO@APTMS, Cu(2+)-doped ZnO (ZnO:Cu@APTMS) and ZnO quantum dots (QDs) with chemisorbed Cu(2+) ions at their surface (ZnO@APTMS/Cu). The dots have a diameter of ca. 5 nm and their crystalline and phase purities and composition were established by X-ray diffraction, transmission electron microscopy, UV-visible and fluorescence spectroscopies and by X-ray photoelectron spectroscopy. The effect of Cu(2+) location on the ability of the QDs to generate reactive oxygen species (ROS) under light irradiation was investigated. Results obtained demonstrate that all dots are able to produce ROS (OH, O2(-), H2O2 and (1)O2) and that ZnO@APTMS/Cu QDs generate more OH and O2(-) radicals and H2O2 than ZnO@APTMS and ZnO:Cu@APTMS QDs probably via mechanisms associating photo-induced charge carriers and Fenton reactions. In cytotoxicity experiments conducted in the dark or under light exposure, ZnO@APTMS/Cu QDs appeared slightly more deleterious to Escherichia coli cells than the two other QDs, therefore pointing out the importance of the presence of Cu(2+) ions at the periphery of the nanocrystals. On the other hand, with the lack of photo-induced toxicity, it can be inferred that ROS production cannot explain the cytotoxicity associated to the QDs. Our study demonstrates that both the production of ROS from ZnO QDs and their toxicity may be enhanced by chemisorbed Cu(2+) ions, which could be useful for medical or photocatalytic applications.

[Predictive factors of obstructive sleep apnea syndrome in obesity]. / Facteurs prédictifs du syndrome d'apnées obstructives du sommeil chez les obèses.

BACKGROUND: Obstructive sleep apnea (OSA) syndrome is frequent, and misdiagnosed. THE AIM: Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese (body mass index > or = 30 Kg/m2) and to determine its predictive factors. METHODS: It's a transversal study. One hundred patients (63 females, 37 males) were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. RESULTS: Sixty-five patients had an OSA syndrome: mild (24.6%), moderate (30.7%) and severe (44.6%). We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men (81% of men vs 55.5 of women had OSA). Age was higher in the group with OSA syndrome (56.8 years +/- 10 vs 48.1 +/- 12, P = 0.04). Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome (p = 0.05 and 0.02 respectively). Cardiopathies and diabetes were more frequent in obese with OSA syndrome. CONCLUSION: In obese persons, male gender, comorbidities and /or clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors.

Accidental extravascular insertion of a subclavian hemodialysis catheter is signaled by nonvisualization of catheter tip.

Subclavian hemodialysis (HD) catheter placement under fluoroscopy with perforation of the superior vena cava (SVC) is a rare complication that needs to be recognized and treated appropriately. We report the case of a 47-year-old black woman under treatment for end-stage renal disease secondary to HIV-associated nephropathy who sustained an extravascular insertion of fluoroscopy-guided subclavian catheterization for HD. Subsequent successful removal of the extravascularly placed catheter along with repair of the lacerated SVC were effected by open thoracic surgery.