Results of robotic TAPP and conventional laparoscopic TAPP in an outpatient setting: a cohort study in Switzerland.

PURPOSE: Recently, robotic surgery has been increasingly performed in hernia surgery. Although feasibility and safety of robot-assisted inguinal hernia repair in an inpatient setting have been already shown, its role in outpatient hernia surgery has not yet been investigated. Thus, this study aimed to compare robot-assisted TAPP (r-TAPP) and conventional laparoscopic TAPP (l-TAPP) in an outpatient setting. METHODS: A prospective database of patients with inguinal hernia treated by l-TAPP or r-TAPP in an outpatient setting during a 1-year period was analyzed in a comparative cohort study. All patients underwent a check-up appointment with their surgeon within 3 days and 6 weeks postoperatively. Data on surgical time, perioperative complications, and postoperative pain were collected. Pain was recorded by using a Verbal Rating Scale (VRS). RESULTS: Overall, outpatient laparoendoscopic inguinal hernia repair was performed in 58 patients (29 l-TAPP; 29 r-TAPP). Mean age was 57 years (21-81), mean BMI 24.5 kg/m2 (19-33) with no differences between both groups. Most patients reported none or only a low postoperative pain level in both groups (89.6% in l-TAPP group; 100% in r-TAPP), while there was a trend for less pain after r-TAPP. In both groups, there was one case of postoperative hematoma, which was successfully treated by conservative means. No other complications occurred during follow-up in either group and there was no 30-day-readmission, no unplanned overstay or any 30-day mortality in the cohort. CONCLUSION: Robot-assisted inguinal hernia surgery can be safely performed in an outpatient setting with a tendency to less pain when compared to the conventional laparoscopic technique. Cost-effectiveness and cost-coverage of outpatient robot-assisted inguinal hernia surgery must be further investigated in times of limited health cost resources and diagnosis-related medical reimbursements.

Alfabetizacao e psicogenese: um estudo longitudinal

O estudo longitudinal analisa o impacto de dois programas de alfabetizacao sobre a psicogenese e o rendimento escolar de 20 criancas matriculadas em escolas publicas de Ceilandia, cidade-satelite de Brasilia, durante tres anos. Abrangeu os anos letivos de 1985, 1986,1987, acompanhando os alunos desde a matricula na primeira ate a terceira serie. Dos dois programas de alfabetizacao analisados, um baseava-se em livro didatico ('tradicional') e o outro nao adotava livro algum ('experimental'). O estudo revelou paradoxalmente que o programa tradicional apresenta vantagens face ao experimental, promovendo tanto a psicogenese quanto o rendimento escolar. Mas isso nao se deve a uma superioridade intrinseca da adocao de livro didatico, e sim ao fato de que o programa que o utiliza depende menos do professor que o programa experimental, revelando-se 'mais apropriado' para um contexto escolar caracterizado pela alta rotatividade e pelo absenteismo do professor.