1,721,058 research outputs found
Acute thrombotic thrombocytopenic purpura after sleeve gastrectomy: a case report and review of the literature
No full textComparative evaluation of contact ultrasonography and transcystic cholangiography during laparoscopic cholecystectomy
No full textFulminant Necrotizing Enteritis after Revisional Roux-en-Y Gastric Bypass: A Rare Case and Review of the Literature
No full textBackground: We report the first case of Pseudomonas necrotizing enteritis in an adult patient after undergoing revision Roux-en-Y gastric bypass. This rare condition has been reported only in the healthy pediatric population. The diagnosis and management of our case was challenging, which is in agreement with the available pediatric literature we summarize in our report.
Conclusion: Despite timely medical and surgical intervention (when indicated), Pseudomonas necrotizing enteritis has a reported high mortality reaching 89%.
Pseudomonas aeruginosa is an important opportunistic pathogen frequently affecting patients with chronic diseases and compromised immune status that can result in high mortality [1]. Patients with prolonged antibiotic exposure can also develop uncomplicated intestinal colonization secondary to Pseudomonas aeruginosa that presents as diarrhea [2]. Sepsis from Pseudomonas enteritis, termed Shanghai fever, is rare, and has been reported only in healthy pediatric patients in Asian countries [3,4]. We report the first case of necrotizing Pseudomonas enteritis in an adult after revisional robot-assisted Roux-en-Y gastric bypass (RYGB)
1st report of unexpected true left-sided gallbladder treated with robotic approach
No full textIntroduction: True left-sided gallbladder (T-LSG)occur when the gallbladder is positioned to the left of the ligamentum teres and falciform ligament and under the surface of the left liver lobe. Presentation of case: Patient is 29-year-old caucasian male, presenting with 9-month history of epigastric right upper quadrant (RUQ)colic pain. RUQ Ultrasound reported cholelithiasis, gallbladder wall thickening, and no intrahepatic biliary dilation. Discussion: Robotic cholecystectomy was the chosen approach. When visceral surface of the liver was exposed, anomalous location of the gallbladder was noted, left to the round ligament. A cystic duct with a “hairpin” configuration and a very cephalad cystic artery were identified. Cholecystectomy was performed safely and uneventfully. Conclusion: No change of port setting was required with the robotic approach. The ICG-aided cholangiography improved surgeon's ability to recognize the concomitant vascular and biliary anomalies. However, no definitive conclusion can be drown until further experience and volume are achieve
[Inefficacy of porto-systemic derivation for heart decompensation. Alcoholic myocardiopathy]
No full textRobotic Training in General Surgery Residency: How Early Can We Begin?
No full textBackground: The increasing demand for robotics in general surgery has prompted academic institutions to train general surgery residents toward the acquisition of basic robotic skills. Our current robotic training curriculum begins in the PGY-3 year and is based on the use of surgical simulators in a risk-free environment, in which each resident must show proficiency prior to advancing to training on an animate model as PGY-4. Our unpublished data on the curriculum indicates that PGY-3s required additional remediation training on the robotic simulator, suggesting room for improvement in our teaching paradigm [8]. Because of resident duty hour restrictions, we could not provide remediation by simply increasing the number of training sessions. We therefore decided to investigate an alternative strategy of shifting the training to an earlier time point in general surgical residency during PGY-1 and PGY-2 years. To explore the feasibility of a new curriculum, we undertook a pilot study to investigate the willingness of residents in their PGY-1 and PGY-2 years to begin robotic training on the robotic simulator, the dV-Trainer (dV-T). We also wanted to see if even minimal early exposure to the dV-T would help overcome residents’ initial diffidence in using the daVinci Surgical System (DaVss).
Methods: Ten general surgery residents (seven PGY-1s and three PGY-2s) with no prior exposure to robotic training were randomly distributed into MIMIC (MIM G) and daVinci (DaV G) groups. The MIM G subjects answered a post-exposure questionnaire about their overall experience with the robotic training. The five MIM G subjects performed five basic skills exercises on the dV-T simulator prior to executing the same exercises on the DaVss, while the five DaV G subjects performed the same exercises only on the DaVss. Two blinded robotic proctors scored each subject’s performance on the DaVss.
Results: All MIM G subjects found their overall experience constructive and viewed the dV-T as useful in preparing them to complete subsequent tasks on the DaVss. The MIM G subjects also performed better than the DaV G (p= 0.32) subjects in operation of the da-Vss, although statistical significance could not be achieved. Given the small sample size, statistical significant was unlikely.
Conclusions: The subjective perception of the dV-T experience was strongly positive, as the residents enjoyed the experience and seemed to be open to the possibility of introducing some robotic training with the robotic simulator earlier in their career. We attribute the fact that MIM G residents performed better with the DaVss than the DaV G residents to the value of minimal exposure to dV-T as a way to overcome the discomfort of using the DaVss for the first time
- …
