177,637 research outputs found
Robotische Hernienchirurgie I: Robotische Leistenhernienversorgung (r‑TAPP). Videobeitrag und Ergebnisse einer Kohortenstudie an 302 operierten Hernien
No full textDie Versorgung von Leistenhernien mit offenen und minimal-invasiven Verfahren hat in den vergangenen 30 Jahren einen vom Ergebnis her gesehen hohen Standard erreicht. Allerdings besteht noch Bedarf an einer weiteren Reduktion der postoperativen Serome, chronischen Schmerzen und des Rezidivs. In diesem Videobeitrag wird die endoskopische Anatomie der Leiste im Hinblick auf die robotische transabdominelle präperitoneale Patchplastik (r‑TAPP) dargestellt und die Operationsschritte der r‑TAPP als Video illustriert. Es werden die Ergebnisse einer Kohortenstudie an 302 konsekutiven Hernien, die mittels r‑TAPP operiert wurden, vorgestellt und hinsichtlich des Mehrwerts der robotischen Technik – auch in der Weiterbildung – diskutiert. Die r‑TAPP ist die natürliche Weiterentwicklung der konventionellen TAPP und hat das Potenzial, bei zunehmender Geräteverfügbarkeit und Reduktion der Materialkosten zu einem neuen Standard zu werden. Künftige Studien werden den vielseitigen Mehrwert der r‑TAPP auch mit neuen Parametern verfeinern müssen
Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes
No full textPURPOSE: To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons. METHODS: Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts. RESULTS: Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age \u3e 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age \u3e 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p \u3c 0.0001); open approach: OR = 1.89 (95% CI 1.05, 3.38; p = 0.031)]. CONCLUSIONS: In this matched analysis, R-TAPP provides similar postoperative complications prior to discharge and a lower rate of postoperative complications through 30 days compared to open repair. R-TAPP is a promising and reproducible approach, and may facilitate adoption of minimally invasive repairs of inguinal hernias
Results of robotic TAPP and conventional laparoscopic TAPP in an outpatient setting: a cohort study in Switzerland
No full textPurpose
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
Reduced risk of recurrence following robotic-assisted TAPP for inguinal hernia repair compared to laparoscopic TAPP:a cohort study of 395 cases
No full textBackground: Minimal invasive inguinal hernia repair is conducted using among others the laparoscopic transabdominal preperitoneal (TAPP) procedure or the extended totally extraperitoneal (eTEP) approach. Robotic-assisted TAPP (R-TAPP) has recently been introduced as an alternative to laparoscopic TAPP and TEP, and a growing number of robotic-assisted procedures are performed worldwide. The present study was conducted to determine the risk of chronic pain and recurrence associated with the two methods. Methods: Three hundred ninety-five patients were retrospectively included in the study and underwent either laparoscopic TAPP (n = 177) or R-TAPP (n = 218). Data on patient demographics, hernia characteristics, and postoperative outcomes were retrieved from medical records. Kaplan-Meier curves and Cox proportional hazards regression were used to assess hernia recurrence. Logistic regression was used to analyze secondary outcomes such as inpatient status, hematoma, and chronic pain. Results: The Kaplan-Meier curves indicated a consistently higher cumulative incidence of recurrence in the TAPP group compared to the R-TAPP. Consistent with this finding, the Cox regression showed a higher risk of recurrence in patients undergoing TAPP, with a hazard ratio (HR) of 3.489 (95% CI: 1.232 to 9.880, p = 0.019). The E-value for this HR was 6.44, suggesting robustness to unmeasured confounding. There was no difference in the rates of chronic pain between the groups (OR: 1.233, 95% CI: 0.430 to 3.533, p = 0.696). A logistic regression analysis for other postoperative complications revealed no significant differences. Conclusion: This study provides evidence that robotic-assisted TAPP is associated with a lower risk of recurrence than laparoscopic TAPP.</p
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
β2-Homo-Amino Acid Scan of µ-Selective Opioid Tetrapeptide TAPP
No full textTAPP (H-Tyr-d-Ala-Phe-Phe-NH2) is a potent, µ-selective opioid ligand. In order to gain further insights into pharmacophoric features of this tetrapeptide, we have performed a β2-Homo-amino acid (β2hAA) scan of the TAPP sequence. To this aim, 10 novel analogues have been synthesized and evaluated for µ-opioid and δ-opioid receptor affinity as well as for stability in human plasma. The derivatives included compounds in which a (R)- or (S)-β2-Homo-Homologue replaced the amino acids in the TAPP sequence. The derivatives with (R)- or (S)-β2hPhe4 turned out to bind µOR with affinities equal to that of the parent. β2hAAs in position 1 and 3 resulted in rather large affinity decreases, but the change differed depending on the stereochemistry. β2-Homologation in the second position gave derivatives with very poor µOR binding. According to molecular modelling, the presented α/β-peptides adopt a variety of binding poses with their common element being an ionic interaction between a protonable amine of the first residue and Asp147. A feature required for high µOR affinity seems the ability to accommodate the ring in the fourth residue in a manner similar to that found for TAPP. Contrary to what might be expected, several compounds were significantly less stable in human plasma than the parent compound
Outcomes of TAPP repair without fixation of mesh in tertiary care public hospitals
No full textBackground: Traditionally, fixation of mesh is the standard procedure in Transabdominal preperitoneal (TAPP) repair and is usually done with staples, clips or sutures. This may result in post hernioplasty pain syndrome. Placing the mesh in the proper place without fixation and covering it properly with peritoneum may be adequate and reduces post hernioplasty pain syndrome as well as the cost of the procedure. Objective: To demonstrate the efficacy of TAPP repair with standard polypropylene mesh (15/12 cm) without any fixation with no increase in recurrence rate. Methods: The study includes patients, who underwent TAPP repair at the department of General Surgery at R .G. Kar Medical College from November 2011 to February 2016 and Murshidabad Medical College from March 2016 to July 2018. Data was prospectively entered and analysed. Results: There were 58 patients of TAPP repair with a mean follow up of 26.52 months. No recurrence has been reported till date. Conclusion: TAPP repair without mesh fixation if done with proper technique, is not associated with any increase in recurrence rate. 
"Closing the R&D Gap, Evaluating the Sources of R&D Spending"
No full textBoth spending and tax policies have been implemented in the United States with the goal of stimulating private sector research and development (R&D). Karier questions whether current R&D policy, especially the research and experimentation tax credit, can contribute to closing the gap between nondefense expenditures on R&D in the United States and such expenditures in other countries, such as Japan and Germany. He also explores possible changes to our current R&D policy to make it more effective.
Bone marrow fibrosis and vascular density lack prognostic significance in childhood acute lymphoblastic leukaemia
No full textA Bharos, A-J de Jong, N Manton, N Venn, C Story, G Hodge, S Nath, R Suppiah, H Tapp, R Sutton and T Reves
Tapp in the treatment of irreducible and inguinoscrotal hernia
No full textLaparoscopic surgery is known to be technically difficult to perform for irreducible and inguinoscrotal hernias. The aim of the work is to conduct a comparative analysis of early postoperative complications in the surgical treatment of irreducible and inguinoscrotal hernias using the modified laparoscopic and classic TAPP techniques. Comparative analysis of the local early postoperative complications in 49 male patients who were surgically treated for irreducible and/or inguinoscrotal hernias was carried out. The patients were divided into 2 groups according to the technique of hernioplasty: the first group (n = 19) - surgical treatment was performed by the classical hernioplasty, described in the literature, TAPP technique; the second group (n = 20) - surgical treatment included a modified laparoscopic TAPP technique. Only 1 (5.3%) patient in group 1 (p = 0.079) who had experienced bleeding during surgery. Post-operative subcutaneous emphysema was common in 5.3% in group 1 and 5.0% in group 2 (p = 0.490), inguinal hematoma in 5.3% and 5.0% (p = 0.490), scrotal hematoma in 10.5% and 0% (p = 0.445), inguinal paresthesia 5.3% and 5.0% (p = 0.490), inguinal seroma 5.3% and 5.0% (p = 0.490), scrotal seroma 26.3% and 0% (p = 0.047), orchiepididymitis 5.3% and 0% (p = 0.079) respectively.
The modified technique of transabdominal preperitoneal repair of irreducible and inguinoscrotal hernia provides low-trauma fractures of surgery, which reduced the incidence of local intra- and postoperative complications
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