Background
Although the open transversus abdominis release (oTAR) is an effective operation for large ventral hernias, it is historically associated with a relatively long length of stay. Robotic ...retromuscular transversus abdominis release (rTAR) allows minimally invasive repair of complex ventral hernias with shorter length of stay (LOS) compared to open repairs (TAR), but hybrid robotic TAR (hrTAR), partial open intervention via incision through the overlying hernia sac for fascial closure, may be required to accomplish effective repair of large defects. We compare LOS and short-term outcomes of a cohort of our hrTAR patients to our historical oTAR patients.
Methods
All hrTAR performed in our institution between November 2015 and July 2017 contained in a prospectively maintained robotic database and/or in the Americas Hernia Society Quality Collaborative (AHSQC) database were analyzed. Additionally, open TAR patients maintained in a prospective personal database and/or in the AHSQC from September 2013 to August 2016 were similarly analyzed and compared with hrTAR patients.
Results
134 TAR patients and 49 hrTAR patients were analyzed. Age, gender, BMI, HTN, DM, and proportion of recurrent hernia were not significantly different. Hernia width (14.3 cm vs 14.0 cm,
p
= 0.80) and length (21.9 vs 20.0 cm,
p
= 0.10) were similar between groups. Mean operative times did not differ significantly between groups (274 min vs 304 min
p
= 0.06). Thirty day wound events including SSI and SSOPI were not significantly different between groups. LOS was significantly shorter in the hrTAR group (3 vs 7 days,
p
≤ 0.001).
Conclusion
Hybrid robotic transversus abdominis release (hrTAR) may be performed with significantly lower LOS, similar wound morbidity and complication profile compared to open TAR. This novel surgical technique provides a minimally invasive option for a challenging subset of large ventral hernias which cannot be treated effectively with a purely robotic approach and would traditionally require and open operation.
Purpose
To examine the hospital length of stay (LOS) and 30 day outcomes of hybrid robotic transversus abdominis release (hrTAR) compared with open transversus abdominis release (oTAR).
Methods
...Patients receiving hrTAR were selected from the AHSQC database and propensity matched with a contemporary cohort of oTAR patients.
Results
The cohort included 95 hrTAR and 285 oTAR patients. There was a significantly shorter median LOS in the hrTAR cohort (3 vs. 5 days,
p
< 0.001). The rate of surgical site occurrences in the hrTAR cohort was also lower than for oTAR (5% vs. 15%,
p
= 0.015). Readmission rates were not different between hrTAR and oTAR (6% vs. 8%,
p
= 0.65).
Conclusion
hrTAR demonstrates improved LOS compared to oTAR as well as fewer surgical site related occurrences. Further studies are needed to investigate the etiology behind the improved LOS and to confirm appropriate long-term outcomes from hybrid robotic TAR.
The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the ...diffuse burning pain.
Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75-100%), good (50-75%), poor (25-50%); or none (0-25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain.
Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.
Virosomes for antigen and DNA delivery Daemen, Toos; de Mare, Arjan; Bungener, Laura ...
Advanced drug delivery reviews,
01/2005, Letnik:
57, Številka:
3
Journal Article
Recenzirano
Specific targeting and delivery as well as the display of antigens on the surface of professional antigen-presenting cells (APCs) are key issues in the design and development of new-generation ...vaccines aimed at the induction of both humoral and cell-mediated immunity. Prophylactic vaccination against infectious diseases in general aims at the induction of humoral immune responses to prevent infection. This humoral immune response is mediated by antibody-producing B cells. On the other hand, therapeutic immunisation against virally infected cells and tumour cells requires the induction of cytotoxic T lymphocytes (CTLs) that can specifically recognise and lyse infected cells or transformed tumour cells. The induction of Major Histocompatibility Complex (MHC) class I restricted CTL activity is optimally achieved by synthesis of antigens within APCs, for example, after immunisation with live attenuated virus. However, immunisation with live vaccines bears the risk of causing disease. Therefore, alternative vaccine delivery systems, which enable introduction of nonreplicating antigen into the MHC class I presentation pathway, are sought. Furthermore, for the induction of effective humoral and cellular responses, MHC class II restricted activation of T helper cells (Th cells) is required. Among other delivery systems, as described in this theme issue of Advanced Drug Delivery Reviews, virosomes seem ideally suited for delivery of antigens into both MHC pathways. In this review, we will focus on the use of virosomes as carrier vehicles for the intracellular delivery of protein antigens and DNA, and the induction of a cellular immune response against encapsulated protein antigens and proteins expressed by virosome-associated plasmids.
