The organ shortage has led to increased use of marginal organs. The Eurotransplant Donor-Risk-Index (ET-DRI) was established to estimate outcome after Liver Transplantation (LT). Currently, data on impact of ET-DRI on long-term outcome for different indications and recipient conditions are missing. Retrospective, single-center analysis of long-term graft survival (GS) of 1767 adult primary LTs according to indication, labMELDcategory (1: ≤18; 2: >18-25; 3: >25-35; 4: >35), and ET-DRI. Mean ET-DRI in our cohort was 1.63 (±0.43). One-, 10, and 15-yr GS was 83.5%, 63.3%, and 54.8%. Long-term GS was significantly influenced by ET-DRI. Accordingly, four ET-DRI categories were defined and analyzed with respect to underlying disease. Significant impact of these categories was observed for: Alcohol, cholestatic/autoimmune diseases (CD/AIH), and HCV, but not for HCC, HBV, cryptogenic cirrhosis, and acute liver failure. labMELD categories showed no significant influence on graft, but on patient survival. Matching ET-DRI categories with labMELD revealed significant differences in long-term GS for labMELDcategories 1, 2, and 3, but not 4. In multivariate analysis, HCV combined with ET-DRI > 2 and labMELDcategory 3 combined with ET-DRI > 2 emerged as negative predictors. To achieve excellent long-term graft survival, higher risk organs (ET-DRI > 1.4) should be used restrictively for patients with CD/AIH or HCV. Organs with ET-DRI > 2 should be avoided in patients with a labMELD of >25-35.

Abstract:The surgical treatment of hernias has developed throughout the evolution of surgery. The fascination with hernia surgery is in part driven by its prevalence and by the variety of treatment options. Minimally invasive hernia surgery has a goal of a robust repair with minimal complications, and new robotic techniques are being developed in complex abdominal wall hernias with promising results. This review focuses on inguinal, ventral, and incisional hernias and their outcomes with a discussion on the traditional open, laparoscopic, and robotic techniques. The prevalence of minimally invasive hernia surgery and its advantages are also outlined. We highlight our experience in these procedures, specifically robotic herniorrhaphy, as it pertains to ventral incisional and inguinal hernia repair. We conclude that the robotic platform is proving to be a benefit to hernia repair. Many studies are showing its feasibility and comparable results to standard laparoscopy, and some have shown improved results, including shorter hospital stay without significant increases in cost. The robotic option of hernia repair has resulted in an increase in minimally invasive hernia repair, a number that has remained stagnant for the last decade. With more surgeons gaining training and experience and greater availability of the robotic platform, we expect to see greater numbers of minimally invasive hernia repair.

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For T2a tumours RAPN is a feasible treatment option in a select patient population when performed by experienced surgeons in institutions equipped to manage postoperative complications. Although RAPN was associated with greater blood loss and longer operating and ischaemia time in T2a tumours, it was not associated with greater complication or positive surgical margin rates compared with T1 tumours. Renal function preservation rates were equivalent for up to 24 months postoperatively; however, 12-month recurrence-free survival was significantly lower in the T2a group. Extended follow-up is required to further evaluate long-term survival.

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