Background: Introduction of the da Vinci Xi system has facilitated the use of robotics in colorectal surgery. Nevertheless, data on the outcomes of robotic surgery for the treatment of colonic diverticulitis have remained scarce. Methods: Patient demographics, clinical characteristics, and perioperative outcomes of the patients undergoing totally robotic with the da Vinci Xi system or laparoscopic surgery for left-sided colonic diverticulitis (LCD) were compared. Results: Laparoscopic and robotic groups included 22 and 20 patients, respectively. There were no significant differences between the two groups in terms of patient demographics, clinical characteristics, operative time, and postoperative complications. There were three conversions in the laparoscopy group and no conversion in the robotic group (P = 0.23). Conversion to open surgery was associated with postoperative morbidity (P = 0.02). Conclusion: Robotic surgery is an applicable alternative for the treatment of LCD. Robotic approach may potentially lower the risk of operative morbidity by reducing the requirement of conversion. K E Y W O R D S colectomy, laparoscopic surgery, left sided colonic diverticulitis, robotic surgery
OBJECTIVE To investigate the effect of selective nuclear factor κ‐B (NFκ‐B) inhibitors, pyrolidium dithiocarbamate (PD) and sulfasalazine (SZ) on renal tubular necrosis and inducible nitric oxide synthase (iNOS) and NFκ‐B expression induced by gentamicin in rats. MATERIALS AND METHODS In all, 48 adult male Sprague‐Dawley rats were divided into six equal groups; group 1, control; group 2, injected with gentamicin for 10 days (100 mg/kg/day, intraperitoneal, i.p.); group 3, injected with gentamicin plus PD (100 mg/kg/day, i.p.); group 4, injected with gentamicin plus SZ (75 mg/kg/day, i.p.); group 5, injected with gentamicin plus distilled water (vehicle for PD); and group 6, injected with gentamicin plus ammonium hydroxide (75 mg/day, 1 m, vehicle for SZ) for 10 days. At 24 h after the last injection, rats were killed and the renal cortex separated from the medulla. A small sample was fixed in formaldehyde solution for histological and immunohistochemical examination. Blood samples were also taken to assess the serum levels of urea, creatinine, Na+, K+ and γ‐glutamyl transpeptidase (GT). Crude extracts of the cortex were used to determine reduced glutathione (GSH‐Px), NO and malondialdehyde (MDA). Immunohistochemically, iNOS and the active subunit of NFκB, P65, were evaluated using mouse monoclonal antibodies. RESULTS On haematoxylin and eosin staining, compared with the controls rats, gentamicin caused widespread tubular necrosis (grade 3 and 4) but in group 3 and 4 there was a marked reduction in the extent of tubular damage. Immunohistochemically there was more marked staining for iNOS and P65 expression in rats given gentamicin than in the control and group 3 and 4 (P < 0.001). In groups 3 and 4 iNOS and P65 expression were significantly less than in rats given only gentamicin. There was no significant difference in serum levels of Na+, K+, blood urea nitrogen and creatinine. Compared with control rats, gentamicin caused hyperproteinuria, a marked increase in levels of serum γ‐GT, MDA and NO, and a decrease in GSH‐Px (P < 0.001). CONCLUSION These results indicate that gentamicin induces iNOS expression through activation of NFκ‐B (P65). It is possible to prevent gentamicin‐induced nephrotoxicity using selective NFκ‐B inhibitors.
Shock wave lithotripsy (SWL) is commonly used for treatment of renal stones. Free oxygen radicals are involved in the pathophysiology of renal injury due to SWL. We investigated the protective effects of curcumin, which is an antioxidant and nuclear factor kappa-B (NF-kappaB) inhibitor, against renal injury. Forty-eight rats were included and divided into four groups: group 1, control; group 2, SWL (15 kW-1,500 shocks); group 3, SWL + curcumin (curcumin orally 75 mg/kg/day dissolved in 10% ethyl alcohol, 1 day before and 5 days after SWL); and group 4, SWL + vehicle (10% ethyl alcohol). The kidneys were removed on days 7 and 35 after SWL. A sample was fixed in formaldehyde solution. Renal tissues were examined for proximal tubular injury under light microscope. iNOS activity and active subunit of NF-kappaB, p65, were evaluated immunohistochemically using rat monoclonal antibodies interpreting results semiquantitatively. There were significant differences between SWL and control groups on days 7 and 35, considering histological changes under light microscope (P < 0.02). There was a significant decrease in necrosis and fibrosis in the curcumin group as compared to the SWL group. Expressions of iNOS and p65 on days 7 and 35 were at basal levels with immunohistochemical staining. These parameters had high levels in the SWL group (P < 0.02). No significant difference was present between the control and the curcumin groups (P > 0.02). Curcumin, decreasing expressions of iNOS and p65 and serum nitric oxide levels prevented interstitial, glomerular, tubular epithelial and endothelial cellular injuries. We suggest that curcumin, could be used, especially in high-risk patients, as a protective agent to prevent renal injury due to SWL.
Fournier's gangrene is a potentially fatal necrotizing fasciitis affecting the perineum and genital area. The usual treatment includes prompt surgical debridement and, in many cases, a diverting colostomy. We present two cases of Fournier's gangrene that were treated with extensive local debridement and rectal diversion with a new device for faecal matter management, avoiding the need for a colostomy.
Background Limited data exist regarding adoption of evolving robotic technology in surgery. This study evaluated trends and the current condition of robotic platforms in surgical specialties and general surgical subspecialties. Methods Between January 2013 and December 2017, all robotic operations performed in Turkey were included. Results In the study period, 13 760 robotic operations were performed at 32 hospitals. The median numbers of general surgical procedures were 43and eight cases per hospital and per general surgeon, respectively. The high‐volume general surgeons performed 1734 (81%) of the cases. Forty‐five percent and 55% of the general surgical operations were performed with the Xi and S/Si robots, respectively. Conclusion Use of the Xi platform seems to increase caseload in general surgery operations possibly by facilitating robotic colorectal surgery. Targeting the high‐volume centres and surgeons for further training and implantation of upcoming robotic technology can be more effective in terms of increasing case volume and improving outcomes.
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