Amer H. Zureikat, MD; Kevin T. Nguyen, MD, PhD; David L. Bartlett, MD; et al.
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Arch Surg. 2011;146(3):256-261. doi:10.1001/archsurg.2010.246
HypothesisRobotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery.DesignSingle-institution retrospective review.SettingTertiary care center.PatientsPatients undergoing completed robotic-assisted pancreatic resection and reconstruction at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, between October 3, 2008, and February 26, 2010.Main Outcome MeasuresPrimary pathology, operative time, operative blood loss, perioperative blood transfusions, pancreatic fistula, 90-day morbidity and mortality, and readmission rate.ResultsThirty patients with a median age of 70 years (range, 32-85 years) underwent completed robotic-assisted pancreatic resection and reconstruction. Procedures were robotic-assisted non-pylorus-preserving pancreaticoduodenectomy (n聽=聽24), robotic-assisted central pancreatectomy (n聽=聽4), and the robotic-assisted Frey procedure (n聽=聽2). The median operative time was 512 minutes (range, 327-848 minutes). The median blood loss was 320 mL (range, 50-1000 mL), with a median length of hospital stay of 9 days (range, 4-87 days). The final diagnoses included periampullary adenocarcinoma (n聽=聽7), pancreatic ductal adenocarcinoma (n聽=聽6), pancreatic neuroendocrine tumor (n聽=聽5), intraductal papillary mucinous neoplasm (n聽=聽4), mucinous cystic neoplasm (n聽=聽3), serous cystic adenoma (n聽=聽2), chronic pancreatitis (n聽=聽2), and solid pseudopapillary neoplasm (n聽=聽1). There was 1 postoperative death. The overall pancreatic fistula rate was 27% (n聽=聽8). The clinically significant pancreatic fistula rate (International Study Group on Pancreatic Fistula grades B and C) was 10% (n聽=聽3). Clavien grade III and IV complications occurred in 7 patients (23%), while Clavien grade I and II complications occurred in 8 patients (27%).ConclusionsRobotic-assisted complex pancreatic surgery can be performed safely in a high-volume pancreatic tertiary care center with perioperative outcomes comparable to those of open surgery. Advances in robotic technology and increasing experience may improve long operative times.
Thomas Anthony, MD, MSc; Bryce W. Murray, MD; John T. Sum-Ping, MD; et al.
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Arch Surg. 2011;146(3):263-269. doi:10.1001/archsurg.2010.249
ObjectiveTo determine if an evidence-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice.DesignSingle-institution, randomized controlled trial with blinded assessment of main outcome. The trial opened in April 2007 and was closed in January 2010.SettingVeterans Administration teaching hospital.PatientsPatients who required elective transabdominal colorectal surgery were eligible. A total of 241 subjects were approached, 211 subjects were randomly allocated to 1 of 2 interventions, and 197 were included in an intention-to-treat analysis.InterventionsSubjects received either a combination of 5 evidenced-based practices (extended arm) or were treated according to our current practice (standard arm). The interventions in the extended arm included (1) omission of mechanical bowel preparation; (2) preoperative and intraoperative warming; (3) supplemental oxygen during and immediately after surgery; (4) intraoperative intravenous fluid restriction; and (5) use of a surgical wound protector.Main Outcome MeasureOverall SSI rate at 30 days assessed by blinded infection control coordinators using standardized definitions.ResultsThe overall rate of SSI was 45% in the extended arm of the study and 24% in the standard arm (P聽=聽.003). Most of the increased number of infections in the extended arm were superficial incisional SSIs (36% extended arm vs 19% standard arm; P聽=聽.004). Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk (95% confidence interval, 1.36-4.56; P聽=聽.003) independent of other factors traditionally associated with SSI.ConclusionsAn evidence-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.Trial Registrationclinicaltrials.gov Identifier:
Koji Yamaguchi, MD, PhD; Shuichi Kanemitsu, MD, PhD; and the Kitakyushu Surgical Study Group
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Arch Surg. 2010;146(3):271-278. doi:10.1001/archsurg.2010.250
ObjectiveTo examine the stress experienced by surgeons in response to surgery and night duty.DesignAnalyses were done by subjective questionnaires and an objective urine analysis.SettingOne university hospital and 15 community/public hospitals in Kitakyushu City, Japan.ParticipantsSixty-six Japanese surgeons.Main Outcome MeasuresScores on the NASA Task Load Index and Stress Arousal Checklist and urine biopyrin levels.ResultsThe Task Load Index score significantly increased in association with the duration of surgery and the amount of surgical blood loss. Urine biopyrin levels significantly increased with the duration of surgery. Night duty significantly decreased sleep time and significantly increased urine biopyrin levels. Stress Arousal Checklist Arousal Scale scores significantly decreased the morning after night duty and the evening after the end of the following day shift.ConclusionSurgery was associated with stress on surgeons and night duty influenced the arousal of the surgeons during the day shift following night duty.
Melanie L. Richards, MD; Geoffrey B. Thompson, MD; David R. Farley, MD; et al.
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Arch Surg. 2011;146(3):280-285. doi:10.1001/archsurg.2011.5
Vincent Liu, MD; David Weill, MD; Jay Bhattacharya, MD, PhD
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Arch Surg. 2011;146(3):286-293. doi:10.1001/archsurg.2011.4
Thomas N. Robinson, MD; Christopher D. Raeburn, MD; Zung V. Tran, PhD; et al.
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Arch Surg. 2011;146(3):295-300. doi:10.1001/archsurg.2011.14
Adrian Ong, MD; Karen Dysert, RN; Cheryl Herbert, RN; et al.
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Arch Surg. 2011;146(3):302-307. doi:10.1001/archsurg.2011.9
Edward H. Livingston, MD; Thomas B. Fomby, PhD; Wayne A. Woodward, PhD; et al.
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Arch Surg. 2011;146(3):308-314. doi:10.1001/archsurg.2011.2
Rocco Ricciardi, MD, MPH; Patricia L. Roberts, MD; Thomas E. Read, MD; et al.
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Arch Surg. 2011;146(3):319-323. doi:10.1001/archsurg.2011.27
Kenny Hanna, MD; Christopher W. Seder, MD; Jeffrey B. Weinberger, MD; et al.
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Arch Surg. 2011;146(3):325-328. doi:10.1001/archsurg.2011.35
Bilal Alkhaffaf, MBChB, MRCS; Edward Parkin, MBChB, MRCS; David Flook, MBChB, FRCS
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Arch Surg. 2011;146(3):329-333. doi:10.1001/archsurg.2011.30
Artur Chernoguz, MD; Dana A. Telem, MD; Edward Chu, BA; et al.
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Arch Surg. 2011;146(3):334-339. doi:10.1001/archsurg.2011.23
Joris A. J. L. Broeders, MD; Werner A. Draaisma, MD, PhD; Jan J. B. van Lanschot, MD, PhD; et al.
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Arch Surg. 2011;146(3):340-346. doi:10.1001/archsurg.2011.32