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IntroductionEstablishing straightforward and reproducible steps to describe the technique performed with the aid of the robotic system for complex hernia surgery is key for good outcomes. Even using the description of open surgery as a parameter for performing the robotic technique, it is important to stress the particularities of this access. To describe the steps to perform robotic-assisted TAR (r-TAR) in a standardized technique, with a critical and safe view of all the anatomical structures.Description of the techniqueWe defined 8 landmarks for the critical view of safety in r-TAR which include: (1) patient position, trocar and docking; (2) posterior rectus sheath mobilization; (3) transversus abdominis release (TAR)—Top–down technique; (4) transversus abdominis release (TAR)—bottom–up technique and mesh insertion; (5) contralateral trocar insertion and redocking, 6) posterior sheath closure; (7) final mesh positioning; and (8) anterior defect closure and drains.DiscussionComplex hernia surgery using a robotic-assisted posterior component separation requires well-established steps so the procedure can be reproducible and achieve better results.

Abstract Basil (Ocimum basilicum) is a medicinal, ornamental and aromatic plant, however, its size can be an obstacle to its commercialization as a potted ornamental plant. Paclobutrazol (PBZ) is a substance that can retard plant growth by inhibiting the synthesis of gibberellins. The objective of this work was to evaluate the effect of paclobutrazol on growth regulation and gas exchange of basil (var. Cinnamon). The experiment was carried out in a completely randomized design with five treatments (PBZ doses: 0, 2.5, 5, 7.5 and 10 mg L-1), with eight replicates. Growth (plant height, number of leaves, stem diameter, leaf dry mass, stem dry mass, inflorescence dry mass, and total), growth rates (leaf mass ratio, stem mass ratio, inflorescence mass ratio, and robustness quotient), chlorophyll indices, gas exchange (gs, A, E, Ci, WUE, iWUE and iCE) were evaluated. Paclobutrazol reduced the growth of basil plants and increased the chlorophyll indices, A, gs, and WUE. Paclobutrazol can be used to regulate plant growth of basil plants var. Cinnamon, without altering its physiological and ornamental characteristics. Resumo Manjericão (Ocimum basilicum) é uma planta medicinal, ornamental e aromática, contudo, seu porte pode ser um entrave para a sua comercialização como planta ornamental de vaso. O paclobutrazol (PBZ) é uma substância que pode retardar o crescimento de plantas, através da inibição da síntese de giberelinas. O objetivo deste trabalho foi avaliar o efeito do paclobutrazol na regulação do crescimento e trocas gasosas no manjericão (Ocimum basilicum var. Cinnamon). O experimento foi realizado em delineamento inteiramente casualizado com 5 tratamentos (doses de PBZ: 0; 2,5; 5; 7,5 e 10 mg L-1), com oito repetições. O crescimento (altura de planta, número de folhas, diâmetro de caule, massa seca da folha, do caule, da inflorescência e total), taxas de crescimento (razão de massa da folha, do caule e da inflorescência e quociente de robustez), índices de clorofilas a e b, trocas gasosas (gs, A, E, Ci, WUE, iWUE e iCE) foram avaliados. Paclobutrazol reduziu o crescimento de plantas de manjericão e aumentou o índice de clorofilas, A, gs e WUE. Paclobutrazol pode ser usado para regular o crescimento de plantas de manjericão var. Cinnamon, sem alterar suas características fisiológicas e ornamentais.

Diaphragmatic hiatal hernia is a potential complication of oesophagectomy in cancer patients. Over the past decades, laparoscopy has become the preferred approach to repairing this condition due to the reduced morbidity, faster recovery and shorter hospital stay when compared with traditional open surgery. The development of robotic technology has added to the benefits of minimally invasive approaches, offering potential technical advantages and overcoming some limitations of traditional laparoscopic techniques when performing complex procedures. We present the first report of a robotic post-oesophagectomy hiatal hernia repair.

Abstract Present recommendations in the literature advocate for a return to sport (RTS) between 5- and 10 months following hip arthroscopy for femoroacetabular impingement (FAI). We have adopted the International Society of Hip Preservation protocol with modifications for the rehabilitation of our patients. The aim of the present study was to examine the time to RTS with this rehabilitation approach after hip arthroscopy for FAI. It was hypothesized that most athletes will RTS by 5 months post-surgery without any adverse effects. Patients undergoing hip arthroscopy for FAI were prospectively followed with preoperative and postoperative Patient Reported Outcome Measures including: Modified Harris Hip Score (mHHS) and Copenhagen Hip and Groin Outcome Score (HAGOS). Preinjury sports and competition level, postoperative RTS rate, time, and level, complications, and revision surgeries were recorded. A total of 56 patients were identified for inclusion (36.6 ± 14.1 years old at date of surgery, 34 females and 22 males). There were 35 recreational athletes and 21 competitive-level athletes (10 in high-demand sports and 11 in moderate-demand sports). In all, 44 patients (79%) returned to sport at 5.3 ± 3.5 months postoperatively. Of the 12 patients who did not RTS, 5 (42%) did not return for reasons other than their hip. Neither HAGOS (P = .458) nor mHHS (P = .424) differed between athletes with RTS in ≤ 5 months (HAGOS: 80.4 ± 22.3; mHSS: 88.0 ± 17.7) versus >5 months (HAGOS: 84.6 ± 11.8; mHSS: 91.5 ± 8.7). The current study demonstrates that accelerated rehabilitation after hip arthroscopy for FAI can safely return athletes to sport within 6 months.

Innominate artery occlusion is a rare entity, particularly when coupled with severe left common carotid artery stenosis. Innominate artery disease may present with varying degrees of symptomatology and can place patients at risk for both posterior fossa and hemispheric ischemic events. We present a symptomatic case of innominate artery occlusion with severe left common carotid disease. We reviewed the literature and current options for the treatment of innominate artery disease. The patient underwent successful hybrid repair with left carotid artery retrograde stenting and left carotid artery to right carotid artery bypass. She has been symptom and re-intervention free during her one-year follow-up. We describe a successful hybrid repair of symptomatic innominate artery occlusion with concomitant severe left carotid artery stenosis in a patient with a prohibitive open thoracic surgical risk.

Performing experimental studies has played an important role in acquiring knowledge about esophageal carcinogenesis. In this context, the choice of a more reliable experimental model requires proof of its effectiveness in order to lend greater credibility to the results. The objective of this study was to evaluate the patency of duodenal-esophageal anastomosis during long-term postoperative follow-up in rats. This was an experimental study in which 45 female Wistar rats were used. A side-to-side anastomosis was performed, going from the anterior side of the esophagus to the second duodenal portion. A standardized radiological technique was used to carry out a contrasted radiological study of the esophagus, stomach, and duodenum during weeks 4, 12, 20, and 30 after surgery. Different contrast media were used, and the animals were divided into groups, ie, group 1 (100% barium sulfate), group 2 (50% barium sulfate), and group 3 (60% aqueous iodinated contrast media). Contrast radiographs were taken in each group at weeks 4, 12, 20, and 30 after the surgical procedure. The radiographic images were evaluated by two radiologists who were blinded regarding the contrast groups. Macroscopic evaluation of each animal was compared with the radiological findings. Postoperative mortality was 13.33%. The remaining animals were divided into study groups. All the contrast radiological examinations showed evidence of the location of the esophagus, stomach, and proximal portion of the intestine, and demonstrated the laterolateral relationship of the distal esophagus and the duodenum in the epigastric region. Patency of the anastomosis was observed at each examination period. The different contrast media used were able to demonstrate this outcome shortly after the first phase of injection. Necropsies corroborated the radiological findings. Regardless of the contrast agent used, contrasted radiography revealed that side-to-side duodenal-esophageal anastomosis in rats allowed patent communication during long-term postoperative follow-up.