Could robotic-assisted surgery reduce mesh-related complications after ventral mesh rectopexy? Experience of a tertiary centre and systematic review of the literature

AIM

The development of robotic assistance has made dissection and suturing in the deep pelvis much easier. The augmented quality of the images and the articulation of the robotic arms have also enabled a more precise dissection. The aim of this study is to present the data on robotic-assisted ventral mesh rectopexy procedures in a university hospital and examine the literature in terms of mesh erosion.

METHOD

The electronic databases Pubmed, Embase and Cochrane were searched. Studies from January 2004 until January 2023 in the English language were included. Studies which included fewer than 10 patients were excluded. Laparoscopic or robotic-assisted ventral mesh rectopexies were included. Mesh erosion rates following laparoscopic or robotic-assisted ventral mesh rectopexies were measured.

RESULTS

Overall, the systematic review presents 5911 patients from 43 studies who underwent laparoscopic ventral mesh rectopexy compared with 746 patients treated with robotic-assisted ventral mesh rectopexy from six studies and our centre. Mesh erosion was rare in both groups; however, the prevalence was greater in the laparoscopy group (0.90% vs. 0.27%).

CONCLUSION

The mesh erosion rates are very low with robotic-assisted ventral mesh rectopexy. For precise results, more studies and experience in robotic surgery are required.

Organizational strategy influence on visual memory performance after stroke: cortical/subcortical and left/right hemisphere contrasts

OBJECTIVE

To examine how organizational strategy at encoding influences visual memory performance in stroke patients.

DESIGN

Case control study.

SETTING

Postacute rehabilitation hospital.

PARTICIPANTS

Stroke patients with right hemisphere damage (n = 20) versus left hemisphere damage (n = 15), and stroke patients with cortical damage (n = 11) versus subcortical damage (n = 19).

MAIN OUTCOME MEASURES

Organizational strategy scores, recall performance on the Rey-Osterrieth Complex Figure (ROCF).

RESULTS

Results demonstrated significantly greater organizational impairment and less accurate copy performance (i.e., encoding of visuospatial information on the ROCF) in the right compared to the left hemisphere group, and in the cortical relative to the subcortical group. Organizational strategy and copy accuracy scores were significantly related to each other. The absolute amount of immediate and delayed recall was significantly associated with poor organizational strategy scores. However, relative to the amount of visual information originally encoded, memory performances did not differ between groups.

CONCLUSIONS

These findings suggest that visual memory impairments after stroke may be caused by a lack of organizational strategy affecting information encoding, rather than an impairment in memory storage or retrieval.

Strauss and Carpenter outcome criteria--revised

Poor inter-rater reliability of the Strauss and Carpenter Outcome Criteria in hospital outcome study was attributed to lack of operational definition. A revision aimed at remedying this problem was used to rate a portion of the original sample of subjects. The revised form proved superior in interrater reliability for seven of the nine categories, suggesting that this more explicitly behavioral version may improve hospital outcome research.