While robotic platforms are increasingly used in MIS inguinal hernia repair, it is still unclear if there is a demonstrable advantage over conventional laparoscopy. This review examines recent randomized controlled trials, meta-analyses using these trials, as well as recent observational data to assess for benefit of robotics in inguinal hernia repair. Current and future trends in MIS hernia repair are examined and discussed. While cost continues to remain a disadvantage, recent studies suggest that operative time may be decreased with robotic surgery. Additionally, one RCT shows decreased rates of short-term complications. Recent population-based and observational data may suggest lower recurrence rates with robotic surgery. Telesurgery has been successfully utilized in robotic inguinal hernia repair. Understanding the current evidence regarding MIS inguinal hernia repair is important to guide current and future practice as well as surgical education.
This review summarizes current knowledge regarding urologic health during spaceflight, with emphasis on nephrolithiasis, renal physiology, sexual and reproductive health, and the feasibility of delivering urologic care during space missions. Spaceflight produces consistent urinary changes that increase stone formation risk, including hypercalciuria, reduced urine volume, hypocitraturia, and increased urinary supersaturation. Recent multi-omic work suggests that spaceflight and galactic cosmic radiation may also cause primary renal remodeling, including altered NCC and NKCC2 regulation and increased susceptibility to crystal adhesion. Evidence also suggests potential effects on fertility, erectile function, gamete viability, and reproductive capacity. Urologic disease represents an important risk for future long-duration missions. Prevention, validated countermeasures, representative astronaut studies, and compact diagnostic and surgical technologies will be essential as human exploration expands throughout the solar system.
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can cause progressive multisystem organ dysfunction in critically ill patients. This review summarizes the epidemiology, pathophysiology, diagnosis, and management of IAH and ACS, emphasizing physiologic mechanisms, early recognition, and strategies to prevent progression to ACS. IAH remains common in critically ill populations, although the incidence of ACS varies substantially according to patient population and surveillance practices. Contemporary evidence emphasizes recognizing accumulating risk factors, standardizing intra-abdominal pressure monitoring in at-risk patients, and early correction of reversible contributors to elevated pressure. Current management still utilizes decompressive laparotomy, but advances in temporary abdominal closure technology and early enteral nutrition have supported earlier definitive fascial closure, which has improved morbidity and mortality. ACS represents the severe end of a continuum of pressure-related organ dysfunction. Early recognition and treatment of IAH are essential, while established ACS requires prompt surgical evaluation and decompression when less invasive measures are insufficient.
Abstract Purpose of review Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can cause progressive multisystem organ dysfunction in critically ill patients. This review summarizes the epidemiology, pathophysiology, diagnosis, and management of IAH and ACS, emphasizing physiologic mechanisms, early recognition, and strategies to prevent progression to ACS. Recent findings IAH remains common in critically ill populations, although the incidence of ACS varies substantially according to patient population and surveillance practices. Contemporary evidence emphasizes recognizing accumulating risk factors, standardizing intra-abdominal pressure monitoring in at-risk patients, and early correction of reversible contributors to elevated pressure. Current management still utilizes decompressive laparotomy, but advances in temporary abdominal closure technology and early enteral nutrition have supported earlier definitive fascial closure, which has improved morbidity and mortality. Summary ACS represents the severe end of a continuum of pressure-related organ dysfunction. Early recognition and treatment of IAH are essential, while established ACS requires prompt surgical evaluation and decompression when less invasive measures are insufficient.
To review the evolving role of robotic recipient liver transplantation, including its emergence from experience in robotic hepatobiliary surgery and living-donor hepatectomy, global adoption, operative techniques, patient and graft selection, and anesthetic and logistical considerations. Robotic liver transplantation has progressed from isolated reports to increasingly standardized procedures across multiple centers using living- and deceased-donor grafts. Early studies demonstrate favorable perioperative outcomes and short-term patient and graft survival in highly selected recipients with pooled evidence of 3 studies and 70 patients, 77
