Introduction Robotic-assisted techniques are common across many surgical subspecialties. While robotic stapling offers increased surgeon control, there is limited information on surgical complications related to robotic stapler use. Methods We reviewed the FDA’s MAUDE database for adverse events related to robotic stapler use. Results Upon review of the FDA database, the most frequently reported robotic stapler complications were malfunction, failure to form staple line, device fragmentation, and misfire. 31 Clavien-Dindo grade II or higher complications were attributed to stapler use since 2014. Conclusions Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.

No abstract

Main Problem: Robotic-assisted techniques are common for living-donor nephrectomy. While robotic stapling offers increased surgeon control, there is limited comparative data versus laparoscopic linear stapler use for ligation of renal vessels. Methods: We retrospectively reviewed 32 consecutive robotic-assisted donor nephrectomies by a single surgeon for perioperative outcomes. Results: Patients in the robotic stapler (RS; N=20) and laparoscopic stapler (LS; N=12) groups were comparable in terms of age and BMI. Estimated blood loss (p = 0.62), warm ischemia time (p=0.50), and console time (p=0.56) were similar between the RS and LS groups. There were no stapler misfires or major intraoperative complications in either group and no cases required conversion to open. Conclusions: Robotic stapler use is safe and effective in robotic-assisted donor nephrectomy. Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.  

Introduction : A 50 year old African American female with a history of hyperlipidemia, hypertension, diabetes mellitus, and peripheral artery disease with right lower extremity bypass earlier in 2021 presented with altered mental status (AMS) and right‐sided facial droop. She presented to an outside hospital where her temperature was 102.1°F and blood pressure was 185/84. The National Institute of Health Stroke Scale (NIHSS) was 16. Notable labs included white blood cell (WBC) count 10.3, sodium 133, lactate 2.7. Urine drug screen notable for THC. Urinalysis, CXR, COVID screen were negative. CT of the head did not show acute findings, CT angiogram did not show any stenosis or large vessel occlusions and CT perfusion revealed perfusion deficits in the left hemisphere. Given her elevated temperature and lactate, a lumbar puncture (LP) was performed. Cerebrospinal fluid (CSF) analysis revealed WBC count 58 (95% neutrophilic predominance), RBC count 128, glucose 324 (serum glucose 576), protein 77 and lactate dehydrogenase (LDH) 23. Concerns for meningitis lead to her being started on broad spectrum antibiotics (ampicillin, ceftriaxone, acyclovir, and vancomycin). She was then transferred to our comprehensive stroke center for further management. Methods : Initially she remained febrile and somnolent, but after 36 hours of antibiotics, her mentation improved. Antibiotics and antivirals were slowly tapered after the CSF meningitis panel, gram stain, cultures, and viral PCRs came back negative. MRI of brain showed acute left posterior cerebral artery (PCA) ischemic stroke with punctate infarcts of right lentiform nucleus and periventricular area. Transthoracic echocardiogram (TTE) showed the left ventricle with severe hypertrophy and ejection fraction (EF) 65–70%. There was concern for endocarditis with systemic infection, however transesophageal echocardiogram (TEE) was negative for infectious vegetations and bubble study was negative. Blood cultures showed no growth after four days. Syphilis screen, ANA, HIV were also negative. Lipids were elevated with total cholesterol 214 and LDL 138. Hemoglobin A1c was also elevated at 13. Results : After being stable for several days, the patient’s NIHSS reduced to three, two points for right homonymous hemianopia and one point for minor facial paralysis. An implantable loop recorder was placed to monitor for any arrhythmias that may have led to her stroke and the patient was discharged home on aspirin and atorvastatin. Conclusions : With the initial presentation of fever and AMS in this patient, there was high suspicion of infective endocarditis. She also suffered an ischemic stroke which was determined to be embolic from an undetermined source. The patient did not meet modified Duke Criteria for “possible infective endocarditis” which is considered when the patient has one major and one minor criteria or three minor criteria. Two minor criteria were met including a temperature > 38oC on admission and vascular embolic phenomena (stroke). Interestingly, blood and CSF cultures never grew an organism although the CSF WBC count was 58. While CSF lymphocytosis has been associated with TIA‐like presentations and other viral or fungal etiologies associated with ischemic stroke, this is perhaps the first case of a neutrophilic‐predominant CSF pleocytosis in setting of ischemic stroke without a clear source.