Background The purpose of this study was to compare the clinical and economic outcomes of robotic versus laparoscopic left lateral sectionectomy (LLS). Methods A retrospective analysis was made comparing robotic (n=11) and laparoscopic (n=18) LLS performed at the University of Pittsburgh Medical Center between January 2009 and July 2011. Demographic data, operative, and post-operative outcomes were collected. Results Demographic and tumor characteristics of robotic and laparoscopic LLS were similar. There were also no significant differences in operative outcomes including estimated blood loss and operating room time. Patients undergoing robotic LLS had more admissions to the ICU (46% vs. 6%), increased rate of minor complications (27% vs. 0%), and longer lengths of stay (4 vs. 3 days). There were no significant differences in major complication rates or 90-day mortality. The cost of robotic and laparoscopic LLS were not significantly different when only considering direct costs ($5,130 vs $4,408, p=0.401). However, robotic LLS costs were significantly greater when including indirect costs, which were estimated to be $1,423 per robotic case ($6 553 vs. $4 408, p=0.021). Discussion Robotic LLS yields slightly inferior clinical outcomes and increased cost compared to the laparoscopic approach.

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Freshly-isolated hepatic dendritic cells (DC) are comparatively immature, relatively resistant to maturation, and can down-modulate effector T cell responses. Molecular mechanisms that underlie these properties are ill-defined. DNAX-activating protein of 12 kDa (DAP12) is an ITAM-bearing transmembrane adaptor protein, that integrates signals through several receptors, including triggering receptor expressed on myeloid cells (TREM)-1, -2; and CD200R. Notably, DC propagated from DAP12-deficient mice exhibit enhanced maturation in response to TLR ligation. Given the constitutive exposure of liver DC to endotoxin draining from the gut, we hypothesized that DAP12 might regulate liver DC maturation. We show that while DAP12 is expressed by both freshly-isolated liver and spleen myeloid DC, LPS-stimulated liver DC maintain DAP12 mRNA expression at higher levels than splenic DC. Moreover, inhibition of DAP12 expression by liver DC using small interfering (si)RNA, promotes their phenotypic and functional maturation, resulting in enhanced TNFα, IL-6 and IL-12p70 production, reduced secretion of IL-10 and enhanced CD4+ and CD8+ T cell proliferation. Furthermore, DAP12 silencing correlates with decreased STAT3 phosphorylation in mature liver DC, and with diminished expression of the IL-1R-associated kinase (IRAK)-M, a negative regulator of TLR signaling. These findings highlight, for the first time, a regulatory role for DAP12 in hepatic DC maturation, and suggest a mechanism whereby this function may be induced/maintained.

Thromboprophylaxis with extended duration enoxaparin decreased the rate of venous thromboembolism after radical cystectomy compared to inpatient only subcutaneous heparin with no increased risk of bleeding.