Eric D. Girard

Literature has previously compared the outcomes amongst the different approaches of operative management of rectal prolapse. There is no national dataset comparing robotic rectopexy to other approaches. This study aims to compare the outcomes of patients undergoing rectopexy with and without resection via a laparoscopic versus robotic approach. A retrospective study of the American College of Surgeons National Surgical Quality Improvement Program database (2022–2023) was performed to identify patients who underwent minimally invasive surgery for rectal prolapse. Laparoscopic versus robotic surgery for rectopexy alone and with sigmoid resection was assessed. Comparisons were made between patient demographics and comorbidities. Post-operative outcomes were evaluated. Younger patients underwent robotic rectopexy, and more females underwent robotic rectopexy with resection compared to laparoscopic. There were no significant differences in terms of race/ethnicity, comorbidities, or morbidity. There was a significantly increased mean operative time in the robotic rectopexy groups compared to laparoscopic. With rectopexy alone, there was a significantly decreased total length of stay in the robotic group. In a sub-analysis of those aged ≥ 65 years, there was a significant reduction in the total length of stay in the robotic with resection group. Robotic rectopexy with and without resection is a safe option with no significant differences in morbidity. Although the mean operative time is greater in the robotic group, there is a decreased length of stay with the robotic approach compared to laparoscopic. Future inquiry should prospectively compare outcomes of robotic rectopexy to other approaches, sub-stratified by age and sex.

Pulmonary diseases represent a large portion of neonatal and adult morbidity and mortality. Many of these have no cure, and new therapeutic approaches are desperately needed. De-cellularization of whole organs, which removes cellular elements but leaves intact important extracellular matrix (ECM) proteins and three-dimensional architecture, has recently been investigated for ex vivo generation of lung tissues. As specific cell culture surfaces, including ECM composition, profoundly affect cell differentiation, this approach offers a potential means of using de-cellularized lungs to direct differentiation of embryonic and other types of stem/progenitor cells into lung phenotypes. Several different methods of whole-lung de-cellularization have been reported, but the optimal method that will best support re-cellularization and generation of lung tissues from embryonic stem cells (ESCs) has not been determined. We present a 24-h approach for de-cellularizing mouse lungs utilizing a detergent-based (Triton-X100 and sodium deoxycholate) approach with maintenance of three-dimensional lung architecture and ECM protein composition. Predifferentiated murine ESCs (mESCs), with phenotypic characteristics of type II alveolar epithelial cells, were seeded into the de-cellularized lung scaffolds. Additionally, we evaluated the effect of coating the de-cellularized scaffold with either collagen or Matrigel to determine if this would enhance cell adhesion and affect mechanics of the scaffold. Finally, we subcutaneously implanted scaffolds in vivo after seeding them with mESCs that are predifferentiated to express pro-surfactant protein C (pro-SPC). The in vivo environment supported maintenance of the pro-SPC-expressing phenotype and further resulted in vascularization of the implant. We conclude that a rapid detergent-based de-cellularization approach results in a scaffold that can maintain phenotypic evidence of alveolar epithelial differentiation of ESCs and support neovascularization after in vivo implantation.