BACKGROUND: The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. METHODS: A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. RESULTS: Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3 cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. CONCLUSION: Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.

• MeSH
• arteriae epigastricae * transplantace   MeSH
• délka operace * MeSH
• délka pobytu MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• odběr tkání a orgánů metody   MeSH
• perforátorový lalok * krevní zásobení   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• roboticky asistované výkony * metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Iliac crest is common site for harvesting bone grafts. Morphometry of iliac crest is of vital importance in orthopedic surgery. Measurements were done on male (n=85) and female (n=85) hip bones. Length of iliac crest, thickness of iliac crest and ilium were measured. Thickness was measured at pre-defined points on crest and ilium 2 cm apart starting from anterior superior iliac spine (ASIS). Ilium was measured at a depth of 2.5 cm from crest. Statistical analysis was done. Iliac crests were longer in male bones. Ventral iliac crest was thickest at 6 cm from ASIS in both sexes. While iliac crest bore minimum thickness at 12 cm and 10 cm from ASIS in male and female bones respectively, however at 2.5 cm below iliac crest surface ilium was thickest at 4 cm from ASIS and at ASIS in male and female bones respectively. In case of male bones, dorsal part of iliac crest was thickest at 2.15 ± 1.29 cm from posterior superior iliac spine (PSIS) while in females it was at 1.78 ± 1.31 cm from PSIS. In dorsal part of ilium, it was observed at 2.31 ± 1.47 cm and 1.9 ± 1.79 cm from PSIS for male and female bones respectively. This study provided detailed variable morphometry and significant sexual dimorphism observed in iliac crest and ilium. Thickest safe zones in both sexes are a useful guide for harvesting appropriate bone grafts.

• Klíčová slova
• Hip bone morphometry, Iliac crest thickness, Ilium, Orthopedic reconstructive surgery,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• odběr tkání a orgánů metody   MeSH
• os ilium * anatomie a histologie   MeSH
• senioři MeSH
• transplantace kostí * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The sural nerve is a somatosensory nerve that provides sensation to the posterolateral aspect of the lower leg and the lateral part of the ankle and foot. Due to its location and anatomical properties, it is often used as an autologous nerve graft. However, the nerve harvest can be complicated by the presence of side branches. The objective of this study was to investigate the anatomy of the sural nerve and to map its side branches. This information can be used to predict the localization of separate incisions during the stair-step incisions technique for nerve harvest, thereby reducing the risk of complications. METHODS: The study involved the dissection of 50 adult cadaveric legs (25 left and 25 right) obtained from 27 Central European cadavers. The focus of the dissection was to identify the sural nerve, small saphenous vein, and surrounding anatomical structures. Detailed measurements were taken on the side branches of the sural nerve, tributaries of the small saphenous vein, and their interrelationship. RESULTS: The average number of sural nerve side branches in a single leg was 4.2±1.9. These side branches were categorized into six groups based on their location and course: mediodistal, medioproximal, lateroproximal, laterodistal, medial perpendicular, and lateral perpendicular. Specific patterns of combination of these side branches were also identified and described. The branching point of the sural nerve was found to be 5.8±2.7 cm proximal to the lateral malleolus, whereas the small saphenous vein branching point was located more distally, 4.5 ± 2.8 cm proximal to the lateral malleolus. The highest density of sural nerve side branches was found 2.1-6.0 cm above the lateral malleolus. CONCLUSION: This study presents valuable data about the relationship between the sural nerve and the surrounding anatomical structures in the distal part of the leg, including the identification of its side branches and their relevance during nerve harvest procedures. On the basis of the most frequent locations of side branches, a three-incision-technique for nerve harvest is proposed.

• Klíčová slova
• Lateral malleolus, Leg, Side branches, Stair-step incisions technique, Sural nerve, Sural nerve harvest,
• MeSH
• bérec * inervace   anatomie a histologie   MeSH
• disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola * MeSH
• nervus suralis * anatomie a histologie   MeSH
• odběr tkání a orgánů metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vena saphena anatomie a histologie   inervace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT: The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION: In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.

• Klíčová slova
• living donor nephrectomy, robotic operation, transplantation,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nefrektomie * metody   MeSH
• odběr tkání a orgánů metody   MeSH
• roboticky asistované výkony * metody   MeSH
• transplantace ledvin * metody   MeSH
• žijící dárci * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Česká republika MeSH

One of the challenges in clinical translation of cell-replacement therapies is the definition of optimal cell generation and storage/recovery protocols which would permit a rapid preparation of cell-treatment products for patient administration. Besides, the availability of injection devices that are simple to use is critical for potential future dissemination of any spinally targeted cell-replacement therapy into general medical practice. Here, we compared the engraftment properties of established human-induced pluripotent stem cells (hiPSCs)-derived neural precursor cell (NPCs) line once cells were harvested fresh from the cell culture or previously frozen and then grafted into striata or spinal cord of the immunodeficient rat. A newly developed human spinal injection device equipped with a spinal cord pulsation-cancelation magnetic needle was also tested for its safety in an adult immunosuppressed pig. Previously frozen NPCs showed similar post-grafting survival and differentiation profile as was seen for freshly harvested cells. Testing of human injection device showed acceptable safety with no detectable surgical procedure or spinal NPCs injection-related side effects.

• Klíčová slova
• cryopreservation, human induced pluripotent stem cells (hiPSCs), human injection device, immunosuppressed adult pig, neural precursor cells (NPCs), spinal cord,
• MeSH
• buněčná diferenciace fyziologie   MeSH
• dospělí MeSH
• genetické vektory genetika   MeSH
• indukované pluripotentní kmenové buňky * fyziologie   transplantace   MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• mícha MeSH
• mozek MeSH
• nervové kmenové buňky * fyziologie   transplantace   MeSH
• odběr biologického vzorku metody   MeSH
• odběr tkání a orgánů metody   MeSH
• prasata MeSH
• přeprogramování buněk * genetika   fyziologie   MeSH
• přežívání štěpu fyziologie   MeSH
• spinální injekce * škodlivé účinky   přístrojové vybavení   metody   MeSH
• transplantace kmenových buněk * škodlivé účinky   přístrojové vybavení   metody   MeSH
• virus Sendai MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY The clinical prospective study presents the results of minimally invasive harvesting of cancellous bone tissue in trauma indications. We focused on evaluating the clinical outcomes of this technique, particularly on the amount of cancellous bone harvested, the effectiveness of its use and complications. The pain in the bone graft harvest site is evaluated and compared with the pain after a standard harvest from the iliac crest. MATERIAL AND METHODS All the patients aged 18-90 years, in whom cancellous bone was harvested by minimally invasive technique using a bone cutter were included prospectively in the study. It was used to fill the defect in treating a fracture or in surgical treatment of non-union. The patients, in whom the grafts harvested in this manner were combined with another substitute, were not included in the study. Thus, 57 adult patients (40 men, 17 women) were included in the group in the period from March 2012 to March 2016. 37 patients, i.e. 65% of the total number of 57 patients, arrived for the evaluation of the clinical outcome. The minimally invasive graft harvesting was performed using the Aesculap® cutters. The graft was harvested either from the skeleton directly in the area of surgical wound or by a mini incision above the harvest site in the area under surgical drapes. The diameter of the cutter was selected based on the planned necessary number of grafts and with account taken of the harvest site. There were 6 harvest sites selected - proximal humerus, proximal ulna, iliac crest, greater trochanter of femur, distal femur and proximal tibia. The age and gender of patients, harvest site, type of the used cutter and the total number of harvested grafts were recorded in the study. The patients underwent a clinical follow-up at 6 weeks, 3 months, 6 months and 1 year postoperatively. The healing of the fracture or non-union was assessed on radiographs and in case of any doubt a CT scan was indicated. The pain at the graft harvest site was quantified with the use of the VAS score. A possible correlation between the age and the harvest site pain was explored by means of the Pearson s correlation coefficient. RESULTS In surgical management of fractures, 10.98 cm³ of bone marrow (σ 5.32) was harvested on average, in non-unions it was 10.85 cm³ (σ 5.52). With the above described technique, the mean healing time of lower extremity fractures was 26 weeks, in upper extremity it was 22 weeks. The non-unions of lower extremity and upper extremity healed after 28 weeks and 19 weeks, respectively. The average pain at the harvest site was 4.08 (σ 2.21, p ˂ 0.001). By calculating the Pearson's correlation coefficient it was confirmed that there is no correlation between the age and pain VAS score at the harvest site (r = -0.05). No early complications at the graft harvest site were observed in our group of patients. DISCUSSION On average, 10.98 cm³ of bone marrow was harvested in treated fractures, which in comparison to standard harvests from the iliac crest offers sufficient amount of tissue to treat complicated fractures and non-unions. Technically, the standard harvest site of cancellous bone tissue from the iliac crest is replaceable. The harvesting technique offers an interesting alternative also in terms of the duration of surgery and material. CONCLUSIONS Our study confirmed that by the minimally invasive technique of bone graft harvesting adequate amount of tissue to treat defect fractures and non-unions can be harvested. Spongioplasty using grafts harvested in this manner is effective, with a minimum percentage of non-unions. The advantage of this technique is the proximity of the harvest site and the operative field and low level of pain. The minimally invasive graft harvesting represents a technique with a low risk of postoperative and late complications. Key words: bone graft, autografts, minimally invasive surgery, ilium, pain.

• MeSH
• dospělí MeSH
• fraktury kostí chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nezhojené fraktury chirurgie   MeSH
• odběr tkání a orgánů metody   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trabekulární kostní tkáň transplantace   MeSH
• transplantace kostí metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH

BACKGROUND: Europe is currently the most active region in the field of pancreatic islet transplantation, and many of the leading groups are actually achieving similar good outcomes. Further collaborative advances in the field require the standardization of islet cell product isolation processes, and this work aimed to identify differences in the human pancreatic islet isolation processes within European countries. METHODS: A web-based questionnaire about critical steps, including donor selection, pancreas processing, pancreas perfusion and digestion, islet counting and culture, islet quality evaluation, microbiological evaluation, and release criteria of the product, was completed by isolation facilities participating at the Ninth International European Pancreas and Islet Transplant Association (EPITA) Workshop on Islet-Beta Cell Replacement in Milan. RESULTS: Eleven islet isolation facilities completed the questionnaire. The facilities reported 445 and 53 islet isolations per year over the last 3 years from deceased organ donors and pancreatectomized patients, respectively. This activity resulted in 120 and 40 infusions per year in allograft and autograft recipients, respectively. Differences among facilities emerged in donor selection (age, cold ischemia time, intensive care unit length, amylase concentration), pancreas procurement, isolation procedures (brand and concentration of collagenase, additive, maximum acceptable digestion time), quality evaluation, and release criteria for transplantation (glucose-stimulated insulin secretion tests, islet numbers, and purity). Moreover, even when a high concordance about the relevance of one parameter was evident, thresholds for the acceptance were different among facilities. CONCLUSIONS: The result highlighted the presence of a heterogeneity in the islet cell product process and product release criteria.

• MeSH
• časové faktory MeSH
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• kultivované buňky transplantace   MeSH
• Langerhansovy ostrůvky cytologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• odběr tkání a orgánů metody   normy   statistika a číselné údaje   MeSH
• perfuze metody   statistika a číselné údaje   MeSH
• počet buněk normy   statistika a číselné údaje   MeSH
• předškolní dítě MeSH
• primární buněčná kultura metody   normy   statistika a číselné údaje   MeSH
• průzkumy a dotazníky statistika a číselné údaje   MeSH
• senioři MeSH
• separace buněk metody   statistika a číselné údaje   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• studená ischemie normy   statistika a číselné údaje   MeSH
• transplantace Langerhansových ostrůvků metody   normy   MeSH
• věkové faktory MeSH
• výběr dárců metody   normy   statistika a číselné údaje   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.

• MeSH
• cholangitida etiologie   MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• odběr tkání a orgánů škodlivé účinky   metody   MeSH
• perfuze škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• přežívání štěpu MeSH
• průzkumy a dotazníky MeSH
• reperfuze škodlivé účinky   metody   MeSH
• transplantace jater škodlivé účinky   MeSH
• uchovávání orgánů škodlivé účinky   metody   MeSH
• žlučové cesty krevní zásobení   transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Geografické názvy
• Evropa MeSH

Although uterus transplantation is still in the experimental stage, it has promising potential as a treatment for women with absolute uterine factor infertility based on the childbirths from living donor trials conducted in Sweden and the United States. We report the main characteristics and perioperative and postoperative courses of both recipients and donors following 4 deceased donor and 5 living donor uterus transplantations. Three main priorities differentiate this study from the previously reported uterus transplantations. First, clinical experience with the largest worldwide group of deceased donor uterine transplants is described. Second, in the majority of living donor uterine recipients, only 2 ovarian veins were used for venous blood outflow. All of these recipient procedures were surgically successful, and follow-up posttransplant ultrasound examinations revealed normal uterine blood supply and outflow. Third, in only one living and one deceased donor recipient, the transplanted uterus relied on only 2 uterine veins for venous outflow with a 50% surgical success rate. In all other recipients, 2 uterine and 2 ovarian veins were utilized. Although a successful pregnancy has not yet been achieved, the presented surgical and functional results of our trial are promising.

• Klíčová slova
• clinical research/practice, donors and donation: deceased, donors and donation: living, obstetrics and gynecology, organ procurement, organ transplantation in general,
• MeSH
• dárci tkání zásobování a distribuce   MeSH
• dospělí MeSH
• klinické zkoušky jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• odběr tkání a orgánů metody   MeSH
• přežívání štěpu MeSH
• prognóza MeSH
• smrt * MeSH
• transplantace orgánů metody   MeSH
• uterus transplantace   MeSH
• ženská infertilita chirurgie   MeSH
• žijící dárci zásobování a distribuce   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: There is still a lack of organs for kidney transplantation. The aim of our experimental animal study was to improve the quality of the kidney grafts from donors after cardiac death (DCD) using immediate start of machine perfusion instead of perfusion based on hydrostatic pressure. METHODS: Ten rabbits were used as an experimental model. In group A, 5 kidneys after ischemic injury were perfused in situ using hydrostatic pressure. In group B, 5 kidneys were perfused in situ using machine pulsatile perfusion. After nephrectomy kidney parenchyma was histologically analyzed. We have evaluated the maximum perfusion flow rate, temperature drop rate, and degree of parenchymal injury. RESULTS: The flow rate in the group of machine-perfused animals (group B) was significantly higher than in the control group (group A), and temperature was significantly decreased in group B (P < .001). Qualitative histopathologic evaluation of the perfusion quality of the grafts was statistically significant, again in favor of machine perfusion in group B (P = .005). DISCUSSION: According to our results, the immediate start of machine perfusion is a superior method of kidney graft preservation in DCDs. All observed modalities were superior in the group with machine perfusion compared with usual clinical practice.

• MeSH
• dárci tkání MeSH
• králíci MeSH
• ledviny * MeSH
• modely nemocí na zvířatech MeSH
• nefrektomie MeSH
• odběr tkání a orgánů metody   MeSH
• perfuze metody   MeSH
• pulzatilní průtok MeSH
• smrt MeSH
• transplantace ledvin metody   MeSH
• transplantáty MeSH
• uchovávání orgánů metody   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH