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Purpose Robotic-assisted minimally invasive esophagectomy (RAMIE) has become one standard approach for the operative treatment of esophageal tumors at specialized centers. Here, we report the results of a prospective multicenter registry for standardized RAMIE. Methods The German da Vinci Xi registry trial included all consecutive patients who underwent RAMIE at five tertiary university centers between Oct 17, 2017, and Jun 5, 2020. RAMIE was performed according to a standard technique using an intrathoracic circular stapled esophagogastrostomy. Results A total of 220 patients were included. The median age was 64 years. Total minimally invasive RAMIE was accomplished in 85.9%; hybrid resection with robotic-assisted thoracic approach was accomplished in an additional 11.4%. A circular stapler size of ≥28 mm was used in 84%, and the median blood loss and operative time were 200 (IQR: 80–400) ml and 425 (IQR: 335–527) min, respectively. The rate of anastomotic leakage was 13.2% (n=29), whereas the two centers with >70 cases each had rates of 7.0% and 12.0%. Pneumonia occurred in 19.5% of patients, and the 90-day mortality was 3.6%. Cumulative sum analysis of the operative time indicated the end of the learning curve after 22 cases. Conclusions High-quality multicenter registry data confirm that RAMIE is a safe procedure and can be reproduced with acceptable leak rates in a multicenter setting. The learning curve is comparably low for experienced robotic surgeons.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In recent years the research on new materials for application in construction had intensified in order to rationalize the manpower in the sector. Thereat, many studies are being conducted with the goal of developing composites for use in construction. The use of composites as wall panels is sustainable when the materials used are biodegradable. The objective of this research is produce and characterize polymeric composites using a castor oil polyurethane matrix reinforced with ramie, sisal and sponge gourd fibers. The composites were reinforced with unidirectional and randomly distributed fibers, with volume of 25%, 35%, 45% and 55%. The composites were produced compressed at room temperature, interleaving fiber and resin to secure the void reduction and adhesion of the fiber to the matrix. Through the tensile test the tensile strength, Young s modulus and maximum deformation were determined. The best results were obtained in composites reinforced with 45% unidirectional continuous sisal fibers. The composites reinforced with ramie fiber also showed excellent Young s modulus (23 GPa). Therefore, the study showed that fiber sisal, rami and sponge gourd reinforced castor oil polyurethane composites presented good properties for many uses in civil construction. / Nos últimos anos intensificou-se a busca por novos materiais para aplicação na construção civil, a fim de racionalizar a mão de obra no setor. Uma alternativa viável é a utilização da construção seca, que utiliza painéis de vedação montáveis com função de compartimentação dos ambientes. Com isso inúmeras pesquisas estão sendo realizadas para caracterização de compósitos para a construção civil. A aplicação de compósitos como painéis de vedação torna-se ainda mais sustentável quando os materiais utilizados são biodegradáveis. Assim, o objetivo deste trabalho é produzir e caracterizar compósitos poliméricos utilizando como matriz a resina poliuretana à base de óleo de mamona, reforçada com teores e distribuições variáveis de fibras de rami, sisal e bucha vegetal. Os compósitos foram reforçados com as fibras distribuídas unidirecionalmente e aleatoriamente, com teor de fibra de 25%, 35%, 45% e 55%, em volume. Os compósitos foram produzidos por compressão à temperatura ambiente, intercalando as camadas de fibras com a resina para redução dos vazios e garantir a adesão das fibras a matriz. A partir do ensaio de tração determinou-se a resistência à tração, módulo de elasticidade e a deformação máxima. As melhores propriedades apresentaram-se nos compósitos com 45% de reforço de fibra de sisal contínuo unidirecional. Os compósitos reforçados com fibra de rami também apresentaram módulo de elasticidade elevado (23 GPa). Portanto, pode-se concluir que os compósitos com resina poliuretana com reforço de sisal, rami e bucha vegetal apresentaram propriedades adequadas para usos diversos na construção civil. / Mestre em Engenharia Civil