The posterior approach for low retrorectal tumors in adults

Background and aims: Retrorectal tumors are uncommon in adults and arise in different tissues in the presacral space. The aim of this study is to evaluate early complete surgical resection by a perineal approach as the therapy-of-choice for tumors under the sacral promontory. Patients and methods: We evaluated the posterior approach, especially intersphincteric and parasacrococcygeal excisions, in terms of resectability, morbidity, risk of recurrence, and anal function. The records of all patients who underwent a posterior surgical procedure in our institution for low-lying retrorectal tumors between 1994 and 2003 were reviewed. Results: Sixteen patients (13 women and three men) were included in this study. The age range was 21 to 57years (median of 37years). Pathological findings included ten tailgut cysts, three teratomas, one leiomyoma, one dermoid cyst, and one schwannoma. Complete tumor resection was obtained in 15 patients. There was one case with a microscopic residual tumor. No postoperative mortality was seen, and a minor complication occurred in one patient. There was no anal dysfunction. The postoperative course was uneventful, with only one tumor recurrence at 5months. The median follow up was 60months (ranging from 18 to 132months). Conclusion: In this study, the posterior approach allows complete resection of low retrorectal tumors, with low morbidity, no incontinence, nearly no recurrence, and no mortalit

Impact of robotic general surgery course on participants' surgical practice

Background: Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. Methods: Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1months (range, 2-48), a retrospective review of the participants' surgical practice was performed using online research and surveys. Results: Among the 101 participants, there was a majority of general (58.4%) and colorectal surgeons (10.9%). Other specialties included urologists (7.9%), gynecologists (6.9%), pediatric surgeons (2%), surgical oncologists (1%), engineers (6.9%), and others (5.9%). Data were fully recorded in 99% of cases; 46% of participants started to perform robotic procedures after the course, whereas only 6.9% were already familiar with the system before the course. In addition, 53% of the attendees worked at an institution where a robotic system was already available. All (100%) of participants who started a robotic program after the course had an available robotic system at their institution. Conclusions: A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system availabl

Robotic Single-Port Cholecystectomy Using a New Platform: Initial Clinical Experience

Background: The technique of single-port laparoscopy was developed over the past years in an attempt to reduce the invasiveness of surgery. A reduction of incisions and their overall size might result in enhanced postoperative cosmesis and potentially reduce pain when compared to conventional techniques. While manual single-port laparoscopy is technically challenging, a newly approved robotic platform used with the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA, USA) might overcome some of the difficulties of this technique. Methods: Patients with cholelithiasis were scheduled for robotic single-port cholecystectomy in an initial clinical trial. Demographic data, intra- and short-term postoperative results were assessed prospectively. Results: Twenty-eight patients (22 females/6 males; median age, 48years) underwent robotic single-port cholecystectomy in our first week of clinical cases. Median OR time was 80min with a median docking time of 8min and median robotic console time of 53min. Two patients underwent intraoperative cholangiography. Eight cases presented with adhesions, tissue alterations, or anatomical abnormalities. No conversions, intra- or postoperative complications occurred. Conclusion: Robotic single-port cholecystectomy appears feasible and safe in our early experience. The robotic approach to single-port surgery seems to overcome some of the technical difficulties of manual single-port surgery. This robotic platform may facilitate completion of more complex case

Structured Cooperative Learning as a Means for Improving Average Achievers' Mathematical Learning in Fractions

International audienceIn primary school, learning fractions is a central mathematical objective. However, the mastery of basic procedures involving fractions presents a difficulty for many students. The aim of the current intervention is to introduce structured cooperative learning as means to improve students' learning, particularly for average achievers. Previous research has underscored that heterogeneous groups might be deleterious for average achievers because they are excluded by the teacher learner relationships that is likely to take place between low and high achievers students. This intervention proposes structuring interactions in order to boost the learning of average achievers in heterogeneous groups. We hypothesize that highly structured cooperative learning should improve average achievers' understanding of the content-targeted in group work as well as progress in terms of fractions learning, when compared to low-structured cooperative learning. In this intervention, 108 fifth graders worked cooperatively in heterogeneous triads (a low, average, and high achiever). The triads had to express the length of one segment using three rulers with different sub-units and respecting three mathematical skills regarding fractions. Triads were randomly assigned to a low-structured or high-structured cooperative learning condition. In the low-structured condition, no specific structure was provided. (i.e., they organized their cooperative work as they wished). In the high-structured condition, each student became an expert for one part before working in the triad and endorsed different responsibilities. The results indicated that highly structured cooperative learning favors the understanding of the targeted task, especially for average-ability students. Moreover, students at all levels progressed from the baseline test to the post-test. Indeed, low and high achievers had the same progression in both conditions, whereas average achievers progressed more in the highly structured condition. Results are discussed in terms of new teaching methods that could efficiently increase average achievers’ performances

Transarterial embolization in acute colonic bleeding: review of 11years of experience and long-term results

Background: Lower gastrointestinal bleeding represents 20% of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding. Methods: From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. Results: Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80years (range, 42-94years). The underlying etiologies included diverticular disease (41.9%), post-polypectomy bleeding (16.7%), malignancy (8.2%), hemorrhoid (4.1%), and angiodysplasia (4.1%). In 23 patients, bleeding stopped (95.8%) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7%). One patient died of ileal ischemia (mortality, 4.1%). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18days (range, 9-44days). After a mean follow-up of 28.6months (range, 4-108months), no other ischemic events occurred. Conclusion: In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21% risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operatio

Single Port Access Laparoscopic Cholecystectomy (with video)

Background: Single port access (SPA) surgery is a rapidly evolving field due to the complexity of NOTES (natural orifice translumenal endoscopic surgery). SPA combines the cosmetic advantage of NOTES and possibility to perform surgical procedure with standard laparoscopic instruments. We report a technique of umbilical SPA cholecystectomy using standard laparoscopic instruments and complying with conventional surgical principle and technique of minimally invasive cholecystectomy. Methods: Preliminary, prospective experience of SPA cholecystectomy in 11 patients (median age, 46 (range, 27-63) years) scheduled for cholecystectomy was evaluated. Diagnoses for cholecystectomy were: symptomatic gallbladder lithiasis (n=7), previous acute cholecystitis (n=3), and biliary pancreatitis (n=1). Results: SPA cholecystectomy was feasible in all patients (median body mass index, 24 (range, 20-34) kg/m2) who were scheduled for preliminary experience using conventional laparoscopic instruments. Median operative time was 52 (range, 40-77) minutes. Intraoperative cholangiography was performed in all patients, except one, and was considered normal. No peroperative or postoperative complications were recorded. Median hospital stay was less than 24 h. Conclusions: SPA cholecystectomy is feasible and seems to be safe when performed by experienced laparoscopic surgeons using standard laparoscopic instrumentation. SPA cholecystectomy may be safer than the NOTES approach at this time. It has to be determined whether this approach would benefit patients, other than cosmesis, compared with standard laparoscopic cholecystectom

Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study

Background: Anastomotic dehiscence is the most severe surgical complication after large bowel resection. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with anastomotic leakage after colorectal surgery. Materials and methods: All procedures involving anastomoses of the colon or the rectum, which were performed between November 2002 and February 2006 in a single institution, were prospectively entered into a computerized database. Results: One thousand eighteen colorectal resections and 811 anastomoses were performed over this 40-month period. The most frequent procedures were sigmoid (276) and right colectomies (217). The overall anastomotic leak rate was 3.8%. The mortality rate associated with anastomotic leak was 12.9%. In univariate analysis, the following parameters were associated with an increased risk for anastomotic dehiscence: (1) ASA score ≥ 3 (p = 0.004), (2) prolonged (>3h) operative time (p = 0.02), (3) rectal location of the disease (p  25 (p = 0.04). In multivariate analysis, ASA score ≥ 3 (OR = 2.5; 95% CI 1.5-4.3, p  3h [OR = 3.0; 95% CI 1.1-8.0, p = 0.02), and rectal location of the disease (OR = 3.75; 95% CI 1.5-9.0 (vs left colon), p = 0.003; OR = 7.69; 95% CI 2.2-27.3 (vs right colon), p = 0.001] were factors significantly associated with a higher risk of anastomotic dehiscence. Conclusions: Three risk factors for anastomotic leak have been identified, one is patient-related (ASA score), one is disease-related (rectal location), the third being surgery-related (prolonged operative time). These factors should be considered in perioperative decision-making regarding defunctioning stoma formatio