Early results of a safety and feasibility clinical trial of a novel single-port flexible robot for transoral robotic surgery

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Hospital Authority audit of the outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong

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TSC1/2 mutations define a molecular subset of HCC with aggressive behaviour and treatment implication

Objective We investigated the mutational landscape of mammalian target of rapamycin (mTOR) signalling cascade in hepatocellular carcinomas (HCCs) with chronic HBV background, aiming to evaluate and delineate mutation-dependent mechanism of mTOR hyperactivation in hepatocarcinogenesis. Design We performed next-generation sequencing on human HCC samples and cell line panel. Systematic mutational screening of mTOR pathway-related genes was undertaken and mutant genes were evaluated based on their recurrence. Protein expressions of tuberous sclerosis complex (TSC)1, TSC2 and pRPS6 were assessed by immunohistochemistry in human HCC samples. Rapamycin sensitivity was estimated by colony-formation assay in HCC cell lines and the treatment was further tested using our patient-derived tumour xenograft (PDTX) models. Results We identified and confirmed multiple mTOR components as recurrently mutated in HBV-associated HCCs. Of significance, we detected frequent (16.2%, n=18/111) mutations of TSC1 and TSC2 genes in the HCC samples. The spectrum of TSC1/2 mutations likely disrupts the endogenous gene functions in suppressing the downstream mTOR activity through different mechanisms and leads to more aggressive tumour behaviour. Mutational disruption of TSC1 and TSC2 was also observed in HCC cell lines and our PDTX models. TSC-mutant cells exhibited reduced colony-forming ability on rapamycin treatment. With the use of biologically relevant TSC2-mutant PDTXs, we demonstrated the therapeutic benefits of the hypersensitivity towards rapamycin treatment. Conclusions Taken together, our findings suggest the significance of previously undocumented mutation-dependent mTOR hyperactivation and frequent TSC1/2 mutations in HBV-associated HCCs. They define a molecular subset of HCC having genetic aberrations in mTOR signalling, with potential significance of effective specific drug therapy.published_or_final_versio

Simultaneous laparoscopic totally extraperitoneal repair for concurrent ipsilateral spigelian and indirect inguinal hernia

Simultaneous unilateral spigelian and inguinal hernia is uncommon. Majority of the approaches to repair of spigelian hernia is open surgery. We report our technique of a simultaneous repair of both spigelian and inguinal hernia using the totally extraperitoneal laparoscopic mesh repair. © 2008 by Lippincott Williams & Wilkins.link_to_subscribed_fulltex

Push-type percutaneous endoscopic gastrostomy with ultrathin endoscope in patients with severe trismus or obstruction due to head and neck cancers: A case series

Aim: Endoscopically-placed, push-type percutaneous endoscopic gastrostomies (PEG) have recently been made possible through the use of a gastropexy device. However, the safety and efficacy of the procedure in patients suffering from severe trismus or malignant obstruction due to head and neck cancers have rarely been reported. The aim of this study was thus to investigate the feasibility, safety and risk of endoscopic push-type PEG in this group of patients. Patients and Methods: Consecutive patients who were indicated for PEG and suffered from severe trismus or malignant obstruction due to head and neck cancers, precluding the introduction of a 9.8mm oesophagogastroduodenoscope were included. Push-type PEG was performed under endoscopic control with a 5-mm endoscope and the loop fixture device. Results: Eleven patients had push-type PEG performed under conscious sedation. All procedures were successful, and minor complications occurred in one patient with a dislodged gastrostomy tube and another with wound infection. There were no mortalities or major morbidities related to the procedure. Conclusions: Push-type PEG with gastropexy inserted under endoscopic control by an ultrathin endoscope is a feasible alternative to open gastrostomy in patients with severe trismus or pharyngeal obstruction. © 2011 The Authors. Surgical Practice © 2011 College of Surgeons of Hong Kong.link_to_subscribed_fulltex

A case-controlled comparison of single-site access versus conventional three-port laparoscopic appendectomy

Background: The aim of this study was to compare patients who underwent single-site access laparoscopic appendectomy (SSALA) to those who underwent conventional three-port laparoscopic appendectomy (TPLA) in a case-controlled manner. Methods: Consecutive patients who underwent SSALA for suspected acute appendicitis between April and September 2009 were retrospectively compared to those who underwent TPLA between January and December 2008 in a case-controlled manner. The patients were matched for age, gender, and pathological findings. The main outcome measurements included postoperative recovery, morbidities, and mortalities. Results: During the study period, a total of 30 patients underwent SSALA and these were matched with 60 TPLA patients. There were no significant differences in the mean operative time, hospital stay, and 30-day morbidity rate between the two groups. None of the patients required conversion. Two patients with significant contamination and abscess collection noted during SSALA required a relaparotomy for peritoneal lavage and adhesiolysis due to prolonged ileus. Conclusions: SSALA is feasible and the perioperative outcome was comparable to that of TPLA. However, future prospective studies will need to evaluate whether SSALA can adequately tackle patients with significant peritoneal contamination. © 2010 Springer Science+Business Media, LLC.link_to_subscribed_fulltex

A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

Background: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.link_to_subscribed_fulltex

A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

Background: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.link_to_subscribed_fulltex