Robotic colorectal surgery initial results after 183 cases

IntroductionColorectal cancer is the third most common malignancy (6.1%) worldwide among men and women, and the second reason for death. The current treatment is based on locoregional therapy: surgery, radiotherapy, and systematic treatment like chemotherapy. Now it is well known that laparoscopic/robotic surgery is equal, or even superior, to the open one in colorectal procedures.AimThe aim of this study was to analyze and share our initial results in robotic colorectal surgery and compare them with literature dataMaterials and Methods: A retrospective study was conducted in order to review our first 183 patients with colorectal cancers operated by a robot-assisted and totally robotic techniques. Gender, age, diagnosis and surgical indications, type of surgery, surgical time, conversion, bleeding, post-operative complications, and hospital stay were analyzed and described.Results: The mean age of the patients was 67.87 ± 14.10 years, 101 (58.38%) of them were male and 72 (41.62%) female. The most common localization for the tumor was the rectum—62 (35.83%), followed by the sigmoid—26 (15.02%), left colon—23 (13.29%), cecum—19 (10.98%), rectosigmoid—12 (6.93%), ascending colon—12 (6.93%), right flexure—10 (5.78%), left flexure—4 (2.33%), transverse colon—4 (2.33). The mean blood loss was 165.45 ± 82.85 mL and the mean operative time was 195.20 ± 82.40 min. The average length of hospital stay was 7.22 ± 4.08 days.Conclusion: Our research shows that robotic colorectal surgery can be performed successfully with good short-term outcomes due to the advantages of the DaVinci system and personal laparoscopic experience. One of the disadvantages of robotic surgery is prolonged operative time, which we think could be improved with the accumulation of experience

The Role of Indocyanine Green in Colorectal Surgery

Introduction: Colorectal cancer is one of the most common gastrointestinal tumors. Anastomotic leakage (AL) after low rectal resections remains a serious problem worldwide, varying between 5% and 20%. The main risk factors for AL are the height of the anastomosis, gender, non-adjuvant therapy, difficult mesorectal excision, advanced age, nutritional status of the patient, as well as the chronic use of certain medications. The concept of intraoperative indocyaninegreen (ICG) angiography is based on its ability to absorb near-infrared (NIR) light up to 800 nm and emit fluorescence at a wavelength of 830 nm. Bolus of ICG is injected into the patient intravenously. After a period of time, NIR light is absorbed by the ICG in the tissues and the resulting fluorescence is a reflection of tissue perfusion.Aim: The aim of study is to evaluate the efficancy of ICG in colorectal surgery.Materials and Methods: We conducted a retrospective study, with all robotic colorectal resections for the last year, with and without ICG, for perfusion assessement before and after the construction of the anastomosis, as well as the last 48 colorectal cases without the use of ICG.In our patients, we did not observe significant differences in the operative time (201.6 ± 87.5 min in the ICG and 204.9 ± 76.1 in the group without, 95% CI: −12.42 to 10.87; p = 0.87), the intraoperative blood loss (100 ± 78. mL in ICG group and 98 ± 68 mL in the other; 95% CI: −16.43 to 7.35; p = 0.42), and in the need for blood transfusion in both groups (95% CI: 0.37–2.72; p = 1.10). The incidence of AL in the ICG and non-ICG group was 1/16.6.2% vs. 4/48,8.3%, (95% CI: 0.39–0.56; p < 0.). In the hospital stay, we did not observe a significant difference in the two groups. It was 6.7 ± 5.2 days in the group with ICG and 6.5 ± 5.1 in the group without (95% CI: −0.84 to 0.05; p = 0.08).Conclusion: The results of our study support the thesis of most authors about reducing the AL rate when using ICG. Larger multicenter studies are needed to confirm these data

Robotic Right and Left Colectomies: Extra- or Intracorporeal Anastomosis

IntroductionRobotic right and left hemicolectomies for colon cancer are among the most common surgical procedures. In the past decades they began to be performed laparoscopically and in recent years—by robotic surgical systems. Despite the enhanced recovery protocols and minimal invasiveness of the procedure, there are still complications. Robotic right and left hemicolectomies with an intracorporeal anastomosis (ICA) are less invasive than the same robotic-assisted procedures, and could lead to fast recovery and shortening of the postoperative period.Aim The aim of the study is to evaluate the feasibility and safety of the intracorporeal anastomosis after robotic left and right colectomies.Results and Discussion: Surgical time was found to be insignificantly shorter in the intracorporeal anastomosis group: 125.1 ± 37.1 vs. 128.2 ± 21.1 for right colectomy and 147.3 ± 39.1 vs. 153.8 ± 58.1 for left colectomy.Many studies show similar results, but the advantages of intracorporeal anastomosis evaluated by visual analog scale (VAS) are even more significant. Our results did not indicate significant difference in number of harvested lymph nodes: 24.9 ± 11.3 vs. 25.1.9 ± 10.1 and 26.8 ± 9.3 vs. 25.9 ± 11. Anastomotic leakage in extracorporeal anastomosis (ECA) after left colectomy was significantly higher: 2 (11.7%), < 0.001. Wound infections in our patients again were insignificantly higher in ECA 0.0 vs. 1 (4.2%) in right and 1 (6.2%) vs. 1 (5.9%) in left colon. Overall hospital stay was also significantly shorter in ICA left colectomies and insignificantly in right ones: 7.0 ± 4.9 vs. 7.8 ± 4.1, P = 0.217, and 6.1 ± 2.5 vs. 8.0 ± 4.9, P < 0.001.Conclusion: The results of our study confirmed the literature data that ICA after colon resection is a safe and feasible procedure, accepted by many colorectal surgeon

Laparoscopic or conventional abdominoperineal extirpation in low rectal cancer

INTRODUCTION: Laparoscopic abdominoperineal resection (LAPR) as a minimally invasive approach for the treatment of large rectal cancer is widely used. It has been proven to be technically feasible and safe with fewer complications and faster postoperative recovery than the open procedure. Our aim was to evaluate LAPR safety and feasibility as compared to the open procedure in large low rectal cancer.PATIENTS AND METHODS: A total of 34 low rectal cancer patients who underwent open APR (OAPR) were matched with 42 patients who underwent LAPR in a one-to-one fashion between 2011 and 2014 in the Divi­sion of General Surgery, Kaspela University Hospital of Plovdiv.RESULTS: Intraoperative parameters of LAPR were better than those of OAPR as followed: mean operation time (121.8±47.8 min versus 152.1±49.2 min), mean operative blood loss (82±30.0 mL versus 120±35.0 mL), mean total number of retrieved lymph nodes (12±1 versus 12±1.4), and percentage of surgical complications (12.3% versus 15.1%). Laparoscopically treated patients showed significantly shorter postoperative analge­sia (2.1±0.7 days versus 3.7±0.6 days), earlier first flatus (36.3±7.9 hours versus 48.5±9.2 hours), shorter uri­nary drainage (3.8±3.4 days versus 5.8±1.3 days), and shorter hospital stay (6.2±1 days versus 8±2.0 days). Local recurrence rate during a three-year period (in 3 versus 4 patients) and metachronous liver metastasis (in 5 versus 6 patients) were less common after LAPR than after OAPR.CONCLUSION: The risks of APR-specific surgical complications such as perineal wound infection and para­stomal hernia were comparable between the laparoscopic and open surgery groups. There were no signifi­cant differences regarding local recurrence and metachronous liver metastasis between these groups. Com­plication and locoregional recurrence rates in low large rectal cancer patients after laparoscopic and open were quite similar. Scr Sci Med 2017; 49(3): 22-2

The role of extended resection in locally recurrent colorectal cancer with invasion of the aortoiliac bifurcation: a rare clinical case

Colorectal carcinoma (CRC) is the third most common cancer and the fourth deadliest. Despite recent advances in screening methods and preoperative imaging techniques, the threat of colorectal cancer remains at an all-time high. Moreover, even after curative treatment, disease recurrence occurs in up to 40% of all cases. However, half of patients with recurrent disease do not register any distant metastases. Therefore, much effort should be expended in identifying and evaluating these patients, as many of them are suitable candidates for en bloc resections with perioperative chemoradiation. In fact, it has recently been found that overall survival benefits greatly from extended resections, provided that free margins are achieved intraoperatively. In this case report, we will present a case of locally advanced recurrent colorectal cancer invading the aortoiliac axis and our approach to achieving a R0 resection

Anticipation in entrepreneurship

Entrepreneurship is a forward looking activity that embodies implicit imaginaries. If we remove the notion of a future from the field of entrepreneurship, field would cease to exist as its whole rationale is prospective. Entrepreneurship creates future value (Schumpeter 1934) through creative destruction; in uncertain contexts (Knight 1923) and with ‘alertness’ to opportunity (Kirzner 1982). Entrepreneurial opportunity em-braces anticipation as imaginative reason, strategically employed and motivated by aspiration. Entrepreneurial effectuation is concerned with the controllable aspects of an unpredictable future. Entrepreneuring is a process (Steyaert 2007) producing ontological emergence. Entrepreneurship is expressed in action and produces change. Nadin observes that anticipation relates to the perception of change (Nadin 2010) and is always expressed in action (Nadin 2015). Entrepreneurial identity is sig-nificant and the models embodied in an anticipatory system are what comprise its individuality; what distinguish it uniquely from other sys-tems. A change in these models is a change of identity (Rosen et al. 2012, p370). Entrepreneurship is relational and is coupled with other ac-tors in the environment, generating a sense of shared anticipation, or anticipatory coupling. Anticipatory coupling as a social phenomenon seems ripe for further research. Being emplaced, entrepreneuring practice involve sensing and anticipation (Antonacopoulou and Fuller 2019). Although anticipation is a natural activity, the effectiveness of anticipation can be improved through greater awareness in each of these sets of processes, among others. We suggest that the dynamics of emergence require anticipations of multiple forms of value. Seeing entrepreneurship from an anticipatory standpoint brings more to the fore the nature of values in practice. Further research can help reveal the anticipatory work is done in entrepreneurship to maintain the anticipatory capacity of the enterprise and of the interdependent relationships that maintain the enterprise

Total extra peritoneal inguinal hernia repair: a single-surgeon preliminary findings report

Introduction: Inguinal hernia repair is one of the most frequent operations in general surgery. Various techniques have been used to repair inguinal hernias since the first reconstructive technique described by Bassini in 1887. In 1989 Lichtenstein reported a new technique: tension free inguinal hernia repair. Laparoscopic inguinal hernia repair was introduced in the early 1990s, and soon also became popular. Literature has shown the benefits of laparoscopy (in comparison with open repair) to be mostly related to the more minimally invasive nature of the surgery, having lower wound infection rates, faster recovery, and less postoperative pain.&amp;nbsp;Aim: To evaluate our totally extraperitoneal (TEP) inguinal hernia repair initial results and compare them to literature data.Materials and methods: In a prospective review and analysis, we examined 61 cases of hernia repair via laparoscopy (specifically TEP), performed by a single surgeon, between April 2019 and December 2019 at the Kaspela University Hospital in Plovdiv. The centre&amp;rsquo;s Institutional Review Board approved the study with no specific consents required due to the retrospective, minimal risk nature of the study. The routine informed consent required by the National Insurance Fund has been considered sufficient for the study objectives.The surgical outcome measures included operating time (hours/minutes), conversion, peritoneal injury, surgical emphysema; and the clinical outcome measures included postoperative seroma, post-operative infection, and post-operative chronic groin pain.Results: Inguinal pain on discharge was characterized as mild by 56 (96.55%) patients and moderate by 2 (3.44%), there were no patients describing the pain as severe. The most frequently reported postoperative complications were annoyance and discomfort (10.34%), swelling (6.9%), seroma (3.44), hematoma (1.72%), paresthesia 1.72% (1); however, only those with seromas required special treatment.Conclusions: Limitations of the present study include the relatively small number of patients, all cases were operated on by a single surgeon and short postoperative follow-up period, but we are sharing our initial six months results. These results demonstrate that laparoscopic TEP inguinal hernia repair without mesh &amp;#64257;xation is a reliable technique, which can reduce postoperative morbidity when applied by experienced surgeons

Prophylactic Central Neck Lymph Node Dissection Adds No Short-Term Benefit to Total Thyroidectomy for Differentiated Thyroid Cancer

Background and Objectives: To answer the research question: “Is prophylactic central neck lymph node dissection (pCNLD) beneficial among differentiated thyroid carcinoma (DTC) patients?” Materials and Methods: This was a retrospective cohort study enrolling DTC patients treated at the University Hospital Kaspela, Bulgaria, from 30 January 2019 to October 2021. The predictor variable was presence of pCNLD (total thyroidectomy with vs. without pCNLD). The main outcome variables were postoperative complications (i.e., vocal cord paralysis, hypoparathyroidism, postoperative bleeding, and adjacent organ injury) and recurrence parameters. Appropriate statistics were computed with the significant level at p ≤ 0.05. Results: During the study period, 300 DTC patients (59.7% with pCNLD; 79.3% females) with an average age of 52 ± 2.8 years were treated. The mean follow-up period of the entire cohort was 45.8 ± 19.1 months. On bivariate analyses, TT with pCNLD, when compared to TT alone, required longer surgical time (mean difference: 9.4 min), caused nearly similar complications (except transient hypothyroidism: p = 0.04; relative risk, 1.32; 95% confidence interval, 1.0 to 1.73), and no significantly different recurrence events, time to recurrence, and recurrent sites. The benefit–risk analyses using the number needed to treat and to harm (NNT; NNH) also confirmed that TT plus pCNLD was not very beneficial in DTC management. Conclusion: The results of this study refute the benefit of pCNLD in DTC patient care with TT. Further well-designed studies in a larger cohort with a longer follow-up period are required to confirm this conclusion

Prophylactic Central Neck Lymph Node Dissection Adds No Short-Term Benefit to Total Thyroidectomy for Differentiated Thyroid Cancer

Background and Objectives: To answer the research question: &ldquo;Is prophylactic central neck lymph node dissection (pCNLD) beneficial among differentiated thyroid carcinoma (DTC) patients?&rdquo; Materials and Methods: This was a retrospective cohort study enrolling DTC patients treated at the University Hospital Kaspela, Bulgaria, from 30 January 2019 to October 2021. The predictor variable was presence of pCNLD (total thyroidectomy with vs. without pCNLD). The main outcome variables were postoperative complications (i.e., vocal cord paralysis, hypoparathyroidism, postoperative bleeding, and adjacent organ injury) and recurrence parameters. Appropriate statistics were computed with the significant level at p &le; 0.05. Results: During the study period, 300 DTC patients (59.7% with pCNLD; 79.3% females) with an average age of 52 &plusmn; 2.8 years were treated. The mean follow-up period of the entire cohort was 45.8 &plusmn; 19.1 months. On bivariate analyses, TT with pCNLD, when compared to TT alone, required longer surgical time (mean difference: 9.4 min), caused nearly similar complications (except transient hypothyroidism: p = 0.04; relative risk, 1.32; 95% confidence interval, 1.0 to 1.73), and no significantly different recurrence events, time to recurrence, and recurrent sites. The benefit&ndash;risk analyses using the number needed to treat and to harm (NNT; NNH) also confirmed that TT plus pCNLD was not very beneficial in DTC management. Conclusion: The results of this study refute the benefit of pCNLD in DTC patient care with TT. Further well-designed studies in a larger cohort with a longer follow-up period are required to confirm this conclusion