Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: a retrospective comparative study

AbstractBackgroundLaparoscopic surgery has traditionally been contraindicated for the management of gall bladder cancer (GBC). This study was undertaken to determine the safety and feasibility of a laparoscopic radical cholecystectomy (LRC) for GBC and compare it with an open radical cholecystectomy (ORC).MethodsRetrospective analysis of primary GBC patients (with limited liver infiltration) and incidental GBC (IGBC) patients (detected after a laparoscopic cholecystectomy) who underwent LRC between June 2011 and October 2013. Patients who fulfilled the study criteria and underwent ORC during the same period formed the control group.ResultsDuring the study period, 147 patients with GBC underwent a radical cholecystectomy. Of these, 24 patients (primary GBC– 20, IGBC – 4) who underwent a LRC formed the study group (Group A). Of the remaining 123 patients who underwent ORC, 46 matched patients formed the control group (Group B). The median operating time was higher in Group A (270 versus 240 mins, P= 0.021) and the median blood loss (ml) was lower (200 versus 275 ml, P= 0.034). The post-operative morbidity and mortality were similar (P= 1.0). The pathological stage of the tumour in Group A was T1b (n = 1), T2 (n = 11) and T3 (n = 8), respectively. The median lymph node yield was 10 (4–31) and was comparable between the two groups (P=0.642). During a median follow-up of 18 (6–34) months, 1 patient in Group A and 3 in Group B developed recurrence. No patient developed a recurrence at a port site.ConclusionLRC is safe and feasible in selected patients with GBC, and the results were comparable to ORC in this retrospective comparison

Cystic Pancreatic Lymphangioma. The First Report of a Preoperative Pathological Diagnosis by Endoscopic Ultrasound-Guided Cyst Aspiration

Context We describe a case of cystic lymphangioma of the pancreas in which a preoperative tissue diagnosis was made with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Case report A 20-year-old female presented with upper abdominal pain of two months duration and was found to have a cystic lesion in the pancreatic tail. Radiological imaging could not determine the organ of origin or the nature of the lesion. On EUS examination, a mixed micro-macrocystic lesion with thin delicate septae, and clear anechoic contents was found in the pancreatic tail. EUS-guided aspiration demonstrated the typical endothelial lined cystic channels. The diagnosis was confirmed after surgical resection. Conclusion Cystic lymphangioma should be considered in the differential diagnosis of cystic pancreatic lesions in which the morphology is difficult to characterize. EUS-FNA has the potential of rendering a positive diagnosis of this benign entity

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Total laparoscopic Billroth-I gastrectomy for corrosive-induced antropyloric stricture

Antro-pyloric stricture with gastric outlet obstruction is a common manifestation of corrosive-induced gastric injury. Surgical management is the only curative option as endoscopic dilatation usually fails in the long term. Billroth I gastrectomy with gastroduodenostomy is the preferred surgery as it restores normal alimentary pathway, reduces dumping and does not complicate colon mobilisation for the future oesophageal bypass. Conventionally, it is performed by the open approach. The present report is the first technical description of total laparoscopic Billroth-I gastrectomy using the laparoscopic linear cutter for corrosive-induced antropyloric stricture. The two patients who underwent this procedure had patent gastroduodenal anastomosis on the post-operative contrast study and tolerating normal diet at 9 and 6 months follow-up, respectively

Laparoscopic management of a rare tumor at an uncommon location: Porta hepatis mesothelial cyst

Mesothelial cysts are rare intra-abdominal fluid-filled cysts that are detected commonly in females on radiological evaluation. Porta hepatis is an uncommon site for these lesions. A 40-year-old female presented with abdominal pain of 2 months duration. Her computed tomography abdomen showed a cystic lesion at the porta hepatis in close proximity to hepatic artery and magnetic resonance imaging showed normal bile duct with a separate cystic lesion at the porta hepatis. Since there were no features of malignancy, a laparoscopic approach was used for cyst excision. With careful dissection, cyst could be excised laparoscopically leaving a small rim of tissue adjacent to hepatic artery. Histological examination showed calretinin positive cells lining the cyst consistent with the mesothelial cyst. At 6 months of follow-up, patient is doing well without signs of recurrence