Port assisted closure of laparoscopic wound: A safe and feasible technique

Objective: Various techniques and instruments have been developed to provide safe and secure closure of laparoscopic wounds. Herein we describe a simple method to close laparoscopic supraumbilical wounds with the aid of a laparoscopic port. Method: This was a retrospective review of prospective data, which were from 151 patients who underwent laparoscopic cholecystectomy for symptomatic gallstone disease from December 2009 to December 2010 in Sultanah Bahiyah Hospital. A senior consultant hepato-pancreato-biliary (HPB) surgeon and two HPB trainee surgeons performed the operations. Postoperatively, all patients were followed up at 4 weeks. Results: All patients successfully underwent closure of the supraumbilical wound with the assistance of a 5mm laparoscopic port. None of the patients had incisional hernia on follow up. Conclusion: Port assisted closure of supraumbilical laparoscopic wounds is a feasible and safe technique

Back pain as first presentation of Hepatocellular Carcinoma

Hepatocellular Carcinoma (HCC) is known to be one of the leading causes of deaths globally. In Malaysia HCC is known to be the eight most common cancer in both genders and the fifth most common cancer for males. The etiological factors associated with HCC are chronic Hepatitis B or C viral infection, liver cirrhosis and nonalcoholic fatty liver disease. Patients with HCC usually present with right upper quadrant pain, jaundice, loss of weight, and a palpable mass over the right hypochondrium. This case report will describe and discuss about the diagnosis of HCC in a patient with an atypical presentation of back pain which was confirmed with supportive findings of CT scan and MRI liver.peer-reviewe

Palliative brachytherapy to axilla and hypopharynx in elderly patient with hypopharyngeal squamous cell carcinoma — case report

Brachytherapy (BT) is an important local treatment of tumor and it can be applied to different anatomical sites either in a curative or palliative setting. BT can deliver large dose of radiation to the tumor while sparing the surrounding normal tissue which translates into a better therapeutic ratio compared to external beam radiotherapy. However, the evidence for the use of brachytherapy in the palliative setting is lacking in the literature. In this case report, we describe the brachytherapy technique and outcome of a patient with squamous cell carcinoma of the hypopharynx who underwent palliative brachytherapy to the hypopharynx and metastatic tumor at the right axilla.

Multi-audience tracking with RGB-D camera on digital signage

Digital signage is widely utilized in digital-out-of-home (DOOH) advertising for marketing and business. Recently, the combination of the digital camera and digital signage enables the advertiser to gather the audience demographic for audience measurement. Audience measurement is useful for the advertiser to understand the audience's behavior and improve their business strategies. When an audience is facing the digital display, the vision-based DOOH system will process the audience's face and broadcast a personalized advertisement. Most of the digital signage is available in an uncontrolled environment of public areas. Thus, it poses two main challenges for the vision-based DOOH system to track the audience's movement, which are multiple adjacent faces and occlusion by passer-by. In this paper, a new framework is proposed to combine the digital signage with a depth camera for tracking multi-face in the three-dimensional (3D) environment. The proposed framework extracts the audience's face centroid position (x, y) and depth information (z) and plots into the aerial map to simulate the audience's movement that is corresponding to the real-world environment. The advertiser can further measure the advertising effectiveness through the audience's behavior

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

Background Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC).Methods The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity.Findings On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84-1.29], p = 0.711 and HR 1.18 [0.95-1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79-1.17], p = 0.67 and HR 1.48 [1.16-1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02-1.74], p = 0.037) and OS (HR 1.26 [1.03-1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3-3.52], p < 0.0010), resection of additional organs (OR 2.22 [1.62-3.02], p < 0.0010) and major hepatectomy (OR 3.81 [2.55-5.73], p < 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02-1.37], p = 0.031) but not OS (HR 1.05 [0.91-1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used.Interpretation In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international col-laborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit.Funding Cambridge Hepatopancreatobiliary Department Research Fund.Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)