Robotic Appendicectomy: A review of feasibility

Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing trend in the use of robotic surgery in abdominal surgery. However, it remains underutilised in emergency surgeries. We aimed to systematically review robotic appendicectomies (RA) feasibility. A 20-year systematic review was performed in compliance with PRISMA guidelines. MERSQI score was applied for quality assessment. The research protocol was registered with PROSPERO. The search resulted in 1242 citations, of which 9 articles were included. Quality scores mean:10.72(SD=2.56). The endpoints across the studies were: rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is safe and feasible technique in elective and emergency settings with minimal blood loss. The operating time and the hospital stay were within acceptable limits. The major drawback of robotic surgery is its high cost and limited availability. Future studies are recommended to evaluate RA with a focus on its application during emergency and on its cost-effectiveness. Keywords: Robot Surgery; Robotic-Assisted Surgery; Robot Enhanced Surgery; Robotic Surgical Procedure; Appendectomy; Appendicectomy; Robotic Appendicectomy; Gastrointestinal Surgical Procedure

The innate aptitude’s effect on the surgical task performance: a systematic review

Surgery is known to be a craft profession requiring individuals with specific innate aptitude for manipulative skills, and visuospatial and psychomotor abilities. The present-day selection process of surgical trainees does not include aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We aimed to scrutinize the significance of innate aptitudes in surgical practice and impact of training on skills by systematically reviewing their significance on the surgical task performance. A systematic review was performed in compliance with PRISMA guidelines. An initial search was carried out on PubMed/Medline for English language articles published over 20 years from January 2001 to January 2021. Search strategy and terms to be used included ‘aptitude for surgery’, ‘innate aptitude and surgical skills, ‘manipulative abilities and surgery’, and ‘psychomotor skills and surgery’. MERSQI score was applied to assess the quality of quantitatively researched citations. The results of the present searches provided a total of 1142 studies. Twenty-one studies met the inclusion criteria out of which six citations reached high quality and rejected our three null hypothesis. Consequently, the result specified that all medical students cannot reach proficiency in skills necessary for pursuing a career in surgery; moreover, playing video games and/or musical instruments does not promote skills for surgery, and finally, there may be a valid test with predictive value for novices aspiring for a surgical career. MERSQI mean score was 11.07 (SD = 0.98; range 9.25–12.75). The significant findings indicated that medical students with low innate aptitude cannot reach skills necessary for a competent career in surgery. Training does not compensate for pictorial-skill deficiency, and a skill is needed in laparoscopy. Video-gaming and musical instrument playing did not significantly promote aptitude for microsurgery. The space-relation test has predictive value for a good laparoscopic surgical virtual-reality performance. The selection process for candidates suitable for a career in surgery requests performance in a simulated surgical environment.</p

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations

IntroductionThe transmission of COVID-19 virus since the outbreak of viral pneumonia due to SARS-CoV-2 gave rise to protective operative measures. Aerosol generating procedures such as laparoscopic surgery are known to be associated with increased risks of viral transmission to the healthcare workers. The safety of laparoscopy during the pandemic was then debated. We aimed to systematically review the literature regarding the safe use of laparoscopy during COVID-19.MethodsWe performed a systematic search using PubMed and ScienceDirect databases from inception to 1st May, 2020. The following search terms were used: ‘‘laparoscopic surgery and COVID-19’’; ‘‘minimally invasive surgery and COVID-19’’. Search items were considered from the nature of the articles, date of publication, aims and findings in relation to use of laparoscopic surgery during COVID-19. The study protocol was registered with PROSPERO register for systematic reviews (CRD42020183432).ResultsAltogether, 174 relevant citations were identified and reviewed for this study, of which 22 articles were included. The analysis of the findings in relation to laparoscopic surgery during the pandemic were presented in tabular form. We completed the common recommendations for performing laparoscopy during the COVID-19 pandemic in forms of pre-, intra- and postoperative phases.ConclusionThere is no scientific evidence to date for the transmission of COVID-19 by laparoscopic surgery. Laparoscopy can be used with precautions because of its benefits compared to open surgery. If safe, conservative management is the primary alternative during the pandemic. We concluded that recommended precautions should be respected while performing laparoscopy during the pandemic.</div

Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review

Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications.</p

Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review

BackgroundRetrograde ‘fundus-first’ cholecystectomy (FF) signifies the dissection that starts from the fundus of the gallbladder to the infundibulum in case structures of Calot's triangle cannot be identified. Although feasible in laparoscopic cholecystectomy (LC), FF remains an underutilized approach in difficult cases. We aimed to systematically review the fundus-first laparoscopic cholecystectomy (FFLC) and to evidence-base its advantages and feasibility.MethodsA systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect and Cochrane-Library for articles published from 2001 to 2021. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ and ‘fundus-down cholecystectomy’. Quality assessments were applied using the Medical Education Research Quality Instrument (MERSQI) scores. Also, evidence levels were employed using GRADE. The protocol was registered with PROSPERO register (CRD42021227518).ResultsAltogether 9393 citations were identified and reviewed for this study. A final 23 studies were included, with a total of 7973 cholecystectomies comprising 3020 with FF approach. The endpoints were operative time, duration of postoperative hospital-stay and intraoperative and postoperative complications, as well as rate of conversion to open surgery. MERSQI mean score was 10.2 (SD= 1.85). The FF dissection was evidenced to be a superior technique when compared to conventional anterograde dissection as regards duration of operation, pain, nausea, conversion to open surgery and duration of sick leave. Furthermore, FF was found to be appropriate for difficult LCConclusionThe fundus-first laparoscopic cholecystectomy was associated with a shorter operating time, decrease in pain and nausea scores and reduced incidence of conversion to open cholecystectomy. Ultrasonic dissection was favoured in the retrograde dissection compared to that with electrocautery.</p