An easier option for "invisible scar" thyroidectomy: hybrid-transoral endoscopic thyroidectomy submental access (H-TOETSA)-experience on twenty-two consecutive patients.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is currently the only "cervical invisible scar" procedure with a surgical access close to the thyroid area. The aim of this technical note was to describe a hybrid technique with a vestibular and a submental access as applied in 22 consecutive patients undergoing lobectomy. METHODS: Out of 502 thyroidectomies performed from February 1, 2018 to May 31, 2019, feasibility of Hybrid-TransOral Endoscopic Thyroidectomy Submental Access (H-TOETSA) was assessed in 22 patients meeting the inclusion criteria. Differently from TOETVA, a central trocar (≤ 10 mm) for the camera was placed on the natural skin depression immediately under the chin. A left 3 mm and a right 5 mm (or 3 mm if a 3 mm energy device was available) trocars were placed in the vestibulum (as in TOETVA). RESULTS: Operative time was 74.32 (± 34.16) min. Two temporary recurrent nerve paralysis and three lip/chin dysesthesia were observed. In two patients, an additional 3 cm horizontal access was performed 2 cm above the clavicle to control a persistent bleeding. Patients complained pain only in the first postoperative hours. All patients perceived excellent cosmetic results even at postoperative day 1. CONCLUSION: H-TOETSA was feasible and resulted to have some technical and clinical advantages maintaining the purpose to avoid a visible scar on the neck.

Laparoscopic ileo-colic resection and right hemicolectomy for Crohn's disease and colon cancer: a preliminary comparative study on post-operative outcome.

Crohn's disease (CD) patients are generally considered at high risk of post-operative complications with respect to non-CD patients. The primary endpoint of this study is to compare early major complications rates between CD and colon cancer (CC) patients undergoing mini-invasive ileo-colic resections or right hemicolectomies. The secondary endpoint is to evaluate the role of pre-operative medication with anti-TNF as a possible risk factor for post-operative complications. An observational retrospective study was carried on patients who underwent mini-invasive ileocolic resections for CD and right hemicolectomies for CC at Digestive Surgery Unit and IBD Unit, Careggi Univeristy Hospital, from January 1, 2008, to June 1, 2019. Data collected included demographic and clinical informations, pre-operative anti-TNF use, major complications and mortality. Hundred and thirty-three mini-invasive ileocolic resections for CD and 131 mini-invasive right hemicolectomies for CC were included. Early major post-operative complications rates were 4.5% for CD patients and 3% for CC patients (p = 0.535). Anastomotic leak rates were 1.5% in both groups. There was no significant difference in mean length of stay; while, mean operation time was significantly longer in CD patients (p < 0.01). Pre-operative use of anti-TNF was not associated with a higher risk for early major post-operative complications in CD patients. In our institution, CD patients undergoing ileocolic resections or right hemicolectomies with a mini-invasive technique do not have a significantly higher risk of postoperative major complications with respect to CC patients, even when treated with anti-TNF agents within 3 months before surgery.

Laparosacopic management with combination of fatty meal and methylen-blu for chylous leak after a left para-aortic paraganglioma excision.

We report a case of chylous leak recognized post-operatively after abdominal surgery for left para-aortic paraganglioma in a young female with a history of open botallo's duct. Conservative measures failed to control the leak and the patient is not eligible for sclerotisation. Laparoscopic exploration with intralipidand methylen blue injection through an orogastric tube revealed the leaking area near the superior mesenteric vein behind the Traitz, and this was ligated with non-asorbable suture and placement of acrylic glue. The patient was discharged the 7th post-operative day after removal of the drainage which appeared to supply <100 cc of serum material. Outpatient control was successful and the patient is actually in good conditions.