Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes.

PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.

Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy.

BACKGROUND: In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC). METHODS: A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared. RESULTS: There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 ± 123.2 vs 159.3 ± 56.1 min (p < 0.001), and the mean number of harvested lymph nodes was higher in the robotic CME group (46.1 ± 22.2 vs 39.1 ± 17.8, p = 0.047). There were only minor differences in length of hospital stay (7.2 ± 3.1 vs 7.9 ± 4.0 days), anastomotic leak (none vs 2.6%), bleeding (none vs 1.3%), surgical site infections (10.5% vs 12.5%), and reoperations (2.6% vs 6.3%). CONCLUSIONS: Robotic CME can be performed with a similar morbidity profile as laparoscopic CC for transverse colon cancer along with a higher rate of intracorporeal anastomosis, and higher number of lymph nodes retrieved, but longer operative times.

The da Vinci Xi system for robotic total/subtotal colectomy vs. conventional laparoscopy: short-term outcomes.

BACKGROUND: The aim of this study was to evaluate the feasibility of robotic total/subtotal colectomy procedures with the Xi robot and to compare its short-term outcomes with those of conventional laparoscopy. METHODS: Between October 2010 and September 2018, consecutive patients with colonic neoplasia, inflammatory bowel disease, familial adenomatous polyposis or colonic inertia who underwent elective robotic or laparoscopic total/subtotal abdominal colectomy at two specialized centers in Turkey were included. Data on perioperative characteristics and 30-day outcomes were compared between the two approaches. RESULTS: There were a total of 82 patients: 26 and 56 patients in the robotic and laparoscopic group, respectively (54 men and 28 women, mean age 54.7 ± 17.4 years). The groups were comparable regarding preoperative characteristics. All the robotic procedures were completed with a single positioning of the robot. Estimated blood loss (median, 150 vs 200 ml), conversions (0% vs 14.3%), and complications (0% vs 7.1%) were similar but operative time was significantly longer in the robotic group (median, 350 vs 230 min, p < 0.001). No difference was detected in the length of hospital stay (7.9 ± 5.7 vs 9.5 ± 6.0 days, p = 0.08), anastomotic leak (3.8% vs 8.3%), ileus (15.4% vs 19.6%), septic complications, reoperations (7.7% vs 12.5%), and readmissions (19.2% vs 12.5%). The number of harvested lymph nodes in the subgroup of cancer patients was significantly higher in the robotic group (median, 66 vs 50, p = 0.01). CONCLUSIONS: In total/subtotal colectomy procedures, the robotic approach with the da Vinci Xi platform is feasible, safe, and associated with short-term outcomes similar to laparoscopy but longer operative times and a higher number of retrieved lymph nodes.

"Top down no-touch" technique in robotic complete mesocolic excision for extended right hemicolectomy with intracorporeal anastomosis.

BACKGROUND: Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a "top down technique" to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients. METHODS: The top down technique consists of two steps. First, the omental bursa was entered to identify the right gastroepiploic vein. Tracing down this vein as a landmark, the gastrocolic trunk was exposed, branches of this trunk and the middle colic vessels were divided. Second, dissection was directed to the ileocolic region and proceeded in an inferior-to-superior direction along the superior mesenteric vein to divide the ileocolic and right colic vessels consecutively. The ileotranverse anastomosis was created intracorporeally. RESULTS: There were 8 males and 4 females with a mean age of 64.8 ± 16.9 years and a mean body mass index of 25.6 ± 3.7 kg/m2. All the procedures were completed successfully. No conversions occurred. The mean operative time and blood loss were 312.1 ± 93.9 min and 110.0 ± 89.9 ml, respectively. The mean number of harvested lymph nodes was 45.2 ± 11.1. The mean length of hospital stay was 7.6 ± 4.7 days. Two patients had intraoperative complications and two had postoperative complications. There was no disease recurrence at a mean follow-up period of 10.4 ± 7.1 months. CONCLUSIONS: The top down technique appears to be useful in robotic CME for an extended right hemicolectomy. Early identification of the gastrocolic trunk and middle colic vessels via this technique may prevent inadvertent vascular injury at the mesenteric root of the transverse colon.

Impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after restorative surgery for rectal cancer.

AIM: The aim of this study was to investigate the impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after rectal cancer surgery. METHODS: Patients undergoing restorative proctectomy for rectal cancer between January 2008 and December 2013 were divided into four groups according to the perioperative lowest haemoglobin (Hgb) level and transfusion status: group 1 with Hgb level ≥ 10 g/dl; group 2 with Hgb level ≥ 7 and < 10 g/dl who did not receive transfusion; and group 3 with Hgb level ≥ 7 and < 10 g/dl and group 4 with Hgb level < 7 g/dl, both of which received a transfusion. Clinical characteristics, anastomotic leakage and infectious complications within 30 days of surgery were compared. RESULTS: There were 398 patients (66% men) with a mean age of 59.3 ± 11.9 years. Groups 1, 2, 3 and 4 included 162 (40.7%), 163 (41.0%), 47 (11.8%) and 26 (6.5%) patients, respectively. Perioperative characteristics were significantly different among groups regarding neoadjuvant chemo/radiotherapy use, preoperative albumin and Hgb levels, operative approach and blood loss, tumour size and stage, surgical margin involvement and histological differentiation. The unadjusted rates of overall infectious complications were 17.2%, 27.6%, 36.2% and 50% in groups 1, 2, 3 and 4, respectively (P = 0.001). In the multivariate analysis, compared to group 2, group 3 was associated with an increased likelihood of organ/space surgical site infections (SSIs) (OR 3.63, 95% CI 1.29-10.22, P = 0.01) with no significant differences in terms of anastomotic leakage, overall SSIs or overall infectious complications. CONCLUSION: Blood transfusion of haemodynamically stable patients with Hgb level ≥ 7 g/dl is associated with increased organ/space SSIs in rectal cancer surgery.

Robotic versus conventional laparoscopic rectal cancer surgery in obese patients.

AIM: Obesity adds to the technical difficulty of laparoscopic colorectal surgery. The robotic approach has the potential to overcome this limitation because of its proposed technical advantages over laparoscopy. The aim of this retrospective study was to compare the short-term outcomes of robotic surgery (RS) vs conventional laparoscopy surgery (LS) in this patient population. METHOD: Patients with a body mass index ≥ 30 kg/m2 undergoing RS or LS for rectal cancer between January 2011 and June 2014 were identified from an institutional database. Perioperative parameters, oncological findings and postoperative 30-day short-term outcomes were compared between the RS and LS groups. RESULTS: The RS and LS groups included 29 and 27 patients, respectively. Groups were comparable in terms of patient demographics, body mass index (34.9 ± 7.2 vs 35.2 ± 5.0 kg/m2 , P = 0.71), comorbidities, surgical and tumour characteristics. Comparison of the intra-operative findings revealed no significant differences between the groups including operative time (329.0 ± 102.2 vs 294.6 ± 81.1 min, P = 0.13), blood loss (434.0 ± 612.4 vs 339.4 ± 271.9 ml, P = 0.68), resection margin involvement (6.9% vs 7.4%, P = 0.99), conversions (3.4% vs 18.5%, P = 0.09) and complications (6.9% vs 0%, P = 0.49). Regarding postoperative outcomes, there were no significant differences in morbidity except that robotic surgery was associated with a quicker return of bowel function (median 3 vs 4 days, P = 0.01) and shorter hospital stay (median 6 vs 7 days, P = 0.02). CONCLUSION: Robotic surgery for rectal cancer in obese patients has short-term outcomes similar to laparoscopy, but accelerated postoperative recovery.

An alternative sutureless repair technique with amelogenin for duodenal perforation.

BACKGROUND: Among the various sutureless techniques, fibrin glue has proved to be effective in the treatment of peptic ulcer perforation as an alternative to classical suture repair. Albeit rare, a potential disadvantage of fibrin glue use is viral transmission or anaphylaxis. The aim of this study is to introduce a new technique for the closure of duodenal perforation using a novel recombinant enamel protein called amelogenin. METHODS: In this case-control experimental study, 32 adult male Wistar Albino rats weighing 250-300 g were randomly divided into four groups, each containing 8 rats. Duodenal perforation of 0.2 cm were performed in the postpyloric region in all rats. Each group received primary repair, primary repair with omentoplasty, fibrin glue, and amelogenin, respectively. All animals were killed on the postoperative day five and the bursting pressure measurements, hydroxyproline levels and histopathologic values of the wound site were evaluated. RESULTS: Bursting pressure levels of the fibrin glue and amelogenin groups were significantly lower than the primary repair and primary repair with omentoplasty groups (P < 0.05) However, no significant difference existed between the fibrin glue and amelogenin groups in this respect (P > 0.05). There was also no statistically significant difference among all groups regarding tissue hydroxyproline levels and histopathologic values (P > 0.05). CONCLUSION: Application of amelogenin as an alternative sutureless repair technique did not improve wound healing in this animal model of duodenal perforation.

Radio-guided occult lesion localisation for breast lesions under computer-aided MRI guidance: the first experience and initial results.

OBJECTIVE: The purpose of this study was to present an alternative technique for the pre-operative localisation of solely MRI-detected suspicious breast lesions using a computer-assisted MRI-guided radio-guided occult lesion localisation (ROLL) technique. METHODS: Between January 2009 and June 2010, 25 females with a total of 25 suspicious breast lesions that could be detected only by MRI, and for whom breast surgery was planned, underwent the computer-assisted MRI-guided ROLL technique. A seven-channel biopsy breast array coil and computerised diagnostic workstation were used for the localisation procedure. Three-phase dynamic contrast-enhanced axial images were taken. After investigating the localisation co-ordinates with the help of intervention software on a workstation, an 18 G coaxial cannula was placed in the exact position determined. Following verification of the cannula position by additional axial scans, (99m)Tc-labelled macroalbumin aggregate and MRI contrast material were injected. Post-procedure MRI scans were used to confirm the correct localisation. RESULTS: All the procedures were technically successful. The mean lesion size was 10.8 mm (range: 4-25 mm). The mean total magnet and the mean localisation times were 28.6 min (range: 18-46 min) and 13.1 min (range: 8-20 min), respectively. Grid and pillar methods were used for localisation in 24 procedures and 1 procedure, respectively. On histopathological examination, 6 malignant, 10 high-risk and 9 benign lesions were identified. All patients tolerated the procedure well. There were no major complications. CONCLUSION: This is the first report documenting the application of MRI-guided ROLL. Based on our preliminary results, this technique is very efficient and seems to be a good alternative to wire localisation.