Robotic resection of presacral tumors.

BACKGROUND: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors. METHODS: This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates. RESULTS: Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant). CONCLUSIONS: Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.

Patient-Reported Barriers to Accessing Surgical Care in Northern Vanuatu.

BACKGROUND: The Lancet Commission on Global Surgery proposed that population access to essential surgical care within 2 h is a core indicator of health system preparedness. Little evidence exists to characterise access to surgical care for island nations, including Vanuatu, a lower middle-income country in the Western Pacific. METHODS: A descriptive, facility-based, survey of surgical inpatients was undertaken over a 6-month period at Northern Provincial Hospital (NPH), Espiritu Santo, Vanuatu. This evaluated demographics, access to surgical care using the 'three delays' framework and clinical outcomes. RESULTS: A total of 121 participants were surveyed (60% of all surgical admissions), of which 31% required emergency surgery. Only 20% of emergency surgical cases accessed care within 2 h. There were no emergency cases from Torba or Malekula. The first delay (delay in seeking care) had the biggest impact on timely access. There was a geographic gradient to access, gender preponderance (males), and a delay in seeking surgical care due to a preference for traditional healers. CONCLUSION: There is urgent need to improve access to surgical care in Vanuatu, particularly for Torba and Malekula catchments. Demographic, geographic, sociocultural, and economic factors impact on timely access to surgical care within the northern regions of Vanuatu and support the notion that addressing access barriers is more complex than ensuring the availability of surgical resources. Future priorities should include efforts to reduce the first delay, address the role of traditional medicine, and review the geographic disparities in access.

Challenges and Opportunities in the Provision of Surgical Care in Vanuatu: A Mixed Methods Analysis.

BACKGROUND: The Pacific island nation of Vanuatu faces a number of challenges in delivering surgical care to its population. We aimed to understand and document the barriers, opportunities and required actions to improve surgical care in the country using a mixed methods analysis which incorporated the perspectives of local health stakeholders. METHODS: A baseline quantitative assessment of surgical capacity in Vanuatu was carried out using the WHO situational analysis tool. Twenty semi-structured interviews were then conducted on the two main islands (Efate and Espiritu Santo) with surgeons, allied health staff, health managers, policy-makers and other key stakeholders, using a grounded theory qualitative case study methodology. Initial informants were identified by purposive sampling followed by snowball sampling until theoretical saturation was reached. Interviews were open and axially coded with subsequent thematic analysis. RESULTS: Vanuatu faces deficits in surgical infrastructure, equipment and human resources, especially in the rural provinces. Geographic isolation, poverty and culture-including the use of traditional medicine and low health literacy-all act as barriers to patients accessing timely surgical care. Issues with governance, human resourcing and perioperative care were commonly identified by stakeholders as key challenges facing surgical services. Increasing outreach clinics, developing efficient referral systems, building provincial surgical capacity and undertaking locally led research were identified as key actions that can improve surgical care. CONCLUSION: Documenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.