Robotic colectomy: is it necessary?

More than 20 years ago the introduction of laparoscopic surgery represented a paradigm shift in the management of colorectal cancer. In most recent years robotic surgery is becoming a viable alternative to laparoscopic and traditional open surgery. The major clear advantages of robotic surgery in comparison with laparoscopy are the lower conversion to open surgery rates and the shorter learning curve. However, the role of robotics in colorectal surgery is still largely undefined and different with respect to its application in abdominal versus pelvic surgery. As for colon cancer there are emerging data that laparoscopic and robotic surgery have the same advantages in terms of faster recovery, although robotic-assisted colectomy is associated with costs increase of care without providing clear reduction in overall morbidity or length of stay. Long-term outcomes for laparoscopic versus robotic colonic resections remain still largely undetermined and randomized controlled clinical trials are required to establish a possible difference in outcomes. Interesting issues for the educational aspects are associated with robotic surgery, as the double console allows the resident to take part actively at the surgical procedure since the beginning of his surgical experience.

Role of robotic surgery in colorectal resections for cancer.

In recent years, robotic surgery is becoming a valid alternative in colorectal diseases treatment to laparoscopic and traditional open surgery. The most relevant reported technical advantages of the robotic surgery are 3D-view, tremor-filtering, seven degree-free motion and a higher comfortable setting for the surgeon. Both case series and comparative studies available in Literature report only short and mid-term outcomes. These studies are able to demonstrate that robotic surgery is as safe and feasible as laparoscopic surgery regarding perioperative outcomes. Trials with long term follow up are needed to establish the real safety and effectiveness of the robotic surgery especially concerning resections for cancer. The robotic surgery could be considered a promising surgical field. The high costs represent one of the most relevant drawbacks.

[Diagnostic findings and the surgical treatment of liver metastases: our experience]. / Orientamenti diagnostici e trattamento chirurgico delle metastasi epatiche: nostra esperienza.

The authors report their 10 year experience of 32 consecutive hepatic resections for metastases. All patients were preoperatively evaluated with US and CT, however, in 9 cases the diagnosis was obtained at laparotomy. In the first years there were no codified criteria for indications to surgery, while recently these were restricted, because of more favourable prognostic evaluations, to the metastases from colorectal carcinoma, endocrine or carcinoid tumours, digestive system neoplasms invading adjacent liver (in this case usually with palliative goal). The low mortality and morbidity registered explain the safety and efficacy of this procedure, also taking into account the fact that currently surgery is the only effective procedure with curative purpose. Criteria for patients selection, particularly in case of colorectal cancer, are referred and discussed and consequently prognostic factors are proposed: hepatic involvement extent, stage of primary tumour, absence of extrahepatic metastases, disease free interval between resection of primary tumour and hepatic resection for metachronous metastases.

[Surgical treatment of liver trauma: our experience]. / Il trattamento chirurgico dei traumi epatici: nostra esperienza.

The Authors report their ten-year experience in the surgical treatment of liver injuries. Thirty-five patients underwent emergency laparotomy for hepatic trauma: 14 showed associated injuries, mostly of the spleen, while 21 had isolated liver lesions. Emergency surgical operation was performed for those patients with hypovolemic shock due to massive haemoperitoneum, while for all stabilized patients a preoperative ultrasonography or a computerized tomography was diagnostic. With a correct diagnosis, nowadays possible thanks to the overmentioned radiologic means, a group of patients was not treated by laparotomy, but strictly monitorized. For the patients who underwent laparotomy, good results with a low mortality rate were obtained using a surgical conservative treatment.

[The use of piperacillin in the preoperative prophylaxis of colorectal surgery]. / L'impiego della piperacillina nella profilassi preoperatoria della chirurgia colorettale.

The authors present a prospective trial in 34 patients undergoing elective colo-rectal surgery. Seventeen patients received 2 g of piperacillin; intravenously, 30' min before surgery, and again 5 times, postoperatively, every 6 hours. The other 17 patients received 2 g of the same drug, intravenously, every 12 hours, immediately after surgery, at least for 5 days. The first group showed postoperative wound infections, with a rate of 11.75%. In the second group 5 patients showed postoperative infection, with a rate of 29.41%. There were 3 wound infections, one urinary tract infection and two pleuropolmonitis (a patient had two infections simultaneously). No side effects were registered. The better results registered in the first group, suggest the use of piperacillin in shortterm prophylaxis. This choice is attractive because of the comparison with other antibiotics, used in a similar way, shows similar results.

[Kaposi's sarcoma--classic form. A rare familial case]. / Sarcoma di Kaposi--forma classica. Un raro caso familiare.

Although Kaposi's sarcoma became very well-known with the outbreak of AIDS, this pathology in the classic Mediterranean form is still unusual and obscure. Nowadays we identify four types of Kaposi's sarcoma: 1) the classic Mediterranean form, 2) the endemic African one, 3) the therapeutical in immunosuppressed patients, 4) the epidemic AIDS-related one. We report a very rare case of familial Kaposi's sarcoma: the father (72 y.o.) manifested Kaposi's sarcoma in 1989 with several angiomatoid nodules on the penis and hands; the son (31 y.o.) presented in 1991 only one little nodule on the penis. The right therapy in these cases (patients with a small number of localizations) was to remove all the tumors and to wait: whereas in other cases it's preferable to use radio- or chemo-therapy or immunomodulator agents. We studied the patients and identified their form of Kaposi like the classic one not completely related (the son) to the HLA DR5, which is the HLA-phenotype most frequent in this sarcoma. Moreover we stress the rarity of genital localization in the classic form, instead it is very common (20%) in the AIDS-related one.