Don't forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions.

Fluorescence-based imaging has found application in several fields of elective surgery, but there is still a lack of evidence in the literature about its use in the emergency setting. Clinical trials have consistently shown that indocyanine green (ICG)-guided surgery can dramatically reduce the risk of postoperative complications, length of in-hospital stay and total healthcare costs in the elective setting. It is well-known that emergency surgery has a higher complication rate than its elective counterpart, therefore an impelling need for research studies to explore, validate and develop this issue has been highlighted. The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies. Furthermore, we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations. In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases. We then deepened the two most described topics in ICG-guided emergency surgery: Acute cholecystitis and intestinal ischemia, focusing on both the advantages and limitations of green-fluorescence application in these two fields. In emergency situations, ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity, facilitating the detection of intestinal ischemic zones, identifying biliary tree anatomy, reducing post-operative complications, and mitigating high mortality rates. The need to improve its application still exists, therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emergency procedures.

ACR TI-RADS Score combined with cytopathology classification improves the risk stratification of indeterminate thyroid nodules.

BACKGROUND: The aim of this retrospective study was the elaboration of a new diagnostic model that integrate cytological reports (2017 Bethesda System for Reporting Thyroid Cytopathology) with ultrasonographic features (based on ACR TI-RADS score) to achieve a more accurate definition of indeterminate thyroid nodule malignancy risk. METHODS: Ninety patients submitted to thyroidectomy were divided in three classes: low malignancy risk (AUS/FLUS with TI-RADS 2/TI-RADS 3 and FN/SFN with TI-RADS 2), intermediate malignancy risk (AUS/FLUS with TI-RADS 4/TI-RADS 5 and FN/SFN with TI-RADS 3/TI-RADS 4), and high malignancy risk (FN/SFN with TI-RADS 5). RESULTS: The surgical approach should be recommended in high-risk patients (81.82% of malignancies), carefully evaluated in intermediate risk (25.42%), whereas a conservative approach can be adopted in low-risk patients (0.00%). CONCLUSIONS: The integration of these two multiparametric systems in a Cyto-US score has proven to be a feasible and reliable aid to achieve a more accurate definition of malignancy risk.

Laparoscopic adrenalectomy for large adrenal tumor guided by a 3D anatomic model. New frontiers in abdominal surgery.

If until few years ago the surgeon could study a complex surgery only on the basis of two-dimensional images, today can use 3D physical models on a scale of 1 to 1 of an organ. We report the case of a 53 years old woman with Cushing's syndrome and a giant right adrenal tumor. To better define the relationship between the neoplasm and inferior vena cava, the vascularization of the adrenal gland, any anatomical anomalies and the specific location of the middle adrenal vein, a 3D printed model was created in 1: 1 size based on the preoperative CT. A laparoscopic right adrenalectomy was performed. No intraoperative and postoperative complications were observed with resolution of the adrenal disorder. This case highlights the feasibility and clinical effectiveness of 3D anatomical models for correct preoperative planning, the surgeon's intraoperative guidance to reduce possible errors and therefore improve the patient's postoperative outcome.

Minilaparoscopic over conventional laparoscopic cholecystectomy and appendectomy: is it worth it? A case series and review of literature.

Minilaparoscopic cholecystectomy was proposed with the aim to improve the cosmesis and reduce the impact on the abdominal wall. Our aim was to analyze the knowledge currently available on this topic with a review of literature and with our experience to suggest patient-centered approach over the use of minilaparoscopic cholecystectomies and appendectomies. From January 2021 to October 2021, we performed 21 minilaparoscopic cholecystectomies and 12 minilaparoscopic appendectomies. Within the established 1-month and 3-month follow-up intervals, clinical examination and scar evaluation were assessed and a satisfaction questionnaire was completed by all the patients. No intraoperative or postoperative complications were recorded. Patients' pain decreases significantly during hospital stay and 30 patients (90,1%) were discharged with VAS 0. The same happened with aesthetic score, that was 2,23 the postoperative-day-1, decrease to 1,87 1 week later and was 1,12 at 1- and 3-month follow-up.

Radiofrequency Thermal Ablation of Benign Thyroid Nodules: The Correlation Between Ultrasound Nodule Characteristics and Results.

Background. The aim of this observational study was to investigate for which nodules a better response to radiofrequency thermoablation (RFA) for nonfunctioning benign thyroid nodules is likely. Methods. Aesthetic score, compressive score, and volume of 32 benign nodules from 32 patients were registered during follow-up at baseline, 1, 3, 6, and 12 months. Results. A volume reduction rate (VRR) of 72.56% at 12 months after the procedure (P = .009) was registered. A significant (P < .001) improvement in the compressive and aesthetic scores was observed. Nodules with a baseline volume <20 mL had VRRs at 3 and 6 months that were significantly greater than those with volume >20 mL (P = .037). Conclusions. RFA was shown to be a safe and effective procedure for the management of benign thyroid nodules and that there is a correlation between the initial size of the nodule and the response to treatment.