Retrospective analysis of operative time and time to discharge for laparoscopic vs robotic approaches to appendectomy and cholecystectomy.

Robotic-assisted appendectomies and cholecystectomies are believed to increase cost compared to the gold standard laparoscopic approach. Two equally qualified surgeons performed both approaches over 2 years to evaluate intraoperative duration, time to discharge, conversion to open procedure, and readmission within 30 days. 110 laparoscopic, 81 robotic-assisted appendectomies; and 105 laparoscopic and 165 robotic-assisted cholecystectomies were performed. Intraoperative time; laparoscopic appendectomy was 1.402 vs 1.3615 h for robotic-assisted (P value = 0.304); laparoscopic cholecystectomy was 1.692 vs 1.634 h for robotic-assisted (P value = 0.196). Time to discharge, was 38.26 for laparoscopic vs 28.349 h for robotic-assisted appendectomy (P value = 0.010), and 35.95 for laparoscopic vs 28.46 h for robotic-assisted cholecystectomy (P value = 0.002). Intraoperative conversion to open; only laparoscopic procedures were converted, one appendectomy and nine cholecystectomies. None in the robotic-assisted procedures. Readmissions, none in the appendectomy group and three in the cholecystectomy group. One laparoscopic and two robotic-assisted cholecystectomy patients were readmitted. Intraoperative times for robotic appendectomy and cholecystectomy were not longer than laparoscopic approach. Robotic approach shortened the time to discharge and the likelihood for conversion to open procedure.

Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome.

Colon cancer is a rare diagnosis in 30-year-old women, which may be further complicated by their concurrent gravid status. Several physiological changes that occur during an intrauterine pregnancy (IUP) can mask symptoms of early colon cancer. Our patient was a 30-year-old, Gravida 2, Para 0 woman with an uncomplicated pregnancy until the 35th week of gestation when she developed preeclampsia and symptoms suggestive of early hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Following induction of labor and the subsequent, uncomplicated vaginal delivery, the patient developed symptoms of nausea, vomiting, and constipation with abdominal pain and bloating. Abdominal computed tomography (CT) revealed a large mass in the right colon along with the involvement of periaortic lymph nodes and the presence of liver metastases. Hepatic metastases were possibly responsible for the patient's elevated liver enzyme levels, which were initially considered to have been caused by HELLP syndrome because the patient also had preeclampsia. The rarity of colon cancer in young, pregnant patients with no family history, such as in this case, results in poor prognosis owing to nonspecific symptoms of the developing malignancy being attributed to pregnancy, which further delays diagnosis and subsequent therapy. Of 29 cases of colon cancer in pregnant patients recorded till date, this is the first report of a stage 4 adenocarcinoma of the colon with hepatic metastasis, elevated liver enzyme levels, and increased blood pressure with associated preeclampsia, which was diagnosed in the postpartum period. It may be important to consider broader differential diagnoses in expectant patients presenting with unusual and persistent symptoms.