Robotic hernia repair with the novel HUGO robot system - An initial experience from a tertiary centre.

BACKGROUND: Hernia repair using robotic platforms has been on the rise in the last decade. The HUGO robotic-assisted surgery (RAS) system, introduced in 2021, is a new addition to the field. In this study, we share our experience with this innovative system for the management of ventral and groin hernias. PATIENTS AND METHODS: The aim of our study was to evaluate the feasibility and safety of using the HUGO robotic platform for hernia surgeries. We conducted a retrospective analysis of all hernia surgeries performed with the HUGO system over a 1-year study period. The study assessed various aspects, including the technical manoeuvres of the robotic system, duration of surgery, length of hospital stay, post-operative pain levels and 30-day morbidity rates. RESULTS AND CONCLUSIONS: A total of seven hernia surgeries were performed using the HUGO system, including five ventral hernias and two groin hernias. The average duration of surgery was 128 min, with a docking duration of 22.8 min. Notably, there were no intraoperative or post-operative adverse events reported during these procedures. The HUGO system features an open console that provides a panoramic view of the operating room. In addition, the individual arm carts can be easily manoeuvred around the operating table, facilitating improved access to multiple quadrants during surgery. In our case series, Robotic hernia repair using the HUGO system has demonstrated feasibility, with post-operative outcomes comparable to traditional approaches. This innovative system serves as an additional tool in the armamentarium of hernia surgery and shows potential for improving surgical outcomes. However, further investigation through large-scale prospective studies is necessary to comprehensively evaluate its efficacy and benefits.

Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor.

Aim: Solid pseudopapillary neoplasm (SPN), a slow-growing pancreatic tumor with a vague clinical presentation and non-specific radiological features, is rather uncommon. We share our experience emphasizing on preoperative diagnosis and the correlation with final histopathological examination. Materials and methods: This is a retrospective analysis of the 468 patients who underwent pancreas-related surgery at our institution between January 2013 and July 2022. Demographic characteristics, symptoms at presentation, preoperative serum calcium carbohydrate antigen (CA 19-9), lesion characteristics on cross-sectional diagnostic imaging, surgical technique, complications in postoperative period, length of stay, histopathological features, and 3-year follow-up findings of the patients with SPN of pancreas were evaluated. Results: The male-to-female ratio was 1:11 and the mean age at presentation was 33.3 ± 9.5 years. Upper abdomen discomfort was the most common presenting complaint (91%). And five patients had findings suggestive of SPN on preoperative CECT abdomen, and the remaining six individuals were diagnosed solely based on final histological examination. The tumor's median diameter was 5.6 cm (range, 4.1-7.9). The distal body and tail of pancreas was the most common location (63%), followed by the head (36%), and was managed with distal pancreatectomy with or without spleen preservation and Whipple's procedure, respectively. One patient developed grade III Clavien-Dindo complication. The average length of in-hospital stay was 8.27±2.72 days. None of the patients had recurrence on follow-up. Conclusion: Solid pseudopapillary neoplasm of the pancreas is often misdiagnosed preoperatively. Endoscopic ultrasound-guided FNA with IHC will be beneficial to diagnose it preoperatively especially in small-sized tumors with atypical features. Complete surgical resection with adequate margins without routine lymphadenectomy is curative in resectable tumors. How to cite this article: Jayapal L, Kumar SR, Jebakumar GS, et al. Solid Pseudopapillary Neoplasm of the Pancreas: Unraveling Insights from a Single Institutional Study Emphasizing Preoperative Diagnosis of a Rare Tumor. Euroasian J Hepato-Gastroenterol 2023;13(2):50-54.

Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study.

Background: Simple approaches for detecting the tumor stage of colon cancer patients are required during the preoperative period. In recent years, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been employed as predictive parameters for systemic inflammatory response and long-term prognosis in a variety of malignancies. The purpose of this study was to determine whether the NLR and PLR correspond with tumor characteristics in colon cancer patients. Materials and methods: About 90 patients with colon cancer who reported to our institute during the time interval July 2021 to December 2022 were included in the study. The NLR and PLR were calculated using data obtained from a complete blood count evaluation. The relationship between inflammatory cell ratio and tumor-specific characteristics were analyzed. Results: Neutrophil-lymphocyte ratio and PLR correlated with pTNM staging in 88 patients. Two patients exhibited diffuse peritoneal metastasis. A significant association was found between PLR and early (Tis + T1 + T2) and advanced (T3 + T4) groups. Although the difference was not statistically significant, patients with lymphovascular invasion (LVI) and perineural invasion (PNI) had greater mean NLR and PLR. Conclusion: Platelet-lymphocyte ratio was found to be more accurate than NLR in predicting colon cancer tumor depth/invasion. A high PLR value aids in prognosticating advanced T-stage colon cancer patients and can be used as a valuable tool for preoperative counseling, but it must be validated with a survival analysis. Clinical practice points: The tumor microenvironment contains a variety of inflammatory cells that contribute to the growth and spread of the neoplasm. The NLR and PLR have been shown to be clinically and prognostically important in a variety of gastrointestinal cancers. The results of this study demonstrate that PLR was more accurate than NLR in predicting colon cancer tumor depth/invasion. Also, a high PLR value aids in prognosticating advanced T-stage colon cancer patients and may be used as a valuable tool for preoperative counseling. How to cite this article: Ramesh SK, Swain SK, Munikrishnan V, et al. Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study. Euroasian J Hepato-Gastroenterol 2023;13(2):61-65.

In recent years, the neutrophil­lymphocyte ratio (NLR) and platelet­lymphocyte ratio (PLR) have been used in diagnosis, staging, and determination of long-term prognosis of various cancers. The study involved 90 colon cancer patients diagnosed between July 2021 and December 2022. The relationship between NLR/PLR and tumor features was investigated. In predicting colon cancer tumor depth/invasion, PLR was found to be significantly more precise than NLR.

Robotic ventral rectopexy: Initial experience in an Indian tertiary health-care centre and review of literature.

BACKGROUND: Minimally invasive ventral rectopexy is a well-described technique for management of rectal prolapse. Robotic system has proven its advantage for surgeries in the pelvis. Applying this technique, ventral rectopexy can be done more precisely with minimal recurrence. With growing experience, the operative duration and cost of robotic ventral rectopexy can be reduced with better outcome. Few case studies have been described in literature with no study from Indian subcontinent. We describe a series of eight cases of robotic ventral rectopexy done for rectal prolapse in a tertiary health-care centre of India. METHODS: A total of 8 patients were operated for complete rectal prolapse during the period from August 2015 to April 2016. da Vinci Si robotic surgical system was used with prolene or permacol mesh for ventral rectopexy. All patients were prospectively followed for a period minimum of 3 months. Pre- and intra-operative findings were recorded along with post-operative outcome. RESULTS: Out of eight patients, prolene mesh was used in five patients and permacol mesh (porcine collagen) in three patients. Mean operative time (console time) was 177 min and mean total time was 218 min. Mean blood loss was 23.7 ml. Functional outcome was satisfactory in all patients. There was no significant complication in any patient with mean hospital stay of 2.2 days. With average follow-up of 8.8 months, no patient had recurrence. CONCLUSION: Robotic ventral rectopexy is a safe technique for rectal prolapse with excellent result in terms of functional outcome, recurrence and complications. With experience, the duration and cost can be comparable to laparoscopic technique.

Parietal Wall Abscess Perforating to Transverse Colon: A Rare Presentation.

Extrapulmonary tuberculosis affects an isolated organ or presents secondary to pulmonary involvement. Lymph nodes are the common sites for extrapulmonary tuberculosis. Primary extrapulmonary tuberculosis involving parietal wall is an unusual presentation. Tubercular abscess of the abdominal wall perforating to large bowel has not been reported. Here, we are reporting a very rare case of anterior abdominal wall abscess of tubercular origin in a 57-year-old female patient who presented with complaints of pain in upper abdomen for four months. CT scan and intraoperative findings revealed perforation of the abscess into transverse colon. Histopathology report confirmed the aetiology and origin of the abscess.

Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time.

BACKGROUND: Nations with emerging deceased-donor liver transplantation programs, such as India, face problems associated with poor donor maintenance. Cold ischemic time (CIT) is typically maintained short by matching donor organ recovery and recipient hepatectomy to achieve maximum favorable outcome. We analyzed different extended criteria donor factors including donor acidosis, which may act as a surrogate marker of poor donor maintenance, to quantify the risk of primary nonfunction (PNF) or initial poor function (IPF). METHODS: A single-center retrospective outcome analysis of prospectively collected data of patients undergoing deceased-donor liver transplantation over 2 years to determine the impact of different extended criteria donor factors on IPF and PNF. RESULTS: From March 2013 to February 2015, a total of 84 patients underwent deceased-donor liver transplantation. None developed PNF. Thirteen (15.5%) patients developed IPF. Graft macrosteatosis and donor acidosis were only related to IPF ( P = .002 and P = .032, respectively). Cold ischemic time was maintained short (81 cases ≤8 hours, maximum 11 hours) in all cases. CONCLUSION: Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Asymptomatic Traumatic Hepatothorax, Symptomatic Gall Stone Disease - A Rare Coincidence.

Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management. We report a case of acute cholecystitis which revealed a rare association of traumatic right diaphragmatic hernia and hepatothorax.

A Rare SOL of the Liver: Diagnostic and Management Dilemma.

Aetiology and clinical presentation of space occupying lesions (SOL) of liver are varied. It can be solid, cystic or heterogenous. Usually liver abscess presents as a symptomatic cystic SOL in a sick patient. Here, we are reporting a case of giant liver abscess presenting as simple benign cyst with corroborative image findings of simple cyst. He had significant co-morbid illness and jaundice on clinical evaluation. Liver abscess was not a differential diagnosis from clinical history. None of the haematological and biochemical parameters were suggestive of liver abscess. It was an intra-operative surprise to find such a huge liver abscess with 2 liters of pus, which was drained. We report this case because of its unusual presentation and associated findings.

Lymphangiocele: A very rare cause of primary infertility.

There are limited causes of surgically treatable male infertility. Lymphangiocele of scrotum is a very rare condition particularly in adult life. Lymphangiocele causing infertility is further rare and not reported in English literature so far. We report an extremely rare case of lymphangiocele in a 29 years male presenting with male infertility that improved after surgery.

Incidental thyroid carcinoma.

OBJECTIVE: to find out the frequency of incidental thyroid carcinoma (ITC) in patients presumably operated for benign thyroid diseases. METHODS: a total of 187 patients undergoing surgery for benign thyroid diseases were included in the study. All the patients underwent fine needle aspiration cytology (FNAC). Only those with benign diseases on FNAC were studied. Patients with undetermined cytology and follicular neoplasm were excluded. RESULTS: Out of the 187 patients operated histology revealed ITC in 38 (20.3 %) of patients. The mean size of the nodule was 4.28 ± 1.48 cm in benign group and 4.21 ± 1.98 cm in ITC group. Papillary carcinoma was the commonest ITC (97.4 %) and follicular variant (16/38) was found more often than micropapillary variant (3/38). ITC was more common in patients with solitary nodule, 23 of 38 (60.5 %), although it wasn't statistically significant (P value 0.262) 0.33 of 38 (86.8 %) were in euthyroid state (P value 0.029). CONCLUSIONS: the result of this study show, a high frequency of ITC (20.3 %). ITC was more frequent in euthyroid patients (P value 0.029). Incidence of ITC is not significantly different between patients presenting with SNG from those with MNG (P value 0.262). Papillary carcinoma was the commonest ITC (97.4 %) and follicular variant (16/38) was found more often than micropapillary variant (3/38).