Needlescopic appendectomy versus conventional laparoscopic appendectomy in young patients.

INTRODUCTION: Several studies have reported that needlescopic appendectomy (NA) is a safe and effective procedure for appendicitis because of reduced trocar wounds and tissue trauma. The aim of this study was to evaluate the efficacy of NA in young patients under 40 years of age whose cosmesis matters with appendicitis by comparing it to conventional laparoscopic appendectomy (CLA). METHODS: We retrospectively reviewed our database looking for patients under 40 years of age diagnosed with appendicitis who underwent NA or CLA from January 2013 to April 2017. Patients were divided into two groups: the NA group, and the CLA group. Data collected from each group included age, gender, body mass index, preoperative C-reactive protein, emergency or non-emergency settings, operative time, postoperative length of stay, postoperative complications, and pathological diagnosis. RESULTS: Fifty-four patients underwent NA and 53 patients underwent CLA. The groups were similar in terms of demographic features. Pathological diagnoses were divided into the following categories: catarrhalis (n = 35), phlegmonous (n = 37), and gangrenous (n = 35). No significant difference was noted regarding the distribution of the three groups (P = .4). NA resulted in significantly shorter operative times (P = .0005), and reduced lengths of hospital stay (P = .03) as compared to CLA. There was no significant difference in the number of complications between the two groups. CONCLUSION: NA might be an effective surgical technique when performing a laparoscopic appendectomy in young patients with appendicitis.

Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report.

BACKGROUND: Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair. CASE PRESENTATION: An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment. CONCLUSIONS: This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

The radius surgical system - a new device for complex minimally invasive procedures in urology?

OBJECTIVE: Complex laparoscopic procedures in urology are technically demanding with an extended learning curve. Robotic systems add significant cost to laparoscopic procedures. We therefore evaluated the use of the Radius Surgical System (RSS), a mechanical manipulator, for complex laparoscopic cases in urology. MATERIAL AND METHODS: The RSS (Tuebingen Scientific) consists of two hand-guided surgical manipulators and provides a deflectable and rotatable tip allowing six degrees of freedom. We evaluated the system by using a series of standardized models in the pelvitrainer. We analyzed the effectiveness of the system and the learning curve. We then evaluated the system in the clinical setting during laparoscopic radical prostatectomy. RESULTS: Surgeons with experience on the RSS were compared to surgeons without previous experience on the system. We identified a learning curve in those participants without experience on the system only when performing complete anastomoses in the pelvitrainer. However, this learning curve included less than 10 anastomoses. The first clinical experiences during laparoscopic extraperitoneal radical prostatectomy (n=10) are promising. All anastomoses were patent on routine (X-ray) examination 8 days after surgery. CONCLUSIONS: The RSS system is easy to use and we identified a very short learning curve. We now optimize the system for use in urology. This device may facilitate complex laparoscopic procedures without the use of costly robotic systems and should be further evaluated in the experimental and clinical setting.