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Abstract Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy is widely used in urgent general surgery, the signifi...
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Abstract Robotically assisted operations are the state of the art in laparoscopic general surgery. They are established predominantly for elective operations. Since laparoscopy is widely used in urgent general surgery, the significance of robotic assistance in urgent operations is of interest. Currently, there are few data on robotic-assisted operations in urgent surgery. The aim of this study was to collect and classify the existing studies. A two-stage, PRISMA-compliant literature search of PubMed and the Cochrane Library was conducted. We analyzed all articles on robotic surgery associated with urgent general surgery resp. acute surgical diseases of the abdomen. Gynecological and urological diseases so as vascular surgery, except mesenterial ischemia, were excluded. Studies and case reports/series published between 1980 and 2021 were eligible for inclusion. In addition to a descriptive synopsis, various outcome parameters were systematically recorded. Fifty-two studies of operations for acute appendicitis and cholecystitis, hernias and acute conditions of the gastrointestinal tract were included. The level of evidence is low. Surgical robots in the narrow sense and robotic camera mounts were used. All narrow-sense robots are nonautonomous systems; in 82%, the Da Vinci? system was used. The most frequently published emergency operations were urgent cholecystectomies (30 studies, 703 patients) followed by incarcerated hernias (9 studies, 199 patients). Feasibility of robotic operations was demonstrated for all indications. Neither robotic-specific problems nor extensive complication rates were reported. Various urgent operations in general surgery can be performed robotically without increased risk. The available data do not allow a final evidence-based assessment.
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Over the last decade, a number of practice-changing clinical trials have been published to guide the management of esophageal, gastric, liver, pancreas, appendiceal, and colorectal pathologies. The following review aims to provide...
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Over the last decade, a number of practice-changing clinical trials have been published to guide the management of esophageal, gastric, liver, pancreas, appendiceal, and colorectal pathologies. The following review aims to provide a succinct summary of these important trials that merit further critical assessment by every gastrointestinal surgeon. After each review, per the Editors' request, the authors have provided their humble opinion as to the clinical context and application of the data.
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Background. Gynecomastia, benign enlargement of the male breast is the most common breast pathology amongst males. The most widely used modality of treatment is liposuction under general anesthesia. To date however there is no pub...
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Background. Gynecomastia, benign enlargement of the male breast is the most common breast pathology amongst males. The most widely used modality of treatment is liposuction under general anesthesia. To date however there is no published study that specifically addresses to use tumescent anesthesia & use of tranexamic acid in it for excision of gynecomastia. Objective. To evaluate the efficacy of tumescent anesthesia in surgical excision of gynecomastia. Methods. A 4-year study with 100 patients of gynecomastia aged 14 to 47 years were enrolled with follow up for 3 months. All patients were given tumescence anesthesia in each breast comprising subcutaneous infiltration of 500 ml RL, 20 ml 0.5% bupivacaine, 30 ml 2% lignocaine, 1 mg adrenaline & 1 gm tranexamic acid. Breast tissue was excised in each breast by a single infraareolar incision & patients were assessed for intra-op pain and post-op pain by using numeric rating scale (NRS). Results. Bilateral presentation was there in 69 patients and 31 unilateral with 4 recurrent cases. Size of gland excised were 12-14 cms in 53 cases, 15-18 cms in 38 & 19-20 cms in 9 patients. Average surgical time required for each breast was 30 minutes. Intraoperative pain NRS-0 for 66, NRS-1 for 31 & NRS-5 for 03 patients. Postoperative pain for first eight hours was NRS-0 for 69 and NRS-1 for 31 patients. Conclusion. Tumescent anaesthesia for surgical excision of gynecomastia using a periareolar incision is a minimally invasive bloodless and painless technique in which ductal and stromal tissue can be removed resulting in a high level of patient satisfaction. In todays covid era it avoids the use of general anesthesia and electrocautery.
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The implementation of robotic surgery in the field of hepato-pancreato-biliary (HPB) has been a slow but significant process. HPB procedures offer a unique challenge when for new technologies, as the surgeries themselves are compl...
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The implementation of robotic surgery in the field of hepato-pancreato-biliary (HPB) has been a slow but significant process. HPB procedures offer a unique challenge when for new technologies, as the surgeries themselves are complex, with long learning curves. Yet the benefits of the robotic approach for this patient population are notable: decreased length of stay, blood loss, postoperative complications, and improving quality of life. The use of robotic simulation focused curriculum plays a crucial role in mentoring experienced surgeons and surgical trainees. Although further study remains, early studies suggest a structured simulation curriculum decreases time, technical errors, and improves proficiency, ultimately leading to a more expedited and safe implementation of robotic techniques in the HPB field.
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While minimally invasive surgery (MIS) to treat liver tumors has increased, data on perioperative outcomes of MIS relative to open liver resection (O-LR) are lacking. We sought to compare short-term outcomes among patients undergo...
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While minimally invasive surgery (MIS) to treat liver tumors has increased, data on perioperative outcomes of MIS relative to open liver resection (O-LR) are lacking. We sought to compare short-term outcomes among patients undergoing MIS vs. O-LR in a nationally representative database.
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Gastrointestinal bleeding (GIB) can occur as a complicating issue in the postoperative course after visceral surgery. It can be of varying clinical extent ranging from mild anemia to fatal hemorrhagic shock. Symptomatic manifestat...
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Gastrointestinal bleeding (GIB) can occur as a complicating issue in the postoperative course after visceral surgery. It can be of varying clinical extent ranging from mild anemia to fatal hemorrhagic shock. Symptomatic manifestations of a GIB are hematemesis, melena and hematochezia. The GIB are fundamentally differentiated into upper and lower GIB. While upper GIB is defined as the occurrence of endoluminal hemorrhage above the ligament of Treitz, correspondingly the definition of lower GIB is intraluminal bleeding distal to the duodenojejunal flexure. Knowledge of their procedure-related incidence during the postoperative course enables a better assessment of the necessary intervention.
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Surgery can only maintain its role in a highly competitive environment if results are continuously improved, accompanied by further reduction of the interventional trauma for patients and with justifiable costs. Significant impuls...
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Surgery can only maintain its role in a highly competitive environment if results are continuously improved, accompanied by further reduction of the interventional trauma for patients and with justifiable costs. Significant impulse to achieve this goal was expected from minimally invasive surgery and, in particular, robotic surgery; however, a real breakthrough has not yet been achieved. Accordingly, the new strategic approach of cognitive surgery is required to optimize the provision of surgical treatment. A full scale integration of all modules utilized in the operating room (OR) into a comprehensive network and the development of systems with technical cognition are needed to upgrade the current technical environment passively controlled by the surgeon into an active collaborative support system (surgery 4.0). Only then can the true potential of minimally invasive surgery and robotic surgery be exploited.
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Objective: Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to ...
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Objective: Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education, and quality improvement interventions.
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Objective: Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to ...
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Objective: Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education, and quality improvement interventions.
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Today, colorectal surgeons globally are practicing in an exciting era where surgical technologies are constantly emerging. Most of these cutting‐edge technologies are readily available in Australia and New Zealand at present. Thu...
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Today, colorectal surgeons globally are practicing in an exciting era where surgical technologies are constantly emerging. Most of these cutting‐edge technologies are readily available in Australia and New Zealand at present. Thus the ‘modern surgeon’ should always be defined by this open‐minded attitude towards these new and emerging surgical technologies. This review article highlights current modalities that we have been using in our north‐Brisbane public and private hospitals for cases predicted to be technically challenging using minimally invasive approaches for most of them. We examined the current evidence regarding the following modalities and critiqued their use in clinical practice: lighted ureteric stents, minimally invasive surgery approaches of laparoscopy and robotic surgery, pressure barrier insufflation devices, 3D camera systems, hand‐assist device ports and indocyanine green dye fluorescence angiography. The objective of this review paper is to alert colorectal surgeons to new surgical technologies available to them, to encourage colorectal surgeons' familiarization with these many technologies, and to support evidence‐based consideration for the clinical use of such. These technologies should be supplemental aides to the safe, oncologically adequate and efficient operation that they already routinely perform.
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