Application of da Vinci robots in the surgery of selected human cancers

The discovery of da Vinci surgical systems significantly contributed to cancer surgeries worldwide, however, the clinical and oncological outcomes are still debatable. Many retrospective studies have highlighted the advantage of robotic surgery over laparoscopic or open surgical procedures for various cancers, however, more multicentered, coordinated, random clinical trials must be conducted to outline the specific advantages of da Vinci robots. They have been widely used in cancer surgeries, however, higher operative cost and comparable oncological outcomes with laparoscopic approaches further forced manufacturers to come up with affordable and efficient specialized robotic surgery systems. Nevertheless, robotic surgery using da Vinci robots has been widely accepted for hysterectomy and prostatectomy over the laparoscopic procedure and this review briefly discusses da Vinci robots in the surgery of various human cancers and their clinical outcomes.

Sub hepatic acute appendicitis: a challenging case to diagnose and successfully managed by laparoscopic procedure

Sub hepatic acute appendicitis is a rare condition to occur. It can present as right upper quadrant pain and makes challenging in diagnosis and early management. Sub hepatic appendix normally due to malrotation of intestine during developmental period. This condition can mimic as acute cholecystitis, liver abscess. We are presenting a case of sub hepatic acute appendicitis and successfully managed by laparoscopic appendectomy. Sub hepatic acute appendicitis is challenging case to diagnosis and early management. Because late in diagnosis can cause to perforation of appendix and its complications.

Abdominal and Laparoscopic Cervical Carcinoma Therapy – a Comparative Economic Assessment

Objective The LACC (Laparoscopic Approach to Cervical Cancer) study revealed advantages in terms of overall survival and relapse risk favouring abdominal radical hysterectomy over the laparoscopic procedure. The present paper will compare the two surgical techniques from the economic point of view based on a process cost calculation. Material/Methods A retrospective cost analysis of all radical hysterectomies from the year 2018 was done at the Hanover University Medical School based on the bottoms-up method and guided by the clinical treatment pathway. Result Of 51 primary cases treated, 19 patients underwent radical hysterectomies, of which 8 were performed using the abdominal technique and 11 as endoscopic surgeries. 89.4% of the cancers were FIGO IB1 carcinomas. The total cost of a laparoscopic radical hysterectomy with an average hospital stay of 4.6 days came to € 2512.34, compared to an abdominal radical hysterectomy at € 2586.78 with an average hospital stay of 7.6 days. The greatest cost factor in which the laparoscopic method exceeded abdominal radical hysterectomy was the surgical procedure itself (€ 1836.75 vs. € 1411.21). Personnel represented the largest cost item in the surgical theatre (59%), so that surgery time was a significant multiplying factor. Average surgical time required for abdominal radical hysterectomy was 154 minutes, whereby the laparoscopic procedure required an average of 220.1 minutes. Inpatient care in the abdominal radical procedure cases was more costly by € 499.98 due to the longer hospitalization and additional medication required. Profit levels, including the DRG revenues, were higher with the abdominal method than with the laparoscopic method by € 186.21 despite longer hospital stays. Conclusion The present paper shows slightly greater profitability for the abdominal radical hysterectomy. On the other hand, this method entails longer hospitalization and a higher level of personnel deployment. Adequate occupancy management could make up for the revenue shortfall observed with the laparoscopic method.

A Prenatal Diagnosis and Repair of Spina Bifida

Before the 2011 Management of Meningomyelocele Study (MOMS) was published, the standard of care for SB was surgical closure of the defect shortly after birth. The MOMS trial showed that prenatal repair could limit damage to exposed spinal contents, arrest spinal fluid leakage, reverse hindbrain herniation, and improve fetal outcomes. Repair,usually between 19 and 25 weeks gestation is done by hysterotomy or a laparoscopic procedure

Effects of Leaving Amputated Ovaries Intra-Abdominally during Elective Bilateral Standing Laparoscopic Ovariectomy in Equids

There is risk of dropping an amputated ovary within the abdomen during standing laparoscopic ovariectomies in mares. If the ovary can no longer be directly visualized with the laparoscope, the procedure is then converted to a flank laparotomy for manual retrieval of the ovary which negates the minimally invasive nature of the laparoscopic procedure. The objective was to identify if ovaries left in the abdomen after amputation would atrophy or if they re-vascularize. Standing bilateral ovariectomies were performed in mature mares, but after transection of the ovarian pedicle, the ovaries were intentionally dropped and left within the abdomen. Post-operative endocrine values were at basal levels and an improvement in all mare’s behavior and general herd dynamics was observed. While this study does not encourage to leave ovaries in the abdomen after amputation, we report no complication related to their voluntary release into the abdomen.

Successful laparoscopic approach for idiopathic adult colo-colonic intussusception: a case report

Background Adult intussusception is recognized as an abdominal emergency. More than 90% of adult patients with intussusception have distinct causes that are related to benign or malignant tumors. In contrast, idiopathic intussusceptions, which are observed in children, are rare conditions in adult. Especially, colo-colonic idiopathic intussusceptions are rare among them. Surgery is traditionally considered the primary treatment option. Recently, laparoscopic surgery has been reported to be safe and feasible. However, laparoscopic surgical reduction, which is a common procedure in pediatric surgery, is not common in adult intussusception. Case presentation We report a 34-year-old man who presented with sudden abdominal pain. Computed tomography revealed the target sign in the transverse colon. There was no evidence of bowel obstruction, bowel wall edema, or tumor. We diagnosed idiopathic intussusception and selected laparoscopic procedure because of the strong abdominal pain experienced by the patient. There were no signs of perforation, bowel wall ischemia, or tumor in abdominal cavity. We confirmed idiopathic colo-colonic anterograde intussusception. Laparoscopic surgical reduction was achieved by a combination of delicate direct pressure on the anal side of the transverse colon and gentle pulling on the oral side. The patient’s postoperative course was uneventful. Conclusions We achieved successful surgical reduction laparoscopically because of an accurate preoperative diagnosis based on characteristic computed tomography features and appropriate surgical technique. Laparoscopic procedure and surgical reduction is considered to be an effective treatment strategy for adult idiopathic intussusceptions with severe symptoms.