Objectives A laparoscopic approach improves short‐term outcomes and maintains long‐term outcomes compared to an open approach. In turn, the recent development of robotic surgery raises the question whether it performs as well as laparoscopic surgery. The aim of this study was to compare the short‐ and long‐term outcomes of laparoscopic liver resection (LLR) and robotic liver resection (RLR) for malignancies. Method From 2011 to 2017, the study population included 111 patients in the LLR group and 61 in the RLR group. Short‐ and long‐term outcomes were compared before and after propensity score matching (PSM). Results Operative mortality rate was nil. The intraoperative blood transfusion rate was higher during RLR (15% vs. 2%, p = 0.0009). Major morbidity and hospital stay were not different between the two groups. The resection margin width (LLR 7 mm vs. RLR 10 mm, p = 0.13) and R1 resection rates (resection margin width < 1 mm; LLR 15% vs. RLR 11%, p = 0.49) were similar. After PSM (55 patients in each group), the blood transfusion, major morbidity, hospital stay and R1 resection were similar between the two groups. When considering the largest subset of patients with hepatocellular carcinoma including 114 patients (66%), the 3‐year overall survival rate was 80% in the LLR group and 97% in the RLR group (p = 0.10) and remained similar after PSM (p = 0.27). The 3‐year recurrence‐free survival rate was 50% in the LLR group and 64% in the RLR group (p = 0.30) and remained similar after PSM (p = 0.26). Conclusions No differences were found in blood transfusion, incidence of positive resection margins and long‐term outcomes between the two techniques. RLR does not compromise short‐term and oncologic outcomes in patients with liver cancers.

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Myxomatous mitral regurgitation (type II Carpentier's functional classification) affects about 1-2% of the population. This represents a very common indication for valve surgery resulting in a low percentage of repairs compared to replacement which is actually performed. In the last decades, several methods for mitral valve repair have been developed, to make the surgical feasibility easier, improve the long-term follow-up thus avoiding the need for reoperations. A very interesting method is represented by the combination of various valve repair techniques, depending on the involvement of the anterior, posterior, or both leaflets, and the use of PTFE artificial chordae tendineae when excessive chordal elongation or rupture due to myxomatous degeneration co-exists. The aim of this review is to summarize the evolution of these techniques from the beginning till now.

Symptomatic pelvic organ prolapse (POP) can have an important impact on general health-related quality of life (QoL) and interfere, as a disability, with physical mobility, pain, emotional reaction, social isolation, energy and sleep (1). The impact of pelvic floor disorders on health related QoL is similar to the impact of other chronic and debilitating conditions as stroke, cancer, diabetes and dementia (2). Lifetime risk of undergoing at least one surgical procedure for prolapse and urinary incontinence (UI) is 11-18 % by the age of 79 years old and the reoperation rate for recurrence of these disorders is 29,2% (3). Over the next 30 years, demand for services to care for female pelvic organ diseases will increase at twice the rate of growth of the same population and the number of surgeries for UI and POP will increase substantially over the next 40 years (4). The high prevalence of POP results in high socio-economic costs and a significant impact on quality of life of these patients.Literature review in terms of colorectal pathology brings out some important observations: there is an unacceptable percentage of obstructed defecation syndrome (ODS) not resolved with conventional surgical procedures. The impact of surgical correction of prolapse symptoms on ODS remains unclear. There are few studies that explore this issue and the data that exist are mixed. Several studies suggest an improvement in constipation levels (5), while others demonstrated a worsening in symptoms or a significant degree of new-onset constipation (6). Furthermore, pre-operative clinical and instrumental evaluations rarely include anatomical-functional examinations of the rectum, thus neglecting that the rectum is one of the pelvic organs that has a high impact in pelvic dynamic, being daily more subjected to mechanical strains. If ODS persists or is created de novo in patients undergoing surgery for POP, this often results in intense straining which represents a daily mechanical stress on all the pelvic organs and supporting structures. We do not exclude that this could be a major cause of the high rate of relapse after conventional surgery. For these reasons, we believe that correcting ODS is a prerequisite in order to avoid relapses and im-

Background: Despite improved overall outcomes rejection continues to occur frequently after pancreas transplantation. Objective: To review the literature and to provide a state-of-the-art assessment of current practice and developments of immunosuppressive regimens in pancreas transplantation. Methods: The English literature was reviewed. Relevant articles were retrieved and analysed. Results: Induction therapy is used in approximately 90% of the transplants, with T-cell depleting antibodies being the prevalent therapy (>90%). Despite the initial enthusiasm on steroid-free regimens, maintenance protocols continue to be mostly based on a combination of steroids, tacrolimus, and mycophenolate mofetil. Tacrolimus is used in the majority of recipients. Sirolimus is rarely used at the time of transplant and is introduced later on in approximately 10% of the recipients, mostly in the context of a switching strategy to address the side effects of calcineurin inhibitors. The overall quality of published studies was quite low, because of the retrospective design, the heterogeneity of study groups with respect to PTx categories, the inclusion of mixed recipient categories with respect to immunologic risk profile, and the use of non-standardized concurrent immunosuppressive therapies. In addition, most reported studies are clearly underpowered, and treatment outcomes were not standardized. Conclusions: Since approximately two decades immunosuppression in pancreas transplantation mostly consists in induction with depleting antibodies and maintenance therapy using a combination of steroids, tacrolimus, and mycophenolate mofetil. While true novelty would be very much needed, this review confirms the wide use and the clinical efficacy of this regimen.

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Objective: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted propensity score analysis. Background: The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. Methods: Overall, 25 robotic resections with LND (2021-2022) from a single-center constituted the study group (Rob group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap group) and 113 open (Open group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit group). Results: Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of > 6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery. Conclusions: Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumors, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.