Objectives  To determine the acceptability by patients of ultrasound‐guided prostatic biopsy without anaesthesia. Patients and methods  From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound‐guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post‐operative questionnaire including a 10 cm linear visual analogue scale (VAS). Results  The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of ≥5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia. Conclusions  Even when anaesthesia‐free, transrectal ultrasound‐guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out‐patient setting should be reassessed.

Background: The role of MRI-detected EMVI (mrEMVI) as a reliable prognostic factor in rectal cancer has been emphasized in recent years but this finding remains underreported by many institutions. Objective: This review aimed to demonstrate the importance of pre-and post-treatment MRI-detected EMVI as independent prognostic factors of adverse oncologic outcomes in patients undergoing neoadjuvant therapy followed by total mesorectal excision. Methods: This review was designed using the PRISMA guidelines. The following electronic databases were searched from January 2002 to January 2020: CENTRAL, Ovid MEDLINE, PubMed, and Ovid Embase. Main outcomes included DFS and overall survival (OS). Other outcomes of interest comprised positive resection margin and synchronous metastases. Results: Seventeen studies involving a total of 3821 patients were included for data synthesis. For preneoadjuvant treatment mrEMVI, pooled hazard ratio (HR) estimate for DFS was 2.30 (95% confidence intervals (CI) 1.54-3.44) for higher recurrence in mrEMVI-positive patients. mrEMVI-positive patients were found to have a lower OS with a pooled HR of 1.68 (95%CI 1.27-2.22). Pooled risk ratio for synchronous metastasis was 4.11 (95%CI 2.80 -6.02) for mrEMVI-positivity. For postneoadjuvant treatment EMVI (ymrEMVI), positive status showed a lower DFS with a pooled HR of 2.04 (95%CI 1.55-2.69). Risk ratio of having a positive resection margin status was 2.95 (95%CI 1.75-4.98) for ymrEMVI-positive patients. Conclusions: This review showed that oncologic outcomes are significantly worse for both pre-and post-neoadjuvant treatment mrEMVI-positive patients. MRI-detected EMVI should be consistently reported in rectal cancer staging and may provide guidance for the targeted use of additional systemic therapy.

Objective To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia. Patients and methods The study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and September 1995. Twenty‐two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons. Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance was determined using an immediate post‐operative questionnaire which included a linear visual analogue scale (VAS) to rate pain. Results No patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean (se) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia. Conclusion TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for the relief of obstruction in high‐risk patients with a small benign prostatic hyperplasia.

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Background: Laparoscopic hepatectomy has recently spread rapidly throughout the world. However, laparoscopic hepatectomy uptake appears to be slower in liver surgery due to concerns regarding the technical feasibility and safety of the technique Methods: In order to solve several problems for laparoscopic hepatectomy, preoperative 3D simulation offers an opportunity to facilitate difficult techniques. And at our institute, CUSA dissection on the right hand and bipolar cautery on the left hand were used for safety dissection and resection. Bipolar device on the left hand was used for several procedure, surgical field of view, hemostasis, and crush cramp. Results: In 93 patients undergoing laparoscopic hepatectomy from 2007e2017, the liver vascular anatomy, liver resection volume, and margin were estimated by simulation preoperatively. We will present a case of a 71-year-old male patient who was diagnosed HCC. Preoperative liver functiona was Child A and the preoperative indocyanine green (ICG) 15 minutes clearance was 16%. Preoperative abdominal enhanced CT showed Hyper vascular tumor was located in the left lateral lobe near the Umbilical portion. And we performed the left hemi-hepatectomy for this patient. Conclusion: In conclusions, three-dimensional simulation of hepatectomy facilitated intraoperative identification of the vascular anatomy, and accurately predicted the resected liver volume and surgical margin. This simulation method and actual technique should contribute to safe and curative laparoscopic hepatectomy. P 102.Background: Percutaneous cholecystostomy (PC) is considered an alternate treatment for severe cases of acute calculous cholecystitis (ACC). We aim to investigate the recurrence rate, complications and perioperative outcomes in patients managed with PC. Methods: We retrospectively reviewed all patients with ACC treated with PC from 2012 to 2015 in our center. Complications related to drain management, recurrence of biliary symptoms following drain removal and perioperative outcomes of delayed cholecystectomy were reviewed. Results: A total of 114 patients were included. There was no immediate complication associated with PC placement. 37 patients (32.5%) had complications related to PC drain management, in whom 6 required early surgery. 21 patients developed symptoms recurrence after drain removal, 4 while awaiting elective surgery. 72 patients (63.2%) underwent complementary cholecystectomy, but only 26 (36.1%) as an outpatient surgery. 69 (95.8%) had a laparoscopic approach with 1 conversion to laparotomy. Perioperative intra-abdominal drain placement was found in 21 patients (29%). There was no biliary tract injury.Conclusion: PC appears to be an effective temporary treatment for ACC but is associated with a significant rate of drain management complications and a high recurrence rate of symptoms following drain removal. Delayed cholecystectomy, while technically challenging, carries an acceptable rate of perioperative complications and should be considered.

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Transanal endoscopic surgery (TES) was introduced in the 1980s, but more widely adopted in the late 2000s with innovations in instrumentation and training. Moreover, the global adoption of minimally invasive approaches to abdominal procedures has led to translatable skills for TES among colorectal and general surgeons. While there are similarities to laparoscopic surgery, TES has unique challenges related to the narrow confines of intraluminal surgery, angled instrumentation, and relatively uncommon indications limiting the opportunity to practice. The following review discusses the current evidence on TES learning curves, including potential limitations related to the broad adoption of TES by general surgeons. This article aims to provide general recommendations for the safe expansion of TES.

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