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Robotic assisted hysterectomy with regional lymphadenectomy is increasingly used for the treatment of endometrial carcinoma. In the present study we evaluated the feasibility and technique of robotic assisted hysterectomy and lymphadenectomy in patients with endometrial carcinoma. A prospective randomized study was undertaken from July 2011 to June 2012, in 50 consecutive patients with carcinoma endometrium. Demographic (age, BMI) and perioperative data (operating time, estimated blood loss, total number of lymph nodes retrieved, hospital stay, conversion to open procedure, intraoperative and postoperative complications) of robotic assisted surgery were compared with open staging procedure. Mean age of the patient and BMI in both groups were comparable with no significant difference. Estimated blood loss (81.28 ml), hospital stay (1.94 days) and perioperative complications were significantly less in robotic assisted group in comparison to open method. Mean number of lymph nodes removed were 30.56 versus 27.6 which is suggestive of significant difference statistically. Operative time decreased as the experience of the surgeon increased but still significantly remained higher than the open procedure after 25 robotic assisted surgeries. All robotic surgeries were completed successfully without converting to open method. Robotic assisted staging procedure for endometrial carcinoma is feasible without converting to open method, with the advantages of decreased blood loss, short duration of hospital stay and less postoperative minor complications. Operative time will decrease further as the experience of surgeon increases. Para-aortic lymph node dissection is easily done and with a better ergonomics for surgeon.

Disseminated intravascular coagulation (DIC) is a complex clinical syndrome, described as a sequential activation of the coagulation and fibrinolytic system. Trauma and sepsis are some of the known precipitating factors. We report a case of nonovert disseminated intravascular coagulation presenting as a huge renal mass in a 3-year-old child, suspected to be a Wilms’ tumor. On imaging studies, it was found to be a renal hematoma. Laboratory investigations revealed an underlying chronic disseminated intravascular coagulation caused by sepsis. The child recovered with conservative treatment; follow up investigations showed resolution of renal hematoma with renal function returning to base line. Clinical presentation of Chronic DIC is variable. Laboratory investigations usually help to diagnose the condition and also to monitor the progress of the treatment. The treatment of the triggering cause is the cornerstone of the management of this condition.

It is inevitable that some patients with suspected or confirmed COVID-19 may require urgent surgical procedures. The objective of this review was to discuss the modifications required in the operating room during COVID-19 times for minimal access, laparoscopy, and robotic surgery, especially with regard to minimally invasive surgical instruments, buffalo filter, trocars with smoke evacuator, and special personal protection equipment. We have discussed the safety measures to be followed for the suspected or confirmed COVID-19 patient. In addition to surgical patients, health care workers should also protect themselves by following the guidelines and recommendations while treating these patients. Although there is little evidence of viral transmission through laparoscopic or open approaches, we recommend modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device use to reduce the risk of exposure to aerosolized particles to the health care team. Therefore, hospitals must follow specific protocols and arrange suitable training of the health care workers. Following well-established plans to accomplish un-deferrable surgeries in COVID-19–positive patients is strongly recommended.

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This study aims to evaluate the safety and technical feasibility of total robot-assisted three-stage esophagectomy. From July 2011 to June 2014, 35 histologically proven resectable carcinoma esophagus patients underwent robot-assisted transthoracic and transperitoneal three-stage esophagectomy. In the initial ten cases, total docking time, thoracic docking time, total operative time, thoracic-phase operative time, and blood loss were 67.9 ± 13.24, 32.2 ± 9.74, 429.2 ± 57.65, and 96.6 ± 20.33 min and 433.20 ± 48.72 ml, respectively. In the subsequent 25 cases, all parameters decreased significantly (33.20 ± 4.16, 13.76 ± 3.43, 321.13 ± 13.75, and 57.04 ± 9.15 min and 256.32 ± 17.52 ml, respectively). Median numbers of lymph node dissected were 32. One case was converted to open method, and there was no in-hospital or 30-day mortality. Two cases required ventilator support for 1 day, with ICU stay for 1 day in 15 patients and 2 days in five patients. Two patients had major complications. Median hospital stay was 8 days. All had microscopic negative resection margins. Robot-assisted three-stage esophagectomy has the benefits of minimally invasive surgery and immediate oncological outcomes are comparable to conventional open surgery. Therefore, it is a safe and feasible technique for the treatment of esophageal cancer in selected patients.

6533 Background: Artificial intelligence is being used to provide support for information-intensive decision making. In this report, we present our experience in explaining how artificial intelligence adds value to MDT’s decision making ability & paves way for personalized therapy. Methods: 1000 cases involving breast, lung, and colorectal cancer were evaluated by a multidisciplinary tumor board at a major cancer center in India between 2016 and 2018. After the tumor board decision was made, MDT was presented with the Watsons recommendations contemporaneously. MDT reviewed their decision after going through Watson’s recommendations and also the evidences that it put forth supporting its decision. Cases in which decision was changed, objective assessment was done by asking MDT to quote the reasons for reviewing and changing their decision. Results: Of 1000 cases, breast, lung, colon & rectal cancers were 620, 130,126 & 124 respectively. There were 712 non-metastatic & 288 metastatic cases. Mean age of the patients was 54.3 ± 12.2. Treatment concordance was observed in 92% for all cancers combined, 93% for rectal cancer, 92% for breast cancer, 89% for lung cancer, and 81% for colon cancer.MDT changed their decision in 136 cases (13.6%). The reasons for tumour board to change their decision was, Watson provided recent evidences for newer treatment in 55%, better personalized alternative in 30% & new insights from genotypic and phenotypic data and evolving clinical experiences in 15% of time. Conclusions: The study suggest that cognitive computing decision support system holds substantial promise to reduce the cognitive burden on oncologists by providing expert, updated, recent evidence-based insights for treatment-related decision-making. The 13.6 % incremental advantage over and above in a tertiary cancer centre with functioning MDT speaks in itself the value of having a learned colleague like Watson for oncology at our disposal. It will certainly add more value in settings lacking ready access to high quality cancer expertise and information. These systems can be valuable adjuncts to strong patient-clinician relationships in the delivery of high quality cancer care.

Aim:Since last decades, more and more thyroidectomies have been performed by the minimally invasive method. Compared to conventional thyroidectomy, minimally invasive thyroidectomy has a superior cosmetic result. However, the outcome depends, in a large extent, on the skill of the operator and the learning curve is relatively long. Robotic thyroidectomy (RT) is a relatively new approach in treating thyroid lesions with improved ergonomics and surgical outcomes.Purpose:We performed a prospective study of robotic-assisted transaxillary approach for thyroidectomy in Indian patients to examine the feasibility of the procedure.Materials and Methods:A total of 35 patients underwent RT. Demographics, surgical indications, operative findings, postoperative functional outcome, local complications and pathological outcomes were recorded and analyzed.Results:The median age of the cohort was 28.6 years and 31 of the patients were women. The median size of the largest nodule was 3.2 cm (range, 1.0–4.5 cm). The median size of the largest nodule was 3.2 cm (range, 1.0–4.5 cm). Eighteen patients underwent less than total thyroidectomy and 17 patients underwent total thyroidectomy, with no conversion. The mean console time standard deviation was 115 min initially, and with experience, it reduced to 106 min for subsequent cases. The mean blood loss was 13 ml. Post-operative outcome was good with no serious complication noted in our series.Conclusion:Robotic-assisted thyroidectomy using a gasless transaxillary approach is a feasible, safe and noninferior surgical alternative for selected patients. We believe with time RT will be widened and it will be performed more often.