Background: To evaluate intraoperative and postoperative cytokines in patients who underwent robotic prostatectomy (RP) at a pressure of 12 or 15 mm Hg, and the risk of postoperative ileus. Materials and methods: We presented the first series evaluating intraoperative and postoperative cytokines in patients undergoing RP at a pressure of 12 or 15 mm Hg by a single surgeon. Changes in cytokine concentrations were shown to correlate with surgical outcomes and pathological states. The study investigated the changes in cytokine concentrations (interferon-γ, tumor necrosis factor-α, interleukin-1β [IL-1β], IL-2, IL-4, IL-6, IL-12, and IL-17) at different pneumoperitoneum pressures and their potential role in the development of postoperative ileus. Results: The data on 10 consecutive patients confirmed that a lower pneumoperitoneum pressure was associated with lower cytokine levels and a lower risk of ileus. There were increased levels of postoperative interferon-γ, tumor necrosis factor-α, IL-12p70, IL-1β, IL-2, IL-4, and IL-17a at 15 mm Hg when compared to 12 mm Hg. Conclusions: The data indicated that lower pressure RP reduced intra-/postoperative cytokine levels confirming our hypothesis. Larger patient numbers are required to further validate this but the implications of this data will benefit not only urological patients but also other speciality patients undergoing minimally invasive surgery.

Background Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. Methods We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery’s 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. Results In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. Conclusions Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

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Aims To report the outcomes of delayed primary repair of zone 2 flexor tendon injuries after 4 weeks. Methods Retrospective evaluation of all adult patients presented with more than 4 weeks of flexor tendon injuries and underwent primary surgical repair between 2016 and 2019. Results 271 patients’ notes have been reviewed. Only 12 patients met the criteria. 70% of patients were male with a mean age of 25 years and 40% of them were manual workers. Knife laceration was by far the most common mechanism of injury. The little finger was the most affected finger followed by the ring and middle fingers. The mean time interval between initial injury and repair was 40 days. Only one infection was reported that was treated with oral antibiotics. Two cases were in need of tenolysis due to flexed contracture. The mean total active range of motion was 167. Patients reported a good functional outcome with a mean DASH score of 10. The number of hospital visits was 40% less compared with their counterparts who underwent two-stage reconstruction. Conclusions In our experience, immediate reconstruction of delayed flexor tendon injuries is a better option for these cases. It is associated with a reasonable range of motion with fewer hospital visits. This facilitates early return to work, especially in the manual workers’ population.