Haemorrhoidal disease (HD) is a common condition that often requires surgical treatment. In comparison with other traditional techniques, radiofrequency thermocoagulation (RFTC) has multiple advantages to traditional repairs and can be a good alternative in surgical management of HD. We retrospectively analysed 20 patients with Grades 2 (n = 6, 30%) and 3 (n = 12, 70%) haemorrhoids undergoing RFTC from 1 September 2019 to 31 December 2021. Outcomes including post-operative (PO) pain, immediate/late PO complications, recurrence and patient satisfaction were assessed. Twenty cases were included in this case series. All pathological symptoms showed significant improvement in PO period. Eight complications were noted, including minor bleeding (n = 2), bleeding that required admissions (n = 3), pain (n = 2) and recurrence (n = 1). The mean time off work is 7 days and all patients were satisfied or very satisfied PO as per telephone questionnaire. RFTC is a safe and effective solution in the management of HD and is a good alternative to conventional procedures.
Introduction: Robotic platforms provide a stable tool with high-definition views and improved ergonomics compared to laparoscopic approaches. Purpose The aim of this retrospective study was to compare the intra- and short-term postoperative results of oncological resections performed robotically (RCR) and laparoscopically (LCR) at a single centre. Methods Between February 2020 and October 2022, retrospective data on RCR were compared to LCR undertaken during the same period. Parameters compared include total operative time (TOT), length of stay (LOS), re-admission rates, 30-day morbidity. Results 100 RCR and 112 LCR satisfied inclusion criteria. There was no difference between the two group’s demographic and tumour characteristics. Overall, median operative time was shorter in LCR group [200 vs 247.5 min, p < 0.005], but this advantage was not observed with pelvic and muti-quadrant resections. There was no difference in the rate of conversion [5(5%) vs 5(4.5%), p > 0.9]. With respects to perioperative outcomes, there was no difference in the overall morbidity, or mortality between RCR and LCR, in particular requirement for blood transfusion [3(3%) vs 5(4.5%), p 0.72], prolonged ileus [9(9%) vs 15(13.2%), p 0.38], surgical site infections [5(4%) vs 5(4.4%), p > 0.9] anastomotic leak [7(7%) vs 5(4.4%), p 0.55], and re-operation rate [9(9%) vs 7(6.3%), p 0.6]. RCR had shorter LOS by one night, but this did not reach statistical significance. No difference was observed in completeness of resection but there was a statically significant increase in lymph node harvest in the robotic series. Conclusion Robotic approach to oncological colorectal resections is safe, with comparable intra- and peri-operative morbidity and mortality to laparoscopic surgery.
Retroperitoneal tumors are rare neoplasms that can reach great dimensions due to a slow growth pattern. Although these tumors rarely metastasize, they have a great risk of recurrence, and majority of times these lesions are a challenge for the surgeon. We report the case of a 63-year-old woman who presented with symptoms of large bowel obstruction and was diagnosed with a large heterogenous mass located in the retroperitoneal space. The fine needle biopsy revealed the histology of liposarcoma. The purpose of this article is to report our approach in management of this kind of tumor. Tumor size (27.1 × 29.1 × 36.1 cm) and involvement to the adjacent organs was a challenge for us in order to reach safe oncological margins. In these cases, the risk of recurrence is high; therefore, the patient should be screened at 6, 12 and 24 months post procedure. Chemotherapy or radiotherapy for this tumor is not yet defined, and if operable, surgery is the treatment of choice.
Introduction and Aim Elective open inguinal hernia repairs are one of the most common procedures carried out in the NHS with over 78000 operations per year. There are many risks associated with this procedure and so obtaining informed consent is imperative to patient care and patient choice. The aim of this study is to compare the quality of consent forms for elective open inguinal hernia repairs to the guidance provided by the Royal College of Surgeons (RCS) and the British Hernia Society (BHS). Method 60 patients (50 male, 10 female) undergoing elective open inguinal hernia repair between 01/09/2021–20/12/2021 were identified retrospectively. Their consent forms were audited against modified guidelines from RCS and BHS. The grade of the consenting surgeon was also noted. Results Sepsis (95%), recurrence (85%), and chronic pain (82%) were the most consented risks. Least consented serious risks were persistent numbness (47%), nerve injury (47%), and mesh infection (40%). Notable disparities existed between rates of consent and grade of surgeon: 64% of registrars consented for nerve injury compared to 9% of SHOs and 82% of SHOs consented for haematoma compared to 20% of consultants. Conclusion Serious risks such mesh infection and nerve injury were often missed from consent forms. There is inconsistency in consented risks between different grades of surgeon. A standardised consent form would improve consent consistency and potentially reduce rate of litigation for doctors and the trust. Comprehensive pre-made consent forms were therefore designed to better facilitate a standardised approach to the consenting process.
A 54-year-old man was seen in the clinic with the chief complaint of epigastric pain radiating to the left groin region and a predominant postprandial abdominal discomfort. Upon examination, a painless round mass with reduced mobility was felt in the left flank during deep palpation of the abdomen. His past medical history was irrelevant. Ultrasound and IV contrast-enhanced CT scan confirmed the presence of a large tumor and an exploratory laparotomy for removal of the tumor was performed. The microscopic examination of the specimen confirmed the primary diagnosis of retroperitoneal tumor (RPT) and identified it as an extragonadal germ cell tumor with a vestigial origin, which is a rare type affecting the kidney and adrenal gland. Primitive RPTs are histologically classified as mesenchymal and neuroectodermal or vestigial. These histological types are rarely found in surgical practice and are challenging to diagnose and treat due to the peculiarities of the site of origin where they develop. RPTs are extremely rare and approximately 80% are malignant and detected lately during the disease's course, commonly discovered in advanced stages of local or systemic evolution. Currently, surgical intervention remains the only effective method of treating these tumors.
Aim To present an analysis of the first 2-years’ experience of robotic-assisted colorectal procedures (RACP) using the DaVinci Xi platform. Methods This data were prospectively collected and include 72 RACP between February 2020 and December 2021.Indications were: malignancy in 74.3%, diverticular disease 10%, inflammatory bowel disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent volvulus 1.4%. Results Over the 13-month study period, 72 RACP were performed including elective 57 cases and 15 semi-elective cases. These comprised: 25 right hemicolectomies, 25 high anterior resections, 6 extended right hemicolectomies,4 low anterior resections, 4 subtotal colectomies 2 restorative proctectomies, 3 abdominoperineal excisions of the rectum, 3 rectopexies that were performed. 51.2% were female and 48.6% were male with a median age of 45 years (22–85 years) and the median body mass index was 31 (18–46) kg/m2. Preoperative American Society of Anaesthesiology scores were reported as 1–2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The median length of stay was 5 days (1–35), with readmission rate within 30 days of 8.6% (n=6) that were resolved conservatively. The mean operating time was 268 minutes and the mean console operative time was 158 minutes, with only 3 (4.3%) reported cases of conversion to open. The incidence of postoperative complications was 24.3% (Clavien–Dindo (CD) I/II- 12.9%, CD III- 10%, and CD V-1 case with superimposed COVID 19 within 30 days. Conclusion RACP is a safe and viable modality in the treatment of colorectal conditions and can be introduced safely with appropriate guidance and proctorship.
Aim To present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH. Methods We report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay. Results The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III. The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM. Conclusion We report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.
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