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Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current era of laparoscopic surgery. A retrospective review of medical records was undertaken to identify all laparoscopic converted to open cholecystectomy performed at a single center over a 2-year period. Reasons for conversion, surgeon's preoperative indications, and specimen pathologic results were documented. A review of published data from the previous two decades was also conducted for comparison of contemporary versus historical reasons for intraoperative conversion. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital System University Medical Center. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. A diagnosis of acute cholecystitis (58.8%) was more common among converted cases. Inflammation (35%), adhesions (28%), and anatomic difficulty (22%) were the three most common intraoperative findings leading to conversion. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management of this condition. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation.

Adjuvant chemotherapy for cholangiocarcinoma (CCA) has not been shown to gain significant improvements in survival. Factors contributing to suboptimal treatment response include aggressive disease biology and late clinical presentation. When feasible, surgical resection is the first line of treatment. Yet, recurrence remains high and longterm survival is rare. Neoadjuvant therapy is an appealing approach, with oncologic advantages in allowing the treatment of occult systemic disease and selection of patients most likely to benefit from radical surgery. However, given the surgery-first treatment paradigm for CCA, there is a paucity of data supporting neoadjuvant therapy. This review summarizes the current evidence on treatment response and margin-negative (R0) resection rate associated with neoadjuvant therapy for CCA.

Capsule endoscopes (CEs) have emerged as an advanced diagnostic technology for gastrointestinal diseases in recent decades. However, with regard to robotic motions, they require active movability and multi-functionalities for extensive, untethered, and precise clinical utilization. Herein, we present a novel wireless biopsy CE employing active five degree-of-freedom locomotion and a biopsy needle punching mechanism for the histological analysis of the intestinal tract. A medical biopsy punch is attached to a screw mechanism, which can be magnetically actuated to extrude and retract the biopsy tool, for tissue extraction. The external magnetic field from an electromagnetic actuation (EMA) system is utilized to actuate the screw mechanism and harvest biopsy tissue; therefore, the proposed system consumes no onboard energy of the CE. This design enables observation of the biopsy process through the capsule’s camera. A prototype with a diameter of 12 mm and length of 30 mm was fabricated with a medical biopsy punch having a diameter of 1.5 mm. Its performance was verified through numerical analysis, as well as in-vitro and ex-vivo experiments on porcine intestine. The CE could be moved to target lesions and obtain sufficient tissue samples for histological examination. The proposed biopsy CE mechanism utilizing punch biopsy and its wireless extraction–retraction technique can advance untethered intestinal endoscopic capsule technology at clinical sites.

Capsule endoscopy (CE) is a convenient and promising alternative endoscopic method for the gastrointestinal diagnostics on clinical sites; however, multifunctional utilization with active targeting locomotion is still challenging due to internal power limitations and micro-size manipulation mechanisms. The biopsy is one of the most demanding functions of intestinal CE, and successful developments could significantly improve the intestinal diagnostics for precise decisions and comfortable usage. In this paper, we present a novel active locomotive robotic biopsy capsule endoscope using an externally driven electromagnetic actuation (EMA) system and a battery-free wireless rotating blade mechanism. The external magnetic field from the EMA system controls both locomotion and biopsy operation, and thus, the proposed mechanism does not consume the internal power of the CE. We prototyped the proposed biopsy module and integrated it into an active locomotive capsule endoscope. Simulations were conducted to design the module and analyze the magnetic responses. We performed experiments with the biopsy capsule endoscope both in vitro and ex vivo to demonstrate its feasibility. In conclusion, the prototyped robotic biopsy capsule endoscope could successfully perform the necessary movements for the capsule in the small intestine and perform a biopsy at the target lesion with sufficient force. The amount of biopsy tissue was sufficient for a histological examination. INDEX TERMS Biopsy capsule endoscope, wireless capsule endoscope, electromagnetic actuation system, intestinal diagnosis.

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BackgroundA subset of metachronous colon cancer recurrence manifests as peritoneal metastases (PM). Risk factors for metachronous PM recurrence are not well‐defined in patients with stage II or III colon cancers after curative resection and standard adjuvant treatments.MethodsPopulation data from the California Cancer Registry for patients with Stage II or III colon cancer were collected between 2004 and 2012. Multivariate analysis was used to identify factors associated with metachronous PM.ResultsOf the 2077 patients with stage II or III colon cancer, female patients (odds ratio [OR] = 1.84, p = 0.02), T4 primary tumor (OR = 2.36, p = 0.02), mucinous (OR = 3.97, p < 0.01) or signet‐ring histology (OR = 6.01, p = 0.01), and right‐sided cancer (OR = 2.2, p < 0.01) were found with increased risk of metachronous isolated PM recurrence after curative resection. Median survival after diagnosis for patients without PM recurrence was 22 months, compared with 12 months for PM recurrence (p < 0.001).ConclusionPM recurrence groups have a worse overall survival than patients with recurrent disease in other sites. A better understanding of the tumor biology and molecular characteristics of colon cancers likely to recur as PM is needed to explain behavior and identify potential targeted therapy.