Lost needles during laparoscopic surgery can be located and retrieved by various methods. We found the laparoscopic magnet to be the safest and most efficient way of retrieving lost needles intraoperatively.
Aim Rectal prolapse is an uncommon but debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients. Perineal stapled prolapse resection is a relatively new perineal approach that offers an promising alternative technique in the surgical management of rectal prolapse. It appears to be a simple, reproducible and efficient method. However, longterm outcomes are limited. The aims of this review are to assess the safety and effectiveness of perineal stapled prolapse resection in the management of rectal prolapse. Method A systematic review of all articles describing this approach was searched using MEDLINE, Embase, PubMed, Cochrane, Scopus, Web of Science and China National Knowledge Infrastructure. Included in this review were all randomized and nonrandomized prospective and retrospective studies reporting patients (aged 16 years and older) with complete rectal prolapse who underwent perineal stapled prolapse resection for the surgical treatment of the rectal prolapse. Results A total of 408 patients across 20 articles were included. There were 58 cases of recurrence out of 368 patients over a median length of follow-up of 18 months (interquartile range 12-34 months). The total weighted overall recurrence was 12%. There were 51 cases of postoperative complications in 350 cases, bleeding being the most common complication. Conclusion The recurrence rate is comparable to those of the well-established Altemeier and Delorme procedures. However, given the heterogeneity of studies and variations in lengths of follow-up, further randomized prospective studies are needed to adequately compare this technique against other procedures for complete rectal prolapse.
Background While socioeconomic deprivation has been shown to affect survival in colorectal cancer, other factors such as global region of birth and ethnicity also exert an effect. We wished to ascertain the influence of socioeconomic deprivation on stage of presentation and cancer survival in an ethnically diverse Australian population. Methods Cases from a database of resections in Western Sydney (n = 1596) were stratified into cohorts of socioeconomic quintiles. Univariate analysis was used to compare demographics, AJCC stage and histopathological details between the least and most socioeconomically deprived groups. Kaplan–Meier analysis and log‐rank testing were used to compare cancer‐specific and all‐cause 5‐year survival between the most deprived quintile and all others, after case–control matching for age and overseas birth. Results A total of 322 (20.2%) patients from the most socioeconomically deprived centile, and 275 (17.2%) from the least were compared. The most deprived were significantly more likely to be aged under 70 (54.1% vs. 44.4%, p = 0.019), born overseas (54.3% vs. 38.6%, p = 0.003), present with stage III disease (37.4% vs. 26.7%, p = 0.005), perforated (12.5% vs. 5.3%, p = 0.005) or circumferential tumours (37% vs. 24.3%, p = 0.043). There was no significant difference in proportions presenting with metastatic disease, or 5‐year survival between the most deprived quintile and all others after correction for age and foreign birth. Conclusions Socioeconomic deprivation is associated with unfavourable colorectal cancer presentation stage but not poorer 5‐year survival in our Western Sydney population. The reasons for this are unclear and demand further attention.
Background: Flexible systems in robotic transanal surgery (RTA) are a proposed solution to the challenges of transanal minimally invasive surgery (TAMIS). RTA was performed with the Medrobotics Flex ® Robotics System to determine its safety and feasibility.Methods: Medrobotics Flex ® Robotics System was used for transanal resection of benign rectal polyps by a single surgeon in a tertiary centre, and cases retrospectively reviewed.Results: Five patients underwent flexible RTA, average age was 67 years. Polyps were between 5 and 12 o'clock, mean distance of 8.3 cm from the anal verge.Average operating time was 143 min. There was no peri-operative or 30-day morbidity or mortality. Histopathology included tubulovillous adenoma (TVA), and one hyperplastic polyp, all were clear of the surgical margin. Conclusion:This is the first case series using Medrobotics Flex ® Robotics System for RTA in a tertiary Australian public hospital. Flexible RTA is safe and feasible for the resection of benign rectal polyps.
The new knot pusher offers a tailored instrument for extracorporeal knot tying.
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