Appendiceal neoplasms in Saudi Arabia: prevalence and clinicopathological profile.

BACKGROUND: The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. OBJECTIVES: Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. DESIGN: Retrospective cohort. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. MAIN OUTCOME MEASURES: Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. SAMPLE SIZE: 25 AN patients. RESULTS: Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. CONCLUSIONS: The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. LIMITATIONS: Data collected retrospectively, a single institution, and a small population.

Use of a robotic camera holder (FreeHand®) for laparoscopic appendicectomy.

Introduction: Use of a mechanical arm to hold the laparoscopic camera has many advantages. FreeHand® (FreeHand Ltd, Guildford, United Kingdom) is a robotic camera holder which uses head movement and infrared technology. This trial assessed the usefulness of FreeHand® in laparoscopic appendicectomy.Material and methods: This was a single center prospective cohort study on patients undergoing emergency laparoscopic appendicectomy using FreeHand®. Patient demographics, operative details, conversion to human camera holder and surgeon discomfort were recorded. Utilization of assistant time while not assisting was also recorded.Results: Twenty-two participants were included, with a mean age of 32 years and a mean BMI of 25.3. The mean set up time was nine minutes. There were five conversions to a manual camera holder (22.7%). There were 22 lens cleaning episodes with nine (40.9%) not requiring any lens cleaning and six (27.3%) requiring one clean. There were no peri-operative complications. Most surgeons reported minimal or no discomfort. Assistant's time was used for ward work (57%), clerking patients (36%) and for a break (7%).Conclusions: FreeHand® can be safely used in laparoscopic appendicectomy. It provides a stable image, puts the surgeon in control of the surgical field, causes minimal user discomfort, and frees up personnel.

Rate of skill acquisition in the use of a robotic laparoscope holder (FreeHand(®)).

BACKGROUND: Robotic equipment can greatly add to the ergonomics of a surgical procedure and pre-operative simulation can provide risk-free training of the surgeon leading to precision surgery and less trauma to the patient. Freehand(®) is a second-generation robotic camera-holding device, which has recently become available to laparoscopic surgeons. It is controlled by the operator selecting a direction using head movement followed by activation with a foot pedal. The purpose of this study was to assess the rate of skill acquisition in the use of the FreeHand(®) robotic laparoscope holder by a group of laparoscopic surgeons by enrolling them into a programme of training modules at The ICENI Centre, Colchester Hospital University, UK. MATERIAL AND METHODS: Twenty surgical registrars performed a series of exercises, escalating in difficulty, to test their skill in controlling the FreeHand(®) robot. Subjective and objective assessments were evaluated by an observer and by tracking analysis software created for this trial. RESULTS: The observed number of head movements showed a Percentage Performance Score (PPS) of 98% by the end of the third repetition of all exercises, the mean Total Head Movements Score (HMS) reached a plateau of performance at 72%. Fifty per cent of the participants selected 'Effective control of movements without difficulty' in the subjective evaluation by the end of the third repetition of exercises, while 35% selected 'competent intuitive movements'. CONCLUSION: The FreeHand(®) robotic laparoscope holder is a useful device, which is easy to operate and requires a very short course of training to achieve competence in its use.