A recurrent epidermoid cyst of the spleen: report of a case and literature review.

BACKGROUND: Splenic cysts are rare disease. Epidermoid cysts of the spleen belong to the primary nonparasitic splenic cysts group. They are an unusual event in surgical practice. Usually, epidermoid cysts occur in children and young female. Most often, they are asymptomatic, but they may present with abdominal discomfort. CASE PRESENTATION: We are reporting a rare case of a 23-year-old female came to our attention with history of intermittent pain and previously undergone two times to laparoscopic decapsulation of the cyst in others institutions. During hospitalization, serum and intracystic levels of tumor marker CA19-9 increased. Enhanced CT of the abdomen showed recurrent large cyst in the upper pole of the spleen with satellite nodules. Laparotomic total splenectomy was performed. Histopathological and immunoreactive examinations were executed, and they revealed stratified squamous epithelium on the inner surface of cystic wall, which was positive for EMA, CEA, and CA19-9. The diagnosis of epidermoid cyst was confirmed. CONCLUSIONS: Recently, the surgical approach is changing towards conservative treatments in order to save the spleen in young patients for immunological reasons. Sometimes, this target is not achievable. In such circumstances, like recurrent large cyst, anomalous anatomical relationship to the surrounding tissues, total splenectomy is safe and necessary.

How emergency surgery has changed during the COVID-19 pandemic: A cohort study.

INTRODUCTION: Various surgical societies constantly update their recommendations in order to adapt surgical activity on current Pandemic conditions. The aim of this study is to analyze how hospitalizations and emergency operations have changed in our Department of Medical and Surgical Sciences in the Hospital of Foggia during covid-19 pandemic. METHODS: Our cohort-study was conducted by analyzing two groups of patients admitted to the Department of Medical and Surgical Sciences of the Hospital of Foggia: those admitted during the no-covid period from March 09th, 2019 to May 09th, 2019 and those during the covid period from March 09th, 2020 to May 09th, 2020. RESULTS: A total of 750 patients admitted during the no-covid period of 2019 and 171 during the covid period of 2020, of these 222 were emergency admission during 2019 and 97 during 2020, 528 were elective admission during 2019 and 74 during 2020. Of the emergency admissions (222 during 2019 and 97 during 2020), 91 were operated during the no covid period in 2019 and 52 during the covid period in 2020. The mean Mannheim Peritonitis Index Score, that is a scoring system used in peritonitis which is simple and cost-effective, were 15.6 during the no covid period of 2019 and 22.2 during the covid period of 2020. We observed 29 post-operative complications during 2019 and 26 during 2020. CONCLUSIONS: Contraction of admissions for urgent and emergent conditions in the first period of lockdown has been followed from some positive effects as well as aggravating consequences.

Robotic voluminous paraesophageal hernia repair: a case report and review of the literature.

BACKGROUND: The treatment for sliding esophageal hernia with mild gastroesophageal reflux is usually conservative, but surgical treatment is recommended for refractory sliding esophageal hernia, paraesophageal hernia liable to prolapse, or paraesophageal hernia with ulceration and/or stenosis. Robotic surgery overcomes laparoscopic pitfalls by providing steady-state three-dimensional visualization, augmented dexterity with endo-wrist movements, and superior ergonomics for the surgeon. CASE PRESENTATION: To investigate robotic paraesophageal hernia repair, a literature search was conducted using PubMed with the following key words: mini invasive surgery, robotic surgery, hiatal hernia, and Nissen fundoplication. We present the case of a 44-year-old Italian woman with a 20-year history of gastroesophageal reflux disease refractory to medical treatment, who underwent robotic Nissen fundoplication. In our center, we use the da Vinci® Xi™ Surgical System, which is an advanced tool for minimally invasive surgery. CONCLUSIONS: Various reports published in the literature suggested that the robot-assisted approach was effective and was associated with very low postoperative morbidity and was accompanied by satisfactory symptomatic and anatomical radiological outcomes during a follow-up period. The robotic approach to paraesophageal repair is safe and effective with low complication rates. With increased experience, the operative time, length of stay, and complications decrease without compromising surgical principles.

Right hemicolectomy: laparoscopic versus robotic approach.

BACKGROUND: Minimally invasive surgery for colorectal cancer has been demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic surgery is an evolution of minimally invasive technique. This study aims to evaluate surgical and oncological short-term outcomes of robotic right colon resection in comparison with the laparoscopic approach. METHODS: Between January 2014 and May 2017, fifteen laparoscopic right hemicolectomies were compared to seven robotic ones. The primary data points included operation time, length of hospital stay, extraction site incision length, complications, and conversions. When malignancy was the indication for surgery, additional data points have been added. RESULTS: The study showed no difference in parameters between the two groups, but estimated blood loss was significantly smaller for Robotic arm. We found a prolonged total operative room time in the robotic arm, while the surgical time is similar in two groups. The data collected about specimen length and number of lymph nodes suggest that robotic procedure is oncologically similar to laparoscopic one. CONCLUSIONS: Robotic approach allows performance of adequate dissection of the right colon with radical lymphadenectomy as in laparoscopic surgery, confirming the safety and oncological efficacy of this technique, with acceptable results and short-term outcomes. KEY WORDS: Da Vinci surgery, XI, Laparoscopic colorectal surgery, Right hemicolectomy, Robot.

Bilateral central neck dissection in the treatment of early unifocal papillary thyroid carcinomas with poor risk factors A mono-institutional experience.

INTRODUCTION: Papillary thyroid carcinoma is the most common type of thyroid cancer worldwide. While total thyroidectomy is widely considered the standard surgical approach for papillary thyroid carcinomas, the role of central lymphadenectomy in early stage poor-risk papillary thyroid tumors is still a matter of debate. This study was designed to assess surgical complications and local disease control rates in patients affected by poor-risk early stage papillary thyroid carcinomas. METHODS: We retrospectively analyze three groups of patients affected by poor-risk early stage papillary thyroid carcinomas treated with three alternative surgical strategies: I) routine total thyroidectomy; II) total thyroidectomy and routine central lymphadenectomy; III) total thyroidectomy and central lymphadenectomy upon positive intraoperative histological evaluation of lymph node involvement. RESULTS: Data from patients treated with routine total thyroidectomy showed 32% of persistence of disease in the central compartment with concurrent positivity in laterocervical compartment in 25% of these cases. By contrast, patients receiving total thyroidectomy and routine central lymphadenectomy showed the involvement of central compartment in 40% of cases, while the remaining 60% of patients were free from lymph node metastases. Finally, patients undergoing total thyroidectomy and central lymphadenectomy upon positive intraoperative lymph node biopsy exhibited lack of persistence of lymph node involvement in central compartment after surgery. Of note, postsurgical complications were lower in patients undergoing conservative surgical approaches. CONCLUSIONS: These data suggest that central lymphadenectomy, performed only in case of positive intraoperative lymph node biopsy, ensures reduced incidence of postoperative complications and optimal loco-regional disease control. KEY WORDS: Bilateral central neck dissection, Intraoperative lymph node biopsy, Papillary thyroid carcinoma, Poor risk factors.

Antegrade cholecystectomy before ligating the elements. A technique that reduces complications.

BACKGROUND: In open surgery, the most common approach is Retrograde approach ("fundus first"), while is less frequent in laparoscopic cholecystectomy. Antegrade access, is obtained by putting in traction the infundibulum and reaching up to the fundus right before clipping the cystic. Our study analyzes a number of surgical procedures performed by surgeons with long experience in laparoscopy. METHODS: From 2002 to 2017, 2020 laparoscopic cholecystectomies were performed at our Institution. The operative technique used since 2002 is the following: incision of the visceral peritoneum from the infundibulum away from Calot's triangle along the gallbladder bed up to the fundus and then to the infundibulum. RESULTS: No bile duct injuries happened. Average operative time was 38 min. 30 conversions to an open procedure (1.5%) occurred, in patients with cholecystitis and cirrhosis Postoperative stay was mean 2 days with no delayed complications on follow up. CONCLUSIONS: Gallbladder antegrade dissection for laparoscopic cholecystectomy may be an easier approach and may reduce the time of surgery. So it may be used as the standard procedure and not only be used for complicated cholecystectomies. KEY WORDS: Difficult cholecystectomy, Laparoscopy, Antegrade dissection, Cholecystectomy, Cholecystitis, Fundus first.

Surgical management of non-parasitic hepatic cysts A single center experience and a review of the literature.

AIM: We present our experience in the laparoscopic management of the hepatic cysts (SHCs) and the polycystic liver disease (PCLD), and a literature review. MATERIAL AND METHODS: Between 2005 and 2018, laparoscopic deroofing was performed in 28 consecutive patients. There were 19 cases with SHCs and only 9 cases with PCLD (Gigot's type I). CT scan was performed in all cases to assess the characteristics, dimensions, and exact position of the lesion. Surgery was planned for all patients because of evident and persistent symptomatology, RESULTS: We have analyzed operative time, surgical procedure, blood loss, hospital stay, complications, and medium follow- up period. All the patients underwent laparoscopic deroofing of the larger cysts and puncturing of the smaller cysts. The total morbidity recorded was 25% (7/28), 3 cases in the group of SHCs (16 %) and 4 cases in the PCLD one (44%) and was characterized of 3 cases of ascites through trocar insertion sites after removal of drainage tube and 4 case of pleural effusion. DISCUSSION: There were no significant group differences in term of length of hospital stay. The follow-up period (a mean of 24 months) confirmed that all the patients remained free of symptoms and relapse of the disease. CONCLUSION: The technical feasibility and the good short- and medium-term results made the laparoscopic approach the procedure of choice for the management of symptomatic liver cysts. KEY WORDS: Hepatic cyst, Liver disease, Minimally invasive surgery.

A Rare Case of Functioning Adrenocortical Oncocytoma Presenting as Cushing Syndrome.

Functioning adrenocortical oncocytoma is very rare neoplasm. It is usually nonfunctional and benign and incidentally detected. Generally, these tumors originate in the kidneys, thyroid, parathyroid, and salivary or pituitary glands; they have also been reported in other sites including choroid plexus, respiratory tract, and larynx. Histologically, they are characterized by cells with eosinophilic granular cytoplasm and numerous packed mitochondria. We reported a case of a 44-year-old female who presented with Cushing syndrome for hypersecretion of cortisol due to adrenocortical oncocytoma. Magnetic resonance of abdomen revealed a right adrenal mass. Laparoscopic adrenalectomy was performed and the tumor was pathologically confirmed as benign adrenocortical oncocytoma. After surgical treatment, Cushing's syndrome resolved.