Evaluating the Adequacy of YouTube Videos for Learning Laparoscopic Right Hemicolectomy With Complete Mesocolic Excision.

AIM:  Complete mesocolic excision (CME) is becoming an oncological surgical principle day by day for right hemicolectomy. However, the procedure is technically difficult and carries a higher risk of complications than open surgery. In this study, the adequacy of YouTube videos that facilitate education for laparoscopic right hemicolectomy with complete mesocolic excision (LRHCME) was investigated. METHODS: In July 2024, in the search bar of the YouTube platform, the term "laparoscopic right hemicolectomy complete mesocolic excision" was searched. The first 100 videos in each search were evaluated. Animations, advertisements, lectures, non-surgical videos (pre-surgery, post-surgery vlog, etc.), and non-English videos were excluded from the study. Steps identified in the Delphi consensus were used to determine the reliability of the videos. The quality of the videos was measured using the Global Quality Scale (GQS) and the modified DISCERN score. RESULTS: Seventy videos were included in the evaluation. While 28 (40%) of these videos were classified as reliable, 42 (60%) were not found reliable. In reliable videos, video description, HD resolution, GQS, modified DISCERN, and duration were significantly higher (p-value <0.001, 0.012, <0.001, <0.001, 0.041 respectively). Reliable videos had a better rank than unreliable videos (p=0.046). CONCLUSION: When evaluated according to Delphi consensus, the most of LRHCME videos on the YouTube platform were unreliable. We conclude that YouTube alone is insufficient for learning LRHCME without a professional instructor.

A method for predicting mortality in acute mesenteric ischemia: Machine learning.

BACKGROUND: This study aimed to develop and validate an artificial intelligence model using machine learning (ML) to predict hospital mortality in patients with acute mesenteric ischemia (AMI). METHODS: A total of 122 patients diagnosed with AMI at Sakarya University Training and Research Hospital between January 2011 and June 2023 were included in the study. These patients were divided into a training cohort (n=97) and a validation cohort (n=25), and further categorized as survivors and non-survivors during hospitalization. Serum-based laboratory results served as features. Hyperfeatures were eliminated using Recursive Feature Elimination (RFE) in Python to optimize outcomes. ML algorithms and data analyses were performed using Python (version 3.7). RESULTS: Of the patients, 56.5% were male (n=69) and 43.5% were female (n=53). The mean age was 71.9 years (range 39-94 years). The mortality rate during hospitalization was 50% (n=61). To achieve optimal results, the model incorporated features such as age, red cell distribution width (RDW), C-reactive protein (CRP), D-dimer, lactate, globulin, and creatinine. Success rates in test data were as follows: logistic regression (LG), 80%; random forest (RF), 60%; k-nearest neighbor (KN), 52%; multilayer perceptron (MLP), 72%; and support vector classifier (SVC), 84%. A voting classifier (VC), aggregating votes from all models, achieved an 84% success rate. Among the models, SVC (sensitivity 1.0, specificity 0.77, area under the curve (AUC) 0.90, Confidence Interval (95%): (0.83-0.84)) and VC (sensitivity 1.0, specificity 0.77, AUC 0.88, Confidence Interval (95%): (0.83-0.84)) were noted for their effectiveness. CONCLUSION: Independent risk factors for mortality were identified in patients with AMI. An efficient and rapid method using various ML models to predict mortality has been developed.

A New Technique for Localization of Parathyroid Adenoma: Infrared Thermal Scanning of the Neck.

Many radiological techniques are used to locate the adenoma preoperatively in cases of primary hyperparathyroidism, but the location of many adenomas still cannot be detected. Since adenomas are hypervascular lesions, their temperature is high. Infrared thermal scanning can reveal local temperature differences in hypervascular lesions. The location of the adenoma could not be determined by preoperative radiological examinations in a 58-year-old male patient who was scheduled for surgery with the diagnosis of primary hyperparathyroidism. By infrared thermal scanning, a nearly 2°F higher temperature was measured in the inferior of the right thyroid lobe compared to the other perithyroidal regions. During the exploration, the adenoma was found at this point and removed. Infrared thermal scanning of the neck is promising as a new technique that can be used both preoperatively and intraoperatively to locate the adenoma in primary hyperparathyroidism cases.

Prognostic significance of common hepatic artery lymph node metastasis in gastric cancer.

PURPOSE: The number of lymph nodes is used to determine the prognosis in patients with gastric cancer undergoing D2 lymph node dissection. However, a group of extraperigastric lymph nodes, including lymph node 8a, are also considered to be effective in prognosis. In our clinical experience, in most patients during D2 lymph node dissection, the lymph nodes are removed en-bloc with the specimen and are not marked separately. The aim was to analyze the importance and prognostic impact of 8a lymph node metastasis in patients with gastric cancer. METHODS: Patients who underwent gastrectomy and D2 lymph node dissection for gastric cancer between 2015 and 2022 were included in the study. Patients were divided into two groups based on metastasis to the 8a lymph node: metastatic and nonmetastatic. The effect of clinicopathologic features and the prevalence of lymph node metastasis on the prognosis of the two groups were analyzed. RESULTS: The present study included 78 patients. The mean number of dissected lymph nodes was 27 (IQR, 15-62). There were 22 (28.2%) patients in the 8a lymph node metastatic group. Patients with 8a lymph node metastatic disease had shorter overall survival and shorter disease-free survival. Those with metastatic 8a lymph nodes among pathologic N2/3 patients had shorter overall and disease-free survival rates (p < 0.05). CONCLUSION: In conclusion, we believe that anterior common hepatic artery (8a) LN metastasis is a key factor that negatively affects both disease-free and overall survival in patients with locally advanced gastric cancer.

Comparison of the efficiency of systemic therapy and intralesional steroid administration in the treatment of idiopathic granulomatous Mastitis. The novel treatment for Granulomatous Mastitis.

BACKGROUND: Idiopathic granulomatous mastitis that has not had a clear consensus about its treatment since the day it was identified as a rare, benign inflammatory breast disease that mimics malignancy due to its appearance features. AIMS: In our research, we intended to compare the efficiency of intralesional and systemic steroids administration in the treatment of idiopathic granulomatous mastitis. STUDY DESIGN: Prospective randomized controlled study. METHODS: A total of 36 female patients who had been histopathologically diagnosed with idiopathic granulomatous mastitis and whose other factors had been microbiologically excluded were included in the study. The patients were randomized into two sub-groups that would be treated with systemic and intralesional steroids. All patients were evaluated through physical examination one week after the completion of the treatment. Subsequently, the follow-up of the patients was performed thorough physical examination and ultrasonography and/or magnetic resonance imaging at the 1st, 3rd, and 6th months. RESULTS: All patients adapted to treatment. Complete clinical regression occurred in 32 patients, while 30 of 36 patients responded to treatment both radiologically and clinically. A total of 4 patients had minor side effects. It was determined that there was no statistically significant difference between local and systemic steroid groups in terms of complete clinical regression, responded to treatment side effects, and recurrence rates. CONCLUSION: Intralesional steroid administration was also considered just as a successful treatment method as the systemic steroid administration. KEY WORDS: Idiopathic granulomatous mastitis, Intralesional steroid, Systemic steroid.

Sclerosing angiomatoid nodular transformation presenting with thrombocytopenia after laparoscopic splenectomy - Case report and systematic review of 230 patients.

BACKGROUND: Sclerosing angiomatoid vascular transformation (SANT) is a rare vascular disease of the spleen, which is difficult to diagnose due to its pre-intervention appearance of malignancy. Case Report: An 85-year-old male was transferred to our clinic for thrombocytopenia and splenic mass. A contrast enhanced abdominal CT and MRI showed nodular lesions, the largest 50mm in diameter, and several areas of heterogeneous contrast field involvement in the spleen parenchyma. Laparoscopic splenectomy was performed with normal range of platelet level. The patient's postoperative course was uneventful and he was discharged on the 6th postoperative day. Histopathology revealed SANT. The patient is now in the 18 th month of remission with platelet levels within normal range and with no recurrence. RESULTS: Between 2004 and April 2020, a total of 230 SANT patients who underwent laparoscopic or open splenectomy or biopsy were reported in the literature. Most patients were female (52.1%), and the median age was 46 years (9 weeks-85 years). Most patients were asymptomatic (56%). Open splenectomy was performed on 166 patients (72.1%),laparoscopic splenectomy on 35 patients (15.2%) and laparoscopic partial splenectomy on 15 patients (6.5%). The median operation time and spleen weight were 143 minutes (88-213) and 260gr (68-2,720), respectively. Median follow-up time was 12 months (0-166). No recurrence was seen in patients undergoing total splenectomy. CONCLUSION: SANT is an unusual disease of the spleen. In the light of this systematic review, a minimally invasive method for total or partial splenectomy,specifically laparoscopy, can be preferred as the treatment of choice.

Pancreatic schwannoma: A rare case and a brief literature review.

INTRODUCTION: Pancreatic schwannoma (PS) is an extremly rare benign tumor. Less than 50 cases of pancreatic schwannoma have been described in the English literature over the past thirty years. PRESENTATION OF CASE REPORT: A 63-year-old female underwent left modified radical mastectomy 2 years ago due to breast cancer. During her routine check-up, a 65×63×55mm measured calcified, well-demarcated, cystic-mass having septations and calcifications that localized to the pancreatic head was detected by abdominal computerized tomography. She was asymptomatic and her tumor markers were in normal ranges. A standard Whipple procedure was performed, and the histo-pathological diagnosis of the resected specimen was reported as ancient schwannoma with clear surgical margins. Patient's postoperative course was eventful. She had a biliary leakage after surgery which was managed conservatively. She is under follow-up. DISCUSSION: Pancreatic schwannoma also known as neurilemoma or neuroma is a slowly growing, encapsulated, mostly benign tumor with smooth well-delineated margins that originates from myelin producing schwann cells located on the nerve sheath of the peripheral epineurium of either the sympathetic or parasympathetic autonomic fibers. PS's are extremly rare. The head of pancreas being involved in the vast majority of cases (40%), followed by its body (20%). Management of pancreatic schwannomas remains largely controversial. Both enucleation and radical surgical resections have revealed great therapeutic efficiency. with a well prognosis without recurrences. CONCLUSION: Although rare, PS's should be considered in the differential diagnosis of the other solid or cystic masses of the pancreas.