Knowledge, attitude, and perception of robotic-assisted surgery among the general population in Saudi Arabia: a cross-sectional study.

Minimally invasive surgery (MIS) has revolutionized surgical practices, with robotic-assisted surgery (RAS) significantly advancing. However, the understanding and acceptance of RAS vary, impacting its widespread adoption. This study aims to assess Saudi Arabians' attitudes and comprehension of RAS, which is crucial for promoting its integration into surgical procedures. A cross-sectional study was conducted in various Saudi Arabian cities. A total of 1449 participants were included, while participants with cognitive issues were excluded. Demographic information, knowledge, technology experience, attitudes, and perceptions about RAS were collected using an online self-administered questionnaire. Data were analyzed using descriptive and inferential statistics. Of the participants, 51.1% demonstrated awareness of RAS, mainly through social media (36.9%). Factors influencing awareness included gender, education, income, occupation, computer literacy, and technology comfort. Gender disparities were evident in attitudes and perceptions toward RAS. Concerns about RAS included robot malfunction (62.0%), surgical errors (45.4%), and surgeon competency (44.7%). 36.4% of the participants believe RAS is faster, 29.9% believe RAS is less painful, and 25.3% believe RAS has fewer complications. Positive perceptions encompassed the belief that robot-using surgeons are more skilled (44.5%) and hospitals offering RAS are better (54.3%). Notably, 47.7% expressed willingness to consider RAS as a treatment option. The study underscores the significance of promoting awareness and informed decisions to ensure the successful integration of RAS in surgical practices. Addressing concerns and misconceptions and enhancing public comprehension are pivotal for facilitating informed decision-making and fostering RAS acceptance within Saudi Arabia's surgical landscape.

Horner's Syndrome Following Thyroid Surgery.

Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman referred to the clinic with a newly diagnosed papillary thyroid carcinoma (PTC). Ultrasound studies were concerning for multiple thyroid nodules and an enlarged lymph node, confirmed by a computed tomography (CT) scan. Cytology results of fine needle aspiration (FNA) diagnostic for PTC showed tumors in the thyroid tissue and lymph node. The patient underwent a thyroidectomy and woke up with right-sided ptosis and miosis. Clinical follow-up revealed subjective ipsilateral anhidrosis. She also developed a low parathyroid hormone level and dysphonia, albeit they resolved after months. The patient still exhibits HS eight months after surgery. This paper reviews the literature and attempts to establish the most probable causal factor while providing implications for surgical teams to minimize HS occurrence in future thyroid surgeries.

Bariatric Surgery Reduces Weight Loss, Comorbidities Prevalence, and Improves Quality of Life in the Southern Region of Saudi Arabia.

Background and Objectives: Bariatric surgery has been proposed as a treatment option for type 2 diabetes, but there is limited research on its efficacy and the use of standardized outcome measures. Therefore, this study aimed to evaluate the efficacy of bariatric surgery in managing type 2 diabetes and to assess the BAROS protocol postoperatively. Material and Methods: This cross-sectional study was conducted in southern Saudi Arabia, involving 346 bariatric surgery patients aged 18-60. This study collected data through an electronic questionnaire distributed via a Telegram group and Twitter hashtag. Anthropometric data, postoperative complications, and the evolution of obesity-related comorbidities were collected. The quality of life was evaluated using the Moorehead-Ardelt questionnaire of the BAROS protocol. The total BAROS score was classified as "Insufficient", "Moderate", "Good", "Very good", or "Excellent", considering the presence of comorbidities. The data were analyzed using SPSS software ver.23. Results: The mean age of the participants was 30.97 ± 8.49 years, and 70.81% were female. Sleeve Vertical Gastrectomy was the most common surgical technique used (n = 336). The excess weight loss percentage (EWL%) was 70.55 ± 22.57%, and 27.75% of participants achieved complete remission of type 2 diabetes. The total BAROS score was "Excellent" for 40.17% of participants and "Moderate" for 27.16%. The presence of comorbidities was negatively correlated with the BAROS score (r = -0.651, p < 0.001). Conclusions: Bariatric surgery effectively manages type 2 diabetes with a high rate of EWL% and complete remission. The BAROS protocol is a valuable tool for assessing the quality of life postoperatively, with most participants achieving a "Moderate" to "Excellent" score. Comorbidities negatively impact the BAROS score, highlighting the importance of managing these conditions postoperatively.

Direct medical costs of robotic sleeve gastrectomy compared to laparoscopic approach in a single academic center.

BACKGROUND: The use of the robotic platform in bariatric surgery remains controversial because of lack of level I evidence to support its superiority compared to the laparoscopic approach and because of cost concerns. Recently, an extended use program (EUP) for robotic instruments was also introduced at our institution to help reduce the associated direct medical costs of robotic surgery. OBJECTIVES:  To evaluate the direct medical costs of a robotic sleeve gastrectomy (R-SG) and compare it to a standard laparoscopic approach (L-SG). SETTING:  Academic, tertiary care center. METHODS:  The analysis included the last 50 R-SG performed at our institution between June 1st 2019 and October 31st 2020. Those cases were compared to the L-SG cases (29 cases) performed in the same time period. All revisions or conversions were then excluded which resulted in a total of 74 primary SG (R-SG = 45 and L-SG = 29). Direct medical costs included operating room cost, instrument cost, miscellaneous cost, and cost of hospital stay. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system. Patients who underwent a primary SG or a primary SG with a concomitant Paraesophageal Hernia Repair (PEH) were analyzed separately using Mann-Whitney rank sum tests and Student's t tests. An additional analysis and subanalysis of the groups was also performed after applying the potential savings of the Extended Use Program (EUP). RESULTS:  Overall, the direct medical cost of R-SG was comparable to L-SG ($6330.77 vs $6804.12 respectively, p = 0.07). The direct medical cost of patients undergoing SG alone without PEH was significantly lower in the R-group compared to the L-group ($5927.08 vs $6508.01, respectively, p = 0.04). When applying the EUP savings to our data, the predicted direct medical cost of R-SG becomes significantly lower than L-SG ($6145.77 vs $6804.12 respectively, p = 0.01). CONCLUSION:  At our academic medical center, we found no difference in direct medical costs between R-SG and L-SG. With the application of the EUP, direct medical costs of R-SG can be significantly lowered compared to L-SG. It is important to consider that cost data are largely dependent upon the academic medical center of interest, and surgeons need to collect their own cost data to evaluate whether robotic surgery is feasible at their institution.

Co-existence of Double Gallbladder and Choledochal Cyst in a Single Patient.

Additional anatomical structures are rare but can be mistaken for other conditions, causing misdiagnoses and poor outcomes for patients. The presence of concurrent anomalies within the extra structures further complicates a rare situation. We present a case of a patient with two gallbladders and a choledochal cyst diagnosed via radiography and confirmed by exploratory laparotomy. He underwent a cholecystectomy, choledochal cyst resection, and hepaticojejunostomy, and he was doing well as of his last follow-up. This case highlights the need to consider radiological imaging in patients with choledochal cysts carefully.