Remote mentoring in laparotomic and laparoscopic cancer surgery during Covid-19 pandemic: an experimental setup based on mixed reality.

In this paper, Mixed Reality (MR) has been exploited in the operating rooms to perform laparoscopic and open surgery with the aim of providing remote mentoring to the medical doctors under training during the Covid-19 pandemic. The employed architecture, which has put together MR smartglasses, a Digital Imaging Player, and a Mixed Reality Toolkit, has been used for cancer surgery at the IRCCS Hospital 'Giovanni Paolo II' in southern Italy. The feasibility of using the conceived platform for real-time remote mentoring has been assessed on the basis of surveys distributed to the trainees after each surgery.

An Intrapancreatic accessory spleen presenting as a neuroendocrine tumor.

Although the second most common site of the accessory spleen is the tail of the pancreas, intrapancreatic accessory spleens (IPAS) are rarely recognized radiologically. When an accessory spleen is located in the pancreas, it may mimic a hypervascular pancreatic tumor. We report a case of intrapancreatic accessory spleen which radiologically (on TC) mimicked a neuroendocrine pancreatic tumor (PNET). It was not possible to be sure that the pancreatic nodule had no malignant potential; because of the close proximity to splenic vessel we performed en bloc resection of the spleen and distal pancreas. Postoperative course was uneventful. IPAS must be considered in the differential diagnosis of pancreatic tail tumors, particulary an asymptomatic small PNET; new and adequate diagnostic studies have demonstrated utility in defining these lesions. We review pertinent literature. KEY WORD: Intrapancreatic accessory spleen, Pancreatic neuroendocrine tumor.

Retrorectal multilocular cyst in a adult female. Case report and review of literature.

Tumors occurring in the retrorectal space are heterogeneous and uncommon. Multiple embryologie remnants derived from a variety of tissues are found in this space and this explains the heterogeneous pathology of cysts and tumors that arise in retrorectal space. Presacral cysts are rare in adults. Most of the lesions are benign. The cysts may be unilocular or multilocular. They are often asymptomatic. These tumors pose a diagnostic and therapeutic interest. Presacral epidermoid cysts are classified as a type of developmental cysts. We report the case of a 57-year-old woman who presented with a painless mass posterior of the anus. Imaging studies showed a multilocular cyst (65 × 100 × 60 mm) in the retrorectal space. The patient underwent surgery via a posterior approach. Histological study revealed a epidermoid cyst. A review of literature of this rare tumor is performed.

A rare case of colon cancer with splenic abscess.

Cancer of the colon does not always present with the familiar symptoms. Perforation and penetration of adjacent organs, with abscess formation as the initial presentation, is uncommon. Splenic abscess is a rare clinical entity. The four causes of a splenic abscess described are: primary pyogenic infection, splenic trauma, hemoglobinopathies and contiguous disease. In this paper we report a case of splenic abscess from colon cancer in an 50-year-old man who had a left lower chest contusion two-week before and review pertinent literature. Only 11 reported cases of splenic abscess from colorectal cancer were found in Medline.

Laparoscopic resection of an incidental appendiceal mucocele: is it correct. Case report.

Mucocele of the appendix is an uncommon disorder, characterized by a cystic dilatation of the lumen; it's mainly due to mucinous cystadenoma. Definite diagnosis is difficult preoperatively. It can be discovered incidentally at laparotomy or laparoscopy performed for other reason. Treatment consist in complete resection avoiding rupture of the cyst in the peritoneal cavity. Indeed, rupture of the lesion either spontaneous or accidental, during surgery may result in the clinical condition of pseudomyxoma peritonei. Therefore, open approach is recommended for the surgical treatment of these lesions. The role of laparoscopic surgery in the management of appendiceal mucocele remains controversial. We report a case of mucous cystadenoma of the appendix, successfully removed during a laparoscopy for perforated peptic ulcer, which was well at a 12-month follow-up. Laparoscopic appendectomy is not contraindicated in mucocele of appendix, if appropriate precautions can be taken intraoperatively.

Intestinal obstruction caused by torsed gangrenous Meckel's diverticulum encircling terminal ileum.

Meckel's diverticulum (MD) is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage, obstruction, and inflammation. Obstruction of various types is the most common presenting symptom in the adult population. Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications. The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies. Delay in the diagnosis of a complicated MD can lead to significant morbidity and mortality. Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum. To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.

Duplication cyst of the stomach with respiratory epithelium in adult: an uncommon finding. Report of case and review of literature.

Gastrointestinal duplication is a congenital rare disease entity. Duplication cyst of the stomach with pseudo stratified columnar ciliated epithelium is extremely rare. The very appearance of a gastric duplication cyst in an adult can present a diagnostic dilemma. In majority of reported cases, the diagnosis is established during surgical exploration. We report on a 34 year-old female patient suffering from repeated episodes of epigastric pain and gastroesophageal reflux. Abdominal computed tomography and endoscopic ultrasound demonstrated a intramural lesion attached to the gastric fundus, suggestive of gastrointestinal stromal tumor (GIST). At exploratory laparotomy a non-communicating cyst, was found along the greater curvature of the stomach in the esophagogastric transition. The lesion was excised along with an adjacent sleeve of the stomach and esophagus wall because shared muscular layer with the stomach and esophagus. The final pathologic examination revealed that the inner wall of the cyst was lined by a pseudostratified columnar ciliated epithelium (respiratory type) and, in part, columnar and gastric foveolar epithelium. Even though a panel of imaging modalities is available, it is still difficult to obtain a preoperative diagnosis. Duplication cyst can be mistaken for a soft tissue tumor of the gastrointestinal tract. There is no therapeutic algorithm. Surgical treatment is recommended for symptomatic cases.

[Role of laparoscopy in acute obstruction of the small bowel: personal experience and analysis of the literature]. / Ruolo della laparoscopia nelle occlusioni acute del tenue: esperienza personale e analisi della letteratura.

Small bowel obstruction is caused by postoperative adhesions in most patients. The traditional surgical treatment has been laparotomy with adhesiolysis and possible resection of the ischaemic intestine. The laparoscopic approach has proved feasible but not without risks. We analysed our experience in the management of acute small bowel obstruction and then reviewed the literature in an attempt to identify the real role of laparoscopy. From January 2003 to June 2008, 19 patients operated on for small bowel obstruction were identified. We evaluated our performance in terms of the aetiology of the obstruction, operative time, length of postoperative hospital stay, conversion rate, and major morbidity and mortality. Postoperative adhesions were responsible for the occlusion in 13 cases; a single band was identified in 47% of patients (9 cases). Neoplastic disease (3 cases), a gallstone ileus, Crohn's disease and an internal hernia were the remaining cases. Laparoscopic treatment was only possible in 7 patients with single adhesions (77%), and a conversion was carried out in the remaining 12 cases (63%), including "laparoscopy-assisted" cases (6 cases). The duration of the intervention (89 +/- 21 min vs 135 +/- 27.5 min) and postoperative hospitalisation (3.6 +/- 1 days vs 6.25 +/- 1.6 days) were in favour of the completely laparoscopic group as compared to the laparoscopy-assisted group. A case of postoperative peritonitis due to bowel perforation required a second intervention. With an appropriate selection of patients, confirming the high incidence of the single adhesions responsible for the occlusion and the resulting high success rate of laparoscopy, we believe that only an initial laparoscopic approach can help identify such favourable situations.