Robots down-under: the current climate of robotic-assisted surgery education in Australia.

Australia has seen a significant rise in the use of Robotic-Assisted Surgery (RAS), with general surgery being the fastest-growing field in this technology. The proportion of general surgical RAS has grown from 1% to 17% of all RAS between 2008 and 2023 in Australasia. As of May 2023, there were 162 robotic platforms in Australasia, with 26 of them in the public sector. As the cost of establishing RAS decreases over time, public hospital robotics systems are expected to become more accessible. Despite the increasing demand, many specialties, including general surgery, do not have an agreed RAS curriculum for trainees. It is imperative for Australia to develop its own curriculum akin to our overseas colleagues to match this growth.

Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre.

BACKGROUND: Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. METHODS: A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. RESULTS: One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). CONCLUSION: Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.

Cystic lymphangioma presenting as an acute abdomen in an adult male with congenital aortic stenosis.

Abdominal cystic lymphangioma rarely presents as an acute abdomen. In this article, we describe a young adult male with congenital aortic stenosis who initially presented with abdominal pain and raised inflammatory markers. The imaging in the form of a computed tomography scan was unfortunately inconclusive. In the evolution of this diagnostic dilemma, we describe the importance of early operative management as well as explore the link between cardiac and lymphatic malformations.

Perineal necrotizing soft tissue infection secondary to rectal perforation from a large fish bone -a painful lesion not to be missed.

Necrotizing soft tissue infection caused by a large 70 mm fish bone that led to a single perforation of the rectum is an incredibly rare phenomenon. We report a case of an adult male in his 50s who presented with perianal pain. A prompt computed tomography (CT) scan revealed a foreign body had perforated through the rectum into the retrorectal space with associated gas locules, indicating a necrotizing infection. In addition, our case report explores the principles of wide exploration and debridement, the role of a defunctioning colostomy in perineal wound management, and principles of wound closure in the context of a foreign body causing significant perineal sepsis.