The effects of laser procedure in symptomatic patients with haemorrhoids: A systematic review.

Purpose: Haemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review. Methods: EMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids. Results: Ten clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias. Conclusion: The laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.

TaTME: analysis of the evacuatory outcomes and EUS anal sphincter.

Introduction: Some patients undergoing transanal total mesorectal excision (TaTME) may experience post-surgical complications, such as impaired bowel function and urogenital and sexual dysfunction. The present work aims to evaluate the one-year impact of TaTME surgery on bowel function, quality of life, and outcomes.Material and methods: Twenty patients undergoing TaTME with cancer in the mid and lower rectum were assessed prospectively by endoscopic transanal ultrasound (EUS) and three physiological function degrees, along with different clinical outcome questionnaires.Results: EUS sphincter evaluation revealed no structural impact in follow-up. For evacuatory evaluation, differences in the scores of the first postoperative month of Wexner questionnaires were shown when compared to a 12-month period. At least 10% of patients remain with major low anterior resection syndrome (LARS) after one year. The (Fecal incontinence Quality of Life) FiQoL questionnaire revealed that the cases in which values were worse in the first month posteriorly recovered to baseline preoperative values.Conclusions: TaTME does not seem to impact sphincter structure and evacuatory function, with a good recovery rate one year post-surgery, but does not seem to interfere with patients' evacuatory function quality of life.

The Influence of 3D in Single-port Laparoscopy Surgery: An Experimental Study.

The aim of this experimental study was to analyze the effect of 3-dimensional (3D) imaging in laparoendoscopic single-site surgery. End points were time, errors, and preference. Twenty-six participants were enrolled in the study, and these were divided into Beginners and Experts, in exercises either with a 2-dimensional or a 3D system. The 4 phantom exercises were chosen from the E-BLUS-European Training in Basic Laparoscopic Urological Skills from the American Fundamentals of Laparoscopic Surgery (FLS) system. A postexercise questionnaire was delivered. Statistical analyses using SPSS 22.0 for Windows yielded a 1-way analysis of variance. There was a significant positive impact of 3D imaging on experts' performance: faster exercise completion with fewer errors. The majority reported improved performance with the 3D system (86%, Beginners; 100%, Experts). 3D systems for laparoscopy would likely increase experts' performance for laparoendoscopic single-site surgery and improve comfort during difficult procedures.