Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes.

PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.

Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy.

BACKGROUND: In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC). METHODS: A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared. RESULTS: There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 ± 123.2 vs 159.3 ± 56.1 min (p < 0.001), and the mean number of harvested lymph nodes was higher in the robotic CME group (46.1 ± 22.2 vs 39.1 ± 17.8, p = 0.047). There were only minor differences in length of hospital stay (7.2 ± 3.1 vs 7.9 ± 4.0 days), anastomotic leak (none vs 2.6%), bleeding (none vs 1.3%), surgical site infections (10.5% vs 12.5%), and reoperations (2.6% vs 6.3%). CONCLUSIONS: Robotic CME can be performed with a similar morbidity profile as laparoscopic CC for transverse colon cancer along with a higher rate of intracorporeal anastomosis, and higher number of lymph nodes retrieved, but longer operative times.

The da Vinci Xi system for robotic total/subtotal colectomy vs. conventional laparoscopy: short-term outcomes.

BACKGROUND: The aim of this study was to evaluate the feasibility of robotic total/subtotal colectomy procedures with the Xi robot and to compare its short-term outcomes with those of conventional laparoscopy. METHODS: Between October 2010 and September 2018, consecutive patients with colonic neoplasia, inflammatory bowel disease, familial adenomatous polyposis or colonic inertia who underwent elective robotic or laparoscopic total/subtotal abdominal colectomy at two specialized centers in Turkey were included. Data on perioperative characteristics and 30-day outcomes were compared between the two approaches. RESULTS: There were a total of 82 patients: 26 and 56 patients in the robotic and laparoscopic group, respectively (54 men and 28 women, mean age 54.7 ± 17.4 years). The groups were comparable regarding preoperative characteristics. All the robotic procedures were completed with a single positioning of the robot. Estimated blood loss (median, 150 vs 200 ml), conversions (0% vs 14.3%), and complications (0% vs 7.1%) were similar but operative time was significantly longer in the robotic group (median, 350 vs 230 min, p < 0.001). No difference was detected in the length of hospital stay (7.9 ± 5.7 vs 9.5 ± 6.0 days, p = 0.08), anastomotic leak (3.8% vs 8.3%), ileus (15.4% vs 19.6%), septic complications, reoperations (7.7% vs 12.5%), and readmissions (19.2% vs 12.5%). The number of harvested lymph nodes in the subgroup of cancer patients was significantly higher in the robotic group (median, 66 vs 50, p = 0.01). CONCLUSIONS: In total/subtotal colectomy procedures, the robotic approach with the da Vinci Xi platform is feasible, safe, and associated with short-term outcomes similar to laparoscopy but longer operative times and a higher number of retrieved lymph nodes.

"Top down no-touch" technique in robotic complete mesocolic excision for extended right hemicolectomy with intracorporeal anastomosis.

BACKGROUND: Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a "top down technique" to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients. METHODS: The top down technique consists of two steps. First, the omental bursa was entered to identify the right gastroepiploic vein. Tracing down this vein as a landmark, the gastrocolic trunk was exposed, branches of this trunk and the middle colic vessels were divided. Second, dissection was directed to the ileocolic region and proceeded in an inferior-to-superior direction along the superior mesenteric vein to divide the ileocolic and right colic vessels consecutively. The ileotranverse anastomosis was created intracorporeally. RESULTS: There were 8 males and 4 females with a mean age of 64.8 ± 16.9 years and a mean body mass index of 25.6 ± 3.7 kg/m2. All the procedures were completed successfully. No conversions occurred. The mean operative time and blood loss were 312.1 ± 93.9 min and 110.0 ± 89.9 ml, respectively. The mean number of harvested lymph nodes was 45.2 ± 11.1. The mean length of hospital stay was 7.6 ± 4.7 days. Two patients had intraoperative complications and two had postoperative complications. There was no disease recurrence at a mean follow-up period of 10.4 ± 7.1 months. CONCLUSIONS: The top down technique appears to be useful in robotic CME for an extended right hemicolectomy. Early identification of the gastrocolic trunk and middle colic vessels via this technique may prevent inadvertent vascular injury at the mesenteric root of the transverse colon.

Icodextrin and Seprafilm do not interfere with colonic anastomosis in rats.

BACKGROUND: Physical barriers and instilled solutions have been studied to prevent intra-abdominal adhesions. However, undesirable side effects of these substances on the healing of intestinal anastomoses may limit their use. This study was designed to compare the effects of antiadhesives on the healing of colonic anastomosis in rats. METHODS: Sixty female Sprague-Dawley rats were divided into 3 groups of 20. The animals received isotonic saline and 7.5% icodextrin, intraperitoneally after standard left colonic anastomosis. In group 3, Seprafilm was wrapped around the anastomosis and also laid over the abdominal viscera. Half of the animals from each group were killed on postoperative day (POD) 4 and the remaining half on POD 21. Adhesion scoring, bursting pressure and tissue hydroxyproline measurements and histopathological assessment were performed. RESULTS: Mean hydroxyproline levels were significantly higher in groups receiving icodextrin and Seprafilm compared with the control group, whereas mean bursting pressures were significantly higher in the group that received icodextrin (p < 0.05). Intraperitoneal administration of icodextrin resulted in significant reduction of adhesion formation on POD 21 (p < 0.05). CONCLUSIONS: Seprafilm does not prevent formation of adhesions as much as icodextrin does, but its effect on the healing of colonic anastomoses is similar.

Are clips useful in the surgical repair of colonic perforations?

PURPOSE: The objective of this study was to assess the effecacy of clip application in the surgical repair of iatrogenic colonic perforations. MATERIAL AND METHODS: Twenty adult male Wistar-Albino rats were divided into two equal groups of ten. In both of the groups an iatrogenic perforation was made in the anti-mesenteric border of the left colon. The defect was closed with interrupted 6/0 polypropylene sutures in group 1 and extraluminal application of vascular clips (VCS--vascular clip system) in group 2. All animals were killed on postoperative Day 4. Wound healing was evaluated with both in situ bursting pressure and hydroxyproline levels. RESULTS: There was no statistically significant difference between the two groups in respect of bursting pressure levels (p = 0.063) whereas hydroxyproline levels were higher in group 2 (p = 0.0021). CONCLUSIONS: Surgical repair of iatrogenic colonic perforations by extraluminal clips gives comparable results according to wound healing parameters. This approach may be a rational alternative to suture or endoscopic repair methods.