Prior Robotic Console Expertise May Improve Basic Skills at the New Hugo RAS Simulator: Results from a Cohort Trial and Implications for Skill Transference Across Platforms.

Background: Robot-assisted surgery ensures minimal invasiveness; since the expiry of the Da Vinci patent, new robotic systems have entered the market. Recently, the Hugo RAS received CE approval for several surgical procedures. However, more is needed to know about skill acquisition at the new simulator. Objective: This study aims to analyse the factors impacting basic surgical skills at the Hugo RAS simulator. Design setting and participants: We present a cross-sectional study involving 71 participants of different backgrounds invited to a hands-on session with the Hugo RAS simulator voluntarily. All of them had no prior expertise with the system. Participants were recruited among medical/nurse students, residents, and laparoscopic and robotic surgeons. Intervention: All participants underwent a hands-on "pick and place" exercise at the Hugo RAS simulator; the metrics of a second-round pick and place exercise were recorded. Outcome measurements and statistical analysis: Metrics were analysed with regard to the following variables: demographics, videogame use, and prior surgical experience (no surgical expertise, experience with laparoscopy, and experience with robotic console). Results and limitations: All participants completed the test. Of them, 77.5% were naïve to surgery, 8.5% had prior laparoscopic expertise, and 14.1% had prior robotic console experience. The time to complete the pick and place exercise was significantly lower (p < 0.001) among prior robotic surgeons (38 s, interquartile range [IQR] 34-45) compared with both naïve participants (61 s, IQR 53-71) and laparoscopists (93 s, IQR 53-162). The overall score of the exercise decreased with age (p = 0.046); however, the overall scores were significantly and steadily higher among surgeons experienced in robotic consoles across all age groups (p = 0.006). Neither gender (p = 0.7) nor videogame use (p = 0.9) correlated significantly with the metrics. Conclusions: This is the first study analysing factors impacting basic skill acquisition at a new robotic simulator. Experience with robotic consoles may represent a major factor, raising the hypothesis of the transferability of basic robotic skills across different robotic systems. Further studies are required to explore this issue. Patient summary: In the present study, we analysed which characteristics may affect the basic surgical skills at a novel robotic platform.

Performance of CT Colonography in Diagnosis of Synchronous Colonic Lesions in Patients With Occlusive Colorectal Cancer.

OBJECTIVE. The purpose of this study was to evaluate the accuracy of CT colonography (CTC) in the diagnosis of synchronous colonic lesions in a cohort of patients with an occlusive colorectal cancer (CRC) causing incomplete colonoscopy. SUBJECTS AND METHODS. Among 109 patients with CRC causing incomplete colonoscopy who underwent CTC with IV contrast enhancement after cathartic purgation, fecal tagging, and colon distention, 70 (mean age, 70 years) for whom reference standards (surgical reports, first surveillance colonoscopy) were available were evaluated. Per-patient and per-lesion sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of CTC in the diagnosis of synchronous colonic lesions measuring 6 mm or larger were assessed. RESULTS. Twenty-seven of the 70 patients (39%) had at least one 6-mm or larger synchronous lesion, and four patients (6%) had a total of five synchronous CRCs. Per-patient sensitivity in diagnosing synchronous CRC was 1.00 (4/4). There were 59 lesions: 20 with a diameter of 10 mm or greater; 30, 6-9 mm; and nine, 5 mm or less. The overall per-patient CTC sensitivity in detecting synchronous lesions 6 mm or larger was 0.93 (25/27); specificity, 0.98 (42/43); PPV, 0.96; and NPV, 0.95. Per-patient sensitivity for the diagnosis of synchronous advanced neoplasia (advanced adenoma and colorectal cancers) was 0.94 (15/16). Per-lesion CTC sensitivity for detecting synchronous lesions 6 mm or larger was 0.88 (37/42); all adenomatous lesions, 0.89 (55/62); and advanced neoplasia, 0.92 (22/24). CONCLUSION. CTC is a highly accurate test for detecting synchronous colonic lesions in patients with occlusive CRC. The prevalence of advanced neoplasia is high (23%).

Preliminary results of transumbilical single-port laparoscopic cholecystectomy.

Single-port laparoscopic cholecystectomy was developed with the aim of reducing the invasiveness of traditional laparoscopy, diminishing postoperative pain and morbidity. The aim of this prospective study was to assess the feasibility and the efficacy of this new approach. Between April and December 2009, a total of 21 patients underwent single-port laparoscopic cholecystectomy for symptomatic gallbladder stone disease. Single surgeon, elective patient, no preoperative diagnosis of common bile duct stone and no previous upper abdominal surgery were the selection criteria chosen for the study. Attempt to reproduce the standard technique (routine intraoperative cholangiography) was considered. Twenty patients (95.2%) successfully completed single-port surgery, and the median operative time was 65 min (range 40-122). Conversion to standard laparoscopic cholecystectomy was required for one patient (4.8%) for a difficult haemostasis. Intraoperative cholangiography was performed for 14 patients (66.7%). Seven patients (33.3%) were discharged on the same day of the operation; median hospital stay was 1 day (range 1-4). No postoperative complications were observed; one patient was reoperated on the same day of surgery because of unexplained abdominal pain and leucocytosis, but relaparoscopy demonstrated no fluid collection. On the 1st postoperative day, median VAS was 3. Most patients declared to be satisfied with the result of the operation and the resulting scar. Transumbilical single-port access cholecystectomy is feasible using standard laparoscopic instruments. It may reduce morbidity, postoperative pain and may offer cosmetic advantages compared with standard laparoscopic approach. However, presently the procedure may be performed only by surgeons with wide experience with this operation through standard laparoscopic access.

[Neuroendocrine tumors. A rare case of duodenal carcinoids]. / Tumori neuroendocrini. Un raro caso di carcinoidi duodenali.

The authors report their experience with a case of double duodenum carcinoid tumors occurring in a 59-year-old female patient. She presented with a one-year history of frequent abdominal painful episodes, associated with dyspepsia, emesis, pyrosis, eructation, skin flushing and easy strain. The laboratory examinations point out high hematic values of serotonin and gastrin, with a raising of urinary 5-HIAA. Preoperative endoscopic examinations showed the presence of 2 little sessile polypoid growths, placed in the duodenal bulb, one of this interested muscular tunic. The patient underwent Billroth I resection and was discharged on postoperative day 8. The authors after a little dissertation on that topic, go on to examine the current diagnostic and therapeutic possibilities. They confirm the elective role of surgical treatment of these rare tumors.

[Voluminous cystic lymphangioma of the retroperioneum in an adult. A case report]. / Voluminoso linfangioma cistico retroperitoneale nell'età adulta. Presentazione di un caso.

Intra-abdominal cystic lymphangiomas are very rare tumours in adults. They are preferentially located in the neck, extremities and axillae in children. The authors report a case occurring in a 37-year-old female who had been experiencing dyspepsia and abdominal tension for a few weeks and was successfully treated surgically.