Nuestra experiencia en el manejo diagnóstico-terapéutico a corto plazo del paciente con displasia anal / Our experience in the short-term diagnostic-therapeutic management of the patient with anal dysplasia

Introducción: La neoplasia intraepitelial anal (NIA) es una lesión premaligna del carcinoma escamoso anal. Los varones VIH que tienen sexo con varones, es la población de riesgo más afectada. La citología y anuscopia son los métodos mejor aceptados para su diagnóstico, aunque es controvertido qué pacientes deben completarlo con una biopsia. Tampoco está bien establecido qué pacientes deben someterse a tratamiento y cuál es el mejor. Con este estudio, queremos exponer nuestra experiencia en el manejo diagnóstico-terapéutico de la NIA a corto plazo. Métodos: Estudio observacional retrospectivo de pacientes con riesgo de NIA con una citología anal alterada a los que se les realizó una anuscopia de alta resolución con biopsia. Tras la confirmación histológica de displasia iniciaron tratamiento con ácido tricloroacético. Se comprobó su efectividad con una citología posterior. Se analizaron las variables demográficas de la muestra y los resultados de las pruebas diagnósticas y de tratamiento. Resultados: La mayoría eran varones VIH positivos (104/115) y el 50% mantenían relaciones sexuales con otros varones. Se incluyeron 115 pacientes con citología anal alterada, de los cuales el 92% presentaron displasia en la biopsia. El 97% con atipia de significado incierto en la citología presentaron displasia histológicamente. El 60% de los pacientes normalizó la citología tras el tratamiento. Conclusión: Se debe considerar de forma sistemática la detección precoz de la NIA en poblaciones de riesgo conocidas. Cualquier anormalidad citológica debe ser biopsiada. El ácido tricloroacético puede ser un tratamiento efectivo consiguiendo un alto porcentaje de regresión, aunque actualmente la información con la que contamos es de bajo nivel de evidencia. (AU)

Introduction: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of anal squamous cell carcinoma. HIV-positive males who have sex with males, are the most affected at-risk population. Cytology and anuscopy are the best accepted methods for its diagnosis, although it is controversial which patients should complete it with a biopsy. Neither which patients should undergo treatment nor which is the best treatment is not well established. With this study, we would like to present our experience in the diagnostic-therapeutic management of AIN in the short term. Methods: Retrospective observational study of patients at risk of AIN with altered anal cytology who underwent high-resolution anuscopy with biopsy. After histological confirmation of dysplasia, they started treatment with trichloroacetic acid. Its effectiveness was verified by subsequent cytology. The demographic variables of the sample and the results of both diagnostic and treatment tests were analyzed. Results: The majority were HIV-positive males (104/115) and 50% had sexual relations with other men. We included 115 patients with altered anal cytology, of whom 92% had dysplasia on biopsy. 97% with atypia of uncertain significance on cytology had histological dysplasia. Cytology normalized after treatment in 60% of patients. Conclusion: Early detection of AIN should be routinely considered in known at-risk populations. Any cytological abnormality should be biopsied. Tricholoroacetic acid can be an effective treatment achieving a high percentage of regression, although currently, the information we have is of low level of evidence. (AU)

Protective ileostomy creation after anterior resection of the rectum: Shared decision-making or still subjective?

AIM: The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. METHOD: Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. RESULTS: Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). CONCLUSION: The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.

Face, Content, and Construct Validity Evaluation of Simulation Models in General Surgery Laparoscopic Training and Education: A Systematic Review.

BACKGROUND: Laparoscopic technical surgical skills (LTS) are considered a fundamental competence for General Surgery residents. Several simulation tools (ST) have been explored to develop LTS. Although a plethora of systematic reviews evaluate the translation of LTS developed in simulation to real surgery, there is a lack of evidence that clarifies effectiveness of different validated ST in acquisition of LTS in surgical residents. The aim of this systematic review (SR) is to summarize published evidence on ST validation used for surgery education and training. METHODS: A protocol was published in PROSPERO. A SR was carried out following PRISMA guidelines. Complete published articles in English or Spanish that validate either content or construct, plus another form of validation of ST to acquire LTS in general surgery were included. Articles that used only one validation or did not validate an ST were excluded. RESULTS: 1052 publications were initially identified across all searched databases. Title review identified 204 studies eligible for full text screening. 10 studies were included for final review. Two studies assessed both face and content, 4 face and construct, and 4 face, content and construct validity. None of the studies presented comparable outcomes due to metrics variation and scores used for the validation strategies. CONCLUSIONS: This study assessed validated laparoscopic simulation models, particularly in content and construct validity. Articles reported an increased use of simulation models in laparoscopic training with positive feedback from trainees, but few studies reported validation of training model. Validation strategies are not standardized, limiting comparability between them.

Our experience in the short-term diagnostic-therapeutic management of the patient with anal dysplasia.

INTRODUCTION: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of anal squamous cell carcinoma. HIV-positive males who have sex with males, are the most affected at-risk population. Cytology and anuscopy are the best accepted methods for its diagnosis, although it is controversial which patients should complete it with a biopsy. Neither which patients should undergo treatment nor which is the best treatment is not well established. With this study, we would like to present our experience in the diagnostic-therapeutic management of AIN in the short term. METHODS: Retrospective observational study of patients at risk of AIN with altered anal cytology who underwent high-resolution anuscopy with biopsy. After histological confirmation of dysplasia, they started treatment with trichloroacetic acid. Its effectiveness was verified by subsequent cytology. The demographic variables of the sample and the results of both diagnostic and treatment tests were analyzed. RESULTS: The majority were HIV-positive males (104/115) and 50% had sexual relations with other men. We included 115 patients with altered anal cytology, of whom 92% had dysplasia on biopsy. 97% with atypia of uncertain significance on cytology had histological dysplasia. Cytology normalized after treatment in 60% of patients. CONCLUSION: Early detection of AIN should be routinely considered in known at-risk populations. Any cytological abnormality should be biopsied. Tricholoroacetic acid can be an effective treatment achieving a high percentage of regression, although currently, the information we have is of low level of evidence.

Desgaste profesional o burnout en los residentes de Cirugía General. Encuesta de la Asociación Española de Cirujanos / Burnout in General Surgery Residents. Survey From the Spanish Association of Surgeons

INTRODUCCIÓN: El desgaste profesional o burnout afecta significativamente a los médicos y, concretamente, a los cirujanos. El exceso de horas de trabajo, así como la discriminación, abuso y acoso sexual, pueden contribuir al desgaste profesional. Recientemente se ha publicado un estudio sobre este tema en residentes de Estados Unidos que demuestra una elevada incidencia de burnout. El objetivo de nuestro estudio es conocer cuál es la situación en España y compararla con lo que sucede en aquel país. MÉTODOS: Estudio observacional, transversal, efectuado en enero-febrero del 2020, a través de una encuesta validada remitida a todos los residentes de Cirugía General y del Aparato Digestivo (CGAD) de España. RESULTADOS: De los 931 residentes de CGAD, 739 accedieron a la encuesta y 452 (61,2%) la cumplimentaron. En alguna ocasión durante la residencia, el 55,1% de los residentes se han sentido discriminados por su género, el 8,8% por su país de origen, el 73,9% afirman haber experimentado abuso verbal/psicológico, el 7,1% abuso físico y el 16,4% acoso sexual. Los cirujanos adjuntos son la causa más frecuente de acoso sexual, abuso físico y verbal. Los pacientes son el origen más común de la discriminación por género. El 47,6% ha tenido síntomas de desgaste profesional y el 4,6% ha presentado ideas suicidas. El 98% ha excedido su jornada laboral y el 47% no libra las guardias. Estos dos últimos puntos son factores predictivos de desgaste profesional. CONCLUSIONES: Durante el periodo de residencia en nuestro país, los residentes de CGAD han sufrido episodios de maltrato en forma de discriminación, abuso y acoso. Todos los tipos de maltrato son más frecuentes en España que en Estados Unidos, excepto la discriminación racial. Con ello se asocia el incumplimiento significativo en las horas de trabajo semanal. Es necesario reconocer estas anomalías y evitarlas para favorecer un ambiente adecuado para la formación profesional especializada en CGAD

INTRODUCTION: Physicians, especially surgeons, are significatively affected by burnout. Duty-hour violation, as well as discrimination, abuse and sexual harassment may contribute to burnout. A study about this topic has been published in residents from United States, demonstrating a high incidence of burnout. Our objective is to know which is the situation in Spain and to compare it with United States. METHODS: Cross-sectional observational study carried out in January-February 2020, based on the responses to a validated survey administered to General Surgery residents in Spain. RESULTS: There are 931 General Surgery Residents. 739 have entered in the survey and 452 (61.2%) eventually responded to it. In any occasion during the training period, 55.1% reported discrimination based on their gender, 8.8% reported racial discrimination, 73.9% reported verbal/psychological abuse, 7.1% reported physical abuse and 16.4% reported sexual harassment. Attending surgeons are the most frequent source of sexual harassment and physical and verbal abuse, whereas patients are the most frequent cause of gender discrimination. Burnout symptoms were reported by 47.6% of residents and 4.6% reported suicidal thoughts. 98% of residents reported duty-hour violations and 47% of them do not have the day off after to be on call. Both of these issues are burnout predictive factors. CONCLUSIONS: Mistreatment (discrimination, abuse and harassment) occurs among General Surgery residents during their training period in our country. Every kind of mistreatment is more frequent in Spain than in the United States, with the exception of racial discrimination. It is associated with exceeding weekly duty-hour. It is necessary to know these problems and to avoid them in order to improve work environment of General Surgery training period

Clinical, Anatomical, and Pathological Grading Score to Predict Technical Difficulty in Laparoscopic Splenectomy for Non-traumatic Diseases.

BACKGROUND: We aimed to develop a grading system based on preoperative parameters that would predict surgical difficulty and morbidity in elective laparoscopic splenectomy. STUDY DESIGN: We retrospectively assessed morbidity in 439 patients who underwent laparoscopic splenectomy for benign and malignant disorders between 1993 and 2013. Medical and surgical records were reviewed and analyzed. We compared preoperative data concerning demographic, clinical, pathological, anatomical, laboratory, and radiological factors with three surgical outcomes: operative time, intraoperative bleeding, and surgical conversion. Univariate and multivariate analyses were performed to identify statistically significant variables. A logistic regression model was used to identify determinant variables and to compose a predictive score. External validation of the score was performed using an independent cohort of 353 patients. RESULTS: Four preoperative parameters (age, male sex, type of pathology, and spleen size based on final spleen weight) were significantly related with operative time, operative bleeding, and conversion to open surgery. Using these results, we developed a classification system with three levels of difficulty: low (≤4 points), medium (4.5-5.5 points), and high (≥6 points), based on the four preoperative parameters. The correlation was highly significant (p = <0.001) according to Spearman's correlation. The area under the ROC curve was 0.671 (95 % CI 0.596-0.745). The external validation showed significant correlations with the present model. CONCLUSIONS: The grading score described here is simple to calculate from the physical examination, laboratory tests, and US or CT images, and we believe it could be useful to preoperatively assess the technical complexity of laparoscopic splenectomy.

¿Qué operan los residentes españoles durante la residencia?: análisis de la aplicabilidad del programa de la especialidad de Cirugía General y Digestiva al finalizar el periodo de residencia / The surgical experience of general surgery residents: An analysis of the applicability of the specialty program in General and Digestive Surgery

El entrenamiento quirúrgico siguiendo un periodo de residencia ha conseguido que los residentes en nuestro país posean una formación homogénea y satisfactoria para el desarrollo de su actividad profesional. Ello se debe a la existencia de planes de formación específicos para cada especialidad. El plan vigente promulgado en 2007 detallaba el número mínimo de intervenciones quirúrgicas y procedimientos que un cirujano debía haber efectuado para completar su periodo de formación. El objetivo de este estudio es conocer la aplicación del programa de la especialidad en cuanto al número de intervenciones practicadas durante el periodo de residencia. MATERIAL Y MÉTODOS: Se diseñó una hoja de recogida de datos que incluía la relación de intervenciones enunciada en el programa de la especialidad, que fue remitida en abril de 2014 a todos los hospitales que disponen de unidades acreditadas para la formación de residentes. En septiembre de 2014 se tabularon las respuestas remitidas y se efectuó un estudio estadístico descriptivo general, y un subanálisis en función del sexo del residente y de la comunidad autónoma. A la vez se analizó la actividad efectuada en función del número de residentes que existiera en cada unidad docente acreditada. RESULTADOS: La encuesta se remitió a los 117 hospitales con unidades acreditadas, que incluyen un total de 190 plazas ofertadas. De ellas se obtuvieron 91 respuestas (53%). La formación ofrecida se adapta en líneas generales a la propuesta por el plan de la especialidad. El número global de intervenciones practicadas de acuerdo a las diferentes subáreas, en cirugía laparoscópica y de urgencias, cumple o supera las cifras previstas, excepto en cirugía esofagástrica y HPB. El subanálisis de la actividad quirúrgica según la comunidad autónoma no evidencia diferencias significativas en el número total de intervenciones, sin embargo, sí se objetivan diferencias en cirugía endocrina (p = 0,001) y de la mama (p = 0,042). Un 55% de los residentes eran mujeres, sin diferencias significativas en cuanto a su distribución en las comunidades autónomas. Sin embargo, las cirujanas operan más que los cirujanos durante la residencia (625 ± 244 vs 527 ± 209; p < 0,01). También se observa que el número de residentes adscrito a cada unidad docente se correlaciona con el número de intervenciones realizadas: han efectuado más intervenciones los cirujanos que están solos en su unidad que aquellos que tienen compañeros de su mismo año (669 ± 237 vs. 527 ± 209; p = 0,004). CONCLUSIÓN: La actividad quirúrgica efectuada por los cirujanos españoles se adecua a la propuesta por el plan actual de la especialidad, excepto en cirugía HPB y esofagogástrica. La distribución es homogénea de acuerdo a las comunidades autónomas, aunque existen diferencias en función del número de residentes por hospital y el sexo del residente. Esta información es esencial para evaluar la idoneidad del plan de formación y el diseño de nuevos planes formativos

Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. MATERIAL AND METHODS: A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. RESULTS: The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P = .001) and breast surgery (P = .042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512 ± 226 vs. 625 ± 244; P < .01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures trained in hospitals where there were less residents (669 ± 237 vs. 527 ±2 09; P = .004). CONCLUSION: The surgical activity performed by spanish surgeons is adequate to the specialty program, except in hepatobiliary and esophageal-gastric surgery. The distribution is homogeneous in the different autonomous regions, although there are differences that depend on the number and sex the of residents in each hospital. This information is essential to evaluate the quality of the specialty program and to design new training programs

El papel del ganglio centinela en la evolución del cáncer de colon / The role of sentinel lymph node in colon cancer evolution

INTRODUCCIÓN: El objetivo de este estudio es llevar a cabo la evaluación de la técnica de detección del ganglio centinela (GC) con tinción de azul de metileno «ex vivo» en el cáncer de colon, así como calcular la supraestadificación y su correlación con la evolución de la enfermedad. MÉTODOS: Entre 2008 y 2011, 101 pacientes fueron operados de cáncer de colon con la detección del GC, estudiándose las micrometástasis. El seguimiento de los pacientes N0 fue mayor a un año en búsqueda de recidivas y si tenían relación con la aparición de dichas micrometástasis. RESULTADOS: El índice de detección del GC fue de 92 casos (91%). Fue positivo para micrometástasis en 9 casos, con una supraestadificación del 14%. La incidencia de falsos negativos fue de 9 pacientes (10%). El seguimiento medio de los 74 pacientes N0 fue de 38 meses. Se observó recurrencia en 4 pacientes (7%) del grupo de pacientes con GC− (65 pacientes) y en 2 pacientes (22%) en el grupo con GC+ (9 pacientes, sin diferencias estadísticas significativas. Tampoco se observaron diferencias en términos de supervivencia entre los 2 grupos. CONCLUSIONES: El estudio del GC es una práctica reproducible sin aumento significativo del tiempo y de costes. Puede llegar a supraestadificar el 14% de pacientes que habían sido clasificados como N0 con técnica convencional. En el seguimiento de los pacientes N0 con GC+ parece haber una tendencia a un porcentaje mayor de recidivas, lo que podría llevar a cambios en las pautas de tratamiento adyuvante, aunque debemos tomarlo con cautela ya que la muestra es escasa

INTRODUCTION: The aim of this study is to evaluate the sentinel lymph node mapping (SLNM) with methylene blue staining "ex vivo" in colon cancer, as well as calculate the upstaging obtained by the determination of micrometastases and its correlation with the evolution of the disease. METHODS: Between 2008 and 2011, 101 patients with colon cancer undergoing resection were studied prospectively with SLNM and detection of micrometastases. The correlation of SLN micrometastases with the disease evolution was evaluated in patients with a follow-up of more than one year. RESULTS: The SLNM rate was 92 cases (91%). Only SLN was positive for micrometastases in 9 cases, with a 14% upstaging. The incidence of false negatives was 9 patients (10%). Mean follow of N0 patients (n = 74) was 38 months. The SLN- (negative) group (65 patients) had a recurrence rate of 4 patients (7%), whereas this rate was 2 patients (22%) in the group of SLN + (positive) (9 patients), but without significant differences. No differences in survival were observed. CONCLUSIONS: SLNM is a reproducible technique without significant increase in time and costs. Upstaging was obtained in 14% of patients staged as N0 by conventional technique. At follow-up of N0 patients with SLN + there seems to be a higher rate of recurrence, which could change the guidelines of adjuvant treatment, but we must interpret the results it with caution because the sample is small

The role of sentinel lymph node in colon cancer evolution.

INTRODUCTION: The aim of this study is to evaluate the sentinel lymph node mapping (SLNM) with methylene blue staining "ex vivo" in colon cancer, as well as calculate the upstaging obtained by the determination of micrometastases and its correlation with the evolution of the disease. METHODS: Between 2008 and 2011, 101 patients with colon cancer undergoing resection were studied prospectively with SLNM and detection of micrometastases. The correlation of SLN micrometastases with the disease evolution was evaluated in patients with a follow-up of more than one year. RESULTS: The SLNM rate was 92 cases (91%). Only SLN was positive for micrometastases in 9 cases, with a 14% upstaging. The incidence of false negatives was 9 patients (10%). Mean follow of N0 patients (n=74) was 38 months. The SLN- (negative) group (65 patients) had a recurrence rate of 4 patients (7%), whereas this rate was 2 patients (22%) in the group of SLN+(positive) (9 patients), but without significant differences. No differences in survival were observed. CONCLUSIONS: SLNM is a reproducible technique without significant increase in time and costs. Upstaging was obtained in 14% of patients staged as N0 by conventional technique. At follow-up of N0 patients with SLN+there seems to be a higher rate of recurrence, which could change the guidelines of adjuvant treatment, but we must interpret the results it with caution because the sample is small.

Cirugía laparoscópica a través de incisión única. Análisis del registro nacional / Single incision laparoscopic surgery: Analysis of the national register

Introducción La cirugía laparoscópica a través de incisión única es un concepto innovador cuya implantación y desarrollo es un reto para los cirujanos. En España, el interés suscitado por estas técnicas motivó que la Sección de Cirugía Endoscópica de la AEC pusiera en marcha un Registro Nacional de Cirugía a través de Incisión Única (RNCIU).El objetivo de este estudio fue recoger los principales datos clínicos, técnicos y las posibles complicaciones de estas técnicas en nuestro país. Material y métodos La recogida de datos se realizó a través de un formulario disponible en la página web de la AEC. Los formularios incluidos en este trabajo se corresponden con los recibidos entre junio de 2010 y junio de 2011.ResultadosDurante el período de estudio han participado 35 centros, recogiéndose 1198 formularios. El 62,2% corresponden a colecistectomías, el 22% a apendicectomías y el 7,8% a colectomías. Además, se registraron procedimientos sobre órganos sólidos (3,4%), cirugía bariátrica (2,7%) y distintas reparaciones herniarias (1,9%).La incidencia global de complicaciones fue de 0,8%. La mortalidad de la serie fue de 0,1%.ConclusionesLa cirugía laparoscópica a través de incisión única es un concepto novedoso al que no es ajena nuestra comunidad científica. Los resultados del registro demuestran la factibilidad de numerosos procedimientos en un contexto de eficacia y seguridad. Por último, el RNCIU es una importante fuente de datos que permitirá el estudio pormenorizado de subgrupos de patologías, con el fin de avanzar en el conocimiento de estas técnicas y generar evidencia científica (AU)

Introduction Laparoscopic surgery through a single incision is an innovative concept which is a challenge for surgeons to implement and develop. The interest aroused by these techniques in Spain led to the Endoscopy Section of the Spanish Association of Surgeons (AEC) to start a National Register for Single-Incision Surgery (RNCIU).The aim of this study was to collect the primary clinical data, techniques, and the possible complications of these techniques in Spain. Material and methods Data were gathered using a form available on the AEC website. The forms included in this study correspond to those received between June 2010 and June 2011.ResultsA total of 35 centers had taken part during the study period, with1,198 forms being collected. The surgeries performed included 62.2% cholecystectomies, 22% appendectomies, and 7.8% colectomies. Procedures on solid organs (3.4%), bariatric surgery (2.7%), and various hernia repairs (1.9%), were also registered. The overall incidence of complications was 0.8%. The mortality rate in the series was 0.1%.ConclusionsSingle incision laparoscopic surgery is a novel concept that is not beyond our scientific community. The results of the Register demonstrate the feasibility of numerous effective and safe procedures. Finally, the RNCIU is an important data source to be able to study sub-groups of diseases in detail, with the aim of advancing the knowledge of these techniques and generating scientific evidence (AU)

[Single incision laparoscopic surgery: analysis of the national register]. / Cirugía laparoscópica a través de incisión única. análisis del registro nacional.

INTRODUCTION: Laparoscopic surgery through a single incision is an innovative concept which is a challenge for surgeons to implement and develop. The interest aroused by these techniques in Spain led to the Endoscopy Section of the Spanish Association of Surgeons (AEC) to start a National Register for Single-Incision Surgery (RNCIU). The aim of this study was to collect the primary clinical data, techniques, and the possible complications of these techniques in Spain. MATERIAL AND METHODS: Data were gathered using a form available on the AEC website. The forms included in this study correspond to those received between June 2010 and June 2011. RESULTS: A total of 35 centers had taken part during the study period, with 1,198 forms being collected. The surgeries performed included 62.2% cholecystectomies, 22% appendectomies, and 7.8% colectomies. Procedures on solid organs (3.4%), bariatric surgery (2.7%), and various hernia repairs (1.9%), were also registered. The overall incidence of complications was 0.8%. The mortality rate in the series was 0.1%. CONCLUSIONS: Single incision laparoscopic surgery is a novel concept that is not beyond our scientific community. The results of the Register demonstrate the feasibility of numerous effective and safe procedures. Finally, the RNCIU is an important data source to be able to study sub-groups of diseases in detail, with the aim of advancing the knowledge of these techniques and generating scientific evidence.