Relationship between age and the histopathological features to chemotherapy response in colorectal cancer patients: a prospective observational study

Introduction: Chemotherapy response in early age-onset colorectal cancer patients is still controversial, and the results of chemotherapy response are unknown. Therefore, the purpose of this study is to determine the relationship between the age of colorectal cancer patients and histopathological features and chemotherapy response. Methods: This is a prospective observational study. The subjects in this study were colorectal cancer patients in the Digestive Surgery division at Tertiary Hospital in West Java from September 2021 to September 2022. Results: There were 86 subjects who underwent chemotherapy in accordance with the inclusion and exclusion criteria. Consisting of 39 patients of early age onset and 44 female patients. The most common histopathological feature in early age onset (EAO) and late age onset (LAO) was adenocarcinoma (25% and 46%, respectively). Stage III colorectal cancer affected 38 patients, while stage IV affected 48 patients. There was a significant relationship between early age onset and late age onset with histological features (p < 0.001). The patients with the highest chemotherapy response had stable diseases in EAO (17 patients) and LAO (20 patients). There was no statistically significant relationship between age, histological features, and stage of colorectal cancer and chemotherapy response (p > 0.05). The results of the ordinal logistic regression test showed no systematic relationship between chemotherapy response and age, histopathological features, gender, or cancer stage (p > 0.05). Conclusion: There was no association between age and histopathologic features with chemotherapy response and there is no difference in chemotherapy response between early and late age onset. (AU)

The prognostic value of COX-2 in predicting metastasis of patients with colorectal cancer: A systematic review and meta analysis.

Introduction: COX-2 is overexpressed in colorectal tumour tissue relative to the healthy colonic mucosa, thus we investigated the prognostic significance of COX-2 in determining the metastasis of patients with colorectal cancer. Methods: PubMed, EMBASE, and Cochrane Library were searched using the following terms colorectal cancer, colon cancer, rectal cancer, colorectal carcinoma, Cyclooxygenase-2, and prognosis to identify articles providing information on the prognostic importance of COX-2 in adult patients with metastatic colorectal cancer. Review papers, non-research letters, comments, case reports, animal studies, original research with sample sizes of fewer than 20, case reports and series, non-English language articles, and pediatric studies (those under the age of 17) were excluded. The Newcastle Ottawa Scale (NOS) was used to assess the credibility of the included studies. The full texts were evaluated and this study complied with the terms of the local protocol and the Helsinki Declaration. Results: Eight relevant studies were included in this review involving 937 patients. The meta-analysis revealed that COX-2 expression is associated with lymph node invasion (RR 1.85 [1.21, 2.83], P = 0.005, I2 = 88 %) and liver metastasis (RR 4.90 [1.12, 21.57], P = 0.04, I2 = 42 %), but not with venous dissemination (RR 1.48 [0.72, 3.03], P = 0.28, I2 = 87 %). Conclusion: COX-2 expression is associated with lymph node invasion in colorectal cancer but further studies are required to determine the prognostic significance of COX-2 expression in determining metastasis status for colorectal cancer patients.

Single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: A systematic review and meta-analysis.

Background: The possibilities of minimally invasive cholecystectomy have emerged since the beginning of single-incision laparoscopic cholecystectomy (SILC) and single-site robotic cholecystectomy (SSRC). This study aimed to compare the feasibility, safety, and pain scores between SSRC and SILC. Methods: The authors searched randomized or non-randomized controlled trials and observational studies in PubMed, EuroPMC, and ClinicalTrials.gov from April 2012 until April 2022. The authors analyzed the operation time, hospital stay, blood loss volume, conversion rate, intraoperative complication rates, postoperative complications, visual analog scale (VAS) immediately after surgery, and VAS at hospital discharge. This study aligned with PRISMA and AMSTAR guidelines. Results: Thirteen studies were selected with 817 and 757 patients who underwent SSRC and SILC. Thus, this study demonstrated a lower incidence of intraoperative complication rates [relative risk (RR) 0.57 (95% CI 0.34-0.96), p = 0.03] and lesser VAS score at hospital discharge [Std. Mean Difference (SMD) -0.23 (95% CI -0.46, -0.01), p = 0.04] in the SSRC group. Regarding operation time and cost, SSRC revealed a longer time [SMD 1.02 (95% CI 0.45, 1.59), p = 0.0004] and higher cost [SMD 4.18 (95% CI 1.77, 6.58), p < 0.00001], respectively. Meanwhile, SSRC did not differ from SILC during a hospital stay, blood loss volume, conversion rate, postoperative complication rates, and VAS immediately after surgery. Conclusions: Concerning intraoperative complication rates and VAS score at hospital discharge, SSRC was superior to SILC. Thus, SSRC is considered a feasible and safe procedure.

Assessment of robotic telesurgery system among surgeons: a single-center study.

The field of robotic-assisted surgery is expanding rapidly; therefore, future robotic surgeons will need to be trained in an organized manner. Here, we aimed to examine surgeon performance on the Sinaflex Robotic Telesurgery System for correlation with training hours spent in training program. This is a prospective study of a single-center experience at the Hasan Sadikin Hospital, Bandung City of West Java, Indonesia. We included 43 surgeons from 11 departments, all invited to train using the Sinaflex Robotic Telesurgery system at the Hasan Sadikin Hospital. All study cohorts have never performed a robotic surgery procedure beforehand and have had at least five years of field experience. The surgeons were free to choose their training duration and simulation. After finishing the training session, they were asked to perform several tasks with increasing difficulty levels. There were nine training tasks in total with increasing levels of difficulty. A total of 43 surgeons from 11 different department were included in this prospective study. Our study was separated into 3 different batches and most surgeons failed to pass the examination (n = 12, 8, and 9, for batches 1, 2, and 3, respectively). The "failed" surgeon, additionally, tended to be older than the "passed" cohort (49.3 ± 7.4 vs 42.1 ± 7.3 years old, p = 0.005). In terms of duration of hours spent training on the robot, there was little difference training hours between the cohort that passed and the cohort that failed cohort (10.0 [8.4-10.1] vs 10.0 [8.0-10.0], respectively) with a p value of 0.265. We found no correlation between the total hours spent in the training program and surgeon performance on the Sinaflex robotic telesurgery system. Structured robot surgical training courses must be incorporated into the training programs.

A 54-Year-Old Man with a Large Rectal Prolapse Treated with Perineal Proctosigmoidectomy with Levatorplasty (Altemeier Procedure): Presentation of Case and Review of Literature.

BACKGROUND The surgical procedure of perineal proctosigmoidectomy with levatorplasty is known as the Altemeier procedure. This report presents the case of a 54-year-old man with a large rectal prolapse treated with perineal proctosigmoidectomy with levatorplasty (Altemeier procedure). CASE REPORT A 54-year-old male had a large bulging in the rectum since 5 months ago. At first, the bulging was small, but its size had increased to approximately 10 cm at presentation. The patient also stated that the bulging used to reduce spontaneously after defecating or manually by applying sufficient pressure, but lately it had been irreducible. Another concern was chronic constipation over the last few years, which was treated with over-the-counter laxatives and stool softeners. Physical examination of the perianal region revealed a full-thickness, irreducible, prolapsed bowel segment, approximately 10 cm long, with multiple mucosal ulcerations. Grade V rectal prolapse was diagnosed. Follow-up at 7, 14, and 30 days after surgery showed complete resolution of symptoms and no recurrence. CONCLUSIONS Individually tailored and prompt surgical treatment for all patients with rectal prolapse is vital. The Altemeier procedure, which has good efficacy with low morbidity, complications, and recurrence, should be considered in elderly patients with an irreducible, large rectal prolapse.

The analysis between clinicopathological aspect of early-onset vs. late-onset colorectal cancer and mortality rate: a cross-sectional study.

Early-onset colorectal cancer (CRC) has different clinical and pathological characteristics compared with late-onset CRC. Mortality rate as a postoperative outcome is a patient's postoperative outcome considered based on the state of life or death. The objective of this research is to analyse the comparison between clinicopathological aspect of early-onset vs. late-onset CRC as well as their correlation with the mortality rate in Indonesia to support global data. Material and methods: The authors performed a case-control study on 170 subjects with CRC from November 2021 to November 2022 in a Tertiary Hospital in Bandung. Data were extracted from electronic medical records CRC Registry. Bivariate and correlation analyses were used to analyse the difference between variables using IBM SPSS 24.0. P less than 0.05 was considered statistically significant. Results: Anaemia and tumour location variables were significantly different in the early-onset group compared with the late-onset group (P<0.001). It was also found that anaemia (P<0.001), pathological features (P<0.001), and tumour location (P=0.013) had significantly low correlation with onset of CRC (r=0.325; r=0.397; r=0.342, respectively). Conclusion: There is no statistically significant correlation between the clinicopathological features of CRC in both onset and mortality rates in this study.

Identification of KRAS mutation and HER2 expression in Indonesian colorectal cancer population: a cross-sectional study.

In Indonesia, colorectal cancer is the third most common type. In 2008, Indonesia ranked fourth in the Association of Southeast Asian Nations (ASEAN) countries, with an incidence rate of 17.2 per 100 000 population. This figure is predicted to continue to increase from year to year. In 30% of colorectal cancer patients diagnosed after metastases, some patients will develop metastases after undergoing surgical resection of the primary tumor. The survival of metastatic colorectal cancer patients has improved significantly in the last 20 years with the introduction of target-oriented drugs, anti-epidermal growth factor receptor (EGFR), and anti-human epidermal growth factor receptor-2 (HER2). This study aims to assess the relationship between Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and HER2 expression for targeted therapy implementation. Patients and methods: This research is a cross-sectional study. The research subjects in this study were colorectal cancer patients in the digestive surgery division. There were 58 study subjects. Examination of KRAS mutations was carried out by PCR on fresh tumor tissue obtained from surgery or colonoscopy. Meanwhile, the HER2 examination used the immunohistochemistry method of paraffin blocks for anatomical pathology examination. Results: Examination of KRAS mutations showed 28/58 (43.8%) patients with colorectal cancer, while HER2 overexpression was found in 6/58 (10.3%) patients with colorectal cancer. Univariate analysis of KRAS mutations and HER2 expression showed that four subjects with KRAS mutations had excess HER2 expression (P=0.341). Conclusion: There is no association between KRAS mutations and HER2 overexpression in colorectal cancer patients.

Anal Repair and Diamond Flap in Patient with Moderate Anal Stenosis After Open Hemorrhoidectomy Surgery: A Case Report.

BACKGROUND Anal stenosis due to anoderm scarring is usually caused by surgical trauma and decreases the patient's quality of life significantly. Even though mild anal stenosis can be treated non-surgically, surgical reconstruction is unavoidable for moderate to severe cases of anal stenosis, especially stenosis that causes severe anal pain and the inability to defecate. In this study, we report the diamond flap method in the treatment of anal stenosis. CASE REPORT A 57-year-old female patient reported difficulty and discomfort in defecation caused by anal stenosis 2 years after a hemorrhoidectomy surgery. On physical examination, a forceful dilatation was needed using the index finger; the size of the anal canal was precisely 6 mm, as measured by a hegar dilator. Laboratory tests results were normal. The patient underwent an anal repair and diamond flap procedure in which the scar tissue at 6 and 9 o'clock was excised and a diamond graft was incised carefully, with attention given to the vascular supply. Finally, the graft was sutured to the anal canal. After 2 days, the patient was discharged without any adverse event. Ten days after surgery, the diamond flap was in good condition and without any complications. The patient was then scheduled for further follow-up at the Digestive Surgery Division. CONCLUSIONS Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when the procedure is performed by an experienced surgeon. The diamond flap was the option used for anal stenosis treatment and had few complications.

Different Clinicopathological Characteristics in Indonesian Colorectal Patients with NRAS Mutations and HER2 Over-Expression.

OBJECTIVE: This study aims to assess the association of subject characteristics and NRAS mutations with HER2 expression in CRC. METHODS: This research is a cross-sectional study. The research subjects in this study were colorectal cancer patients in the Digestive Surgery division at Dr. Hasan Sadikin Hospital. There were 58 study subjects. Examination of NRAS mutations was carried out by Polymerase Chain Reaction (PCR) from fresh tumour tissue obtained from surgery or colonoscopy. Meanwhile, HER2 examination used the Immunohistochemistry (IHC) method of paraffin blocks for anatomical pathology examination of the same patients. RESULT: HER2 overexpression was found in 6/58 (10.3%) patients with CRC, and from 8 subjects with NRAS mutations, only 1 subject (1.7%) showed overexpression of HER2. Univariate analysis of HER2 expression showed no significant associations to age, sex, histologic feature, tumor location, and NRAS mutations. A significant association was found between HER2 expression and stage of the CRC with p=0.001. CONCLUSION: There is no association between NRAS mutations and HER2 overexpression in colorectal cancer patients.

Complications of biliary stenting versus T-tube insertion after common bile duct exploration: A systematic review and meta-analysis.

BACKGROUND: Complications following the insertion T-tube or stent after common bile duct exploration (CBDE) remain problematic in nowadays surgical era. Based on our knowledge, we did not find any meta-analysis intentionally evaluating the complications between both groups. At this moment, we aimed to analyze and compare both procedures' complications, efficacy, efficiency, and feasibility. METHODS: We searched literature from four databases (EuroPMC, PubMed, Scopus, and ClinicalTrials.gov) up to June 2022 to compile the randomized controlled trials and pro-/retrospective cohort studies. Review Manager 5.4 was used to statistically analyze each outcome measured between biliary stenting and T-tube insertion. RESULTS: Sixteen studies with 1,080 patients (534 biliary stents and 546 T-tube) were included for qualitative and quantitative analysis. The pooled risk ratio (RR) of the overall postoperative complications rate was significantly lower in the biliary stent group compared to the T-tube group 0.43 [95% confidence interval (CI) 0.23-0.80, p = 0.007]. In terms of the operation time, length of hospital stay, and readmission rate was also decreased in stenting as biliary drainage over T-tube placement 1.02 minutes [95% CI -1.53, -0.52, p < 0.0001], 1.96 days [95% CI -2.63, -1.29, p < 0.00001], and RR 0.39 [95% CI 0.15-0.97, p = 0.04], respectively. CONCLUSIONS: Stenting as biliary drainage after CBDE was superior to T-tube insertion. A shorter operation time and hospital stay in biliary drainage resulted in a lower overall postoperative complication rate. Other influences, including the complexity and shorter learning curve, might also affect the superiority of biliary stenting.

The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta-analysis, and meta-regression of randomised clinical trials.

Pain and wound after haemorrhoidectomy constantly bothered the patient's convenience. Recurrently, topical sucralfate is used to treat excoriations and burns. It is considered to enhance epidermal growth and tissue granulation, thus, alleviating patients' problems. This study evaluated topical sucralfate's feasibility, safety, and superiority after haemorrhoidectomy. We searched randomised controlled trial (RCT) studies in PubMed, Google Scholar, Europe PMC, and ClinicalTrials.gov until March 29th, 2022. We investigated the influence of topical sucralfate on pain score postoperatively (24 hours, 7 days, and 14 days), pethidine usage, diclofenac usage, and wound healing rate compared to placebo. This study was conducted following the PRISMA guidelines. This study sorted the final six studies with 439 patients underwent haemorrhoidectomy. Topical sucralfate demonstrated significant outcomes on VAS 24 hours post-operative [Std. Mean Difference -1.00 (95% CI -1.70, -0.31), P = .005], VAS 7 days post-operative [Std. Mean Difference -2.29 (95% CI -3.34, -1.25), P < .0001], VAS 14 days post-operative [Std. Mean Difference -1.88 (95% CI -2.74, -1.01), P < .0001], pethidine usage within 24 hours post-operative [Std. Mean Difference -0.62 (95% CI -0.96, -0.27), P = .0004], diclofenac usage 7 days post-operative [Std. Mean Difference -1.76 (95% CI -2.61, -0.92), P < .0001], diclofenac usage 14 days post-operative [Std. Mean Difference -1.64 (95% CI -2.38, -0.91), P < .0001], and wound healing rate at 28-day post-operative [RR 1.45 (95% CI 1.25-1.68), P < .00001]. Topical sucralfate alleviated pain, improved wound healing, and minimised the usage of pethidine and diclofenac compared to placebo.

Efficacy and Safety of Near-Infrared Florescence Cholangiography Using Indocyanine Green in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

Background: Achieving critical view of safety is a key for a successful laparoscopic cholecystectomy (LC) procedure. Near-infrared fluorescence cholangiography using indocyanine green (NIF-ICG) in LC has been extensively used and accepted as beneficial auxiliary tool to visualize extrahepatic biliary structures intraoperatively. This study aimed to analyze its safety and efficacy. Materials and Methods: Searching for potential articles up to March 25, 2022 were conducted on PubMed, Europe PMC, and ClinicalTrials.gov databases. Articles on the near infrared fluorescence during laparoscopy cholecystectomy were collected. Review Manager 5.4 software was utilized to perform the statistical analysis. Results: Twenty-two studies with a total of 3457 patients undergo LC for the analysis. Our meta-analysis revealed that NIF-ICG technique during LC was associated with shorter operative time (Std. Mean Difference -0.86 [95% confidence interval (CI) -1.49 to -0.23], P = .007, I2 = 97%), lower conversion rate (risk ratio [RR] 0.28 [95% CI 0.16-0.50], P < .0001, I2 = 0%), higher success in identification of cystic duct (CD) (RR 1.24 [95% CI 1.07-1.43], P = .003, I2 = 94%), higher success in identification of common bile duct (CBD) (RR 1.31 [95% CI 1.07-1.60], P = .009, I2 = 90%), and shorter time to identify biliary structures (Std. Mean Difference -0.52 [95% CI -0.78 to -0.26], P < .0001, I2 = 0%) compared with not using NIF-ICG. Conclusions: NIF-ICG technique beneficial for early real-time visualization of biliary structure, shorter operative time, and lower risk of conversion during LC. Larger randomized clinical trials are still needed to confirm the results of our study.

Validation of Immune Status Questionnaire (ISQ) in Indonesian Bahasa Language as simple assessment of perceived immune status.

OBJECTIVE: This study aimed to determine whether the ISQ can be used to assess immune status in daily clinical practice in Indonesia by translating the questionnaire into Bahasa and analyzing its validity and reliability. METHODS: The ISQ was translated both forward and backward by a professional translator fluent in both English and Bahasa. In this study, a cross-sectional study design was used, and Pearson's correlation test and Cronbach's Alpha calculation were used to perform the validity and reliability test. The questionnaire is valid if the computed R-value exceeds the R table value. Furthermore, it will also be considered reliable if Cronbach's Alpha value is greater than 0.60. RESULT: The computed R-value for each item is greater than the R table value (0.361), implying that all items in the questionnaire are valid. The Cronbach's Alpha value of 0.706 demonstrates that the questionnaire is reliable. CONCLUSION: The ISQ is a reliable and valid questionnaire, which can be used in Bahasa to assess patients' perspectives about their immune status.

Secondary healing of horseshoe perianal abscess in a patient with morbid obesity: experience at a rural hospital.

INTRODUCTION: Perianal abscess is defined as a local collection of pus in the perianal tissues. It is among the most common anorectal problems encountered by surgeons. Further extension of this infection into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. Morbid obesity is a risk factor for horseshoe perianal abscess with the potential to disrupt the normal healing process. CASE REPORT: A 35-year-old male with morbid obesity presented to the surgery outpatient clinic in a hospital in Subang, West Java, Indonesia, with continuous severe pain and swelling around the anus of approximately 7 days' duration. Local examination of the anogenital area revealed a horseshoe perianal abscess extending to the ischiorectal fossa, approximately 1 cm from the anal verge and measuring 7.5 cm × 4.5 cm × 10 cm. Physical examination findings included tenderness to palpation; the presence of blood, pus, and necrotic tissue; and fluctuance. Incision and drainage were performed in the operating room under general anesthesia. In lieu of colostomy, the patient chose wound healing by secondary intention. Postoperative open wound care consisted of wet-to-moist gauze dressings during the first 2 postoperative days, followed by hydrocolloid dressing after the pus and blood were adequately drained, and finally, alginate dressing after granulation tissue formed. Aluminum silicate (microporous ceramic) was used as the external (secondary) wound dressing. Time to healing was 8 weeks. CONCLUSION: Horseshoe abscesses are challenging to manage. Thorough and careful diagnosis, prompt fluid resuscitation to overcome fluid and electrolyte imbalance and to ensure proper antibiotic administration, nutrition intake, and a planned surgical approach as well as individualized postoperative care are necessary to achieve healing.

Ten Years of Change in Bariatric/Metabolic Surgery in the Asia-Pacific Region with COVID-19 Pandemic: IFSO-APC National Reports 2021.

BACKGROUND: On November 25, 2021, the IFSO-Asia-Pacific Chapter (IFSO-APC) Virtual Meeting 2021 was held online, and the representatives from the Asia-Pacific region presented 10 years of change in bariatric/metabolic surgery and the influence of COVID-19 in the special session of "IFSO-APC National Reports 2010-2020". We herein report the summarized data. METHODS: National bariatric/metabolic surgery data, which included the data of 2010 and 2020, were collected from the representatives using a questionnaire that consisted of 10 general questions. At the congress, the data were calculated and summarized. RESULTS: Thirteen of the 14 national societies responded to the survey. From 2010 to recent years, the populations of individuals with obesity (BMI ≥ 30 kg/m2) and individuals with diabetes both significantly increased. Eight countries and regions expanded the lower limit of criteria for bariatric surgery by 2-5 kg/m2 (BMI), and 5 countries newly established criteria for metabolic surgery in the last ten years. Sixty-nine percent of the countries currently run public health insurance systems, which doubled from 2010. The number of bariatric surgeons and institutions increased more than threefold from 2010. In 2010, 2019, and 2020, surgeons in IFSO-APC societies performed 18,280, 66,010, and 49,553 bariatric/metabolic surgeries, respectively. Due to the COVID pandemic, restriction policies significantly reduced access to surgery in South and Southeast Asian countries. The biggest changes included increased numbers of bariatric surgeons and institutions, operation numbers, public insurance coverage, raising awareness, and national registry systems. CONCLUSION: For the last 10 years, bariatric/metabolic surgery has rapidly grown in the Asia-Pacific region.

Relation between expression of hMLH1 and p53 mRNA genes, in the feces of patients with colorectal carcinoma. Cross-sectional study.

Colorectal carcinoma (CRC) is one of the main public health problems. The mortality of CRC is about 8%. Early detection of CRC is very important to prevent death because this cancer could be cured through surgery if the diagnosis can be made as early as possible. Therefore screening strategy for early detection of CRC is critical in reducing mortality. Many investigations supporting the detection of CRC have been developed, including the fecal DNA mutation test using advanced cytological techniques. It is capable of assessing colonocytes for the presence of DNA, RNA, and protein as molecular biomarkers of neoplasia in CRC, including p53 and hMLH1. This study implemented observational approach with a cross-sectional study of the feces of patients with CRC regardless of the stage and grade. The purpose of this study was to determine the expression of the hMLH1 and p53 mRNA genes in the feces of 48 patients with CRC from two hospitals in Indonesia, Siloam Hospitals in Cikarang and Dr. Wahidin Sudirohusodo Hospital in Makassar. The results showed that all adenocarcinoma feces samples with various tumor stages and grades had excess mRNA expression (more than twice the normal amount in Fold Change units) for both the hMLH1 and p53 genes. The average expression of the hMLH1 mRNA gene was the highest at stage two and grade one, while the lowest was at stage four and grade three. In contrast, the average p53 mRNA gene expression was the highest at stage four and grade three, while the lowest was at stage two and grade one. The study suggested that there was a relation between and the expression of hMLH1 and p53 mRNA gene. We concluded that while both hMLH1 and p53 genes in patients' feces with CRC were overexpressed, they did not significantly affect the grade of CRC.

Advances in gastrointestinal surgical endoscopy.

Surgeons have a role in observing, detect abnormalities, disease, and other deficiencies in function which could be treated. Diagnosing and treating back days were challenging for many reasons. However, technology's innovation enhances surgeons' ability to treat their patients. The term endoscopy refers to the Greek prefix endo- ("within") and the verb skopein ("to view or observe"). Endoscopy is practical both in the diagnosis and treatment of various pathologies. Technological advances, especially in endoscopy, gradually progress and discover many possibilities which allow rapid advancement. Endoscopy development aims to assess human orifice that has not been inspected, probed, and examined over the centuries. Endoscopy over these decades is improving, which led to new problem solving using advanced technological approaches. Thus, a surgeon can solve any issues from examination, diagnosis, and treatment using progressive endoscopy evolution. This review delivers a brief history of advances in surgical endoscopy and describes current endoscopy development.

Minimally invasive gastrointestinal surgery: From past to the future.

The improvement of the science and art of surgery began over 150 years ago. Surgical core tasks, "cutting and sewing" with hand and direct contact with the organs, have remained the same. However, in the 21st century, there has been a shifting paradigm in the methodology of surgery. The joint union between innovators, engineers, industry, and patient demands resulted in minimally invasive surgery (MIS). This method has influenced the techniques in every aspect of abdominal surgery, such as surgeons are not required to direct contact or see the structures on which they operate. Advances in the endoscope, imaging, and improved instrumentations convert the essential open surgery into the endoscopic method. Furthermore, computers and robotics show a promising future to facilitate complex procedures, enhance accuracy in microscale operations, and develop a simulation to improve the ability to face sophisticated approaches. MIS has been replacing open surgery due to improved survival, fewer complications, and rapid recoveries in recent years. Minimally invasive surgery's further research in diagnostic and therapeutic modalities is under investigation to achieve genuinely "noninvasive" surgery. Thus, MIS has gained interest in recent days and has been improving with promising outcomes.

Giant Left-Sided Amyand's Hernia: A Challenging Procedure in a Rural Hospital.

The finding of a vermiform appendix in the case of an inguinal hernia that extends below the midpoint of the inner thigh when the patient is in a standing position is defined as giant left-sided Amyand's hernia. It is a very rare case and significantly challenging in terms of preoperative diagnosis and surgical management. Here we present our experience with a case of a giant left-sided Amyand's hernia that was followed up for 2 months.

Initial experience with laparoscopic-assisted transvaginal cholecystectomy: a hybrid approach to natural orifice surgery.

Minimally invasive surgery is designed to provide a friendlier surgical therapy, in terms of faster recovery times, improved cosmetic results, and reduced postoperative pain. In recent years, a new genre for exploring the abdominal cavity without incisions has been developed. Incisionless surgery is considered the next frontier in minimally invasive surgery. The idea is to use natural orifices as the entry point to the abdomen, by using an endoscope through a transgastric, transvaginal, transvesical, or transcolonic access; hence, it is called as natural orifice transluminal endoscopic surgery (NOTES). We report our first case of laparoscopic-assisted transvaginal cholecystectomy. We support that NOTES can provide benefits in terms of reduced pain, faster recovery, and better cosmetic results compared with conventional laparoscopic surgery.