A New Reusable Platform for TransAnal Minimally Invasive Surgery: First Experience.

INTRODUCTION: TransAnal Minimally Invasive Surgery (TAMIS) has generated interest and attracted research in the last decade. This approach is used to treat primary benign and malignant diseases, but it can also be adopted to resolve colorectal complications, such as leak and fistula, bleeding and stenosis. A new reusable transanal platform formed by a new port and monocurved instruments has been invented and here presented. MATERIALS AND METHODS: The first experience included 13 patients submitted to TAMIS for rectal adenocarcinoma (8), immediate colorectal leak (1), early rectovaginal fistula (1), late colorectal fistula (1), immediate colorectal bleeding (1), and benign stenosis (1). Mean age was 62.3 years (38-74), and mean BMI was 25.2 kg/m2 (20.5-32.1). RESULTS: Mean operative time for transanal total mesorectal excision (TME) was 149.2 minutes (96-193) and for the other procedures 80.6 minutes (15-163). Mean operative bleeding was 51.1 cc (0-450). Mean hospital stay was 5.0 days (2-8). The 3 patients with coloanal anastomosis presented diarrhea postoperatively. No other early postoperative complications were registered. Pathologic report in the oncologic diseases showed that a mean number of 14.7 nodes (16-20) were removed. After a mean follow-up of 8 months (1-14), there were no late complications in any of the 13 patients treated. CONCLUSION: TAMIS is a feasible alternative approach to treat rectal cancer and a completely new technique to manage colorectal complications. Moreover, this new transanal platform offers surgeons a satisfactory working ergonomy, with no increase in cost of the procedures, because entirely reusable materials are adopted.

Short-Term functional comparison of three total knee arthroplasties-Journey II, Genesis II and Profix.

AIM OF THE STUDY: To compare the outcomes of three knee arthroplasty design philosophies and surface tribology.• A zirconium-surfaced, bicruciate-stabilised implant designed to mimic kinematic movement and improve flexion and outcomes;• A cobalt-chrome surfaced, multi-radius design with built-in femoral external rotation to aid balancing and patella tracking through a deeper trochlea groove;• A zirconium-surfaced, single-radius implant designed on surface conformity, particularly within the patello-femoral joint. METHODS: 313 knee replacements - 103 Journey II, 103 Genesis II and 107 Profix - were statistically assessed at a minimum of 2 years using WOMAC, Oxford and SF-12 scores, and range of movement. RESULTS: There was no difference between the actual or unit change in WOMAC scores (p = 0.140 and p = 0.287), SF-12 physical (p = 0.088) or mental scores (p = 0.975) between the three implants; or between the actual or unit change in Oxford score (p = 0.912 and p = 0.874) for the Journey II or Genesis II. The Journey II produced more flexion and range of movement than the Genesis II (p < 0.001 and p = 0.018) and Profix (p < 0.001 and <0.001) with no difference between the latter two (p = 0.402 and 0.568); with no difference in extension between the three implants (p = 0.086). There was no difference between those with or without a resurfaced patella. CONCLUSION: The three design philosophies and surfaces yielded no difference in outcome scores at 2 years post-operatively. The Journey II demonstrated better post-operative flexion. Resurfacing the patella did not alter the outcome scores or flexion.

Single-Incision Laparoscopic Nontraumatic Left Lateral Diaphragmatic Hernia Repair.

Diaphragmatic hernia is a quite uncommon disease, being congenital or posttraumatic. Its diagnosis is frequently accidental. Surgical treatment can be performed through the abdomen as well as through the chest. Laparoscopy and thoracoscopy offer a surgical benefit because of reduced wall trauma and added advantages of minimally invasive surgery. Besides the improved cosmetic result, transumbilical single-incision laparoscopy can add other advantages to minimally invasive surgery like reduced postoperative pain, shorter hospital stay, and improved patient's comfort. The authors describe the technique of transumbilical single-incision laparoscopic suture and mesh reinforcement for a nontraumatic left lateral diaphragmatic hernia, discovered accidentally in a 45-year-old male.