Background: 

The Competency-Based Assessment of Robotic Surgery Skills (CARS) scale was developed as a novel approach to assess robotic surgery (RS) skills through 10 relevant RS competencies. CARS 2.0 aimed to expand on the findings of CARS by conducting a global survey study in which participants graded a blinded, edited surgical video with the CARS scale for 7 competencies measurable via video.

Methods: 

CARS 2.0 is being conducted globally, including participants across medical specialties and training stages, from medical students to attending/consultant surgeons. Participants evaluated a blinded, edited surgical video using the CARS scale via an anonymous Google form, focusing on 7 video-measurable competencies.

Results: 

A total of 320 responses were collected over 3 months, including 125 (39.06%) attending/consultant surgeons, 98 (30.6%) surgical specialty postgraduate trainees, 96 (30%) medical students, and 1 pre-medical student. ANOVA (analysis of variance) analysis showed that the operator scores increased with the evaluators’ level of experience, reaching statistical significance across all 7 competency categories. Spearman’s correlation indicated moderate associations between participants’ surgical experience and proficiency (ρ = 0.314, P < 0.001), as well as between their comfort with the CARS scale and proficiency (ρ = 0.337, P < 0.001). Regression analysis demonstrated that robotic stapler use and camera handling were predictors of higher CARS scores based on participants’ experience.

Conclusions: 

CARS represents a first step toward establishing competency-based assessment of RS performance independent of specific surgical procedures. Its integration into surgical training programs can facilitate trainees’ attainment of RS competency. Longitudinal studies could further validate its effectiveness at improving surgical training with its implementation into training curricula.

Gastrojejunal (GJ) stricture is one of the most common complications following Roux-en-Y gastric bypass with a hand-sewn anastomosis. This study aimed to evaluate the risk of GJ strictures in a series of robotic Roux-en-Y gastric bypasses (RRYGBP) performed by a single surgeon. This retrospective observational study included 314 consecutive patients with severe obesity who underwent RRYGBP with a 3-layer continuous hand-sewn GJ anastomosis using absorbable sutures between September 2017 and September 2024. All patients were followed up at 6-month intervals after the first month post-surgery. The mean age of the patients was 42.8 ± 11.3 years, and the mean pre-operative BMI was 41.3 ± 5.54 kg/m². The majority of patients were female 220 (70.1%), and 120 had obesity-associated comorbidities. A total of 68 (21.6%) revisional surgeries were performed. The average operative time (console time) was 150 ± 39.2 min, with the GJ anastomosis completed in an average of 15 min. Patients were discharged on the second postoperative day with a mean hospital stay of 3.13 ± 4.05 days. There were no complications related to the robotic platform. Early postoperative complications included 10 (3.1%) strictures, 3 (0.9%) leaks, and 4 (1.27% hemorrhage). Upper endoscopy was performed on postoperative day 1 in 5 (1.6%) cases for GJ dilation to allow gastroscope passage. There were no conversions to laparoscopy or laparotomy, and no mortality occurred. Anastomotic GJ stricture remains a common complication of laparoscopic Roux-en-Y gastric bypass for morbid obesity. The risk of stricture following RRYGBP is comparable, with important technical considerations that may help mitigate this complication.

Background: 

Hepatopancreatobiliary (HPB) surgery is among the most complex domains in oncologic care, where decisions entail significant risk–benefit considerations. Artificial intelligence (AI) has emerged as a promising tool for improving individualized decision-making through enhanced risk stratification, complication prediction, and survival modeling. However, its role in HPB oncologic surgery has not been comprehensively assessed. 

Methods: 

This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO ID: CRD420251114173. A comprehensive search across six databases was performed through 30 May 2025. Eligible studies evaluated AI applications in risk–benefit assessment in HPB cancer surgery. Inclusion criteria encompassed peer-reviewed, English-language studies involving human s ubjects. Two independent reviewers conducted study selection, data extraction, and quality appraisal. 

Results: 

Thirteen studies published between 2020 and 2024 met the inclusion criteria. Most studies employed retrospective designs with sample sizes ranging from small institutional cohorts to large national databases. AI models were developed for cancer risk prediction (n = 9), postoperative complication modeling (n = 4), and survival prediction (n = 3). Common algorithms included Random Forest, XGBoost, Decision Trees, Artificial Neural Networks, and Transformer-based models. While internal performance metrics were generally favorable, external validation was reported in only five studies, and calibration metrics were often lacking. Integration into clinical workflows was described in just two studies. No study addressed cost-effectiveness or patient perspectives. Overall risk of bias was moderate to high, primarily due to retrospective designs and incomplete reporting. 

Conclusions: 

AI demonstrates early promise in augmenting risk–benefit assessment for HPB oncologic surgery, particularly in predictive modeling. However, its clinical utility remains limited by methodological weaknesses and a lack of real-world integration. Future research should focus on prospective, multicenter validation, standardized reporting, clinical implementation, cost-effectiveness analysis, and the incorporation of patient-centered outcomes.

Robotic-assisted Roux-en-Y gastric bypass (RYGB) is a well-established procedure in bariatric surgery, offering enhanced precision, ergonomics, and visualization. While the conventional four-arm robotic approach is widely used, it may increase operative costs and complexity. This report presents a case of a 33-year-old female with a BMI of 50.7 who underwent a robotic three-arm RYGB, aiming to evaluate the feasibility, safety, and efficiency of this streamlined technique. A modified three-port configuration was used, along with suture-based liver retraction. Key steps included gastric pouch creation, gastrojejunal and jejunojejunal anastomoses using stapled and hand-sewn techniques, and Roux limb configuration confirmed by methylene blue leak testing. The procedure was completed without intraoperative complications, with a console time of120 min. The patient resumed oral fluids within 1 h, ambulated at 2 h, and was discharged within 24 h. No postoperative complications were observed. Compared to the standard four-arm approach, the three-arm technique maintained surgical efficacy while potentially reducing costs, postoperative pain, and improving reproducibility. This case highlights the potential utility of a three-arm robotic RYGB approach in select patients. Larger studies are needed to validate these findings and assess long-term outcomes, training adaptability, and scalability across surgical centers.

Background: 

Single-Anastomosis Duodenoileostomy with Sleeve Gastrectomy (SADI-S) has been reported as both a safe and effective surgical procedure. However, these findings have not been directly compared to those of more established and less complex procedures, such as Sleeve Gastrectomy (SG), which remains the most commonly performed technique in Metabolic and Bariatric Surgery (MBS).

Objective

This study aimed to assess and contrast the intraoperative and postoperative outcomes between patients who underwent SADI-S and those who underwent SG.

Methods: 

A systematic review and meta-analysis were performed and registered under PROSPERO with the ID CRD42024532504. A comprehensive search strategy was executed on 15 April 2024, covering PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct from the first reports to March 2024. The search strategy incorporated relevant keywords, including: “SADI-S” OR “Single Anastomosis Duodenal-Ileal bypass” and “Sleeve Gastrectomy”. We included studies comparing adult patients (≥18 years old) undergoing SADI-S and SG, reporting at least one clinical outcome of interest.

Results: 

Five studies published between 2019 and 2023, comprising 3593 patients, were included. Of these, 461 patients (12.8%) underwent SADI-S, while 3132 (87.2%) underwent SG. The mean patient age was 42.96 years, with 89.6% female participants. Patients undergoing SADI-S had a significantly higher Body Mass Index (BMI) than those undergoing SG (Mean: 49.73 ± 8.10 vs. 45.64 ± 7.84; Mean Difference [MD]: 3.83, 95% CI: 0.52–7.14; p = 0.02) and an increased risk of hypertension (OR: 1.38, 95% CI: 1.04–1.84; p = 0.03). SADI-S also resulted in longer operative times (125.63 ± 51.91 min vs. 49.67 ± 26.07 min; MD: 65.97 min, 95% CI: 61.71–70.25; p < 0.001) and length of hospital stay (2.30 ± 2.76 days vs. 1.21 ± 0.81 days; MD: 1.03 days, 95% CI: 0.70–1.37; p < 0.001). Moreover, patients who underwent SADI-S demonstrated a significantly higher risk of postoperative complications, such as readmissions and reinterventions (OR: 3.17, 95% CI: 2.15–4.67; p < 0.001), and experienced greater excess weight loss (MD: 12.42%, 95% CI: 0.92–23.92; p = 0.03). No significant differences were observed between the groups regarding age, sex, or the prevalence of obstructive sleep apnea (OSA).

Conclusions: 

SADI-S appears to be a promising surgical technique for facilitating substantial weight loss in individuals with severe obesity. Given the higher risk of postoperative complications associated with SADI-S, careful evaluation and personalized decision-making for patient selection and education are essential to optimize clinical and safety outcomes.

Robotic metabolic and bariatric surgery (RMBS) has emerged as the most effective approach in the treatment of severe obesity in academic medical centers (AMCs) and community medical centers (CMCs) in the United States of America (USA). However, differences in their scientific productivity in their fields remain unexplored. This bibliometric analysis evaluates the differences in the scientific production related to RMBS in AMC vs. CMC in the USA from the point of view of bibliometric analysis. In the core collection of the Web of Science database, the research technique used in this bibliometric analysis includes specific keywords for “robotic” and “bariatric surgery”. Original articles released up until 2023 were included. A total of 89 articles were included in the study, with 73 originating from AMC and 16 from CMC. Compared with CMC, AMC had a higher average number of articles per year (3.48 vs. 1.1, P = 0.002) and a higher annual growth rate (13.23% vs. 7.6%). However, in terms of scientific impact, there was no difference in the average citations per article (22.73 ± 32.96 vs. 12.25 ± 9.59, P = 0.213) or the proportion of articles published in the highest quality scientific journals (54.8 vs. 56.3, P = 0.916). The scientific output of RMBS increased by 14.5% annually, showing a rising linear trend in AMC and an unclear trend in CMC. The University of Illinois was the most frequent AMC, while the Orlando Health network was the most common CMC. Both CMC and AMC play a pivotal role in the scientific production related to RMBS in the USA, with academic centers having a higher scientific production, but with similar scientific impact to the field at this time.

Background: 

Obesity is a chronic disease associated with increased risk for several cancers, including colorectal cancer (CRC), a leading cause of cancer-related mortality. The majority of CRC cases are associated with modifiable risk factors. Metabolic and bariatric surgery (MBS) is a proven, durable, and successful intervention for obesity. This study aimed to evaluate the impact of MBS on CRC risk through measures of association, such as relative risk (RR) and odds ratio (OR).

Methods: 

A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted to identify systematic reviews (SR) and meta-analyses examining the relationship between obesity treated with MBS and CRC incidence. The PICO framework guided inclusion criteria, and three independent reviewers screened articles using Rayyan software. Quality assessment was performed using AMSTAR2.

Results: 

Of 1336 screened articles, 10 SR met inclusion criteria, encompassing 53,452,658 patients. Meta-analyses consistently showed a significant reduction in CRC risk following MBS in patients with severe obesity. Risk reductions were reported by Liu et al. (RR: 0.46, 95% CI: 0.32–0.67, p < 0.01), Chierici et al. (RR: 0.46, 95% CI: 0.28–0.75, p = 0.018), Wilson et al. (RR: 0.69, 95% CI: 0.53–0.88, p = 0.003), and Pararas et al. (RR: 0.56, 95% CI: 0.40–0.80, p < 0.001). Sensitivity analyses supported these findings. For colon cancer, Liu and Chierici both reported an RR of 0.75 (95% CI: 0.46–1.21, p = 0.2444) with significant heterogeneity (I² = 89%). A trend towards reduced rectal cancer risk (RR: 0.74, 95% CI: 0.40–1.39, p = 0.3523) was noted but limited by fewer studies. Sex-specific analyses revealed protective effects in both sexes, with a more pronounced impact in females (RR: 0.54, 95% CI: 0.37–0.79, p = 0.0014). 

Conclusions: 

This umbrella review synthesizes current evidence on the impact of MBS on CRC risk, highlighting a consistent protective association. The findings also indicate a potential risk reduction for both colon and rectal cancer, with a more pronounced effect observed among females compared to males. Given the profound implications of MBS on cancer incidence, morbidity, and mortality, further high-quality, long-term studies are essential to deepen our understanding and optimize its role in cancer prevention and patient care.

Background: 

Robot-assisted minimally invasive gastrectomy (RAMIG) represents a significant advancement in the surgical management of gastric cancer, offering superior dexterity, enhanced visualization, and improved ergonomics compared to laparoscopic gastrectomy (LG). This review systematically evaluates the current evidence on perioperative outcomes, oncological efficacy, learning curves, and economic considerations, providing insights into RAMIG’s potential role in modern gastric cancer surgery.

Methods: 

A thorough analysis of retrospective, prospective, and meta-analytic studies was conducted to compare RAMIG with LG. Key outcomes, including operative time, intraoperative blood loss, lymph node retrieval, postoperative complications, learning curve duration, and cost-effectiveness, were assessed. Emphasis was placed on both short-term and long-term oncological outcomes to determine the clinical value of RAMIG.

Results: 

Evidence indicates that RAMIG is associated with reduced intraoperative blood loss, lower morbidity rates, and a shorter learning curve, with proficiency achieved after 11–25 cases compared to 40–60 cases for LG. The robotic platform’s articulated instruments and enhanced three-dimensional visualization enable more precise lymphadenectomy, particularly in complex anatomical regions. Despite these advantages, operative time remains longer, and costs remain higher due to system acquisition, maintenance, and consumable expenses. However, emerging data suggest a gradual narrowing of cost disparities. While short-term outcomes are favorable, further high-quality, multicenter studies are needed to validate long-term oncological efficacy and survival outcomes. 

Conclusions: 

RAMIG offers significant technical and clinical advantages over conventional LG, particularly in terms of precision and learning efficiency. However, the long-term oncological benefits and economic feasibility require further validation. Future research should focus on cost optimization, advanced technological integration such as near-infrared fluorescence and artificial intelligence, and multicenter trials to solidify RAMIG’s role as a standard approach for gastric cancer surgery.

Background: 

Esophageal cancer, the seventh most common malignancy globally, requires esophagectomy for curative treatment. However, esophagectomy is associated with high postoperative morbidity and mortality, highlighting the need for minimally invasive approaches. Robotic-assisted surgery has emerged as a promising alternative to traditional open and minimally invasive esophagectomy (MIE), offering potential benefits in improving clinical and oncological outcomes. This review aims to assess the postoperative morbidity and outcomes of robotic surgery.

Methods: 

A comprehensive review of the current literature was conducted, focusing on studies evaluating the role of robotic-assisted surgery in esophagectomy. Data were synthesized on the clinical outcomes, including postoperative complications, survival rates, and recovery time, as well as technological advancements in robotic surgery platforms. Studies comparing robotic-assisted esophagectomy with traditional approaches were analyzed to determine the potential advantages of robotic systems in improving surgical precision and patient outcomes. 

Results: 

Robotic-assisted esophagectomy (RAMIE) has shown significant improvements in clinical outcomes compared to open surgery and MIE, including reduced postoperative pain, less blood loss, and faster recovery. RAMIE offers enhanced thoracic access, with fewer complications than thoracotomy. The RACE technique has improved patient recovery and reduced morbidity. Fluorescence-guided technologies, including near-infrared fluorescence (NIRF), have proven valuable for sentinel node biopsy, lymphatic mapping, and angiography, helping identify critical structures and minimizing complications like anastomotic leakage and chylothorax. Despite these benefits, challenges such as the high cost of robotic systems and limited long-term data hinder broader adoption. Hybrid approaches, combining robotic and open techniques, remain common in clinical practice. 

Conclusions: 

Robotic-assisted esophagectomy offers promising advantages, including enhanced precision, reduced complications, and faster recovery, but challenges related to cost, accessibility, and evidence gaps must be addressed. The hybrid approach remains a valuable option in select clinical scenarios. Continued research, including large-scale randomized controlled trials, is necessary to further establish the role of robotic surgery as the standard treatment for resectable esophageal cancer.

Objective: 

This systematic review and meta-analysis aimed to determine the degree to which pancreaticobiliary maljunction (PBM) increases the risk of different types of biliary cancer (BC). 

Methods: 

A systematic review and meta-analysis were carried out using the following databases: PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct. We systematically searched from inception to April 2024. The search terms included were derived from the keywords “Pancreaticobiliary Maljunction” OR “Anomalous Pancreaticobiliary Junction” AND “Cancer” OR “Malignancy”. Studies that provided data comparing BC rates in relation to PBM presence or vice versa were included. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. The random-effects model was used.

Results: 

Fifteen studies were included with a total sample of 8604 patients, of whom 5015 (58.29%) were female with a mean age of 54.58 years. Patients with PBM had 8.42 (95% CI = 3.57–19.87) more risk of developing any type of BC, with a higher risk of GBC than BDC (OR = 16.91 vs. OR = 3.36, p-value = 0.003). There was a higher risk of having PBM in patients with GBC than BDC only when considering the Asian population (OR = 3.12, 95% CI = 1.09–8.94). Meta-regression analysis revealed that neither mean age (p = 0.087) nor percentage of female patients in the study population (p = 0.197) were statistically associated with the variations in OR for the risk of BC based on the presence of PBM.

Conclusions: 

There is a significant association between PBM and the risk of having BC, mainly GBC when compared to BDC. Most of the studies published reported data from Japanese patients, which limits the generalization of the results. The age of patients and sex were not significantly associated with the relation between PBM and BC. Further prospective studies in broader populations will provide additional details to take measures for screening and early management of PBM and BC.

Aim:

This study aimed to assess and compare outcomes of robotic inguinal hernia repair (RIHR) in patients under and over 70 years old, performed by a fellowship-trained robotic surgeon at a single institution.

Methods: 

A retrospective analysis of patients undergoing robotic primary transabdominal preperitoneal inguinal hernia repair between 2020 and 2022 was conducted. Patients were categorized into two age groups: those under 70 years and 70 years and older. Data were collected through chart reviews with a mean follow-up of 30 days. Concurrently, a systematic review (SR) of relevant high-level literature was carried out.

Results: 

Among the 37 patients studied, 75.7% (n = 28) were male, with a mean age of 64.8 years. Demographic features did not significantly differ based on age groups. Patients > 70 years had a higher incidence of reported complications (52.3% vs. 87.5%, p < 0.461). There were no differences in operative time or length of stay between the groups. In the SR, only 23.7% (n = 9) of studies provided age-related conclusions. Three studies identified age over 70 as a risk factor for postoperative complications, while two studies suggested that RIHR is feasible and safe in patients aged 80 years and older.

Conclusions: 

Patients over 70 years old demonstrated a higher incidence of complications compared to younger patients. However, current literature indicates that the robotic approach may offer a safe and minimally invasive option for inguinal hernia repair in both younger and older adults.

Background: 

Honeycomb gallbladder (GB) is a rare condition characterized by multiple septations in the GB wall, giving it a honeycomb appearance. First described by Knetsch in 1952, this anomaly is typically congenital but can also be acquired. Patients with a honeycomb GB often present with a variety of symptoms, the most common being abdominal pain.

Case Description:

We present the case of a 62-year-old female with a history of symptomatic chronic calculus cholecystitis. She underwent a laparoscopic cholecystectomy, which resolved her symptoms. Preoperative ultrasound imaging showed no evidence of multiple septations; however, post-operative examination revealed a multiseptated gallbladder.

Conclusions: 

Honeycomb GB is an unusual presentation. Among the theories explaining multiseptated GB, one suggests that chronic calculus cholecystitis leads to extensive denudation of the epithelial lining, causing fibrosis and calcification beneath, which results in contraction. Our case supports this theory, as these pathological changes likely contributed to the honeycomb appearance. While medical management typically focuses on symptomatic relief, cholecystectomy has been shown to completely resolve symptoms.

Aging is a multifactorial biological process characterized by a decline in physiological function and increasing susceptibility to various diseases, including malignancies and gastrointestinal disorders. Helicobacter pylori (H. pylori) infection is highly prevalent among older adults, particularly those in institutionalized settings, contributing to conditions such as atrophic gastritis, peptic ulcer disease, and gastric carcinoma. This review examines the intricate interplay between aging, gastrointestinal changes, and H. pylori pathogenesis. The age-associated decline in immune function, known as immunosenescence, exacerbates the challenges of managing H. pylori infection. Comorbidities and polypharmacy further increase the risk of adverse outcomes in older adults. Current clinical guidelines inadequately address the specific needs of the geriatric population, who are disproportionately affected by antibiotic resistance, heightened side effects, and diagnostic complexities. This review focuses on recent advancements in understanding H. pylori infection among older adults, including epidemiology, diagnostics, therapeutic strategies, and age-related gastric changes. Diagnostic approaches must consider the physiological changes that accompany aging, and treatment regimens need to be carefully tailored to balance efficacy and tolerability. Emerging strategies, such as novel eradication regimens and adjunctive probiotic therapies, show promise for improving treatment outcomes. However, significant knowledge gaps persist regarding the impact of aging on H. pylori pathogenesis and treatment efficacy. A multidisciplinary approach involving gastroenterologists, geriatricians, and other specialists is crucial to providing comprehensive care for this vulnerable population. Future research should focus on refining diagnostic and therapeutic protocols to bridge these gaps, ultimately enhancing clinical outcomes and reducing the burden of H. pylori-associated diseases in the aging population. 

Background: 

Obesity is a global health issue that significantly increases morbidity and mortality when the Body Mass Index (BMI) reaches values ≥ 50. While metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, it carries risks. Robotic surgery is promising but not extensively studied in Mexico, which presents an opportunity for research at a National Hospital with an academic program.

Methods: 

This retrospective study reviewed 44 patients who underwent robotic MBS using the da Vinci surgical system from January 2018 to August 2023 at Centro Médico Nacional 20 de Noviembre, ISSSTE. Data collected included surgery type, duration, complications, and weight loss metrics over 54 months post-operatively.

Results: 

The study involved 44 patients with severe obesity including BMI ≥ 50-59.9 kg/m² for group 1 and BMI ≥ 60 kg/m² for group 2. The average initial BMI was 54.7 kg/m² for group 1 and 68 kg/m² for group 2. The average operative times for group 1 were 10.09 min for docking, 86.23 min for robotic console time, and 95.73 min for total intraoperative time. Group 2 had average times of 9.80 min for docking, 82.4 min for robotic console time, and 92.2 min for total intraoperative time. Follow-up showed significant weight loss initially, with weight recurrence after 24 months due to different factors. No serious complications or mortality were observed.

Conclusions: 

Robotic MBS at a national academic medical center in Mexico shows promising outcomes for patients with BMI ≥ 50-59.9 and BMI ≥ 60, with significant weight and BMI improvements at 54 month follow-up. Further studies with larger cohorts and longer follow-up are needed to strengthen these findings.

Background: 

Robotic metabolic and bariatric surgery (RMBS) has emerged as an innovative approach in the treatment of severe obesity by combining the ergonomic precision of robotic technology and instrumentation with the established benefits of weight loss surgery. This study employs a bibliometric approach to identify local research trends and worldwide patterns in RMBS.

Methods: 

The research methodology used “robotic” and “metabolic” or “bariatric surgery” to search Web of Science. Articles that were published prior to December 31st, 2023, were included. The analyses were developed using the Rayyan and Bibliometric, in R Studio. 

Results: 

265 articles from 51 different journals were included. Scientific production of RMBS experienced a significant annual growth rate of 21.96% from 2003 to 2023, resulting in an average of 12.6 papers published per year. A high correlation (R2 = 0.94) was found between the year and number of articles. The mean number of citations per document was 13.25. Approximately 90% of the journals were classified as zone 3, according to the Bradford categorization. International collaboration was identified in 10.57% of cases, with the University of California and the University of Illinois being the most common organizations. The countries with the highest number of corresponding authors, in descending order, were the United States of America, China, and Switzerland.

Conclusions: 

Scientific production in RMBS has experienced sustained growth since the first original publications in 2003. While it has not yet reached the volume, impact, and international collaboration seen in studies related to non-robotic metabolic and bariatric surgery, RBMS holds potential that remains to be explored.

Background: 

Post-operative residual curarization (PORC) has been a concern for over 40 years, particularly with the use oflong-acting neuromuscular blocking agents. Even with the introduction of intermediate-acting agents, studies continue tohighlight the prevalence of PORC.

Question

This study aimed to determine and compare the residual neuromuscular blockade in the immediate post-operativeperiod after balanced general anaesthesia using cis-atracurium, rocuronium, and vecuronium.

Methods: 

We conducted a prospective, randomized, single-blinded study over 18 months in the Department ofAnaesthesiology and Intensive Care at our tertiary care hospital. A total of 150 patients were included in the study according to the inclusion and exclusion criteria.

Results: 

Our findings indicated that residual neuromuscular blockade was less pronounced in the cis-atracurium andvecuronium groups, while it was more prominent in the rocuronium group immediately after surgery. However, at the 30-minute mark, significant paralysis was observed with vecuronium only. No significant paralysis was noted with any of thegroups one and a half hours after extubation. Hemodynamic parameters during general anaesthesia were more favourable with cis-atracurium and vecuronium both intraoperatively and postoperatively.

Conclusions: 

Cis-atracurium emerges as the preferred drug due to its minimal post-operative residual neuromuscular paralysis. Cis-atracurium at 0.15 mg/kg and vecuronium at 0.1 mg/kg exhibited a slower onset of action compared to rocuronium at 0.6 mg/kg and provided excellent intubating conditions in most patients after 180 seconds. Although slighttachycardia was observed in the rocuronium group, it remained within normal vital limits (HR < 100/minute), while slight bradycardia was noted in the cis-atracurium and vecuronium groups (HR > 60/minute) during the intraoperative period.

The integration of multidisciplinary tumor boards (MTBs) is fundamental in delivering state-of-the-art cancer treatment, facilitating collaborative diagnosis and management by a diverse team of specialists. Despite the clear benefits in personalized patient care and improved outcomes, the increasing burden on MTBs due to rising cancer incidence and financial constraints necessitates innovative solutions. The advent of artificial intelligence (AI) in the medical field offers a promising avenue to support clinical decision-making. This review explores the perspectives of clinicians dedicated to the care of cancer patients—surgeons, medical oncologists, and radiation oncologists—on the application of AI within MTBs. Additionally, it examines the role of AI across various clinical specialties involved in cancer diagnosis and treatment. By analyzing both the potential and the challenges, this study underscores how AI can enhance multidisciplinary discussions and optimize treatment plans. The findings highlight the transformative role that AI may play in refining oncology care and sustaining the efficacy of MTBs amidst growing clinical demands.

Pyoderma Gangrenosum (PG) is an inflammatory skin disorder associated with chronic inflammation and neoplastic conditions. It is relatively rare, with an estimated annual incidence of 3 to 10 cases per million people, with the highest occurrence between 20 and 50 years of age. Proper differential diagnosis is essential to guide appropriate treatment and management strategies for affected individuals. This case study presents a compelling instance of PG with a unique twist-the extracutaneous involvement of the pulmonary system, an uncommon and diagnostically challenging manifestation requiring multidisciplinary management.

Background: 

Amyand’s hernia, an uncommon occurrence, involves the incarnation of the appendix within a hernial sac, typically presenting as an inguinal hernia. The incidence of appendicular mucocele is around 0.2–0.7%. The presented case is unique, with an extensive appendicular mucocele reaching into the retroperitoneum and involving the psoas muscle.

Case Description:

This is a case of a 74-year-old male who presented with a 15-year history of intermittent pain in right groin, which had gradually intensified over the past 3 months. The case presentation delves into the surgical management of an extensive appendicular mucocele, with a part of it protruding as an inguinal hernia and the other portion extending retroperitoneally up to the level of the psoas muscle. A computed tomography (CT) scan identified two different tubular cystic formations in continuity with each other: one adjacent to the right psoas muscle and the other emanating from the base of the cecum in the right iliac fossa. The patient underwent surgery involving the complete dissection and excision of the lesion, followed by a mesh hernioplasty.

Conclusions: 

The patient recovered well without any postoperative complications. An extensive literature review suggests that this is the only case that exhibits such an atypical presentation of appendicular mucocele with extensive involvement extending into the retroperitoneum and psoas muscle. Recent surgical advances and timely imaging have played a crucial role in the diagnosis and management of this case.

Two females, 25 and 35-year old, presented with complaint of localized bumpy swelling on right upper lid, with intermittent episodes of pain. On examination, both were found to have cilia incarnatum externum in an atypical “running-stitch” pattern, wherein the eyelash emerged out of the skin after a brief subcutaneous course. Epilation was done in both the cases and a tract was identified in one of them, which was removed completely to prevent recurrence.

Background: 

Abnormal uterine bleeding (AUB) poses a significant health and financial burden, especially in perimenopausal women. Despite the PALMCOEIN classification, gaps persist in correlating clinical and histopathological aspects. Our study, utilizing diagnostic modalities like Ultrasonography, Hysteroscopy, and Endometrial sampling, seeks to enhance diagnostic precision in AUB, contributing to improved management strategies and patient outcomes.

Methods: 

This descriptive study investigated Abnormal Uterine Bleeding (AUB) in 126 women aged 35 and above at our hospital from September 2019 to February 2021. The study utilized the PALM-COEIN classification system for categorizing AUB causes. Inclusion criteria covered various AUB presentations, while exclusion criteria excluded specific conditions. Data collection involved a structured proforma, and diagnostic interventions encompassed Ultrasonography, Hysteroscopy, and Endometrial sampling. Statistical analysis employed various measures, including the concordance index and Chi-square test, utilizing SPSS 21.

Results: 

This hospital-based study enrolled 126 women presenting with abnormal uterine bleeding (AUB), offering comprehensive insights into their demographic, clinical, and histopathological profiles. The mean age of the cohort was 45.96 years, with a notable concentration in the 40-44.99 age group. The majority resided in urban areas (96.83%) and belonged to the upper middle class (65.87%), with housewives constituting 97.62%. AUB patterns, including irregular bleeding (56.35%) and postmenopausal bleeding (15.87%), were meticulously examined. Comorbidities, predominantly hypertension (31 patients) and hypothyroidism (22 patients), were identified in 60 patients. Ultrasonography revealed Leiomyoma in 54.76% and Adenomyosis in 24.6%. Clinical diagnoses, utilizing the PALM-COEIN classification, highlighted AUB-L as the primary cause (54.76%). Diagnostic modalities such as Hysteroscopy, Hysterectomy, and concordance analyses contributed to enhanced diagnostic precision, emphasizing the multidimensional approach imperative for effective AUB management in clinical practice.

Conclusions: 

Our study underscores the efficacy of the PALM-COEIN classification in correlating clinical and histopathological findings for Abnormal Uterine Bleeding (AUB). Leiomyoma emerged as the primary etiology, showcasing the classification’s utility in identifying dual pathologies. Histopathological examination significantly complemented clinical diagnoses, emphasizing the system’s value in optimizing patient care.

Background: 

Infertility, affecting 10%-15% of global reproductive-age couples, stands as a complex challenge with profound societal ramifications. This study distinctively focuses on scenarios where male infertility is ruled out, emphasizing on exploration of potential female factors in the infertility.

Methods: 

The research was conducted from August 2019 to May 2020, which encompasses a cohort of 45 infertile patients undergoing Diagnostic Hysterolaparoscopy (DHL). Recognized as a gold standard tool amalgamating laparoscopy and hysteroscopy, DHL provides a comprehensive visualization, thus causing early diagnosis of the cause of infertility. The study methodically explores demographic intricacies, socioeconomic parameters, and infertility durations, maintaining a balance between primary and secondary infertility cases. 

Results: 

The investigation delves into common menstrual irregularities, ovarian factors, and discerns correlations, particularly with Anti-Mullerian Hormone (AMH). The study accentuates the pivotal role of DHL in unravelling the intricate etiology of infertility. DHL demonstrates a 95% detection rate of abnormalities, DHL emerges as a highly effective diagnostic tool. The research identifies a spectrum of causative factors, with a notable prevalence of ovarian pathologies. Post-DHL intervention, a substantial 28.9% conception rate is observed, coupled with tailored interventions significantly ameliorating patient outcomes. 

Conclusions: 

Diagnostic Hysterolaparoscopy stands out as a cost-effective and efficacious diagnostic modality, significantly increasing the fertility rate within six months post-procedure. This research advocates the application of DHL in both primary and secondary infertility cases, underscoring its pivotal role in the comprehensive and management of infertility.

Background: 

Laparoscopic cholecystectomy is one of the most common surgeries done in the surgical specialty. But the incidence of moderate to severe pain remains high for the first 24 hours post-surgery due to segmental innervation of nociceptor afferent pathways. Therefore, for the management of this post-operative pain, bilateral subcostal TAP block is given. This TAP block is given laparoscopically and under ultrasound guidance. Laparoscopic guided TAP Block has recently been introduced, and there are not many studies regarding this technique.

Methods: 

A retrospective observational study was done on 108 patients with an age range of 18–65 years.
The TAP block was done with bilateral injection of 30cc Bupivacaine between layers of internal oblique and transversus abdominis, either under laparoscopic visualization or under US guidance just below the coastal margin in the mid-clavicular line. The postoperative analgesia assessment was done blindly by the controller with the VAS scale, every half hourly for the first 2 post-operative hours, then every 2 hourly for the next 8 post-operative hours, and later as per need and indication for the next 14 hours, completing 24 hours of assessment for the study. Therefore, the need for rescue analgesia was noticed.

Results: 

Box-plot analysis with Wald-type and ANOVA-type tests was applied, and calculations for testing group and time effects and interaction were made. Significant differences between the two groups were seen during the initial part of the study. Later, the significant difference was reduced with the consequent formulation of the surgeon’s technique of administration. As a result, the post-operative pain with the laparoscopically guided TAP Block significantly improved. With the passage of time, more patients were getting similar results in the control of post-operative pain, either by laparoscopic or ultrasound-guided methods.

Conclusions: 

The laparoscopic guided TAP Block has some advantages over the ultrasound guided TAP Block, as it can be administered in the operating theatre itself within 30 seconds, and there is no requirement for an interventional radiologist in the operating theatre. Also, there is no need for the ultrasound machine in the operative theatre for the administration of the block. Therefore, laparoscopic guided TAP block must be considered as an effective method for post-operative pain management.

Background: 

Foramen of Winslow hernias is a rare and critical form of internal hernia that can present in individuals
with signs and symptoms of bowel obstruction. This case report entails the operative management of a right-side colon herniation through the foramen of Winslow in an elderly female with a previous history of Hysterectomy. The patient presented with worsening abdominal pain, nausea, and multiple episodes of vomiting. Delay in diagnosis often results in higher morbidity and mortality.

Case Presentation: 

A 46 years old female, presented with acute upper abdominal pain, constipation, and loss of appetite for 24 hrs. Computed tomography showed foramen of Winslow hernia with partial volvulus right colon as content with incomplete rotation of gut which was managed laparoscopically without the need for bowel resection. The patient recovered well with no postoperative complications and no immediate technical failure of repair confirmed by a cross-sectional study. The patient is doing well on follow-up.

Discussion: 

Herniation of the bowel through the foramen of Winslow is very rare, comprising only 8% of all internal herniations. Historically, the majority of cases were diagnosed intra-operatively during laparotomy. Bowel resection was often done in cases of ischemia. In recent times, early diagnosis & increasing expertise in minimal access surgery that is resulting in a lower morbidity and mortality rate along with other added benefits of minimal access surgery.

Conclusions: 

Herniation contents through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognise the diagnosis and could prevent bowel ischemia & its management with minimal access surgery leads to early recovery, shorter hospital stay, less pain & early return to work.

The article discusses the potential ocular adverse effects of topiramate, an antiepileptic medication commonly used for migraine prevention. Topiramate-induced acute angle closure (TiAAC) is of particular concern as it can result in the sudden diminution of vision. The exact mechanism behind TiAAC is uncertain, but it is thought to involve prostaglandin release, leading to ciliary body effusion. In this case, a young male who had been emmetropic postmyopic LASIK surgery presented to us with sudden onset high myopia. Detailed history revealed that the patient had been recently using topiramate. On examination, there was anterior displacement of iris lens diaphragm. In-depth investigations confirmed it to be a case of TiAAC. The patient was advised to discontinue topiramate and was put on topical steroids, intraocular pressure-lowering agents, and cycloplegics which relieved his condition within 10 days.

Graves’ disease is a self-limiting autoimmune thyroid disorder caused by stimulating antibodies to the thyroid-stimulating hormone receptor. It usually affects middle-aged females in the fourth to sixth decade of life. It is distinguished by keratopathy, chemosis, proptosis, and eyelid swelling, in addition to ocular discomfort. A total of 3-5% of cases present with a severe form of Graves’ orbitopathy, which manifests with diminution of vision, optic nerve compression, optic neuropathy, and exposure keratopathy. We describe a case of a 34-year-old female patient who presented with the chief complaint of rapid deterioration of vision over a period of three months in the right eye. Ocular examination revealed proptosis, widened palpebral aperture, elevation of intra-ocular pressure (IOP) in the upgaze, restricted eye movements, and signs of optic nerve compression. Findings were confirmed on a CT scan of the orbit. The unusual presentation in this case was that she had rapid, significant deterioration of vision in the right eye, with a progression of proptosis more marked in the contralateral eye. This underlies the importance of thoroughly examining for any possible orbital apex syndrome in both eyes, not just the eye with marked proptosis. The patient, being reluctant for orbital decompression, was prescribed IV methylprednisolone 1 g for three consecutive days, which reduced her proptosis and improved her vision. This acted as a temporary measure to increase the duration of the surgical window until the time the patient undergoes the surgery.

Background: 

The duration of analgesia produced by local anaesthesia is limited if administered alone. Therefore,
supplementation of local anaesthetics with adjuvants helps to improve the efficacy of the subarachnoid block, especially in long-duration surgeries like bilateral total knee replacement. The most preferred drugs used are opioids, but due to new drug development like dexmedetomidine has been introduced and proved to be effective adjuvant.

Aim: 

This study was conducted to evaluate and compare the characteristics of subarachnoid blockade and hemodynamic stability. The VAS was used pre-operatively, after intrathecal, immediately post-operatively, and on the basis of the need for rescue analgesia or epidural

Methods:

A total of 150 patients were taken aged between 30-80 years classified as American Society of Anesthesiologists (ASA) undergoing bilateral TKR under neuraxial anaesthesia were included in the study. The patients were randomly allotted to two groups to receive 4.0 mL of 0.5% hyperbaric bupivacaine with 0.2 mL of dexmedetomidine (5 μg) intrathecally (Group D; n = 75) and another group to receive 4.0 mL of 0.5% hyperbaric bupivacaine with 0.2 mL of buprenorphine (60 μg) intrathecally (Group B; n = 75).

Results: 

There was no significant difference between groups regarding demographic characteristics, no
significant difference in hemodynamic variables. The motor, sensory, blockade, and time of rescue analgesia were significantly prolonged in Group D compared to Group B. Hence, Group D was far better than Group B in terms of duration of analgesia, time of onset of sensory block, time for maximum levels of sensory block, and modified bromage score.

Conclusions: 

Intrathecal dexmedetomidine, compared to intrathecal buprenorphine, causes prolonged anaesthesia and analgesia with a reduced need for sedation and rescue analgesics. Also, reduced adverse effects are seen with intrathecal dexmedetomidine. Complications with Group D were less as compared to Group B.