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Abstract Purpose To examine the trajectory of psychological distress from 1 to 2 years after esophageal cancer surgery, and whether dispositional optimism could predict the risk of postoperative psychological distress. Methods This Swedish nationwide longitudinal study included 192 patients who had survived for 1 year after esophageal cancer surgery. We measured dispositional optimism with the Life Orientation Test-Revised (LOT-R) 1 year post-surgery and psychological distress with the Hospital Anxiety and Depression Scale 1, 1.5, and 2 years post-surgery. Latent growth curve models were used to assess the trajectory of postoperative psychological distress and to examine the predictive validity of dispositional optimism. Results One year after surgery, 11.5% (22 of 192) patients reported clinically significant psychological distress, and the proportion increased to 18.8% at 1.5 years and to 25.0% at 2 years post-surgery. Higher dispositional optimism predicted a lower probability of self-reported psychological distress at 1, 1.5, and 2 years after esophageal cancer surgery. For each point increase in the LOT-R sum score, the odds of psychological distress decreased by 44% (OR, 0.56; 95% CI, 0.40 to 0.79). Conclusion The high prevalence and longitudinal increase of self-reported psychological distress after esophageal cancer surgery indicate the unmet demands for timely psychological screening and interventions. Measuring dispositional optimism may help identify patients at higher risk of developing psychological distress, thereby contributing to the prevention of postoperative psychological distress.

Portal vein occlusion through embolization or ligation (PVE, PVL) offers the possibility of increasing the future liver remnant (FLR) and thus reducing the risk of hepatic failure after extended hepatectomy We reviewed the indications, scope and applicability of PVE/PVL in treatment of primary and secondary liver tumours. A thorough PubMED, Embase, Ovid and Cochrane database search was carried out for all original articles with 30 patients or more undergoing either PVE and any patient series with PVL, irrespective of number with outcome measure in at least one of the following parameters: FLR volume change, complications, length of stay, time to surgery, proportion resectable and survival data. PVE can be performed with a technical success in 98.9 % (95 % confidence interval 97–100) patients, with a mean morbidity of 3.13 % (95 % CI 1.21–5.04) and a median in-hospital stay of 2.1 (range 1–4) days (very few papers had data on length of stay following PVE). The mean increase in volume of the FLR following PVE was 39.75 % (95 % CI 30.8–48.6) facilitating extended liver resection after a mean of 37.13 days (95 % CI 28.51–45.74) with a resectability rate of 76.88 % (95 % CI 70.91–82.84). Morbidity and mortality following such extended liver resections after PVE is 26.58 % (95 % CI 19.20–33.95) and 2.59 % (95 % CI 1.34–3.83) respectively with an in-patient stay of 13.57 days (95 % CI 9.8–17.37). However following post-PVE liver hypertrophy 6.29 % (95 % CI 2.24–10.34) patients still have post-resection liver failure and up to 14.2 % (95 % CI −8.7 to 37) may have positive resection margins. Up to 4.80 % (95 % CI 2.07–7.52) have failure of hypertrophy after PVE and 17.46 % (95 % CI 11.89–23.02) may have disease progression during the interim awaiting hypertrophy and subsequent resection. PVL has a greater morbidity and duration of stay of 5.72 % (95 % CI 0–15.28) and 10.16 days (95 % CI 6.63–13.69) respectively; as compared to PVE. Duration to surgery following PVL was greater at 53.6 days (95 % CI 32.14–75.05). PVL induced FLR hypertrophy by a mean of 64.65 % (95 % CI 0–136.12) giving a resectability rate of 63.68 % (95 % CI 56.82–70.54). PVL failed to produce enough liver hypertrophy in 7.4 % of patients (95 % CI 0–16.12). Progression of disease following PVL was 29.29 (95%CI 15.69–42.88). PVE facilitates an extended hepatectomy in patients with limited or inadequate FLR, with good short and long-term outcomes. Patients need to be adequately counselled and consented for PVE and EH in light of these data. PVL would promote hypertrophy as well, but clearly PVE has advantages as compared to PVL on account of its inherent “minimally invasive” nature, fewer complications, length of stay and its feasibility to have shorter times to surgery.

The dramatic rise in the prevalence of obesity worldwide has led to the rapid growth of bariatric surgery. The aim of this pooled analysis is to evaluate the relationship between institutional and surgeon volume and outcomes following bariatric surgery. Medical, Embase, trial registries, conference proceedings and reference lists were searched for trials comparing clinical outcome following bariatric surgery at high and low volume hospitals and by high and low volume surgeons. Outcomes analysed were mortality, morbidity and length of hospital stay. Fifteen publications were included in this analysis. In total, 289,732 bariatric procedures were included in the institutional volume analysis, and 32,920 bariatric operations were included in the surgeon volume analysis. Mortality was reduced following surgery at high volume institutions (0.24 vs. 2.18 %; pooled odds ratio = 0.26; P = 0.004) and by high volume surgeons (0.41 vs. 2.77 %; pooled odds ratio = 0.21; P < 0.001). Similarly, morbidity was reduced in high volume institutions (7.84 vs. 8.85 %; pooled odds ratio = 0.52; P < 0.001) and with high volume surgeons (6.92 vs. 7.29 %; pooled odds ratio = 0.47; P < 0.001). There were insufficient data for conclusive statistical analysis of length of hospital stay. This pooled analysis does suggest a benefit in the centralisation of bariatric surgery to high volume institutions and surgeons with respect to mortality and morbidity. Future high-powered studies with adjustment for procedural and patient case mix are required to further define the volume–outcome relationship in bariatric surgery.

The field of robotic surgery is rapidly advancing both in terms of the surgical procedures performed and the potential applications of this technology. This survey study attempts to evaluate the opinions of the public regarding a number of issues in robotic surgery. A web-based survey study was constructed using the web-based software "Kwiksurveys". This survey was then advertised and distributed over the Internet to gain responders from a wide range of socio-economic groups and in a number of countries. Responses were collected over a six-month period. One-hundred and fifty-five participants took part in this survey study. The mean age of participants was 35.5 ± 3.4 years. The majority of participants (52%) were either comfortable or totally comfortable with the current version of robotic surgery during which a surgeon in the same room controls instruments inside the patient. Sixty-eight percent of responders reported they would be very uncomfortable with the idea of not seeing the operating surgeon in person before or after surgery. Forty-five percent of participants reported they would consider the idea of an internal robot operating internally with little or no external scarring. This survey study has demonstrated that currently the public seem to be comfortable with the current version of robotic surgery, with the operating surgeon in the same room as the patient. The results of this survey study show that even with technical advances in robotic surgery, patients will still want to have contact with their operating surgeon.

Despite improvements in minimally invasive techniques over recent decades, kidney implantation into the iliac fossa has remained a domain of open surgery. However, it was hypothesized that it would be feasible to perform robotic transplant kidney implantation as a means of reducing surgical trauma. Two robotic kidney transplantations into the iliac fossa were attempted in human cadavers. In the first cadaver, a 5 cm incision was placed in the right lower abdomen, the peritoneum was mobilized in a cranial direction, the iliac vessels were identified, and the kidney placed in the pre-peritoneal space. The incision was sealed with a gel port through which the Vinci(©) Surgical System was installed. In the second cadaver, a robotic kidney implantation with robotically sutured vascular and ureteric anastomoses was performed trans-abdominally. Open incision, identification, placement of gel port, and robotic docking were feasible. Robotic performance of vascular anastomosis was not possible in the first cadaver because of advanced decay and excess fat in the surgical field. Robotic kidney positioning was feasible and anastomoses were performed successfully in the second cadaver within 35, 25, and 20 min (arterial, venous, and ureteric, respectively). Robotic kidney transplantation seems feasible in human cadavers if tissue condition is suitable, but is very technically challenging. Because of the delicacy of anatomical structures, the cadaveric model with the risk of advanced decay and the absence of circulation sets limits on the exploration of this complex procedure. Hence, further research and animal work in this area is critical to improve understanding of the benefits and limitations of robotic kidney implantation.