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Aim: Although there is growing evidence to support the feasibility of a minimally invasive approach for acute small bowel obstruction, the inability to adequately evaluate compromised bowel segments has been cited as a major limitation. The aim of this work is to report a novel application of extemporaneous indocyanine green (ICG) fluorescence to assess bowel viability where there is a concern for ischaemic damage. Method: After the cause of obstruction has been identified and resolved, and where there are dubious signs of bowel ischaemia present, fluorescent selective angiography is undertaken. The segment of bowel in question is observed under both normal and fluorescent light to assess local microcirculation. The adequacy of both the arterial supply and the venous drainage is thus appraised to define bowel viability. Results: Among 71 patients who have undergone surgery for acute small bowel obstruction with a laparoscopic approach, seven received extemporaneous ICG fluorescence assessment of bowel viability. Different presentations with their relevant management are described. Conclusions: Selective use of intraoperative fluorescent angiography may overcome some of the intrinsic limitations of laparoscopy in assessing bowel viability during surgery for acute small bowel obstruction. [ABSTRACT FROM AUTHOR]

Background: In recent years there has been a growing interest in the application of minimally invasive surgery in the management of cholecystectomy‐related injury to the biliary tract. The aim of this analysis was to identify and combine the available evidence on the argument, with particular reference to major injuries to the main bile duct requiring biliodigestive anastomosis. Methods: The PubMed/MEDLINE, Embase, and Web of Science electronic databases were queried through May 2019. Inclusion criteria considered all studies reporting detailed data about patients with bile duct injury following cholecystectomy receiving minimally invasive (both laparoscopic and robotic) surgical repair. Clinical outcomes data were pooled and analyzed. Results: A total of 31 studies reporting on the outcomes of 218 patients were eventually included in the analysis, whereby 148 patients with type D or E injury. Of these, there were 31 patients (21%) receiving direct bile duct repair and 117 patients (79%) undergoing bilioenteric reconstruction. Among patients with major bile duct injury, postoperative morbidity was 24%, being 12% the incidence of major complications and 6% the rate of patients requiring subsequent, further surgery. Conclusions: The absence of high‐level evidences precludes the possibility to draw definitive conclusions. However, the available data derived from a growing number of centers demonstrate that minimally invasive surgery may offer its well‐known advantages on postoperative outcomes also in the setting of severe iatrogenic injury to the bile ducts. [ABSTRACT FROM AUTHOR]

Although end colostomy closure following Hartmann's procedure is a major surgery that is traditionally performed by conventional celiotomy, over the last decade there has been a growing interest toward the application of different minimally invasive techniques. We aimed at evaluating the relative outcomes of conventional surgery versus minimally invasive surgery by meta-analyzing the available data from the medical literature. The PubMed/MEDLINE, Cochrane Library and EMBASE electronic databases were searched through August 2018. Inclusion criteria considered eligible all comparative studies evaluating open versus minimally invasive procedures. Conventional laparoscopy, robotic and single-port laparoscopy were considered as minimally invasive techniques. Overall morbidity, rate of anastomotic failure, rate of wound complications and mortality were evaluated as primary outcomes. Perioperative details and surgical outcomes were also assessed. The data of a total of 13,740 patients from 26 studies were eventually included in the analysis. There were no significant differences on baseline characteristics such as age, BMI and proportion of high-risk patients between the two groups of patients. As compared to the conventional technique, minimally invasive surgery proved significantly superior in terms of postoperative morbidity, length of hospital stay and rate of incisional hernia. The current literature suggests that minimally invasive surgery should be considered in performing Hartmann's reversal, if technically viable. However, due to the low level of the available evidence it is impossible to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: With the advance of modern laparoscopic technology, laparoscopic colorectal surgery and laparoscopic liver surgery are both worldwide accepted. Preliminary brief series have shown the feasibility of combined laparoscopic resection of colorectal cancer (CRC) and synchronous colorectal liver metastases (SCRLM). We aim to report a large International multicenter series of laparoscopic simultaneous resection of CRC and SCRLM. Methods: Between 1997 and 2013, 142 laparoscopic liver resections were performed with simultaneous colorectal surgery for SCRLM. The surgical and postoperative variables evaluated were the duration of the intervention, blood loss, transfusion rate, conversion rate, resection margin, specific and overall morbidity, perioperative mortality, length of hospital stay, and survival. Univariate and multivariate analyses were performed examining postoperative morbidity in the all cohort of patients. Results: The median number of liver lesions was 1 (1-9) and the median larger diameter at diagnosis was 28 (2-100) mm. The median operative time was 360 (120-690) min. Seven patients (4.9 %) required conversion. The global morbidity was 31.0 % and the mortality was 2.1 %. After a median follow-up of 29 (1-108) months, 40 patients (28.2 %) developed tumor recurrence. Curative treatment of recurrence was possible in 17 patients (12.0 %), including a second liver resection in 13 patients (9.1 %), which was performed by laparoscopy in 7 patients (4.9 %). Overall 1-, 3-, and 5-year survivals were 98.8, 82.1, and 71.9 %, respectively. By multivariate analysis, ASA score ≥3 [OR 13.6 (1.8-99.6); P = 0.01] and operative time [OR 1.008 (1.001-1.016); P = 0.03] were independent predictors of postoperative morbidity. Conclusions: Our combined data show that in experienced centers, simultaneous laparoscopic approach is technically feasible, safe, and associated with good oncological outcomes. [ABSTRACT FROM AUTHOR]

Background: Robotic surgery was introduced as a means of overcoming the limitations of traditional laparoscopy. This report describes the results of a matched comparative study between traditional (TLLR) and robot-assisted laparoscopic liver resection (RLLR) performed in two European centers. Methods: From January 2008-April 2013, 46 patients underwent RLLR at San Matteo degli Infermi Hospital. Each patient was matched to a patient who had undergone TLLR at Antoine Béclère Hospital. The variables evaluated were operative time, blood loss, conversion rate, morbidity, mortality, and length of hospital stay. Results: Twenty-eight patients were included in each group. Despite matching, more tumors were solitary in the TLLR group ( P = 0.02) and more were localized in the superior and posterior segments in the RLLR group ( P = 0.003). The median duration of surgery was 210 and 176 min in the RLLR and TLLR groups, respectively ( P = 0.12). Conversion rate, blood loss, morbidity, and length of stay were similar in both groups. In multivariate analysis in all cohorts of patients, the sole independent risk factor of postoperative complications was the operative duration [OR = 1.016; P = 0.007]. Conclusions: Robotic LLR is associated with outcomes similar to those obtained with TLLR. However, robotics may facilitate LLR in patients with superior and posterior liver tumors. [ABSTRACT FROM AUTHOR]

Here note the left linea semilunaris and the lateral edge of the rectus abdominis; the intact plane of the external oblique muscle; the so-called Spigelian hernia belt, which is the transverse area where the vast majority of these hernias occur. Despite growing evidence suggesting a number of advantages over conventional surgery, the application of minimally invasive surgery for the treatment of SH is still limited, especially in the setting of acute bowel obstruction [5,6]. I Dear Sir i , Spigelian hernia (SH) is said to be a rare condition, accounting for less than 1% of all hernias of the abdominal wall [1-4]. [Extracted from the article]

I Dear Editor i A 47-year-old woman with a history of Crohn's disease (CD) was admitted to our hospital due to abdominal pain, vomiting and fever. Herein, we present the surgical treatment of this patient (Video S1), which consisted of division of the fistula, sigmoidectomy with primary anastomosis and direct bladder repair. Although the recent years have seen an increased use of laparoscopy for CD, minimally invasive colovesical fistula repair is still rarely reported. [Extracted from the article]

Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon.All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures.The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications.The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage. [ABSTRACT FROM AUTHOR]

Acute large bowel malignant obstruction of the splenic flexure: Fully robotic resection with central ligation and intracorporeal anastomosis - a video vignette Minimally invasive surgery (MIS) for large bowel obstruction due to left-sided colonic malignancy is rarely reported, especially in the case of splenic flexure (SF) tumour [2-5] Indeed, MIS for SF malignancies is considered difficult due to its intrinsic anatomical complexity, especially when the tenets of adequate oncological resection such as complete mesocolic excision (CME) and central vascular ligation (CVL) are required [4,5]. Oncologic outcomes of self-expandable metallic stent as a bridge to surgery and safety and feasibility of minimally invasive surgery for acute malignant colonic obstruction. [Extracted from the article]