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The term robot first appeared in 1921 when Karel Capek mentioned it in his play Rossom's Universal Robots, which in free translation means forced labor. Today, robots are still unintelligent machines, but great strides have been made to integrate them as much as possible into people's daily lives. At present, this statement can no longer be supported, robots are used in the field of surgery almost daily in some specialized medical centers, the surgical system is used even to perform a trans-continental cholecystectomy in 2000. However, robotic surgery belongs to the field of minimally invasive surgery that began in 1987 with the first laparoscopic cholecystectomy. Since then, this type of surgery has grown rapidly and has been assigned more and more interventions as the skills and confidence of the surgeons who used it to increase. The degrees of movement of laparoscopic instruments are limited, namely, most of them have only 4 degrees of movement, also the physiological tremor of the surgeon is transmitted to the instrument he works with making delicate interventions such as anastomosis of 2 vessels very difficult. Therefore, the origin of robotic surgery lies in the desire to overcome these shortcomings of laparoscopy and to exploit to the maximum the resources of minimally invasive surgery.

Cytoreductive surgery and HIPEC have become de pillars of treatment in advanced, metastatic colorectal cancer. This state of evolution of the disease was considered terminal just a few years ago. It has been demonstrated that by combining these therapies in selected patients one can increase survival time. Once this has been obtained to some length modern studies have been focused on the quality of life, safety, and how this time interval can be increased. We have reviewed the most important prospective, randomized clinical trials regarding HIPEC and peritoneal carcinomatosis. The technique, complications, principles of action, and evolution through time of HIPEC have been addressed and covered. Special consideration had been given to the correlation between the carcinomatosis index and HIPEC. HIPEC with maximal cytoreduction can be considered a curative procedure only in strictly selected patients diagnosed with colorectal cancer and peritoneal carcinomatosis. Although it has been present in the medical field for almost 30 years, it is not wide-spread due to the high costs of implementation and the requirement of highly specialized surgical and medical teams. As technology evolves, the costs can be decreased and HIPEC should be largely available in oncological centers since the foundation of implementation is solid and the fact that clear benefits although small have been demonstrated. Taking into account all of the above, HIPEC should not be considered a standard treatment at present and should only be performed in experienced centers. The correct selection of patients is critical to the success of this procedure. Maximum cytoreduction should only be performed if the carcinomatosis index allows.

The liver is one of the most affected organs in abdominal trauma mostly because of its considerable dimensions, the fragility of the liver parenchyma. We present the case of a 29-year-old patient who sustained an abdominal trauma after an accidental fall from a 3 m height. The patient tested positive at RT-PCR for SARS-CoV-2 at admission, without any symptoms of viral infection. The emergency CT scan revealed a blunt liver trauma with an expanding hematoma (grade III). The patient was initially hemodynamically stable but shortly after admission became unstable and required surgical treatment that initially consisted of damage control and liver packing. Reintervention was decided 36 hours later, after reevaluation unpacking and hepatorrhaphy were done. The postoperative evolution was uneventful. The case indicated the importance of continuous monitoring of the traumatic patient. In liver trauma, hemodynamic instability guarantees an emergency laparotomy. The time of operations in trauma patients with SARS-CoV-2 must be reduced to the maximum both as an objective of damage control and also to minimize the risk of contagion.

Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.

Mesenteric lesions in abdominal trauma are encountered in 3% of the cases. Diagnosis of these lesions is difficult, which translates into important delays until surgery that affects patient survival. The short-term consequences of mesenteric lesions translate in bowel ischemia or important blood loss. If a lesion is confirmed after imagistic investigations, one must have complete knowledge of the anatomy and the particular distribution of the main arterial and venous trunks to predict the region of the small bowel that will have to be observed or resected if surgery is required. The aim of our study was to demonstrate this particular distribution of blood vessels through cadaver dissection and to note the resources available to diagnose such lesions.

We performed an analytical, cohort, retrospective study, starting from our own experience, to explore the role of laparoscopy in acute gynecological abdominal emergencies. The present work was obtained at the “Prof. Dr. Agrippa Ionescu” Hospital, Bucharest and includes a consecutive series of 37 patients, admitted in emergency settings, during the past 5 years. In order to complete the diagnosis, all of the patients included in the study were investigated using an abdominal ultrasound. The following aspects were investigated: the correlation between the preoperative diagnosis and the lesions identified by laparoscopy, the rate of postoperative complications, reintervention rate, length of hospital stay, conversion rate. Our results show that the laparoscopic approach has a decreased length of hospital stay, and can offer both a diagnosis opportunity and a therapeutic opportunity with results comparable with that of an open approach. Also, laparoscopy allows simultaneous treatment of other abdominal pathologies using the same access path. Our experience shows that the need for a correct and rapid diagnosis when an acute surgical abdomen is suspected is of paramount importance and laparoscopy can offer this opportunity.

Flail chest in a trauma patient presents itself with a number of problems. The mainstay treatment in the past was analgesia with non-operative observation but due to the increased rate of complications, new treatment modalities have been researched. Chest wall plate fixation has emerged as the go-to solution for these patients but consensus lacks regarding when it should be applied, to what category of trauma patients, which technique and which surgical specialty should be the promoter of this technique. All these problems have arisen due to the lack of large prospective studies. A number of these studies are ongoing with results to be published in the near future. Until then, preliminary data have demonstrated the superiority of plate fixation in flail chest in comparison with the non-operative management.

Introduction: Pelvis fractures that associate bleeding with hemodynamic instability warrant immediate treatment. The therapeutic options in these cases vary from angioembolization to extraperitoneal pelvic packing. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: 38 papers were identified. After screening, 27 papers were used to complete the analysis. Discussion: Frequently, bleeding has a venous source in the pelvis. In the case of pelvic fractures with hemodynamic instability, extraperitoneal pelvic packing is one of the core treatments but not a stand-alone treatment, as it needs to be coupled with a pro-efficient trauma resuscitation protocol. Its intended use is as a bridge therapy until conclusive investigations regarding the place of bleeding can be obtained. Angiography is recommended if hemodynamic instability exists after pelvic packing and effective hemodynamic resuscitation. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients and large multicentric studies.

Neuroendocrine tumors represent a varied group of neoplasms which have the potential to produce and secrete a wide range of hormones along with other vasoactive substances.The care of these patients involves several specialties including:surgery, oncology, radiotherapy, interventional radiology and nuclear oncology. Despite this large number of options there is currently no consensus on the optimal sequence of these treatment resources for metastatic patients.We present the case of a 24 year women who was diagnosed with a gastric tumor (could not be biopsied) by imagistics and liver metastatsis. A Pean resection with metastasectomy was done. The histopathology study revealed that the gastric tumor was benign ectopic pancreas tissue and the metastases were actualle of neuroendocrine origin. A somatostatin receptor scintigraphy (OctreoScan) was done which revealed the primary tumor in the ileal mesentery which was resected in a secondary intervention. The patient was started on long acting sandostatin with no recurence.

Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion: Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made: surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance

Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the postoperative incidence of this complication and its severity. The current study is a retrospective study in which consecutive patients with rectal tumors, regardless of location (upper, middle or lower) were enrolled during a 1 year period in the General Surgery Clinic of the Emergency Clinical Hospital Prof. Dr. Agrippa Ionescu, Hospital, Bucharest. The patient files, paraclinical investigations, operative protocols, and histopathological bulletins were reviewed and data regarding age, gender, date of diagnosis, medical treatment administered including neoadjuvant therapy and reinterventions were collected. The IIEF-5 type questionnaires were used to assess sexual function at 6 months. We identified a number of 30 patients with amedian age of 60 years. All the patients were operated via open approach. Total mesorectal resection (TME) was practiced in 18 cases. Mean period follow-up was 10 months. Perioperative mortality was 0. There was no recurrence 1 year after surgery. Ten patients benefited from neoadjuvant radiotherapy. Rate of erectile dysfunction was 80%. The rate of ejaculation dysfunction was 70%. Patients operated for rectal cancer via an open approach showed severe sexual dysfunctions (SD). These complications affect the patient’s quality of life and need a multidisciplinary approach towards a better understanding of this problem by both the medical staff and the patient.

After more than 20 years from the beginning of laparoscopic surgery, laparoscopic cholecystectomy still holds a conversion rate of 5.1 % in the specialty literature. We have conducted a retrospective study based on the experience of the clinical unit of General Surgery within “Prof. Dr. A. Ionescu” Emergency Clinical Hospital, between 1997 and 2013. A number of 2,309 laparoscopic cholecystectomies were performed. The average age of the group was 47.3 years. Conversion was performed to a number of 58 patients (2.51%), out of which 74.13% women (no. = 43) and 26% men (no. 15). The average age of the patients to whom the conversion was performed was 57. Conversion to open cholecystectomy was more frequent in patients over 60 (no. 38). The main preoperative diagnosis in converted patients was acute lithiasic cholecystitis. Laparoscopic cholecystectomy is a safe method with optimal results, being considered the “gold standard” in the treatment of bladder lithiasis. Conversion to open surgery is an expression of the surgeon’s experience and wisdom.

Introduction: Over time, the management of rectal cancer has undoubtedly evolved with the use of neoadjuvant radiochemotherapy. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: We identified 42 papers. After screening 27 papers were used to complete the analysis. Discussion: There is an increased interest towards the non-operative management of rectal cancer, as up to 25% of patients with preoperative radiochemotherapy have demonstrated complete pathological response (absence of tumor cells on the operative specimens). This information leads to the tantalizing idea that in some cases, surgery can be avoided. Unfortunately, there is a lack of quality data to support this view. Due to increased interest in this subject, an international database in which patients with w w therapy can be enrolled and monitored. Up to now, the database contains over 900 patients. Also, quality prospective trials are emerging. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients in the follow-up period.

Backround/Objective: The aim of investigation was to evaluate if there is a pattern regarding the anatomical location of the disease and type of surgery performed/surgical indication. Also a analysis was performed regarding the complication rate in two subgroups deriving from urban and rural environments. Methods: Data was obtained from the medical records of patients with CD and centralized. Tests of statistical analysis included the CHY-SQUARE test and the results were presented as a retrospective, longitudinal study. Results: The group was formed of 60 patients. Patients with ileocolic disease were frequently diagnosed with obstruction and benefited from an enterectomy with anastomosis. Patients with colonic disease were frequently diagnosed with perforation and benefited from colectomy and stomy. Patients from rural areas had a milder evolution when compared with patients from urban enviroments. Conclusions: Although most patients with CD eventually require surgery, the indication could be anticipated by recognition of the concept of clinical patterns, and type of surgery required could be predicted if the clinical aspect of the patient/disease were identified.

Based on a case operated in our clinic the paper discusses the various applications of robotic surgery in the surgical treatment of the hepatic hydatid cyst. We present the case of a 29- year-old patient who presented to our clinic with chronic abdominal pain (8 months) localized in the right upper quadrant, without irradiation and showing no other accompanying phenomena. The patient was hospitalized and after clinical and laboratory investigations we confirmed the diagnosis of hepatic multilocular hydatid cyst located in the V, VI and VIII segments. Surgery was performed under general anesthesia and with the help of the STANDARD da Vinci robotic system equipped with four arms. The parasite was intactivated, a partial pericystectomy was done and the remaining cavity was drained. The patient's postoperative evolution was favorable and she was discharged in the 8th postoperative day. The 8 month follow-up showed no complications or pathological changes. In conclusion, robotic surgery can be successfully used in the treatment of the hepatic hydatid cyst.

We present the case of patient SC aged 44 years who underwent surgery 5 years prior to thepresentation to our clinic for a tumor in the head of the pancreas, the operation than consisted of acephalic duodenopancretectomy which was followed by a number of complications. On admissionthe patient had abdominal pain in the right flank, giant median postoperative eventration and aexternal ”a la Witzel” biliary drainage tube. Abdominal ultrasound revealed the presence of ainterhepaticodiaphragmatic collection that measured 4.6 / 3 cm. A cholangiography was donewhich showed biliary tract opacification of the left lobe with the full stop of the contrast in thedistal left main hepatic duct without intrahepatic biliary dilatation. Surgery was undertaken undertotal anesthesia – the intraoperative diagnosis consisted of: almost complete stenosis of the biliojejunostomy.After the adhesions were cut, the bilio-jejunostomy was redone using the left hepaticduct in a terminal-lateral anastomosis. The collection was drained and the abdominal defect wascorrected. The patient maintained a favorable external biliary drainage of about 200 ml per day soin the 5-th postoperative day the drainage was clamped without any complications. Conclusions: 1. Duodenopancreatectomy should be reserved for average / high volume surgical centers. 2. During the intervention the steps to achieve the biliary-digestive anastomosis should be respectedthoroughly 3. Fast reoperation may increase the chance of survival of the patient.

Goals To evaluate the indications of TAAP vs TEP in the treatment of unilateral inguinal hernia and the limitations of each technique using the experience of our clinic. Material and method The study is retrospective, extends over 4 years and includes patients with unilateral inguinal hernia operated using either TAAP or TEP technique. Results: We identified a number of 40 patients of which 25 were treated with the TAPP and 15 with the TEP technique. The mean age in the TAAP group was 42 years and 38 years in the TEP group. Mean surgery time for TAAP was 52 min; for TEP it was 62 min. Large inguinoscrotal hernias were operated with the TAAP technique. Conversion from TEP to TAAP was encountered in 2 cases, while conversion to open a hernia was encountered in 3 cases. No deaths were recorded in the follow-up time. Conclusions: Both TAAP and TEP are feasible surgical options to treat an inguinal hernia. The use of the TEP technique is limited by the size of the hernia defect while the TAAP technique has the advantage of larger intraoperative field, and an increased risk of injury to major abdominal organs.