Short-term Operative Outcomes Research Articles

Short-term Outcomes of Robot-assisted Colectomy Using the Overlap Method for Right-sided Colon Cancer.

The recent development of minimally invasive surgery has led to transition from laparoscopic right colectomy (LC) to robot-assisted right colectomy (RC) in Japan. However, it is unclear whether the introduction of RC in municipal hospitals could be as safe as that in high-volume centers in Japan. Therefore, this retrospective study aimed to compare the short-term operative outcomes of RC and LC for right colon cancer at a local municipal hospital in Japan. Patients with stage I-IV right colon cancer who underwent elective RC or LC between January 2021 and July 2023 were retrospectively analyzed. Patients with double cancer and those who underwent delta anastomosis were excluded. Postoperative surveillance included patient interviews, physical examinations, tumor marker examinations, and whole-body computed tomography every six months. Forty patients were analyzed, and 24 (60%) and 16 (40%) patients assigned in the LC and RC groups, respectively, were compared. The operative time, bleeding, postoperative complications, and pathological examinations did not differ significantly between the LC and RC groups. RC using overlapping anastomoses was comparable to LC in terms of short-term operative outcomes. The introduction of RC with overlapping anastomosis is a feasible surgical technique.

OGBN P29 Short term outcomes after anti-reflux surgery for Gastro-Oesophageal Reflux disease

Abstract Background Laparoscopic fundoplication is the standard surgical practice for management of Gastro-oesophageal reflux Disease (GORD). However, post operative complications and recurrence can be problematic. We conducted this study to assess short-term post operative outcomes following anti-reflux surgery (ARS) for GORD at our UGI surgery unit at a busy District General Hospital (DGH). Methods All patients above 18 years of age undergoing ARS between January 2016 and December 2021 were included. We excluded patients who underwent fundoplication as part of treatment of achalasia or large hiatus hernia repairs. Data was collected retrospectively from a prospectively maintained database. Pre –operative investigations and surgical procedure was recorded. Primary outcome assessed were post-operative complications recorded as per Clavien-Dindo grade and re-operation rates. Secondary outcomes assessed were symptomatic relief and proton pump inhibitor (PPI) discontinuation. Results 86 patients were included. The median age at surgery was 52 years. 98% patients had typical symptoms of GORD at presentation. On pre-operative OGD, 29% patients had oesophagitis and 77.91% had hiatus hernia. 79 (91.86%) patients underwent pH manometry. 97.67% patients underwent Nissen fundoplication. All cases were successfully completed laparoscopically with no conversions to open. The median post-operative length of stay was 1 day. 93.02% had no post operative complications, and none had 30 day re-operation. At 1-year follow up, 97.67% patients reported improvement in symptoms and 94.19% patients were able to stop PPI use. Conclusions Laparoscopic fundoplication provides excellent relief of GORD symptoms with low incidence of post operative complications and re-operation rates.

Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases.

To assess the short-term operative and fertility outcomes of single-incision robotic myomectomy. We performed this retrospective cohort study of 286 women who underwent robotic single-site myomectomy using the da Vinci® Xi surgical system (RSSM group, n = 70) or robotic single-port myomectomy using the da Vinci® SP surgical system (RSPM group, n = 216). Data were collected through chart reviews and telephone interviews. Except operating time (94.6 ± 30.1min in RSSM vs. 81.7 ± 20.1min in RSPM) and location of the removed fibroids, there were no significant differences in the operative outcomes or characteristics of the removed fibroids between both groups. The proportion of fibroids in the lateral wall in RSPM (13.4%) was approximately twice that in RSSM (6.3%). There was no conversion to laparotomy or multiport access, and none of the women required readmission in either group. No significant difference in the complication rate was noted between groups, and all complications were resolved with conservative treatment. During the approximately 20-month follow-up period, in the RSSM and RSPM groups, the pregnancy rates were 54.5% and 67.4%, respectively, and the abortion rates were 33.3% and 22.6%, respectively. In terms of operative and fertility outcomes, single-site robotic myomectomy appears to be feasible and safe in women with symptomatic fibroids. The da Vinci® SP system is thought to be helpful in reducing operation time and surgically difficult myomectomy.

The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort.

Abdominal aortic aneurysms (AAA) are the most frequent aortic dilation, with considerable morbidity and mortality. Inflammatory (infl) and IgG4-positive AAAs represent specific subtypes of unclear incidence and clinical significance. Here, histologic and serologic analyses with retrospective clinical data acquisition are investigated via detailed histology, including morphologic (HE, EvG: inflammatory subtype, angiogenesis, and fibrosis) and immunhistochemic analyses (IgG and IgG4). In addition, complement factors C3/C4 and immunoglobulins IgG, IgG2, IgG4 and IgE were measured in serum samples and clinical data uses patients' metrics, as well as through semi-automated morphometric analysis (diameter, volume, angulation and vessel tortuosity). A total of 101 eligible patients showed five (5%) IgG4 positive (all scored 1) and seven (7%) inflammatory AAAs. An increased degree of inflammation was seen in IgG4 positive and inflAAA, respectively. However, serologic analysis revealed no increased levels of IgG or IgG4. The operative procedure time was not different for those cases and the short-term clinical outcomes were equal for the entire AAA cohort. Overall, the incidence of inflammatory and IgG4-positive AAA samples seems very low based on histologic and serum analyses. Both entities must be considered distinct disease phenotypes. Short-term operative outcomes were not different for both sub-cohorts.

Short Term Clinical Outcomes in Spine Surgeries. A Descriptive Cross Sectional Study in a Tertiary Care Hospital

Objective: To find out the short-term post operative outcomes faced by patients undergoing various spine procedures. Study Setting: Neurosurgery department Khyber Teaching Hospital Peshawar Khyber Pakhtunkhwa. Study Duration: January 2022 to January 2023 Study Design: Cross-sectional study (descriptive). Material and Methods: After taking approval from the hospitals ethical and research committee a single center review of the medical records of all patients who underwent common surgical procedures of the spine were collected and patients followed for short term post -operative outcomes. Data was analyzed by using the statistical software SPSS version 23.0 and the results were presented in the form of tables and charts. Results: Out of 360 patients included in the study, 206 (57.2%) were males and 154 (42.8%) were females with a mean age of 41.3 ± 13.4. The highest percentage of patients presented with a PIVD at L4-L5 (n=176, 48.9%). It turns out that aged patients had more VRS scores compared to young candidates after surgery (p-value= 0.05) and patients who underwent only decompressive laminectomies had noticeable reduction frequency of discitis (p-value= 0.40) and a remarkable improvement in the VRS score after surgery (p value=<0.01) as compared to other procedures. Conclusion: Even though laminectomy, being the procedure of choice in so many cases, significantly treats neurogenic claudication, still unresolved back pain is the most common complaint made by patients in the post operative period. However, despite complications, patient satisfaction rates have improved over the period of time. Keywords: Post-operative complications, laminectomy, discectomy, neurosurgery

A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC VERSUS OPEN REPAIR OF INCISIONAL HERNIA AT A TERTIARY CARE INSTITUTE.

Introduction Incisional hernia is a bulge or protrusion near or directly along a prior abdominal surgical incision.Repair of ventral hernias has always been challenging because of the distorted anatomy due to previous surgery. With the advancement in technology as well as surgical techniques, laparoscopic incisional hernia repair (LVHR) is more commonly being performed as compared to open repair in various centers throughout the World. Our study aimed to compare the short-term operative outcomes between laproscopic and open repair. Materials and methods Fifty patients diagnosed with non-complicated incisional hernias were included in this prospective study and were randomly divided into the laparoscopic group and the open group. The two groups were compared to evaluate operative time, postoperative pain, length of hospital stay and time taken to return to normal activity. A p-value of less than 0.05 was considered to be statistically signicant. Mean operative time Results was longer in Laproscopic repair (100 min) as compared to open repair (76 min)(p<0.01). Patients experienced more pain on the rst and seventh postoperative days in the open group (p<0.01) and they also had a longer duration of hospital stay as compared to the laparoscopic group . Conclusion Laparoscopic repair carries a signicant advantage over open hernia repair, especially in terms of reduced postoperative pain, duration of hospital stay, and early resumption of normal activity

The Impact of Improving Nutrition Status, Pre-habilitation, Optimization of Cardiac Hemodynamics Including use of Temporary Mechanical Support When Indicated on the Reduction of Frailty in Patients Evaluated for Advanced Heart Failure Therapies

Background: Advanced frailty and age are associated with increased mortality, adverse surgical and transplant outcomes. Aside from bridge-to-transplant ventricular assist device (VAD) implant, minimal literature exists regarding reversing frailty. The aim of this study was to assess interventions used by Lutheran Heart Transplant (HTx) and VAD Program on reducing frailty and the impact on short-term operative outcomes. Methods: A retrospective chart review of 29 patients evaluated in the Lutheran HTx and VAD program was performed. Data collected included biomarker and demographic data for June 2020 to present. The study population was analyzed and then stratified by their modified Fried Frailty Phenotype (mFFP) score. Independent analysis was performed for HTx and VAD cohorts. Fisher’s exact and t-tests were used to analyze categorical and continuous variables, respectively (alpha = 0.05). Results: 18 out of 29 patients (62%) were classified as frail at initial assessment. Significant improvements were observed in bilirubin (p=0.017), creatinine (p=0.001), eGFR (p=0.001), lactic acid (p=0.002), and prealbumin (p=0.002) for the total study population. Frail patients experienced longer intubation (3 vs 4 days) and hospitalization (20 vs 23 days) times post-HTx. Due to limited sample size, we were unable to analyze the VAD cohort by mFFP score. Conclusions: Significant improvements were seen in kidney function and nutrition status as indicated by creatinine, eGFR, and prealbumin data. However, the available data was insufficient to examine the interventions impact on frailty as described by the Fried Frailty Phenotype. Similar to other studies, frailty was associated with increased intubation and hospitalization duration post-HTx.

Ankle Fractures, Short Term Operative Outcome: A Retrospective Case Series

Introduction and Background: Ankle injury is one of the most frequent presenting injuries to the emergency room and ankle fractures are common fracture in the lower limbs injuries that may require operative treatment with variable outcomes. Materials and Methods: Sixty-three patients were included in my retrospective study, and all with a displaced fracture of the ankle caused by high energy trauma were treated by open reduction and rigid internal fixation. Results: After follow-up at six weeks and twelve weeks, the results were satisfactory in fifty-five percent out of all the sixty-three patients. Conclusions and Recommendations: Ankle fractures occur mainly in young males of the age group between 26 and 35 years, mostly caused by fall down and motor vehicle accident.

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience.

Obesity is a major public health problem and a well-known cause of multiple comorbidities. With the increasing application of minimally invasive surgery for benign and malignant liver lesions, the results of laparoscopic liver resection (LLR) in obese patients are of great interest. To evaluate the short-term operative outcomes after LLR in obese patients and compare them to patients with normal weight and overweight. All 235 consecutive patients undergoing LLR from 2008 to 2023 were retrospectively analysed. Patients were categorized into 3 groups based on their body mass index (BMI): normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). The groups were then compared regarding preoperative data and intra- and postoperative outcomes. Despite higher ASA score and associated comorbidities in the obese group, there were no significant differences in intraoperative complication (blood loss, damage to surrounding structures, conversion rate) between BMI groups (20.8% vs. 16.8% vs. 22.7%, p = 0.619). There were no significant differences in overall morbidity (34.7% vs. 27.7% vs. 29.5%, p = 0.582), as well as major morbidity (15.9% vs. 11.8% vs. 11.4%, p = 0.784) or mortality rates (1.4% vs. 1.7% vs. 0.0%, p = 1.000). Univariate logistic regression did not show BMI or obesity as a predictive variable for intraoperative complication. Obesity is not a significant, strong risk factor for worse short-term outcomes, and LLR may be considered also in patients with overweight and obesity.

State and Government Administrative Databases: Medicare, National Inpatient Sample (NIS), and State Inpatient Databases (SID) Programs.

The availability of large state and federally run administrative health-care databases provides potentially comprehensive population-wide information that can dramatically impact both medical and health-policy decision-making. Specific opportunities and important limitations exist with all administrative databases based on what information is collected and how reliably specific data elements are reported. Access to patient identifiable-level information can be critical for certain long-term outcome studies but can be difficult (although not impossible) due to patient privacy protections, while more easily available de-identified information can provide important insights that may be more than sufficient for some short-term operative or in-hospital outcome questions. The first section of this paper by Sarah K. Meier and Benjamin D. Pollock discusses Medicare and the different data files available to health-care researchers. They describe what is and is not generally available from even the most granular Medicare Standard Analytic Files, and provide an analysis of the strengths and weaknesses of Medicare administrative data as well as the resulting best and inappropriate uses of these data. In the second section, the Nationwide Inpatient Sample and complementary State Inpatient Database programs are reviewed by Steven M. Kurtz and Edmund Lau, with insights into the origins of these programs, the data elements that are recorded relating to the operative procedure and hospital stay, and examples of the types of studies that optimally utilize these data sources. They also detail the limitations of these databases and identify studies that they are not well-suited for, especially those involving linkage or longitudinal studies over time. Both sections provide useful guidance on the best uses and pitfalls related to these important large representative national administrative data sources.

442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy

Abstract Aim Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP. Method We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality. Results Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (> 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group. Conclusions According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.

Intraoperative Ultrasound Guided Robotic Pancreatic Enucleation, Does a Distance of 3mm Still Matters?

Background: A minimal distance of 3mm to main pancreatic duct (MPD) was generally considered to be necessary for pancreatic enucleation (PE). This study was designed to report the safety and feasibility of PE for tumors located in 3mm to MPD Under the intraoperative ultrasound (IOUS) guidance.Methods: The data of patients who received IOUS guided robotic PE from January 2018 to May 2019 in the second department of hepato-pancreato-biliary surgery were reviewed in this study. According to the distance to MPD (less than 3mm or not), patients were divided in 2 groups, and the short-term operative outcomes were compared.Statistics: Students' t-test and Mann-Whitney U test were used for comparing continuous variables, and Chi-squared test was used for comparing categorical variables.Results: And a total of 56 patients were analyzed, and a minimal distance less than 3mm between the tumor and pancreatic duct measured by IOUS was found in 12 patients. The tumors and MPD were clearly revealed intraoperatively in all the cases. The operative duration was significantly longer in patients with tumors located in 3mm from MPD (143.25 ± 40.89min vs 107.14 ± 37.73min, t = 2.756, P=.014). There was no significant difference between the rate of post-operative pancreatic fistula and other complications in the different groups (χ2 =.924, P=.48).Discussion and conclusion: robotic PE could be safely performed under IOUS guidance for benign or low-grade malignant tumors located less than 3mm to the MPD.

A COMPARATIVE STUDY BETWEEN LAPAROSCOPIC VERSES OPEN REPAIR OF VENTRAL HERNIA.

Introduction: With the advancement in technology as well as surgical techniques, laparoscopic ventral hernia repair (LVHR) is more commonly being performed as compared to open repair in various centers throughout the World. Our study aimed to compare the short-term operative outcomes between LVHR and open repair. Materials and methods: Sixty patients diagnosed with non-complicated ventral hernias were included in this prospective study and were randomly divided into the laparoscopic group and the open group. The two groups were compared to evaluate operative time, postoperative pain, length of hospital stay and time taken to return to normal activity. Ap-value of less than 0.05 was considered to be statistically signicant. Results:Mean operative time was longer in LVHR (116 min) as compared to open repair (67 min)(p<0.01). Patients experienced more pain on the rst and seventh postoperative days in the open group (p<0.01) and they also had a longer duration of hospital stay as compared to the laparoscopic group (6.23 ± 0.35 vs 2.17 ± 1.12 days,p = 0.02). Patients in the laparoscopic group returned to normal activity faster as compared to the open group (1.47 ± 0.11 vs 2.87 ± 0.34, p<0.01). Conclusion: LVHR carries a signicant advantage over open hernia repair, especially in terms of reduced postoperative pain, duration of hospital stay, and early resumption of normal activity.

Penetrance of Advanced Laparoscopic Colorectal Skills via Global Surgery Concept

Background: This study was performed to assess the penetrance of laparoscopic colorectal surgical skill to junior general surgeons in hospitals without colorectal service in Malaysia. The surgeries were proctored by accredited consultant colorectal surgeons. We evaluated the short-term operative outcomes of laparoscopic colorectal cancer in those hospitals

Open Versus Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial

IntroductionWith the advancement in technology as well as surgical techniques, laparoscopic ventral hernia repair (LVHR) is more commonly being performed as compared to open repair in various centres throughout the world. Our study aimed to compare the short-term operative outcomes between LVHR and open repair.Materials and methodsSixty patients diagnosed with noncomplicated ventral hernias were included in this prospective study and were randomly divided into the laparoscopic group and the open group. The two groups were compared to evaluate operative time, postoperative pain, length of hospital stay and time taken to return to normal activity. A p-value of less than 0.05 was considered to be statistically significant.ResultsMean operative time was longer in LVHR (116 min) as compared to open repair (67 min)(p<0.01). Patients experienced more pain on the first and seventh postoperative days in the open group (p<0.01) and they also had a longer duration of hospital stay as compared to the laparoscopic group (6.23 ± 0.35 vs 2.17 ± 1.12 days, p = 0.02). Patients in the laparoscopic group returned to normal activity faster as compared to the open group (1.47 ± 0.11 vs 2.87 ± 0.34, p<0.01).ConclusionLVHR carries a significant advantage over open hernia repair, especially in terms of reduced postoperative pain, duration of hospital stay, and early resumption of normal activity.

Hybrid Appendectomy in Pediatric Appendicitis: A Comparative Analysis of Single-Port and Multiport Laparoscopic Appendectomy.

Background: Hybrid appendectomy (HA) has the technical advantages of the excellent visual field provided by laparoscopic surgery and is fast and easy similar to open surgery. We aimed to compare the safety and effectiveness of HA with single- and multiport laparoscopic appendectomy (SPLA and MPLA) in pediatric patients with acute appendicitis. Materials and Methods: This retrospective study compared the short-term operative outcomes between HA, SPLA, and MPLA groups. From January, 2010 to December, 2019, 239 patients aged <12 years who underwent laparoscopic appendectomy for acute appendicitis were included. The primary outcome was the 30-day postoperative complication rate, stratified according to the modified Clavien-Dindo classification. Results: In 239 patients, HA was more frequently performed in patients with a low body mass index (17.42 versus 18.97 kg/m2 in the SPLA group versus 18.44 kg/m2 in the MPLA group, P = .029) and tended to be more frequently adopted in uncomplicated appendicitis. In uncomplicated appendicitis, the HA group had a significantly shorter operation time than the MPLA group (31.77 versus 40.09 min, P < .001), but had a comparable operation duration with the SPLA group. The rate of 30-day postoperative complications was not significantly different between the groups (HA 7.6% versus SPLA 7.8% versus MPLA 5.4%, P = .841). The postoperative time to resume water intake was significantly longer in the SPLA group than in the HA and MPLA groups (P = .008). Conclusions: HA showed a short operation time, fast functional recovery, and acceptable postoperative complication rate in patients with uncomplicated appendicitis and can be safely and effectively performed in these patients.

Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

BackgroundThis study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy.MethodsThis is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes.ResultsAll patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups.ConclusionThe LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal

Introduction: Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts. Methods: This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination. Conclusion: Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome.

A new technique for uterine incision closure at the time of cesarean section: does it make a difference?

The purpose of this study was to compare the short-term operative outcomes of three different surgical techniques for uterine incision closure during caesarean section (CS). This trial enrolled 120 patients scheduled for primary caesarean delivery. Patients were randomised into either classical double-layer uterine closure, purse-string double-layer uterine closure (Turan), or our new approach of uterine closure (double layer step up-step down technique). For short-term comparison, transvaginal ultrasonography was planned for all patients 6 weeks after surgery. Compared to group II and Group III, residual myometrial thickness was significantly thinner in group I (p < .001). The number of patients with uterine niche was 10 (50% of all scar defects) in group I whereas it was 4 (20%) in group II and 6 (30%) in group III. Operative time was significantly longer in group II (p < .001). This led to our conclusion that Turan technique and our new approach are associated with thicker myometrial thickness and less frequency of uterine scar defect than classical double-layer uterine incision closure; however, our approach takes less operative time. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04681378 Impact statement What is already known on this subject? Many variations in CS technique have been studied. For example, single-layer uterine incision closure has been compared to double-layer uterine incision closure. Purse string double layer (Turan) has been also compared to the traditional double-layer technique. Double layer unlocked closure has been shown to result in a thicker residual myometrium and as a consequence can possibly lead to the decrease of niche development after a CS compared to single-layer closure with lower frequency of uterine scar defect with Turan technique. What do the results of this study add? Here we introduce a new uterine closure technique, which we have named double-layer step up–step down technique, as an alternative method. With this technique, the uterine incision contract more than with the traditional double layer technique and has similar results to the Turan technique; however, our approach takes less operative time. What are the implications of these findings for clinical practice and/or further research? These alternative techniques of uterine incision closure decrease the frequency of uterine niche that may be associated with many clinical problems such as ectopic pregnancy at the CS scar, placenta accreta, rupture of the uterus during a subsequent pregnancy. Future studies are needed to investigate the frequency of uterine rupture in a subsequent pregnancy following different uterine incision closure techniques.

Robotic Radical Prostatectomy at the Egyptian National Cancer Institute: Overcoming the Challenges in the Initial Case Series

BACKGROUND: Robotic prostatectomy is showing progressive worldwide spread owing to potential clinical benefits, but at a higher cost. AIM: This article describes the challenges and clinical outcomes of the first group of patients undergoing robotic prostatectomy in Egypt. DESIGN, SETTING, PARTICIPANTS: From 2017 to 2019, the data of all (55) patients undergoing robotic radical prostatectomy at the National Cancer Institute of Egypt were retrospectively analyzed. OUTCOME EVALUATION: Short-term operative outcomes, complications, technical difficulties, pathologic data, and biochemical recurrence were reported. RESULTS: Average blood loss was 296 ml; one patient required blood transfusion. One case required open conversion, another required re-docking of the robot. Setup time was significantly improved from an average of 27.7 min in the first 27 cases to an average of 17.3 min in the final 28 cases (p &lt; 0.0001). Complications developed in 27% of our patients. Continence recovery at catheter removal, 1st, 3rd, 6th, and 12th months were 32.7%, 50.9%, 65.5%, 74.5%, and 96%, respectively. CONCLUSIONS: Results from the first series of robotic radical prostatectomy were encouraging. Technical challenges can be overcome in a short period using a dedicated team supplemented by institutional support. Acceptable complication rate and satisfactory outcomes regarding continence and blood loss were observed.