Advances In Surgery Channel

5 things you should know about Primary HPT resolution criteria and intraoperative PTH monitoring

Bariatric surgery is performed worldwide at a rate of over 500 000 procedures/year. Although many reports have been published, there’s no uniformity in the definition of results after these procedures.

In this video, we review the different types of meshes and materials available in the market to perform an ideal hernia repair.

In this lecture, Professor Antonino Spinelli talks about the use of fluorescence imaging to confirm vascularisation of the ileal pouch. Fluorescence imaging has been used widely in the recent years as a tool to evaluate perfusion in colorectal surgery. It appears to be of even more importance in pouch construction, but it needs refining and decisions must be guided by clinical experience.

We conducted a literature review of the literature published so far on the use of minimally invasive surgery in the treatment of patients suffering from thoracic trauma in the context of accidents classified as polytrauma

In the 6th episode of the Ileal Pouch Series, Dr. Roel Hompes MD PhD explains the arguments in favor of close rectal dissection in cases of protectomy for benign disease. Dr. Hompes highlights the benefits of this technique over TME dissection, mainly, less bleeding, nerve preservation, leak prevention and mitigation. In cases of FAP, close dissection is only beneficial if there is no suspicion of cancer, but more data is required.

Intraoperative bleeding can be life-threatening, so fast and effective blood management plan incorporating topical hemostatic agents is essential. Hemostatic agents provide rapid and effective hemostasis, are available in multiple delivery forms, and surgeons must be familiar with them in order to use them in the operating room.

The microbiome plays a key role in the pathophysiology of obesity and its comorbidities. Bariatric surgery has a heavy impact on the gut microbiota that might help achieve its beneficial effect on weight loss and metabolic profile.

In this EHTG/ESCP lecture Professor Antonino Spinelli from Humanitas Research Hospital in Milano explains the pros and cons of performing a “near to TME” dissection when performing a pouch for FAP. Despite the fact TME dissection has been considered as the gold standard in these cases, there are some advantages when dissection is performed close to the rectal wall. Some studies indicate that “near to TME ” dissection could be related to a lower pelvic complication rate as well as better functional outcome due to autonomic nerve preservation. Moreover, possible pitfalls and complications regarding anatomical issues and oncological outcome are also discussed.

Roel Hompes from the Academic Medical Center of Amsterdam talks about the lessons learned from the international TaTME registry for benign disease. After making a comprehensive review of all the developing phases of TaTME, Dr. Hompes explain how the international registry was designed as well as which were the initial variables that were studied. TaTME cases for benign disease represent less than 10% of all the registered data with high variability of indications. Technical variations when compared to TaTME for cancer, learning curve issues, postoperative outcome are discussed. Some of the current drawbacks and areas for improvement of the TaTME benign disease registry are also reviewed.

Laparoscopic surgery has gained acceptance as a less invasive approach in the treatment of recto-vaginal fistulas. However, laparoscopic surgery for diseases located in the pelvis is still challenging because of limited accessibility. Robotic surgery overcomes the limitations of laparoscopy associated with anatomy and offers certain advantages, including 3-D imaging, dexterity and ambidextrous capability, lack of tremors, motion scaling, and a short learning curve.  The possible superiority of robotic surgery in terms of the preservation of autonomic function has yet to be established in research based on larger numbers of patients. Although robotic pelvic surgery is safe, feasible, and appears to overcome some of the technical limitations associated with conventional laparoscopic surgery, the advantages provided by this technical innovation are currently limited.

This third chapter on the management of paraesophageal hernias will focus on the most popular antireflux techniques used in the repair of hiatal hernias.

In this video, Baljit Singh speaks about the recorded data about pouches from 2012 to 2017. Pouch surgery is not a common surgery within the scope of colorectal surgery. Of the approximately 400 surgeons who have ever performed this surgery, only 26 have performed more than 15 operations. The majority of them, 126, have only performed one pouch surgery. The ratio of complications and readmission is high in this surgery. The most common diagnosis of patients having primary ileoanal pouch surgery is ulcerative colitis and familial adenomatous polyposis. In recent years there has been a variation in the use of the different Pouch designs. Currently almost 100% of the pouch made are J-Pouch.

“Is the international surgical community ready to prepare training modules for essential surgery?” Dr. Halfdan Mahler, Director General of the World Health Organization (WHO), made this question 40 years ago. He pointed out for the first time that the vast majority of the world’s population has no access to skilled surgical care and that surgical first aid is an essential part of primary health care. Surgical need transects all disease categories. “The era of only the best for the few and nothing for the many is drawing to a close”, he stated. Global surgery is an area of study, research, practise and advocacy that seeks to improve health outcomes and achieve health equity for all people who need surgical and anesthesia care, with a special emphasis on underserved populations and populations in crisis. This new approach regarding the urgent need for surgical care and its human and economic impact led to the aim of developing safe, essential, life-saving surgical and anesthesia care in low-income and middle-income countries (LMICs).

This video aims to answer questions about surgical technique: what you should know but are afraid to ask. Three theoretical questions will be presented and answered.

In this video in the Ileal Pouch Series, Dr. Kienle talks about the disadvantages of TaTME. Restorative proctocolectomy is indicated for treatment of inflammatory bowel diseases such as ulcerative colitis or in familial polyposis. Only around 20% of cases require an oncological procedure, performing a total mesolectal excision. In this video Dr. Kienle presents the disadvantages of TaTME-Pouch from his point of view. There is no hard evidence on nerve damage, functional impact, or better anastomotic results, for taTME versus lapTME. According to Dr. Kienle, making a purse-string to create an anastomosis is more difficult because if the purse-string is not tight, the risk of tissue and organ injury is higher due to impaired vision. Dr. Kienle concludes that using taTME for a restorative proctocolectomy has no proven advantages, may be harmful and more expensive, but it is important to investigate further.