New trends in colorectal surgery: Single port and natural orifice techniques

Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.

Laparoscopic treatment of complicated colonic diverticular disease:A review

Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates,Hartmann's procedure(HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery,laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands,the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease,such as HP,sigmoid resection with primary anastomosis(RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage(LLD),particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage,however,most of our knowledge in these fields relies on studies of low-level evidence. More than ever,well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure(laparoscopic HP or RPA),as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.

Integrative medicine and surgery:what are the diet and supplement recommendations for someone with pancreatic cancer?

Although a study in 2009 analyzing 20,000 cancer patients argued for a protective effect against pancreatic cancer in patients who adhered to a Mediterranean diet,the European Prospective Investigation into Cancer and Nutrition(EPIC)study looked at a population of 10 million people and identified 865 patients with pancreatic cancer and did not find a link to pancreatic cancer risk when a strict Mediterranean diet was followed(1).Regardless,there is a well-known correlation between obesity leading to chronic inflammation and resultant carcinogenesis(2).

Is robotic pancreatic surgery finally ready for prime-time?

The white paper entitled,“International consensus statement on robotic pancreatic surgery”,has been devised by leading minimally invasive surgeons to evaluate the current state for robotic pancreatic surgery.Six experts started the process by developing guidelines of robotic pancreatic surgery.Six experts started the process by developing guidelines of robotic pancreatic surgery.The guidelines were refined over a total of 4 meetings with the input and assistance of 20 additional international experts.A total of 19 recommendations involving the burgeoning field of robotic pancreatic surgery have been published in this article.With the recent publication of the International Summit on Laparoscopic Pancreatic Resection(ISLPR)“Coimbatore Summit Statements”,and the LEOPARD-1 and 2 trials this paper is particularly timely(1-3).