No abstract available.
Cesarean Section* ; Female ; Pregnancy

Robotic surgical systems were created partly to solve several constraints of laparoscopic surgery and to offer technical advantages. With a substantial body of evidence demonstrating its efficacy in rectal cancer treatment, robotic surgery will soon become another conventional treatment. However, further investigations and randomized trials focusing on primary endpoints are necessary to establish some advantages of robot-assisted colon surgery.Current Concepts: Da Vinci Single-Site and SP platforms (Intuitive Surgical Inc.) were developed to overcome the shortcomings of single-port laparoscopic surgery. Despite the currently insufficient evidence, it seems that the SP platform addresses several limitations of single-port transabdominal or transanal surgery. Robotic transanal minimally invasive surgery and total mesorectal excision were developed to overcome conventional platforms’ limitations, using wristed instrumentation to enhance dexterity and ergonomics. Studies on the effectiveness and viability of this novel approach are ongoing. The near-infrared fluorescence technique, real-time stereotactic navigation technology, and other surgical data platforms based on artificial intelligence incorporated into the robotic system will play an important role in improving outcomes.Discussion and Conclusion: Robotic systems for advanced colorectal cancer offer technical advantages for complex and precise surgeries. If robotic surgery costs are reduced by expanding its indications and enhancing competition among different robotic platforms, it will provide clinical benefits to more patients and reduce social healthcare costs.

Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a bridge of surgery in the literature are still controversial. Stent insertion for obstructed cancer provides an opportunity for bowel preparation and makes preoperative work-up and clinical staging possible. However, although stenting is becoming a more frequent treatment modality, studies with a significant number of patients acting as a bridge between surgery are still lacking. In this issue of Journal of Minimally Invasive Surgery, the study by Kim et al.highlights the efficacy of stent insertion as the initial treatment and analyzed the prognostic factors in symptomatic obstructive colon cancer. The study demonstrated that emergent surgery, vascular invasion, and omitting adjuvant chemotherapy were independent poor prognostic factors in long-term oncologic outcomes suggested that stent insertion should be considered an initial treatment for symptomatic obstructive colon cancer.

Although obstructive colon cancer can often be treated with first-stage resection with primary anastomosis, the results of the oncological outcome of using stenting as a bridge of surgery in the literature are still controversial. Stent insertion for obstructed cancer provides an opportunity for bowel preparation and makes preoperative work-up and clinical staging possible. However, although stenting is becoming a more frequent treatment modality, studies with a significant number of patients acting as a bridge between surgery are still lacking. In this issue of Journal of Minimally Invasive Surgery, the study by Kim et al.highlights the efficacy of stent insertion as the initial treatment and analyzed the prognostic factors in symptomatic obstructive colon cancer. The study demonstrated that emergent surgery, vascular invasion, and omitting adjuvant chemotherapy were independent poor prognostic factors in long-term oncologic outcomes suggested that stent insertion should be considered an initial treatment for symptomatic obstructive colon cancer.

No abstract available.
Ifosfamide*

PURPOSE: Dysbiosis of gut microbiota has been reported to participate in the pathogenesis of colorectal cancer, but changes in microbiota due to radiotherapy have not been studied. In this study, we tried to elucidate the changes in the microbiome in rectal cancer after chemoradiotherapy using RNA sequencing analysis.MATERIALS AND METHODS: We included 11 pairs of human rectal cancer tissues before and after irradiation between August 2016 and December 2017 and performed RNA sequencing analysis. Mapped reads to human reference genomes were used for pair-wise transcriptome comparisons, and unmapped (non-human) reads were then mapped to bacterial marker genes using PathSeq.RESULTS: At microbiome level, interindividual variability of mucosal microbiota was greater than the change in microbial composition during radiotherapy. This indicates that rapid homeostatic recovery of the mucosal microbial composition takes place short after radiotherapy. At single microbe level, Prevotella and Fusobacterium, which were identified as important causative microbes of the initiation and progression of rectal cancer were decreased by radiotherapy. Moreover, changes in Prevotella were associated with changes in the human transcriptome of rectal cancer. We also found that there was a gene cluster that increased and decreased in association with changes in microbial composition by chemoradiation.CONCLUSION: This study revealed changes in tumor-associated microbial community by irradiation in rectal cancer. These findings can be used to develop a new treatment strategy of neoadjuvant therapy for locally advanced rectal cancer by overcoming radio-resistance or facilitating radio-sensitivity.
Chemoradiotherapy ; Colorectal Neoplasms ; Dysbiosis ; Fusobacterium ; Gastrointestinal Microbiome ; Genes, vif ; Genome ; Humans ; Microbiota ; Neoadjuvant Therapy ; Prevotella ; Radiotherapy ; Rectal Neoplasms ; Sequence Analysis, RNA ; Transcriptome

PURPOSE: Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. METHODS: The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. RESULTS: Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5-14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30-155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0-3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0-5 days) and 3 days (1-7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. CONCLUSION: Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.
Abscess* ; Adult ; Appendectomy* ; Appendicitis* ; Diet ; Drainage ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Natural Orifice Endoscopic Surgery ; Needles ; Postoperative Complications ; Surgical Wound Infection ; Wounds and Injuries

Blastomycosis-like pyoderma is an uncommon vegetating tissue reaction, often secondary to a bacterial infection occurring in patients with a compromised immune system. We describe a clinically blastomycosis-like pyoderma on the right ankle and knee in a patient with iatrogenic Cushing syndrome, hypertension, hypercholesterolemia and congestive heart failure.
Ankle ; Bacterial Infections ; Cushing Syndrome ; Heart Failure ; Humans ; Hypercholesterolemia ; Hypertension ; Immune System ; Knee ; Pyoderma*

In rectal cancer surgery, gentle opening of the plane by continuous traction and optimized visualization is essential. Recently, a wristed robotic suction-irrigation device was developed for efficient traction of the rectum and good surgical visualization. This video shows a technique of robotic total mesorectal excision using a wristed robotic suction-irrigation device. A 74-year-old woman with rectal cancer had a biopsy-proven adenocarcinoma within 9 cm of the anal verge. She underwent totally robotic total mesorectal excision using a dual-docking technique. Total procedure time was 445 minutes. The patient was discharged on postoperative day 8 without any complications. Total number of lymph nodes harvested was 12, and proximal and distal resection margins were 11.2 and 4.7 cm, respectively. Totally robotic total mesorectal excision using a wristed robotic suctionirrigation device was an efficient and useful procedure for rectal cancer.
Adenocarcinoma ; Aged ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Rectal Neoplasms ; Rectum ; Robotic Surgical Procedures ; Traction* ; Wrist*