Ovarian cystadenomas in adolescents are rare neoplastic tumors arising from the ovarian epithelium. These are seen in adult women, posing diagnostic challenges in the pediatric age group. Due to its propensity to become large up to 30cm, its acute presentation and complications necessitate urgent management. We present a case of a 17-year-old female who came in due to increasing abdominal girth of 1-year duration with a CT scan finding of 35 cm hypodense non-enhancing abdominopelvic mass. Tumor markers were requested, leading to non-malignancy, and the patient underwent minimally invasive surgery. This clinical case highlights the importance of a comprehensive approach to the diagnosis of intraabdominal masses in adolescents while providing optimal management and reducing potential complications.

BACKGROUND

Laparoscopic surgery is a widely accepted treatment modality, but with few disadvantages.

To describe the demographic, clinical, tumor, and operative characteristics of patients with colorectal cancer who underwent laparoscopic surgery.

Descriptive study.

47 males and 40 females, aged 19 years and older with colorectal cancer who underwent laparoscopic colorectal surgery.

Surgery Department - Colorectal Surgery section, Southern Philippines Medical Center, Davao City, August 2014 to August 2018.

Demographic and clinical characteristics, tumor profile, and operative outcomes.

This study analyzed 87 patients with colorectal cancer who underwent laparoscopic colorectal surgery. The participants had a mean age of 56.55 ± 11.99 years, with a slight male predominance (54.02%). Most patients resided within Davao Province (72.41%) and commonly presented with comorbidities, particularly hypertension (22.99%). Tumors were mostly located in the rectum (62.07%), and the majority of patients had advanced disease, with 59.77% classified as stage IIIB. Advanced tumor invasion was common, with 60.92% of patients presenting with T3 and 32.18% with T4 disease, while lymph node involvement was observed in 75.86% of cases. Distant metastasis was present in 11.49% of patients, most frequently involving the liver. Low anterior resection was the most commonly performed procedure (39.08%). The mean operative time was 278.89 ± 72.76 minutes, with a mean blood loss of 476.73 ± 341.86 mL and a conversion-to-open rate of 23.26%. Postoperative outcomes showed a morbidity rate of 26.44% and a mortality rate of 3.45%, with patients resuming oral intake after a mean of 4.02 ± 2.17 days and a mean hospital stay of 8.35 ± 6.38 days.

Laparoscopic colorectal surgery at our institution was performed among middle-aged patients, mostly males. Rectal cancer was the most common diagnosis, with most patients presenting with advanced stage IIIB disease, and low anterior resection was the most frequently performed procedure. The mean operative time was 279 minutes, with a conversion-to-open rate of nearly 25%. The mean intraoperative blood loss was 476 mL. Oral intake was resumed after a mean of 4 days. The mean hospital stay was 8 days, with low mortality despite a moderate morbidity rate.

OBJECTIVE

The aim of this study was to determine the different attitudes and perception of obstetrics and gynecology residents on laparoscopic skills training.

A cross-sectional research was conducted in a tertiary hospital’s Department of Obstetrics and Gynecology using a survey questionnaire. The respondents were resident physician trainees using population sampling. An approval to use the survey questionnaire from its developer was obtained. Descriptive statistics was used for analysis of the demographic profile. Pearson product moment correlation was used to determine correlation between expectancy-value constructs, simulation use and surgical experience.

The average hours the residents spent in simulation laparoscopic exercises was 11 h in the last 12 months and at least 1 h per week with supervision (76%). The reasons for using laparoscopic simulation include skill development (94%), proximity to the simulation lab (90%), free time (85%), recommendation of attending surgeon (84%), and requirement for rotation (84%). Among the expectant value constructs, only intrinsic interest utility value (r = −0.390) showed statistical correlation suggesting a weak negative correlation with simulation use. Hours of simulation use were significantly negatively correlated with self-efficacy for learning skills required to become proficient at minimally invasive surgery (MIS) (r = −0.390) and self-efficacy for learning sufficient MIS skills to perform procedures safely (r = −0.351).

The residents were motivated to do well and had greater self-belief and enjoyed performing and mastering the laparoscopic skills training. The residents’ perception revealed that there was an improvement in their MIS skills with the laparoscopic simulation exercises in the short time they spent in the simulation. Despite the residents’ positive attitude and perceptions, voluntary participation was limited. The most commonly cited barriers to the access of the surgical knowledge improvement laboratory and laparoscopy simulation unit were the lack of time due to the workload, conflicting schedules, and COVID-19 pandemic restrictions. Supervision of the residents is of great importance to provide guidance and motivation to the residents in improving their technical skills and performance in the operating room.

INTRODUCTION

Splenic Abscess is an ongoing infectious process with pus accumulation specifically at the spleen, this is associated with a high mortality rate with studies showing 16.6% among those diagnosed, with risk factors mainly present are among immunocompromised state. Among the immunocompetent population, an incidence of 0.14-0.70% were documented. 13 The etiology for this may include hematogenous or contiguous spread of infection as a pathophysiology, with bacterial seeding at the site. Detection of this is through ultrasound or CT scan, with a goal of identify a complex or a simple abscess. Therapeutics lie in choosing splenectomy, placing the patient in an immunocompromised state despite being at a young age against the conservative percutaneous drainage on top of the maximized antibiotic use. A recent meta-analysis showed a mortality rate of 12% among patients with splenectomy and a complication rate of 26%, however the percutaneous drainage had a mortality of 8% and a complication rate of 10% 14 This highlights the clinical awareness and decision among patients with splenic abscess.

Presenting a case of 37-year-old female who came in with left upper quadrant pain. This patient had undergone laparoscopic cholecystectomy 6 months prior to admission with an unremarkable outcome. An onset of left upper quadrant pain was noted 3 months prior to admission and was initially conservatively managed with unrecalled antibiotics. Persistence of this prompted further work up where ultrasound revealed an abscess in the spleen and was then admitted for broad spectrum antibiotics, namely piperacillin-tazobactam and further imaging. CT scan of whole abdomen with contrast was then done which revealed splenomegaly with rim enhancing near fluid attenuating lesions in the mid to inferior pole. The complexity of the abscess prompted the decision for splenectomy, the gold standard for treatment for splenic abscess. Patient had tested negative for HIV.

Splenic abscess is a rare condition, usually presenting with fever and left upper quadrant pain, the patient however did not present with fever despite a complex abscess. Splenic abscess is associated with a high mortality rate. A wide array of differentials is considered in patients with left upper quadrant pain and laboratories are directed into investigating the structural cause for left upper quadrant pain as the spleen has many adjacent organs which may present similarly. The decision to choose splenectomy and percutaneous abscess determines survivability of infection as splenectomy places patient in an immunocompromised state, thus early recognition of splenic abscess, and feasibility of percutaneous drainage is vital to the out-hospital outcome for the patient. Among immunocompetent individuals, given the lower mortality and lower complication rates, it may be ideal to combine both medical and minimally invasive procedures and a rise in complication may then warrant splenectomy.

The clinical burden of colorectal cancer (CRC) is high. Population-based screening and early detection are essential to improve the long-term clinical outcome. Nonetheless, a significant proportion of patients still present at an advanced stage, including with acute large bowel obstruction. Image-enhanced endoscopy and artificial intelligence can improve the detection and diagnosis of colonic adenomas and early cancer. Endoscopic resection is regarded as the preferred curative treatment option for colonic adenoma and T0 and T1 CRC limited to the superficial submucosa. Emergency colonic stenting as bridge to interval curative surgery is increasingly accepted as a first-line option when technically feasible. Minimally invasive resection techniques such as laparoscopic colectomy and robot-assisted colorectal surgery have also come of age. These techniques reduce post-treatment morbidity, shorten the recovery process and can be cost-effective while maintaining long-term oncological cure. These outcome measures are relevant to our patients; therefore, minimally invasive approaches to curative resection should be embraced.
Humans ; Colorectal Neoplasms/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy/methods* ; Colectomy/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Colonoscopy/methods*

Visual minimally invasive acupotomy is applicable for the diseases with the pathological characteristics of soft tissue injury, including disorders of spine, four limbs and joints, peripheral nerve compression and chronic soft tissues. The diseases with superior effect obtained are cervicogenic headache, lumbar disc herniation, carpal tunnel syndrome and flexor tendon stenosing tenosynovitis. Under the guidance with ultrasound, visual minimally invasive acupotomy is advantaged at preoperative diagnosis, intraoperative guidance and postoperative evaluation in clinical practice so that it is precise, safe and reliable in clinical treatment. Visual minimally invasive acupotomy is essentially a kind of "ultra-minimally invasive" technique in treatment, focusing on the self-rehabilitation of the body induced by external treatment measures. It is highly complementary to the repair and reconstruction of minimally invasive surgery of modern medicine in clinical application.
Humans ; Acupuncture Therapy/methods* ; Minimally Invasive Surgical Procedures

Liver transplantation is an effective treatment for end-stage liver disease. Liver transplantation is technically complex and associated with significant trauma. In recent years,minimally invasive surgical techniques,such as laparoscopy and robotic surgery,have rapidly developed and been widely applied across various surgical fields. Minimally invasive surgery offers advantages including reduced trauma,less bleeding,and faster postoperative recovery,and has become a mainstream trend in surgical development. In the field of liver transplantation,laparoscopic and robotic donor hepatectomy techniques for living donor liver transplantation have made significant progress. However, due to difficulties in exposing the anastomotic sites of the donor liver and challenges in vascular anastomosis,the application of minimally invasive techniques in donor liver implantation has progressed relatively slowly. With advancements in laparoscopic and robotic surgical techniques and related instruments,laparoscopic donor liver implantation has gradually become feasible. Currently,multiple liver transplant centers worldwide have begun to progressively perform laparoscopic or robot-assisted liver transplantation in recipients,demonstrating potential advantages in reducing surgical trauma and accelerating postoperative recovery. However,there is currently a lack of guidelines or consensus on the application of minimally invasive surgery in liver transplant recipients. Therefore,Branch of Organ Transplantation of Chinese Medical Association,Surgery Group of Chinese Society of Surgery of Chinese Medical Association,and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association invited experts in the field to discuss clinical issues. Combining published guidelines,consensus statements,and research advancements,they formulated the "Technical guidelines for minimally invasive surgery in liver transplant recipients（2025）", aiming to provide reasonable guidance and references for clinical practitioners in the field of liver transplantation.
Humans ; Liver Transplantation/methods* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy ; Robotic Surgical Procedures ; Practice Guidelines as Topic

OBJECTIVE: To explore effectiveness of TiRobot-assisted screw implantation in the treatment of coracoid process fractures of the scapula. METHODS: A retrospective analysis was conducted on the clinical data from 24 patients with coracoid process fractures of the scapula admitted between September 2019 and January 2024 and met selection criteria. Among them, 12 patients underwent TiRobot-assisted screw implantation (robot group) and 12 underwent manual screw implantation (control group) during internal fixation. There was no significant difference ( P>0.05) in baseline data such as gender, age, body mass index, disease duration, cause of injury, coracoid process fracture classification, and proportion of patients with associated injuries between the two groups. The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, coracoid process fracture healing time, and complications were recorded and compared, as well as pain visual analogue scale (VAS) score, and Constant-Murley score at last follow-up. RESULTS: The intraoperative blood loss and incision length in the robot group were significantly lower than those in the control group ( P<0.05); however, there was no significant difference in operation time and hospital stay between the two groups ( P>0.05). All patients were followed up 8-27 months (mean, 17.5 months), and the difference in follow-up time between the two groups was not significant ( P>0.05). At last follow-up, the VAS score for shoulder pain in the robot group was signifncatly lower compared to the control group, and the Constant-Murley score was significantly higher ( P<0.05). In the robot group, 16 screws were implanted intraoperatively, while 13 screws were implanted in the control group. Radiographic re-evaluation showed that the excellent and good rate of screw implantation was higher in the robot group (93.8%, 15/16) than in the control group (61.5%, 8/13), but the difference in the precision of screw implantation between the two groups was not significant ( P>0.05). Four patients in the robot group and 1 in the control group achieved double screws fixation; however, the difference in achieving double screws fixation between the two groups was not significant ( P>0.05). All fractures healed in both groups with 1 case of malunion in the control group. There was no significant difference in healing time between the two groups ( P>0.05). During follow-up, 1 patient in the control group experienced screw loosening and displacement. There was no significant difference in the incidence of screw loosening and fracture malunion between the two groups ( P>0.05). CONCLUSION Compared with manual screw implantation, TiRobot-assisted minimally invasive treatment of coracoid process fractures of the scapula can reduce intraoperative blood loss, shorten incision length, alleviate pain, and obtain better promote shoulder joint functional recovery.
Humans ; Male ; Female ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Minimally Invasive Surgical Procedures/instrumentation* ; Adult ; Middle Aged ; Fractures, Bone/surgery* ; Bone Screws ; Coracoid Process/surgery* ; Robotic Surgical Procedures/methods* ; Scapula/surgery* ; Treatment Outcome ; Operative Time ; Young Adult ; Length of Stay ; Blood Loss, Surgical

OBJECTIVE: To investigate the effectiveness of posterior minimally invasive approach in the treatment of posterior wall acetabular fractures. METHODS: The clinical data of 17 patients with posterior wall acetabular fractures treated with posterior minimally invasive approach between March 2019 and June 2023 were retrospectively analyzed. There were 14 males and 3 females with an average age of 41 years ranging from 28 to 57 years. The causes of injury were traffic accident in 12 cases and falling from height in 5 cases. There were 3 cases complicated with posterior hip dislocation and 2 cases complicated with sciatic nerve injury. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 11 cases of type A1.1 and 6 cases of type A1.2. The time from injury to operation was 5-8 days, with an average of 6.2 days. The incision length, intraoperative blood loss, and operation time were recorded. The quality of posterior wall fracture reduction were evaluated by Matta criteria, and hip function were evaluated by modified Merle d'Aubign-Postel score criteria at 6 months after operation and last follow-up. RESULTS: The operation was successfully completed in 17 cases. The length of incision ranged from 7 to 9 cm, with an average of 8.3 cm, and all incisions healed by first intention. The intraoperative blood loss ranged from 200 to 350 mL, with an average of 281 mL. The operation time ranged from 45 to 70 minutes, with an average of 57 minutes. Two patients had sciatic nerve injury before operation, and the sciatic nerve function recovered completely at 3 months after operation; the other 15 patients had no symptoms of sciatic nerve injury after operation. All the 17 patients were followed up 14-27 months, with an average of 19.5 months. At 1 week after operation, according to the Matta criteria, anatomical reduction was achieved in 12 cases and satisfactory reduction in 5 cases, with a satisfaction rate of 100%. According to the modified Merle d'Aubign-Postel scoring system, the hip function score was 13-18 (mean, 16.1) at 6 months after operation. Among them, 5 cases were excellent, 9 were good, and 3 were fair, with an excellent and good rate of 82.4%. At last follow-up, the hip function score was 7-18 (mean, 13.7), of which 3 cases were excellent, 9 were good, 3 were fair, and 2 were poor, with an excellent and good rate of 70.6%. During the follow-up, there was no infection, failure of internal fixation, and femoral head necrosis, and heterotopic ossification occurred in 2 cases. CONCLUSION The posterior minimally invasive approach has the advantages of less trauma, shorter operation time, less blood loss, without cutting off the external rotator muscle. Exposure through the gluteus medius-piriformis space and piriformis-supercilium space can provide sufficient safe exposure for the posterior wall acetabulum fracture, which is a reliable alternative approach for the posterior acetabular fracture.
Humans ; Acetabulum/surgery* ; Male ; Female ; Adult ; Middle Aged ; Minimally Invasive Surgical Procedures/methods* ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Fractures, Bone/diagnostic imaging* ; Treatment Outcome ; Operative Time

OBJECTIVE: To compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. METHODS: A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. RESULTS: One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found ( P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation ( P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width ( P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant ( P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation ( P>0.05). However, there were significant differences in the two groups between the pre- and post-operation ( P<0.05). CONCLUSION The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.
Humans ; Hallux Valgus/surgery* ; Osteotomy/methods* ; Male ; Female ; Minimally Invasive Surgical Procedures/methods* ; Retrospective Studies ; Middle Aged ; Forefoot, Human/pathology* ; Adult ; Treatment Outcome ; Aged