Transtumoral endoprothesis in surgery of colorectal cancer, complicated with colonic obstruction: advantages and disadvantages. A review of the literature

A multifactorial analysis of the literature data on the treatment of acute tumor colonic obstruction using minimally invasive endoscopic surgical technology was carried out. On the basis of the analysis of special publications, the effectiveness of stenting of the large intestine, as a minimally invasive endoscopic method of decompression, is presented. Indications and contraindications for colorectal stenting, advantages and disadvantages, possibilities and prospects of endoscopic decompression of the colon are described in detail. It is postulated that stenting, used in acute tumor obstruction of the colon as a «bridge to surgery», being a worthy alternative to classical colostomy, allows an effective antegrade decompression of the colon and prepares the patient to surgical treatment with the performance of oncological justified primary radical and one-stage restorative operations in more optimal conditions with minimal risk. It is shown that in the late stages of the malignant process and in the presence of neresect-leucorrhoea colorectal cancer, as well as in the presence of absolute contraindications to a radical surgeon Colon stenting can serve as the final treatment for inoperable patients.

Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network

Purpose In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. Methods A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. Results The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. Conclusions The social implementation of telesurgery using the currently available commercial communication network is feasible.

Fungal endophthalmitis

The question of the pathogenesis and development of fungal endophthalmitis is an urgent research topic Purpose. Evaluation of the clinical effectiveness of treatment of patients with fungal endophthalmitis over the past 5 years using the developed surgical technology. Material and methods. In the period 2016-2021, 5 patients with fungal endophthalmitis were treated. With the fungal etiology of endophthalmitis, one patient was after a penetrating wound, 4-after corneal microtraumas with the development of keratouveitis (all after using contact lenses). Surgical treatment included taking intraocular material for examination, performing vitrectomy in the maximum possible volume, tamponade of the vitreal cavity with perfluorodecalin (for 5-14 days) and intravitreal administration of amphotericin B in 10 mcg in 0.1 ml. Results. As a result of treatment of fungal endophthalmitis, it was possible to preserve the eye as an organ in 3 patients (60%), to preserve visual functions in 1 patient (20%). Conclusion. Fungal endophthalmitis is a severe pathology of the visual organ. The prognosis for the preservation of visual functions is unfavorable, the preservation of the eye is doubtful. Key words: fungal endophthalmitis, vitrectomy, perfluorodecalin, amphotericin B.

Comparison of Two Sternal Closure Techniques Based on Risk Factors: A Prospective, Observational Study

Background. Stainless steel wires are still commonly used as a sternum closure technique. However, it can cause fatal complications due to rupture and dehiscence. It was anticipated that the sternal Cable System (Pioneer Surgical Technology Inc., Marquette, MI, USA) could provide a better sternal fixation and reduce the possible complications. Materials and Method. A total of 100 patients (57 male, 43 female) at high risk of dehiscence were included in this prospective observational study. Among those with EuroSCORE value of 4 and above, patients with chronic lung disease, chronic kidney disease, diabetes mellitus, obesity, smoking, body mass index, advanced age, and resurgery were operated in two separate centers. Standard steel wires ( n : 51) used for sternotomy were compared with the sternal cable ( n : 49). Early and late sternal dehiscence rates were compared in the study. The relationship between risk factors causing dehiscence and both methods was assessed statistically. Results. Early dehiscence rates were 6.4% in those closed with a sternal cable ( n : 3) and 11.8% in those closed with a sternal wire ( n : 6) ( p < 0.05 )). In risky patients, body mass index was the most determining parameter in terms of sternum dehiscence risk. Conclusion. In risky patients, we recommend the sternal cable system as a good and reliable closure technique to achieve a more stable and compact sternum.

SP10.2.11 Horses for Courses – do surgical courses exist outside of the Royal Colleges?

Aims Educational courses supplement deanery-led teaching, and may be mandatory for training progression. The Royal College websites are the first contact for trainees to search for courses, with other courses identified by word of mouth. This project aimed to collate a first comprehensive database of courses available for core and higher general surgical trainees and to identify areas requiring development. Methods A snowballing approach was used to systematically search all online available resources. This includes, but was not limited to, websites of the Royal Colleges, sub-speciality societies, trainee organisations, regional centres, deaneries and surgical technology companies. Course target grade, price, provider and dates were collated into a database. Conferences and symposiums were excluded. Results 47 sources yielded 173 courses, priced between £50 to £1600 (median £450). Technical skills (89/173) and clinical courses (45/173) entailed the majority; only 3 courses developed non-technical skills and 4 developed surgical leadership. Other categories include revision (11.6%), teaching (5.2%), and research skills (1.7%). The Royal Colleges provided 27.7% of all available courses, with the majority developed and delivered by other institutions. There was significant variability in available course information. Conclusions There are a wide variety of courses available for surgical trainees, however this information is fragmented, duplicated and incomplete. A central database requires maintenance, but would provide a reliable source of information. Leadership, research and non-technical skills are critical skills for surgeons – the lack of courses in these areas was surprising and require development as only 4 courses are endorsed by the Royal Colleges.

TP8.2.3 Horses for Courses – the Impact of Covid-19 on Surgical Training Courses

Aims Surgical training has been disrupted by the Covid-19 pandemic. Educational courses may be mandatory for training progression, complementing critical skills for surgical trainees. Previous work collated a first comprehensive database of available courses. The aim of this project was to determine the extent of disruption caused to courses by the current pandemic. Methods A snowballing approach was used to systematically search all online resources for courses available in 2021. This included websites of the Royal Colleges, sub-speciality societies, trainee organisations, regional centres, deaneries and surgical technology companies. Course target grade, price, provider and dates were collated and compared to matching data from 2020. Results 35 sources yielded 127 courses. Since 2020, 78 courses had been cancelled and 37 new courses had been introduced. Courses price ranged between £90-1260 (median £495), with 12 courses increasing in cost overall and 4 reducing in cost due to online delivery. Only 13/127 courses were delivered online, 9 of which were newly available in 2021. Technical, clinical and revision courses constituted the majority (115/127), with only 3 courses dedicated to leadership or research. Conclusions Educational courses supplement aspects of deanery-led teaching which are perceived to be lacking. However, course providers must respond to the need of trainees and adapt to the training restrictions necessitated by the Covid-19 pandemic by improving the availability of online courses. Whilst technical skills are often the primary focus of surgical training, the importance of non-technical, leadership and research skills is arguably greater than ever and should be recognised.

Digital Surgery Group Versus Traditional Experience Group in Head and Neck Reconstruction: A Retrospective Controlled Study to Analyse Clinical Value and Time-Economic-Social Effect

Objective: Explore the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection, and comprehensively evaluate the operation time and cost-effectiveness.Methods: Retrospective analysis of head and neck cancer patients who underwent reconstruction in head and neck surgery of Sichuan cancer hospital from January 2015 to January 2021. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases in the digital surgery (DS) group and 27 cases in the conventional surgery (CS) group. The clinical pathological characteristics, postoperative complications, functional and aesthetic evaluation indexes and time-cost-satisfaction evaluation indexes of the two groups were compared and statistically analyzed. Typical cases of digital surgery assisted surgery were shared.Results: There was no significant difference between the two groups in the defect size, pathological type and other major clinicopathological features and operation related indicators (P > 0.05). There was comparability between the two groups, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). The incidence of titanium plate displacement, deformation or exposure and facial scar deformity in DS group was significantly lower than that in CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in DS group was significantly reduced (P < 0.05), and the speech and social functions were improved, but there was no significant difference (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this study (P > 0.05). At the same time, the total operation time, preparation time of donor site bone flap, osteotomy time and reconstruction time in DS group were significantly lower than those in traditional operation group (P < 0.05), but the plastic time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in DS group was shorter than that in CS group (P < 0.05). In particular, the preoperative doctor-patient communication of DS group was more effective, and the treatment satisfaction of patients and their families was higher (P < 0.05).Conclusion: Comprehensive application of digital surgical technology in reconstruction of head and neck after tumor resection is feasible in clinical practice, which can improve the accuracy of repair, decrease some surgical complications, preserve better and improve the patient's diet and speech function, reduce the operation and hospitalization time, but also increase the treatment cost. Futhermore, it is conducive to doctor-patient communication and improve patient satisfaction.

Room Size Influences Flow in Robotic-Assisted Surgery

The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = −2.488, df = 54, β = −0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.