Acta Chirurgica Croatica

Robotic versus conventional laparoscopic technique for the treatment of colorectal cancer disease

Igor Černi — 2024-11-25

Background: Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. The purpose of this study is to analyze the differences between laparoscopy and robotics for colorectal cancer in terms of oncologic and clinical outcomes in an initial experience.
Methods: In our study we analyzed and compared two group of patients operated robotically and laparoscopically. 85 patients operated robotically (49% female, 51% male). The average age was 63.5 years, 110 patients operated laparoscopic operations (64% male, 36% female), the average age was 65.5 years.
Results: In all patients radical resection has been done. The average number of isolated lymph nodes in the robotic method was 19 while in laparoscopic method was 15,5. The hospitalization was shorter in robotic operated patients (average 7,3days), on the other hand the time of the robotic operations was longer than laparoscopic operations. Intraoperative blood loss was in the robotic method smaller (50-120 ml) in comparison with laparoscopic method (100-300 ml). Conversion to open surgery was in robotic method lower (4,5%) than in laparoscopic method (7%). Laparoscopic method has more frequent complications 9 (10,3%) while robotic method 4 (9%). In 10 years follow up 9 laparoscopically operated died (10,3%), (5 due to cardiovascular disease, 4 due to progression of disease). In this period 3 robotically operated patients died (6%), one due to progression of disease, the others due to cardiovascular disease. The most common operation was right hemicolectomy (46%) by laparoscopic procedure, in the robotic method was anterior resection of rectum (54%).
Conclusion: Robotic colorectal surgery (RCS) is a promising technique and is safe and effective alternative to laparoscopic colorectal surgery. The advantages of RCS include reduced EBLs, lower conversion rates and shorter times to recovery of bowel function. Further studies are required to define the financial effects of RCS and the effects of RCS on long-term oncologic outcomes.

Introduction of robot-assisted surgery at University Hospital Centre Split

Zdravko Perko — 2024-11-25

Robot-assisted surgery is becoming a widely accepted method, especially as it expands indications for minimally invasive surgical procedures. This technology enhances accuracy, safety, and improves treatment outcomes, as it is associated with reduced blood loss, decreased morbidity, and accelerated recovery. For the safe and successful introduction of robotassisted surgery into a hospital, especially if it involves a new and first robotic system in the country, several interconnected prerequisites need to be fulfilled. First of all, it is necessary to have secured funds and the cooperation and support of the Ministry of Health. In particular project, funds are secured from EU funds.
Additionally, it is necessary to have a consensus of the hospital’s directorate and the heads of the organizational units within the hospital. The hospital must have a developed program for minimally invasive surgery and a large number of surgical procedures. Finally, the support and cooperation from the Agency for Medicinal Products and Medical Devices, equipment manufacturers and hospital specialist services are required. This program has been developing at University Hospital Split for about two years and the first surgical procedures were performed on March 11, 2024.

The effect of continuous use of intravenous analgesia on the quality of postoperative health care

Leonita Orascanin — 2024-11-25

Background: To investigate the effects of continuous administration of intravenous analgesia on the quality of postoperative care, and the impact of analgesia on reducing the length of stay in the intensive care unit.

Material and methods: A cross-sectional study was conducted that included 199 patients who were hospitalized at the Clinic for Anesthesiology, Reanimation, Intensive Medicine and Pain Therapy, Department of Anesthesiology, Postoperative Care and Intensive Medicine for Surgical Patients, University hospital Center Zagreb. For the purpose of the research, a visual analogue pain assessment scale was used. The research was conducted in the period from June 2022 to September 2022.

Results: The average age of the patients is 66 years, 67.8% had abdominal surgery, and 64.8% were male. Trauma patients are significantly younger than abdominal and vascular patients (P=0.001). The largest number of patients after abdominal surgery received continuous + bolus analgesia (P<0.001). Older patients have a lower initial VAS than younger patients (P=0.014). Men (P<0.001), abdominal patients (P=0.010) and patients after continuous (P=0.010), continuous + bolus (P=0.001) and bolus analgesia (P<0.001) had a higher initial VAS value and average VAS value. . Patients with higher initial values on the VAS scale had a higher average VAS value (P<0.001).

Conclusion: The continuous application of analgesia with the use of bolus analgesia has a more favorable effect on pain and affects the quality of patient healthcare during hospitalization in the Intensive Care Unit.

Surgical treatment of gastrointestinal stromal tumors – a single centre retrospective study

Dražen Tufeković — 2024-11-25

Background: Gastrointestinal stromal tumors (GIST) account for 1-3% of all malignant tumors of the gastrointestinal tract, with an annual incidence of 1.5 per 100,000 inhabitants. GISTs are the most common symptomatic tumors of the small intestine while the most common site of is the stomach followed by the small intestine and colon.
Material and methods: A retrospective, single centre study was conducted and it encompassed all patients who underwent surgical treatment of GIST in a period
2010-2020 at General Hospital Karlovac. Data were obtained from medical records using institutional digital system. Data on demographic, tumor and operative characteristics as well as outcomes were collected and analysed.
Results: A total of 12 patients with pathological diagnosis of GIST were treated in the study period. There were four men and eight women with mean age
of xx (ranged 49 - 79 years). The tumor was located in stomach in seven cases (58.3%), three were arising in small intestine, one in omentum, and one in mesenteric root. The most common clinical presentation was bleeding in seven patients followed
by obstruction in three and palpable tumor mass with pain in two patients. All patients underwent surgery under general anaesthesia. They were monitored over
a period of minimally 5 years and 10 patients had no recurrence, while one patient died within the first year due to cardiovascular incident. Only one patient died as
a result of disseminated GIST.
Conclusion: GISTs are uncommon tumors, but in most cases have favorable prognosis mainly due to successful surgical resection and availability of potent targeted
therapy. Abdominal surgeons should be familiar with etiology and pathophysiology of GISTs and diagnostic and therapeutic approaches in GIST management.

Traumatic dislocation of L4 vertebra, associated with perforation of small intestine and dissection of infrarenal aorta: a case report and review of literature

Tihomir Banic — 2024-11-25

Background: A section of the spine most often affected by trauma is located between the T10 and L2 segments. In this paper, we present a patient who suffered injury
at the l4–l5 level, as well as dissection of the infrarenal aorta and perforation of the small intestine.
Case study: A 39-year-old woman was injured in a car accident as a passenger, restrained by a seat belt. After resuscitation and diagnostic procedures, the injuries were treated in three stages. First, explorative laparotomy, resection, and T-T anastomosis of the small intestine were done. Repair of infrarenal aorta dissection with the CERAB technique followed. Finally, open reduction and stabilization of the lumbar spine, with exploration of the spinal canal and repair of the dural sac, were performed. In the postoperative period, normal function of the gastrointestinal tract, normal blood flow in the lower extremities, and normal alignment of the lumbar spine were restored, associated with partial recovery in the neurological status of the lower extremities.
Conclusion: The possibility of abdominal aortic rupture associated with lumbar spine fracture should always be considered in blunt force trauma. Endovascular stentgraft
repair techniques, including the CERAB method, are a valid method for treating these patients. Vascular repair needs to be followed by early spinal stabilization to further diminish mortality and complications rate.

Abdominoscrotal hydrocele in a 5-month old infant: case report

Asmir Jonuzi — 2024-11-25

Abdominoscrotal hydrocele (ASH) is a very rare condition in which the hydrocele sac extends beyond the scrotum to the abdomen via the inguinal canal. This condition is characterised by a large abdominal and scrotal component connected by an isthmus within the inguinal canal. The precise etiology of ASH is not known. Diagnosis can be made clinically and confirmed by ultrasound. Spontaneous resolution is rare and longstanding ASH may lead to complications, thus early surgical intervention is recommended. We present a 5-month-old male infant with a large right cystic inguinoscrotal mass that had been increasing in size since birth.

Laparoscopic cholecystectomy in situs inversus totalis: a case report and review of the surgical techniques

Hakan Arıkan — 2024-11-25

Background: Situs inversus totalis is a rare condition characterized by the mirror image transposition of internal organs. Diagnosis may be difficult when the patient has situs inversus as the presenting symptoms may lead to confusion. Laparoscopic cholecystectomy becomes more technically demanding for surgeons due to the modification and reorientation of the surgical procedure.
Case study: A 46-year-old male patient presented with left upper quadrant pain, nausea, and vomiting. Physical examination revealed mild tenderness to palpation in the left upper quadrant region. Murphy’s sign was negative and the laboratory results were normal. Abdominal ultrasonography revealed situs inversus and a single 36-mm gallstone. The patient underwent laparoscopic cholecystectomy and the postoperative course was uneventful.
Conclusion: Due to the reversal of internal organs in patients with situs inversus totalis, laparoscopic cholecystectomy becomes technically demanding in patients who present with cholelithiasis. Various techniques have been suggested to minimize reorientation issues during surgery.

Portomesenteric thrombosis with bowel necrosis in COVID-19 patient: case report

Vedrana Biošić — 2024-11-25

Background: COVID-19 related hypercoagulability is by now a well-established complication of this viral disease. The exact pathophysiological mechanisms of this process are not entirely clear but endothelial cell damage is thought to be a precursor to the pathological activation of the coagulation cascade. Although pulmonary embolism is the commonest thrombotic event, thromboemboli can form anywhere in the body and intraabdominal vessels are no exception. Descriptions of cases with bowel necrosis due to portomesenteric thrombosis have been increasingly emerging.
Case study: We present the case of a 60-year-old male COVID-19 positive patient with a radiologically confirmed portal vein and superior mesenteric vein thrombosis with small bowel necrosis treated surgically at our Institution. The thrombotic event was contributed to the viral infection and in conjunction with surgical treatment anticoagulant therapy was introduced.
Conclusion: Although often self limiting, gastrointestinal complaints in covid patients could also prove to be a surgical emergency. High risk of thromboembolic events in COVID-19 patients has to be taken into consideration while examining and treating the patient.