Objective: The aim of this retrospective study was to describe and evaluate our single center experience with robotic aortic and non-aortic vascular surgery to treat mostly occlusive disease and aneurysms. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon.

Methods: From November 2005 to June 2020, 500 robot assisted vascular operations were performed. 326 patients were prospectively evaluated for occlusive disease, 127 patients for abdominal aortic aneurysm (AAA), 5 for a common iliac artery aneurysm, 10 for a splenic artery aneurysm, 1 for a internal mammary artery aneurysm, 16 patients for median arcuate ligament release, 10 for endoleak II treatment post endovascular aneurysm repair (EVAR), 2 for renal artery reconstruction and 3 cases were inoperable. 5 hybrid procedures in study were performed.

Results: 477 cases (95,4%) were successfully completed robotically, 3 patient's surgery (0,6%) was discontinued due to heavy aortic calcification and severe peri-aortitis respectively. In 20 patients (4%) conversion was necessary. The thirty-day mortality rate was 0,4% (2 patients), and early non-lethal postoperative complications were observed in 8 patients (1,7%).

Conclusions: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The robotic system provides a real opportunity for minimally invasive surgery in the field of vascular surgery and offers true mini-invasive surgical vascular interventions with all its advantages. Robotic AAA treatment and aorto-femoral represent the standard operations in vascular surgery, and they are not only possible but also safe and successful.

Aim: To study available data on the advantages of peritoneal lavage with distilled water following CRC resection, and compare that to Betadine® and saline peritoneal lavages in improving overall patient outcomes.

Methods: PubMed, Google Scholar, and Cochrane database were searched until October 2020. References from relevant articles were reviewed to widen the search.

Results: Overall, 3 experimental studies were identified. Water was found to be superior to other peritoneal lavage solutions in inducing tumorigenic cell lysis in vitro. Mice who underwent peritoneal lavage with water survived longer and had a significantly reduced peritoneal tumour burden compared to mice who did not undergo lavage, or those treated with saline lavage solution. Peritoneal secretions were found to contaminate water lavage and reduce its cell-lytic effect. Nonetheless, complete cell lysis was achieved in vivo by prolonging the time of cell exposure to contaminated lavage solution by 20 min.

Conclusion:  This systematic review appreciates that water would not eliminate the risk of disease recurrence, but it could potentially reduce it. As peritoneal lavage is a simple, inexpensive and well-practiced technique in cancer surgery, despite any overwhelming evidence, we suggest adjusting the procedure and utilising distilled water, as murine model studies suggest it may improve prognosis in patients with disseminated disease. Further evidence is required to regard sequential peritoneal lavages with water as beneficial and safe in humans.

Parastomal hernias are a common complication of stomas. However, gastric outlet obstruction secondary to a parastomal hernia is a rarity, with only 14 reported cases in literature and predominantly found among elderly women above 75 years -old with colostomies. It has been hypothesized that gastric ligament laxity and acquired fascial defects increase the risk of parastomal gastric herniation. We report a retrospective case of a 60-year-old lady who presented with the above mentioned picture on a background of a previous abdominoperineal resection with an end colostomy for a colorectal carcinoma 9 years ago as well as 3 previous incisional hernias with mesh reinforcements. The patient presented with gastric outlet obstruction from a pre-existing parastomal hernia that manifested in localized upper abdominal pain and profuse vomiting. She had two previous admissions for partial gastric outlet obstruction from her parastomal hernia which were managed symptomatically. On this presentation, she was febrile, tachycardic with an irreducible tender parastomal hernia and elevated inflammatory marker. Computed tomography (CT) abdomen revealed more pronounced proximal gastric dilatation compared to previous scans with the body of stomach situated within the parastomal hernia. The patient was resuscitated and had nasogastric decompression pre-operatively and was noted to have dense intra-abdominal adhesions with a substantial stomach volume incarcerated within a large parastomal hernia intra-operatively. She had adhesiolysis performed laparoscopically using two robotic ports situated between two 12mm ports, an old mesh that was adherent to the stomach and small bowel was reduced with hernia reduced . The Sugarbaker technique was applied to repair the hernia with a Biodesign mesh and subsequently the end colostomy was mobilized, pulled through the hernial sac and the stoma refashioned. The patient had an uneventful recovery period post-operatively and was discharged on day five. The significance of this case in literature would be that it is the first where roboticassociated laparoscopic surgery was applied.

Objectives

The object of this study is to introduce a novel USG approach for lumbar periradicular injections by investigating radicular artery nearby (IRAN) technique and to assess the feasibility and preliminary means by fluoroscopy.

Study Design

The USG periradicular injection is performed under real time imaging. An axial scanning view is obtained through identifying the spinous processes, lamina, zygapophyseal joints and transverse processes.

Setting

The curve probe put transversally  and the needle site check in axial and sagittal view.

Methods

The IRAN technique was defined by sliding probe a little lower under the facet joint in sagittal plane to view the pulse of nearby radicular artery by Doppler or Pulse Echo. Then spinal needles are advanced with in-plane technique toward the artery until touch the nearby bone.

Results

Fluoroscopy examination confirms that the needle tip is correctly placed under the pedicle along the nerve root  and  lateral to the pars interarticularis with no intravascular injection.

Limitation

Although searching for small vessels is difficult in cadaver studies, the IRAN technique would be confirmed in the future on Cadaver section.

Conclusion

The IRAN technique introduce pulse of  artery (spinal ramus branch of the lumbar segmental artery (SA) or SA itself, not radicular artery) as a new sonoanatomic landmark for safe periradicular placement of the needle for extraforaminal injection.

In many young patients, blood pressure with a tendency to be low associated with fine vessels causes many arteriovenous fistulas for hemodialysis (AVF) in upper limbs with prostheses to fail.

These patients remain for months or for life with indwelling catheters, with the risk of infection that means and a decrease in their quality of life. In some, another AVF is made with prostheses in femoral vessels, but the problems associated with the prostheses continue.

For this reason we think of a technique that is with a vein, which these patients would benefit.

In this way we avoid the risk of occlusion due to hypotension and infections typical of AVF with prostheses.

Objective
Avoid indwelling catheters and AVFs with femoral prostheses in young patients with exhaustion of vascular accesses.

Material and method

Between July and October 2020, 5 patients were operated on with transposition of the femoral vein.

It was used in 4 patients under 30 years of age and in a 57-year-old patient.

In all 5, access to upper limbs was exhausted. The 57-year-old also had a left femoral AVF with prosthesis.

Varicose veins and lower limb arteriopathy were ruled out in the 5 patients.

Results

In all the patients they began to puncture at approximately 30 days; with flows greater than 300 ml / min and venous resistance less than 200 mmHg.

The punctures were started with needle No. 17, currently No. 15. The pump flow is between 300 and 400 ml / min, the venous resistance is less than 200 mmHg. The KTV around 1.5.