Colorectal cancer (CRC) is one of the most common solid malignancies worldwide. Although sporadic CRC represents the most common form, genetic alterations is increasingly being identified in a relevant portion of patients with CRC. Familial CRC describes an increased incidence of adenomatous polyps and CRC in first - degree relatives. Hereditary CRC is defined by the identification of deleterious mutations in known predisposing genes. Typical hereditary syndromes with predisposition to CRC include: hereditary non-polyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, Peutz-Jeghers syndrome and MUTYH associated polyposis. Newly identified genetic alterations with increased risk for CRC include: PPAP, NAD, MSH3 and NTHL1. The diagnosis, surveillance and optimal surgical management of patients with hereditary predisposition to CRC warrant a good understanding of the genetic syndrome in question. Prophylactic surgery must be segregated from symptom-related procedures depending on the syndrome in question. The need for extended surgical procedures must be made in an individualized manner based on gene and gender. The patient should play an active role in the surgical decision-making. Minimally invasive access should be the preferred approach and postoperative quality of life must be seen as a primary outcome measure.

Percutaneous renal access remains the cornerstone initial step in varied clinical settings. For obtaining the best surgical outcome and minimizing patient morbidity, an appropriate access to the target calyx is needed. Though the site of entry depends upon anatomy of pelvicalyceal system and indication for access, a proper technique should be used for gaining access and at the same time minimizing the associated complications. This article describes our technique of gaining access to the pelvicalyceal system and subsequent percutaneous nephrostomy placement in a stepwise manner.

Pathologists are an integral member of the colorectal multidisciplinary team and are able to closely interact with surgeons, radiologists and oncologists to facilitate improvements in surgical quality and patient outcomes. Accurate, high quality pathology reports containing all vital prognostic information are essential to ensure the patient receives optimal treatment. These reports should also integrate feedback to all members of the multidisciplinary team on the accuracy of preoperative staging, response to preoperative treatment, and the quality of surgery. Pathologists have played a key role in improving outcomes in patients with rectal cancer by recognising the prognostic importance of an involved circumferential resection margin. In addition, pathologists have described an assessment of the surgical planes of dissection as a marker of surgical quality and thereby a means of quality control. This article will review the current best practice for the pathological assessment of anterior resections and abdominoperineal excisions for rectal cancer and ultimately look at how pathologists can influence quality control in rectal cancer surgery.

Lumbar disc herniation (LDH) is a common disease characterized by leg pain, numbness, and low back pain, which are also encountered in peripheral nerve and paralumbar spine disease. This study describes other diseases with symptoms similar to LDH. Patients with paralumbar spine diseases such as superior cluneal nerve entrapment neuropathy (NEN), gluteus medius muscle pain, piriformis syndrome, and sacroiliac joint pain experience lowback, buttock, and leg pain. Peripheral nerve diseases of the leg including lateral femoral cutaneous NEN, common and superficial peroneal NEN, and tarsal tunnel syndrome also cause leg symptoms. These diseases can produce intermittent claudication, thought to be specific to lumbar spine disease, and can be misdiagnosed as LDH. They are rather common and can be treated less invasively. As a misdiagnosis may result in failed back-surgery syndrome, it is important to differentiate between LDH and the diseases described here.

Robot-assisted surgery is a commonly performed procedure in the recent urological approach. The scientific data that reveal the complication rates also tend to increase by the rising popularity of the robot-assisted surgeries in the treatment of urological cancers. Patient characteristics, nature of the cancer and learning curve of the surgeon are the determinant factors of the complication rates. Nevertheless, robot-assisted surgical techniques are safer with acceptable morbidity and mortality rates as compared to open surgical methods. In urology practice, robotic surgery is most commonly performed in the treatment of prostate cancer. Thus, this review subjected to reveal the commonly seen and the serious complications of robot-assisted radical prostatectomy, and their prevention and management.

In colon cancer surgery, laparoscopic resection is a safer and more feasible method than open resection; however, despite its increasing popularity in recent years, laparoscopic approaches for the treatment of rectal cancer have not become a standard therapy option, due to the technical difficulties in gaining access to the deep and narrow pelvis and the steep learning curve. Multiple randomized trials found that short-term oncological outcomes and perioperative mortality and morbidity were comparable between laparoscopic and open rectal surgery, whereas comparative data between the two approaches. Comparative data between the two approaches on long-term oncological outcomes remain limited. In this review, we summarize the current status of laparoscopic surgery in rectal cancer in the light of recent studies.

Colorectal cancer (CRC) is one of the most common solid malignancies worldwide. Although sporadic CRC represents the most common form, genetic alterations is increasingly being identified in a relevant portion of patients with CRC. Familial CRC describes an increased incidence of adenomatous polyps and CRC in first - degree relatives. Hereditary CRC is defined by the identification of deleterious mutations in known predisposing genes. Typical hereditary syndromes with predisposition to CRC include: hereditary non-polyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, Peutz-Jeghers syndrome and MUTYH associated polyposis. Newly identified genetic alterations with increased risk for CRC include: PPAP, NAD, MSH3 and NTHL1. The diagnosis, surveillance and optimal surgical management of patients with hereditary predisposition to CRC warrant a good understanding of the genetic syndrome in question. Prophylactic surgery must be segregated from symptom-related procedures depending on the syndrome in question. The need for extended surgical procedures must be made in an individualized manner based on gene and gender. The patient should play an active role in the surgical decision-making. Minimally invasive access should be the preferred approach and postoperative quality of life must be seen as a primary outcome measure.

Pathologists are an integral member of the colorectal multidisciplinary team and are able to closely interact with surgeons, radiologists and oncologists to facilitate improvements in surgical quality and patient outcomes. Accurate, high quality pathology reports containing all vital prognostic information are essential to ensure the patient receives optimal treatment. These reports should also integrate feedback to all members of the multidisciplinary team on the accuracy of preoperative staging, response to preoperative treatment, and the quality of surgery. Pathologists have played a key role in improving outcomes in patients with rectal cancer by recognising the prognostic importance of an involved circumferential resection margin. In addition, pathologists have described an assessment of the surgical planes of dissection as a marker of surgical quality and thereby a means of quality control. This article will review the current best practice for the pathological assessment of anterior resections and abdominoperineal excisions for rectal cancer and ultimately look at how pathologists can influence quality control in rectal cancer surgery.

Aim: To evaluate the application of laminectomy using the interlaminar approach (ILA) for percutaneous endoscopic lumbar discectomy (PELD).

Methods: Minimal laminectomy using the ILA for PELD was performed in 13 patients with lumbar disc herniation (LDH). The width of the interlaminar space, shape of the caudal margin of the upper vertebral laminae (CM-UVL), LDH size, and caudal migration grade were radiologically evaluated. Ten LDHs were removed via the shoulder of the corresponding nerve root, and three via the axilla of the corresponding nerve root and dural sac. Bone status was evaluated preoperatively and postoperatively using two- and three-dimensional computed tomography.

Results: All patients (mean age 46.3 years) underwent PELD at a single spinal level, mostly at L5/S1. Compared with a previous study without laminectomy, the mean operative duration (57.5 min) and operative outcome, evaluated using the modified Japanese Orthopaedic Association and Numerical Rating Scale scores, were similar; no complications were observed. However, the width of the interlaminar space was significantly narrower, and eight cases revealeda narrow interlaminar space (width < 20 mm and/or lost concave shape of CM-UVL).

Conclusion: Minimal laminectomy using the ILA for PELD is feasible for treating LDH with the narrow space and highly migrated LDH.

Percutaneous renal access remains the cornerstone initial step in varied clinical settings. For obtaining the best surgical outcome and minimizing patient morbidity, an appropriate access to the target calyx is needed. Though the site of entry depends upon anatomy of pelvicalyceal system and indication for access, a proper technique should be used for gaining access and at the same time minimizing the associated complications. This article describes our technique of gaining access to the pelvicalyceal system and subsequent percutaneous nephrostomy placement in a stepwise manner.

In colon cancer surgery, laparoscopic resection is a safer and more feasible method than open resection; however, despite its increasing popularity in recent years, laparoscopic approaches for the treatment of rectal cancer have not become a standard therapy option, due to the technical difficulties in gaining access to the deep and narrow pelvis and the steep learning curve. Multiple randomized trials found that short-term oncological outcomes and perioperative mortality and morbidity were comparable between laparoscopic and open rectal surgery, whereas comparative data between the two approaches. Comparative data between the two approaches on long-term oncological outcomes remain limited. In this review, we summarize the current status of laparoscopic surgery in rectal cancer in the light of recent studies.

Lumbar disc herniation (LDH) is a common disease characterized by leg pain, numbness, and low back pain, which are also encountered in peripheral nerve and paralumbar spine disease. This study describes other diseases with symptoms similar to LDH. Patients with paralumbar spine diseases such as superior cluneal nerve entrapment neuropathy (NEN), gluteus medius muscle pain, piriformis syndrome, and sacroiliac joint pain experience lowback, buttock, and leg pain. Peripheral nerve diseases of the leg including lateral femoral cutaneous NEN, common and superficial peroneal NEN, and tarsal tunnel syndrome also cause leg symptoms. These diseases can produce intermittent claudication, thought to be specific to lumbar spine disease, and can be misdiagnosed as LDH. They are rather common and can be treated less invasively. As a misdiagnosis may result in failed back-surgery syndrome, it is important to differentiate between LDH and the diseases described here.

Robot-assisted surgery is a commonly performed procedure in the recent urological approach. The scientific data that reveal the complication rates also tend to increase by the rising popularity of the robot-assisted surgeries in the treatment of urological cancers. Patient characteristics, nature of the cancer and learning curve of the surgeon are the determinant factors of the complication rates. Nevertheless, robot-assisted surgical techniques are safer with acceptable morbidity and mortality rates as compared to open surgical methods. In urology practice, robotic surgery is most commonly performed in the treatment of prostate cancer. Thus, this review subjected to reveal the commonly seen and the serious complications of robot-assisted radical prostatectomy, and their prevention and management.

Technology keeps advancing in this era allowing surgery to become less invasive in many surgical sciences. Besides these technological advances, minimally invasive procedures such as laparoscopy and robotic assisted laparoscopy are preferred widely around the globe by both surgeons and patients. Because of the increasing demand to laparoscopy and robotic surgery, anesthetists also should adapt to these specific surgical procedures. Carbon dioxide (CO₂) insufflation is applied in these procedures in order to provide working space and exposure to target organs. CO₂ insufflation (pneumoperitoneum if applied intrabdominally) and positional maneuvers such as steep Trendelenburg position is used in urologic laparoscopy and robotic surgery, which have vital effects on patient’s physiology regarding cardiovascular, respiratory, renal, ocular and neurological systems. Special positions and unique surgical tools used in these procedures may hinder vital interventions such as cardiopulmonary resuscitation and open conversion. Comprehension of these pathophysiological effects and specific considerations is crucial to detect, to prevent and to manage serious complications that may occur during surgery.

Anisakiasis is increasing worldwide, even in Europe and in the Mediterranean region due to the increased practice of raw fish consumption. Usually, a detailed food history is the key to the diagnosis. A 52-year-old woman affected by pathological obesity underwent esophagogastroduodenoscopy (EGD) for a 1-year history of epigastric pain. In the gastric fundus, an Anisakis sp. larva, was casually detected. The nematode was successfully removed with a biopsy forceps. In this case, the finding of the parasite was casual, being detected during an accurate EGD performed for a 1-year history of epigastric pain in the patient.

Aim: Single-incision laparoscopic hernia repair (SILHR) is a popular technique, especially in female children, as it reduces the number of incisions while achieving a better cosmetic outcome. However, intracorporeal suturing and knotting remains a major obstacle during SILHR and it requires a relatively long learning curve. Conversely, extracorporeal suturing and knotting is straightforward, though it has several drawbacks. The purpose of this report is to describe a simple technique for SILHR in female children.

Methods: Between May 2014 and December 2016, 100 girls with 120 hernias of the Canal of Nuck (34 with right-side inguinal hernia, 46 with left-side hernia, and 20 with bilateral hernia) underwent SILHR. The opened internal inguinal ring was closed using a complete purse string suture fashioned by epidural needle with intracorporeal knot tying. The main outcomes were feasibility, operative time, complications and cosmetic outcome.

Results: The mean age was 2.0 ± 2.2 years, and the mean operative time was 8.0 ± 2.2 min for unilateral hernia repair and 16.0 ± 4.3 min for bilateral cases. All cases were completed laparoscopically without intraoperative complications. During follow-up, there were no recurrences and umbilical scars were almost invisible.

Conclusion: This simplified technique is feasible, quick, achieves better cosmetic results in female children, and avoids the drawbacks of extracorporeal knotting.

Aim: To evaluate the application of laminectomy using the interlaminar approach (ILA) for percutaneous endoscopic lumbar discectomy (PELD).

Methods: Minimal laminectomy using the ILA for PELD was performed in 13 patients with lumbar disc herniation (LDH). The width of the interlaminar space, shape of the caudal margin of the upper vertebral laminae (CM-UVL), LDH size, and caudal migration grade were radiologically evaluated. Ten LDHs were removed via the shoulder of the corresponding nerve root, and three via the axilla of the corresponding nerve root and dural sac. Bone status was evaluated preoperatively and postoperatively using two- and three-dimensional computed tomography.

Results: All patients (mean age 46.3 years) underwent PELD at a single spinal level, mostly at L5/S1. Compared with a previous study without laminectomy, the mean operative duration (57.5 min) and operative outcome, evaluated using the modified Japanese Orthopaedic Association and Numerical Rating Scale scores, were similar; no complications were observed. However, the width of the interlaminar space was significantly narrower, and eight cases revealeda narrow interlaminar space (width < 20 mm and/or lost concave shape of CM-UVL).

Conclusion: Minimal laminectomy using the ILA for PELD is feasible for treating LDH with the narrow space and highly migrated LDH.

Laparoscopic Heller’s myotomy is the most common surgical procedure to treat achalasia. It is the most accepted therapy for non-advanced stages of the disease. In the setting of advanced disease with marked esophageal dilatation or sigmoid-shaped esophagus the ideal surgical procedure is debatable. Esophagectomy is believed by several authors to be the operation of choice in these cases. Others; however, opt for less invasive alternatives. Laparoscopic Heller’s myotomy has been shown to be a safe and resourceful alternative in end-stage achalasia as well.

Idiopathic and Chagas’ disease achalasia are characterized by absent or partial lower esophageal sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation, heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic examination and esophageal manometry, which is considered the most accurate exam to characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus. Despite similarities in clinical and manometric presentation there is evidence of greater loss of inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas’ disease there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect patients’ clinical presentation, and hence treatment options should be the same for both diseases.

Aim: The advent of minimally invasive abdominal and thoracic surgeries has led to a meaningful reduction in complication and mortality rates among patients undergoing esophagectomy, especially when used for the treatment of benign diseases such as megaesophagus.

Methods: Two hundred thirty-one patients, 152 (65.8%) men and 79 (34.2%) women, with a mean age of 52.46 (19-80) years, were treated for advanced megaesophagus between September 1996 and October 2016. Two hundred ten patients (90.91%) had chagasic megaesophagus and 21 patients (9.09%) had idiopathic megaesophagus.

Results: Immediate complications were observed in 37 patients (16.01%): hemopneumothorax in 22 cases (9.52%), gastric stasis in 11 (4.76%), cervical fistula in 11 (4.76%), dysphonia in 18 (7.8%), and mediastinitis in 1 case (0.43%). Two patients (0.86%) died: 1 patient with a pacemaker died of cardiorespiratory arrest on postoperative day 12 and the other patient died of mediastinitis on day 28. Our standardized protocol includes nutritional and pulmonary outpatient care.

Conclusion: With a standardized multidisciplinary protocol and a team adequately trained in laparoscopy, minimally invasive esophagectomy is an excellent option for the treatment of advanced megaesophagus. The technique is easily standardized and reproducible, and provides excellent postoperative outcomes.

Achalasia is a primary esophageal disorderth variable causes, with an incidence between 0.03 to 1/100,000 people, and prevalence of approximately 10/100,000, with no difference between gender. It is more frequent in South and Central America, where Chagas disease is endemic. There are several methods to treat achalasia including endoscopic and surgical procedures, however, all of these methods are palliative. This article discusses 2 different endoscopic methods to treat advanced megaesophagus in Chagas disease, pneumatic balloon dilatation (PBD), and peroral endoscopic myotomy (POEM). Although varying between studies, PBD has an average symptom relief in 93% of patients in 6 months and 44% in 6 years. Some risk factors for failure of PBD are: younger age, male gender, a wider esophagus, poor emptying on post-treatment barium esophagogram and Eckardt scale < 3 before the treatment. Despite relatively short-term follow-up of an average of 3 years, POEM has excellent results. The clinical success achieved in 98 % with the Eckardt score decreased from 6.9 preoperatively to 0.77. Regarding sigmoid-shaped esophagus, only a few papers have been published on POEM. The largest population was 32 patients with a follow-up of 2 years. There was an efficacy of 96%, with the Eckardt scale decreasing from 7.8 to 1.4. In conclusion, PBD, is still widely used mainly due to its availability, especially in patients with a higher surgical risk and in patients who already had a Heller myotomy who persist or develop dysphagia. POEM has already demonstrated excellent results, but it requires advanced technical skills and Long-term results and randomized clinical trials are needed to validate the use of POEM in routine clinical practice.

Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications.This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus.

Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation.

Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients.

Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up.