Robotic assisted surgery reduces ergonomic risk during minimally invasive colorectal resection: the VOLCANO randomised controlled trial.

Purpose: Minimally invasive surgery benefits patients but poor operating ergonomics causes musculoskeletal injuries in surgeons. This randomised controlled trial aims to assess whether robotic-assisted surgery with the open-console Versius® system can reduce surgeons' ergonomic risks during major colorectal resections.

Methods: Prospectively registered at ClinicalTrials.

The ICaRAS randomised controlled trial: Intravenous iron to treat anaemia in people with advanced cancer - feasibility of recruitment, intervention and delivery.

Background: Anaemia is highly prevalent in people with advanced, palliative cancer yet sufficiently effective and safe treatments are lacking. Oral iron is poorly tolerated, and blood transfusion offers only transient benefits. Intravenous iron has shown promise as an effective treatment for anaemia but its use for people with advanced, palliative cancer lacks evidence.

Implementation of robotic hernia surgery using the Versius® system.

This case series aims to demonstrate that hernia surgery is safe and feasible using the Versius® robotic system from CMR Surgical, and to describe the surgical techniques used. It is the first series published using this novel system. Forty-one consecutive hernia repair cases were completed using Versius®, including inguinal and ventral hernias.

Initiation and feasibility of a multi-specialty minimally invasive surgical programme using a novel robotic system: A case series.

Introduction: There are a number of small case series examining new robotic surgical systems, but this is the first large case series assessing the feasibility of the Versius® system from CMR Surgical (1 Evolution Business Park, Cambridge, UK) in a multi-specialty setting.

Materials And Methods: All patients undergoing Versius®-assisted surgery in a previously robot-naïve centre were consented for collection of data on demographics, pre-, intra-, and postoperative outcomes. Data collection was performed prospectively from the start of the robotic surgical programme.

Intravenous iron is non-inferior to oral iron regarding cell growth and iron metabolism in colorectal cancer associated with iron-deficiency anaemia.

Oral iron promotes intestinal tumourigenesis in animal models. In humans, expression of iron transport proteins are altered in colorectal cancer. This study examined whether the route of iron therapy alters iron transport and tumour growth.

Understanding complaints made about surgical departments in a UK district general hospital.

Background: Patient complaints are increasingly recognized to provide a valuable insight into patients' experience of healthcare. Being local and subjective, they can bring to light previously under-appreciated causes of patient dissatisfaction. The focus of surgical care is usually an intervention, and the nature of complaints made about surgical care may vary substantially from that in non-surgical specialties.

Open Appendicectomy under Spinal Anesthesia-A Valuable Alternative during COVID-19.

 Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic.

A local experience of non-operative management for an appendicitis cohort during COVID-19.

Background: During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort.

Methods: An observational study was conducted in a district general hospital.

A colorectal straight-to-test cancer pathway with general-practitioner-guided triage improves attainment of the 28-day diagnosis target and increases outpatient clinic capacity.

Aim: This study investigates whether a straight-to-test (STT) colorectal cancer pathway improves attainment of the National Health Service (NHS) England 28-day Faster Diagnosis Standard and the effect of the pathway on reducing face-to-face outpatient clinic appointments. Patient satisfaction and the safety of a novel general practitioner (GP) led patient triage system regarding suitability for colonoscopy are also evaluated.

Methods: This is an observational study of all patients managed via an STT colorectal cancer pathway between 1 September 2019 and 19 March 2020.

Iron therapy for preoperative anaemia.

Background: Preoperative anaemia is common and occurs in 5% to 76% of patients preoperatively. It is associated with an increased risk of perioperative allogeneic blood transfusion, longer hospital stay, and increased morbidity and mortality. Iron deficiency is one of the most common causes of anaemia.

Feasibility of Intravenous Iron Isomaltoside to Improve Anemia and Quality of Life During Palliative Chemotherapy for Esophagogastric Adenocarcinoma.

Background: Anemia is common with esophagogastric adenocarcinoma, increasing mortality, blood transfusions, and reducing quality of life (QOL). No clear evidence exists for safe and effective treatment.

Methods: Anemic patients (Hb <12 g/dl women, <13 g/dl men) with esophagogastric adenocarcinoma were recruited before initiation of palliative chemotherapy.

Is there still a role for the adult general surgeon in general paediatric surgery within a District General Hospital setting? National questionnaire amongst adult general surgical trainees.

Introduction: In recent years there has been a trend towards centralisation of services for general paediatric surgery in the United Kingdom. Fewer District General Hospitals supply provision of paediatric surgery, placing a strain on Specialist Centres. The cause behind the decline is unclear but lack of interest from general surgical trainees may be a contributing factor.

LAP-VEGaS Practice Guidelines for Reporting of Educational Videos in Laparoscopic Surgery: A Joint Trainers and Trainees Consensus Statement.

Objective: Consensus statement by an international multispecialty trainers and trainees expert committee on guidelines for reporting of educational videos in laparoscopic surgery.

Summary Of Background Data: Instructive laparoscopy videos with appropriate exposition could be ideal for initial training in laparoscopic surgery, but there are no guidelines for video annotation or procedural educational and safety evaluation.

Methods: Delphi questionnaire of 45 statements prepared by a steering group and voted on over 2 rounds by committee members using an electronic survey tool.

Development of a surgical trainer assessment questionnaire.

Background: The assessment of surgical trainees has become well-established in practice; however, this is not yet the case for surgical trainers. The aim of this study was to develop a trainer assessment questionnaire (OxTrAQ) based on the 12 key trainer attributes identified by a previous systematic review, to then explore this questionnaire's potential domains and test its reliability.

Methods: The OxTrAQ was piloted at two surgical training centres in two surgical sub-specialities.

A cohort investigation of anaemia, treatment and the use of allogeneic blood transfusion in colorectal cancer surgery.

Introduction: Preoperative identification and treatment of anaemia is advocated as part of Patient Blood Management due to the association of adverse outcome with the perioperative use of blood transfusion. This study aimed to establish the rate of anaemia identification, treatment and implications of this preoperative anaemia on ARBT use.

Methods: All patients who underwent elective surgery for colorectal cancer over 18 months at a single Tertiary Centre were reviewed.

Iron therapy for pre-operative anaemia.

Background: Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia.

Snapshot quiz - recurrent right iliac fossa pain in the patient with a previous history of appendicitis.

A low threshold for computed tomography (CT) scanning in patients with previous appendicectomy and right iliac fossa pain helps facilitate timely diagnosis and exclusion of other differential diagnoses. Here, we present a rare cause which has significant medicolegal ramifications and is accurately diagnosed with CT.

Recurrent right iliac fossa pain in patients with previous appendicectomy.

Recurrent appendicitis can occur up to 40 years after appendicectomy. A history of appendicectomy has often led to late diagnosis, as sepsis is attributed to other organs, usually the urinary tract. A case of a patient presenting with retained faecolith and recurrent/stump appendicitis 2 years after laparoscopic appendicectomy is presented.

An observational study investigating the effect of platelet function on outcome after colorectal surgery.

Introduction: Previous studies have assumed patients have uniform responses to aspirin, yet significant numbers are occult hypo- or hyper-responders. A new validated test of platelet function measures platelet P-selectin expression, which rises with increased platelet activity. This study investigated the measured perioperative changes in platelet function in response to aspirin, and subsequently whether quantitative variations in platelet activity affected perioperative complication severity and frequency.

Is there a role for intravenous iron therapy in patients undergoing colorectal cancer resection?

Worldwide, colorectal cancer (CRC) is one of the most common forms of malignancy and is increasing in incidence in many regions. At diagnosis, approximately 40% of patients with CRC are anemic, a figure that increases over the course of a patient's treatment due to many factors, including ongoing hemorrhage. Preoperative anemia is therefore associated with increased allogenic red blood cell transfusion (ARBT) rates.

Haematuria 2: Imaging investigations, management and follow up.

Haematuria is a common complaint presenting to doctors in both primary and secondary care. It can be a sign of underlying urinary tract malignancy. Appropriate investigation and management should follow evidence-based practice and recognized guidelines, and subsequently lead to a rapid diagnosis.

Haematuria 1: risk factors, clinical evaluation and laboratory investigations.

Haematuria is a common complaint presenting to doctors in both community and acute centres. It can be a sign of underlying urinary tract malignancy. Appropriate investigation and management should follow evidence-based practice and recognized guidelines, and subsequently lead to a rapid diagnosis.