The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery.

The Xi is the latest da Vinci surgical system approved for use in colorectal surgery. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures - from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis.

Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer.

Background: Laparoscopic total mesorectal excision (TME) remains a technically challenging procedure. This study aims to compare the surgical outcomes of the robotic-assisted laparoscopic (RAL) versus hand-assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers.

Methods: A retrospective review of all patients who underwent RAL TME for rectal cancers was performed.

Managing Deep Postanal Space Sepsis via an Intersphincteric Approach: Our Early Experience.

Purpose: Managing deep postanal (DPA) sepsis often involves multiple procedures over a long time. An intersphincteric approach allows adequate drainage to be performed while tackling the primary pathology at the same sitting. The aim of our study was to evaluate this novel technique in managing DPA sepsis.

Laparoscopic versus an open colectomy in an emergency setting: a case-controlled study.

Purpose: Laparoscopy continues to be increasingly adopted for elective colorectal resections. However, its role in an emergency setting remains controversial. The aim of this study was to compare the outcomes between laparoscopic and open colectomies performed for emergency colorectal conditions.

To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula?

Background: The ideal surgery following seton insertion for high anal fistulas remains debatable.

Objective: This study aimed to compare the success between the endorectal advancement flap and the ligation of intersphincteric fistula tract techniques as the definitive procedure following seton placement.

Design: This study is a retrospective review.

Screening based on risk for colorectal cancer is the most cost-effective approach.

Background & Aims: Performing single endoscopic examinations or selective screening based on risk might be more practical than recommended screening strategies for colorectal cancer (CRC). We investigated the cost effectiveness of these strategies, under real-life conditions of suboptimal compliance, and the societal cost perspective.

Methods: We used Markov modeling to analyze data from 787,000 individuals in Singapore, aged 50 to 75 years, with an age-standardized rate of CRC of 30 to 40/100,000 in 2009.

The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years.

Background: Although the ligation of intersphincteric tract technique is a promising sphincter-preserving option in managing anal fistulas, failures are still seen.

Objective: This study aimed to illustrate the patterns of failures and recurrences following the ligation of intersphincteric tract procedure for anal fistulas.

Design: This study is a retrospective review.

Artificial bowel sphincter implantation for faecal incontinence in Asian patients.

Background: To evaluate the outcomes with the American Medical Systems artificial bowel sphincter (ABS) implantation for the treatment of intractable faecal incontinence in an Asian population.

Methods: Six Asian patients who underwent ABS implantation between March 2004 and December 2007 for the treatment of faecal incontinence were reviewed.

Results: The ABS was successfully implanted in six patients [mean age 50 (20-73) years; 4 males].

A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection.

Background: The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function.

Natural history of small, "indeterminate" hepatic lesions in patients with colorectal cancer.

Purpose: The initial staging CT scan for patients with colorectal cancer may reveal small, "indeterminate" hepatic lesions. The significance of these lesions is often unknown at the time of diagnosis. Surveillance of these lesions is often recommended because they may have an impact on the subsequent management of these patients.

Necrotising colitis related to clozapine? A rare but life threatening side effect.

We report here a case of a 34-year-old gentleman who developed right-sided necrotising colitis after clozapine usage. Anticholinergic activity is believed to the cause. We believe that in patients who have been consuming medications known to have an association with necrotising colitis, constipation with concomitant increasing abdominal pain, distension and fever should be treated with a strong index of suspicion.

Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma.

Background: Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis.

Stapled haemorrhoidectomy: bothersome staple line bleeding.

Background: The stapled haemorrhoidectomy procedure has been popularized as a painless and effective treatment for prolapsing haemorrhoidal disease. We have noted that staple line bleeding is a contributory factor to postoperative morbidity.

Methods: This was a retrospective analysis of the clinical records of consecutive stapled haemorrhoidectomy procedures performed in patients over a 1-year period.