Comparison of FreeHand robot-assisted with human-assisted laparoscopic fundoplication.

Objective: To compare the safety, operative time and feasibilty of FreeHand robot (FreeHand Ltd, Guildford, United Kingdom) with manual camera control approach for Laparoscopic Fundoplication.

Material And Methods: A case control study was performed for patients undergoing laparoscopic fundoplication. Primary outcome was operative time; secondary outcomes included length of stay, post-operative morbidity, symptoms at first follow-up and total post-operative out-patient visits.

Single hospital visit day case laparoscopic hernia repair without prior outpatient consultation is safe and acceptable to patients.

Background: For some common conditions, pre-operative clinic visits are often of little value to the patient or surgeon with transfer to the waiting list being predictable. In response to local patient feedback, we introduced a single hospital visit laparoscopic hernia surgery pathway with focus on informed consent, patient-reported outcomes and post-operative interaction with primary care services.

Methods: A single hospital visit service for elective hernia repairs was created.

Feasibility of a consultant-led, trainee-delivered urgent laparoscopic cholecystectomy service.

Background: Urgent laparoscopic cholecystectomy has become the gold standard for the treatment of acute gallstone disease. Since 2005 we have implemented a consultant-delivered urgent surgical service for this condition. In an attempt to increase the capacity of this service, we have recently introduced a new policy of also allowing selected trainee surgeons to perform urgent laparoscopic cholecystectomy with consultant assistance available on request.

Reduced access aortic exposure (RAAE) technique for infrarenal abdominal aortic aneurysm (AAA) repair.

Objective: A reduced access aortic exposure (RAAE) technique for repair of infrarenal AAA repair has been evaluated and the short-term surgical outcomes are compared with conventional open repair (OPEN).

Methods: All consecutive patients having repair of infrarenal AAA over a period of 3 years were included in this study. A group of these patients had AAA repair using the RAAE technique with a small midline incision (<8 cm).

Laparoscopic management of heterotopic pregnancy--a rare cause of acute abdomen in women.

Heterotopic pregnancy is a rare condition of coexisting intrauterine and extrauterine pregnancy and can present as an acute abdomen. The management can be challenging as the diagnosis is difficult to establish preoperatively. We report a case of a 31-year-old female presenting with acute abdominal pain and a mass in the right iliac fossa at 22 weeks of gestation.

Urgent cholecystectomy for acute cholecystitis in a district general hospital - is it feasible?

Introduction: Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gall stone disease. However, its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate. Tertiary referral centres have reported good results.

Blood and body fluid splashes during surgery--the need for eye protection and masks.

Introduction: While most surgeons make an effort to avoid needlestick injury, some can pay little attention to reduce the potential route of infection occurring when body fluids splash into the eye. It has been shown that transmission of HIV, hepatitis B or C can occur across any mucous membrane. This study aims to quantify how frequently body fluids splash the mask and lens of wrap around protective glasses thus potentially exposing the surgeon to infection.

Diaphragm disease: the limitation of laparoscopy and assessment of the small bowel for strictures using a ball bearing.

Diaphragm disease is a rare cause of intestinal obstruction that will be seen with increasing frequency with the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs). We present a case study of a patient with diaphragm disease where the diagnosis was not apparent at laparoscopy, and passage of a steel ball through the small intestine was required to identify all strictures present. A high index of suspicion, recognition of the limitations of conventional diagnostic aids, and the need to assess the full length of the small bowel are all important in the surgical management of this condition.

An audit of post-splenectomy prophylaxis--are we following the guidelines?

Introduction: Asplenic individuals have major difficulties coping with specific infections (e.g. Streptococcus pneumoniae).

Varicose veins made easy!

A novel device that is more convenient than other tourniquet systems is described.

Tourniquet use during varicose vein surgery: a survey of current practice among Wessex surgeons.

The use of a tourniquet during varicose vein surgery, has been shown, through previous randomised trials, to result in a significant reduction in blood loss, superior post-operative cosmesis with no increase in operating time. Nonetheless, it would seem that few surgeons use this technique. Using postal questionnaires (n = 107), we have assessed the views and current practice among general surgeons (consultants and higher surgical trainees) in Wessex where the method was first proposed, to see how widely it has been adopted.

Prospective randomized placebo-controlled trial of aprotinin for elective aortic reconstruction.

Background: The serine protease antagonist, aprotinin, reduces perioperative blood loss in cardiac surgery and orthotopic liver transplantation. A pilot study suggested that the drug may also reduce bleeding during infrarenal aortic replacement; the aim was to confirm or refute this observation with a prospective, randomized, double-blind, placebo-controlled trial.

Methods: Some 136 patients were randomized to receive either aprotinin, given as a loading dose of 2 x 10(6) kallikrein inactivator (KI) units followed by 0.

Randomized controlled trial of patch angioplasty for carotid endarterectomy. The Joint Vascular Research Group.

A randomized controlled trial was performed to evaluate patch angioplasty for patients undergoing carotid endarterectomy. There were 213 patient episodes affecting 148 men and 65 women, with 109 allocated to patch angioplasty. Following surgery six patients suffered transient ischaemic attacks but these did not delay discharge from hospital.

Review of the perceptions of general surgical staff within the Wessex region of the status of quality assurance and surgical audit.

The opinion of surgical staff about the present state and effectiveness of surgical audit within a single regional health authority has been obtained by questionnaire. Seventy-five per cent of registrars/senior registrars and 72 per cent of consultants completed and returned the proforma. The majority of registrars (86 per cent) believe that it is vital or very important to collect clinical outcome information that is relevant, accurate and complete.

Axillary nodal status in women with screen-detected breast cancer.

A prospective study of the axillary nodal status of women found to have an invasive breast cancer within the prevalence screening round is reported. Thirty-one per cent of patients were lymph node positive. Twenty-two per cent of patients with an impalpable tumour and 41% of those with a palpable tumour had involved axillary lymph nodes.

Antimicrobial prophylaxis in 'clean' surgery: hernia repair.

Antimicrobial prophylaxis is not traditionally employed for patients undergoing 'clean' surgery. The true rates of septic complications are grossly under reported for this group of patients, with up to 72% of all complications occurring, undetected by the surgical team, after discharge from hospital. The implied costs of these infections, coupled with the costs to both the patient and the community services, suggest that antimicrobial prophylaxis should be seriously considered for many types of 'clean' surgery.

Closure of laparotomy wounds: skin staples versus sutures.

To investigate the routine use of a skin stapling device for the closure of midline abdominal wounds, 48 patients were randomized to receive skin staples or subcuticular polydioxanone sutures. The mean (range) time for closure with staples was 8.0 (3.

Non-invasive monitoring of cardiac output changes during aortic cross-clamping for infrarenal reconstruction--a new technique using suprasternal Doppler-derived cardiac output.

There is a significant morbidity and mortality associated with elective infrarenal aortic reconstruction. To examine the value of continuous cardiac output monitoring for predicting those at risk, 40 consecutive patients were monitored using Doppler-derived cardiac output. The anaesthetist was blind to all information from the monitor and managed the patients using standard techniques.

Community surveillance of complications after hernia surgery.

Objective: To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia.

Design: Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance.

Setting: Academic surgical unit of three consultant surgeons.

Duplex scanning alone before carotid endarterectomy: a 5-year experience.

The role of duplex scanning and arteriography as a means of assessing patients for carotid endarterectomy has been reviewed for the period 1984 to 1988 when 98 carotid endarterectomies were performed. Of these 44 were selected for surgery on the basis of duplex assessment alone, 48 after carotid angiography and duplex scanning and six after angiography alone. No difference between the groups of patients was observed for either perioperative or follow-up complication rates, although all late deaths occurred in patients who had been examined by angiography.