Abstract: Groin hernia repairs are one of the most common surgeries performed in the world. The first repairs dates back to ancient Egypt in which physicians reduced the hernia and applied heat to the hernia sac. This review article explores the evolution of inguinal hernia repairs. It begins with the history of open inguinal hernia repairs and the evolution of minimally invasive approaches from laparoscopic to robotic repairs. The article also provides a comprehensive review of inguinal hernia anatomy and the myopectineal orifice. Laparoscopic inguinal hernia repairs are the recommended approach by multiple international guidelines to bilateral and recurrent hernias. This article provides a review of the comparison between open Lichtenstein (OL) repairs with minimally invasive approaches such as the laparoscopic transabdominal preperitoneal (TAPP) repair, totally extraperitoneal (TEP) repair and robotic-assisted TAPP repairs. Overall, laparoscopic repairs are associated with reduced post-operative pain, faster return to work/activities, decreased rate of hematoma and wound infections while hernia recurrence are comparable with OL repairs. This article also explores the emergence of robotic-assisted repairs with data suggesting that robotic repairs are a promising approach for patients with complex hernias such as recurrent hernias, post-prostatectomy, and for obese patients. This article also discusses the current utilization of minimally invasive inguinal hernia repairs around the world and the financial implications.

Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.

Background and Objective: With the advent of minimally invasive approaches, coronary artery bypass grafting (CABG) surgery has evolved to maintain good outcomes and improve patient experience. The increased use of robotic and hybrid platforms in cardiac surgery has allowed for smaller incisions, quicker recovery times, while maintaining acceptable outcomes. While minimally invasive techniques are growing in popularity, sternotomy remains the most common means of exposure. The following manuscript explores the opportunities that mini thoracotomy, robotic surgery, and hybrid coronary revascularization (HCR) provide to the modern cardiac surgeon. Methods: A comprehensive search strategy was constructed on minimally invasive approaches for CABG. All resulting articles were manually screened and selected for chapter review. Key Content and Findings: The chapter reviews the data on CABG via mini-thoracotomy incision, robotic CABG, and HCR. It also discusses patient selection and cost analysis. With careful patient selection, minimally invasive approaches to CABG can provide equivalent or better outcomes to standard open CABG. Some limitations to the growth in its popularity may be the need for a higher patient volume in order for hospitals to justify investing in robotic technology. However, with equivalent survival outcomes and better patient recovery, minimally invasive CABG is the future of surgical treatment of coronary artery disease. Conclusions: Through smaller incisions and robotic platforms, minimally invasive CABG is a safe and effective option for cardiac surgery patients. Future research is required into how best to finance minimally invasive surgery (MIS) CABG modalities in order to make it more readily available to the general public.

Background and Objective: Obesity and its associated chronic medical conditions such as diabetes and hypertension are among the leading health concerns in the developed world. Bariatric and metabolic surgery has emerged as an established and definitive treatment for severe obesity. Given the disproportionate burden of obesity and diabetes on different racial and socioeconomic populations, studies have assessed the impact of these disparities in bariatric surgery patients. Methods: A comprehensive search of the current literature utilizing the following keywords was performed: bariatric surgery and a combination of disparities, outcomes, complications, mortality, access to care or socioeconomic factors. Key Content and Findings: We review the impact of ethnoracial differences on access to care and outcomes of bariatric surgery including weight loss, comorbidity remission, complications and mortality. Existing literature demonstrates reduced weight loss and higher complication rates in non-Hispanic Black patients compared to White patients with trends toward normalization of weight loss variation and comorbidity remission among ethnic groups over longer follow up times. Conclusions: Bariatric surgeons should consider ethnoracial and socioeconomic when counseling patients regarding bariatric surgery to support patients at risk of poorer outcomes. Further prospective research is needed to examine impact of ethnoracial and socioeconomic disparities on bariatric surgery patients.

Background and Objective: Minimally invasive surgery (MIS) is associated with reduced postoperative pain, shorter hospital stay, faster return to normal activity and diet, and improved cosmesis when compared to conventional open surgery. After the first laparoscopic ileocecal resections described in 1993, colorectal surgeons around the world started using multiport laparoscopic, single-port laparoscopic, and even robotic approaches for the surgical treatment of Crohn’s disease (CD), from simple uncomplicated cases to more challenging forms of penetrating and recurrent disease, in order to achieve the mildest surgical stress and the best postoperative functional recovery. This narrative review aims to provide a comprehensive description of the forms of MIS currently used for the surgical treatment of CD. Methods: We searched original papers and reviews, published by November 2022, about the applications of MIS in the operative management of CD using PubMed. Relevant studies were identified using different combinations of the following search terms: “Crohn’s disease”, “fistulizing Crohn’s disease”, “penetrating Crohn’s disease”, “recurrent Crohn’s disease”, “Crohn’s colitis”, “ileocecal resection”, “laparoscopy”, “laparoscopic surgery”, “robotic surgery”, “minimally invasive surgery”, and “ERAS”. Key Content and Findings: We describe a variety of minimally invasive surgical approaches for the treatment of CD, from laparoscopic ileocecal resection for uncomplicated and complicated diseases, to laparoscopic colectomies and robotic-assisted procedures, focusing on the advantages of each technique in terms of short- and long-term outcomes. Conclusions: It is unquestionable that MIS has demonstrated improved peri-operative results in the surgical management of CD, thus representing the current “gold standard” approach even in this patients’ category, when appropriate expertise is available.

Quirine C. A. van Steenwijk, Louisa N. Spaans, David J. Heineman, Bas B. Koolen, Frank J. C. van den Broek, Chris Dickhoff

Background and Objective: Natural orifice specimen extraction surgery (NOSES) is an innovative technique, used in minimally invasive surgery for colorectal cancer. NOSES has been demonstrated as a safe and effective method in patients matching the inclusion criteria. Objective was to analyze and review articles regarding short- and long-term outcomes in NOSES in left-sided colon and upper rectal cancer.

The pathophysiology of fecal incontinence (FI) is often considered to primarily depend on disturbed mechanisms of faecal containment. Barrier mechanisms such as the anal sphincters and puborectalis muscle provide an easily comprehensible model for FI that satisfies some clinical observations in relation to risk, e.g., obstetric trauma, iatrogenic injury during anal surgery and diagnostic findings, e.g., anal contractile pressures and integrity on ultrasound evaluation. However, this barrier-centric containment model is insufficient to explain many lived observations of FI, including the origin of the symptom of urgency and continence development over the life course. It also fails to explain several other major risk factors such as rectal inflammation and irritable bowel syndrome, epidemiological (e.g., roughly equal prevalence in men) and treatment observations, i.e., the general failure of barrier augmentation vs. success of a treatment that does not overtly alter barrier closure [sacral neuromodulation (SNM)]. This review presents a revisionist view where reflex control of rectal contractility is considered central to FI pathogenesis and the anorectum is considered a single functional unit that cooperates with the colon and central nervous system (CNS) to maintain continence. This revised understanding implicates the barrier not only as a means of containment but also as a reflex controller of rectal function. Together, this serves as a much more adequate theory to explain human observations of the condition and a better starting point for the development of new treatments.

: Obesity and weight related metabolic disorders (e.g., diabetes, hypertension, dyslipidemia, disability, non alcoholic fatty liver disease, gastroesophageal reflux, obstructive sleep apnea, some cancers) are major health problems with global concerns. Currently, non surgical methods can not provide consistent success by virtue of the fact that inadequate weight loss or maintanence. Bariatric surgery is the most effective treatment modality for morbidly obesity and related medical co-morbidities. Therefore, the number of patients undergone bariatric surgery has rapidly increased, in the last two decades in particular. However, weight regain is a phenomenon which the majority of bariatric surgery patients will encounter in the long term. Although there are abundant patients suffering from weight regain, it is one of the related topics of bariatric surgery with a relatively limited number of publications reflecting the vagueness of the entity. The factors influencing long term weight loss management after a bariatric surgical procedure can be assorted into three categories: environmental, patient related and procedure related. Environmental factors can be elucidated as threats similar to the ones that the patients’ had before surgery. While patient related factors may arise from metabolic disarrangements, dietary contravention, physical inactivity or mental disorders, procedure related issues may directly originate from complications of surgically altered anatomy or patients’ lack of compliance. The current review aims to clarify the definition, underlying aetiologies and management of weight regain after bariatric surgery.