Rectal surgery is the standard treatment for patients with non-metastatic rectal cancer. Expert surgery, which includes total mesorectal excision (TME) (1), is of crucial importance for mid-rectal and low rectal cancer patients in that it provides complete removal of the tumor-bearing rectum and its associated lymph nodes within the mesorectum and thus minimizes the risk of resection margin positivity and local recurrence. However, patients with advanced low rectal cancer occasionally develop metastases to the lateral pelvic lymph nodes like common iliac, internal iliac, external iliac, and obturator nodes, which are located outside the surgical field of TME (2,3). Additional treatment is therefore often required to reduce local recurrence.

The use of non-absorbable oral antibiotic preparation (OAB) in colorectal surgery was first proposed by Rosenberg and colleagues in 1971 (1), who in their randomised controlled trial (RCT) of combined mechanical bowel preparation (MBP) and one (phthalylsulphathiazole) or two oral antibiotics (phthalylsulphathiazole and neomycin) found a significant reduction in surgical site infection (SSI) and anastomotic leak rates in a population of patients undergoing large bowel surgery after combined OAB and MBP when compared with those who received MBP alone.

Surgical site infection (SSI) is the most frequent postoperative morbidity in colorectal surgery. Once SSI occurs, hospital stay and medical cost increase, resulting in decreased quality of lives of patients. Therefore, controlling SSI has been recognized as the major challenge for surgeons. For this purpose, the use of prophylactic antimicrobial agents is now widely accepted in colorectal surgery.

Colorectal cancer can present as an emergency, with bowel obstruction, perforation, and bleeding, requiring urgent surgical intervention. Bowel obstruction was reported to be seen in 15–20% of patients with colorectal cancers (1,2). The treatment for obstructive colorectal cancer (OCRC) has been of great interest to colorectal surgeons because of poor surgical outcomes.

Hand-assisted laparoscopic surgery (HALS) provides an important tool in the repertoire of a colorectal surgeon. It combines the advantages of both minimally invasive surgery and conventional open surgery. This technique offers similar short- and long-term benefits to that of straight laparoscopic procedures. HALS may shorten operative times and allow surgeons to perform a minimally invasive colorectal resection in a patient with high body mass index (BMI), bulky disease, a hostile abdomen that may otherwise be too difficult to complete laparoscopically.

Abstract: Robotic-assisted adrenalectomy (RA) was established since 2001 as an alternative to open and laparoscopic adrenalectomy, although re-operative RA after upper pole partial nephrectomy is uncommon. Here, we describe RA for presumed renal cell carcinoma (RCC) recurrence after ipsilateral upper pole robotic-assisted partial nephrectomy (RPN), using the da Vinci Xi. A 43-year-old male underwent left RPN in November 2017 for a 3.3 cm upper pole enhancing solid renal mass. Pathology revealed clear cell, RCC, FG 2, pT1a, negative margins. Seven months later, routine surveillance CT scan demonstrated a 2.09 cm enhancing left adrenal nodule, suspicious for recurrent RCC. MRI was performed and confirmed the presence of enhancing adrenal nodularity suspicious for tumor recurrence. Percutaneous biopsy of the adrenal lesion was performed and it was inconclusive. The multidisciplinary tumor board recommended excision, and a robotic approach was selected. The RA was performed using three 8 mm robotic Xi trocars, one midline 12 mm blunt tip Hasson trocar, and one 5 mm AirSeal trocar for assistant ports. The 8 mm robotic Xi instruments (fenestrated bipolar forceps, monopolar curved scissors and permanent cautery hook) were used during the procedure. Total operation time was 249 minutes. Total console time was 134 minutes. Blood loss was 250 mL and there were no complications. He was discharged on post-operative day one. Pathology showed adrenal gland without significant histopathological changes. The gland measured 8.3 cm × 7.6 cm × 2.8 cm and weighed 63.2 grams. The final pathology report showed that there was no evidence of involvement by RCC. The post-operative course was unremarkable. The da Vinci Xi RA is a safe and feasible procedure for adrenal masses after ipsilateral RPN. Surgeons attempting the procedure should be comfortable with the inflammation and adhesions encountered in re-operative surgery and should work with an experienced team to avoid damage to surrounding organs (such as the spleen, pancreas, colon and stomach) and major vessels (such as the aorta, renal artery and vein). For masses of unclear etiology proceeding with adrenal mass biopsy prior to re-operative surgery should be considered as false-positive imaging results are possible.

Abstract: The prevalence of obesity worldwide is increasing. With it, obesity associated co-morbidities are also on the rise. On such complication concerning the abdominal wall is “hernia”. Similarly, annually a high volume of abdominal laparotomies are performed worldwide, especially in young. Rising life expectancy, increasing prevalence of obesity and comorbidities like diabetes has ultimately led to an increasing prevalence of incisional hernias. When combined together, general surgeons and bariatric surgeons are faced with a new dilemma: an obese patient with an abdominal wall hernia. This review briefly summarizes the impact of obesity on the natural history of hernia, its associated complication, management strategies and options.

The expert consensus statement published on ALES is an interesting survey among opinion leaders in colorectal surgery about evidence and perspectives of complete mesocolic excision (CME) for colonic cancer.

For a colorectal surgeon, the immediate goal in rectal cancer surgery is to extract a perfect total mesorectal excision (TME) specimen with clear oncologic margins. Since the introduction of the TME concept by Heald in 1982, data from both historic and modern randomized controlled trials (RCT) comparing surgical approaches for rectal cancer have demonstrated that this can be challenging (1-5). The subjective perception of a technically challenging and often unsatisfactory pelvic dissection, paired with the ongoing controversy regarding the optimal surgical approach, fuel the need for further innovation.

Abstract: Ventral or Incisional hernia repair is one of the commonest operations performed in surgical practice. High recurrence rates following standard open repair, combined with the advent of minimal invasive surgery has led surgeons towards accepting laparoscopy as an alternative to management of ventral or incisional hernias. Ever since the first laparoscopic ventral hernia repair in 1993, more surgeons have readily accepted it. In laparoscopic ventral or incisional hernia repair, the principles of conventional posterior approach (Rives-Stoppa-Wantz) are borrowed, wherein the mesh is placed either intra-peritoneally or in the sublay position. To facilitate laparoscopic repair, over the year’s newer instruments like tackers, specialized mesh, fixation devices have been developed. No procedure is immune to complications. In this review we explore the complications associated with laparoscopic ventral and incisional hernia repair and its management options.