Single-stage tracheal resection and anastomosis represents the gold standard for benign subglottic stenosis' management. Nevertheless, also considering the complexity of the surgical procedure, some patients are considered unfit for tracheal surgery (stenosis involving vocal cords, comorbidities, and relapse after surgery). Until now, the only alternative was tracheostomy which represents the only real alternative to secure the patency of the airway. Thanks to the creation of "transcordal stents", patients considered unfit for surgery have a valid alternative to tracheostomy and the conformation of the stent reduces the risk of stent migration, preserving airway patency, swallowing, and phonation. This study aims to evaluate the use of a new custom-made transcordal stent, comparing its safeness with traditional transcordal stent. Between 2017 and 2021, 28 consecutive patients underwent transcordal stenting for benign tracheal stenosis in 3 centers. Patients were divided into 2 groups: 16 treated with the new custom-made stent (Group 1) and 12 treated with conventional stents (Group 2). Intra-, post-operative complications, swallowing capacity, quality of voice, granulation tissue, stent migration, and quality of life (QoL) were compared between the two groups. Group 2 showed reduced swallowing capacity (p = 0.0001), higher rate of stent migration (p = 0.0003), higher rate of granulation tissue (p = 0.0044), and higher rate of stent replacement (p = 0.0001). Voice reduction was not significantly different between the two groups. QoL was better in Group 1. Despite this represent the largest study analyzing transcordal stenting as definitive treatment of subglottic stenosis in patients unfit for surgery, results could not draw definitive conclusions because of the small number of patients, the lack of randomization, and the small follow-up. Nevertheless, the use of the new custom-made transcordal stent could be considered safe and effective, guaranteeing stable results with low rate of long-term complications and better QoL compared to the traditional stents.

We aimed to determine the usefulness of the new setup, the "Narrow setting," by examining our initial experience with the Hugo™ RAS system. 78 hysterectomies using the Hugo™ RAS system performed in "Narrow setting" at our institution from November 2023 to December 2024 were included in this study. We retrospectively examined the patient's clinical information and surgical outcomes from the medical record. We also investigated the learning curve of docking time in this setting by cumulative summation analysis. The median age, body mass index, and uterine weight of the patients were 48 (31-76) years, 22.9kg/m2 (16.1-42.4), and 178g (40-2000g), respectively. More than half of the surgical indications were uterine myomas (52.6%, 41/78). The median operative, console, and docking times were 68min (48-198min), 46min (29-151min), and 9min (6-31min), respectively. The median estimated blood loss was 5mL (5-220mL). A total of eight perioperative complications were observed, but only one was classified as Clavien-Dindo grade III or higher. No conversion to open or laparoscopic surgery was required. The learning curve for docking time showed that docking in the "Narrow setting" can be proficient in 19 cases. We reported on our initial experience with hysterectomy using the Hugo™ RAS system and found the "Narrow setting" to be safe and efficient.

Anal fistula treatment remains a surgical challenge. This study focuses on the efficiency and safety of the Ligation of Intersphincteric Fistula Tract (LIFT) procedure for high intersphincteric anorectal fistulas, aiming to identify prognostic factors for success and complications. A retrospective chart review was conducted on all patients who underwent LIFT procedure at a tertiary referral hospital between January 2013 and January 2021. The primary endpoint was the success rate of fistula closure, confirmed with clinical investigation. Secondary endpoints included postoperative complications, reintervention and self-reported incontinence. Logistic regression analyses were performed for assessing prognostic factors for fistula closure and postoperative complications. Ninety-two patients were included in the study; after a median follow-up of 19.3months, fistula closure was achieved in 71% (n = 65) and in 89% (n = 82) after reinterventions. 46% (n = 42) reported persistent symptoms, although 83% of which (n = 32/42) had succesful fistula tract closure by clinical evaluation. One patient developed incontinency for gas. Smoking emerged as a significant risk factor for fistula closure failure, OR = 6.75, 95% CI = [1.65, 27.69], p = 0.030. Wound dehiscence was the most common complication, occuring in 25% (n = 23). Prolonged oral antibiotics demonstrated a significant protective effect against wound dehiscence, OR = 0.31, 95% CI = [0.10, 0.96], p = 0.036. The LIFT procedure is an efficient and safe treatment for complex perianal fistula. Patient satisfaction emerged as a crucial treatment goal, as patients can remain symptomatic after fistula closure. Emphasizing smoking cessation is integral to the treatment approach. The findings suggest prolonged antibiotic treatment as a potential preventive measure for wound dehiscence.

To compare the results of Minimally Invasive Esophagectomy performed with a Fully Robot-Assisted technique (F-RAMIE) and a Hybrid approach with laparoscopic abdominal phase (H-RAMIE). Multicentric retrospective analysis of patients who underwent F-RAMIE and H-RAMIE between 2018 and 2023. The primary endpoint was the rate of postoperative complications, secondary endpoints were clinical outcomes, oncological results and costs. Survival analyses were calculated according to the Kaplan-Meier method. The economic evaluation included costs related to operating room time, length of stay, surgical tools, and robotic system maintenance. A total of 100 patients from two experienced surgical centers were included: 64 H-RAMIE and 36 F-RAMIE. The two groups were comparable in baseline clinical conditions and staging. F-RAMIE was associated with longer operative time (434.7 ± 46.4 Vs. 477.3 ± 47.5min, p < 0.001) and shorter length of Intensive Care Unit stay (1.1 ± 1.1 Vs. 2.3 ± 2.3days, p = 0.002) than H-RAMIE. There were no significant differences in conversion rate, postoperative complications and length of stay. F-RAMIE demonstrated superior lymph node retrieval (43.8 ± 15.2 Vs. 22.4 ± 10.3, p < 0.001), but no differences in R0 resection rates. Overall survival and recurrences were comparable. Cost analysis revealed a slight economic advantage for F-RAMIE (20,556.3 ± 3,601.2 € Vs. 23,302.4 ± 5,894.5 € p = 0.012), mainly due to hospital stay-related cost (11,267.6 ± 5,912.8 € for H-RAMIE Vs. 8,360.3 ± 3,550.6 €, p = 0.007). F-RAMIE and H-RAMIE proved to be equally safe and effective in terms of postoperative complications and oncological outcomes.

This study aimed to evaluate the quality and accuracy of responses provided by two user-interactive AI chatbots, namely ChatGPT and ChatSonic, in response to patient queries regarding laparoscopic repair of inguinal hernias, and additionally determine the suitability of these chatbots in addressing patient queries related to inguinal hernia repair. Ten questions regarding laparoscopic repair of inguinal hernias were developed and presented to ChatGPT 4.0 and ChatSonic. Responses were evaluated by two experienced surgeons blinded to the source, using the Global Quality Score (GQS) and modified DISCERN Score to gauge response quality and reliability. ChatGPT demonstrated high-quality responses (GQS = 4 & 5) for all ten questions according to one evaluator, and for seven out of ten questions according to the other. Similarly, ChatGPT showed high reliability (DISCERN = 4 & 5) for nine responses according to one evaluator, and for three responses according to the other, with only slight agreement between evaluators for both GQS (kappa = 0.20) and modified DISCERN scores (kappa = 0.08). ChatSonic also provided high-quality and reliable responses for a majority of questions, albeit to a lesser extent than ChatGPT, and both demonstrating limited concordance in responses (p > 0.05). Overall, Both ChatGPT and ChatSonic demonstrated potential utility in providing responses to patient queries about hernia surgery. However, due to inconsistencies in reliability and quality, ongoing refinement and validation of AI generated medical information remain necessary before widespread clinical adoption.

We have previously reported laparoscopic total biopsy methods for suspected gallbladder cancer (GBC). The present prospective observational study evaluated the safety and feasibility of a novel two-stage algorithm using laparoscopic total biopsy methods. The two-stage algorithm was applied for 40 patients with suspected GBC between July 2018 and September 2022. Laparoscopic whole-layer cholecystectomy (LWLC) was performed for early-stage or suspected malignant lesions without liver invasion and laparoscopic gallbladder bed resection (LGBR) was performed for lesions with an unclear border between the gallbladder and liver. The appropriate strategy could be selected postoperatively depending on the final pathological diagnosis according to examination of permanent sections of gallbladder. If preoperative imaging reveals enlarged lymph nodes (LNs) with possible metastases, LN sampling with intraoperative pathological diagnosis is performed prior to gallbladder removal to determine whether to introduce neoadjuvant chemotherapy. As the first diagnostic procedure, we performed LWLC in 30 cases, LGBR in 8 cases, and LN sampling alone in 2 cases. Median operation time was 165min and median blood loss was 5.5ml. No bile leakage caused by intraoperative perforation of the gallbladder was observed. Histologically, GBC was diagnosed in 16 cases (pTis, n = 2; pT1a, n = 2; pT1b, n = 2; pT2, n = 6; pT3, n = 4). Seven of the 10 pT2/3 cases underwent additional open lymphadenectomy. The two-stage algorithm using laparoscopic total biopsy methods for suspected GBC appears to represent a safe, feasible procedure that could play an important role in the optimal treatment strategy.

Subtotal cholecystectomy is one of the most frequent bail-out procedures performed during difficult cholecystectomy. A common complication to this procedure is bile leak, and thus multiple strategies have been created to avoid its appearance. This study aims to evaluate the effectivity of using an omental patch as bile leak prevention in patients undergoing subtotal cholecystectomy. A retrospective cohort study including patients who underwent subtotal cholecystectomy between 2014 and 2022 was performed. 17 patients had an omental patch, while 378 did not; the latter were included to evaluate surgical outcomes with bile leak as a primary outcome using a propensity score matching analysis (PSM). Patients’ median age in both groups after PSM was 71.00 (IQR: 59.00–81.00) and 69.00 (IQR: 61.75–80.25) years, respectively. The dominant sex in both groups was male. In most cases surgical procedure indication was cholecystitis. Patients who had an omental patch did not present statistically significant differences for bile leak rates compared to patients who did not (29.4% versus 17.6%, p = 0.456, respectively). Similar results were observed when evaluating the need for postoperative ERCP for bile leak management (23.5 versus 5.9%, p = 0.078). A statistically significant higher proportion of major complications were observed in patients who had an omental patch (47.1% versus 19.1%, p = 0.038). Pedicled omental patch was not an effective measure for preventing bile leak, and it even presented a higher rate of complications. It is thus imperative to continue evaluating other strategies for the prevention of bile leak during subtotal cholecystectomy.