Experienced surgeons have reported excellent results for laparoscopic Nissen fundoplication to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up. This review focuses on the proper preoperative workup, patient selection, surgical technique, and follow-up for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD and the esophageal physiology is essential. An extensive dissection of the esophagus and crus in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication are important technical points. New onset or persistent symptoms after the operation must be carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup, patient selection, surgical technique and follow-up are rigorously observed.

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths in the world. Therefore, there is a need to intensify treatments of these tumors. Because stage I NSCLC is a nonmetastatic disease, local therapies are indicated, among which surgery is the most commonly deployed strategy. Pulmonary wedge/sublobar resection is therefore discussed in comparison to stereotactic body radiation therapy for stage I lung cancer. Review of retrospective and prospective clinical trials reveal similar outcomes for both strategies, while a multicenter randomized prospective study comparing the efficacy of both therapies is on-going. Because the results of pulmonary wedge/sublobar resection may depend on tumor size, tumor-distance from surgical margin, tumor size-to-margin distance ratio, and margin cytology, prospective studies to evaluate the clinical implications of these factors, so as to inform patient prognostication, are recommended.

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

Methods: This prospective study was conducted on 12 children with persistent complete rectal prolapse who failed to respond to adequate conservative measures from July 2015 to July 2016. The technical details of the procedure are described. Patients were followed up for at least 6 months and were assessed clinically and radiologically for continence and constipation using the appropriate scoring systems.

Results: Twelve patients were included, 8 females and 4 males, laparoscopic rectopexy and sigmoidopexy were done for all cases. The mean duration for surgery was 58.42 min. No intraoperative complications recorded. One case (8.3%) had partial thickness recurrence and 1 case had skin stitch sinus. No postoperative constipation nor incontinence was observed.

Conclusion: The laparoscopic rectopexy and sigmoidopexy is an effective approach for the treatment of refractory complete rectal prolapse in children. The 3-point fixation proved efficient in controlling rectal prolapse in children with minimal complications.

Aim: Mesh is commonly utilized in the laparoscopic repair of sports hernias. A hybrid mesh was recently released containing a single light weight layer of macroporous, polypropylene mesh between layers of biologic mesh. Having an extensive experience with laparoscopic and sports hernia repairs, a small sample of hybrid mesh was trialed.

Methods: From April 2015 to August 2016, 16 male patients with sports hernias were consented for hybrid mesh repair. A prospective data base was developed and patients were followed at 1 week, 4 weeks and 4 months after surgery.

Results: Ages ranged from 18 years to 43 years (average 22.9 years). Operative times ranged from 25 min to 75 min (average 42.5 min). All were athletes playing basketball, soccer, baseball, football and track. There were no operative problems. Two patients developed post-operative seromas requiring radiologic drainage. All patients completed a post-operative therapy program and all have returned to their sport without problems.

Conclusion: There is not one type of mesh repair that has been proven to be the most effective treatment for sports hernias. Continued follow up as well as a more structured study will be necessary to prove if hybrid mesh has long term effectiveness for the laparoscopic treatment of sports hernias. The initial study has promising findings.

Aim: This study proposed the robot-assisted laparoscopic simple prostatectomy (RASP) as safe and reliable surgical option for the treatment of men with prostate size > 80 mL. It was aimed to evaluate preoperative and postoperative results in RASP using a surgical variation to the standard technique: the temporary bilateral internal iliac arteries clamping.

Methods: This study analyzed 18 patients underwent RASP with temporary clamping of bilateral internal iliac arteries. Procedures were performed by two surgeons in two different hospitals using the same surgical technique. Preoperative and postoperative data were collected and statistically analyzed.

Results: The temporary clamping duration was less than 12 min during each adenoma’s enucleation. Despite the vascular control, the median operating time was similar to RASP performed without iliac clamping. The results showed minimal blood loss, a median catheter duration of 5 days, a median duration of postoperative continuous catheter irrigation of 41 h, and short hospitalization (3.2 days). A significant corellation was observed between the estimated blood loss and the duration of irrigation.

Conclusion: RASP performed with bilateral vascular control, combined with the known benefits of minimally invasive surgery resulted in bleeding reduction. The minimal blood loss further reduces catheter duration, decreases continuous catheter irrigation and patient’s hospitalization duration.

Lumbar disc herniation (LDH) is a common disease characterized by leg pain, numbness, and low back pain, which are also encountered in peripheral nerve and paralumbar spine disease. This study describes other diseases with symptoms similar to LDH. Patients with paralumbar spine diseases such as superior cluneal nerve entrapment neuropathy (NEN), gluteus medius muscle pain, piriformis syndrome, and sacroiliac joint pain experience lowback, buttock, and leg pain. Peripheral nerve diseases of the leg including lateral femoral cutaneous NEN, common and superficial peroneal NEN, and tarsal tunnel syndrome also cause leg symptoms. These diseases can produce intermittent claudication, thought to be specific to lumbar spine disease, and can be misdiagnosed as LDH. They are rather common and can be treated less invasively. As a misdiagnosis may result in failed back-surgery syndrome, it is important to differentiate between LDH and the diseases described here.

Aim: To evaluate the application of laminectomy using the interlaminar approach (ILA) for percutaneous endoscopic lumbar discectomy (PELD).

Methods: Minimal laminectomy using the ILA for PELD was performed in 13 patients with lumbar disc herniation (LDH). The width of the interlaminar space, shape of the caudal margin of the upper vertebral laminae (CM-UVL), LDH size, and caudal migration grade were radiologically evaluated. Ten LDHs were removed via the shoulder of the corresponding nerve root, and three via the axilla of the corresponding nerve root and dural sac. Bone status was evaluated preoperatively and postoperatively using two- and three-dimensional computed tomography.

Results: All patients (mean age 46.3 years) underwent PELD at a single spinal level, mostly at L5/S1. Compared with a previous study without laminectomy, the mean operative duration (57.5 min) and operative outcome, evaluated using the modified Japanese Orthopaedic Association and Numerical Rating Scale scores, were similar; no complications were observed. However, the width of the interlaminar space was significantly narrower, and eight cases revealeda narrow interlaminar space (width < 20 mm and/or lost concave shape of CM-UVL).

Conclusion: Minimal laminectomy using the ILA for PELD is feasible for treating LDH with the narrow space and highly migrated LDH.

Aim: Full-endoscopic posterior cervical foraminotomy (FPCF) has been utilized to treat cervical lateral disc herniation and provided good surgical outcomes. The authors examined the superiority of FPCF in patients with spondylotic foraminal stenosis.

Methods: Fifty-nine cases of FPCF were evaluated. Of the 59 patients, 34 had lateral disc herniation (group H) and 25 had spondylotic foraminal stenosis (group S). Operative time, complications, length of hospital stay, visual analog pain scale scores of neck and arm pain, and the amount of facet joint resection were compared between the groups.

Results: The mean operative times were 96 min (group H) and 100 min (group S). The lengths of hospital stay were 3.0 days and 3.9 days, respectively. No significant differences were observed in pre-operative neck and arm pain between the groups. Average neck pain at the final follow-up was significantly less severe in group H (2.9) than in group S (12). However, postoperative arm pain was the same after surgery in both groups (14). In both groups, 52% of the facet joint was resected.

Conclusion: The surgical outcome of FPCF in patients with spondylotic foraminal stenosis is equivalent to that in patients with lateral disc herniation.

Aim: This study aimed to document the use of percutaneous endoscopic cervical laminectomy (PECL) and the treatment results.

Methods: Eleven patients with a limited cervical spinal canal stenosis were indicated for the surgery. Under general anesthesia, the interlaminar space between the affected vertebrae was approached from 5 mm outside the midline. Laminectomy was performed using a 2.5-mm or 3.5-mm high speed drill, and an endoscope. Subsequently, the bilateral yellow ligament was removed and sufficient decompression of the dural sac was confirmed. Surgery was completed after the placement of an indwelling drain. Pre- and postoperative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) score.

Results: The mean operation time was 87.1 min, and no complications were observed. During the mean follow-up period of 16.6 months, the mJOA score improved significantly from 10.9 ± 0.7 to 14.3 ± 1.3 (P = 0.0000002).

Conclusion: PECL is a minimally invasive surgical technique for cervical posterior decompression. This is a useful procedure, although it is technically demanding, and must be carefully performed under strict indication by a surgeon with sufficient experience of endoscopic techniques.

Aim: Percutaneous endoscopic lumbar laminectomy or laminotomy (PELL) is a minimally invasive surgical technique to treat lumbar canal stenosis. The procedure is undertaken using a single port endoscope, as with percutaneous endoscopic lumbar discectomy (PED). PED has become popular with spinal surgeons in Japan as a suitable surgery for lumbar disc herniation patients. Because PED has the powerful advantage of structural preservation, it allows for short hospital stays and early recovery of the patient. PELL and PED are conceptually very similar, in that they are both minimally invasive. PELL is not as popular as PED, however. The aim of the current study was to explore the reasons why.

Methods: The current study reports the early experiences of surgeons at this institution in using the PELL technique, and its limitations.

Results: The goal of PELL is total flavectomy and decompression of the bony structure. Currently, there are difficulties and limitations in achieving decompression using PELL with small tools.

Conclusion: PELL requires much more skill than PED and the learning curve is not steep. PELL is minimally invasive for the patient, but further developments of the endoscope or procedures are required to achieve widespread use.

Aim: Cardiac surgery, as with other surgical specialties, has moved toward minimally invasive procedures. Currently, since the cardiopulmonary bypass machine remains necessary for most cardiac surgery procedures, efforts have focused on decreasing surgical trauma by limiting vascular access sites and any unnecessary dissection. This study presents the authors’ approach for less invasive valve surgery, which aimed to avoid a conventional midline sternotomy and reducing the length of incision.

Methods: For patients with aortic valve involvement, parasternal approach was the primary choice. A longitudinal 5-6 cm incision was made one fingerbreadth lateral to the sternal border. The 3rd rib was cut at the chondrosternal junction and bent into the right pleural cavity. After either central aortic or peripheral cannulation, all procedures were completed under surgeon’s direct vision and conventional instruments. The rib was reduced into position with a wire to offer stability and eliminate postoperative chest deformity.

Results: The authors’ experience of more than 500 cases with the minimally invasive approach showed that bypass time and ischemic time for parasternal valve surgery were compatible with to a full-sternotomy approach. In this series, postoperative ventilation time, blood product consumption and overall mortality were reduced.

Conclusion: Reviewing the parasternal aortic valve series of more than 500 cases, parasternal approach is safe, effective, and reproducible. The surgical trauma and blood product consumption were minimized with this approach. Multiple valve procedures and ablation for atrial fibrillation are also feasible. Stable sternoclavicular joints could facilitate early and aggressive activity of upper extremities for improved postoperative recovery. This approach could be a good alternative option in aortic or multiple valve surgical procedures.

Aim: Single-incision laparoscopic hernia repair (SILHR) is a popular technique, especially in female children, as it reduces the number of incisions while achieving a better cosmetic outcome. However, intracorporeal suturing and knotting remains a major obstacle during SILHR and it requires a relatively long learning curve. Conversely, extracorporeal suturing and knotting is straightforward, though it has several drawbacks. The purpose of this report is to describe a simple technique for SILHR in female children.

Methods: Between May 2014 and December 2016, 100 girls with 120 hernias of the Canal of Nuck (34 with right-side inguinal hernia, 46 with left-side hernia, and 20 with bilateral hernia) underwent SILHR. The opened internal inguinal ring was closed using a complete purse string suture fashioned by epidural needle with intracorporeal knot tying. The main outcomes were feasibility, operative time, complications and cosmetic outcome.

Results: The mean age was 2.0 ± 2.2 years, and the mean operative time was 8.0 ± 2.2 min for unilateral hernia repair and 16.0 ± 4.3 min for bilateral cases. All cases were completed laparoscopically without intraoperative complications. During follow-up, there were no recurrences and umbilical scars were almost invisible.

Conclusion: This simplified technique is feasible, quick, achieves better cosmetic results in female children, and avoids the drawbacks of extracorporeal knotting.

Aim: Posterolateral percutaneous endoscopic discectomy (PLPED) is commonly performed under local anesthesia, but patients and surgeons are concerned about intraoperative uncontrolled pain. The purpose of this study was to evaluate the safety of the PLPED under general anesthesia with free-running electromyography (EMG) monitoring.

Methods: The clinical outcomes of consecutive 48 cases of lumbar disc herniation (LDH) were evaluated by numeric rating scale (NRS) score and MacNab’s criteria. Hospital stay and time to ambulation and return to work were also assessed.

Results: NRS score for the affected leg significantly improved from 6.4 to 0.9 immediately after the operation. MacNab’s criteria were 91.5% for a follow-up period of 13.5 months. Although no serious complication occurred, 3 patients (6.3%) had transient paresis that completely disappeared by 3 months. No recurrences were observed during the follow-up period.

Conclusion: PLPED combined with EMG monitoring under general anesthesia is a safe and efficacious procedure for the treatment of LDH.

Idiopathic and Chagas’ disease achalasia are characterized by absent or partial lower esophageal sphincter relaxation, absence of peristaltic esophageal contraction, food retenction in the esophagus and esophageal dilatation. The most frequent symptoms are dysphagia, regurgitation, heartburn, weight loss and non-cardiac chest pain. The diagnosis is made by radiologic examination and esophageal manometry, which is considered the most accurate exam to characterized achalasia. In both diseases there is destruction of the esophageal myenteric plexus. Despite similarities in clinical and manometric presentation there is evidence of greater loss of inhibitory neurons of the myenteric plexus in idiopathic achalasia, whereas in Chagas’ disease there is a loss of both excitatory and inhibitory neurons. Such differences, though do not affect patients’ clinical presentation, and hence treatment options should be the same for both diseases.

Laparoscopic Heller’s myotomy is the most common surgical procedure to treat achalasia. It is the most accepted therapy for non-advanced stages of the disease. In the setting of advanced disease with marked esophageal dilatation or sigmoid-shaped esophagus the ideal surgical procedure is debatable. Esophagectomy is believed by several authors to be the operation of choice in these cases. Others; however, opt for less invasive alternatives. Laparoscopic Heller’s myotomy has been shown to be a safe and resourceful alternative in end-stage achalasia as well.

Aim: Current financial and work hour constraints make proctored on-site laparoscopic simulation training challenging. An independent learning approach utilizing proficiency-based training is a potential solution. The purpose of this study was to determine if an independent approach using a portable, laparoscopic training device within one’s home environment could effectively train novices in laparoscopic procedural skills.

Methods: After baseline testing, laparoscopic novices (n = 16) were randomized to one of two study groups. The on-site group (n = 7) received unlimited access to the workplace laparoscopic trainers and the home group (n = 9) received portable laparoscopic trainers for home. Both groups underwent self-directed, proficiency-based training for three months then were retested. Results were compared with parametric and non-parametric statistical tests.

Results: Baseline characteristics were similar between groups. The practice rate (56%) and practice time (range, 0.18 to 2.6 h) were poor in both groups during the training period. At post-test, the number of participants who demonstrated an improvement (86% on-site, 78% home) on the peg task was not different between groups. The successful completion of the suturing task post-test had significantly improved compared with pre-test in both groups (71% vs. 29% on-site; 44% vs. 22% home, P < 0.001). Although the majority of participants reported it was difficult to practice on a regular basis (86% on-site, 89% home), 56% of the home group participants agreed that the at-home trainer was a helpful teaching modality.

Conclusion: Learning of laparoscopic skills by novice trainees can be augmented by an independent learning approach using either home or on-site laparoscopic trainers. Although over half the candidates found it was useful to have the training device at home, none of the participants practiced more than an hour or two in the three month training period. Thus, the solution to conducting training does not lie in merely providing home training, but rather to understand the work-related stressors and reconfigure jobs.

Aim: Laparoscopic pancreatic surgery is a minimally invasive technique that has been widely applied only in the past decade. The purpose of this study was to evaluate its safety and assess whether laparoscopic distal pancreatectomy (LDP) is cost-effective compared with open distal pancreatectomy (ODP).

Methods: The medical records of patients treated for left-sided pancreatic lesions were retrospectively analysed, and the analysis of costs for hospital stay, operative time, and equipment were analysed. Twelve patients underwent LDP, while 12 patients underwent ODP.

Results: The two groups were homogeneous according to age, ASA score, BMI, and distribution of pathological findings. Both the size of the specimen (5.33 ± 3.2 vs. 5.58 ± 2.57 cm) and the number of removed lymph nodes (10.5 ± 4.3 vs. 12.1 ± 3.1) did not differ. Although LDP required a longer operative time (197.5 ± 33.7 vs. 122.5 ± 35.4 min), intraoperative bleeding, postoperative pain intensity (measured by VAS scale) and hospital stay were significantly reduced.

Conclusion: The mini-invasive approach offers several advantages compared with open surgery, including a significant reduction of blood loss and postoperative pain, and an earlier recovery. The global costs of laparoscopic surgery should be carefully re-evaluated, considering the saving that arises from these advantages.

Aim: Intra-abdominal collection or abscess (IAA) is a dreaded complication post open or laparoscopic appendectomy for perforated appendicitis. There have been many discussions on the role of laparoscopic irrigation during laparoscopic appendectomy for perforated appendix but not its role for patients who subsequently developed IAA post-surgery.

Methods: All patients who developed clinical symptoms and radiological evidence of IAA of more than 5 cm × 5 cm post appendectomy from January 2014 to May 2016 were subjected to delayed laparoscopic suction (DLS) of the IAA. Days to resolution of fever and improvement of symptoms post the DLS were recorded. Complications during DLS like bowel injury, bleeding and conversion to open surgery were documented and analysed. Patients were followed up for 1 month to a year to look for potential adhesive intestinal obstruction.

Results: Seven patients who met the criteria of large IAA were subjected to DLS at post-operative day 3 to day 5 post appendectomy. Six of the cases were post laparoscopic appendectomy and one case was post open appendectomy from another institution. Ports were inserted via the same sites as used during the first surgery. Turbid intraperitoneal fluid and abscesses were laparoscopically sucked without irrigation. There was no bowel injury, bleeding or conversion in any of the cases. All patients were afebrile within 24 h post procedure and their associated symptoms improved significantly. All patients were discharged within three days of DLS and have not returned with adhesive obstruction.

Conclusion: Early recognition of IAA is important and early attempt at DLS resulted in better outcome of patients and lesser hospital stay. DLS is a safe and feasible technique.

Achalasia is a primary esophageal disorderth variable causes, with an incidence between 0.03 to 1/100,000 people, and prevalence of approximately 10/100,000, with no difference between gender. It is more frequent in South and Central America, where Chagas disease is endemic. There are several methods to treat achalasia including endoscopic and surgical procedures, however, all of these methods are palliative. This article discusses 2 different endoscopic methods to treat advanced megaesophagus in Chagas disease, pneumatic balloon dilatation (PBD), and peroral endoscopic myotomy (POEM). Although varying between studies, PBD has an average symptom relief in 93% of patients in 6 months and 44% in 6 years. Some risk factors for failure of PBD are: younger age, male gender, a wider esophagus, poor emptying on post-treatment barium esophagogram and Eckardt scale < 3 before the treatment. Despite relatively short-term follow-up of an average of 3 years, POEM has excellent results. The clinical success achieved in 98 % with the Eckardt score decreased from 6.9 preoperatively to 0.77. Regarding sigmoid-shaped esophagus, only a few papers have been published on POEM. The largest population was 32 patients with a follow-up of 2 years. There was an efficacy of 96%, with the Eckardt scale decreasing from 7.8 to 1.4. In conclusion, PBD, is still widely used mainly due to its availability, especially in patients with a higher surgical risk and in patients who already had a Heller myotomy who persist or develop dysphagia. POEM has already demonstrated excellent results, but it requires advanced technical skills and Long-term results and randomized clinical trials are needed to validate the use of POEM in routine clinical practice.

Aim: The need for an antireflux procedure after myotomy is no longer as controversial as it used to be. However, the choice of the best fundoplication after myotomy is still controversial. The authors present the results of laparoscopic myotomies associated with postero-latero-anterior fundoplications (Heller-Pinotti).

Methods: Medical records and endoscopic findings were reviewed for achalasia patients that had submitted to the procedure following 5 years of follow-up.

Results: In total, 445 patients were enrolled: 39 (8.7%) presented erosive esophagitis, the Los Angeles classification being A-21, B-12, C-2 and D-4 (2 with peptic substenosis and 2 Barret); 41 (9.2%) patients had dysphagia, 4 needed reinterventions; 49 (11%) presented a migration of the fundoplication wrap to the thorax due to hiatal hernia, this was correlated with a higher risk of present erosive esophagitis (P = 0.047) and dysphagia (P < 0.001).

Conclusion: Laparoscopy myotomy postero-latero-anterior fundoplication (Heller-Pinotti) produces a good long-term outcome for dealing with dysphagia and in terms of reflux prevention.

Aim: The advent of minimally invasive abdominal and thoracic surgeries has led to a meaningful reduction in complication and mortality rates among patients undergoing esophagectomy, especially when used for the treatment of benign diseases such as megaesophagus.

Methods: Two hundred thirty-one patients, 152 (65.8%) men and 79 (34.2%) women, with a mean age of 52.46 (19-80) years, were treated for advanced megaesophagus between September 1996 and October 2016. Two hundred ten patients (90.91%) had chagasic megaesophagus and 21 patients (9.09%) had idiopathic megaesophagus.

Results: Immediate complications were observed in 37 patients (16.01%): hemopneumothorax in 22 cases (9.52%), gastric stasis in 11 (4.76%), cervical fistula in 11 (4.76%), dysphonia in 18 (7.8%), and mediastinitis in 1 case (0.43%). Two patients (0.86%) died: 1 patient with a pacemaker died of cardiorespiratory arrest on postoperative day 12 and the other patient died of mediastinitis on day 28. Our standardized protocol includes nutritional and pulmonary outpatient care.

Conclusion: With a standardized multidisciplinary protocol and a team adequately trained in laparoscopy, minimally invasive esophagectomy is an excellent option for the treatment of advanced megaesophagus. The technique is easily standardized and reproducible, and provides excellent postoperative outcomes.

Aim: Transhiatal esophagectomy is a therapeuthic option for the treatment of end-stage achalasia that avoids the complications of a thoracotomy. This technique; however, is still linked to some degree of morbimortality especially due to pleuromediastinal complications. Esophageal mucosectomy and endomuscular pull-through could avoid these complications.This study aims to evaluate the short and long-term outcomes of esophageal mucosectomy and endomuscular pull-through in a series of patients with advanced megaesophagus.

Methods: We retrospectively studied 115 patients with end-stage achalasia that underwent esophageal mucosectomy and endomuscular pull-through. Digestive tract reconstruction was accomplished most times using the stomachthourgh the muscular tunnel. Outcomes were evaluated in a short and long-term follow-up based on clinical, endoscopic and tomographic evaluation.

Results: Anastomotic leak or stenosis was present in 27%. Pleural efusion was noticed in 11% and pneumonia in 9%. Mortality was 1.7%. Long-term follow-up (over 10 years) was possible in 42 patients. Excellent and good clinical results were obtained in 83% of the patients.

Conclusion: Esophageal mucosectomy and endomuscular pull-through is a valuable procedure for the treatment of end-stage achalasia. It shows a low rate of complications and good outcomes at long-term follow-up.

Aim: To investigate the short-term outcomes of laparoscopic colorectal resection compared with open surgery in psychiatric patients with colorectal cancer.

Methods: The authors retrospectively reviewed the medical records of 31 consecutive patients who underwent open surgery (OS) or laparoscopic surgery (LS) for colorectal cancer between April 2013 and September 2015. All patients were involuntarily admitted to the hospital, because of anosodiaphoria. The clinicopathological characteristics, intraoperative outcomes, and postoperative data of the two groups were analyzed. Categorical data were compared using the χ² test or Fisher exact test, as appropriate. Continuous variables were compared using the Student t test or Mann-Whitney U test, as appropriate. Statistical analyses were performed using the statistical software program, SPSS, version 22 (SPSS Japan, Tokyo). P-values < 0.05 were considered statistically significant.

Results: Sixteenpatients underwent LS, and 15 underwent OS. Blood loss was lower in the LS group than in the OS group (P = 0.001). LS was associated with the earlier resumption of psychiatric drug treatment (P < 0.001) and a shorter hospital stay (P = 0.021) compared with OS.

Conclusion: Laparoscopic colorectal surgery is safe for psychiatric patients. The main advantages of LS include a shorter washout period and reduced hospital stay.

Percutaneous renal access remains the cornerstone initial step in varied clinical settings. For obtaining the best surgical outcome and minimizing patient morbidity, an appropriate access to the target calyx is needed. Though the site of entry depends upon anatomy of pelvicalyceal system and indication for access, a proper technique should be used for gaining access and at the same time minimizing the associated complications. This article describes our technique of gaining access to the pelvicalyceal system and subsequent percutaneous nephrostomy placement in a stepwise manner.

Interstitial cystitis, also called painful bladder syndrome, is a chronic condition causing bladder pain and sometimes pelvic pain. The exact cause of interstitial cystitis is not known. Often, signs and symptoms are hard to elucidate and no single treatment works for everyone. We report two cases of patients affected by interstitial cystitis treated with endovesical instillation of platelets rich fibrin (PRF). PRF is an autologous component that promotes angiogenesis, tissue growth and repair. This report presents the safety and the efficacy of PRF instillations in controlling clinical symptoms and restoring quality of life.