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Introduction/Background The purpose of our study is to compare the costs of conventional open-surgery versus the robotic-assisted laparoscopy in the treatment of endometrial cancer. Methodology 108 patients with endometrial cancer who were operated at the department of Gynaecologic Surgery of ‘’Euroclinic Hospital’’, Athens, Greece from 2010 to 2019, were randomised for this study. All women underwent hysterectomy, bilateral salpingo-oophorectomy (BSOE) and pelvic lymphadenectomy for endometrial carcinoma according to evident-based guidelines.50 patients were operated with the use of robotic system da Vinci S & Si while 58 patients were operated via laparotomy. In the hospital perspective the costs were defined by examining the medical pathway for each type of intervention Patients‘ BMI was similar for the two groups. We analysed the stage and grade of disease, the comorbidity factors, the number of lymph nodes removed and the percentage of complications (such as blood loss) and readmissions. We defined the overall medical care cost by adding the cost of surgery, the post-operative hospital stay and/or hospitalisation within one month after surgery. Results For endometrial cancer, the surgical procedure cost for robotic-assisted laparoscopy was €5.950 versus €4.950 for conventional laparotomy. Considering the overall medical care, the average cost of the in-patient treatment was €7.467 (median €6.302) for the robotic group (with average hospital stay of 3,12 days), compared to €8.086 (median €7.024) for the open-surgery group (with average hospital stay of 5,34 days). p value for the cost of surgeries is calculated to 0,37 while p value for the average stay is 0,00001. Conclusion The cost of a robotic hysterectomy-BSOE-pelvic lymphadenectomy exceeds the cost of the open-surgery for endometrial cancer due to the higher cost of instruments and equipment. However, when considering overall medical care, conventional surgery for endometrial cancer is found 1,08 times more expensive than robotic-assisted surgery. Disclosure Nothing to disclose.

Thoracic duct cysts of the mediastinum are extremely rare entities and their pathogenesis still remains unknown. Imaging methods are not specific and show a cystic mass, however the real nature of the lesion is confirmed only with the help of histopathological examination after surgical excision. Here, we present a case of thoracic cyst in a 28-year-old female, lining in posterior lower mediastinum. The cyst was removed by video-assisted thoracic surgery (VATS) and the histopathological findings were that of thoracic duct cyst. Through this case, we propose an ideal surgical approach and diagnostic procedure.

Ilias Karapantzos,1 Paul Zarogoulidis,2 Charalampos Charalampidis,3 Chrysanthi Karapantzou,1 Ioannis Kioumis,2 Kosmas Tsakiridis,4 Andrew Mpakas,4 Nikolaos Sachpekidis,4 John Organtzis,2 Konstantinos Porpodis,2 Konstantinos Zarogoulidis,2 Georgia Pitsiou,2 Athanasios Zissimopoulos,5 Christoforos Kosmidis,6 Evagelia Fouka,2 Theodoros Demetriou31Ear, Nose and Throat Department, “Saint Luke” Private Hospital, Panorama, 2Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, 3Department of Anatomy, Democritus University of Thrace, Alexandroupolis, 4Cardiothoracic Surgery Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, 5Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, 6Surgery Department, “Interbalkan” European Medical Center, Thessaloniki, GreeceAbstract: Jugular veins bring deoxygenated blood from the head back to the heart. There are two sets of external and internal veins. The external jugular vein receives the greater part of the blood from the cranium and the deep parts of the face. It commences from the substance of the parotid gland and runs down the neck at the posterior border of sternocleidomastoideus and ends in the subclavian vein in front of the scalenus anterior. The external jugular vein is covered by the platysma and its upper half runs parallel with the great auricular nerve. There is also another minor jugular vein, the anterior, draining the submaxillary region. In our patient, we recognized a shunt between the external and internal jugular veins. It appeared in the middle of the veins, between the pair of valves, which are placed ~2.5 cm above the termination of the vessel. The anastomosis was fully functional, and there was no problem in the blood pressure of the patient. Moreover, the shunt was not associated with any systemic disease.Keywords: jugular veins, anastomosis, parotid gland

Sternal wound complications occur rarely but sometimes are devastating for the patients. Although appropriate therapy mediastinitis also can lead to death in some patients.