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Introduction: The main cause of groin pain is inguinal hernia (IH). The most commonly used imaging test for diagnosis is sonography, which is also useful in distinguishing between indirect and direct hernias. Aim: In this study, measurements were made with sonography in the semi-erect position (45°) in addition to the supine position and the effectiveness of this position in detecting the defect was investigated. Material and methods: The IH cases diagnosed by ultrasound between March 2019 and October 2023 were evaluated retrospectively. According to the diameter of the defect in the supine position, the cases were divided into three groups: Group A (≤1.5 cm), Group B (1.5–3 cm), and Group C (≥3 cm). A total of 252 patients with unilateral IH were identified. Results: For Group A, the mean value was 1.09 ±0.23 (0.64–1.48) cm in the supine position and 1.28 ±0.26 (0.67) cm in the semi- -erect position (p<0.001). For Group B, the mean value was 2.29 ±0.29 (1.57–2.82) cm in the supine position and 2.41 ±0.31 (1.65–2.94) cm in the semi-erect position (p<0.001). For Group C, the mean value was 3.57 ±0.23 (3.28–4.05) cm in the supine position and 3.62 ±0.24 (3.32–4.10) cm in the semi-erect position (p<0.05). Conclusions: Superficial ultrasound, which provides reliable results in the diagnosis of IH, is an easily accessible modality. Unlike previous studies, this study was the first to examine the semi-erect position in IH patients. It showed that it is effective in determining the optimal diameter of the defect. [ABSTRACT FROM AUTHOR]

The aim of this pooled analysis was to evaluate the impact of robotic total mesorectal excision (TME) on pathology metrics in Male Overweight patients with Low rectal cancer (MOL). This was a multicenter retrospective pooled analysis of data. Two groups were defined: MOL (Male, Overweight, Low rectal cancer) and non-MOL. Overweight was defined as BMI ≥ 25 kg/m2. Low rectal cancer was defined as cancer within 6 cm from the anal verge. The primary endpoints of this study were histopathological metrics, namely circumferential resection margin (CRM) (mm), CRM involvement rate (%), and the quality of TME. Circumferential resection margin (CRM) was involved if < 1 mm. 836 (106 MOL and 730 non-MOL) patients that underwent robotic TME by six surgeons over 3 years were compared. No significant differences in demographics and perioperative variables were found, except for operating time, distal margin, and number of lymph nodes harvested. CRM involvement rate did not significantly differ (7.5% vs. 5.5%, p = 0.395). Mean CRM was statistically significantly narrower in MOL patients (6.6 vs. 7.7 mm, p = 0.04). Quality of TME did not differ. Distance of tumor from the anal verge was the only independent predictor of CRM involvement. Robotic TME may provide optimal pathology metrics in overweight males with low rectal cancer. Although CRM was a few millimeters narrower in MOL, the values were within the range of uninvolved margins making the difference statistically significant, but not clinically. Being MOL was not a risk factor for involvement of circumferential resection margin. [ABSTRACT FROM AUTHOR]

In this study, we aimed to retrospectively evaluate the volumes and cosmetic scores of mixed-type and spongy-type thyroid nodules treated with ethanol and radiofrequency (RF) ablation before and after treatment. In addition, the safety and efficacy of ethanol and RF ablation treatment methods were compared. In the radiology department, mixed-type and spongy-type benign thyroid nodules undergoing ethanol and RF ablation between February 2015 and March 2020 were evaluated retrospectively. Consequently, 50 patients who received ethanol ablation therapy and 46 patients who received RF ablation therapy were included in the study. Nodule volumes obtained in pretreatment, third-month, and sixth-month control ultrasounds were noted. Similarly, the cosmetic scores obtained pretreatment and at the sixth-month follow-up were recorded for all patients. All of the patients had a single nodule, and 46 patients (47.9%) received RF ablation, and 50 patients (52.1%) received ethanol ablation. The mean volume pretreatment in nodules with RF ablation was 21.41 ml, at the third-month control was 5.68 ml, and at the sixth-month control, it was 4.12 ml (p < 0.05). In ethanol ablation therapy, the mean volume pretreatment was 20.52 ml, at the third-month control was 8.76 ml and at the sixth-month control was 6.01 ml (p < 0.05). A minimally invasive approach is increasingly used in the treatment of benign thyroid nodules. Our study showed that RF ablation was somewhat more successful in reducing cosmetic scores in patients with biopsy-proven benign mixed-type and spongy-type thyroid nodules, and both techniques were similarly effective in volume reduction. [ABSTRACT FROM AUTHOR]

Introduction: The collateral pathways between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) play an important role in colonic surgery. The most well-known are the Drummond marginal artery and Riolan's arch. The Moskowitz artery, also known as the meandering mesenteric artery, is a lesser-known collateral pathway and represents another link between SMA and IMA. The Moskowitz artery runs along the colonic mesentery floor and represents the link between the proximal segment of the middle colic artery and the ascending branch of the left colic artery. Aim: To comprehend the presence and importance of the Moskowitz artery (meandering mesenteric artery) in preoperative patients by using computed tomography (CT) studies. Material and methods: We retrospectively reviewed all abdominal CT images performed using intravenous contrast for any reason at the Radiology Department of Yeditepe University Hospital between April 2015 and September 2018. Patients older than 18 years with intravenous contrast (arterial and venous phases with a cross-section thickness of 0.625 mm), who underwent abdominal CT scan, and patients without any abdominal surgery were included in the study. As a result of the screening, 109 CT scans with eligibility criteria were included in this study. Results: There were 109 cases in this study; 50 (45.9%) of them were male and 59 (54.1%) were female. Moskowitz artery was found in 18 (16.5%) cases; 8 were males and 10 were females. Riolan's arch was present in 30 cases, of whom 15 were male and 15 were female. In our study Moskowitz artery and Riolan's arch were monitored as separate vascular structures, and in all cases with Moskowitz artery, Riolan's arch was also present. There was a statistically significant difference (p < 0.05) between the combined MCA emerging type and the presence of MA, and 12 cases with combined branch and 6 cases with single branch had Moskowitz artery. There was a statistically significant difference (p < 0.05) between LCA types and the presence of MA, and the Moskowitz artery was the most common seen at type 1 LCA. Conclusions: Knowledge of the relationship between Riolan's arch and the Moskowitz artery is valuable, and preoperative evaluation of this artery may be beneficial in the presence of Riolan's arch. In addition, preoperative radiological evaluation and its importance are prominent in minimising intraoperative bleeding during splenic flexure mobilisation with a medial laparoscopic approach and reducing the risk of colorectal anastomosis leakage. [ABSTRACT FROM AUTHOR]

Transanal minimally invasive surgery (TAMIS) can be performed robotically assisted (R-TAMIS) for easier rectal defect suture closure particularly on the anterior rectal wall. The surgical technique described in this technical note emphasizes three safety points: 1) decreased likelihood for rectal injury when the ports are inserted into the GelPOINT® Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, California) on the back table rather than being inserted into the rectum; 2) decreased external collision between ports when using ports of different length; and 3) increased stabilization of pneumorectum when insufflating with an AirSeal™ port (Intelligent Flow System, ConMed, Utica, New York). Although R-TAMIS can be safely performed with the da Vinci® Si® or Xi® (Intuitive Surgical Inc., Sunnyvale, California) patient cart, the following differences are noteworthy: a) the Si® vertically-mounted arms design forces the patient in an uncomfortable position with asymmetrical hip flexion as opposed to the Xi® boom-mounted horizontal arm design; b) the 28cm circumference of each Si® patient cart arms operating between the patient's legs offer decreased maneuvering freedom as opposed to the 19cm circumference of the Xi® counterparts; and c) the abduction pattern of movement of the Si® arms potentially increases the risk of external collision with the patient's legs as opposed to the Xi® "jack-knife" pattern of movement.