Watford General Hospital is a 521-bed acute District General Hospital situated on Vicarage Road, Watford, Hertfordshire. Together with Hemel Hempstead Hospital and St Albans City Hospital, it is operated by West Hertfordshire Hospitals NHS Trust.
Multiple robotic systems are now available for colorectal cancer surgery, yet comparative real-world evidence to guide NHS adoption remains limited. This study compared perioperative, oncological, and learning-curve outcomes for laparoscopic, Versius (CMR), and da Vinci Xi (dV) resections. A single-centre evaluation included elective colorectal cancer resections between November 2021 and May 2025 using laparoscopy, CMR or dV. Primary outcomes were length of stay (LOS) and operative time; secondary outcomes included lymph-node yield and Clavien–Dindo ≥ 2 complications. Analyses used non-parametric tests, Bonferroni-adjusted comparisons and multivariable regression. Learning curves were assessed with rolling means, LOWESS and CUSUM. A total of 290 patients were included: laparoscopy (n = 85), CMR (n = 103), and dV (n = 102). Median LOS was 5, 5 and 4 days respectively (p < 0.001) with dV significantly shorter than laparoscopy after adjustment (− 2.33 days; 95
To compare early outcomes of extracorporeal anastomosis (ECA) versus robotic intracorporeal anastomosis (ICA) in right hemicolectomy within a UK setting. We performed a retrospective cohort study of all minimally invasive right hemicolectomies at our institution between January 2023 and October 2025. The primary outcome was total length of recovery, defined as in‑hospital stay plus days enrolled in a “virtual hospital”. Secondary outcomes were operative time, postoperative inflammatory response (day‑1 C‑reactive protein, CRP), lymph node harvest, resection margin status, and postoperative complications (Clavien–Dindo). To account for baseline differences between groups, we applied inverse probability of treatment weighting (IPTW) based on preoperative demographic and clinical variables. A total of 163 patients were included: 100 undergoing ECA and 63 robotic ICA. After IPTW adjustment, ICA was associated with a significantly shorter total length of stay (RR 0.76, 95
SummaryWe report a rare case of Cushing's syndrome in a pregnant woman carrying twins. Interestingly, the patient did exhibit many of the classic clinical features typically associated with hypercortisolism, including Cushingoid facies, violaceous striae, insulin-dependent diabetes, raised central adiposity, chronic hypertension and peripheral myopathy. Her case was less straightforward given her previous gastric sleeve bariatric surgery, which led to rapid weight loss prior to pregnancy. The occurrence of an atraumatic fracture of the femoral neck in a young woman with a medical history of type 2 diabetes mellitus, chronic hypertension and possible severe osteoporosis raised clinical suspicion of a unifying diagnosis, prompting further evaluation.Biochemical testing, including elevated cortisol and suppressed adrenocorticotropic hormone levels, alongside imaging studies, confirmed the diagnosis of adrenal Cushing's syndrome. This case prompted a deeper investigation into the physiological changes of the hypothalamic-pituitary-adrenal axis during normal pregnancy, as well as the unique challenges in diagnosing and managing Cushing's syndrome during pregnancy.This case highlights the need for a high index of suspicion and a multidisciplinary approach in diagnosing and managing complex presentations in pregnancy. Early recognition and treatment of Cushing's syndrome are critical to optimising maternal and fetal outcomes.Cushing's syndrome during pregnancy is a rare but serious hormonal syndrome characterised by elevated cortisol levels. This hypercortisolism may be a result of functional adrenal or pituitary tumours, or iatrogenic. Though uncommon, it poses a significant threat to both maternal and fetal health due to the high risk of complications. This case study aims to provide a current overview of the diagnosis and management of Cushing's syndrome in pregnancy, with an emphasis on minimising associated maternal and fetal morbidity. The case report highlights missed differential diagnoses of Cushing's syndrome in the pre-pregnancy period despite the presence of type 2 diabetes, hypertension and morbid obesity in a young patient. Bariatric surgery further complicated the differential diagnosis.
ABSTRACT Background Virtual Hospital (VH) pathways enable early discharge and are promoted across the NHS. However, evidence supporting their safety, effectiveness, equity, and patient acceptability in elective colorectal surgery remains limited. Objective To evaluate implementation of a VH pathway following elective colorectal surgery and its impact on clinical outcomes, patient-centred recovery, and equality, diversity and inclusion (EDI). Design Retrospective service evaluation with a historical comparator. A 1:1 propensity-matched analysis was performed in colorectal cancer patients using age, sex, body mass index, ASA grade, Charlson Comorbidity Index, procedure type, tumour site, and anastomosis. Setting West Hertfordshire Teaching Hospitals NHS Trust. Patients Patients undergoing elective colorectal surgery between November 2023 and March 2025 managed via a VH pathway, compared with a non-VH cohort. Main outcome measures Primary outcomes were inpatient length of stay (IPLOS), VH length of stay (VHLOS), and days alive and at home within 30 days (DAH30). Secondary outcomes were patient-reported experience and EDI characteristics. Results Eighty-one patients were managed via VH. Median [Q1–Q3] IPLOS was 2 [1–2] days and VHLOS was 2 [2–3] days, with no deaths. Forty-two colorectal cancer patients were propensity matched 1:1 to a pre-VH cohort. IPLOS was shorter in the VH cohort (2 [1–2] vs 4 [3–5] days; p<0.001), and DAH30 was higher (28 [28–29] vs 25.5 [24–27] days;p<0.0001). Patient experience was positive, with mean satisfaction >8.5/10 and over 90% preferring VH-supported recovery. Sex and ethnicity distributions were similar, although VH patients were younger (p=0.028). Limitations This single-centre retrospective evaluation had a modest sample size and non-randomised design. VH patients were carefully selected, limiting generalisability. Conclusions A VH pathway following elective colorectal surgery is feasible, safe, and acceptable. Compared with a pre-VH cohort, VH care reduced inpatient stay and improved patient-centred recovery without compromising safety.
