Laparoscopic colorectal surgery is associated with improved outcomes compared with open procedures; however, its accessibility remains limited in rural Canada. We aimed to evaluate the implementation of laparoscopic colorectal surgery in a rural Canadian hospital. We conducted a retrospective cohort study of adult patients who underwent laparoscopic colorectal resection between January 2016 and January 2022 at Le Royer Hospital in Quebec. The primary outcome was the rate of anastomotic leak (AL). Secondary outcomes included perioperative variables, complications, length of hospital stay, 30-day readmission, and mortality rates. A total of 233 patients were included [57.1% male, mean age 65.2 years, mean body mass index (BMI) 27.8 kg/m 2 ]. Nearly half of the patients had an ASA score of 2. Most surgeries were elective (89.7%). Right hemicolectomy (43.8%) and anterior resection (39.1%) were the most common procedures performed. Conversion to open surgery occurred in 6.9% of cases. The median hospital stay was 5 days (range, 3.0–7.00). The perioperative mortality was 0.9%. AL occurred in 13 patients (5.6%), primarily managed by laparoscopic diverting ileostomy. The overall complication rate was 37.3%, with ileus being the most common complication (9.9%). Elevated C-reactive protein levels on postoperative day 3 were associated with AL ( P = 0.0054). To our knowledge, this is one of the largest rural series of laparoscopic colorectal surgeries performed at a single site. This practice appears safe and effective, with outcomes comparable to those of larger centers. Broader adoption, enhanced recovery protocols, and emerging technologies such as fluorescence may further improve the quality of care.
Importance and introduction: Fallopian tube torsion is a rare gynecologic emergency that often mimics other causes of acute abdominal or adnexal pain. Its diagnosis is challenging because symptoms and imaging findings are typically nonspecific, especially in women with previous pelvic surgery or tubal ligation. Case presentation: A 41-year-old G5P5 woman presented with a 4-day history of intestinal ileus, nausea, vomiting, fever, chills, and abdominal discomfort. Her history included two cesarean sections with a Pomeroy tubal ligation. Examination showed dehydration, left iliac tenderness, and an enlarged, painful uterus. Laboratory tests revealed elevated WBC (11.9 × 10 3 /µL), C-reactive protein (91 mg/dL), and estimated sedimentation rate (55 mm/h). Ultrasound detected a complex left adnexal mass consisting of a 63-mm cystic component and a 58-mm mixed-echogenic component. CT showed minimal pelvic free fluid and parauterine fat stranding. Due to worsening symptoms, laparotomy was performed, revealing a completely necrotic left fallopian tube twisted five times and a normal contralateral tube. Bilateral salpingectomy and appendectomy were performed. Histopathology confirmed hemorrhagic infarction with no malignancy. The patient recovered well. Clinical discussion: This case illustrates the diagnostic difficulty of isolated tubal torsion, which may be influenced by prior tubal surgery and altered pelvic anatomy. Imaging can suggest adnexal pathology but is rarely definitive. Conclusion: Clinicians should consider fallopian tube torsion in women with acute unilateral pelvic pain and adnexal masses, as timely surgery is essential to prevent irreversible ischemia.
Background: Lumbosacral radiculopathy, commonly caused by disc protrusion or joint hypertrophy, can also stem from lumbar epidural varix (LEV), a rare condition involving vertebral venous plexus dilation. This systematic review evaluates the diagnostic approaches used to identify LEVs in patients presenting with radiculopathy, with particular emphasis on imaging modalities and clinical diagnostic strategies. Methodology: Using the PICO framework, studies from January 2014 to June 2024 were systematically reviewed. MEDLINE, CINAHL, PubMed, and Embase were searched for peer-reviewed articles in English. Included studies examined diagnostic methods used to identify LEVs, including imaging modalities such as magnetic resonance imaging (MRI), CT myelography, and venospondylography, as well as clinical findings reported in affected patients. Data synthesis focused on diagnostic accuracy parameters and treatment outcomes following surgical interventions. Results: Seven studies met the inclusion criteria, involving 109 patients with LEV-related radiculopathy. MRI demonstrated high sensitivity (87%–100%) and specificity (80%–95%) in identifying varices and associated neural compression. Surgical interventions, including laminectomy and microsurgical techniques, consistently led to symptom resolution and minimal recurrence rates. Conclusion: This review underscores MRI’s efficacy in diagnosing LEV and guiding effective surgical management, despite diagnostic challenges. Early and accurate diagnosis through comprehensive clinical and imaging evaluations is crucial for optimizing therapeutic strategies and improving patient outcomes in LEV-related radiculopathy.
Background: Totally laparoscopic liver resection (TLLR) is increasingly adopted for benign and malignant liver diseases; however, achieving operative proficiency remains challenging, especially during the transition from open hepatobiliary surgery to advanced laparoscopy. This study evaluated proficiency development and perioperative outcomes of TLLR performed by a single hepatobiliary surgeon at a tertiary referral center. Methods: A prospective observational cohort study was conducted on 99 consecutive patients who underwent TLLR from January 2019 to May 2025. Patients were divided into two predefined chronological phases for comparative analysis. Demographics, operative parameters, postoperative complications, and short-term surgical and margin outcomes were compared. Cumulative sum (CUSUM) analysis of operative time was used to identify the proficiency threshold. Results: Median operative time decreased from 295 minutes in Group A to 207 minutes in Group B ( P = 0.006), and median blood loss decreased from 300 to 115 mL ( P = 0.006). Blood transfusion was less frequent in Group B (34.7% vs. 6.0%, P = 0.003), and conversion occurred only in Group A (16.3% vs. 0%, P = 0.002). Clinically significant complications (Clavien–Dindo ≥ II) were comparable (12.2% vs. 10.0%, P = 0.102), with a similar length of stay (11 vs. 9 days, P = 0.670). CUSUM analysis identified the 25th case as the proficiency inflection point. Conclusion: Operative proficiency in TLLR was achieved after approximately 25 cases, with clear improvements in operative performance, maintenance of low morbidity, and acceptable short-term surgical and margin outcomes.
Background: Kinematic alignment total knee arthroplasty (KA TKA) has the potential to restore native knee kinematics and improve functional outcomes compared with conventional mechanical alignment (MA) techniques; however, controlling tibial varus cuts remains a challenge, particularly in resource-limited settings. Methods: This study aimed to evaluate a modified KA TKA technique using conventional mechanical instruments combined with a 3D-printed tibial recut guide to control tibial varus alignment, and to compare its radiologic measures with those of MA TKA performed with navigation assistance. A historical control trial was conducted involving 100 patients. Fifty patients underwent KA TKA using mechanical instruments and a 3D-printed tibial recut guide (2020–2022), and 50 historical controls underwent MA TKA with navigation (2016–2019). Radiologic assessments included joint-line obliquity, femoral and tibial mechanical angles (TMAs), and the hip-knee-ankle (HKA) angle, measured using EOS imaging pre- and postoperatively. Results: Postoperative femoral mechanical angles showed no significant difference between groups (KA: 89.6° ± 2.9, MA: 89.3° ± 2.4; P = 0.497). TMAs indicated slight varus alignment in the KA group (86.9° ± 2.5) versus neutral alignment in the MA group (89.8° ± 2.0; P < 0.001). Postoperative HKA was more varus in the KA group than in the MA group (2.5°± 3.1 vs 1.1° ± 2.9; P = 0.020), but the difference was not significant after adjustment for preoperative HKA ( P = 0.161). Nine patients exhibited HKA varus > 6°; four were from the navigation mechanical group and five from the manual kinematic group. The most extreme tibial varus observed in the kinematic TKA group was 9°, corresponding to a HKA angle of 6°. Knee joint line obliquity was maintained near neutral in the KA group (−0.8° ± 2.6) and significantly increased laterally in the MA group (4.0° ± 2.6; P < 0.001). Conclusions: The modified KA TKA technique, using conventional instruments combined with a 3D-printed tibial recut guide, achieves reliable joint line restoration and controlled tibial varus cuts comparable to navigation-assisted MA TKA.
