Wellen Cristina Canesin, Raphael Del Roio Liberatore Junior, Alberto Facury Gaspar, Fábio Perecin Volpe, Mariá Liborio Pereira Leite, José Sebastião Dos Santos, Lourenço Sbragia
{"title":"Correction of Congenital Hyperinsulinism by Robotic-Assisted Laparoscopy in an Infant.","authors":"Wellen Cristina Canesin, Raphael Del Roio Liberatore Junior, Alberto Facury Gaspar, Fábio Perecin Volpe, Mariá Liborio Pereira Leite, José Sebastião Dos Santos, Lourenço Sbragia","doi":"10.4293/CRSLS.2025.00024","DOIUrl":"10.4293/CRSLS.2025.00024","url":null,"abstract":"<p><strong>Background: </strong>Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion, in which dysregulation of insulin secretion by pancreatic β cells causes persistent hypoglycemia in neonates and infants. Babies diagnosed with CHI require preferentially minimal invasive surgical treatment with near-total pancreatectomy (NTP).</p><p><strong>Material and methods: </strong>CHI was treated with robotic-assisted laparoscopy (RAL).</p><p><strong>Results: </strong>The authors present an unreported case of CHI in an infant less than 10 kg, which was submitted to NTP treated by RAL. The procedure was performed with 3 arms of Da Vinci robot using adaptable size of trocars and the surgery was well succeeded.</p><p><strong>Conclusions: </strong>The RAL is a challenge in pediatric pancreatic surgery to CHI due to the size of the trocars. To our knowledge, this is the first case reported in the English literature of an infant weighing less than 10 kg having been submitted to NTP by RAL.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liaisan Uzianbaeva, Salma Moustafa, Tamera Paczos, Emily Suskin, Sara Said-Delgado, Sara Rabin-Havt, Pengfei Wang
{"title":"Leiomyoma with Bizarre Nuclei and Hereditary Leiomyomatosis and Renal Cell Carcinoma.","authors":"Liaisan Uzianbaeva, Salma Moustafa, Tamera Paczos, Emily Suskin, Sara Said-Delgado, Sara Rabin-Havt, Pengfei Wang","doi":"10.4293/CRSLS.2025.00015","DOIUrl":"10.4293/CRSLS.2025.00015","url":null,"abstract":"<p><strong>Introduction: </strong>Leiomyoma with bizarre nuclei (LBN) is a leiomyoma variant that can be associated with fumarate hydratase (FH) deficiency. Germline pathogenic variants in the <i>FH</i> gene are linked to hereditary leiomyomatosis and renal cell carcinoma (HLRCC), which presents with cutaneous leiomyomata, aggressive renal cell carcinomas (RCCs), and symptomatic uterine leiomyomas.</p><p><strong>Case description: </strong>A 22-year-old nulligravida female presented with multiple uterine fibroids, heavy menstrual bleeding and pelvic pain, lasting over two years. The patient subsequently underwent laparoscopic myomectomy. Histological analysis of the leiomyomas indicated the presence of bizarre nuclei. Immunohistochemical studies confirmed FH deficiency, characterized by loss of FH expression and overexpression of S-(2-succino)-cysteine (2SC). Genetic testing revealed a likely pathogenic variant (c. 1176_1181delTGCTGT) in the <i>FH</i> gene.</p><p><strong>Discussion: </strong>Due to potentially devastating consequence and the occult nature of RCCs, the discovery of LBN should be followed with further investigation for HLRCC.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Lost Gallstone: Thoracoscopic Removal of Retained Gallstone Following Cholecystectomy.","authors":"Aulon Jerliu, Brian Wong Won, Alicia McKelvey","doi":"10.4293/CRSLS.2024.00030","DOIUrl":"10.4293/CRSLS.2024.00030","url":null,"abstract":"<p><p>Cholecystectomy, the surgical removal of the gallbladder, is a common abdominal operation often performed laparoscopically due to its minimally invasive nature. Despite its safety and efficacy, rare complications such as gallstone retention outside the biliary system can occur. One unusual complication is the migration of gallstones into the thoracic cavity, potentially causing severe outcomes like pleural effusion, empyema, or bronchopleural fistula, which present diagnostic challenges due to their rarity and varied symptoms. Advanced imaging techniques are essential for diagnosis, while treatment ranges from conservative management for asymptomatic cases to surgical intervention for significant complications. This report details the case of an 80-year-old male who presented with epistaxis and hemoptysis, later found to have a retained thoracic gallstone postcholecystectomy. Despite initial normal imaging and clinical improvement, further investigation revealed a gallstone eroding through the diaphragm into the thoracic cavity. The patient underwent successful thoracoscopic removal of the stone but experienced a prolonged hospital stay due to complications, including atrial fibrillation exacerbation, hemothorax, and lower extremity ischemia. The report underscores the diagnostic complexities of intrathoracic gallstone migration and the severe complications that can arise. A high index of suspicion is necessary for patients with persistent respiratory symptoms following cholecystectomy, and timely imaging and surgical intervention are crucial to minimize morbidity.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kazushi Jinno, Alfred Honore, Silje Skarsjø, Kjell Øvrebø
{"title":"Small Bowel Strangulation under External Iliac Vessels after Robot-Assisted Prostatectomy.","authors":"Kazushi Jinno, Alfred Honore, Silje Skarsjø, Kjell Øvrebø","doi":"10.4293/CRSLS.2024.00071","DOIUrl":"10.4293/CRSLS.2024.00071","url":null,"abstract":"<p><strong>Introduction: </strong>Internal herniation under the external iliac vasculature is a rare cause of small bowel obstruction, however an increasing number of cases have been reported in recent years.</p><p><strong>Presentation of the case: </strong>We report a case of 74-year-old male patient who presented with diffuse abdominal pain. He had undergone robot-assisted laparoscopic prostatectomy 4 months earlier. Computed tomography showed signs of internal herniation under the right external iliac vessels. The patient was operated laparoscopically with small bowel resection and peritoneal flap.</p><p><strong>Conclusion: </strong>Internal herniation under external iliac vessels is a rare and challenging condition. Operation can be performed well with both laparotomy and laparoscopy. We suggest closing peritoneal defects during index operation and strongly recommend defect closure after an episode of internal herniation.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Incidental Gastrointestinal Stromal Tumor in a Patient Undergoing Robotic Sleeve Gastrectomy.","authors":"Adham Ahmed, Tara Ranjbar, Ricky Y Lovell, Samantha Colon, Branden Tejada, Claire Platt, Caitlin Russell, Indraneil Mukherjee, Olivia Haney","doi":"10.4293/CRSLS.2024.00045","DOIUrl":"10.4293/CRSLS.2024.00045","url":null,"abstract":"<p><p>Bariatric surgery is the most effective treatment option for patients with refractory morbid obesity to help facilitate weight-loss and reduce long-term metabolic morbidity and mortality. Over 200,000 procedures are performed annually in the United States with sleeve gastrectomy being the most common surgical approach. However, the growing popularity of surgical bariatric interventions has led to an increase in incidental findings of gastrointestinal neoplasms in intraoperative specimens. We report our experience performing a robotic sleeve gastrectomy in a 58-year-old woman who was later found to have a gastrointestinal stromal tumor (GIST) with positive immunohistochemical marking.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Kaleem, Deema Othman, Carlos Yanez, Jody Miller
{"title":"Acute Internal Pelvic Hernia: A Complex Diagnostic Challenge.","authors":"Ahmad Kaleem, Deema Othman, Carlos Yanez, Jody Miller","doi":"10.4293/CRSLS.2024.00074","DOIUrl":"10.4293/CRSLS.2024.00074","url":null,"abstract":"<p><strong>Introduction: </strong>Internal abdominopelvic hernias, whether congenital or acquired, are a rare cause of acute small bowel obstruction. Symptoms range from recurrent abdominal pain to acute obstruction, which can lead to severe complications like bowel ischemia, perforation, or death if untreated. Diagnosis is often difficult due to variable symptoms, but prompt surgical intervention is crucial to prevent life-threatening outcomes.</p><p><strong>Case description: </strong>We treated a 42-year-old female airline cabin crew member who presented with colicky abdominal pain, bilious vomiting, and lower abdominal tenderness. Her abdominal computed tomography (CT) scan showed small bowel obstruction with loops of small bowel predominantly in the left lower abdomen. She had a history of a single episode of similar abdominal pain many years prior, which resolved spontaneously. The rest of her history was unremarkable. She received nonoperative management initially, but due to persistent abdominal pain and vomiting, a diagnostic laparoscopy was done. The diagnostic laparoscopy showed congested but viable small bowel herniating into a peritoneal defect through the lateral part of left broad ligament at the lateral pelvic wall into the retroperitoneum. The hernia was reduced, and the defect was repaired. Postoperatively, she had an uncomplicated recovery.</p><p><strong>Discussion: </strong>Internal hernia is an important differential diagnosis in patients presenting with an acute abdomen, especially with a history of recurrent small bowel obstructions, regardless of surgical history. Physicians need to have a high index of suspicion to diagnose and treat this condition without delay, preventing morbidity and mortality in this patient group.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Melecchi de Oliveira Freitas, Vagner Menegotto Comin, Eduardo Rodrigues
{"title":"360-Degree Running Suture Technique in Robotic-Assisted Surgery for Bladder Neck Contracture.","authors":"Daniel Melecchi de Oliveira Freitas, Vagner Menegotto Comin, Eduardo Rodrigues","doi":"10.4293/CRSLS.2024.00041","DOIUrl":"10.4293/CRSLS.2024.00041","url":null,"abstract":"<p><strong>Introduction: </strong>Benign prostatic hyperplasia (BPH) affects a significant proportion of aging males, often requiring surgical intervention when conservative treatments fail.</p><p><strong>Case description: </strong>This case report details the management of a 58-year-old male with severe lower urinary tract symptoms and a markedly enlarged prostate, presenting with bladder stones and persistent obstruction despite medication. The patient underwent an open simple prostatectomy but developed bladder neck contracture and recurrent urinary retention, necessitating a suprapubic cystostomy. Following this, a robotic-assisted approach was chosen to address the complex contracture. The surgical strategy involved a vertical posterior bladder incision, after guide wire was visualized a bladder stone was removed, resection of inflammatory tissue, and a novel 360-degree running suture with 3-0 thread for bladder neck reconstruction. This approach was followed by closure with a double-layer running suture using 3-0 V-Lock material. The patient showed significant improvement in urinary flow and symptom resolution postoperatively, with no residual contracture detected on follow-up imaging.</p><p><strong>Discussion: </strong>This report highlights the effectiveness of the robotic-assisted technique and the innovative use of the 360-degree running suture for managing challenging bladder neck contractures, marking a novel application in surgical practice.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hassan Hifni, Ali A AlQahtani, Nuha Qattan, Abdullah I AlJunaydil, Ashwaq A Almajed, Nouf AlShammari, Fahad Bamehriz
{"title":"Primary Repair of Gastrobronchial Fistula Presenting 12 Years Post Uncomplicated Laparoscopic Sleeve Gastrectomy.","authors":"Hassan Hifni, Ali A AlQahtani, Nuha Qattan, Abdullah I AlJunaydil, Ashwaq A Almajed, Nouf AlShammari, Fahad Bamehriz","doi":"10.4293/CRSLS.2023.00057","DOIUrl":"10.4293/CRSLS.2023.00057","url":null,"abstract":"<p><strong>Background: </strong>Obesity is an alarmingly increasing global public health issue. Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery owing to its simplicity, effectiveness, and low complication rates. The complications can be classified as early or late, with fistula formation being one of the most severe complications. Here, we report a rare gastrobronchial fistula (GBF) that presented 12 years post LSG.</p><p><strong>Case presentation: </strong>A 34-year-old woman who underwent LSG in 2011 was referred to our institution. The patient complained of recurrent upper respiratory tract infections, nausea, and vomiting. Abdominal computed tomography (CT) with oral contrast showed abnormal fistulous communication between the fundus and left lung. Conservative management was initiated but failed multiple times. After counseling the patient on the surgical options, she underwent fistula removal and primary repair of the fundus with a healthy omental wrap and an omental diaphragmatic flap. She tolerated the procedure well, recovered uneventfully, and was discharged on postoperative day 7.</p><p><strong>Conclusion: </strong>GBF diagnosis is challenging. Imaging studies, such as CT and radiography with contrast and endoluminal diagnosis with esophagogastroduodenoscopy (EGD), bronchoscopy, and bronchial secretion analysis, aid in the diagnosis. GBF management requires a multidisciplinary team. Patients should be initially offered conservative management with the understanding that reoperation would be the only option if failure is seen for 3 months.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullah A Aljunaydil, Rafif E Mattar, Khadija Almufawaz, Ghada AlOthman, Hamad Aljaedi, Faisal Alalem
{"title":"Synchronous Acute Appendicitis and Cholecystitis.","authors":"Abdullah A Aljunaydil, Rafif E Mattar, Khadija Almufawaz, Ghada AlOthman, Hamad Aljaedi, Faisal Alalem","doi":"10.4293/CRSLS.2024.00004","DOIUrl":"10.4293/CRSLS.2024.00004","url":null,"abstract":"<p><strong>Introduction: </strong>Acute appendicitis and acute cholecystitis are two of the most commonly encountered surgical entities. Multiple hypotheses are behind their coexistence, which include pathogen predilection, and mucosal ischemia inducing portal vein bacteremia as the management of uncomplicated acute cholecystitis and acute appendicitis is surgical, for which a single operation for synchronous presentation is effective. Here, we report a case with coexistent acute cholecystitis and acute appendicitis managed at our institution.</p><p><strong>Case/technique description: </strong>A 30-year-old female presented with right upper quadrant abdominal pain for four days. The pain was radiating to the right shoulder, not related to fatty foods, associated with vomiting, anorexia, and burning micturition. On examination, she was vitally stable and afebrile with soft nondistended abdomen, a negative Murphy's sign, right lower quadrant rebound tenderness, and suprapubic tenderness. Laboratory tests showed leukocytosis (17.59 × 10<sup>9</sup>) and high ALT (40 IU/L) and AST (32.5 IU/L). Ultrasound showed a distended gallbladder with two echogenic intraluminal nonshadowing echogenicity, the largest measuring 0.57 cm. Due to the vague presentation we elected to go for computed tomography of the abdomen which showed a distended gallbladder with adjacent fat stranding, subhepatic appendix with distended tip and no surrounding fat stranding. She underwent diagnostic laparoscopy with cholecystectomy and appendectomy. The patient had an uneventful postoperative course and was discharge home on day 1.</p><p><strong>Conclusion: </strong>We aim to shed light on the rare, but possible, synchronous coexistence of these diseases, raise the index of clinical suspicion. Management options for synchronous presentation can follow their asynchronous guidelines such as Tokyo and WSES.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Robotic Laparoscopic Assisted Treatment of Inguinal Hernia Containing an Incarcerated Ectopic Pregnancy.","authors":"Nashali Ferrara, Michael Scutella, Hetal Lad, Tiffany Hsiung, Yasmin Abedin, Arpit Amin","doi":"10.4293/CRSLS.2024.00013","DOIUrl":"10.4293/CRSLS.2024.00013","url":null,"abstract":"<p><strong>Introduction: </strong>It is rare for adult female patients to present with incarcerated inguinal hernias containing ovary, fallopian tube, or uterine tissue. Potential surgical treatment options for incarcerated inguinal hernias containing ovary, fallopian tube or uterine tissue include open inguinal hernia repair (IHR), laparoscopic or robotic IHR.</p><p><strong>Case description: </strong>Herein, we report a case of an adult female presenting with a unilateral incarcerated inguinal hernia containing ectopic pregnancy. Patient was treated with laparoscopic lysis of adhesions, reduction of incarcerated ectopic pregnancy and unilateral salpingectomy. Patient then underwent robotic assisted transabdominal preperitoneal IHR (rTAPP-IHR).</p><p><strong>Discussion: </strong>Minimally invasive laparoscopic salpingectomy and rTAPP-IHR can be safely performed in patients presenting with unilateral incarcerated inguinal hernia containing ectopic pregnancy.</p>","PeriodicalId":72723,"journal":{"name":"CRSLS : MIS case reports from SLS","volume":"11 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}