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Colorectal resections for malignancy: A pilot study comparing conventional vs freehand robot-assisted laparoscopic colectomy

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World Journal of Clinical Cases 2024年第3期12卷 488-494页

作者： Shamir O Cawich Joseph Martin Plummer Sahle Griffith vijay naraynsingh Department of Surgery University of the West IndiesSt AugustineTrinidad and Tobago Department of General Surgery and Consultant General and Colorectal Surgeon Department of SurgeryUniversity of the West IndiesKingstonKIN7Jamaica Department of Surgery Queen Elizabeth HospitalBridgetownBarbados Department of Surgery Port of Spain General HospitalPort of SpainTrinidad and Tobago

BACKGROUND Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer,but we have experienced resistance to the introduction of the FreeHandffrobotic camera holder to augment laparoscopic colorectal *** To compare the initial results between conventional and FreeHandffrobot-assisted laparoscopic colectomy in Trinidad and *** This was a prospective study of outcomes from all laparoscopic colectomies per-formed for colorectal carcinoma from November 29,2021 to May 30,*** following data were recorded:Operating time,conversions,estimated blood loss,hospitalization,morbidity,surgical resection margins and number of nodes *** data were entered into an excel database and the data were analyzed using SPSS ver *** There were 23 patients undergoing colectomies for malignant disease:8(35%)FreeHandff-assisted and 15(65%)conventional laparoscopic *** were no *** time was significantly lower in patients under-going robot-assisted laparoscopic colectomy(95.13±9.22 vs 105.67±11.48 min;P=0.045).Otherwise,there was no difference in estimated blood loss,nodal harvest,hospitalization,morbidity or *** The FreeHandffrobot for colectomies is safe,provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.

关键词： Laparoscopic Colectomy Robot Surgery Minimally invasive

Whipple’s operation with a modified centralization concept:A model in low-volume Caribbean centers

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World Journal of Clinical Cases 2022年第22期10卷 7620-7630页

作者： Shamir O Cawich Neil W Pearce vijay naraynsingh Parul Shukla Rahul R Deshpande Department of Clinical Surgical Sciences University of the West IndiesSt Augustine 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom

Conventional data suggest that complex operations,such as a pancreaticoduodenectomy(PD),should be limited to high volume ***,this is not practical in small,resource-poor countries in the *** these settings,patients have no option but to have their PDs performed locally at low volumes,occasionally by general *** this paper,we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income ***,we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating studies published on outcomes after PD in high volume *** data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization *** the authors’opinions,most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed *** these settings,their only options are to have their operations in the resource-poor,low-volume settings in the ***,post-operative outcomes may be improved,despite low-volumes,if a modified centralization concept is encouraged.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

Clinical outcomes after major hepatectomy are acceptable in low-volume centers in the Caribbean

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World Journal of Hepatology 2019年第2期11卷 199-207页

作者： Shamir O Cawich Ravi Maharaj vijay naraynsingh Neil Pearce Wesley Francis Kimon O Bonadie Dexter A Thomas Department of Clinical Surgical Sciences University of the West Indies Department of Surgery University Hospital Southampton NHS Trust Department Surgery University of the West Indies Department Surgery Cayman Islands Health Service Authority

BACKGROUND Major hepatectomies are routinely performed because they are often the only curative treatment for metastatic liver *** has been a trend to concentrate major hepatectomies in referral hospitals that perform these operations at high *** high volume referral centers are usually located in developed countries,but many patients in developing nations are not able to access these centers because of financial limitations,lack of social support and/or travel ***,local hospitals are often the only options many of these patients have for surgical treatment of metastatic liver *** is the situation in many Caribbean *** To determine the clinical outcomes after major liver resections in a low-resource hepatobiliary center in the *** We prospectively studied all patients who underwent major liver resections over five *** following data were extracted:patient demographics,diagnoses,ECOG status,operation performed,post-operative morbidity and *** analyses were performed using SPSS ver 16.0 RESULTSThere were 69 major liver resections performed by two teams at a mean case volume of 13.8 major resections/***-nine major hepatic resections were performed for:colorectal liver metastases 40(58%),non-colorectal metastases 9(13%),hepatocellular carcinoma 8(11.6%),ruptured adenomas 4(5.8%),hilar cholangiocarcinomas 4(5.8%),hemangiomata 2(2.9%),trauma 1(1.5%) and hepatoblastoma 1(1.5%).Twenty-one patients had at least one complication,for an overall morbidity rate of 30.4%.There were minor complications in 17(24.6%)patients,major complications in 11(15.9%) patients and 4(5.8%) *** There are unique geographic,political and financial limitations to healthcare delivery in the ***,clinical outcomes are acceptable in the established,low-volume hepatobiliary centers in the Eastern Caribbean.

关键词： Liver Surgery Resection Caribbean Volume Outcomes

Alternative to mesh repair for ventral hernias: Modified rectus muscle repair

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World Journal of Surgical Procedures 2023年第3期13卷 14-21页

作者： vijay naraynsingh Shamir O Cawich Samara Hassranah Department of Surgery Port of Spain General HospitalPort of SpainTrinidad and Tobago Department of Surgery University of the West IndiesSt.AugustineTrinidad and Tobago Department of Surgery Medical Associate HospitalSt.JosephTrinidad and Tobago

BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections,adhesions,seromas,fistula formation and significant postoperative *** modified rectus muscle repair(RMR)is as an option to repair midline ventral hernias without *** To evaluate the short term outcomes when the modified RMR was used to repair ventral *** This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias>5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon *** were reviewed in an outpatient clinic at 3,6 and 12 mo and evaluated for hernia recurrence on clinical *** patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect *** data were examined with SPSS ver *** Over the 5-year study period,there were 52 patients treated for ventral hernias at this *** patients were excluded and there were 48 in the final study sample,at a mean age of 56 years(range 28-80).The mean maximal diameter of the hernia defect was 7 cm(range 5-12 cm).There were 5(10.4%)seromas and 1 recurrence(2.1%)at a mean of 36 mo *** The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral *** seroma rate can be further reduced with routine use of *** modified RMR also has the benefit of eliminating all mesh-specific complications.

关键词： Ventral Hernia Mesh Complication Recurrence

Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections

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World Journal of Surgical Procedures 2019年第2期9卷 12-18页

作者： Shamir O Cawich vijay naraynsingh Ramesh Jonallagadda Cameron Wilkinson Department of Clinical Surgical Sciences University of the West IndiesSt.AugustineTrinidad & TobagoWest Indies Department of Surgery University of the West IndiesCave HillBarbadosWest Indies Department of Surgery Windsor UniversitySt. KittsWest Indies

Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.

关键词： Diabetes Surgery Infection Caribbean Foot

Whipple’s pancreaticoduodenectomy at a resource-poor,low-volume center in Trinidad and Tobago

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World Journal of Clinical Oncology 2022年第9期13卷 738-747页

作者： Shamir O Cawich Dexter A Thomas Neil W Pearce vijay naraynsingh Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Department of Surgery Southampton General Hospital National Health Services TrustSouthampton SO166YDUnited Kingdom

BACKGROUND Many authorities advocate for Whipple’s procedures to be performed in highvolume centers,but many patients in poor developing nations cannot access these *** sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume,resource-poor setting in the West *** To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,*** This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,*** This center performed an average of 11.25 procedures per *** were 72 patients in the final study population at a mean age of 60.2 years,with 52.7%having American Society of Anesthesiologists scores≥III and 54.1%with Eastern Cooperative Oncology Group scores≥*** Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in *** vein resection/reconstruction was performed in 19(26.4%)*** patients undergoing open procedures there was 367±54.1 min mean operating time,1394±656.8 mL mean blood loss,5.24±7.22 d mean intensive care unit stay and 15.1±9.53 d ***(8.3%)patients experienced minor morbidity,10(14%)major morbidity and there were 4(5.5%)*** This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple’s *** volume centers in resource poor nations can achieve good short-term *** is largely due to the process of continuous,adaptive learning by the entire hospital.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

腹腔镜Roux—en—Y胃旁路手术中意外发现中肠旋转不良的应对

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中华胃肠外科杂志 2010年第9期13卷 678-680页

作者： DAN Dilip BASCOMBE Nigel HARNANAN Dave HARIHARAN Seetharaman naraynsingh vijay Trinidad 西印度群岛大学St. Augustine San Fernando总院临床外科外学部

目的探讨在腹腔镜肠道手术中意外发现中肠旋转不良的应对策略.方法 1例37岁男性肥胖症患者,体质量140 kg,BMI大于65,伴有严重下背部疼痛及睡眠呼吸暂停.行腹腔镜Roux-en-Y胃旁路手术（LRYGB）,术中意外发现中肠扭转.术中仔细探查后制... 详细信息

目的探讨在腹腔镜肠道手术中意外发现中肠旋转不良的应对策略.方法 1例37岁男性肥胖症患者,体质量140 kg,BMI大于65,伴有严重下背部疼痛及睡眠呼吸暂停.行腹腔镜Roux-en-Y胃旁路手术（LRYGB）,术中意外发现中肠扭转.术中仔细探查后制订合理手术计划,除行原胃旁路手术外,另加行阑尾切除术.结果手术顺利实施,术中出血极少,手术用时3.17 h.术后恢复良好,体质量明显下降,相关症状亦显著改善.结论在腹腔镜肠道手术中应留意此类畸形的出现;对于伴有中肠旋转不良的患者,LRYGB手术仍然可安全施行;阑尾切除术或可使患者受益.

关键词：中肠旋转不良胃旁路术腹腔镜阑尾切除术

Freehand-robot-assisted laparoscopic colorectal surgery:Initial experience in the Trinidad and Tobago

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World Journal of Surgical Procedures 2022年第1期12卷 1-7页

作者： Shamir O Cawich Yardesh Singh vijay naraynsingh Ramdas Senasi Tan Arulampalam Department of Surgery University of the West IndiesSt AugustineTrinidad and Tobago Department of Clinical Surgical Sciences University of the West IndiesSt.AugustineTrinidad and Tobago Department of Surgery South Tyneside and Sunderland NHS TrustSouth Shields NE340PLUnited Kingdom Department of General Surgery Colchester Hospital University National Health Services Foundation TrustColchesterEssexEnglandColchester CO45JLUnited Kingdom

BACKGROUND Laparoscopic colorectal surgery is still developing in the Anglophone Caribbean,having been first performed in the region in the year *** report the initial outcomes using a robot camera holder to assist in laparoscopic colorectal *** To report our initial experience using the FreeHand®robotic camera holder(Freehand 2010 Ltd.,Guildford,Surrey,United Kingdom)for laparoscopic colorectal surgery in Trinidad&*** We retrospectively collected data from all patients who underwent laparoscopic colorectal resections using the Freehand®(Freehand 2010 Ltd.,Guildford,Surrey,United Kingdom)robotic camera holder between September 30,2021 and April 30,*** following data were recorded:patient demographics,robotic arm setup time,operating time,conversions to open surgery,conversions to a human camera operator,number and duration of intra-operative lens *** the termination of the operation,before operating notes were completed,the surgeons were administered a questionnaire recording information on ergonomics,user difficulty,requirement to convert to a human camera operator and their ability to carry out effective movements to control the robot while *** Nine patients at a mean age of 58.9±7.1 years underwent colorectal operations using the FreeHand robot:Right hemicolectomies(5),left hemicolectomy(1),sigmoid colectomies(2)and anterior resection(1).The mean robot docking time was 6.33 minutes(Median 6;Range 4-10;SD±1.8).The mean duration of operation was 122.33±78.5 min and estimated blood loss was 113.33±151.08 *** were no conversions to a human camera *** laparoscope was detached from the robot for lens cleaning/defogging an average of 2.6±0.88 times per case,with cumulative mean interruption time of 4.2±2.15 minutes per *** mean duration of hospitalization was 3.2±1.30 days and there were no complications *** the surgeons were interviewed after operation,the surgeons reported that there were

关键词： Laparoscopic Robotic Minimally invasive Colorectal

Surgical relevance of anatomic variations of the right hepatic vein

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World Journal of Transplantation 2021年第6期11卷 231-243页

作者： Shamir O Cawich vijay naraynsingh Neil W Pearce Rahul R Deshpande Robbie Rampersad Michael T Gardner Fawwaz Mohammed Roma Dindial Tanzilah Afzal Barrow Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Radiology University of the West IndiesSt.Augustine 000000Trinidad and Tobago Department of Radiology Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesSt Augustine 000000Trinidad and Tobago

BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons,interventional radiologists,and other medical practitioners who treat liver *** drainage patterns of the right hepatic veins(RHVs)are particularly relevant to transplantation *** The aim was to identify variations of the patterns of venous drainage from the right side of the *** the best of our knowledge,there have been no reports on RHV variations in in a Caribbean *** Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral *** outflow patterns were observed and RHV variants were described as:(1)Tributaries of the RHV;(2)Variations at the hepatocaval junction(HCJ);and(3)Accessory *** A total of 118 scans met the inclusion *** 39%of the scans found conventional anatomy of the main hepatic *** RHVs were present 49.2%and included a well-defined inferior RHV draining segment VI(45%)and a middle RHV(4%).At the HCJ,83 of the 118(70.3%)had a superior RHV that received no tributaries within 1 cm of the junction(Nakamura and Tsuzuki type I).In 35 individuals(29.7%)there was a short superior RHV with at least one variant *** to the Nakamura and Tsuzuki classification,there were 24 type II variants(20.3%),six type III variants(5.1%)and,five type IV variants(4.2%).CONCLUSION There was significant variation in RHV patterns in this population,each with important relevance to liver *** radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

关键词： Liver Variant Hepatic Vein Anomaly Venous,Drainage,Vena cava