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Background. Seroma formation after videoendoscopic repair of inguinal hernias, known as “pseudorecurrence”, may vary from an asymptomatic, self-limiting occurrence to a painful, chronic problem. The aim of this study was to investigate the incidence of postoperative seroma in robotic-assisted transabdominal preperitoneal hernia repair (R-TAPP), modified by suturing and fixating the transversalis fascia to the Cooper ligament. Methods. The study was approved by the local ethics committee (2019-01132 CE-3495). Patients undergoing R-TAPP for direct inguinal hernia from October 2017 to December 2019 were included. In all patients, a barbed running suture of the transversalis fascia was performed to close the cavity resulting from the direct hernia reduction and to fix it to the Cooper ligament, then a lightweight mesh was placed. Demographic and clinical data were collected and analysed. Results. Over the study period, 67 R-TAPP in 51 patients were identified. All patients were male, with a mean age of 63.1 ± 12.7  years. There was 1 case of conversion to open surgery due to adhesions of the caecum to the groin as a result of perforated appendicitis. The mean length of the hospital stay was 1.8 ± .6  days. After discharge, no cases of seroma or recurrence at 30  days nor chronic pain at a mean follow-up of 10.3 ± 6.8  months was detected. Conclusions. In the treatment of direct inguinal hernia with R-TAPP, suturing and anchoring the transversalis fascia to the Cooper ligament are safe, feasible and recommendable in order to prevent postoperative seromas.

After cholecystectomy, the presence of dysplasia at resection margins on the cystic duct is rare and evidences lack. A 44-year-old woman underwent a cholecystectomy and a low-grade dysplasia of the cystic duct with involvement of the resection margin was found. A robot-assisted resection of the cystic duct stump was performed as close as possible to the common bile duct and the patient had an uneventful recovery. The histological examination did not show dysplasia on the proximal resection margin. In our experience, the surgical treatment of low-grade dysplasia on the resection margins after cholecystectomy provided optimal results. Further studies are needed to investigate the role of surgery and follow-up of this uncommon condition.

Background We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video‐assisted thoracoscopic surgery (VATS) in a single institute. Methods We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010–2019). We divided the study period into three groups: OT period (2010–2013), early VATS (2014–2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018–2019). Groups were compared to investigate the outcomes evolution. Results Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5–10], 10 [7.5–17.5], and 7 [5–10] for OT period, early VATS, and late VATS, respectively, p = 0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5–11], 6.5 [3–9], and 2.5 [1.5–5.5], p = 0.003), chest tube duration (5.5 days [5–7.5], 6 [4–6], 4 [3–5], p = 0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p = 0.01). Conclusions Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase.

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