Our experience is limited and we cannot conclude for the long term benefits of robotic surgery for esophageal tumors. In our experience the early outcomes were better then using classic open approach, but similar with the cases performed by thoracoscopic approach. We have noticed significant advantages of robotic surgery in relation of lymph node retrieval, leiomyoma dissection safe from esophageal mucosa and suturing. Ergonomics for the surgeon was incomparable better then with the thoracoscopic approach.

COVID-19 has significantly affected public health, social life, and economies worldwide. The only effective way to combat the pandemic is through vaccines. Although the vaccines have been in use for some time, safety concerns have still been raised. The most typical adverse effects of receiving a COVID-19 vaccine are localized reactions near the injection site, followed by general physical symptoms such as headaches, fatigue, muscle pain, and fever. Additionally, some people may experience VITT (vaccine-induced immune thrombotic thrombocytopenia), a rare side effect after vaccination. We present the case of a 60-year-old female patient that developed VITT-like symptoms with spleno-portal thrombosis and intestinal ischemia two weeks after the administration of the Ad26.COV2-S vaccine. Surgical treatment consisted of extensive bowel resection with end jejunostomy and feeding ileostomy. Two weeks after the first operation, a duodenal-ileal anastomosis was performed. The patient was discharged five weeks after the onset of the symptoms. Although some rare adverse effects are associated with the SARS-CoV-2 vaccines, the risk of hospitalization from these harmful effects is lower than the risk of hospitalization from COVID-19. Therefore, recognizing VITT is significant for ensuring the early treatment of clots and proper follow-up.

Background:The aim of this study was to analyze the treatment of patients with complicated liver hydatid cysts. Methods: The records of 184 patients who had undergone surgery for complicated liver hydatid cyst in our institution during 2005 and 2014 were reviewed retrospectively. Results: Among all complications, the most common were intrabiliary rupture (140 patients) and suppuration of the cysts (27 patients). Eleven cases had a combination of two complications. Other complications were rupture in the thorax (4 cases), rupture in the peritoneum (7 patients) and vascular erosions (6 patients). Surgery was based on the nature of complications, number and sizes of hydatid cysts and patients general condition. The surgical treatment of choice was partial (peri) cystectomies and drainage of the residual cavity with suture of the biliary fistula. In cases with complications such as suppuration, remaining bile fistulas, large cyst cavities or extrahepatic location, external drainage of the common bile duct (CBD)was mandatory. Post-operative complications occurred in 45 patients (24.4 %). Postoperative mortality was 1 % (two patients). Conclusion: Appropriate investigation and well planned surgical techniques may improve the outcome of complicated liver echinococcosis. These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.

Aims: Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. Material and Metods: From 2005 to 2014 we operated on 853 patients with liver hydatid cysts, 4 of thme having intrathoracic rupture of a hepatic hydatid cyst. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed in all patients. Results: In two cases a combined thoracic and abdominal approach was used, in one case a thoracic approach with phrenotomy was preferred, and in one case an abdominal approach with phrenotomy was chosen. The postoperative course was somewhat uneventful in 3 cases, but 1 patients died due to pulmonary embolism. Conclusions: The therapeutic approach depends on ultrasonographic and computer tomography findings (CT). We believe CT-scan to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.