Over the last decade, the use of electrosurgical devices has become commonplace across all surgical specialities. The current market is large enough to warrant a comparative review of each device. This has even more impetus given the budgetary constraints of NHS organisations. This review aims to compare the benefits and drawbacks of the most popular electrosurgical devices, whilst conducting a critical review of the literature. Structured searches using databases Medline and EMBASE were conducted. The search was restricted to English language papers only. Due to the abundance of literature, this review will focus on common general surgical procedures alone. Despite a plethora of available devices, individual preference still dictates use. Conventional diathermy may always have its place, but may see a decline in use if costs improve. Newer devices have shown comparable precision and added advantages.

Introduction: Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis. Methods: A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations. Results: We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001). Conclusion: Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.

Interaction between students and patients is a universal and essential component of a high-quality medical education. However, little work has been done to assess the attitudes of inpatients towards medical students on the ward. This study thus aimed to elicit patients' thoughts on the role and impact of medical students in the inpatient setting.

Some patients with bowel cancer have significant comorbidities, making them unfit for major surgery under general anaesthesia. However, treatment without surgery offers no possibility of cure, and furthermore, symptom control may be poor. We investigated the possibility of performing these resections under local anaesthesia in patients with a slim body habitus in a cohort of patients rejected for general anaesthesia. Eight patients (4 M, 4 F) aged 77-89 were included in this study. All had significant comorbidities and were deemed unfit for general anaesthesia by the consultant anaesthetist in charge of pre assessing high-risk patients. All patients had undergone a thorough assessment, which included P-POSSUM scoring. The recruited patients underwent a careful and fully informed consenting process, leading to standard cancer resections. These resections occurred between 2005 and 2012, under combined local anaesthesia and sedation. The operations undertaken were four right hemicolectomies (for caecal cancer), two Hartmann's procedures (for sigmoid cancer), one Hartmann's procedure with en bloc small bowel resection (for sigmoid cancer invading small bowel) and one transverse colectomy (for mid transverse colon cancer). Seven patients survived radical surgery without complications, although one died from an unrelated cause 8 months after surgery. One of these surviving patients subsequently underwent CABG and further bowel surgery under GA 2 years later for a metachronous sigmoid cancer. There was one postoperative death due to cardiogenic shock on the third postoperative day. Radical cancer resections under local anaesthesia are feasible in suitably selected high-risk patients with acceptable mortality and comparable medium-to long-term results.