The single-docking robotic technique should be considered as an alternative option for rectal surgery. This approach is safe and feasible and in our study it has demonstrated favourable clinical outcomes.

The diagnosis of inflammatory bowel disease (IBD) remains a challenging task despite significant increase in the understanding of the disease aetiology and pathogenesis. Recent decade has seen a massive interest in the non-invasive diagnostic biomarkers of IBD, consequently a number of studies have explored a variety of potential biomarkers to diagnose the disease and monitor the disease activity. Volatile metabolites are the chemicals, which emanate from biological fluids and can reflect the status of health and disease of an individual. Recent advances in the analytical techniques have enabled the detection and interpretation of the changes in volatile metabolites in breath, urine, faeces and blood of an individual in correlation with various gastrointestinal (GI) disorders including IBD. This can provide a simple, fast and reproducible diagnosis at the point of care. This review focuses on the current and future novel approaches for detecting and the monitoring gut inflammation in IBD by using volatile organic metabolites.

Background: Laparoscopic rectal cancer surgery offers several advantages over open surgery, including quicker recovery, shorter hospital stay and improved cosmesis. However, laparoscopic rectal surgery is technically difficult and is associated with a long learning curve. The last decade has seen the emergence of robotic rectal cancer surgery. In contrast to laparoscopy, robotic surgery offers stable 3D views with advanced dexterity and ergonomics in narrow spaces such as the pelvis. Whether this translates into a shorter learning curve is still debated. The aim of this literature search is to ascertain the learning curve of robotic rectal cancer surgery. Methods: This review analyses the literature investigating the learning curve of robotic rectal cancer surgery. Using the Medline database a literature search of articles investigating the learning curve of robotic rectal surgery was performed. All relevant articles were included. Results: Twelve original studies fulfilled the inclusion criteria. The current literature suggests that the learning curve of robotic rectal surgery varies between 15 and 44 cases and is probably shorter to that of laparoscopic rectal surgery. Conclusions: There are only a few studies assessing the learning curve of robotic rectal surgery and they possess several differences in methodology and outcome reporting. Nevertheless, current evidence suggests that robotic rectal surgery might be easier to learn than laparoscopy. Further well designed studies applying CUSSUM analysis are required to validate this motion.

In medical literature, studies are divided into two categories; experimental and observational settings. Experimental studies, entitled randomized controlled trials could test the relationship between exposure and outcome experimentally via control group and random allocation. Observational settings include either analytical or descriptive studies. Descriptive studies consist of case reports and case series that are helpful in present the experience of a case or a series of cases with similar diagnoses in detail which results in hypothesis generation. Cross-sectional studies, as analytical designs, are not capable to survey the temporality of exposure and outcome as simultaneously exposure and outcome status are measured. In case-control studies, subjects follow back from outcome to exposure. The rare diseases are recommended to study using case-control setting to save expenses and time. Both exposure measurement and patient selection is before disease detection in cohort studies. Therefore, they are inefficient for rare diseases or diseases with long latency. Cohort studies are time consuming with high cost and loss to follow-up. This paper elaborately reviews the features, advantages, and disadvantages of different types of observational and experimental studies.

Dear Madam, Ccolon resection (colectomy) is the surgical removal of diseased sections of the colon due to their underlying etiology, which may be in the form of colon cancer, precancerous or inherited conditions among many other issues. It has a 2% to 6% mortality rate with several contributing factors, including the type of operative procedure employed [1]. Open surgery, minimally invasive laparoscopic surgery (MIS), and robotic surgery are the procedures in practice for colectomy. This letter    assesses the clinical and cost-related outcomes of MIS and open surgery for colon resection, addressing the debate about their efficacy and safety. In this regard, Cone et al. compared the two colectomy techniques with a sample population of 1314696 patients and concluded that the laparoscopic colectomy attenuates the risk of mortality with an odds ratio of 0.51 and a reduction in mortality from 3.9% to 0.9% in the laparoscopic group [1].  Laparoscopic procedures are also believed to minimize the cytokine response and avoid a period of relative immunosuppression that is normal in open surgery [1]. When treating stage III colon adenocarcinoma, Lee L et al. found MIS positively correlated with reduced delays in starting adjuvant systemic therapy [2]. Furthermore, results from Hakim et al’s. recent study substantiated that open surgery had a longer length of stay, and higher readmission and mortality rates with a 13 times higher probability of mortality at discharge compared to MIS resection [3]. MIS has already demonstrated superiority over open surgery for colectomy in terms of mortality, median LOS, 30-day readmission rate, and procedure cost. Considering these potential advantages, open surgery should no longer be regarded as gold standard for colectomy. On the other hand, several studies also concluded that there is no significant difference in early mortality between open and laparoscopic groups. However, these database studies were limited by patient selection and whether the study was single or multi-institutional. In conclusion, the use of minimally invasive surgeries should be prioritized to provide excellent care to the patient. Public hospitals must also consider these techniques of surgery as they are less time-consuming, given the long waiting list at government facilities. Additionally, it should be noted that MIS requires a shorter stay at the hospital and less monitoring from the physician, hence it can also be used to alleviate the problem of inadequate doctor-patient ratio, which is currently at 1:1300 in Pakistan, much lower than that recommended by WHO.