Autonomous and semi-autonomous systems are beginning to emerge in various interventions, automating important steps of the operation. These systems are expected to become standard modality and revolutionize the face of surgery.

Ancient schwannoma is often diagnosed only when it is large enough to produce symptoms. Robotic surgery with adjunctive electrophysiological monitoring is a safe technique for the removal of large pelvic neurinomas.

IntroductionSclerosing mesenteritis is a rare disease resembling a mesenteric tumour. We present here a case of sclerosing mesenteritis that affected both the large and the small intestine of the patient. Therapeutic and diagnostic issues are discussed.Case presentationA 62-year-old man with a history of non-Hodgkin lymphoma presented with fatigue, a palpable tender abdominal mass and clinical signs of progressing intestinal obstruction. The preoperative evaluation failed to prove recurrence of the lymphoma or any other definite diagnosis. A laparotomy was performed through a midline incision. The mesentery resembled a tumour-like thickened and fibrotic mass. Abundant, rigid intestinal loop adhesions were observed. Diffuse fibrotic infiltration of the ileum and of the sigmoid colon, which obviously affected the intestinal vascular supply, were identified. A right colectomy and partial sigmoidectomy were performed. Pathological evaluation revealed extensive myofibroblastic reaction of the mesentery with accompanying loci of fat necrosis and areas of inflammation. A diffuse fibrotic infiltration that focally showed a ground-glass appearance was observed. The post-operative course was complicated by respiratory insufficiency and infections and the patient died 2 months after the operation.ConclusionSclerosing mesenteritis that affects both the small and the large intestine is extremely rare. The disease is characterized by myofibroblastic reaction, fat necrosis and diffuse fibrosis of the mesentery. Pathological confirmation may be required for definite diagnosis. If the disease is characterized by severe and diffuse fibrosis, then the application of surgical therapy may be problematic.

STZ-induced diabetes in swine leads to a reliable large animal model for assessment of metabolic surgical procedures. STZ is an effective but highly toxic means for inducing stable diabetes in the sensitive porcine model. Duodenojejunal bypass, although less invasive, seems to exert better antidiabetic effects than gastroileal conduit.

Telesurgical systems have met with a great degree of acceptance in urology but indications are not yet that clear in the field of general surgery. The surgical robot overcomes certain limitations of conventional laparoscopy by offering three-dimensional, high definition vision, and seven degrees of freedom to the articulating instruments. Newer robots provide image integration, telestration and the dual-console capability for training purposes. According to our experiencs indications for robotic surgery are: the need for intracorporeal suturing, the expectant narrow surgical field, the expectant difficult dissection and/or adhesiolysis, especially in the upper abdomen, near the hiatus or very low in the pelvis. Although the use of robotic systems for simple laparoscopic cases is generally opposed on the basis of its increased operative time and cost, most teams accept that the beginning of the learning curve in robotic surgery must rely upon simple procedures such as cholecystectomies and Nissen fundoplications. Recent studies show more indications for robotic approach of cholecystectomies, such as in the setting of a reoperative, hostile abdomen following gangrenous cholecystitis, or in completion cholecystectomy.Robotic surgery constitutes a revolutionary stage in the evolution of surgery. Current systems aim to overcome certain limitations of laparoscopy. More advanced forms of robotic assistance are expected in the future, incorporating special software for intraoperational navigation and augmented reality guidance, help with the decision-making process, and smart "robotic-assistants" with artificial intelligence and autonomy. Integration of this technology will determine the definite role of robotics in the operating theater.