General Surgery I

Pandemic Period Covid-19 (p=0,002). Perioada de spitalizare a fost mai mare în pandemie 10±1 zile (p=0,031), fără diferenţe semnificative între grupuri în ceea ce priveşte internarea la Terapie Intensivă (p=0,122). Mortalitatea totală s-a dublat procentual, cu 31 de cazuri (19%) în pandemie şi 28 cazuri (9%) în non-pandemie. (p=0,001). Pandemia COVID-19 a jucat un rol esenţial în tratarea cazurilor de abdomen acut chirurgical. Rata mare de solicitare a serviciilor de urgenţă a întârziat diagnosticul şi tratamentul cazurilor chirurgicale severe. Deoarece amploarea acestei pandemii este fără precedent, protocoalele standard cu modificări minore nu oferă rezultate adecvate. abdomen acut chirurgical, COVID-19, chirurgie de urgenţă, prepandemie, pandemie

Background: Seminoma accounts for the most common testicular origin histological type of malignancies with
increased incidence in young male patients. Retroperitoneal seminoma is a rare encounter with the most common
cause due to remnant embryological origin. Objective: The aim of this study is to present the surgical
management and challenges of a giant metastatic seminoma located in the retroperitoneal space. Material and
methods: We present a 51-year-old male know with intellectual disability that presents diffuse abdominal pain with
a distended abdomen at 1-year following right side orchidectomy. Abdominal CT indicates a huge differentiated
and encapsulated tumor formation located in the left flank encompassing the inferior pole of the right kidney with
associated hydronephrosis. He was admitted to the 1st Surgical Clinic Tirgu Mures Emergency County Hospital.
After preoperative preparation, we performed an exploratory laparotomy where we discover a giant tumor mass
(19x20x21 cm) in the retroperitoneal space that enveloped the left kidney with the initial part of the ureter, the
descendent and sigmoid mesocolon and with compression at the level of the middle abdominal cava and aorta.
Results: We perform a tumor extirpation with left nephrectomy, left parietal peritonectomy, appendicectomy and
local lymphadenectomy with no intraoperative complications. The patient was discharged after 25 days of
postoperative care with the recommendation for further oncologic monitorization. Conclusions: Giant seminoma
retroperitoneal tumors can represent a surgical challenge when secondary organ invasion is involved. Optimal
resection margins are required. It remains undetermined if such tumors are developed primarily at extragonadal
sites or represent metastasis of the primary testicular tumor.

The management of rectal cancer recognizes surgical resection as the most important
step towards a permanent cure. Respecting the oncological principles, functional preservation
represents a priority in achieving an acceptable quality of life for the patient. This study aimed to
compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR),
in terms of postoperative outcome.
We conducted a retrospective, observational study on a group of 147 patients with LAR
or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency
County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low
rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less
than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative
evolution was followed.
The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution
regarding patients’ demographic and biological parameters and tumor pathological features. A
significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR
procedures. We found no statistically significant differences between LAR and VLAR in terms of
associated postoperative morbidity or mortality, neither in hospitalization time.
There was no statistical difference in terms of early postoperative outcomes among
LAR and VLAR. The most important factor in achieving good oncologic and functional results in low
rectal cancer is choosing the adequate, tailored to the case surgical management.

Background. The COVID-19 pandemic has significantly impacted healthcare systems worldwide, raising concerns about the quality of care for patients with various medical conditions, including gastric cancer. This retrospective study aims to compare the treatment outcomes and complications among patients treated for gastric cancer two years before and two years during the pandemic. Aims. The objective is to gain insights into the potential impact of the pandemic on the management of gastric cancer. Methods. An analysis was conducted on a cohort of patients who underwent surgical treatment for gastric cancer. The cohort consisted of patients treated two years before and two years during the pandemic. The medical records of these patients were reviewed to collect data on treatment outcomes, complications, and other relevant parameters. Statistical analysis was performed to compare the outcomes between the two groups. Results. The pandemic group had a higher incidence of emergency surgery, anastomosis fistulas, and gastric stenosis than the pre-pandemic group. While both groups reported spleen penetration, only the pandemic reported penetrations affecting other organs. The pandemic group had a longer operation time but shorter hospital stays, with a higher mortality rate. The pre-pandemic group had more patients receiving preoperative chemotherapy and more T2-stage cases based on the TNM classification. No significant differences were found in bleeding, wound infection, or evisceration. Conclusions. The higher rate of complications, particularly anastomosis fistula, and the lower utilization of preoperative chemotherapy during the pandemic highlight healthcare systems' challenges in providing optimal care during crises. The shorter hospitalization period observed during the pandemic suggests a potential adaptation to minimize patient exposure and optimize hospital resources.

Laparoscopic surgery has revolutionized the management of abdominal emergencies, offering a minimally invasive alternative with a history of skepticism that turned to widespread acceptance after the 1980s' technological advancements. Its adoption in emergencies draws from its elective success, touting reduced incision sizes, diminished pain, lower infection risks, and expedited recovery. This retrospective study analyzed clinical records from Târgu Mureș County Clinical Emergency Hospital's General Surgery Department I over eight years. It focused on laparoscopic versus open surgical approaches for various abdominal emergencies, excluding thoracic, vascular, and traumatic cases. Data encompassed demographic details, operative duration, postoperative complications, conversion rates, and hospitalization length, analyzed using Graph Pad Prism and EasyMedStats©, with ethical oversight by SCJU Clinical Hospital Tg. Mures. Laparoscopic procedures outnumbered open surgeries, with appendicitis being the most common emergency. Notably, laparoscopic approaches saw fluctuating but generally declining admissions from 2014 to 2021, mainly due to the COVID-19 pandemic. Operative times were shorter for laparoscopy across all procedures, with hospital stays also reduced for laparoscopic methods except in incisional hernia repairs, where times were comparable. Conversion rates varied, with hernia repairs least likely to convert and appendectomies most likely. The study underscores the preferential role of laparoscopy in emergency surgical care, aligning with shorter operative times and hospital stays. Despite higher conversion rates for certain conditions, the benefits of laparoscopy remain compelling. Ongoing advancements in laparoscopic technology will further solidify its pivotal role in modern surgical practice.

Introduction: Amyand's hernia, named after Claudius Amyand, is a rare hernia variant characterized by the presence of the vermiform appendix within the hernial sac. Accounting for about 1% of all inguinal hernias, its exact development mechanism remains unclear. The clinical presentation can vary significantly, often mirroring symptoms of a hernia or acute appendicitis. Material & Method: A retrospective case series study was conducted at the General Surgery Clinic 1 of the SCJU Tg. Mures Emergency County Hospital. It involved a comprehensive review of medical records of patients diagnosed with Amyand's hernia who underwent emergency surgery. Data collected included demographics, clinical presentation, surgical management, postoperative complications, and follow-up details. Descriptive statistical analysis was performed using EasyMedStat software. Results: Over five years, seven cases of Amyand's hernia were reported, with an increase in 2023. The average age of the patients was 77.8 years, all male, demonstrating a higher incidence in older males. Symptom onset varied widely, from four months to nearly 20 years. Most patients experienced abdominal pain, with approximately half reporting fever. The primary diagnosis was often intestinal occlusion with an incarcerated inguinal-scrotal hernia. Surgical approaches varied, with the Lichtenstein operation being the most common. Mesh repair was used in most cases, and all patients underwent appendectomy. The median hospital stay was five days, with minimal postoperative complications. Conclusion: Amyand's hernia presents a surgical challenge due to its rarity and variable clinical presentation. This study underscores the need for individualized treatment strategies to optimize patient outcomes. The findings contribute to understanding Amyand's hernia, highlighting the importance of tailored surgical approaches and diligent postoperative care.

Transverse colon involvement by gastric cancer represents a significant clinical challenge, requiring sophisticated surgical techniques for effective management. Addressing this complexity requires an in-depth analysis of contemporary literature and clinical experiences to identify the most effective treatment strategies. This study aims to merge findings from specialized literature with clinical outcomes observed at the First Surgical Clinic SCJU Tg. Mures. By adopting a dual approach, we conducted a review of existing literature on the surgical management of gastric cancer extending to the transverse colon. We performed a retrospective analysis of cases treated at our institution. We evaluated surgical techniques, patient demographics, treatment protocols, and outcomes. As identified in systematic reviews and clinical trials over the past decade, the predominant strategy involves the combined resection of the stomach and affected colon segments. In our clinical practice, we managed four cases with personalized surgical treatments. Our findings revealed a 75% survival rate and a 50% comorbidity rate, with an average hospitalization duration of eight days. The findings highlight the necessity for personalized surgical approaches in managing complex gastric cancer cases involving the transverse colon. The study advocates integrating academic research with clinical practice to refine treatment protocols and enhance patient outcomes.

The presentation provides an overview of AI's development, starting from philosophical roots, through foundational theories in logic and computation, to key milestones like neural networks, expert systems, and modern AI applications in speech recognition and reinforcement learning.

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Introduction. Rare but significant anatomical differences in the biliary ducts, such as having two ducts, can create challenges in surgeries like laparoscopic cholecystectomy, according to a study that examined a case of double cystic duct found during cadaver dissection and its implications in practice. Material and method. In the study, dissections were done on 25 cadavers at the Anatomy Department of the University of Medicine Pharmacy Science and Technology in Târgu Mureș, where a cadaver with a secondary cystic duct anomaly was observed. A series of measurements and histological examinations were conducted to validate the results and juxtapose them with prior literature. Results. The secondary cystic duct showed a shape resembling the letter “Y,” with separate insertions of the ducts at the common hepatic duct level with the same macroscopic anatomical features. Histological examinations revealed normal biliary epithelium and tubular shaped structure. Conclusion.Finding a secondary duct underscores the importance of vigilance during surgery because such variations can raise the chances of bile duct damage during gallbladder cholecystectomy. It is advised to use imaging, before surgery and cholangiography during surgery to manage the risks linked to these abnormalities.

The presentation "From Laparoscopy to Robotic and Digital Surgery" outlines the evolution of surgical techniques from traditional laparotomy to modern robotic and digital surgery. It highlights the paradigm shift initiated by laparoscopy, the impact of video endoscopy, and the introduction of robotic systems, such as telepresence platforms and surgical robots. The presentation also touches on future trends, including the integration of 5G technology and the potential of fully digital surgical pl

This course, titled "The Origins of Minimally Invasive and Robotic Surgery and Their Impact on Surgical Practice: A Sociological and Technological History," is a comprehensive exploration of the evolution of surgical techniques, particularly focusing on minimally invasive and robotic methods. It covers the historical progression from early surgical innovations, including the development of the endoscope and the first laparoscopic procedures, to the advent of robotic surgery systems like the da Vinci robot.

The course emphasizes the significant technological advancements that have shaped modern surgery, as well as the sociological impact these innovations have had on surgical practice, education, and patient care. Through the study of various key milestones—from the pre-industrial era to the current widespread use of robotic surgery—the course provides valuable insights into how these advancements have enhanced surgical outcomes, education, and the overall practice of surgery. It also critically discusses the challenges and disadvantages of these technologies, including the loss of tactile feedback and the potential for a less intuitive surgical experience.

By the end of the course, participants gain an understanding of the historical, technological, and sociological contexts of modern surgery, with a focus on the continuing evolution of minimally invasive and robotic surgical techniques.

The presentation titled "Institute for Surgical Excellence: Its Role in the Standardization of Training and Accreditation in Robotic Surgery" explores the mission and impact of the Institute for Surgical Excellence (ISE), a non-profit organization established in 2014. The institute aims to address complex healthcare challenges associated with emerging surgical technologies to enhance patient outcomes and safety.

The course focuses on the Fundamentals of Robotic Surgery (FRS), which includes consensus conferences designed to standardize robotic-assisted surgery (RAS). These conferences, led by experts like Drs. Richard Satava, Roger Smith, and Vipul Patel, emphasize key aspects such as instrument handling, task coordination, safety protocols, and ergonomic practices in robotic surgery.

The curriculum planning for RAS includes practical tasks such as docking/instrument insertion, knot tying, vessel dissection, and other essential robotic surgery techniques. By providing clear outcome measures and structured training guidelines, the ISE plays a pivotal role in improving surgical training, accreditation, and patient safety in the evolving field of robotic surgery.

This course is integral in setting global standards for robotic surgery and ensuring that the next generation of surgeons is equipped with the necessary skills and knowledge to perform these advanced procedures effectively and safely.

The successful optimization of a Da Vinci robotic surgical program involves more than having robotic surgeons and technology. It requires a cohesive approach integrating all stakeholders under unified planning, objectives, policies, and procedures. Effective collaboration between clinical and administrative teams is essential for aligning goals, managing the surgeon learning curve, and improving outcomes.

A data-driven, proactive strategy focusing on governance, performance metrics, and analytics is critical to achieving clinical excellence while maintaining cost efficiency. A well-optimized program transitions from an early-stage initiative to a mature, efficient, and highly effective model, providing minimally invasive, high-quality surgical care for patients.

MEDICAROID envisions surgical robotics as a trusted partner for surgeons, surgical teams, and patients. Inspired by the idea of robots collaborating with humans to enhance healthcare, their approach emphasizes integrating robotic solutions to improve patient outcomes, healthcare quality, and the overall surgical experience. Their mission aims to build robotic systems that support and elevate human capabilities, fostering trust and innovation in the surgical field.

The political dimensions of robotic surgery encompass challenges such as public perception, team dynamics, and the organizational hurdles of implementing advanced technologies. Successful programs navigate three phases: the "Hype Phase," marked by steep learning curves; the "Trough of Disillusionment," involving confidence challenges; and "Establishing a New Normal," where true program value is realized. Key strategies include fostering high-performing teams, honest communication, and selecting supportive hospital environments to ensure sustainable progress and quality outcomes.

Background: Precise surgical interventions can influence treatment outcomes and, with the utilization of artificial intelligence (AI) have displayed the potential to enhance screening procedures and treatment choices by assisting surgeons in real-time during operations to make more precise surgical judgments and improving postoperative care. Material and methods: A review of studies was conducted that explored how AI is utilized in the treatment stages of gastric cancer care, with a particular emphasis on its involvement in surgical interventions. The research encompassed investigations into the use of AI technology in planning and predictive outcome models during surgeries. The articles were chosen from a span of five years, between 2019 and 2024. Results: AI systems have proven to be beneficial, in improving the precision of cancer surgeries. These systems utilize real-time guidance tools during the procedure to accurately pinpoint tumor boundaries and body structures, achieving 95% accuracy levels for both sensitivity and specificity. By employing convolution networks (CNNs), medical images from endoscopies and radiology scans have been analyzed with precision compared to traditional methods, resulting in quicker diagnosis times. Additionally, predictive models developed post-surgery that incorporate body measurements and dietary markers have proven to predict mortality risks over 90 percent of the time in validation groups. Together, these tools enhance the choice of patients for treatment and the creation of treatment plans to achieve the best surgical results possible. Conclusions: The adaptation of AI in gastric cancer surgery can be an innovation that ensures precise and personalized treatment for patients. Using AI to diagnose and predict real-time outcomes is beneficial and improves the overall performance of applied surgical procedures and surgeon decision-making. Maximization of AI usage is essential to expand the capabilities by appling data sets and analytical frameworks,