Introduction: The purpose of the present study is to evaluate the clinical and radiographic results of simultaneous surgical correction for bilateral hallux valgus compared with unilateral correction using Percutaneous Forefoot Surgery Techniques (PFS).

Material and methods: A prospective cohort study of 82 patients (106 feet). The mean follow-up was 58.7 ± 31.5 months (range 22.3 to 112.1). Patients were divided into two groups, unilateral surgical group (group U, 58 feet) and simultaneous bilateral surgical group (group B, 48 feet).

Results: Preoperative mean Visual Analog Scale (VAS) was 6.2 points in group U and 6.3 in group B (p = 0.170), at the last follow-up it decreased in both groups (1.6 group U and 1.8 group B, p = 0.277). American Orthopaedic Foot and Ankle Society (AOFAS) score improved from approximately 50 points preoperative in both groups, to 88 at the last follow-up. Mean hallux valgus angles in groups U and B changed from 34.7 degrees and 34.3 degrees preoperatively (p = 0.838), to 21.3 degrees and 22.4 degrees follow-up, respectively (p = 0.635). With the numbers available, no significant inter-group differences were observed in clinical and radiographic outcomes.

Conclusions: PFS is a valid procedure for outpatient simultaneous surgical correction in patients with bilateral hallux valgus.

Level of evidence: II Prospective Comparative Cohort Study

Minimally Invasive Surgery (MIS) continues to play an important role in surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation has seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We review the differences in new developments and advancement in the different techniques in the last ten years. We also aim to explain these differences as well as the implications for the future.

Introduction: Central obesity is a side effect of Cushing’s disease. Patients with pituitary-based tumors who have failed other surgical and medical treatments often face the option of bilateral end organ (adrenalectomy) removal.

Methods: In the past two years, four obese patients underwent robotic bilateral transabdominal adrenalectomy (RBTA) at our institution. One patient was obese (body mass index (BMI) 30.6 kg/m2 ), another was severely obese (BMI 37 kg/m2 ), another morbidly obese (BMI 40.4 kg/m2 ) and one was super-obese (BMI 53.2 kg/m2 )

Results: The operative times for the super obese, morbidly obese, severely obese and obese patients were 350, 310, 202 and 165 minutes, respectively. Removal of the left adrenal gland took longer (average 133 minutes) than right side (average 90 minutes). Blood loss was minimal (<25 mi). There was a minor liver laceration in the super obese patient. No other complications were observed at a median follow-up of IO months. The obese and severely obese patients were discharged post-op day 1 and 2; the morbidly and super obesepatients were discharged post-op day 4.

Conclusion: Despite the higher anesthetic risks, difficulties with positioning, thick abdominal walls and limited working space in obese patients, RBTA is a safe and effective method to remove the adrenal glands allowing this subset of patients the opportunity to undergo minimally invasive surgery.

Recurrent pyloric stenosis is a rare occurrence that presents weeks after initial operative management and a history of complete cessation of symptoms. We report on a case managed with a repeat laparoscopic pyloromyotomy with a successful outcome. Brief commentary is provided on the emerging significance of administration of general anesthesia and the possible long-lasting deleterious neurocognitive effects in the pediatric population

Background: Reports of cholecystectomy under local or regional anesthesia are rare. Nevertheless, it can be a useful tool in selected patients with high risk or unwillingness for general anesthesia. An updated review of the cases published in the medical literature was conducted.

Method: The Medline/PubMed database and the Medical Subject Headings (MeSH) vocabulary were used to search original articles regarding cholecystectomy under local or regional anesthesia. The main terms used for the literature review were: “local anesthesia”, “spinal anesthesia”, “epidural anesthesia”, “nerve block” and “cholecystectomy”.

Findings: In regard to local anesthesia, four studies were found with a total of 125 patients in which an open cholecystectomy was performed under local anesthesia plus sedation through a small abdominal incision. Operative duration varies from 40 to 101 minutes. Regarding regional anesthesia 14 studies, all using a laparoscopic approach, were included in our review. The most common complications of this approach were severe shoulder pain (6-55% of patients) and hypotension (5-59% of patients). An inconvenience of all these procedures is the occasional need for conversion into general anesthesia (up to 37%). When reported, patient satisfaction is 100%.

Conclusion: Cholecystectomy under local or regional anesthesia plus sedation can be a safe and feasible procedure in selected patients, when there is a high risk or unwillingness for general anesthesia.