Introduction: Recurrent posterior instability necessitating revision posterior cruciate ligament reconstruction is rare. The purpose of this study was to systematically evaluate all literature on revision PCLRs and analyze outcomes, complications, and reoperation rates in these patients.

Methods: Following the PRIMSA guidelines, a systematic review of the literature was performed. A comprehensive search of all literature published before August 2016 was performed and yielded a total of 1,479 studies. Articles containing data on revision PCL reconstruction cases were included, and 4 studies were utilized for this review after application of inclusion and exclusion criteria.

Results: Across all 4 studies, there were 43 cases that underwent revision PCLR and had sufficient follow-up. These patients had a mean age of 31.0 years, a mean length of 32.8 months between index surgery and revision reconstruction, and a mean follow-up of 41.0 months. Patient outcomes and knee stability improved significantly at time of the latest follow-up compared to the preoperative state. However, 15/37 (41%) cases had a complication, none of which were intraoperative. The majority of reported complications were significant motion loss and persistent knee laxity. A 13.3% revision failure rate was reported in one study.

Conclusion: Revision PCL reconstruction can improve overall knee function in patients with PCL insufficiency and allow these patients to perform activities of daily living with minimal limitations. However, it should be noted that motion loss and persistent knee laxity is a problem in patients undergoing this procedure. Future studies should focus on long-term follow-up of patients undergoing revision PCL reconstruction in hope of gathering more data on the outcomes and failure rates of these challenging procedures.

Background: Minimally Invasive Surgery (MIS) is gaining traction within surgical oncology. We aim to evaluate outcomes of patients with gallbladder cancer undergoing MIS surgery compared to open surgery.

Methods: Using the institutional cancer registry and administrative databases, we retrospectively reviewed patients who underwent a central hepatectomy with portal lymphadenectomy for gallbladder cancer from 2011-2014. We excluded gallbladder cancer patients without oncologic resection and those with metastatic disease.

Results: Thirty-four patients underwent surgery: 17 MIS (14 robotic; 3 laparoscopic) and 17 open. There was no statistically significant difference in median operative time (MIS=182 vs open=190 min; p=0.23) or R0 resection (MIS=88.2% vs open=88.2%; p=1.0); however, the MIS cohort had less intraoperative blood loss (median 50 ml vs 400 ml; p=0.006) and placement of peri-hepatic drains (29.4% vs 76.5%; p=0.01) compared to open.MIS cohort went to oral pain medications quicker (2 vs 3 days; p=0.02) and discharged home earlier (4 vs 6 days; p=0.018), than the open cohort. No differences in postoperative 30-day complication rates (52.9% vs 52.9%; p=1.0).

Conclusion: The minimally invasive approach to liver surgery is a safe and equally effective technique for the management of the gallbladder cancer with improvement in blood loss and length of stay.